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. Author manuscript; available in PMC: 2026 Sep 28.
Published in final edited form as: Behav Ther. 2024 Aug 20;56(3):487–500. doi: 10.1016/j.beth.2024.08.007

Impact of a Brief Parenting Intervention on Parent and Infant Imitation

Caroline J Gillenson 1, Matthew J Valente 2, Mary B Hagan 3, Anastassia Cafatti Mac-Niven 4, Daniel M Bagner 5
PMCID: PMC13616502  NIHMSID: NIHMS2209809  PMID: 40287178

Abstract

Research examining the effect of behavioral parenting interventions, such as parent–child interaction therapy (PCIT), on parent and child imitation is limited despite known benefits to early child development. We examined the effect of a brief, home-based adaptation of PCIT, the Infant Behavior Program (IBP), on changes in observed frequency of parent and infant imitation, moderating effects of parent language (English, Spanish), and mediational effects of parent and infant imitation on the effect of intervention on infant behavior problems. Participants were 60 12- to 15-month-olds with elevated behavior problems and their primary caregiver, all of which were mothers. Parent–infant dyads were randomly assigned to receive either the IBP or standard pediatric primary care. Parents receiving the IBP demonstrated significantly higher rates of observed imitation at postintervention and at the 3-month follow-up compared to those receiving standard care, and the effect at postintervention was stronger for English-speaking than for Spanish-speaking families. Although the IBP did not directly affect changes in infant imitation at postintervention or the 3-month follow-up, rates of infant imitation increased significantly for those who received the IBP at the 6-month follow-up. Additionally, moderation results suggested that the IBP led to improvements in infant imitation at post for Spanish-speaking families but not for English-speaking families. There were no significant mediational effects of parent or infant imitation. Future research is needed to examine the impact of increases in imitation on other aspects of child development, such as social–cognitive and language abilities, and to examine how cultural factors may play a role in individual differences in imitation.

Keywords: parent imitation, infant imitation, behavior problems, parenting interventions

Parent and child imitation are fundamental developmental processes for optimal child development (Bloom et al., 1974; Eckerman & Stein, 1990; McEwen et al., 2007; Meltzoff & Decety, 2003; Smeets & Kauffman 1980). Child imitation is a necessary process involved in social (Forman et al., 2004), cognitive (Bauer et al., 2000), behavioral (McEwen et al., 2007), and language development (Carpenter et al., 2005; Gampe et al., 2016; Sundquist et al., 2016). Parent imitation of their child’s behavior at an early age predicts increased prosocial behaviors (Carpenter et al., 2013; van Baaren et al., 2004) and understanding of others’ mental states (Meltzoff & Decety, 2003). Children who are imitated by parents and other adults also have been found to imitate others more frequently (Kokkinaki & Kugiumutzakis, 2000; Pawlby, 1977). Although imitation is a skill included in parent–child interaction therapy (PCIT) to reinforce desired behaviors for children with behavior problems, limited research has examined imitation in children with behavior problems and how imitation may foster positive behaviors and overall development and well-being.

Research on imitation in children with behavior problems is limited but crucial for understanding their developmental trajectories. Behavior problems, including externalizing (e.g., hyperactivity, aggression, defiance) problems, are a major public health concern, occurring in about 17% of children below the age of 8 years in the United States (Cree, 2018). These problems often persist throughout childhood (D’Souza et al., 2019; Mathiesen & Sanson, 2000). The high rates of child behavior problems and subsequent mental health disorders have left many children untreated, especially children living in poverty and/or from traditionally marginalized communities, such as those identifying with Latine ethnicity (Kataoka et al., 2002). Furthermore, children with persistent behavior problems are at increased risk for later and more severe mental health difficulties, as well as adverse outcomes, such as poor social, emotional, and academic outcomes (Campbell, 1995; Huaqing Qi & Kaiser, 2003). The potential for negative trajectories for children with behavior problems, as well as the growing unmet need for mental health services, highlight the importance of delivering interventions early in the child’s life.

Behavioral parenting interventions have a large evidence base for the reduction of childhood behavior problems (Mingebach et al., 2018). Specifically, programs such as PCIT (Zisser & Eyberg, 2010), Helping the Noncompliant Child (McMahon & Forehand, 2005), Triple P (Sanders et al., 2003), and Incredible Years (Webster-Stratton & Reid, 2010) have documented efficacy in their treatment of early childhood behavior problems (Comer et al., 2013; Eyberg et al., 2008). The goal of these programs is to reduce child behavior problems by teaching parents to increase their use of positive parenting skills (i.e., providing positive attention for appropriate behaviors) and decrease their use of negative parenting behaviors (e.g., avoid questions, commands, and criticisms), while ignoring undesirable child behaviors (Hanisch et al., 2014).

PCIT has been mostly examined in preschool-age children (Thomas & Zimmer-Gembeck, 2007; Thomas et al., 2017) with growing evidence for its efficacy with children younger than 2 years (Lieneman et al., 2017), which we define herein as infancy. In the first phase of PCIT, known as child-directed interaction (CDI), parents are taught PRIDE skills (praises, reflective statements, imitation, descriptions of child behavior, and enjoyment), also known as “do skills,” which promote positive reinforcement of desirable behaviors. Parents are also taught to ignore undesirable behaviors and limit their use of “don’t skills,” which include criticisms, questions, and commands, to reduce the opportunity for negative emotions and divergence from child-led play. The Dyadic Parent–Child Interaction Coding System (DPICS-IV; Eyberg et al., 2014) is used to measure parenting behaviors to guide treatment, monitor proficiency of skills, and measure treatment efficacy.

