systematic literature review impact of parent-child...
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PCI VIDEO-FEEDBACK INTERVENTIONS 1
Systematic Literature Review
Impact of parent-child interaction video feedback interventions on child
neurocognitive and neurobiological outcomes: a systematic review
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PCI VIDEO-FEEDBACK INTERVENTIONS 2
Abstract
This systematic literature review aims to investigate the impact of Parent-Child
Interaction (PCI) video-feedback interventions on child neurocognitive and
neurobiological outcomes. Nine studies were reviewed, and the findings suggest a
positive impact of parent-child interaction video-feedback interventions on child
neurobehavioural and neurobiological outcomes. Overall, the studies provide
moderate-strong evidence in support of such interventions, particularly the long-term
impact; positive child outcomes appear to be more pronounced at follow-up, than
post-intervention. Furthermore, positive results were found for ‘at-risk’ and targeted
population, such as developmental delay and Autism Spectrum Disorder (ASD).
There is, however, large variability in outcomes studied and the outcome measures
used, making comparison across studies difficult. Additionally, significant variation
exists in the types of video-feedback interventions used.
Key words: Video Feedback Intervention; Parent-child interaction; child
development; neurobiological outcomes; neurocognitive outcomes
PCI VIDEO-FEEDBACK INTERVENTIONS 3
Introduction
Parent-child (PC) attachment is a time-honoured and widely researched subject. John
Bowlby, Mary Ainsworth and other established theories have framed our
understanding of parenting in child development. There is growing research and
policies about the societal costs of insecure parent-child attachment and consequential
unfavourable child outcomes, resulting in a need for clinicians to develop evidence
based, cost-effective interventions.
This review aims to investigate the impact of Parent-Child Interaction (PCI) video-
feedback interventions on child neurocognitive and neurobiological outcomes; and
highlights how clinicians can help mitigate the costs of insecure attachment styles.
Previous reviews conducted focus on parent outcomes (Bakermans-Kranenburg, Van
Ijzendoorn, Pijlman, Mesman, & Juffer, 2008; Fukkink, 2008); to the author’s
knowledge, this is the first review focusing on child outcomes.
Attachment and Child Outcomes
Empirical research has built upon attachment theories and today it is widely accepted
that the PC relationship holds a unique role in influencing scholastic achievement,
emotional, social and behavioural adjustment, and physical health (Lerner &
Castellino, 2002; Puig, Englund, Simpson, & Collins, 2013; Sroufe, 2005). Forcada-
Guex et al. (2006) identify that maternal and infant interactional behaviours tended to
match in a predictable way; sensitive mothers with cooperative children and
controlling or unresponsive mothers with compliant, difficult, or passive children,
with the type of dyad having an impact on emotional, behaviour and somatic
outcomes.
Advances in neuroscience have allowed researchers to focus on the neurological
PCI VIDEO-FEEDBACK INTERVENTIONS 4
impact of parent-child interactions. In animal studies, early experiences are found to
impact brain structure and gene expression (Kaffman & Meaney, 2007; Marshall &
Kenney, 2009; Stiles, Barkham, Mellor-Clark, & Connell, 2008). While human
studies are scarce; they all lend to the hypothesis that early experiences, including PC
attachment, have an impact on brain development (Gunnar, 2001; Rutter, Kreppner, &
Sonuga-Barke, 2009; Shore, 2002). Interestingly, parenting seems to play a mediating
role in the development of neurological stress response (Hostinar, Sullivan, &
Gunnar, 2014; Sheikh et al., 2014). Additionally, pre and postnatal stress impacts
synaptic organisation, even into adulthood (Richard & McEwen, 2012). Such research
highlights the importance of identifying ways to promote reciprocity and sensitivity in
parent-child attachments.
Parent-Child Interaction (PCI) Interventions
A meta-analysis of attachment-based interventions demonstrates that short-term
programs oriented directly at increasing the predictability, consistency, and warmth of
parental behavior are more effective than longer term, representational approaches
(Bakermans-Kranenburg et al., 2008; Femmie Juffer & Steele, 2014). Further studies
show that capacity-building interventions focused on strengthening family-systems,
have direct effects on parent self-efficacy and well-being, and indirect effects on
parent-child interactions and child development (Trivette, Dunst, & Hamby, 2010).
Video Feedback PCI Interventions
Video-feedback interventions involve a practitioner videoing a parent-child
interaction, so as to enhance parenting practices, parental sensitivity and parent-child
reciprocity through reflection and/or instruction. The types of video-feedback
interventions vary considerably, however all are built upon attachment theory by
PCI VIDEO-FEEDBACK INTERVENTIONS 5
developing attuned interactions (Figure 1) to develop PCI.
