Child Interaction Therapy Research Articles

Parent–child interaction therapy for preschool children with disruptive behaviour problems in the Netherlands

BackgroundPersistent high levels of aggressive, oppositional and impulsive behaviours, in the early lives of children, are significant risk factors for adolescent and adult antisocial behaviour and criminal activity. If the disruptive behavioural problems of young children could be prevented or significantly reduced at an early age, the trajectory of these behavioural problems leading to adolescent delinquency and adult antisocial behaviour could be corrected. Parent–Child Interaction Therapy (PCIT) is a short-term, evidence-based, training intervention for parents dealing with preschool children, who exhibit behavioural problems. Recently, PCIT was implemented in a Dutch community mental health setting. This present study aims to examine the short-term effects of PCIT on reducing the frequency of disruptive behaviour in young children.MethodsThis study is based on the data of 37 referred families. Whereby the results of which are derived from an analysis of parent reports of the Eyberg Child Behavior Inventory (ECBI), obtained during each therapeutic session. Furthermore, demographic information, extracted from client files, was also utilized. However, it must be noted that eleven families (27.5%) dropped out of treatment before the treatment protocol was completed. To investigate the development of disruptive behaviour, a non-clinical comparison group was recruited from primary schools (N = 59).ResultsThe results of this study indicate that PCIT significantly reduces disruptive behaviour in children. Large effect sizes were found for both fathers and mothers reported problems (d = 1.88, d = 1.99, respectively), which is similar to American outcome studies. At post treatment, no differences were found concerning the frequency of behavioural problems of children who completed treatment and those who participated in the non-clinical comparison group.ConclusionThe findings of this study suggest that PCIT is potentially an effective intervention strategy for young children and their parents in the Dutch population. However, further research into the evaluation of PCIT using a randomised controlled trial is recommendable.

Evidence-based intervention for young children born premature: Preliminary evidence for associated changes in physiological regulation

The current study examined whether changes in maternal behaviors following an evidence-based treatment—Parent–Child Interaction Therapy (PCIT)—was associated with improvements in cardiac vagal regulation in young children born premature. Participants included 28 young children (mean age=37.79 months) that were born premature and presented with elevated externalizing behavior problems. To assess cardiac vagal regulation, resting measures of respiratory sinus arrhythmia (RSA) and RSA change (withdrawal or suppression) to a clean-up task were derived pre and post-treatment. Results indicated that an increase in behaviors mothers are taught to use during treatment (i.e., do skills—praise, reflection, and behavioral descriptions) was associated with an improvement in children's post-treatment RSA suppression levels. The current study illustrates the important role of caregiver behavior in promoting physiological regulation in children born premature.

Adapting Parent–Child Interaction Therapy to Treat Severe Conduct Problems With Callous-Unemotional Traits

Children with conduct problems and callous-unemotional traits (i.e., lack of empathy, guilt, and lack of caring behaviors)(CP + CU) show poor response to empirically supported interventions for treating disruptive behaviors. Children with CP + CU are specifically less responsive to discipline components of parent training, although they respond well to reward-based behavioral strategies. This case study presents the treatment of a 5-year-old boy with severe disruptive behavior (CP, attention-deficit/hyperactivity disorder) and pronounced CU traits using Parent–Child Interaction Therapy, followed by the delivery of an adjunctive token economy system. Interventions that treat children with CP + CU are critically needed and have the potential for significant societal impact given the stability of their traits and severe behavioral outcomes. Findings from this case report (a) document an improvement in CP that was maintained to follow-up and (b) provide preliminary support for adapting parent-training interventions to modify severe CP in young children with CU traits.

The Effectiveness of Group Parent–Child Interaction Therapy with Community Families

Parent–Child Interaction Therapy (PCIT) is a behavioral, parent-training program that incorporates both operant learning and play therapy techniques to treat child disruptive behavior problems. The present pilot study examined the use of a group PCIT protocol with a mixed clinical sample of primarily low-socioeconomic status community families. Forty families with a child between the ages of 2 and 8 years old were either self-referred to the group or referred by child protective services, and 27 began treatment. Following a standard group PCIT protocol, 17 families completed treatment. Caregivers who completed the PCIT group reported a significant decrease in child disruptive behavior and parenting stress following completion of the 12-week group. Behavior observations of the treatment completers revealed a significant increase in parent prosocial behavior and a decrease in inappropriate parent behavior from pre- to post-treatment. As there have been no demonstrations, to date, of group PCIT in a community-based setting, this study presents evidence that PCIT is a promising treatment format for dissemination research and practice. The benefits and challenges of using a group PCIT format for delivery of clinical services are discussed.