Parent imitation, which is defined as a parent behavior that copies the child’s immediately preceding behavior, is one of the skills taught to parents in PCIT and is thought to reinforce positive behaviors and enhance child self-esteem (McNeil & Hembree-Kigin, 2010). Although therapists measure overall parent imitation using a rating of “satisfactory” or “needs practice” in each session progress note, parental imitation is not included in the DPICS coding system and has been neglected in existing research on PCIT and other parenting interventions. Instead, DPICS primarily measures parent verbalizations and does not include codes for parent or child imitation. Therefore, therapists do not code each instance of imitation during treatment sessions, which may, in turn, result in reduced focus on the coaching of imitation in PCIT.

The examination of imitation in PCIT is particularly important early in life as infants imitate actions before learning to speak (Carpenter et al., 2005; Jones, 2009). Through imitation of others’ actions, infants learn to understand observations and communicate with others (Uzgiris, 1981). Infants can also recognize others imitating them as early as 9 months of age (Carpenter et al., 2013). Specifically, infants look and smile more at adults who imitate them compared to adults who perform other actions (Agnetta & Rochat, 2004; Asendorpf et al.,1996; Meltzoff, 1990). Furthermore, the influence of parent and child imitation on child development in the sensitive period of infancy has important implications for the development of child prosocial behavior, social communication, and cognitive skills (Carpenter et al., 2013; Meltzoff & Decety, 2003), which are vital areas of developmental improvement for children with behavior problems.

The developmental processes associated with parent and infant imitation may vary based on cultural and linguistic differences (Tamis-LeMonda et al., 2014; Wang & Wang, 2017). Imitation is an important mechanism for the transmission of cultural information (Hopper et al., 2010; Whiten, 2005), and research has mostly highlighted cultural differences as contextual influences on parent and infant imitation (Tamis-LeMonda et al., 2014). Language differences may also impact changes in imitation as previous research has identified differential effects of behavioral parenting interventions on Spanish-speaking compared to English-speaking families. For example, Spanish-speaking families took longer to acquire skills taught in treatment (Matos et al., 2006; McCabe & Yeh, 2009). Similarly, it is possible that Spanish-speaking families may not imitate as frequently as their English-speaking counterparts and may take longer to increase their use of imitation. Given these differences in intervention effects by language, the known cultural differences in parent and infant imitation, and the findings that early parent imitation may predict prosocial behavior (Carpenter et al., 2013), it is important to examine whether parent language spoken affects the impact of a parenting intervention on parent and infant imitation.

In addition to examining differences in parent language spoken, another gap in the literature is the lack of studies examining the effect of parenting interventions on parent and infant imitation. Although some research has shown parenting interventions led to increases in imitation in children with autism spectrum disorder and intellectual and developmental disabilities (Ingersoll, 2010; Ingersoll & Schreibman, 2006), only one study, to our knowledge, examined the effect of a parenting intervention for child behavior problems on parent and child imitation. Specifically, McCabe and colleagues (2021) developed a valid and reliable coding system of imitation and found increases in parent and child imitation following PCIT among Mexican American families with 3- to 7-year-old children, as well as an association between increases in parent imitation and decreases in child behavior problems. However, this study only examined imitation effects from pre- to postintervention, did not examine the effect of language spoken on these changes in imitation, and reported concurrent associations between imitation and child behavior problems rather than longitudinal mediation effects of imitation on changes in child behavior.

Given the importance of imitation as a necessary skill for developmental processes in infancy and early childhood (Bloom et al., 1974; Eckerman & Stein, 1990; Meltzoff & Decety, 2003; Smeets & Kauffman 1980) and its exclusion from most studies examining parenting interventions, research is needed to replicate and extend the findings of McCabe et al. (2021) to explore longer-term effects of behavioral parenting interventions on parent and child imitation. Furthermore, although infancy is a critical period for the development of imitation (Jones, 2009; Uzgiris, 1981), no study has examined the impact of a behavioral parenting intervention delivered in infancy on parent and infant imitation and their effects on infant behavior problems.

Current Study

The purpose of this study was to examine the effect of the Infant Behavior Program (IBP), a brief, home-based adaptation of PCIT for infants with elevated behavior problems, on parent and infant imitation. Based on the preliminary findings from McCabe and colleagues (2021), we hypothesized that in a randomized controlled trial, relative to families in standard care, there will be higher levels of parent and infant imitation for families in the intervention group at postintervention and at 3- and 6-month follow-ups. Second, we hypothesized that there will be a moderating effect of parent language spoken on the effect of treatment group on parent and infant imitation, such that the IBP will lead to higher levels of parent and infant imitation in English-speaking families than in Spanish-speaking families. Third, we hypothesized that parent and infant imitation will mediate the effect of the intervention on infant behavior problems at 3- and 6-month follow-ups.