Figure 1. Attuned Interactions explained (Kennedy, Landor, & Todd, 2011)
A meta-analysis by Fukkink et al. (2008) found that shorter programs appear more
effective in improving parenting skills. Overall, video-feedback interventions are
found to positively impact parental sensitivity, attitudes and behavior, and child
attachment security. Hoffenkamp et al.’s (2015) RCT reported a positive impact on
parental sensitive behaviour and diminished withdrawn behaviour towards pre-term
infants.
PCI video feedback interventions are recommended in the UK by the National
Institute of Clinical Excellence (NICE) (Excellence, 2012, 2013) and National
Society for the Prevention of Cruelty to Children (NSPCC) (Whalley & Williams,
2015).
Why study child outcomes?
Research demonstrates what many caregivers and theorists know intuitively - being
consistently available, sensitive and receptive to an infant's signals promotes healthy
DISCORDANT CYCLEATTUNED CYCLE
YES NO
Child receives parent’s
turn
Child misses
Parent’s turn
Parent receives
child’s initiative
Parent misses
child’s initiative
PCI VIDEO-FEEDBACK INTERVENTIONS 6
attachment. What is yet to be robustly identified, is if intervening early and
developing the parent-child attachment can alter a child’s development; and which
interventions are most effective/efficient.
This Review
The purpose of this review is to examine the impact of PCI video-feedback
intervention on child neurocognitive and neurobiological outcomes. Neurocognitive
outcomes are defined in accordance with the Diagnostic and Statistical Manual 5th
Edition (DSM-5) (Association, 2013), referencing six key neurocognitive domains:
learning and memory, executive functioning, perception and motor functioning,
language, complex attention and social cognition. Neurobiological outcomes are
defined in accordance with Stedman’s Medical Dictionary (Lanthrop, 2008) as the
“biology of the nervous system”.
Methods
Search Process
Online research databases (PubMed and Psychinfo) were systematically scanned for
studies that met the inclusion criteria (see table 1). Keywords for the relevant
intervention [“parent child interact*” AND “feedback”, “playback”, “parental
training”, “intervention”, “treatment” and “video*”] were combined with terms for
family populations [“parent*”, “family*”, “child*”, “marital”, “mother*”, and
“father*”]. Once relevant articles were identified, ancestral searches through reference
lists of primary journals in the field were also carried out as per Figure 2.
PCI VIDEO-FEEDBACK INTERVENTIONS 7
Table 1
Inclusions Criteria
Inclusion Exclusion
1. Written in English Not written in English
2. Published before 2016
3. Include the words ‘video’, and ‘child’
or ‘parent’ in the title/abstract
Does not include the words ‘video-
feedback’, ‘outcomes’, ‘child’ or ‘parent’
and in the title/abstract
4. Participants must be parents and their
child/children that participated in a
video-feedback intervention focused
on the quality of parent-child
attachment.
Participants are not parents and their
child/children
5. Studies that are a Randomised
Control Trial (RCT) and provide
empirical data on the neurocognitive
or neurobiological outcomes of the
child
Studies that are not a RCT and do not
provide empirical data on the
neurocognitive or neurobiological
outcomes of the child
7. Journal Article/Dissertation/thesis Book
8. Intervention identified as an
attachment focused parent-child
video-feedback intervention
Intervention not identified as an
attachment focused parent-child video-
feedback intervention
10. Novel, empirical data is produced
Data from a review of studies
PCI VIDEO-FEEDBACK INTERVENTIONS 8
Figure 2. Search Process flow chart
Eligibility Criteria
Eligible studies were written in English and implemented a video-feedback
intervention focused on PCI. No age restriction was applied so as to increase the pool
of studies. There was no start date, and the end date was 2016, as this is when the
review was carried out. Journal articles, theses and dissertations were considered,
provided they were empirical studies, with novel data.
Randomized control studies with matched control groups, examining the impact
through pre/post intervention data collection were deemed most appropriate for the
PCI VIDEO-FEEDBACK INTERVENTIONS 9
review question. Reasons for exclusion of studies can be provided by contacting the
author.
Nine RCT studies were identified as meeting the eligibility criteria. These are
summarized in Table 2.
PCI VIDEO-FEEDBACK INTERVENTIONS 10
Table 2.
Summary of Studies’ Characteristics
Study WoE Intervention Context Parents Children
Bakermans et al.
(2008)
High
VIPP-SD
Early Intervention
4 monthly sessions + 2 alt. monthly
sessions (1.5 hours)
Manual with themes
Playback: Edited/selected
Focus: Positive – sensitive parenting
Community
support
Child behaviour
support
Netherlands
Community Sample Emotional Behaviour
Difficulties
Age: 1year-3years
Clear description
Hoivik et al.