Effectiveness of community dissemination of parent–child interaction therapy.

The Trauma Treatment Training Center (TTTC) at Cincinnati Children's Hospital examined the imple- mentation and effectiveness of Parent-Child Interaction Therapy (PCIT) in community agencies working with high-risk families through an awarded grant from the Substance Abuse and Mental Health Services Administration. The current study summarizes posttreatment data collected from community clinicians trained by the TTTC. Results include 53 posttreatment outcomes from 23 clinicians in 15 agencies in the United States. Significant improvement was seen on several measures regarding child behavior, child trauma symptoms, child dissociative characteristics, and caregiver stress. Community clinicians trained in PCIT during a five-day workshop did get effective results with even their first PCIT cases. It is only in the last generation that treatments for child mal- treatment establishing efficacy through randomized controlled studies have been developed and tested (Silverman et al., 2008). Trauma-Focused Cognitive Behavioral Therapy, the one well- established treatment for traumatized/maltreated children and their caregivers, includes a brief component about effective parenting, but further research in this area is warranted to help rebuild attachment relationships between maltreated children and their caregivers and to give parents the skills to deal with the emotional and behavioral dysregulations that often accompany child abuse and neglect. Parent-Child Interaction Therapy (PCIT), originally developed for families of children with disruptive behavior disor- ders, has shown potential to fill this gap in childhood trauma treatment by helping physically abusive parents transform their parenting practices and by offering a variety of skills to nonof- fending parents and caregivers (Chaffin et al., 2009). This study examined the dissemination and effectiveness of PCIT in commu- nity practices after clinicians, whose caseloads included substantial numbers of high-risk and maltreated children, were trained in a five-day workshop. PCIT is a dyadic treatment supported by more than 20 years of research and practice (Herschell, Calzada, Eyberg, & McNeil, 2002). It has demonstrated long-term maintenance of treatment gains of up to six years posttreatment (Hood & Eyberg, 2003). More than 100 randomized controlled trials support PCIT's effec- tiveness. Originally developed by Dr. Sheila Eyberg in the 1970s for young children with disruptive behavior disorders, PCIT has been successfully used with a variety of other populations, includ-

Utilizing Benchmarking to Study the Effectiveness of Parent–Child Interaction Therapy Implemented in a Community Setting

Benchmarking is a program evaluation approach that can be used to study whether the outcomes of parents/children who participate in an evidence-based program in the community approximate the outcomes found in randomized trials. This paper presents a case illustration using benchmarking methodology to examine a community implementation of Parent–Child Interaction Therapy (CI-PCIT) utilized as a child maltreatment prevention effort. Data were collected from 83 parent–child dyads. Change scores were compared to treatment and control effect sizes aggregated from the PCIT literature. Pre-post results indicated significant positive changes in child behavior for CI-PCIT completers. Benchmarking analyses revealed that parents who completed CI-PCIT reported significantly greater positive child outcomes than the aggregate control group benchmark, and significantly less than observed in the treatment benchmark. A summary of decision points and implications for utilizing this methodology in the child maltreatment field are postulated.

Therapists’ Attitudes Toward Evidence-Based Practices and Implementation of Parent–Child Interaction Therapy

Child abuse and neglect affects many families each year, but evidence-based parent training programs can be instrumental in reducing maltreatment. Parent-Child Interaction Therapy, a parent training program developed for treatment of disruptive child behavior, has demonstrated effectiveness with families at risk of or exposed to child maltreatment. However, methods for disseminating this evidence-based intervention in community settings are not well understood. This study examined the association between community-based therapists' attitudes toward evidence-based practices (EBPs) and their participation in an implementation research project in which they received two forms of consultation. Results showed that therapists' self-reported unwillingness to diverge from EBPs was positively associated with their use of phone consultation and satisfaction with consultation. The degree to which therapists found EBPs appealing was positively associated with satisfaction as well. Open therapist attitudes toward EBPs were associated with greater attendance for online consultation. The next step in this line of research is to examine how therapists' attitudes toward EBPs can be improved, if changing attitudes affects therapist acquisition of treatment skills, and if such improvements enhance implementation efforts.

