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. Author manuscript; available in PMC: 2026 Sep 28.
Published in final edited form as: J Clin Child Adolesc Psychol. 2025 Nov 20;55(3):528–541. doi: 10.1080/15374416.2025.2579279

Imitation in Hispanic/Latine Children with Developmental Delay and Their Caregivers Following a Remote Parenting Intervention

Caroline J Gillenson 1, Timothy Hayes 1, Anastassia Cafatti Mac-Niven 1, Morganne Warner 1, Enid Moreira 1, Saina Haghdan 1, Jonathan S Comer 1, Daniel M Bagner 1
PMCID: PMC13616503  NIHMSID: NIHMS2209802  PMID: 41264371

Abstract

Objective:

We examined the longitudinal effects of internet-delivered PCIT (iPCIT) on caregiver and child imitation in young Hispanic/Latine children with developmental delay (DD). We also examined the moderating roles of acculturation and enculturation on such treatment effects.

Method:

Three-year-old, Hispanic/Latine children aging out of early intervention services for developmental delay (n = 98) and their primary caregivers were randomized to receive iPCIT or referrals as usual (RAU) in the community. Caregiver and child imitation were observationally coded during a 5-min child-directed play situation, which occurred during home-based evaluations at four timepoints – i.e. Baseline, Post, 6-month follow-up, and 12-month follow-up.

Results:

Treatment effects were significantly moderated by caregiver acculturation. Specifically, iPCIT was associated with greater caregiver and child imitation among families reporting higher, but not lower, levels of caregiver acculturation. However, caregiver enculturation did not moderate the effects of iPCIT on either caregiver or child imitation.

Conclusions:

Findings suggest parenting intervention effects on levels of imitation were particularly strong for Hispanic/Latine caregivers reporting higher levels of acculturation. This highlights the promotive role acculturative identity can play in boosting parenting intervention effects, particularly those of caregiver and child imitation. Findings also underscore the importance of assessing cultural factors to better inform personalized care and skill acquisition among Hispanic/Latine samples. Future research is needed to identify mechanisms that help explain precisely how cultural identity factors, such as acculturation and enculturation, can boost treatment-related imitation gains for Hispanic/Latine children with DD and their families.

Children learn many fundamental developmental processes – such as social (Over, 2020), cognitive (Wang et al., 2015), behavioral (Nielsen & Blank, 2011), and language skills – through imitation of others (Gampe et al., 2016; Sundquist et al., 2016). Early caregiver imitation of their child’s behavior also promotes increased prosocial behaviors (Brownell & Early Social Development Research Lab, 2016; Schuhmacher et al., 2019), understanding of others’ mental states (Meltzoff, 2011), and subsequent child imitation (Essler et al., 2023). Whereas parent–child dyadic play offers a natural opportunity for typically developing children to acquire such skills, the imitation differences often observed in young children with developmental delay (DD; Dohmen et al., 2013; Stewart et al., 2013) may hinder important play-based social, cognitive, and behavioral learning (Ledford & Windsor, 2022). In addition to differences in imitation of behaviors, young children with DD often display increased rates of behavior problems (Bhatia & Vaidya, 2020), which, in turn, are associated with significantly higher levels of mental health challenges, language delays, and social skills differences compared to typically developing peers (Delehanty et al., 2018). Despite behavioral challenges and imitation differences commonly observed in children with DD (Bhatia & Vaidya, 2020), few studies have examined the effect of parenting interventions targeting behavior problems on imitation behaviors in children with DD and their caregivers. Understanding the extent to which supported behavioral intervention for young children with DD can improve child and caregiver imitation skills is critical.

Hispanic/Latine Cultural Factors and Imitation

Imitation in early childhood is influenced by family cultural values and processes (Nielsen et al., 2016), and accordingly, imitation often varies across racial and ethnic groups as well as between Western and non-Western indigenous populations (Legare & Nielsen, 2015). Cultural identity factors (Ramos et al., 2018) may help explain observed differences across families in imitation. For example, the psychological processes by which individuals come to identify with, adopt, and/or adapt to a dominant majority culture (i.e., acculturation, Wolin et al., 2009), and the psychological processes by which individuals maintain awareness of, connection to, and affinity with, their culture(s) of origin (i.e., enculturation; Yoon et al., 2013), may be important factors to consider when studying imitation.

Hispanic (i.e., people with ancestry from Spanish-speaking countries)/Latine (i.e., a gender-neutral, linguistically appropriate description of individuals with an ancestral origin from within Latin American countries [Mexico, Central America, South America, and the Caribbean]) individuals represent a diverse cultural group with a range of values, beliefs, and behaviors and have been found to have some shared characteristics and tendencies related to caregiving styles (Guiberson & Ferris, 2019). Among Hispanic/Latine caregivers, research has shown cross-sectional negative associations between acculturation and interdependent caregiving styles, such as directive parenting behaviors (e.g., directing a child’s attention, responding to child’s complete communication, and teaching children to complete skills correctly). That is, research has shown with lower levels of acculturation, Hispanic/Latine caregivers tend to have more directive caregiving styles, which may be inconsistent with caregiver imitation given that this occurs when the caregiver is following the child’s lead (Guiberson & Ferris, 2019). Alternatively, enculturation in many Hispanic/Latine caregivers is associated with caregiving styles rooted in ethnic identity and cultural values (e.g., familismo and respeto), which are associated with prosocial behaviors in children, such as imitation (Carlo & Conejo, 2019). Importantly, acculturation and enculturation processes are not at odds with one another but rather represent distinct constructs (Yoon et al., 2013) with differing risk and protective influences (Schwartz et al., 2010). However, no studies to our knowledge have examined acculturation or enculturation effects on the impact of behavioral parenting interventions on caregiver and child imitation among Hispanic/Latine families.

Interventions Targeting Imitation in Children with DD

Research has shown promise increasing imitation in children with DD through therapist and caregiver-implemented imitation interventions (Ingersoll & Gergans, 2007; Ledford & Windsor, 2022). Although caregiver-mediated imitation interventions (e.g., Reciprocal Imitation Training and video modeling) have been found to increase imitation in autistic children and children with intellectual and developmental disabilities (Ingersoll, 2010; Ingersoll & Schreibman, 2006), limited research has examined the effects of well-established behavioral parenting interventions, which target child behavioral challenges via changes in caregiver behavior, on caregiver and child imitation. Given that imitation is a core skill taught to caregivers in behavioral parenting interventions, examining imitation outcomes in the context of behavioral parenting intervention is critical to understanding the broader applicability and utility of these services for families of children with DD and behavior problems.

Parenting Interventions, Child Behavioral Improvements, and Dyadic Imitation

Behavioral parenting interventions, such as Parent–Child Interaction Therapy (PCIT; Zisser & Eyberg, 2010), have a large evidence base for reducing early childhood behavior challenges (Comer et al., 2013; Eyberg et al., 2008), including those found in children with DD (Bagner & Eyberg, 2007; Bagner et al., 2010). Support has been found for traditional clinic-based formats (Comer et al., 2013; Eyberg et al., 2008) as well as telehealth formats that leverage the videoconferencing to remotely treat families in their natural settings (iPCIT; Bagner et al., 2023; Comer et al., 2015, 2017). By coaching caregivers to increase the use of positively reinforcing parenting skills (e.g., labeled praise, imitation) and decrease harsh and coercive parenting behaviors (e.g., critical statements), the goal is to reduce child behavior problems (Zisser & Eyberg, 2010). The Dyadic Parent–Child Interaction Coding System – Fourth Edition (DPICS-IV; Eyberg et al., 2014) is used to measure verbal parenting behaviors to monitor treatment progress, proficiency of skills, and treatment efficacy. Although therapists measure overall caregiver imitation using a rating of “satisfactory” or “needs practice” following each session, caregiver imitation is not included in the DPICS-IV coding system and has largely been neglected in existing research on PCIT and other parenting interventions. Typically, 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. In contrast to the well-documented research on the acquisition and use of verbal skills coded in DPICS-IV (Lindhiem et al., 2014), the omission of caregiver and child imitation from the coding system and research represents a significant gap in the literature.

