Dyadic Parent-Child Interaction Coding System Research Articles

Trajectories of Change in Parent–Child Interaction Therapy Outcomes in Latinx Families: Implications for Cultural Adaptation

ABSTRACT Objective Parent–Child Interaction Therapy (PCIT) is a parenting program in which caregivers must achieve “skill criteria” in using Do Skills and avoiding Don’t Skills to complete treatment. Despite PCIT’s emphasis on these skills, little is known about how Latinx caregivers acquire these Western-based parenting practices and whether cultural mismatches lead to inequities in outcomes. This study compared the trajectories of change in PCIT skills and treatment outcomes of Latinx and non-Latinx White families. Method We analyzed weekly treatment data from 64 families (20.3% Spanish-speaking Latinx, 51.6% English-speaking Latinx, 28.1% non-Latinx White) served in community clinics. Caregivers were mostly females (95.3%), on average 35.13 years old, and lived in poverty (77.6%). PCIT skills were coded using the Dyadic Parent–Child Interaction Coding System, and child behavior problems were reported using the Eyberg Child Behavior Inventory. Results Latinx and non-Latinx White caregivers acquired Do Skills similarly during treatment. In contrast, some Latinx caregivers began treatment using significantly more Don’t Skills and needed more sessions to achieve some aspects of PCIT skill criteria compared with non-Latinx White caregivers. Latinx families also experienced similar or even more pronounced reductions in child behavior problems than non-Latinx White families. There were no significant differences in the percentage of caregivers who achieved PCIT skill criteria or left treatment prematurely. Conclusions This study provides evidence that strictly defined PCIT skill criteria may lead to inequities in treatment length for some Latinx families. Informed by these findings, we propose data-driven adaptations to improve the cultural fit of PCIT for Latinx groups.

Quality of parent–child interaction in underserved migrant areas in Kyrgyz Republic: a pilot study

BackgroundAfter societal change in Kyrgyz Republic, the pattern of parent–child interaction in the changing parenting culture is an important factor influencing the positive development of Kyrgyz children. This study is aim to assess the quality of parent–child interactions in Kyrgyzstan by analyzing the interaction patterns and playfulness of children during free play at home.MethodsThis was a descriptive pilot study using video-recorded observations to explore parent–child interactions. The Dyadic Parent–Child Interaction Coding System and a playfulness instrument were used to assess the patterns and quality of the interaction. A total of 20 dyads of children aged 24 to 58 months and their parents, living in migrant communities of Kyrgyzstan, participated in this study.ResultsMajor parent–child interaction patterns included 731 turns of parent–child dyads during 1040 episodes. Verbal as well as nonverbal behaviors of parents were observed while interacting with their children. Parents used direct and indirect commands most frequently, while praise was used the least in interactions. Children frequently used compliance as well as noncompliance when they interacted with their parents. Children had low playfulness scores while interacting with their parents. Cognitive spontaneity was the component with the lowest score among all subdomains of playfulness.ConclusionFuture studies are recommended to develop strategies to facilitate parents’ active interaction with their children, promote children’s playfulness, and improve the quality of their mutual interaction.

Evaluation of Virtual Enhanced Child Adult Relationship Enhancement in Primary Care Intervention.

Because of COVID-19 pandemic social distancing requirements, the in-person Child Adult Relationship Enhancement in Primary Care (PriCARE) positive parenting intervention was adapted for virtual delivery. Objective was to evaluate the efficacy of the virtual PriCARE program to improve parenting capacity, decrease child behavioral problems, and decrease child maltreatment risk. Caregivers of children 2 to 6 years old recruited from pediatric primary care were randomized to PriCARE (n = 92) or waitlist control (n = 90). Dysfunctional parenting, positive parenting skills, child behaviors, and child maltreatment risk were measured at baseline and 2 to 3 months after intervention using the Parenting Scale (PS), Dyadic Parent-Child Interaction Coding System (DPICS), Eyberg Child Behavior Inventory (ECBI), and Child Abuse Potential Inventory (CAPI). Kruskal-Wallis test compared median change scores from baseline to follow-up by treatment arm. Of 182 enrolled caregivers, 92% (168) were mothers and 67% (122) completed study measures at baseline and follow-up. The median decrease (improvement) in total PS score was greater in the PriCARE group compared with the control group (-0.3 [IQR 0.69] vs -0.1 [IQR 0.56], p = 0.028) as was the median decrease (improvement) in ECBI problem score (-3 [IQR 9] vs -1 [IQR 7], p = 0.045) and ECBI intensity score (-9 [IQR 21] vs 0 [IQR 25], p = 0.006). Improvements in 4 positive parenting skills measured by DPICS were greater in the PriCARE group compared with the control group (all p< 0.003). Median decrease in CAPI abuse score did not differ significantly by study arm ( p = 0.055). The PriCARE virtual adaptation demonstrated promise in promoting positive parenting and decreasing child behavior problems.