(2015)
High
VIPI- Video Feedback of Infant-Parent
interaction
Therapists described
Community –
interactional
problems
Community Sample
Parent-child interaction
problems
Age: 0 to 24 months
PCI VIDEO-FEEDBACK INTERVENTIONS 11
8 sessions
Manualised
Playback: Edited/selected
Focus: Positive – sensitive parenting
-Parent/social
worker
Trondheim & Oslo
Norway
Green et al.
(2015)
Medium
iBASIS- VIPP
12 sessions – 6 VIPP + 6 boosters
(According to need)
Manual with themes
Playback: Edited/selected
Treatment fidelity checked
Focus: Positive – sensitive parenting
Targeted ‘at risk’
ASD
Home based
UK
Mother Sibling ASD
Age: 9-14 months
No medical
Juffer et al.
(1997)
Medium
Targeted Intervention
3 sessions video feedback
+ Book on sensitive parenting
Playback: Edited/selected
Adoption
Netherlands
White families
Well described
Age: 5-12 months
Adopted Asian children
PCI VIDEO-FEEDBACK INTERVENTIONS 12
Focus: Positive – sensitive parenting
Mendelsohn et al.
(2005)
Medium
Video Interaction Project VIP + standard
care
12 sessions
Early Intervention
Playback: Immediate
New York Latino
Low education (no grad.
High school)
No psychosocial issues
Age: 2wks-3 years; 21-
month follow-up
Latino
Risk of dev delay
No medical complications
Mendelsohn et al.
(2007)
High
Video Interaction Project VIP + standard
care
12 sessions
Early Intervention
Playback: Immediate
New York Latino mothers
Low maternal education
poverty
Age: 2wks-3 years; 33-
month follow-up
Latino
Risk of dev delay
No medical complications
Poslawsky et al.
(2015)
High
VIPP-AUTI
5 sessions + 1 boosters
Manal with themes
Playback: Edited/selected
Home-based
Netherlands
90% mothers
Middle/upper SES
Age: ASD diagnosis
16-61 month
PCI VIDEO-FEEDBACK INTERVENTIONS 13
Focus: Positive – sensitive parenting
Treatment fidelity checked
Greene et al.
(2010)
High
PACT intervention
12 sessions over 6 months
6 monthly follow up session
20-30 minutes between session family
activities
Focus: parenting in ASD population
Clinic based
UK
Parents of children with
ASD
Autism diagnosis – ‘core
autism’
Age:
Pickles et al.
(2016)
High
PACT intervention
12 sessions over 6 months
6 monthly follow up session
20-30 minutes between session family
activities
Focus: parenting in ASD population
Clinic based
UK
Parents of children with
ASD
Autism diagnosis – ‘core
autism’
Age: 2-4:11 years old
PCI VIDEO-FEEDBACK INTERVENTIONS 14
Data Extraction
The information in table 3 was extracted for each of the studies.
Table 3.
Data Extracted from Studies
Research Design Randomised Control Trial
Type of Allocation
Blind/unblinded to researcher and participant
Statistical analysis and
appropriateness
Appropriateness of statistical analysis to the data
Appropriateness of statistical analysis to RQ
Correction for Type 1 error (if needed)
Sample size and
characteristics
Sample size + Power analysis
Detail given
Location Country
Setting
Intervention Type Established programme/not
Manualised/non-manualised
Number of sessions
Programme duration
Type of Clip selection (Immediate or later edited)
Focus of the intervention (if any)
Outcome measures Development and standardisation
Reliability and validity on current sample
Number of sources/informants
PCI VIDEO-FEEDBACK INTERVENTIONS 15
Number of methods used
Child outcomes Aspect of development related to
Quality Assessment/Coding
The methodological quality was assessed using a coding protocol adapted from
Kratochwill (2003) (see Appendix 1) with studies subsequently weighted according to
the Weight of Evidence (WoE) Framework (Gough, 2007) as summarized in Table 4
and weightings outlined in Table 5.
Table 4
Weight of Evidence Criteria
Weight of evidence A – with consideration to the study’s methodological quality:
coherence and integrity of the information gathered. A study scored either high,
medium or low if it addresses most of the criteria in the relevant section.
High: Random assignment of comparison group/random selection of
participants if empirically validated intervention is used; Reliability of
measures for current sample calculated (alpha equal or over .70); Two or
more informants on measures; Intervention outlined in high level of
detail which would allow for replication.