Method

PARTICIPANTS

Participants were 60 mother–infant dyads with a 12- to 15-month-old who were recruited during wellness visits at a pediatric primary care clinic in a large children’s hospital in South Florida. All primary caregivers who participated in the study were mothers. Participating families were recruited as part of a randomized controlled trial of the IBP (Bagner et al., 2016), from which the current study is a secondary data analysis. Study procedures were approved by the university and hospital Institutional Review Boards.

Study eligibility criteria included (a) infants who scored above the 75th percentile on the problem scale of the Brief Infant–Toddler Social and Emotional Assessment (BITSEA; Briggs-Gowan & Carter, 2006), a parent-report screener of infant behavior problems; (b) primary caregivers were required to speak English or Spanish; and (c) English-speaking primary caregivers were required to receive an estimated IQ score of 70 or higher on two subtests (the Vocabulary and Matrix Reasoning subtests) of the Wechsler Abbreviated Scale of Intelligence (WASI; Wechsler, 1999), and Spanish-speaking primary caregivers were required to receive an average scaled score of 4 or higher on the Vocabulary and Matrix Reasoning subtests of the Escala de Inteligencia de Wechsler para Adultos—Third Edition (EIWA-III; Pons et al., 2008b), if they chose to complete the assessment in Spanish.

Sixty families were randomized, using a random number generator, to the IBP (n = 31) or to the standard pediatric primary care (n = 29). Of the 60 randomized families, 58 families completed the home-based baseline assessment. There were no significant differences on demographic variables between families in the IBP group and the standard pediatric care group. Infants were between 12 and 15 months, with an average age of 13.52 months (SD = 1.31). Most infants were reported to be of Hispanic or Latine ethnicity (94.8%) and White race (82.8%). Mothers were on average 29.9 years (SD = 5.3), and most mothers (90.0%) reported identifying as Hispanic or Latine ethnicity. The mean IQ T score for mothers was 46.35 (SD = 12.55), which was derived from an average of the T scores on the Vocabulary and Matrix Reasoning subtests of the WASI and following the conversion of scaled scores to T scores and subsequent average of the T scores on the Vocabulary and Matrix Reasoning subtests of the EIWA-III. Sixty percent of the families reported incomes below the poverty line. A little over half of mothers (56.7%) reported Spanish as their primary language. Demographic information and outcome variable information at baseline is presented in Table 1.

Table 1.

Demographic Characteristics (N = 60)

Total Sample (n = 60)
 Intervention Group (n = 31)
 Standard Care (n = 29)
 p value
% n % n % n
Infant sex (male) 55 33 58.1 18 51.7 15 .62
Infant ethnicity (Hispanic/Latinx) 94.8 56 90.3 28 96.6 28 .34
Mother ethnicity (Hispanic/Latinx) 90 54 87.1 27 93.1 27 .45
Mother reported Spanish as primary language 56.7 34 45.2 14 69 20 .07
Below poverty line 60 35 58.1 18 58.6 17 .71
Mean SD Mean SD Mean SD p value
Infant age (months) 13.52 1.31 13.71 1.4 13.21 1.18 .14
Mother age (years) 29.9 5.3 30.03 5.5 29.1 5.5 .50
Mother IQ T-Scorea 46.35 12.55 47.21 12.17 45.43 13.09 .59
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Note. IQ intellectual quotient

a

T-scores were combined between the WASI and EIWA-III Vocabulary and Matrix Reasoning subtests

PROCEDURE

Families that met study criteria at the time of screening were scheduled for a baseline assessment, during which questionnaires and behavioral observations of mother–infant interactions were administered in the family’s home. Sixty eligible mother–infant dyads consented to participate and were randomly assigned to receive the IBP (i.e., a home-based adaptation of PCIT for infants with elevated behavior problems) or standard pediatric primary care, in which the infant received care as usual (i.e., sick and well visits at the pediatric primary care clinic but did not receive the IBP). Of the 60 randomized mother–infant dyads, 58 families completed the baseline assessment. The postintervention assessment was conducted approximately 2 months following the baseline assessment. Follow-up assessments were conducted 3- and 6 months after the postintervention assessment. Families were compensated $50 for completion of each assessment. Of the 58 families that completed the baseline assessment, 48 families completed the postintervention assessment (83% retention), and 46 families completed the 3- and 6-month follow-up assessments (79% retention). Videotaped observations between the mother and infant were conducted at each home assessment. Frequency of infant and parent imitation was observed and coded during a 5-minute infant-led play situation, which occurred at each assessment time point, consistent with previous research (McCabe et al., 2021).

SCREENING MEASURES

Brief Infant–Toddler Social and Emotional Assessment

The BITSEA (Carter & Briggs-Gowan, 2006) is a 42-item standardized screener that assesses parent report of behavioral problems, including externalizing (e.g., hyperactivity, aggression, defiance) problems and competencies in 12- to 36-month-old children. The Problem scale is a 31-item subscale with excellent test–retest reliability (r = .91–.92) and good interrater reliability (r = .70–.78; Carter & Briggs-Gowan, 2006). There is also strong support for the use of the 75th percentile as the clinical cutoff (Briggs-Gowan et al., 2004). Cronbach’s alpha for the Problem scale in the current sample was .77.