Assessment of Parent–Child Interaction Quality from Dyadic Dialogue

The quality of parent–child interaction is critical for child cognitive development. The Dyadic Parent–Child Interaction Coding System (DPICS) is commonly used to assess parent and child behaviors. However, manual annotation of DPICS codes by parent–child interaction therapists is a time-consuming task. To assist therapists in the coding task, researchers have begun to explore the use of artificial intelligence in natural language processing to classify DPICS codes automatically. In this study, we utilized datasets from the DPICS book manual, five families, and an open-source PCIT dataset. To train DPICS code classifiers, we employed the pre-trained fine-tuned model RoBERTa as our learning algorithm. Our study shows that fine-tuning the pre-trained RoBERTa model achieves the highest results compared to other methods in sentence-based DPICS code classification assignments. For the DPICS manual dataset, the overall accuracy was 72.3% (72.2% macro-precision, 70.5% macro-recall, and 69.6% macro-F-score). Meanwhile, for the PCIT dataset, the overall accuracy was 79.8% (80.4% macro-precision, 79.7% macro-recall, and 79.8% macro-F-score), surpassing the previous highest results of 78.3% accuracy (79% precision, 77% recall) averaged over the eight DPICS classes. These results show that fine-tuning the pre-trained RoBERTa model could provide valuable assistance to experts in the labeling process.

"You did a great job building that!" Links between parent-child prosocial talk and spatial language.

We investigated the extent to which parents' prosocial talk and negations relate to the quantity and diversity of parents' spatial language production. We also examined similar associations among children. Participants included 51 children of ages 4-7 years and their parents recruited from South Florida. Most of the dyads included mothers and were Hispanic and bilingual. Dyads constructed a Lego house for 10 min. Sessions were transcribed and coded for instances of parent prosocial talk (praises, reflective statements, and behavior descriptions), child general positive statements (all positive contributions to the interaction), and parent and child negations (criticisms, corrections, and disapprovals) using the Dyadic Parent-Child Interaction Coding System. Transcripts were also coded for quantity and diversity of spatial language including shape terms (e.g., square), dimensional adjectives (e.g., little), orientations (e.g., turn), locations (e.g., middle), and spatial features/properties (e.g., edge). Parents' prosocial language, but not negations, were significantly associated with the quantity and diversity of parents' spatial language. Children's general positive statements were significantly associated with children's spatial language quantity. Exploratory data analyses also revealed significant associations between parent-child talk about shapes, dimensions, and spatial features and properties. Findings suggest that variability in parent-child prosocial and spatial talk during collaborative spatial play relates to aspects of their own-and each other's-spatial language production. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The dyadic parent-child interaction coding system (DPICS): Negative talk as an indicator of dysfunctional mother-child interaction

BackgroundThe Dyadic Parent-Child Interaction Coding System (DPICS-IV) is a widely used observational instrument that assesses Parent-child interaction (PCI) quality. However, studies specifically examining its psychometric properties published in peer-reviewed journals are scarce. The present study aimed to provide evidence on the discriminative validity of the DPICS-IV to identify indicators of parent–child interaction among clinical mother–child dyads compared to non-clinical. MethodParticipants were 177 mother–child dyads with children aged 4 to 8 years: (1) a clinical sample of 80 dyads where mothers experienced significant difficulties managing their children's behavior problems and identified by Child Welfare and Child Protection Services as at risk for child maltreatment or with substantiated reports, and (2) a non-clinical sample of 97 dyads from the general population. ResultsDPICS Negative talk factor showed high discriminant capacity (AUC = 0.90) between samples, with a cut-off score of 8 that allowed mother–child dyads to be classified with a sensitivity of 82 % and a specificity of 89 %. ConclusionsFindings of the present study suggested that the DPICS-IV Negative Talk factor is a robust indicator of dysfunctional PCI patterns of families involved with the Child Protection Services. Further research is needed to confirm these findings and to test the accuracy of the cut-off score with a representative sample of the general population.