Medium: Comparison group present/clear description of participant recruitment
with validated intervention, although non-random, or unclear assignment
to group (or selection); Reliability of measures calculated, but below
PCI VIDEO-FEEDBACK INTERVENTIONS 16
0.70; Clear informant on each measure; Intervention outlined in some
general detail which could lead to replication.
Low: No comparison group/non-random selection of participants; Reliability
of measures not calculated for the current sample; unclear who the
informant is in the measures; Intervention not outlined in sufficient
detail to understand specifics, and cannot be replicated
Weight of evidence B – with consideration to the research design and their
relevance for answering the review question. Rating as follows:
High Compares pre-post increases on measures of effectiveness of PCI video-
feedback interventions, when compared to a TAU control group
Medium Compares pre-post increases on measures of effectiveness of PCI video-
feedback interventions.
Low Study design does not allow for of pre-post PCI video-feedback
interventions,
Weight of evidence C – with consideration to the relevance of the evidence to the
current review question. Rating as follows:
High Examination of a PCI video-feedback intervention with primary focus
on multiple child neurobehavioral and neurobiological related outcomes
Medium Examination of a PCI video feedback intervention with child
neurobehavioral and neurobiological outcomes as secondary outcomes
PCI VIDEO-FEEDBACK INTERVENTIONS 17
Low Examination of a PCI video feedback intervention, outcomes not child
neurobehavioral and neurobiological outcomes (for example: number of
sessions attended, dropout rates rather than child related outcomes)
Weight of evidence D – judgements from weightings A, B and C are
combined to create an overall assessment of evidence weighting. This is an average
across weightings A, B and C.
Table 5.
Study’s Weightings
Study WoE A WoE B WoE C WoE
Bakermans et al. (2008)
Medium High High High
Hoivik et al. (2015)
High High High High
Green et al. (2015)
Medium High Medium Medium
Juffer et al. (1997)
Medium Medium Medium Medium
Mendelsohn et al. (2005)
Medium Medium High Medium
Mendelsohn et al. (2007)
High Medium High High
Poslawsky et al. (2015) High High High High
PCI VIDEO-FEEDBACK INTERVENTIONS 18
Green et al. (2010) High High High High
Pickles et al (2016) High High High High
Description of Studies
Intervention
All nine studies used a PCI video-feedback intervention underpinned by positive
psychology; focused on parents’ strengths, aiming to promote sensitive and
responsive parenting. Eight studies utilised a manualised programme and one study
was led by the client’s goals. The number of sessions ranged from three to twelve. In
two studies’ the interventionist engaged in feedback with the parents immediately
following videoing; seven utilised programmes that required the interventionist to edit
footage and select clips to playback at a later date. Seven studies had participants
solely undergoing this intervention; whereas two were an add-on to treatment as usual
(Mendelsohn et al., 2005; Mendelsohn et al., 2007). A summary of the studies’
interventions can be found in Table 6.
Table 6.
Summary of Studies’ Interventions
Study
WoE
Name Manual Sessions Length Immediate
(I) or
later/edited
playback
(E)
Number Frequency Duration
PCI VIDEO-FEEDBACK INTERVENTIONS 19
Bakermans
et al. (2008)
High
VIPP-
SD
Y 6 4 monthly
2 alt.
month
1.5 hrs 8m E
Hoivik et al.
(2015)
High
VIPI Y 8 - - - E
Green et al.
(2015)
Medium
iBASIS-
VIPP
Y 12 - - - E
Juffer et al.
(1997)
Medium
- N 3 - - - E
Mendelsohn
et al. (2005)
Medium
VIP N 12 - - 3Years I
Mendelsohn
et al. (2007)
High
VIP N 12 - - 3
Years
I
Poslawsky et
al. (2015)
High
VIPP-
AUTI
Y 6 E
Greene et al.
(2010)
High
PACT Y 18 2/per
month for
6 months;
20-30
minutes
- E
PCI VIDEO-FEEDBACK INTERVENTIONS 20
follow-up
every 6
months
Pickles et al.
