Feasibility of Digital Augmentation of Parent-Child Interaction Therapy: A Randomized Clinical Trial
Open accessAbstract
Importance: The potential utility of real-time digital therapeutics that identify impending behavioral outbursts to proactively apply evidence-based interventions for managing children with disruptive behavior disorder has not been tested. Objectives: To evaluate feasibility and adherence of a digitally augmented, real-time, proactive behavioral intervention (smartwatch) for children with disruptive behaviors. Design, Setting, and Participants: This randomized clinical trial was conducted between March 1, 2022, and December 31, 2023, at Mayo Clinic in Rochester, Minnesota. The study enrolled children aged 3 to 7 years with externalizing behavior problems rated above the clinically significant range (I score ≥120; T score ≥60) on the Eyberg Child Behavior Inventory (ECBI). Interventions: Twelve weekly sessions of parent-child interaction therapy (PCIT) (treatment as usual [TAU] arm) vs artificial intelligence (AI)-enhanced PCIT augmented with real-time behavioral outburst alerts (PCIT-AI arm). Main Outcomes and Measures: The primary outcome was achieving the a priori feasibility benchmark set at greater than 70% for both completion of PCIT sessions and daily smartwatch wear. Parental reaction time to behavior prompts was measured in seconds. Secondary outcomes were percentage changes in ECBI and Pediatric Sleep Questionnaire scores. Behavioral outburst duration was examined based on parental logs of start and end times of observed tantrums using a smartphone application. Result: This study enrolled 50 children (median [IQR] age, 5.0 [4.0-6.0] years; 34 [68%] male and 16 [32%] female; 28 randomized to the PCIT-AI arm and 22 to the PCIT-TAU arm). Of these children, 37 (74%; 21 in the PCIT-AI arm and 16 in the PCIT-TAU arm) completed PCIT, with children wearing the watch a median (IQR) 75.7% (67.8%-82.9%) of the time, thus achieving the feasibility benchmark (primary outcome). Median (IQR) response time to behavior prompts in the PCIT-AI arm was 3.65 (2.07-7.08) seconds. Assessing between-group differences, there was no statistically significantly greater numerical improvement in ECBI-intensity percentage change (13.86%; 95% CI, -1.41% to 29.14%), ECBI-problem percentage change subscale scores (38.59%; 95% CI, -1.22% to 78.40%), or absolute change in Pediatric Sleep Questionnaire scores (-0.16; 95% CI, -1.85 to 1.53) with the PCIT-AI arm than with the PCIT-TAU arm. Children in the PCIT-AI arm had significantly shorter mean (SD) tantrum durations (10.4 [20.8] minutes vs 22.1 [30.0] minutes; P < .001) and lower odds of tantrums lasting for 15 minutes or more (odds ratio, 3.66; 95% CI, 2.72-4.95). Conclusions and Relevance: In this randomized clinical trial, both recruitment and technology feasibility benchmarks were achieved. The findings inform the design of fully powered efficacy study of wearable, digitally augmented PCIT for children with disruptive behaviors. Trial Registration: ClinicalTrials.gov Identifier: NCT05077722.
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The feasibility of digital augmentations similar to those proposed for ACT-PAC has been established [61].