Reliability and validity of an observation-based parent-child interaction rating scale for Chinese children aged 0-6 years.

We examined the psychometric properties of a parent-child interaction rating scale (IRS) in Chinese children. We recruited 346 dyads of children aged 0-6 years (Mage = 2.72 years, SD = 1.52 years) and their caregivers from four cities in China. Parent-child interactions were videotaped in a controlled laboratory and coded by two trained coders. Internal reliability and test-retest reliability were used to measure the reliability of test scores from the IRS in our sample. We performed confirmatory factor analysis (CFA) to examine the factor structure of the Chinese version of the parent-child interaction rating scale (IRS-C). The third version of the dyadic parent-child interaction coding system (DPICS) was applied to assess the convergent validity of the IRS-C. Test scores from the IRS-C exhibited strong internal consistency (Kuder-Richardson 20 score 0.855) and test-retest reliability (intraclass correlation coefficient 0.809 over a 1-month interval). Results of confirmatory factor analyses indicated that the five-factor structure for both the child's and caregiver's domains of the IRS-C was suitable for the Chinese sample. Convergent validity in interpretation was also verified with significant correlations between the IRS-C and DPICS. Our findings suggested that the IRS-C produces reliable and valid test scores in the evaluation of parent-child interactions among Chinese children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review.

Parenting interventions to support parent/child attachment and psychosocial adjustment in foster and adoptive parents and children: A systematic review.

68.3 LONG-TERM OUTCOMES OF PARENT-CHILD INTERACTION THERAPY ON ADHD SYMPTOMS

This study examines the long-term effects of Parent-Child Interaction Therapy (PCIT) on female and male caregiver ratings of ADHD symptoms, as well as on observational interaction measures in preschoolers randomized to individual or group PCIT. Data from 128 children participating in treatment were examined (mean age at study entry = 4.8 years). Children with ADHD, half of whom also met the criteria for disruptive behavior disorder (DBD), were randomized to group or individual PCIT and outcomes were assessed posttreatment as well as 1 and 2 years after treatment completion. Pretreatment and posttreatment measures included: 1) parent rating scales, like the Child Behavior Checklist (CBCL) Externalizing Problems Subscale; the SNAP-IV; the Eyberg Child Behavior Inventory (ECBI) Intensity Score; and the Columbia Impairment Scale (CIS); and 2) observations of the parent-child interaction using the Dyadic Parent-Child Interaction Coding System (DPICS). PCIT results in clinically and statistically significant improvements in ADHD symptoms and reductions in impairment as rated by female and male caregivers. There are no differences in outcomes at posttreatment between children with and without DBD, or between those in individual or group PCIT. For both PCIT treatment formats, improvements are maintained at 1- and 2-year follow-up on all caregiver measures, including ADHD-specific ratings, externalizing behavior ratings, CIS scores, and observational measures of parent-child interactions. ADHD symptom reduction is not an original goal of PCIT intervention, yet significant improvements occur in ADHD symptoms based on both caregivers’ reports and observational data. These findings suggest that PCIT may be an effective treatment for the behavioral and attentional symptoms of ADHD in preschoolers with or without DBD and that it merits further study as a promising intervention for preschoolers with ADHD.

Dyadic Parent-Child Interaction Coding System (DPICS): Factorial Structure and Concurrent Validity.

Comprehensive family assessments in Child Protection Services should include instruments with suitable psychometric characteristics. The present study aims to provide initial evidence of the factorial structure and other psychometric properties of the Dyadic Parent-Child Interaction Coding System (DPICS). Participants were 80 mother-child dyads with children aged 4-8 who received family support from Child Protection Services in Spain. Confirmatory factor analysis showed good fit for a four-factor solution (Praise, Questions, Clear commands and Negative talk) with 15 items. Inter-rater reliability indices were optimal. Evidence of concurrent validity found that DPICS factors were related to self-reported parenting and teacher-informed child behavior problems. This study provides preliminary evidence of the DPICS's psychometric properties for assessing mother-child interaction within Child Protection Services. Further research with larger samples of mother-child and father-child dyads is still needed to confirm the four-factor solution.