(2016)
High
PACT Y 18 2/per
month for
6 months;
follow-up
every 6
months
20-30
minutes
- E
Demographics
Four studies were UK based, three in the Netherlands, two in New York and one in
Norway. Children ranged from 0 to 61 months across the studies. All studies had a
target population, which included:
• children at risk for developmental delay (based on maternal education)
(Mendelsohn et al., 2005; Mendelsohn et al., 2007)
• children at risk for developing ASD based on sibling diagnosis (Green et al.,
2015)
• children with ASD (Green et al., 2010; Green et al., 2015; Poslawsky et al.,
2015)
• children with emotional and behaviour difficulties (Bakermans-Kranenburg et
al., 2008)
• Adopted children (F Juffer, Hoksbergen, Riksen-Walraven, & Kohnstamm,
1997)
• Parent-child interaction problems (Hoivik et al., 2015)
PCI VIDEO-FEEDBACK INTERVENTIONS 21
Research Design
Control group. All studies were RCTs with a matched control group. The
control group type varied: seven studies used treatment as usual (TAU), one utilised
ongoing telephone support and another used a no intervention control group. All
studies conducted a post-hoc analysis comparison between control and treatment
groups; in instances where a clinical population was used, groups were also matched
based on the criteria for diagnosis. The type of control group utilised impacted WoE
A.
Sample size. Study samples ranged from 54 to 237, with clear descriptions of
participants provided, enhancing the replicability of the study. Bakermans-
Kranenburg et al. (2008) had a small sample within each group, however no power
calculation was conducted, making the reliability and validity of their results
questionable; the sample size and power analysis was accounted for in the weighting
of studies.
Time points. Two pairs of articles are taken from two longitudinal studies:
Mendelsohn et al. (2007) followed up the VIP project 12-months after Mendelsohn et
al. (2005); Pickles et al. (2016) followed up the PACT intervention 6-years after
Green et al. (2010). Two further studies employed a follow-up design: Hoivik carried
out a 6-month follow-up and Poslawsky carried out a 3-month follow-up. Three
studies employed between-group pre-post intervention designs, whereas Green et al.
(2015) employed a within-group pre-post intervention design. The validity of the
results is impacted by the study’s design and effects the WoE A.
PCI VIDEO-FEEDBACK INTERVENTIONS 22
Statistical analysis. Most studies utilised statistical analyses appropriate to the
research question. However, Green et al. (2015) analysed within-group change to
estimate intervention effect; no further statistical analysis to compare between group
differences were computed. Within group statistical analysis for intervention effect
has been found to be statically invalid and not clinically useful as it does not account
for within-group natural changes over time and regression towards the mean (Bland &
Altman, 2011).
Noteworthy, is that Mendelsohn et al. (2005) carried out a number of t-tests,
increasing the possibility of type 1 error. Given the small N in each group, and
dichotomous variables, Juffer et al. (1997) appropriately carried out a Mann Whitney
U; however, the non-parametric analysis reduces the power of the findings.
Outcomes and Outcome Measures. As will be discussed below, there was a
large variability in the outcomes studied. Bakermans et al. (2015) and Green et al.
(2010) were the only studies to measure child outcomes as a primary outcome; .in
seven studies child-focused outcomes were secondary outcomes. For the purpose of
this review only child neurocognitive and neurobiological outcomes were considered.
Eight studies measured each variable using one outcome measure; this varied from
well-standardised tools, to protocols created for the purpose of the study. Juffer et al.
(1997) used a protocol created for their study, with a reported ICC of 1.0. Poslwasky
et al. (2015), Mendelsohn et al. (2005) and Green et al. (2016) used standardized
PCI VIDEO-FEEDBACK INTERVENTIONS 23
observational tools, and reported the ICC, enhancing the validity of their findings; the
remaining studies did not report the reliability for their study’s sample.
Green et al. (2010) and Pickles et al. (2016) utilised multiple sources of data
collection from multiple informants, including researchers, parents and teachers,
which positively impacted their rating on WoE B. They did not report the alpha
coefficient for their current sample for most of the measures used. Outcomes and
outcome measures are summarised in Table 7. Outcomes termed by the studies’
authors are listed in Table 8.
Table 8
Outcomes Termed by Studies’ Authors
Study Outcome Definition
Juffer et al. (1997) Infant Exploratory
Competence
Contingency analysis (ability to
learn relationship between an act
and consequence) and the
amount and quality of
exploration, are considered to
reflect children's exploratory
competences
Green et al. (2010)
and Pickles et al.
(2016)
Autism Severity As measured by the Autism
Diagnostic Schedule
PCI VIDEO-FEEDBACK INTERVENTIONS 24
Green et al. (2015) Gap-overlap task The gap overlap task uses Tobii
1750/YX120 eye trackers to
assess the time taken to shift
their eye gaze between visual
stimuli.
Social Behaviour As measured by the Autism
Observation Scale for Infants
Poslawski et al. (2015) Initiated Joint
Attention (IJA)
“the child’s ability to initiate
spontaneously another person’s
visual attention to share”.
Responsive Joint
Attention (RJA)
“child’s ability to follow and
share another person’s visual
lead”.