“The feasibility of similar digital augmentations has been established [61]”
From A Qualitative Study of Participant Feedback on an Acceptance and Commitment Therapy Group-Based Intervention for Parents of Youth with Anxiety Disorders. (2026) · cites this paper as [61]
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Cites
CONSORT 2025 statement: updated guideline for reporting randomised trials
Hopewell, S., Chan, A.-W., Collins, G. S., Hróbjartsson, A., Moher, D., Schulz, K. F., Tunn, R., Aggarwal, R., Berkwits, M., Berlin, J. A., et al. (2025) · BMJ · doi:10.1136/bmj-2024-081123 · Cited by 1,195 · see citing works
Hollis, C., Falconer, C. J., Martin, J. L., Whittington, C., Stockton, S., Glazebrook, C., & Davies, E. B. (2017) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.12663 · Cited by 846 · see citing works
Assessment of child behavior problems: The validation of a new inventory
Eyberg, S. M., & Ross, A. W. (1978) · Journal of Clinical Child Psychology · doi:10.1080/15374417809532835 · Cited by 646 · see citing works
Eyberg, S. M., Funderburk, B. W., Hembree-Kigin, T. L., McNeil, C. B., Querido, J. G., & Hood, K. K. (2001) · Child & Family Behavior Therapy · doi:10.1300/j019v23n04_01 · Cited by 385 · see citing works
Hood, K., & Eyberg, S. (2003) · Journal of Clinical Child & Adolescent Psychology · doi:10.1207/s15374424jccp3203_10 · Cited by 356 · see citing works
Parent-Child Interaction Therapy: A Meta-analysis
Thomas, R., Abell, B., Webb, H. J., Avdagic, E., & Zimmer-Gembeck, M. J. (2017) · Pediatrics · doi:10.1542/peds.2017-0352 · Cited by 353 · see citing works
Chaffin, M. J., Funderburk, B. W., Bard, D., Valle, L. A., & Gurwitch, R. H. (2010) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0021227 · Cited by 252 · see citing works
Belden, A. C., Thomson, N. R., & Luby, J. L. (2007) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2007.06.030 · Cited by 97 · see citing works
Welch, V. E., Wy, T. J., Ligezka, A. N., Hassett, L. C., Croarkin, P. E., Athreya, A. P., & Romanowicz, M. (2022) · Journal of Medical Internet Research · doi:10.2196/33560 · Cited by 97 · see citing works
Qiu, H. J., Liang, X., Wang, P., Zhang, H., & Shum, D. (2023) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2023.103692 · Cited by 74 · see citing works
Ros, R., Hernandez, J., Graziano, P. A., & Bagner, D. M. (2015) · Behavior Therapy · doi:10.1016/j.beth.2015.08.004 · Cited by 64 · see citing works
Di, J., Demanuele, C., Kettermann, A. E., Karahanoğlu, F. I., Cappelleri, J. C., Potter, A., Bury, D. P., Cedarbaum, J. M., & Byrom, B. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106661 · Cited by 52 · see citing works
Rey, J. M. (1993) · American Journal of Psychiatry · doi:10.1176/ajp.150.12.1769 · Cited by 48 · see citing works
Psychosocial Correlates of Severe Temper Tantrums
Needlman, R. D., Stevenson, J., & ZUCKERMAN, B. S. (1991) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/00004703-199104000-00002 · Cited by 45 · see citing works
Webb, H. J., Thomas, R., McGregor, L., Avdagic, E., & Zimmer‐Gembeck, M. J. (2016) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2016.1247357 · Cited by 37 · see citing works
Giurgiu, M., Kolb, S., Nigg, C., Burchartz, A., Timm, I., Becker, M. L., Rulf, E., Doster, A.-K., Koch, E. D., Bussmann, J. B. J., et al. (2022) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2021-001267 · Cited by 36 · see citing works
Stokes, J. O., Jent, J. F., Weinstein, A., Davis, E., Brown, T. M., Cruz, L., & Wavering, H. M. (2016) · Behavior Therapy · doi:10.1016/j.beth.2016.04.004 · Cited by 31 · see citing works
Children's emotion recognition and aggression: A multi‐cohort longitudinal study
Acland, E. L., Jambon, M. M., & Malti, T. (2021) · Aggressive Behavior · doi:10.1002/ab.21989 · Cited by 23 · see citing works
Beltrán, S., Sit, L., & Ginsburg, K. R. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2021.2127 · Cited by 23 · see citing works
Temper Tantrums in Toddlers and Preschoolers: Longitudinal Associations with Adjustment Problems