To our knowledge, only two published studies have begun to investigate the impact of PCIT on imitation. Using a valid and reliable coding system of imitation, McCabe et al. (2021) found increases in imitation following PCIT among typically developing Mexican American children and their caregivers, and a negative association between parent imitation and child behavior problems. Another study by Gillenson and colleagues (2024) using the same imitation coding system in a majority Hispanic/Latine sample found increases in imitation following an adaptation of PCIT for infants, with greater increases in caregiver imitation among English-speaking caregivers and greater infant imitation among children of Spanish-speaking caregivers. In addition to these studies specifically targeting imitation within PCIT, a third study examining PCIT for autistic youth found positive effects of imitation (Masse et al., 2016).

Previous Findings and the Current Study

In prior research, McCabe et al. (2021) developed a valid and reliable coding system of caregiver and child imitation and found increases in caregiver and child imitation following PCIT among 58 typically developing 3- to 7-year-old Mexican American children and their caregivers. However, this study only examined acute imitation effects (i.e., pre-to-post intervention), excluded children with DD, and did not consider the potential moderating roles of acculturation and enculturation on treatment-related imitation gains despite its ethnically diverse sample. Gillenson and colleagues (2024) separately found a brief home-based adaptation of PCIT for infants led to significant increases in observed caregiver imitation during a child-led play task. However, this study was also not focused on children with DD and did not consider potentially moderating influences of acculturation or enculturation on imitation outcomes.

The current study extended the findings from these studies in several ways. This study examined the impact of an internet-delivered adaptation of PCIT (iPCIT; Comer et al., 2015, 2017) on observationally coded caregiver and child imitation in a sample of Hispanic/Latine children with DD and behavioral challenges. In iPCIT (Comer et al., 2015, 2017), therapists use videoconferencing (instead of a one-way mirror) to remotely observe family interactions in real time and provide live feedback to caregivers via a wireless caregiver-worn earpiece. We predicted that caregivers and children receiving iPCIT would display higher rates of observed imitation across time than those receiving referrals as usual (RAU). Second, we examined acculturation and enculturation as potential moderators of the intervention effects on caregiver and child imitation. We predicted acculturation and enculturation would each moderate associations between iPCIT and caregiver and child imitation across time, such that the effects of iPCIT on imitation would be stronger for families reporting higher levels of acculturation and lower levels of enculturation. These hypotheses build on previous research in which language spoken was used as a proxy for acculturation and enculturation, such that English-speaking was a proxy for higher acculturation and lower enculturation, and Spanish-speaking was a proxy for lower acculturation and higher enculturation. Using these proxies for acculturation and enculturation, in previous research, caregiver language spoken moderated the effect of an adaptation of PCIT on caregiver imitation, such that the PCIT adaptation led to higher levels of caregiver imitation for English-speaking compared to Spanish-speaking families (Gillenson et al., 2024). Previous research has also found skill utilization in PCIT to be greater among English-speaking than Spanish-speaking families (Ramos et al., 2024), suggesting a need to further examine cultural differences and understand how cultural factors, such as acculturation and enculturation, may help to promote treatment-related gains among Hispanic/Latine families.

Methods

Participants and Study Design

This study is a secondary data analysis from a randomized controlled trial (RCT) examining the effect of iPCIT for children with DD aging out of Early Intervention (EI) Part C services of the Individuals with Disabilities Education Act (Bagner et al., 2023). Study procedures were approved by the university Institutional Review Board and each participating EI site. Families were recruited at three Part C regional EI sites in South Florida. Recruitment occurred during the child’s EI exit evaluation within 3 months of the child’s third birthday. Inclusion criteria among these youth with DD for the original RCT design and current analyses were: (a) clinically significant score (i.e., T-Score > 60) on the Externalizing Problems subscale of the Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2001); and (b) the primary caregiver spoke English or Spanish. Families were excluded from eligibility for the original RCT design and current analyses if: (a) the child was receiving psychiatric medication for behavior challenges; (b) the child or caregiver was deaf or blind; (c) the primary caregiver reported the child displayed severe social communication differences as indicated by a T-score > 75 on the Social Responsiveness Scale (SRS-2; Constantino & Gruber, 2012), although children with moderate social communication skills (scores between 66 and 75), including those with autism spectrum disorder, were eligible; or (d) primary caregiver standard score < 4 on vocabulary subtest of the Wechsler Abbreviated Scale of Intelligence-Second Edition (WAIS for English speakers; Wechsler, 1999) or Escala de Inteligencia Wechsler Para Adultos-Third Edition (EIWA for Spanish speakers; Pons, Flores-Pabón, et al., 2008; Pons, Matías-Carrelo, et al., 2008). Youth with high levels of social communication differences, as indicated by the severe range on the SRS-2, were excluded from the original RCT and the current analyses because iPCIT relies heavily on social communication. The vocabulary subtest of the WAIS and EIWA was used as exclusionary criteria for caregivers in the larger clinical trial as well as the current analyses as a measure of verbal knowledge to ensure that the caregivers would be able to learn and implement the skills taught in iPCIT.

Families were initially screened during their child’s exit evaluation for EI services, and then participated in a home-based baseline evaluation once EI services terminated and the child turned 3-years-old. For the larger clinical trial (see CONSORT diagram for original RCT, Bagner et al., 2023, p. 234), out of 197 interested and eligible families, 150 families (76.1%) completed the baseline in-home evaluation and were randomized to receive up to 20 weeks of iPCIT (n = 75) or referrals as usual (n = 75). These families completed four home-based evaluation timepoints from child ages 3 years to 4 years and 6 months—i.e., Baseline, Post (M = 22.1 weeks after Baseline), 6-month follow-up (M = 42.3 weeks after Baseline), and 12-month follow-up (M = 67.5 weeks after Baseline).

Treatment sessions occurred for iPCIT families over the 20-week period between Baseline and Post evaluation, during which time the control group received referrals for services in the community as typically provided at their EI exit interviews. Primary caregivers completed questionnaires via RedCap on a tablet provided by the study, or on their own device, and received $100 for their participation in each home-based evaluation.

The present analyses focused on the subset of Hispanic/Latine children and their caregivers (n = 98; 65% of the clinical trial sample) that participated in the larger clinical trial. In the current sample of 98 child-caregiver dyads, about 58% provided information on the primary caregiver’s specific country of origin: Cuba (n = 18, 18.4%), Venezuela (n = 14, 14.3%), Columbia (n = 8, 8.2%), Honduras (n = 8, 8.2%), Dominican Republic (n = 3, 3.1%), Nicaragua (n = 3, 3.1%), Ecuador (n = 1, 1%), Guatemala (n = 1, 1%), and Mexico (n = 1, 1%). An additional 41 primary caregivers who identified as “Hispanic or Latino” did not provide their specific country of origin. Therefore, the term “Hispanic/Latine” is a gender-neutral term used in the manuscript to describe the ethnicity of participants with ancestry from Spanish-speaking or Latin American countries. Table 1 provides an overview of key baseline demographics for the current sample (see Bagner et al., 2023 for demographic details of the full clinical trial sample).