Play Behaviour Observed during a 15 minute
videotape which were then coded
for coded for toy preference and
level of play category;
manipulative, relational,
functional, and symbolic play
Results
Biological
Bakermans et al. (2015) was the only study to have a bio-behavioural focus. With an
overall ‘high’ weighting, the results are promising for the field of PCI video-feedback
interventions. The intervention reports a significant positive impact on challenging
PCI VIDEO-FEEDBACK INTERVENTIONS 25
behaviour (n2 = 0.05) and cortisol levels (n2 = 0.04) in children with the dopamine
receptor gene (DRD4).
Learning and Intellectual Development
A team of researchers at New York University School of Medicine reported a
longitudinal study investigating the impact of the Video Intervention Project (VIP): a
PCI video-feedback intervention, augmenting treatment as usual for children aged 2-
weeks to 3-years-old deemed ‘at risk’ for developmental delay. When compared to a
TAU control group, at 21-months old Mendelson et al. (2005) reported a non-
significant intervention effect on cognitive development, with a significant effect in
mothers with a low education level: 7th – 11th grade (d= 0.41). In Mendelson et al.
(2007) at 33-months the VIP intervention had an overall significant, moderate effect
(r = .20). Similar to the 2005 paper, they also found a greater impact on mothers with
an education level between 7-11th grade (r= 0.39).
Juffer et al. (1997) investigated ‘exploratory competence’ of 5-12 month olds in
adoptive families. They report significant intervention effect on their measure of
infants ‘ability to ‘learn a contingency’ and a positive trend for ‘exploratory
behaviour’. Conversely, Poslawky et al. (2015) found that VIPP-AUTI in children
with autism had no significant effect on play behaviour; hypothesising that the
neuroatypical profile of ASD needs more explicit guidance with play.
Social
Green et al. (2010) and Pickles et al. (2016) investigated long-term impacts of the
PACT intervention on a range of child outcomes. Green et al. (2010) found a positive
PCI VIDEO-FEEDBACK INTERVENTIONS 26
trend for the reduction in ‘autism severity’. Subsequently, 6 years later, Pickles et al.
(2016) found a significant intervention effect in ‘autism severity’, as well as ‘child
communication initiations’ and ‘repetitive behaviours’. However, no change was
found for teacher-reported adaptive functioning.
Following the intervention ‘Video feedback of Infant-Parent Interaction’ (VIPI),
Hoivik et al. (2015) found a post-intervention positive trend, as well as a significant
positive effect on social-emotional development at 6-month follow-up.
Poslawsky et al.’s (2015) study found that the VIPP-AUTI group showed significant
positive change in ‘initiated joint attention’ with a large effect size, and positive trend
for responsive joint attention. Interestingly, no change on infant involvement was
found at post-intervention and follow-up.
In their small pilot study, Green et al. (2015) investigated the impact of VIPP-iBASIS
in a sample characterised as ‘at risk’ for ASD. They found an overall within-group
change for the intervention group, largely mediated by increased caregiver non-
directedness. They also found a significant within-group change on social behaviour,
as measured by the AOSI and parental reports. The intervention group showed faster
disengagement in the ‘gap-overlap task’, which is suggestive of improved attentional
switching; typically, an area of difficulty for children with ASD. The resulting
conclusion was that the intervention group showed reduced signs of typical ASD-
behaviours. Conversely, there were no changes in infant attentiveness and parent-
reported infant communication skills decreased. Of note, however, is that this was a
small sample using within-group comparisons; therefore, competing hypotheses,
PCI VIDEO-FEEDBACK INTERVENTIONS 27
cannot be ruled out and we cannot conclude that the within-group change is due the
intervention.
Language
At the 21-month follow-up Mendelson et al. (2005) found that the VIP intervention
had significant impact on expressive language development, while not on receptive
language development for the overall sample. At 33-months, Mendelson et al. (2007)
found no between-group difference in language; however, they reported a global
score, and so the impact on receptive and expressive language is unknown.
Following the VIPP-iBASIS Green et al. (2015) found no within-group change on
parent reported vocabulary development, and no change on the Mullen Language
Scales. Similarly, Green et al. (2010) and Pickles et al. (2016) found no intervention
effect on receptive and expressive language.
PCI VIDEO-FEEDBACK INTERVENTIONS 28
Table 7.
Summary of Studies’ Outcomes
Study
WoE
N= Control
group
Design Statistics Measures Significant findings Non-significant
Findings
Bakermans
et al. (2008)
High
237
Telephone
conversation
Post hoc
Comparison
RCT
Pre-Post
MANOVA Behaviour/temperament:
Infant Characteristic
Questionnaire (ICQ)
Child Behaviour
Checklist (CBCL)
Cortisol:
Established protocol
DRD4 genotyping
Intervention group
(IG):
Intervention + Gene
N2 = 0.05
Intervention + Gene +
Cortisol n2 = 0.04
PCI VIDEO-FEEDBACK INTERVENTIONS 29
Hoivik et al.
