The high prevalence of challenging behavior is a primary concern among many children with autism. These behaviors, which encompass aggression, self-injury, prolonged tantrums, inflexibility, and defiance, are typically associated with increased family isolation, parental stress, and interference with education or interventional programming. Therefore, families with children on the autism spectrum are in desperate need of accessible, high-quality evidence-based treatments that simultaneously target disruptive behaviors and are congruent with busy family life. This study aimed to gain a better understanding of parent and child progress during their enrollment in an intensive, telehealth-delivered version of Parent Child Interactive Therapy (PCIT) and an emotion-focused modification of the standard PCIT curriculum for young children with autism. Trial results suggest that both approaches can effectively equip parents with positive parenting strategies, but only families who received traditional Parent Directed Intervention (PDI) coaching were observed to experience significant improvements in child externalizing behaviors and parental self-efficacy. Further analyses also revealed comparable improvements in parent responsiveness to their child’s positive behaviors, and core child autism symptoms in both groups. These findings suggest that the Child Directed Intervention (CDI) phase included in both conditions may be effective in increasing parent recognition of child positive behaviors and utilization of “do skills”, and improving core autism symptoms, even when delivered in a brief, intensive telehealth format.