P-310 - Parent-child interaction therapy for children with high functioning autism: a single-subject report

As parent-child interaction therapy (PCIT; Eyberg et al, 1995) relies on social contingencies, it was assumed that it would not be appropriate for children with autism spectrum disorders (ASD). Yet, many behaviors of children with high functioning autism (HFA) are reinforced by social attention. The purpose of this study was to investigate the efficacy of PCIT for young children (ages 2 to7) with HFA and behavioral problems. In this study an A-B single-subject experimental design across five subjects was used. Their behavioral problems were assessed by the Eyberg Child Behavior Inventory (ECBI) in each session. Findings demonstrate improvements in parental reports of child behavior for all participants following the implementation of PCIT especially through the second phase of the treatment. Clinical implications regarding the possible benefits of PCIT for improving the effectiveness of the program as well as limitations and future directions for research and treatment are discussed.

Using an online viewing system for parent–child interaction therapy consulting with professionals.

Parent-Child Interaction Therapy (PCIT) training was provided to therapists working with parents of children with disruptive behavior problems. Therapists uploaded video-recordings of selected sessions using a web-based tool for video sharing and review, the Video Analysis Tool (VAT). Trainers utilized the VAT for consultation to improve treatment fidelity. Clinical practice benefits include the ability to provide targeted, specific feedback to the trainees soon after a session and to disseminate PCIT to a larger, global audience.

Parent-Child Interaction Therapy for Mexican Americans: Results of a Pilot Randomized Clinical Trial at Follow-up

We examined treatment effects over a 6- to 24-month period posttreatment for 3 different interventions for externalizing behavior problems in young Mexican American (MA) children: a culturally modified version of Parent–Child Interaction Therapy (PCIT), called Guiando a Niños Activos (GANA), standard PCIT, and treatment as usual (TAU). Fifty-eight MA families with a 3- to 7-year-old child with clinically significant behavior problems were randomly assigned to GANA, standard PCIT, or TAU. As previously reported, all three treatment approaches produced significant pre-post improvement in conduct problems across a wide variety of parent-report measures, and those effects remained significant over the follow-up period. GANA produced results that were significantly superior to TAU on 6 out of 10 parent-report measures 6 to 24months posttreatment, and GANA significantly outperformed PCIT on child internalizing symptoms. However, PCIT and TAU did not differ significantly from one another. These data suggest that both PCIT and GANA produce treatment gains that are maintained over time, and that GANA continues to outperform TAU over the long term.

A novel early intervention for preschool depression: findings from a pilot randomized controlled trial

Validation for depression in preschool children has been established; however, to date no empirical investigations of interventions for the early onset disorder have been conducted. Based on this and the modest efficacy of available treatments for childhood depression, the need for novel early interventions has been emphasized. Large effect sizes (ES) for preschool psychotherapies for several Axis I disorders suggest that earlier intervention in depression may also be promising. Therefore, a novel form of treatment for preschool depression, Parent-Child Interaction Therapy Emotion Development (PCIT-ED) was developed and tested. A preliminary randomized controlled trial (RCT) was conducted comparing PCIT-ED to psycho-education in depressed 3- to 7-year-olds and their caregivers. A total of 54 patients met symptom criteria for DSM-IV major depressive disorder and were randomized, 19 patients completed the active treatment (n = 8 dropouts) and 10 completed psycho-education (n = 17 dropouts). Both groups showed significant improvement in several domains, with PCIT-ED showing significance in a greater number of domains. An intent-to-treat analysis suggested that PCIT-ED was significantly more effective than psycho-education on executive functioning (p = .011, ES = 0.12) and emotion recognition skills (p = .002, ES = 0.83). The RCT proved feasible and suggests an individual control condition should be used in future trials to minimize differential dropout. These pilot data, although limited by power, suggest that PCIT-ED may be a promising early intervention for depression. Larger scale randomized controlled trials of PCIT-ED for depressed preschoolers are now warranted.