Wechsler Abbreviated Scale of Intelligence; Escala de Inteligencia de Wechsler para Adultos—Third Edition

The WASI (Wechsler, 1999) is a screening measure of intelligence with high reliability and validity (Hays et al., 2002). The EIWA-III (Pons et al., 2008b) is the Spanish version of the Wechsler Adult Intelligence Scale (Wechsler, 1999) that is reliable (Pons et al., 2008b) and valid (Pons et al., 2008a). The Vocabulary and Matrix Reasoning subtests were administered. To ensure the understanding of the program content, mothers were required to receive an estimated IQ score at or above 70 on the WASI or an average scaled score at or above a 4 on the EIWA subtests. No mothers were excluded based on this criterion.

OUTCOME MEASURES

Parent and Infant Imitation

C.J.G., M.J.V., and M.B.H. were masked to intervention group and coded parent and infant imitation using the imitation coding guidelines developed by McCabe and colleagues (2021). The authors who also coded imitation for the current study were masked to treatment condition to minimize potential bias in the coding process and to ensure that observations were conducted objectively. As per imitation coding guidelines, parent imitation was defined as a parent behavior that copied the child’s immediately preceding behavior, and infant imitation was defined as an infant behavior that copied the parent’s immediately preceding behavior. In these guidelines, imitation included gestures but not verbalizations. Examples of imitation in the coding guidelines were when a parent mimicked a child’s hand gesture within 5 seconds of its completion or when a child replicated a parent’s building action on a similar structure.

Specifically, the frequency of parent and infant imitation was coded in sixty 5-second intervals during a 5-minute child-directed play situation. The frequency of parent imitation was defined as the sum of parent imitations of infant behavior, and the frequency of infant imitations was defined as the sum of infant imitations of parent behavior exhibited during the 5-minute observation. Coders in the current study completed training videos and coded 20% of the videos for interrater reliability. Consistent with interrater agreement reported by McCabe et al. (2021) using Guilford’s G, which provides an unbiased estimate of agreement for low base rate items (Xu & Lorber, 2014), interrater agreement in the present study was excellent and ranged from .96 to .98 for the three codes of no imitation, infant imitation, and parent imitation.

Infant–Toddler Social and Emotional Assessment (ITSEA)

The ITSEA (Carter & Briggs-Gowan, 2006) is a 166-item questionnaire that assesses behavior problems in 12- to 36-month-olds. It has excellent test–retest reliability (r = .85–.91) and very good interrater reliability (r = .70–.76; Carter & Briggs-Gowan, 2006), including support for high persistence of elevated behavior problems with the youngest age group of 12–23 months (Briggs-Gowan, 2006). The ITSEA has a broad externalizing domain that includes three subscales: Aggression/Defiance, Activity/Impulsivity, and Peer Aggression. However, the Peer Aggression subscale was not scored for approximately one quarter of infants (22%–29% at each assessment) given their limited interaction with other children. Thus, the subscales were weighted differentially for the externalizing domain across infants with and without scores on the Peer Aggression subscale. Additionally, previous research has indicated that early aggression has a more pronounced impact on later functioning, such as academic achievement, compared to other externalizing dimensions like activity and impulsivity (Brennan et al., 2012). Therefore, the current study examined ITSEA scores on the Aggression/Defiance subscale as a measure of infant behavior problems. Internal consistency of the Aggression/Defiance subscale in the present sample, averaged across the four time points, was good (α = .74).

INTERVENTION

The IBP is a home-based adaptation of PCIT for high-risk infants and their families. Parents in IBP are coached to follow their infant’s lead in play by increasing their use of the PRIDE skills and decreasing their use of questions, commands, and criticisms. Parents are also taught to ignore undesirable behaviors, such as whining and temper tantrums. Consistent with standard PCIT, the first session is a teach session, during which the parents are taught the skills and role-play the skills with the therapist. The sessions following the teach session are coaching sessions, during which the therapist provides live coaching to parents while they play with their infant.

In the present study, doctoral students in clinical psychology served as therapists for the intervention and were supervised by a PCIT International Global Trainer (C.J.G.). Sessions took place weekly in the parents’ home for approximately 1–1.5 hours and were provided in either English or Spanish based on the preference of the family. Outside of sessions, parents were instructed to practice the skills they learned in session with their infant for 5 minutes each day. Families were offered a maximum of 7 sessions and completed the intervention in an average of 6.1 sessions (ranging from 5 to 7 sessions). Based on findings suggesting that a time-limited (i.e., 14-session) PCIT (with an average of 6.5 CDI and 5.6 PDI sessions) performed comparable to, and sometimes better than, performance-based PCIT, which required meeting mastery criteria (Thomas & Zimmer-Gembeck, 2012), we limited the intervention to 7 sessions (including the teach session) and did not require the primary caregiver to meet mastery criteria for intervention completion. However, 45% of families completed the intervention in fewer than 7 sessions (ranging from 5 to 6 sessions) because the primary caregiver met mastery criteria, demonstrating proficiency in both the “do skills” (i.e., 10 labeled praises, 10 behavior descriptions, and 10 reflections or reflecting 75% of the infant’s speech, consistent with previous work with children with developmental delay; Bagner & Eyberg, 2007) and the “don’t skills” (i.e., fewer than 3 questions, commands, and criticisms) during a 5-minute infant-led play. All sessions were videotaped in the home. Adherence to the IBP protocol was assessed and coded for 63% of randomly selected sessions based on the percentage with which the therapists implemented key intervention elements, such as checking in with parents and teaching the parenting skills. The adherence of the intervention of each session was 97%.