(2015)
High
152
Power
Analysis
TAU
Post hoc
Comparison
RCT
Pre-Post
& FU
(6m)
ANCOVA Ages and Stages
Questionnaire: Social-
Emotional (ASQ-SE)
FU: ASQ-SE not
delayed
ES: NR
+VE TREND AT
POST
Green et al.
(2015)
Medium
54
Power
Analysis
No
intervention
Post hoc
Comparison
RCT
(block)
Pre-Post
Within
group
Within
group
Effect size
Infant attentiveness:
Manchester Assessment
of Caregiver–Infant
interaction
ICC = 0.64-.75
Atypical social-
behaviour:
Autism Observation
Scale for Infants (AOSI)
IG improvement:
AOSI (0.50)
Faster disengagement
(0.48)
Adaptive behaviour
Infant attentiveness
No difference:
MCDI, Mullen, ERP
PCI VIDEO-FEEDBACK INTERVENTIONS 30
Attention
disengagement:
Gap-overlap task
Development:
Mullen Scales Emotional
Learning (MSEL)
Adaptive behaviour:
Vineland Adaptive
Behaviour Questionnaire
Vocabulary:
MacArthur-Bates
Communicative
PCI VIDEO-FEEDBACK INTERVENTIONS 31
Development Inventory
(MCDI)
Juffer et al.
(1997)
Medium
90
(small N
in each
group)
TAU
Only book
Post Hoc
Comparison
Adjusted
RCT
B Pre-
Post
Mann-
Whittney-U
Infant Exploratory
Competence
Devised – observation
and task
IR = 1.0
IG: Faster learning
tempo in mastering a
contingency
+ve trend:
exploratory
behaviour
Mendelsohn
et al. (2005)
High -
medium
93
TAU
Post hoc
RCT
Pre-Post
Intervention
x maternal
education
2x2
ANOVA
Cognitive ‘mental’
Development:
Bayley’s
Expressive Language:
Preschool Language
Scale–3 (PLS-3)
+ve Main VIP effect
positive effect: group x
maternal education x
expressive language
Maternal Education 7th
– 11th Grade:
+ve trend: group x
maternal education x
cognitive
development
Maternal Education:
7-11th Grade
PCI VIDEO-FEEDBACK INTERVENTIONS 32
Between
group
t-tests
type 1 error
Semi- structured
observation
Receptive Language:
PLS-3
IRR = 0.84
Cognitive development
r= 0.41
expressive language
r=0.40
Maternal Education
<7th Grade
Expressive language
+ve trend: Receptive
Language
<7th Grade
+ve trend:
cognitive
development
language
development
Mendelsohn
et al. (2007)
High
99 TAU
Post hoc
RCT
12
months
Follow-
up
T-test
Spearman
Rank
Development:
Bayley’s
PLS-3
CBCL
IG: normal
Development
r=0.39
+ve trend in
Behaviour and
language
PCI VIDEO-FEEDBACK INTERVENTIONS 33
Poslawsky
et al. (2015)
High
78
TAU
Home visits
Post hoc
analysis
RCT
Pre –
post –
follow-up
3 months
MANOVA Infant Joint
Attention/Responsive
Joint Attention
Early social
communication scales –
Protocol
ICC: 0.92-0.94
Play behaviour
Ethogram by Naber et al.