Parent-Child Interaction Therapy as a Family-Oriented Approach to Behavioral Management Following Pediatric Traumatic Brain Injury: A Case Report

To present a case study illustrating the application of parent-child interaction therapy (PCIT) for management of a child's externalizing behaviors related to a severe traumatic brain injury (TBI). An 11-year-old boy's history and injury are described, followed by a description of PCIT and the course of therapy. After 9 sessions of PCIT, the child displayed fewer negative behaviors, and his mother's distress was reduced. This case demonstrates the feasibility of using PCIT with a child older than the recommended age range to address behavior problems associated with TBI.

Parent Engagement in Audiologic Habilitation

Parent Engagement in Audiologic Habilitation

The Effectiveness of Parent–Child Interaction Therapy with Depressive Mothers: The Changing Relationship as the Agent of Individual Change

This study uses a multi-method approach to investigate the effectiveness of Parent-Child Interaction Therapy (PCIT) in reducing children's behavior problems when parents report clinical levels of depressive symptoms. Participants were 132 children, 2-7 years of age, and their biological mothers, who either reported low (N = 78) or clinical levels of depressive symptoms (N = 54). Results showed that depressive mothers were likely to report more severe child behavior problems than non-depressive mothers at the pre-treatment assessment, but that depressive mothers reported greater reductions in child behavior problems than non-depressive mothers from pre- to post-treatment. The two groups showed similar levels of observed interaction quality at the pre-treatment assessment (i.e., parent and child emotional availability and parent verbalization patterns) and similar improvements in interaction quality from pre- to post-treatment. The implications of the findings for clinical practice were discussed.

Using Parent–Child Interaction Therapy to develop a pre-parent education module

The current study examined outcomes related to a pre-parent education module based on two sessions from the Parent–Child Interaction Therapy (PCIT) treatment protocol. The study included 300 undergraduate non-parents aged 19 to 25 who were enrolled in psychology courses at a large state university. Student knowledge of positive parenting skills and demonstration of effective behavioral parenting skills were examined through a self-report measure and an analog behavior observation. Exposure to the pre-parent education module resulted in significant increases in scores on a PCIT content quiz and frequency of praise during the role-play behavior observation from pre- to post-test. The results of this study suggest that undergraduate non-parents are open, and able, to learn about parenting strategies during a classroom-based parent education module. These findings highlight the feasibility of teaching parenting skills as a preventive strategy during pre-parenthood.

A combined motivation and parent–child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial.

A package of parent-child interaction therapy (PCIT) combined with a self-motivational (SM) orientation previously was found in a laboratory trial to reduce child abuse recidivism compared with services as usual (SAU). Objectives of the present study were to test effectiveness in a field agency rather than in a laboratory setting and to dismantle the SM versus SAU orientation and PCIT versus SAU parenting component effects. Participants were 192 parents in child welfare with an average of 6 prior referrals and most with all of their children removed. Following a 2 x 2 sequentially randomized experimental design, parents were randomized first to orientation condition (SM vs. SAU) and then subsequently randomized to a parenting condition (PCIT vs. SAU). Cases were followed for child welfare recidivism for a median of 904 days. An imputation-based approach was used to estimate recidivism survival complicated by significant treatment-related differences in timing and frequency of children returned home. A significant orientation condition by parenting condition interaction favoring the SM + PCIT combination was found for reducing future child welfare reports, and this effect was stronger when children were returned to the home sooner rather than later. Findings demonstrate that previous laboratory results can be replicated in a field implementation setting and among parents with chronic and severe child welfare histories, supporting a synergistic SM + PCIT benefit. Methodological considerations for analyzing child welfare event history data complicated by differential risk deprivation are also emphasized.

Accumulating Evidence for Parent–Child Interaction Therapy in the Prevention of Child Maltreatment

In a randomized controlled trial, the effectiveness of Parent-Child Interaction Therapy (PCIT) and correlates of maltreatment outcomes were examined. Mothers (N = 150) had a history or were at high risk of maltreating their children. After 12 weeks and compared to waitlist, PCIT mothers were observed to have improved parent-child interactions and reported better child behavior and decreased stress. At PCIT completion, improvements continued and mothers reported less child abuse potential and had improved maternal sensitivity. Also, PCIT completers were less likely to be notified to child welfare than noncompleters. Finally, those families not notified post-PCIT showed greater reductions in child abuse potential and improvements in observed sensitivity during treatment. Implications for theory and practice are discussed.