DATA ANALYSIS

Path analyses were conducted in Mplus version 7.2 (Muthén & Muthén, 1998–2012) to first estimate the impact of the intervention on parent and infant imitation from pre- to postintervention and at the 3- and 6-month follow-ups in the first model. Initially, the analysis aimed to estimate direct intervention effects on parent and infant imitation. Second, we conducted moderation analyses to examine whether the intervention effects on parent and infant imitation at post and follow-ups differed based on languages spoken (English or Spanish). We included an interaction term between group (intervention vs. control) and language. Specifically, English-speaking participants were dummy coded as English = 0 and Spanish = 1. This approach allowed for the estimation of intervention effects separately for English and Spanish speakers. Third, we examined mediating effects of the intervention on infant behavior problems through parent and infant imitation at both follow-up time points. Model indirect (Muthén & Muthén, 1998–2012) and percentile bootstrap confidence intervals (MacKinnon et al., 2004) were used to estimate these mediated effects and assess their significance.

Results

MISSING VALUES ANALYSIS AND COVARIATES

Fifty-eight families completed the baseline assessment and were included in the analyses (30 families in the intervention group and 28 families in standard care); the remaining two families completed only the screening and therefore had insufficient data (i.e., the BITSEA for the infant and the WASI for the mother), neither of which was included in subsequent analyses. There were no significant differences on any demographic or outcome measures between families completing all assessment waves and families not completing all assessment waves. Missing value analysis showed that missing data on outcome variables at later waves was related to intervention group membership and to values of previous waves of the same variable; both group membership and previous waves of the outcome variables were included in the models. This pattern of missing data is consistent with a missing at random (MAR; Rubin, 1976) pattern. Missing data at post and follow-up waves were handled using full-information maximum likelihood (FIML) with robust standard errors in Mplus (Muthén & Muthén, 1998–2012). The groups did not significantly differ on any demographic characteristics, except parent language spoken (as shown in Table 1). The groups also did not differ on observed frequency of parent and infant imitation at baseline. Parent language was included as a covariate because it was significantly different between groups at baseline.

DESCRIPTIVE ANALYSIS

Descriptive statistics were conducted to examine the distribution of the frequency of parent and infant imitation at baseline. We conducted tests to examine the normality and homoscedasticity of the residuals, which indicated assumptions were met. Across all time points, the minimum total frequency of parent imitation was 0 and the maximum was 15, and the minimum total frequency of infant imitation was 0 and the maximum was 10. Table 2 presents means and standard deviations for the observed frequency of parent and infant imitation by group (standard care vs. intervention) at each time point. Table 3 presents correlations between parent imitation, infant imitation, and infant behavior problems at each time point.

Table 2.

Means and Standard Deviations of Parent and Infant Imitation Across Conditions

Pre
 Post
 3 mo.
 6 mo.
Mean SD Mean SD Mean SD Mean SD
Total Sample P-IM .77 1.2 1.6 2.9 1.7 2.6 1.1 1.9
I-IM 1.1 1.2 1.3 1.6 1.3 1.4 1.3 2.0
Intervention Group P-IM .76 1.2 2.9 3.9 2.5 3.5 1.7 2.2
I-IM 1.1 1.2 1.3 1.8 1.6 1.6 1.8 1.8
Standard Care P-IM .79 1.2 .74 1.4 .96 1.0 .75 1.4
I-IM 1.0 1.3 1.3 1.5 1.1 1.1 .89 2.0
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Note. P-IM = parent imitation; I-IM = infant imitation

Table 3.

Means, Standard Deviations, and Correlations Among Variables

Variables M(SD) 2 3 4 5 6 7 8 9 10 11 12
1. P-IM Pre .77 (1.2) .016 −.061 .278 .392** .105 .249 .200 .097 .036 −.169 −.080
2. P-IM Post 1.6 (2.9) - .504** .266 .052 .281 .162 .077 −.099 .029 −.158 −.245
3. P-IM 3mo 1.7 (2.6) - - .275 .162 .158 .480** .097 −.025 −.128 −.166 −.209
4. P-IM 6mo 1.1 (1.9) - - - .092 .188 .333* .499** .023 −.166 −.098 −.287
5. I-IM Pre 1.1 (1.2) - - - - .093 .235 −.017 −.060 −.062 −.220 .039
6. I-IM Post 1.3 (1.6) - - - - - .326* .004 −.079 −.029 −.178 −.243
7. I-IM 3mo 1.3 (1.4) - - - - - - .029 −.037 −.176 −.217 −.161
8. I-IM 6mo 1.3 (2.0) - - - - - - - −.191 −.269 −.014 −.310*
9. ITSEA Pre .79 (.40) - - - - - - - - .704** .623** .646**
10. ITSEA Post .84 (.41) - - - - - - - - - .699** .640**
11. ITSEA 3 mo .84 (.42) - - - - - - - - - - .700**
12. ITSEA 6 mo .86 (.44) - - - - - - - - - - -
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Note: P-IM = parent imitation; I-IM = infant imitation; ITSEA = Infant Toddler Social Emotional Assessment (ITSEA) Aggression/Defiance Scale.