(2008)
ICC = 0.71 – 0.99
Responsive/Involvement:
IJA
N2=0.24
P=0.03
+ve trend:
RJA
Involvement
Play Level behaviour
PCI VIDEO-FEEDBACK INTERVENTIONS 34
Parental Emotional
Availability Scale
ICC= 0.73-0.75
Greene et
al. (2010)
High
152 TAU Autism Severity:
Autism Diagnostic
Observation Schedule-G
(ADOS –G)
ICC = 0.83
Communication &
Language:
Child Communication
Initiation
Pre-school language
scales
Autism Severity
d= -.04
Communication &
Language
+ve increase CCI
d = 0.07 (PLS
receptive language)
d=0.35 (PLS
expressive language)
no group difference
MCI, CCSB
PCI VIDEO-FEEDBACK INTERVENTIONS 35
MacArthur
communication
inventory (Parents)
Communication and
Symbolic Behavior
Scales Developmental
Profile
ICC = 0.59
Child adaptive
functioning
Vineland Adaptive
Behaviour Scale
(Teacher)
Child adaptive
functioning
No difference
PCI VIDEO-FEEDBACK INTERVENTIONS 36
Pickles et
al. (2016)
High
125 TAU RCT
Between
Follow-
up (6
years)
ITT Autism Severity:
ADOS-CCS
Social Communication
Questionnaire
Repetitive Behaviour
Questionnaire (RBQ)
ICC = 0.73
Communication &
Language:
Child communication
initiation
Strengths & Difficulties
Questionnaire (SDQ)
Autism Severity
d = 0.55 (0.009)
0.4
0.87 & 0.82
Communication &
Language
d = 0.44 (0.004) (CCI)
Communication &
Language
d = 0.15 (CELF-IV)
d=0.4 (SDQ)
Child adaptive
functioning
d=0.27
0.34
Co-morbid
psychopathology
d=0.07; =0.13; 0.11;
0.51
PCI VIDEO-FEEDBACK INTERVENTIONS 37
Clinical Evaluation of
Language Function –IV
(CELF-IV)
ICC = 0.8
Child adaptive
functioning:
Vineland Adaptive
Behaviour Scale
(Teacher & Parent)
Co-morbid
psychopathology:
PCI VIDEO-FEEDBACK INTERVENTIONS 38
Development and Well-
Being Assessment
(DAWBA)
PCI VIDEO-FEEDBACK INTERVENTIONS 39
Conclusion
The aim of this review was to establish the impact of PCI video-feedback interventions on
child-related neurocognitive and neurobiological outcomes. Nine papers were identified
according to inclusion criteria. The ratings of these studies varied between ‘medium to high’
(Gough, 2007). Current research indicates positive results, providing moderate-strong
evidence in support of video-feedback interventions. There is, however, large variability in
types of video-feedback interventions, outcomes studied and the outcome measures used,
making comparison across studies difficult.
Bakermans et al. (2015) found promising results for the bio-behavioural impact of video-
feedback interventions, with a gene mediated effect on cortisol levels. This study provides an
explanatory framework for the differential responses to interventions, and links to Ellis &
Boyce’s research (2005; 2008) where they discuss differential biological sensitivity to stress.
It resonates with research, that has identified that different attachment styles are needed for
different temperaments (Bates & McFayden-Ketchum, 2000). This highlights the importance
of identifying biomarkers, so that targeted intervention can be provided. Distinctively, a
differential effect of the interventions was also found in relation to demographic variables;
Mendelsohn et al. (2005; 2007) found better results for lower maternal education.
Longitudinal studies highlight the importance of long-term monitoring of interventions due to
‘delayed effects’, as all showed more favourable child outcomes at follow-up. This suggests a
potential delayed intervention impact on the child, as a consequence of the positive changes
in parenting practices; which has been well documented (Fukkink et al. 2008).
Such findings resonate with theories of interactive specialisation (M. H. Johnson, 2011)
which propose the interactive nature of genetic factors and environmental factors in child
PCI VIDEO-FEEDBACK INTERVENTIONS 40
development. The above research provides promise for developing intervention that can
adapt environmental factors, such as PCI, to promote child development.
Positive results are also indicated for targeted populations. The impact of video-feedback
interventions in the ASD population show positive results, with the range of interventions
used. Results indicate positive impacts on ‘core’ ASD symptoms (Green et al 2010; Pickles et
al 2016), and social skills (Green et al 2014; Poslawsky et al. 2015). However, there is
limited effectiveness for language development (Green et al 2010; Pickles et al 2016;
Mendelsohn et al. 2005; 2007); suggesting that explicit, targeted intervention may be
required to promote language development.
Clinical Impact
This review has strong implications for clinical practice. Firstly, highlighting the promise of
video-feedback interventions in promoting child development. Secondly, serving as a
reminder that gains may not be immediate, and long-term follow-up is essential in
understanding the impact of interventions. Additionally, it highlights the differential
responses to the same intervention, and the importance of accounting for this in both clinical
practice and future research.
Further Research
This review highlights the promise of video-feedback interventions and emphasises the need
for longitudinal studies. However, variability exists in the type of video-feedback
interventions, outcomes and populations studied, meaning firm conclusions cannot be drawn.
The general positive trend highlights the importance of further studies, with the suggestion of
a differential response warranting the need for comparison studies across populations. At the
PCI VIDEO-FEEDBACK INTERVENTIONS 41
time this review was written, there was insufficient evidence to compare the outcomes based
on the video-feedback interventions characteristics (e.g. manualised vs. non-manualised);
however, future reviews and research should begin to explore this, so as to understand the
clinical utility of the different interventions.
PCI VIDEO-FEEDBACK INTERVENTIONS 42
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