Table 1.

Baseline demographic characteristics across sample and by condition.

Total (n = 98) iPCIT group (n = 52) RAU group (n = 46)
% n % n % n p value
Child sex (male) 75.5 74 76.9 40 73.9 34 .73
Child ethnicity (Hispanic/Latine) 98 96 100 52 95.7 44 .13
Child race .15
Black/African American 5.1 5 1.9 1 8.7 4
White 90.8 89 96.2 50 84.8 39
Another race/biracial 4.1 4 1.9 1 6.5 3
Caregiver ethnicity (Hispanic/Latine) 100 98 100 52 100 46
Caregiver racea .15
Black/African American 5.1 5 1.9 1 8.7 4
White 90.8 89 96.2 50 84.8 39
Another race/biracial 4.1 4 1.9 1 6.5 3
Primary Caregiver Languageb .43
English 43.9 43 40.4 21 47.8 22
Spanish 54.1 53 57.7 30 50.0 23
Other (e.g., Creole) 1.0 1 0.0 0 2.2 1
High school graduatec or less 27.6 27 30.7 16 23.9 11 .66
Income-to-needs ratiod .27
Extreme poverty/poor 15.3 15 13.5 7 17.4 8
Low income 43.9 43 50.0 26 37.0 17
Adequate income 18.4 18 11.5 6 26.1 12
Affluent 15.3 15 15.4 8 15.2 7
Mean SD Mean SD Mean SD p value
Child age (months) 35.5 .57 36.08 .54 36.15 .60 .46
Primary Caregiver age (years) 34.88 6.34 34.86 7.04 34.91 5.60 .13
Acculturation 3.00 .76 2.90 .78 3.12 .73 .38
Enculturation 3.19 .63 3.27 .63 3.10 .63 .62
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a

Based on n = 98 families who reported child racial/ethnic identity in contact form.

b

Based on n = 97 of primary caregivers who reported primary language spoken.

c

Based on n = 96 of primary caregivers who reported education level.

d

Based on n = 91 who reported income and dependents in the household to calculate the income to needs ratio based on Federal Poverty Threshold from 2017.

Measures

Caregiver and Child Imitation

Caregiver and child imitation were coded using the imitation coding guidelines developed by McCabe and colleagues (2021). The imitation coding guidelines, which can be found in Table 2, consist of 13 rules used to identify both caregiver and child imitation. Specifically, the frequency of caregiver and child imitation was coded in 60 5-s intervals during a 5-min child-directed play situation, which occurred during each of the four home-based evaluations. These 5-min child-directed play situations were the same caregiver-child play observation tasks used for DPICS-IV coding to measure iPCIT treatment efficacy in the larger clinical trial. The frequency of caregiver imitation is defined as the sum of caregiver imitations of child behavior, and the frequency of child imitation is defined as the sum of child imitations of caregiver behavior exhibited during the 5-min observation. Coders completed training videos and double-coded 20% of the videos for interrater reliability. Interrater agreement was assessed at baseline from the 20% of segments double coded. Consistent with interrater agreement reported by Gillenson et al. (2024) and 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 .94 to .97 for the three codes of no imitation, child imitation, and caregiver imitation.

Table 2.

Caregiver Imitation coding guidelinesa.

Rule name Rule content
Definition of imitation Caregiver imitation occurs when the caregiver intentionally copies the child’s immediately preceding play behavior.
Five-second rule Each time the child completes an action or gesture, imitation is coded if the caregiver begins to mimic the child’s immediately preceding action or gesture within 5 seconds of action completion by the child. Imitation is also coded if the caregiver begins to perform actions that are necessary to imitate the child’s original action during the 5-second interval.
Complete action rule Caregiver imitation is coded only for actions completed by the child. Imitation of unfinished or partially completed actions is not coded.
Compound action rule If the child completes an action that requires multiple steps and the steps are separated by intervals of fewer than 2 seconds, the set is coded as one action.
Simultaneous action rule If the caregiver and child are engaged in a behavior simultaneously and it is unclear who initiated the action, imitation is not coded. However, if it is clear who initiated the action, imitation is coded.
Sequential imitation rule If the child imitates a caregiver action or gesture and the caregiver then imitates the child, imitation is coded.
Verbalization rule If a caregiver performs an imitative act, imitation is coded regardless of accompanying verbalizations.
Multiple imitation rule If a caregiver imitates the child’s action more than once, each instance of imitation that begins within the 5-second interval is coded as imitation.
Vagueness rule Actions that are too vague to judge imitative intent (e.g., looking, searching, handing, selecting toys, picking up toys, putting toys down) are not coded as imitation.
Building rule During building activities, imitation is coded when the caregiver imitates the child’s action on a similar structure with a similar piece and puts it in the same location that the child did.
Helping and correcting rule Imitation is not coded when a caregiver performs an action that corrects or helps the child’s completed action.
Cleanup rule During caregiver imitation of child cleanup activities, imitation is coded if the child and caregiver are intentionally putting toys in a specific container. Imitation is not coded if the child and caregiver are engaging in vague cleanup actions (e.g., moving, pushing).
Game rule Game interactions refer to actions that are performed within the scope of an activity with established, known rules. Imitation is not coded when a caregiver copies a child’s action in accordance with the rules of a structured game.
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a

Child imitation guidelines parallel the caregiver guidelines.

Acculturation and Enculturation

The Abbreviated Multidimensional Acculturation Scale (AMAS-ZABB; Zea et al., 2003) is a 42-item questionnaire of self-reported acculturation and enculturation across three dimensions of identity, language competence, and cultural competence. Items are rated on a 4-point Likert-style scale from 1 (strongly disagree, not at all) to 4 (strongly agree, extremely well). The total acculturation score assesses the extent to which respondents identify with and feel they successfully navigate the dominant U.S.–American mainstream culture and possess strong English language competency. The total enculturation score assesses the extent to which respondents identify and maintain a psychological connection with their stated “culture of origin” (however they identify it). The AMAS-ZABB has demonstrated a reliable factor structure and strong validity in Latine, Asian American, diverse multicultural treatment-seeking samples (e.g., Urcuyo et al., 2023; Zea et al., 2003). In the current sample, the AMAS-ZABB has demonstrated excellent reliability for both the acculturation (α = .95) and enculturation (α = .92) subscales. We z-scored the AMAS-ZABB total acculturation score and total enculturation score and used these variables at baseline as measures of participants’ acculturation and enculturation in analyses, respectively.

Data Analysis

Analyses were conducted in R version 4.3.3 (R Core Team, 2024) using a multilevel Poisson mixed model. For our primary aim, we examined the effect of iPCIT on caregiver and child imitation at all time points following baseline (i.e., Post, 6-month follow-up, and 12-month follow-up). We examined a treatment by time interaction on the effect of caregiver and child imitation. Given that a linear function of time, which would assume an improvement in imitation at equal unit increments of time, was unrealistic, we dummy-coded time, such that 0 represented Baseline, and three dummy codes represented each additional time point. Zero was a reference category for all dummy variables—i.e., Time 2 was a dummy-coded variable (coded: 1 for Post, 0 for all other time points); Time 3 was a dummy-coded variable (coded: 1 for 6-month follow-up, 0 for all other time points); and Time 4 was a dummy-coded variable (coded 1 for 12-month follow-up, 0 for all other time points). This coding allowed the amount of change to be unique to each time point with unequal increments of change to have the most flexible modeling of time (Singer & Willett, 2003).