*

p < .05.

**

p < .01.

INTERVENTION EFFECT OF IBP ON PARENT AND INFANT IMITATION

Path analyses, conducted in Mplus version 7.11 (Muthén & Muthén, 1998–2012), were used to test the effect of the intervention group on parent and infant imitation at postintervention and 3-and 6-month follow-ups with language and baseline measures of parent and infant imitation as covariates, respectively. Table 4 presents standardized estimates for all pathways in Model 1 and Model 2. For parent imitation, there was a statistically significant intervention effect of group on parent imitation at postintervention when adjusting for parent language (β = 1.90, ρ = .02). Parents in the intervention group exhibited a higher frequency of imitations compared to parents in the standard care group. The intervention effect of group on parent imitation was also significant at the 3-month follow-up (β = 1.62, ρ = .02). However, the effect of group on parent imitation, adjusted for parent language, was not significant at the 6-month follow-up (β = 0.81, ρ = .15).

Table 4.

Analyses from Model 1 and Model 2

Parameter B(SE) Beta z p 95% CI
Lower Upper
Outcome: P-IM T2
Main Effect of Group 1.90 (.79) 0.66 2.39 .02 .034 3.45
Group × Language −3.81 (1.55) −1.29 −2.46 .01 −6.85 −0.77
Group Effect - English 4.11 (1.50) 1.39 2.74 .01 1.17 7.05
Group Effects - Spanish 0.30 (0.51) 0.10 0.58 .56 −0.70 1.30
Outcome: P-IM T3
Main Effect of Group 1.62 (0.68) 0.64 2.38 .02 .29 2.95
Group × Language −0.50 (1.48) −0.20 −0.34 .73 −3.39 2.39
Group Effect - English 1.93 (1.37) 0.76 1.41 .16 −0.76 4.62
Group Effects - Spanish 1.43 (0.64) 0.56 2.22 .03 0.16 2.69
Outcome: P-IM T4
Main Effect of Group 0.81 (0.57) 0.45 1.44 .15 −0.30 1.93
Group × Language −1.08 (1.10) −0.60 −0.99 .32 −3.23 1.07
Group Effect - English 1.49 (0.76) 0.82 1.97 .04 0.01 2.98
Group Effects - Spanish 0.41 (0.78) 0.23 0.53 .60 −1.11 1.93
Outcome: I-IM T2
Main Effect of Group −0.21 (0.44) −0.13 −0.47 .64 −1.06 0.65
Group × Language −2.63 (0.88) −1.60 −3.00 .00 −4.35 −0.91
Group Effect - English 1.37 (0.79) 0.83 1.73 .09 −0.19 2.92
Group Effects - Spanish −1.26 (0.39) −0.77 −3.25 .00 −2.02 −0.50
Outcome: I-IM T3
Main Effect of Group 0.55 (0.41) 0.41 1.32 .19 −0.27 1.36
Group × Language −1.09 (0.80) −0.82 −1.36 .17 −2.65 0.48
Group Effect - English 1.23 (0.60) 0.92 2.06 .04 0.06 2.40
Group Effects - Spanish 0.14 (0.53) 0.11 0.27 .79 −0.89 1.18
Outcome: I-IM T4
Main Effect of Group 1.13 (0.51) 0.57 2.23 .03 0.14 2.13
Group × Language −0.23 (1.14) −0.12 −0.21 .84 −2.47 2.00
Group Effect - English 1.28 (0.66) 0.65 1.94 .05 −0.01 2.57
Group Effects - Spanish 1.05 (0.79) 0.53 1.33 .18 −0.50 2.59
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Note. P-IM = parent imitation, I-IM = infant imitation. Main Effect of Group for each outcome variable is from Model 1. All other group effects with the interaction term are from Model 2.

For infant imitation, there was no statistically significant intervention effect of group on infant imitation at postintervention (β = −0.21, ρ = .64) or 3-month follow-up (β = 0.55, ρ = .19), when adjusting for parent language. However, the intervention effect was statistically significant at the 6-month follow-up (β = 1.13, ρ = .03), when adjusting for parent language, suggesting that infants of parents in the intervention group displayed a higher frequency of imitation compared to infants of parents in the standard care group when observed 6 months following the intervention.

MODERATING ROLE OF LANGUAGE SPOKEN

Moderation analyses were conducted to examine the moderating effect of parent language on the associations between intervention group and parent and infant imitation. There was a significant interaction between intervention group and parent language spoken on parent imitation at posttreatment (β = −3.81, ρ = .01). The effect of intervention group on parent imitation was stronger for English-speaking parents than for Spanish-speaking parents. Specifically, there was a significant effect at posttreatment for English-speaking parents (β = 4.11, ρ = .01) but a nonsignificant effect at post-treatment for Spanish-speaking parents (β= 0.30, ρ = .56). There were no significant moderating effects of the interaction between intervention group and parent language spoken on parent imitation at the 3-month (β = −0.50, ρ = .73) or 6-month (β = −1.08, ρ = .32) follow-ups.