Treating Externalizing Behaviors in Toddlers with ASD Traits Using Parent-Child Interaction Therapy for Toddlers: A Case Study

Up to 27% of children with autism spectrum disorder (ASD) experience clinically significant externalizing behavior. Child emotional dysregulation is thought to be one of the main reasons for the manifestation of externalizing behaviors during toddlerhood and has also been associated with insecure and disorganized parent-child attachment relationships. Parent-Child Interaction Therapy for Toddlers (PCIT-T) is an attachment and behavioral based parent training program targeted at children aged 12 to 24 months with externalizing behavior. This study assessed the effectiveness of PCIT-T in reducing child externalizing behavior as well as improving child emotional regulation and the parent-child attachment relationship in a child with moderate-to-severe ASD traits, low intellectual and adaptive functioning, externalizing behaviors within the clinical range, and a disorganized/insecure mother-child attachment relationship. The intervention occurred over a 12-week period and focused on improving positive parenting skills, parent emotional regulation, and child emotional regulation. Treatment progress was tracked using the Child Behavior Checklist Externalizing Behavior subscale, the Deverux Early Childhood Assessment for Toddlers Attachment/Relationship and Self-Regulation subscales, the Dyadic Parent-Child Interaction Coding System, version 4, and the Strange Situation Procedure. Study results provide preliminary support for the use of PCIT-T in reducing externalizing behavior, improving the parent-child attachment relationship and child emotional regulation. These results indicate that PCIT-T can be beneficial for children with ASD traits, however, further research with a larger sample size is needed to strength these findings.

Convergence of Parent Report and Child Behavior using the Dyadic Parent-Child Interaction Coding System (DPICS)

The Dyadic Parent-Child Interaction Coding System (DPICS) is an analogue behavioral observation that examines the quality of parent-child interactions as well as child prosocial and disruptive behaviors. With previous research focusing primarily on parent verbal behaviors, there is limited psychometric support and understanding of the DPICS coding categories for child behaviors. As such, the current study investigated associations between child verbal behaviors coded using updated DPICS editions and parent ratings on measures of child functioning for externalizing, internalizing, and adaptive behavior. Participants were 120 parent-child dyads drawn from two samples who participated in a DPICS observation and completed measures. Children were between ages 2 and 11 and exhibited a range of clinical problems (e.g., conduct issues, anxiety, no clinical problems). Results revealed significant associations between child verbalizations coded during the DPICS and parent-reported child functioning for externalizing and adaptive areas but not for internalizing problems. Specifically, children who exhibited more negative talk and who were less compliant during the DPICS were rated higher on parent-report measures of externalizing behaviors, whereas children who asked more questions, engaged in more prosocial talk, and exhibited fewer vocalizations (e.g., yelling, whining) were rated higher on parent-reported measures of adaptive skills and lower on parent-report measures of externalizing behavior. These findings demonstrate convergence between observed child behavior and parent ratings, enhancing clinical interpretation of the DPICS child codes within a broader clinical population. This study provides support for multi-method assessment and highlights the need for future research examining bidirectional effects within parent-child interactions.

Parent–Child Interaction Therapy with Toddlers: A Community-based Randomized Controlled Trial with Children Aged 14-24 Months

ABSTRACT Objective: Children with early-onset behavioral issues are at high risk for ongoing behavioral, psychological, and social issues. Method: This study examined the efficacy of the first phase of Parent–Child Interaction Therapy with Toddlers, Child-Directed Interaction – Toddler, using a randomized control design. Sixty-six mother-toddler dyads (Child Mage = 19.13 months; 63% male; 34% from a non-English speaking background) referred to a community-based child behavior clinic in Australia received CDI-T immediately or were assigned to a waitlist control condition. At baseline (Time 1) and post-treatment/post-waitlist (Time 2), mothers completed questionnaires (Child Behavior Checklist, Edinburgh Postnatal Depression Scale, Parenting Stress Index – Short Form) and participated in a structured parent–child dyadic play-based interaction later coded using the Dyadic Parent–Child Interaction Coding System and the Emotional Availability Scales. Results: Compared to those who did not receive treatment, mother-child dyads who received the intervention showed significantly better parenting skills (increases in positive parenting skills and decreases in negative parenting skills), emotional availability (increases in parental sensitivity and parental non-intrusiveness), child behavior (decreases in externalizing and internalizing behaviors) and parental perceptions of child difficulty. Conclusions: Results suggest that the CDI-T phase of PCIT-T is a promising intervention for toddlers presenting with behavioral issues. Future studies should be conducted to assess efficacy in other settings and to assess longer-term outcomes.