For our second aim, we examined the longitudinal moderation effects of acculturation and enculturation on the effects of iPCIT on caregiver and child imitation. These were examined in separate models for 1) the moderation effect of acculturation on treatment effects on caregiver imitation, 2) the moderation effect of acculturation on treatment effects on child imitation, 3) the moderation effect of enculturation on treatment effects on caregiver imitation, and 4) the moderation effects of enculturation on treatment effects on child imitation. Significant moderation findings were followed up with post-hoc probing to clarify the nature and direction of interaction.

Missing Data

For our primary analyses reported in Table 4, all predictor values were complete. Specifically, all rows of the data contained assignment to iPCIT vs. RAU, and all rows contained a value for time. Our caregiver and child imitation variables were also mostly complete, except for a handful of participants (approximately 8% of cases), who had imbalanced data on these dependent variables (i.e., complete data at most time points but also missing values at some time points). However, under the missing at random (MAR) assumption (Rubin, 1976), maximum likelihood estimation of multilevel models effectively handles imbalanced cases such as when not all participants have complete data at all time points (Raudenbush & Bryk, 2002; Snijders & Bosker, 2011). For the moderator analyses reported in Tables 5 and 6, there was a single participant with missing data on both the acculturation and enculturation moderator variables. Because this one case represented such a small proportion of missing data (< 1% missing data), we removed this participant from our moderator analyses.

Table 4.

Treatment effects on parent and child imitation.

Parent Imitation Child Imitation
b SE p b SE p
(Intercept) −0.22 0.20 0.27 −0.73 0.22 <.001
iPCIT 0.07 0.27 0.81 0.20 0.29 0.49
Time 2 −0.01 0.20 0.98 0.29 0.25 0.25
Time 3 −0.03 0.20 0.86 0.35 0.25 0.16
Time 4 −0.68 0.24 <.001* −0.15 0.28 0.60
iPCIT*Time 2 0.26 0.26 0.33 0.18 0.33 0.57
iPCIT*Time 3 0.35 0.27 0.20 0.34 0.32 0.29
iPCIT*Time 4 0.60 0.31 0.05 −0.08 0.38 0.82
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Note. iPCIT = Internet-delivered Parent–Child Interaction Therapy. Time 2 is a dummy variable coded 1 for Post and 0 for all other time points. Time 3 is a dummy variable coded 1 for 6-month follow-up and 0 for all other time points. Time 4 is a dummy variable coded 1 for 12-month follow-up and 0 for all other time points.

Table 5.

Moderation by acculturation.

Acculturation
Parent Imitation Child Imitation
b SE p b SE p
(Intercept) −0.16 0.19 0.39 −0.69 0.22 <.001*
iPCIT 0.04 0.26 0.87 0.17 0.29 0.56
Acculturation −0.49 0.14 <.001* −0.38 0.13 <.001*
Time 2 −0.01 0.20 0.97 0.29 0.25 0.25
Time 3 −0.03 0.20 0.86 0.35 0.25 0.16
Time 4 −0.68 0.24 <.001* −0.14 0.28 0.61
iPCIT*Acculturation 0.74 0.20 <.001* 0.62 0.18 <.001*
iPCIT*Time 2 0.31 0.27 0.24 0.23 0.33 0.49
iPCIT*Time 3 0.40 0.27 0.14 0.38 0.32 0.24
iPCIT*Time 4 0.65 0.31 0.04* −0.04 0.38 0.92
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Note. iPCIT = Internet-delivered Parent–Child Interaction Therapy. Acculturation measured via the Abbreviated Multidimensional Acculturation Scale (AMAS) Total Acculturation score. Time 2 is a dummy variable coded 1 for Post and 0 for all other time points. Time 3 is a dummy variable coded 1 for 6-month follow-up and 0 for all other time points. Time 4 is a dummy variable coded 1 for 12-month follow-up and 0 for all other time points.

Table 6.

Moderation by Enculturation.

Enculturation
Parent Imitation Child Imitation
b SE p b SE p
(Intercept) −0.19 0.20 0.33 −0.71 0.22 <.001*
iPCIT 0.04 0.27 0.89 0.15 0.29 0.60
Enculturation 0.21 0.16 0.21 0.34 0.16 0.03*
Time 2 −0.01 0.20 0.99 0.30 0.25 0.23
Time 3 −0.04 0.20 0.86 0.34 0.25 0.16
Time 4 −0.68 0.24 <.001* −0.13 0.28 0.64
iPCIT*Enculturation −0.41 0.22 0.06 −0.36 0.21 0.08
iPCIT*Time 2 0.30 0.27 0.26 0.21 0.33 0.51
iPCIT*Time 3 0.40 0.27 0.14 0.38 0.32 0.24
iPCIT*Time 4 0.65 0.31 0.04* −0.04 0.38 0.91
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Note. iPCIT = Internet-delivered Parent–Child Interaction Therapy. Enculturation measured via the Abbreviated Multidimensional Acculturation Scale (AMAS) Total Enculturation score. Time 2 is a dummy variable coded 1 for Post and 0 for all other time points. Time 3 is a dummy variable coded 1 for 6-month follow-up and 0 for all other time points. Time 4 is a dummy variable coded 1 for 12-month follow-up and 0 for all other time points.

Results

Descriptive Analyses

Descriptive analyses were conducted using SPSS. Table 1 includes Baseline AMAS-ZABB means and standard deviations. All measures demonstrated sufficient variability in the current sample. We also examined the frequency of caregiver and child imitation across groups. Across all time points and groups, total frequency of caregiver imitation ranged from 0 to 15, and total frequency of child imitation ranged from 0 to 14. Table 3 presents means and standard deviations for the observed frequency of caregiver and child imitation by group (PCIT vs. RAU) at each time point. For a clear distinction between caregiver and child imitation in tables and figures, caregiver imitation is denoted as “Parent Imitation” or “P-IM,” and child imitation is indicated as “Child Imitation” or “C-IM.”

Table 3.

Parent and child imitation across time, by condition.

Baseline Post 6-Month Follow-up 12-Month Follow-up
Mean SD Mean SD Mean SD Mean SD
Total Sample P-IM 1.2 1.9 1.4 2.0 1.4 2.3 .85 1.5
C-IM .69 1.1 1.0 1.6 1.2 2.0 .58 .89
iPCIT P-IM 1.2 1.9 1.6 2.0 1.6 2.5 1.1 1.8
C-IM .75 .87 1.2 1.7 1.5 2.4 .61 .95
RAU P-IM 1.2 1.9 1.2 2.0 1.1 2.0 .60 1.1
C-IM .63 1.3 .86 1.5 .91 1.4 .55 .83
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Note. iPCIT = Internet-delivered Parent–Child Interaction Therapy (treatment); RAU = Referrals as Usual (control); P-IM = parent imitation; C-IM = child imitation.

Intervention Effects on Caregiver and Child Imitation

As described above, we examined a treatment by time interaction on the effect of group (i.e., iPCIT or RAU) on caregiver and child imitation across all time points. The time by treatment interactions (i.e., interaction of each dummy coded time variable with treatment) of the longitudinal effects of group on caregiver and child imitation were not significant (see Table 4). However, at 12-month follow-up for caregiver imitation, the conditional effect of the Time 4 dummy variable was significant, b(se) = −.68(.24), p < .001, and suggests that those in the control group had a .68 unit decrease on the expected log count of caregiver imitation between baseline and 12-month follow-up.