There was also a significant interaction between intervention group and parent language spoken on infant imitation at posttreatment (β = −2.63, ρ = .00). The effect of intervention group on infant imitation was stronger for Spanish-speaking parents than for English-speaking parents. Specifically, there was a significant intervention effect for Spanish-speaking parents (β = −1.26, ρ = .00) and a nonsignificant intervention effect for English-speaking parents (β = 1.37, ρ = .09). However, there were no significant moderating effects of the interaction between intervention group and parent language spoken on infant imitation at the 3-month (β = −1.09, ρ = .17) or 6-month (β = −0.23, ρ = .84) follow-ups.

MEDIATING EFFECT OF PARENT AND INFANT IMITATION

Mediation analyses were conducted in a separate model to examine the indirect effects of parent and infant imitation at posttreatment on the relation between intervention group and infant behavior problems at 3- and 6-month follow-ups. Each mediation analysis included covariates of parent or infant imitation at baseline and infant behavior problems at baseline. Figure 1 presents a basic figure of this model. There were no significant mediated effects of parent imitation on the association between intervention group and infant behavior problems at 3-month (β = −0.04, 95% CI [−0.14, 0.06]) or 6-month (β = −0.01, 95% CI [−0.11, 0.01]) follow-ups. There were also no significant mediated effects of infant imitation on the association between intervention group and infant behavior problems at 3-month (β = 0.01, 95% CI [−0.02, 0.09]) or 6-month follow-ups (β = −0.01, 95% CI [−0.07, 0.04].

FIGURE 1. Mediation Analyses.

FIGURE 1

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Note. P-IM = parent imitation, I-IM = infant imitation, ITSEA Agg = aggression/defiance subscale of the Infant-Toddler Social and Emotional Assessment (ITSEA), T1 = baseline, T2 = post-intervention, T3 = 3-month follow-up, T4 = 6-month follow-up. This figure includes 4 mediation analyses: (1) P-IM T2 mediating the effect of group on ITSEA Agg T3, with covariates of P-IM T1 and ITSEA Agg T1, (2) P-IM T2 mediating the effect of group on ITSEA Agg T4, with covariates of P-IM T1 and ITSEA Agg T1, (3) I-IM T2 mediating the effect of group on ITSEA Agg T3, with covariates of I-IM T1 and ITSEA Agg T1, and (4) I-IM T2 mediating the effect of group on ITSEA Agg T4, with covariates of I-IM T1 and ITSEA Agg T1.

Discussion

The current study examined the effect of a brief, home-based adaptation of PCIT for infants with elevated behavior problems on parent and infant imitation. Specifically, we examined the effect of IBP compared to standard care on parent and infant imitation, the moderating role of parent language spoken (i.e., English or Spanish), and the mediating effect of parent and infant imitation on the association between the IBP and infant behavior problems. Consistent with our first hypothesis and McCabe et al. (2021), findings revealed a significant group effect on the observed frequency of parent imitation during infant-led play from pre- to postintervention and at the 3-month follow-up, such that parents of infants in the intervention group displayed significantly higher levels of observed frequency of imitation compared to parents of infants that received the standard pediatric primary care. Although this effect was maintained at the 3-month follow-up, the intervention effect on increases in observed frequency of parent imitation was not maintained at the 6-month follow-up.

One possible explanation as to why this effect did not last at the 6-month follow-up is that parents may not have been explicitly coached to imitate their children as much as the verbal skills (i.e., praises, reflections, behavioral descriptions). Research on the use of in vivo coaching in PCIT has largely reported that coaching of verbal skills, such as praises and behavior descriptions, has been associated with increases in parental verbal skill acquisition (Shanley & Niec, 2010). Therefore, although gains in coded verbal parenting skills were maintained at the 6-month follow-up in the present sample (Bagner et al., 2016), parent imitation may not have been emphasized during coaching as much as verbal parenting skills, which limited long-term maintenance of intervention effects on imitation. Additionally, the discrepancy in intervention effects across time points may be due to a smaller effect at the 6-month follow-up and the relatively small sample size with decreased power to detect significant effects. Thus, further research is needed with a larger sample to understand the effects and maintenance of changes in parent imitation following a brief behavioral parenting intervention.

The effect of the intervention on parent imitation at postintervention depended on parent language spoken and only led to increases in parent imitation for English-speaking families but not for Spanish-speaking families. Previous research suggesting that Spanish-speaking families may need additional time and practice for skill acquisition in PCIT (Matos et al., 2006; McCabe & Yeh, 2009) may explain why the intervention did not lead to increases in parent imitation for Spanish-speaking families. This increased time to acquire treatment skills may be due to the cultural norm of personalismo, which is a value experienced in many homes with Spanish speakers that emphasizes interpersonal relationships and may be prioritized over time efficiency (Matos et al., 2006). Additionally, in the current sample, Spanish-speaking families were found to use higher rates of “don’t skills” than English-speaking families (Ramos et al., 2018). The increased use of “don’t skills,” such as commands, among Spanish-speaking parents may have precluded parents from imitating their children because it may have been harder to follow their infant’s lead in play when giving more directive verbalizations. The moderation effect of parent language on the effect of the intervention on parent imitation was not maintained at either follow-up. Future research should identify culturally and linguistically responsive approaches for enhancing skill acquisition in Spanish-speaking families.