Parent-child interaction therapy emotion development: a novel treatment for depression in preschool children

Psychotherapies with known efficacy in adolescent depression have been adapted for prepubertal children; however, none have been empirically validated for use with depressed very young children. Due to the centrality of the parent-child relationship to the emotional well being of the young child, with caregiver support shown to mediate the risk for depression severity, we created an Emotional Development (ED) module to address emotion development impairments identified in preschool onset depression. The new module was integrated with an established intervention for preschool disruptive disorders, Parent Child Interaction Therapy (PCIT). Preliminary findings of an open trial of this novel intervention, PCIT-ED, with depressed preschool children are reported. PCIT was adapted for the treatment of preschool depression by incorporating a novel emotional development module, focused on teaching the parent to facilitate the child's emotional development and enhance emotion regulation. Eight parent-child dyads with depressed preschoolers participated in 14 sessions of the treatment. Depression severity, internalizing and externalizing symptoms, functional impairment, and emotion recognition/discrimination were measured pre- and posttreatment. Depression severity scores significantly decreased with a large effect size (1.28). Internalizing and externalizing symptoms as well as functional impairment were also significantly decreased pre- to posttreatment. PCIT-ED seems to be a promising treatment for preschoolers with depression, and the large effect sizes observed in this open trial suggest early intervention may provide a window of opportunity for more effective treatment. A randomized controlled trial of PCIT-ED in preschool depression is currently underway.

Parent–Child Interaction Therapy (PCIT) in school-aged children with specific language impairment

Parents play a critical role in their child's language development. Therefore, advising parents of a child with language difficulties on how to facilitate their child's language might benefit the child. Parent-Child Interaction Therapy (PCIT) has been developed specifically for this purpose. In PCIT, the speech-and-language therapist (SLT) works collaboratively with parents, altering interaction styles to make interaction more appropriate to their child's level of communicative needs. This study investigates the effectiveness of PCIT in 8-10-year-old children with specific language impairment (SLI) in the expressive domain. It aimed to identify whether PCIT had any significant impact on the following communication parameters of the child: verbal initiations, verbal and non-verbal responses, mean length of utterance (MLU), and proportion of child-to-parent utterances. Sixteen children with SLI and their parents were randomly assigned to two groups: treated or delayed treatment (control). The treated group took part in PCIT over a 4-week block, and then returned to the clinic for a final session after a 6-week consolidation period with no input from the therapist. The treated and control group were assessed in terms of the different communication parameters at three time points: pre-therapy, post-therapy (after the 4-week block) and at the final session (after the consolidation period), through video analysis. It was hypothesized that all communication parameters would significantly increase in the treated group over time and that no significant differences would be found in the control group. All the children in the treated group made language gains during spontaneous interactions with their parents. In comparison with the control group, PCIT had a positive effect on three of the five communication parameters: verbal initiations, MLU and the proportion of child-to-parent utterances. There was a marginal effect on verbal responses, and a trend towards such an effect for non-verbal responses. Despite the small group sizes, this study provides preliminary evidence that PCIT can achieve its treatment goals with 8-10-year-olds who have expressive language impairments. This has potentially important implications for how mainstream speech and language services provide intervention to school-aged children. In contrast to direct one-to-one therapy, PCIT offers a single block of therapy where the parents' communication and interaction skills are developed to provide the child with an appropriate language-rich environment, which in turn could be more cost-effective for the service provider.

The Effectiveness of Parent–Child Interaction Therapy for Victims of Interparental Violence

This study compares the effectiveness of Parent-Child Interaction Therapy (PCIT) in reducing behavior problems (e.g., aggression, defiance, anxiety) of 62 clinic-referred, 2- to 7-year-old, maltreated children exposed to interparental violence (IPV) with a group of similar children with no exposure to IPV (N=67). Preliminary analyses showed that IPV-exposed dyads were no more likely to terminate treatment prematurely than non IPV-exposed dyads. Results of repeated-measures MANCOVAs showed significant decreases in child behavior problems and caregivers' psychological distress from pre- to posttreatment for IPV-exposed and IPV nonexposed groups, and no significant variation by exposure to IPV. Stress in the parent role related to children's difficult behaviors and the parent-child relationship decreased from pre- to posttreatment, but parental distress did not decrease significantly over the course of PCIT. Results of an analysis testing the benefits of a full course of treatment over the first phase of treatment showed that dyads completing the full course of treatment reported significantly greater improvements in children's behavior problems than those receiving only the first phase of treatment.