Tests of Moderation Hypotheses

Acculturation and Treatment Effects on Imitation

We examined the moderating effect of acculturation on the effect of iPCIT on caregiver and child imitation, separately, with results presented in Table 5. There was a significant two-way interaction between iPCIT and acculturation on caregiver imitation, (b(se) = 0.74 (0.20), p < .001), and child imitation, (b(se) = 0.62 (0.18), p < .001), such that for those who reported higher baseline levels of acculturation, receiving iPCIT led to higher (log) caregiver and child imitation compared to those receiving RAU. For caregiver imitation, each SD increase from the mean of the moderator, acculturation, produced a .74-unit increase in the slope of (log) caregiver imitation on experimental condition (0 = RAU vs. 1 = iPCIT). Those reporting relatively low levels of acculturation had a .70-unit decrease in (log) caregiver imitation. For child imitation, each SD increase from the mean of the moderator, acculturation, produced a .62-unit increase in the slope of (log) child imitation. Caregivers reporting relatively low levels of acculturation had a .45-unit decrease in (log) child imitation in the iPCIT condition compared to the RAU condition. These findings are displayed in Figure 1, graphs A (caregiver imitation) and B (child imitation). Note that whereas the model coefficients just reviewed are interpretable in terms of the expected effect of each predictor on the log count, Figure 1 displays our results on the expected (exponentiated) raw count metric. In each graph, there are three lines representing low (−1 SD), moderate (mean), and high (+1 SD) levels of self-reported caregiver acculturation. These findings highlight the particularly increased effects of iPCIT relative to RAU on caregiver and child imitation among more highly acculturated families.

Figure 1.

Figure 1.

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Caregiver acculturation moderates the effects of iPCIT on caregiver and child imitation.

Enculturation and Treatment Effects on Imitation

We also examined the moderating effect of enculturation on the effect of iPCIT on caregiver and child imitation, separately, with results presented in Table 6. As seen in Table 6, enculturation did not moderate the effects of iPCIT on either caregiver or child imitation. However, enculturation did exert a direct effect on child imitation, such that individuals higher in enculturation were also higher in their levels of child imitation regardless of condition.

Discussion

The current study offers the first examination of the effects of a behavioral parenting intervention on caregiver and child imitation among families of young Hispanic/Latine children with DD, as well as the moderating roles of acculturation and enculturation on such treatment effects. The present study provided a unique opportunity to examine how parenting interventions can promote dyadic imitation which can, in turn, optimize social-cognitive, language, and behavioral development – several crucial developmental areas, particularly among youth with DD. Despite previous literature supporting associations between parent-mediated interventions on imitation (Ingersoll & Gergans, 2007; Ledford & Windsor, 2022) and associations between imitation and child developmental outcomes (Carpenter et al., 2013; Gampe et al., 2016), little empirical work has examined these associations in the context of a parenting intervention and among children with DD, nor has such work considered how dimensions of cultural identity influence such associations. In a sample of families of young children with DD with Hispanic/Latine ethnic identities, the present study found the effects of iPCIT on caregiver and child imitation were particularly strong among families reporting higher levels of acculturation.

The small body of literature examining the effects of PCIT on caregiver and child imitation has been limited to typically developing children and has produced somewhat mixed findings. For example, McCabe and colleagues (2021) found PCIT to lead to increases in parent imitation but not child imitation, whereas Gillenson and colleagues (2024) found an adapted version of PCIT for infants to lead to increases in imitation in English-speaking, but not Spanish-speaking families. The current study focused on Hispanic/Latine children with DD and their caregivers and did not find significant longitudinal effects of treatment on changes in caregiver or child imitation. This lack of significant effects may be related to the baseline differences in imitation typically seen among children with DD (Dohmen et al., 2013; Stewart et al., 2013), resulting in a lower frequency of initiative and interactive behaviors (Van Keer et al., 2019). Additionally, previous research indicates that caregivers of children with DD tend to be more directive and less responsive (Kelly & Barnard, 2000; Spiker et al., 2002), which may explain lower levels of caregiver imitation in this sample. These findings specific to children with DD in combination with previous research on PCIT showing slower skill acquisition among Latine caregivers (Ramos et al., 2024), which may be a result of the development of PCIT in majority White, English-speaking samples, highlights a need to continue to assess the efficacy of PCIT and other behavioral parenting interventions among Hispanic/Latine samples and children with DD.

Despite the lack of treatment by time interaction on the effect of iPCIT on caregiver and child imitation, we found a somewhat delayed iPCIT effect on caregiver imitation at 12-month follow-up, such that iPCIT protected families against the decreasing caregiver imitation observed across time among control families who did not receive iPCIT. This finding suggests a preventive effect of treatment on caregiver imitation, which is particularly important in a population such as this in which caregiver imitation may not as readily be naturally reinforced (e.g., children with social differences may be less likely to observably respond to caregiver imitation behaviors). The lack of earlier time-specific effects and this delayed effect are supported by previous research suggesting that the process of acquiring imitative skills may be slower in children with DD, which has also been correlated with caregiver responsiveness (Van Keer et al., 2019). Accordingly, therapists working with families of young children with DD may particularly benefit from putting even greater emphasis into coaching imitation.

The present study included a diverse sample with families identifying with Hispanic/Latine ethnicities, providing a unique opportunity to examine the possible moderating role of cultural identity dimensions on the effect of iPCIT on caregiver and child imitation. Previous studies examining cultural differences in caregiver and child imitation have largely focused on between-groups differences between cultural populations (Tamis-LeMonda et al., 2014; Corriveau et al., 2017) or differences between languages spoken (Gillenson et al., 2024). However, differences in caregiving and child behaviors vary within an individual-oriented concept of culture (Legare & Nielsen, 2015), which does not assume individuals from the same cultural groups share the same values and practices (Dunst et al., 2017). Modern person-centered examinations of cultural variations emphasize within-group variability across cultural dimensions as much as between-group variability, particularly in the realm of child and family mental health care (Lau, 2006; Sanchez, Comer, et al., 2022; Sanchez, Jent, et al., 2022). In the current sample of Hispanic/Latine families from various nationalities of origin (e.g., Cuban, Venezuelan, Columbian, Honduran, etc.), caregivers who received iPCIT and reported higher levels of acculturation exhibited higher caregiver and child imitation. This finding suggests that greater psychological affinity to and identification with the majority dominant culture may promote the acquisition of imitation skills in Hispanic/Latine caregivers and children with DD. Additionally, this moderating acculturation effect may explain the overall lack of a treatment effect across the full sample on caregiver and child imitation, as the treatment effect depends on the caregiver’s level of acculturation. Future research should examine the effects of specific subcomponents of acculturation (e.g., identity, language competence, and cultural competence) on imitation to provide more culturally responsive care and improve outcomes for Hispanic/Latine families reporting lower levels of acculturation.