In contrast to effects on parent imitation, the intervention did not lead to changes in infant imitation immediately following the intervention or at the 3-month follow-up. However, the intervention did lead to changes in infant imitation at the 6-month follow-up. The delayed effect of the intervention on infant imitation at the 6-month follow-up may be because the intervention did not directly target increases in infant imitation, such as encouraging parents to praise instances of infant imitation. Research has suggested that children imitate more frequently following parent imitation (Kokkinaki & Kugiumutzakis, 2000; Pawlby, 1977). However, the relatively low frequency of parent imitation may have prevented this type of effect in the current sample. It is also possible that an increase in infant imitation was too small to detect, especially with the relatively small sample size. The intervention effect on infant imitation at the 6-month follow-up may be related to the developmental growth of infants at this later age in conjunction with imitation (Nielsen & Dissanayake, 2004).

Although the IBP did not lead to changes in infant imitation following the intervention, it did lead to changes in infant imitation for some families. In contrast to findings on parent imitation, the IBP led to changes in infants from Spanish-speaking families but not English-speaking families. Although parental language differences have not been previously examined in relation to infant imitation, research has identified a cultural emphasis on using nonverbal communication, such as imitation, in Latine children (Mejía-Arauz et al., 2005). Given that the majority of families in the sample identified as Latine, future research needs to further explore the potential influences of language and culture on infant imitation to better understand the clinical implications of the use of imitation in behavioral parenting interventions with families from diverse backgrounds.

Last, the hypothesis that the intervention would reduce infant behavior problems through increased parent and infant imitation was not supported. Although McCabe et al. (2021) did not examine mediational effects, the study found that pre-to-post changes in parent imitation, but not infant imitation, was significantly associated with pre-to-post changes in behavior problems. The current study extended these findings by examining the mediational effects of parent and infant imitation on infant behavior problems across time. Additionally, it is possible that parent and infant imitation do not mediate effects on infant behavior or that this mediating effect may only occur in combination with the other parenting verbal skills. In the current sample, the verbal skills did significantly increase over time for the intervention group in conjunction with a decrease in behavior problems (Bagner et al., 2016). Therefore, examining the combination of imitation with the other “do skills” as a mediator of the impact of the intervention on behavior problems compared to imitation alone as a mediator of this effect would be an important future direction. Additionally, given the moderation effects, future research should examine a longitudinal moderated multiple mediator model with a larger sample size.

This study contains both strengths and limitations that are worth noting. This study effectively used and replicated the use of an objective observational coding system for parent and infant imitation with high estimates of interrater reliability. Another strength is the multiple time points included in the study that allowed for the examination of maintenance of effects and mediation. This study also included families from predominantly low-income and Latine ethnic backgrounds, which is both a strength and a limitation. The study addressed the need to examine effects of behavior parenting interventions with families from traditionally marginalized backgrounds (Ortiz & Del Vecchio, 2013) but the lack of information on within-group differences, such as cultural origin and racial diversity, limits generalizability to other ethnic and racial groups. An additional limitation is the relatively small sample size, which may have decreased the power to detect effects. We did not include an active control condition, which limits our ability to control for potential nonspecific treatment effects of home-based interventions (Stormshak et al., 2002). Additionally, although multilevel models were beyond the scope of this paper, future research should use specific models for dyadic data to parse apart the interdependence between the individuals within a dyad, which would build upon the findings in the present study. Last, the study relied on parent report of infant behavior problems. Future research should place a stronger emphasis on the intricacies of how individual differences, such as ethnic and racial identities, languages spoken, and acculturation status may contribute to differences in the acquisition of parent and infant imitation within a larger sample.

CONCLUSIONS

This study addressed a significant gap in the literature by examining the effect of a brief parenting intervention for infants with elevated behavior problems on parent and infant imitation, which is typically a skill taught to parents but has not been measured in intervention studies. Findings suggest that a brief parenting intervention led to short-term increases in parent imitation and long-term increases in infant imitation. Findings also suggest that language spoken impacted the use of parent and infant imitation differently, with higher levels of imitation in English-speaking parents and Spanish-speaking infants. These findings highlight a need for future research to more broadly examine cultural factors that may play a role in differences between parents and infants in imitation, as well as within-group cultural and language differences in parent and infant imitation. Future research should examine potential clinical implications of increased imitation in infancy and how parenting interventions can best incorporate this skill into coding systems to promote optimal social–cognitive, language, and behavioral development.

Acknowledgments

We would like to thank all of the families in the study for their participation.

The authors declare that they have no conflict of interest. This work was supported by National Institute of Mental Health (NIMH) career development award (K23 MH085659) to Daniel M. Bagner.

Contributor Information

Caroline J. Gillenson, Florida International University

Matthew J. Valente, University of South Florida

Mary B. Hagan, Florida International University

Anastassia Cafatti Mac-Niven, Florida International University.

Daniel M. Bagner, Florida International University

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