van den Akker, A. L., Hoffenaar, P., & Overbeek, G. J. (2022) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0000000000001071 · Cited by 21 · see citing works
Braem, C. I. R., Yavuz, U. Ş., Hermens, H. J., & Veltink, P. H. (2024) · Sensors · doi:10.3390/s24051526 · Cited by 20 · see citing works
Romanowicz, M., Croarkin, K. S., Elmaghraby, R., Skime, M. K., Croarkin, P. E., Voort, J. L. V., Shekunov, J., & Athreya, A. P. (2023) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2023.0038 · Cited by 14 · see citing works
Parent-Child Interaction Therapy
Briegel, W. (2016) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000453 · Cited by 12 · see citing works
Developmental pathways from preschool temper tantrums to later psychopathology
Hoyniak, C. P., Donohue, M. R., Quiñones-Camacho, L. E., Vogel, A. C., Perino, M. T., Hennefield, L., Tillman, R., Barch, D. M., & Luby, J. L. (2023) · Development and Psychopathology · doi:10.1017/s0954579422000359 · Cited by 12 · see citing works
Saliba, M. T., Drapeau, N., Skime, M. K., Hu, X. Y., Accardi, C. J., Athreya, A. P., Kołacz, J., Shekunov, J., Jones, D. P., Croarkin, P. E., et al. (2023) · Pilot and Feasibility Studies · doi:10.1186/s40814-023-01254-w · Cited by 10 · see citing works
Myths of Randomized Controlled Trial Analysis in Pediatric Psychopharmacology
Mills, J. A., & Strawn, J. R. (2025) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2025.0005 · Cited by 7 · see citing works
Mapes, A. R., Quetsch, L. B., Parisi, K. E., Girard, E. I., & McNeil, C. B. (2021) · Families Systems & Health · doi:10.1037/fsh0000639 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [5]Sisterhen LL, Wy PAW. Temper Tantrums. StatPearls; 2025. 31335006
- [24]Bergenstal RM. Understanding continuous glucose monitoring data. In: Role of Continuous Glucose Monitoring in Diabetes Treatment. ADA Clinical Compendia Series. American Diabetes Association; 2018. 34251769
Cited by
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Raftery-Helmer, J., Hart, A. S., Faro, A. L., Baez, D., & Moore, P. (2026) · Children · doi:10.3390/children13060837
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Giansanti, D., & Lastrucci, A. (2026) · AI · doi:10.3390/ai7080296
Zhu, M., Spencer, J. D., Chesak, S. S., Romanowicz, M., Chauhan, M., Dyrbye, L. N., Croarkin, P. E., Bobo, W. V., & Athreya, A. P. (2026) · Clinical and Translational Science · doi:10.1111/cts.70693
Delaney, K., Saliba, C. T., Garzon, J. F., Wilton, A. R., Sangster-Carrasco, L., Saliba, M. T., Athreya, A. P., Shekunov, J., Croarkin, P. E., & Romanowicz, M. (2026) · JAACAP Open · doi:10.1016/j.jaacop.2026.07.007
- Authors
- Romanowicz, M., Saliba, M. T., Wilton, A. R., Garzon Hincapie, J. F., Croarkin, K. S., Saliba, C. T., LeMahieu, A., Drapeau, N., Schlichting, B., Skime, M., Bobo, W. V., Vande Voort, J. L., Shekunov, J., Croarkin, P. E., & Athreya, A. P.
- Affiliations
- Mayo Clinic (US)
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
- Florida State University (US)
- Corresponding author
- Romanowicz, Magdalena
- Athreya, Arjun P.
- ORCID
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2025-12-15
- Volume
- 8
- Issue
- 12
- Pages
- e2548869
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC12706678
- OpenAlex
- W4417334189
- Cited by
- 4
- References
- 28
- Citations by year
- 2026: 4
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Education › Child Development and Digital Technology
- Keywords
- Parent-Child Interaction Therapy, disruptive behavior disorders, digital therapeutics, smartwatches, artificial intelligence, externalizing problems, preschool children, medication adherence, feasibility, sleep disorders, tantrums, Eyberg Child Behavior Inventory, Pediatric Sleep Questionnaire, mobile application
- MeSH terms
- Behavior Therapy, Child, Child Behavior Disorders, Child, Preschool, Feasibility Studies, Female, Humans, Male, Parent-Child Relations
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