Contrary to our hypothesis regarding enculturation, caregiver’s levels of enculturation did not significantly moderate the effects of iPCIT on either caregiver or child imitation. However, regardless of treatment or control group, those with higher levels of enculturation had higher levels of child imitation. This lack of findings further highlights the need to better understand acculturation and enculturation separately as distinct constructs (Schwartz et al., 2010; Yoon et al., 2013). On average, caregiving styles for many Hispanic/Latine caregivers often include cultural values (e.g., familismo and respeto), which promote maintaining healthy relationships within the family (Gonzalez & Barnett, 2023). Parenting skills taught in PCIT that contribute to healthy caregiver–child relationships (such as imitation) may be viewed as aligning well with the cultural values of familismo and respeto in promoting healthy relationships. Future research on Hispanic/Latine families should emphasize the importance of considering within group concepts of culture and dimensions of cultural identity, such as acculturation and enculturation, rather than differences between groups, when examining parenting interventions and imitative behaviors in children and families with diverse Hispanic/Latine and other ethnic identities.

Strengths and Limitations

This study used an experimental and longitudinal design to examine behavioral parenting intervention effects on caregiver and child imitation, as well as dimensions of cultural identity as potential moderators among Hispanic/Latine children and caregivers. The sample in this study had sufficient power to detect small-to-moderate effects, which is consistent with research examining growth curve models (Hallahan & Rosenthal, 1996). This design allowed for the examination of changes over time and the use of rigorous statistical analyses. In the longitudinal design, the flexible treatment of time using dummy-coded variables was a strength, such that change over time was displayed more clearly than a linear examination of time, which would not have been appropriate conceptually. Within the design, the imitation variables were count outcomes, which were treated appropriately through use of multilevel Poisson mixed model. Another strength of this study was the relatively large sample size (n = 98), which allowed for these complex statistical analyses with sufficient power to detect small-to-moderate effects.

There were some limitations in this study that should be considered. First, the sample of Hispanic/Latine families within a majority-minority city may affect the generalizability of the findings to other geographical regions and minoritized groups, particularly due to potential differences in acculturation and enculturation. Second, imitation was coded in the context of a standardized structured parent–child interaction task. This approach offers improved reliability in the assessment of imitation, but the generalizability of these findings to more naturalistic interactions can be called into question. Future studies examining imitation should more consistently code imitation along with DPICS-IV coding and should also consider ways to assess imitation in more naturalistic interactions. Third, in the current study, the control group did not receive any active treatment. Future research examining imitation in behavioral parenting interventions may do well to include a more active treatment condition to better control for nonspecific therapeutic effects (e.g., support, rapport). Additionally, the present study found acculturation, but not enculturation, moderated the effects of iPCIT on imitation but cannot speak to why or how these cultural identity dimensions impact outcomes. Future research is needed to identify mechanisms that help explain precisely how acculturation and enculturation can boost treatment-related imitation gains. Lastly, due to the exploratory nature of the combination and interaction of variables in the current study, the findings should be viewed as preliminary and interpreted with caution, and future research is needed to replicate and extend these findings.

Conclusion

This study addressed significant gaps in the literature by assessing the effects of behavioral parenting intervention on caregiver and child imitation in a sample of young Hispanic/Latine children with DD and behavioral challenges. By assessing cultural identity factors that may explain variations in treatment response, this study extended previous findings with a focus on individual cultural factors. Findings suggest iPCIT effects on imitation are particularly strong for families reporting higher levels of acculturation. This underscores recent calls to more systematically incorporate cultural assessments at the outset of treatment to better inform treatment planning and case conceptualization and to improve efforts to maximize treatment engagement (e.g., Sanchez, Comer, et al., 2022; Urcuyo et al., 2023). In addition, future research is needed to examine treatment adaptations that can better meet the needs of Hispanic/Latine families reporting lower levels of acculturation and to better understand the role of enculturation. Additionally, research is needed to elucidate the mechanisms through which cultural identity factors can influence the effectiveness of treatment. Such findings are particularly needed to further the treatment of Hispanic/Latine youth with DD, with specific attention to how treatments can better promote dyadic imitation that can, in turn, optimize social-cognitive, language, and behavioral development.

Acknowledgments

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

Funding

The work was supported by the National Institute of Child Health and Human Development [R01HD084497].

Footnotes

Disclosure Statement

No potential conflict of interest was reported by the author(s).

References

  1. Achenbach TM, & Rescorla LA (2001). Manual for the ASEBA school-age forms & profiles. University of Vermont, Research Center for Children, Youth & Families. [Google Scholar]
  2. Bagner DM, Berkovits MD, Coxe S, Frech N, Garcia D, Golik A, Heflin BH, Heymann P, Javadi N, Sanchez AL, Wilson MK, & Comer JS (2023). Telehealth treatment of behavior problems in young children with developmental delay: A randomized clinical trial. JAMA Pediatrics, 177(3), 231–239. 10.1001/jamapediatrics.2022.5204 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bagner DM, & Eyberg SM (2007). Parent-child interaction therapy for disruptive behavior in children with mental retardation: A randomized controlled trial. Journal of Clinical Child and Adolescent Psychology, 36(3), 418–429. 10.1080/15374410701448448 [DOI] [PubMed] [Google Scholar]
  4. Bagner DM, Sheinkopf SJ, Vohr BR, & Lester BM (2010). Parenting intervention for externalizing behavior problems in children born premature: An initial examination. Journal of Developmental & Behavioral Pediatrics, 31(3), 209–216. 10.1097/DBP.0b013e3181d5a294 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bhatia HS, & Vaidya PM (2020). An association of imitation skills with language development in typically developing children versus children with autism spectrum disorder and developmental delay: An observational cross-sectional study. Indian Journal of Occupational Therapy, 52(3), 104–107. 10.4103/ijoth.ijoth_27_19 [DOI] [Google Scholar]
  6. Brownell CA, & Early Social Development Research Lab. (2016). Prosocial behavior in infancy: The role of socialization. Child Development Perspectives, 10(4), 222–227. 10.1111/cdep.12189 [DOI] [Google Scholar]
  7. Carlo G, & Conejo L (2019). Traditional and culture-specific parenting of prosociality in US Latino/as. The Oxford Handbook of Parenting and Moral Development, 247–266. 10.1093/oxfordhb/9780190638696.013.15 [DOI] [Google Scholar]
  8. Carpenter M, Uebel J, & Tomasello M (2013). Being mimicked increases prosocial behavior in 18-month-old infants. Child Development, 84(5), 1511–1518. 10.1111/cdev.12083 [DOI] [PubMed] [Google Scholar]
  9. Comer JS, Chow C, Chan PT, Cooper-Vince C, & Wilson LA (2013). Psychosocial treatment efficacy for disruptive behavior problems in very young children: A meta-analytic examination. Journal of the American Academy of Child and Adolescent Psychiatry, 52(1), 26–36. 10.1016/j.jaac.2012.10.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Comer JS, Furr JM, Cooper-Vince C, Madigan RJ, Chow C, Chan PT, Idrobo F, Chase RM, McNeil CB, & Eyberg SM (2015). Rationale and considerations for the internet-based delivery of parent-child interaction therapy. Cognitive and Behavioral Practice, 22 (3), 302–316. 10.1016/j.cbpra.2014.07.003 [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Comer JS, Furr JM, Miguel E, Cooper-Vince CE, Carpenter AL, Elkins RM, Kerns C, Cornacchio D, Chou T, Coxe S, DeSerisy M, Sanchez AL, Golik A, Martin J, Myers K, & Chase R (2017). Remotely delivering real-time parent training to the home: An initial randomized trial of Internet-delivered parent–child interaction therapy (I-PCIT). Journal of Consulting & Clinical Psychology, 85(9), 909–917. 10.1037/ccp0000230 [DOI] [PubMed] [Google Scholar]
  12. Constantino JN, & Gruber CP (2012). Social responsiveness scale: SRS-2. Western psychological services. Encyclopedia of Autism Spectrum Disorders. 10.1007/978-3-319-91280-6_296 [DOI] [Google Scholar]
  13. Corriveau KH, DiYanni CJ, Clegg JM, Min G, Chin J, & Nasrini J (2017). Cultural differences in the imitation and transmission of inefficient actions. Journal of Experimental Child Psychology, 161, 1–18. 10.1016/j.jecp.2017.03.002 [DOI] [PubMed] [Google Scholar]
  14. Delehanty AD, Stronach S, Guthrie W, Slate E, & Wetherby AM (2018). Verbal and nonverbal outcomes of toddlers with and without autism spectrum disorder, language delay, and global developmental delay. Autism & Developmental Language Impairments, 3. 10.1177/2396941518764764 [DOI] [Google Scholar]
  15. Dohmen A, Chiat S, & Roy P (2013). Nonverbal imitation skills in children with specific language delay. Research in Developmental Disabilities, 34(10), 3288–3300. 10.1016/j.ridd.2013.06.004 [DOI] [PubMed] [Google Scholar]
  16. Dunst CJ, Hamby DW, Raab M, & Bruder MB (2017). Family socioeconomic status, ethnicity, acculturation and enculturation, and parent beliefs about child behavior, learning methods and parenting roles. Journal of Education and Culture Studies, 1(2), 99–122. 10.22158/jecs.v1n2p99 [DOI] [Google Scholar]
  17. Essler S, Becher T, Pletti C, Gniewosz B, & Paulus M (2023). Longitudinal evidence that infants develop their imitation abilities by being imitated. Current Biology, 33(21), 4674–4678.e3. 10.1016/j.cub.2023.08.084 [DOI] [PubMed] [Google Scholar]
  18. Eyberg S, Boggs S, & Jaccard J (2014). Does maintenance treatment matter? Journal of Abnormal Child Psychology, 42 (3), 355–366. 10.1007/s10802-013-9842-9 [DOI] [PubMed] [Google Scholar]
  19. Eyberg SM, Nelson MM, & Boggs SR (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37(1), 215–237. 10.1080/15374410701820117 [DOI] [PubMed] [Google Scholar]
  20. Gampe A, Brauer J, & Daum MM (2016). Imitation is beneficial for verb learning in toddlers. The European Journal of Developmental Psychology, 13(5), 594–613. 10.1080/17405629.2016.1139495 [DOI] [Google Scholar]
  21. Gillenson CJ, Valente MJ, Hagan MB, MacNiven AC, & Bagner DM (2024). Impact of a brief parenting intervention on parent and infant imitation. Behavior Therapy, 56(3), 487–500. 10.1016/j.beth.2024.08.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Gonzalez H, & Barnett MA (2023). Familismo, respeto, and caballerismo: Cultural values as buffers against links between psychological distress and US Mexican-origin fathers’ positive parenting practices. Applied Developmental Science, 27(1), 1–15. 10.1080/10888691.2023.2225775 [DOI] [Google Scholar]
  23. Guiberson MM, & Ferris KP (2019). Identifying culturally consistent early interventions for Latino caregivers. Communication Disorders Quarterly, 40(4), 239–249. 10.1177/1525740118793858 [DOI] [Google Scholar]
  24. Hallahan M, & Rosenthal R (1996). Statistical power: Concepts, procedures, and applications. Behaviour Research and Therapy, 34(5–6), 489–499. 10.1016/0005-7967(95)00082-8 [DOI] [PubMed] [Google Scholar]
  25. Ingersoll B (2010). Brief report: Pilot randomized controlled trial of reciprocal imitation training for teaching elicited and spontaneous imitation to children with autism. Journal of Autism & Developmental Disorders, 40(9), 1154–1160. 10.1007/s10803-010-0966-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Ingersoll B, & Gergans S (2007). The effect of a parent-implemented imitation intervention on spontaneous imitation skills in young children with autism. Research in Developmental Disabilities, 28(2), 163–175. 10.1016/j.ridd.2006.02.004 [DOI] [PubMed] [Google Scholar]
  27. Ingersoll B, & Schreibman L (2006). Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral approach: Effects on language, pretend play, and joint attention. Journal of Autism & Developmental Disorders, 36(4), 487. 10.1007/s10803-006-0089-y [DOI] [PubMed] [Google Scholar]
  28. Kelly JF, & Barnard KE (2000). Assessment of parent-child interaction: Implications for early intervention. Handbook of Early Childhood Intervention, 2, 258–289. 10.1017/CBO9780511529320.014 [DOI] [Google Scholar]
  29. Lau AS (2006). Making the case for selective and directed cultural adaptations of evidence-based treatments: Examples from parent training. Clinical Psychology Science & Practice, 13(4), 295–310. 10.1111/j.1468-2850.2006.00042.x [DOI] [Google Scholar]
  30. Ledford JR, & Windsor SA (2022). Systematic review of interventions designed to teach imitation to young children with disabilities. Topics in Early Childhood Special Education, 42(2), 202–214. 10.1177/02711214211007190 [DOI] [Google Scholar]
  31. Legare CH, & Nielsen M (2015). Imitation and innovation: The dual engines of cultural learning. Trends in Cognitive Sciences, 19(11), 688–699. 10.1016/j.tics.2015.08.005 [DOI] [PubMed] [Google Scholar]
  32. Lindhiem O, Higa J, Trentacosta CJ, Herschell AD, & Kolko DJ (2014). Skill acquisition and utilization during evidence-based psychosocial treatments for childhood disruptive behavior problems: A review and meta-analysis. Clinical Child & Family Psychology Review, 17(1), 41–66. 10.1007/s10567-013-0136-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Masse JJ, McNeil CB, Wagner S, & Quetsch LB (2016). Examining the efficacy of parent-child interaction therapy with children on the autism spectrum. Journal of Child & Family Studies, 25(8), 2508–2525. 10.1007/s10826-016-0424-7 [DOI] [Google Scholar]
  34. McCabe KM, Sakamoto M, Rosas YG, Kehoe K, La R, Zerr A, & Yeh M (2021). Keeping an “I” on pride: Measuring imitation in parent-child interaction therapy. Behavior Therapy, 52(1), 28–38. 10.1016/j.beth.2020.01.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Meltzoff AN (2011). Social cognition and the origins of imitation, empathy, and theory of mind. The Wiley-Blackwell Handbook of Childhood Cognitive Development, 2, 49–75. 10.1002/9781444325485 [DOI] [Google Scholar]
  36. Nielsen M, & Blank C (2011). Imitation in young children: When who gets copied is more important than what gets copied. Developmental Psychology, 47(4), 1050–1053. 10.1037/a0023866 [DOI] [PubMed] [Google Scholar]
  37. Nielsen M, Mushin I, Tomaselli K, & Whiten A (2016). Imitation, collaboration, and their interaction among Western and Indigenous Australian preschool children. Child Development, 87(3), 795–806. 10.1111/cdev.12504 [DOI] [PubMed] [Google Scholar]
  38. Over H (2020). The social function of imitation in development. Annual Review of Developmental Psychology, 2(1), 93–109. 10.1146/annurev-devpsych-033020-024051 [DOI] [Google Scholar]
  39. Pons JI, Flores-Pabón L, Matías-Carrelo L, Rodríguez M, Rosario-Hernández E, Rodríguez JM, Herrans LL, & Yang J (2008). Confiabilidad de la escala de inteligencia Wechsler para adultos versión III, Puerto Rico (EIWA-III). Revista Puertorriqueña de Psicología, 19(1), 112–132. [Google Scholar]
  40. Pons JI, Matías-Carrelo L, Rodríguez M, Rodríguez JM, Herrans LL, Jiménez ME, Medina G, Rosario E, Nolasco NO, & Yang J (2008). Estudios de validez de la escala de inteligencia Wechsler para adultos versión III, Puerto Rico (EIWA-III). Revista Puertorriqueña de Psicología, 19, 75–111. [Google Scholar]
  41. R Core Team. (2024). R: A language and environment for statistical computing. R Foundation for Statistical Computing. https://www.R-project.org [Google Scholar]
  42. Ramos G, Blizzard AM, Barroso NE, & Bagner DM (2018). Parent training and skill acquisition and utilization among Spanish-and English-speaking Latino families. Journal of Child & Family Studies, 27(1), 268–279. 10.1007/s10826-017-0881-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Ramos G, Woller M, Quetsch L, Girard E, Barnett M, Montoya A, Le K, Reyes Y, Chavira D, Villodas M, & Lau A (2024). Trajectories of change in parent-child interaction therapy outcomes in Latinx families: Implications for cultural adaptation. Journal of Clinical Child and Adolescent Psychology, 1–15. 10.1080/15374416.2024.2395272 [DOI] [PubMed] [Google Scholar]
  44. Raudenbush SW, & Bryk AS (2002). Hierarchical linear models: Applications and data analysis methods. Sage. [Google Scholar]
  45. Rubin DB (1976). Inference and missing data. Biometrika, 63(3), 581–592. 10.1093/biomet/63.3.581 [DOI] [Google Scholar]
  46. Sanchez AL, Comer JS, & LaRoche M (2022). Enhancing the responsiveness of family-based CBT through culturally informed case conceptualization and treatment planning. Cognitive and Behavioral Practice, 29(4), 750–770. 10.1016/j.cbpra.2021.04.003 [DOI] [Google Scholar]
  47. Sanchez AL, Jent J, Aggarwal NK, Chavira D, Coxe S, Garcia D, La Roche M, & Comer JS (2022). Person-centered cultural assessment can improve child mental health service engagement and outcomes. Journal of Clinical Child and Adolescent Psychology, 51(1), 1–22. 10.1080/15374416.2021.1981340 [DOI] [PubMed] [Google Scholar]
  48. Schuhmacher N, Köster M, & Kärtner J (2019). Modeling prosocial behavior increases helping in 16-month-olds. Child Development, 90(5), 1789–1801. 10.1111/cdev.13054 [DOI] [PubMed] [Google Scholar]
  49. Schwartz SJ, Unger JB, Zamboanga BL, & Szapocznik J (2010). Rethinking the concept of acculturation: Implications for theory and research. The American Psychologist, 65(4), 237. 10.1037/a0019330 [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Singer JD, & Willett JB (2003). Treating time more flexibly. In Applied longitudinal data analysis: Modeling change and event occurrence (pp. 138–188). Oxford Academic. 10.1093/acprof:oso/9780195152968.003.0005 [DOI] [Google Scholar]
  51. Snijders TA, & Bosker R (2011). Multilevel analysis: An introduction to basic and advanced multilevel modeling (2nd ed.). Sage Publications. [Google Scholar]
  52. Spiker D, Boyce GC, & Boyce LK (2002). Parent-child interactions when young children have disabilities. In Glidden LM(Ed.), International review of research in mental retardation (Vol. 25, pp. 35–70). Academic Press. 10.1016/S0074-7750(02)80005-2 [DOI] [Google Scholar]
  53. Stewart HJ, McIntosh RD, & Williams JH (2013). A specific deficit of imitation in autism spectrum disorder. Autism Research, 6(6), 522–530. 10.1002/aur.1312 [DOI] [PubMed] [Google Scholar]
  54. Sundquist A, Nordqvist E, Koch FS, & Heimann M (2016). Early declarative memory predicts productive language: A longitudinal study of deferred imitation and communication at 9 and 16 months. Journal of Experimental Child Psychology, 151, 109–119. 10.1016/j.jecp.2016.01.015 [DOI] [PubMed] [Google Scholar]
  55. Tamis LeMonda CS, Song L, Luo R, Kuchirko Y, Kahana-Kalman R, Yoshikawa H, & Raufman J (2014). Children’s vocabulary growth in English and Spanish across early development and associations with school readiness skills. Developmental Neuropsychology, 39(2), 69–87. 10.1080/87565641.2013.827198 [DOI] [PubMed] [Google Scholar]
  56. Urcuyo AE, Conroy K, Sanchez AL, Silva K, Furr JM, Bagner DM, & Comer JS (2023). Psychometric evaluation of the abbreviated multidimensional acculturation scale (AMAS) in a treatment-seeking sample of first-generation immigrant caregivers. Child Psychiatry and Human Development, 55(6), 11–13 10.1007/s10578-023-01525-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Van Keer I, Ceulemans E, Bodner N, Vandesande S, Van Leeuwen K, & Maes B (2019). Parent-child interaction: A micro-level sequential approach in children with a significant cognitive and motor developmental delay. Research in Developmental Disabilities, 85, 172–186. 10.1016/j.ridd.2018.11.008 [DOI] [PubMed] [Google Scholar]
  58. Wang Z, Williamson RA, & Meltzoff AN (2015). Imitation as a mechanism in cognitive development: A cross-cultural investigation of 4-year-old children’s rule learning. Frontiers in Psychology, 6, 562. 10.3389/fpsyg.2015.00562 [DOI] [PMC free article] [PubMed] [Google Scholar]
  59. Wechsler D (1999). Wechsler abbreviated scale of intelligence. APA PsycTests. 10.1037/t15170-000 [DOI] [Google Scholar]
  60. Wolin KY, Colangelo LA, Chiu BCH, & Gapstur SM (2009). Obesity and immigration among Latina women. Journal of Immigrant & Minority Health, 11(5), 428–431. 10.1007/s10903-007-9115-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  61. Xu S, & Lorber MF (2014). Interrater agreement statistics with skewed data: Evaluation of alternatives to Cohen’s kappa. Journal of Consulting & Clinical Psychology, 82(6), 1219. 10.1037/a0037489 [DOI] [PubMed] [Google Scholar]
  62. Yoon E, Chang CT, Kim S, Clawson A, Cleary SE, Hansen M, Bruner JP, Chan TK, & Gomes AM (2013). A meta-analysis of acculturation/enculturation and mental health. Journal of Counseling Psychology, 60(1), 15–30. 10.1037/a0030652 [DOI] [PubMed] [Google Scholar]
  63. Zea MC, Asner-Self KK, Birman D, & Buki LP (2003). The abbreviated multidimensional acculturation scale: Empirical validation with two Latino/Latina samples. Cultural Diversity & Ethnic Minority Psychology, 9(2), 107–126. 10.1037/1099-9809.9.2.107 [DOI] [PubMed] [Google Scholar]
  64. Zisser A, & Eyberg SM (2010). Parent-child interaction therapy and the treatment of disruptive behavior disorders. In Weisz JR & Kazdin AE (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 179–193). The Guilford Press. https://psycnet.apa.org/record/2010-09488-01 [Google Scholar]

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