Keeping an “I” on PRIDE: Measuring Imitation in Parent-Child Interaction Therapy

In parent–child interaction therapy (PCIT), therapists encourage parents to imitate child behaviors in order to convey approval of the child’s actions and promote the development of linguistic and social–cognitive skills. However, the Dyadic Parent-Child Interaction Coding System (DPICS-IV), used to measure skills taught during PCIT, does not include guidelines for coding parent–child imitation, making it difficult to determine how PCIT affects it. The current study addresses this problem by developing guidelines for coding imitation, which were then used to code DPICS-IV segments from 58 Mexican American families that participated in a past clinical trial. Results suggest that these coding guidelines can be used to reliably measure parent and child imitation. A series of additional analyses supported the construct validity of the codes. Specifically, there was a trend for parent imitation, but not child imitation, to increase more from pre–post treatment in PCIT relative to treatment as usual. In addition, parents who imitate their children were found to have children who imitate them more in return. Finally, improvement in parent imitation, but not child imitation, was significantly related to a decrease in child behavior problems. Further study is needed to determine the optimal frequency of imitation, and findings suggest that additional attention to coaching imitation may be warranted.

Psychometric Properties of the Dyadic Parent-Child Interaction Coding System in The Netherlands

The current study explored the psychometric properties of a parent-child interaction observation system, the Dyadic Parent-Child Interaction Coding System (DPICS) in the Netherlands. Participants included 31 Dutch mother-child dyads and 86 U.S. mother-child dyads for a community sample (2–7 years; 50% boys). Good one-week test-retest reliability was demonstrated among the Dutch sample. Similarities were found between Dutch and U.S. samples on most interaction codes, but mothers in the U.S. sample used more directive behaviors (e.g., commands) in some situations. Findings suggest that the DPICS is a reliable measure of mother-child interactions in the Dutch population. Cultural issues regarding the use of the DPICS are discussed.

An Exploratory Study of the Utility of the Dyadic Parent-Child Interaction Coding System for Children with Autism Spectrum Disorder

Parent-child interactions are critically important for children with autism spectrum disorder (ASD) as a number of the core symptoms of ASD are specifically impacted by parental behaviors and many efficacious treatment options for children with ASD rely on altering parental behaviors. Research has reported on the use and effectiveness of Parent Child Interaction Therapy (PCIT) in addressing behavioral difficulties in children with ASD. A core feature of PCIT is observations of parent-child interactions using the Dyadic Parent-Child Interaction Coding System (DPICS) for assessment, treatment planning, and outcome monitoring. As the clinical usage and evidence base for PCIT with children with ASD grows, the question of the utility of the DPICS in children with ASD remains. The current study explores the reliability, validity, and utility of the DPICS in 88 parent-child dyads of children with (n = 46) and without (n = 42) autism symptomology. Results indicate fair to strong inter-correlations for all DPICS behavioral categories but do not support convergent validity with the Eyberg Child Behavior Inventory or the Parent Stress Index for dyads of a child with ASD. Significant differences were found between parents of children with ASD and those without on the DPICS. Within the context of interactions of children with ASD, inter-rater reliability was broadly obtained, although more research on the convergent validity is needed. The DPICS gathers important information to characterize parent-child interactions in dyads of children with ASD, but may not be as tied to parent report of child behaviors as in typically developing samples.

Emotional Availability Scale Among Three U.S. Race/Ethnic Groups.

This study used a cross-sectional design to conduct a subgroup psychometric analysis of the Emotional Availability Scale among matched Hispanic ( n = 20), African American ( n = 20), and European American ( n = 10) English-speaking mother-child dyads in the United States. Differences by race/ethnicity were tested ( p < .05) among (a) Emotional Availability Scale dimensions with ANOVA, and (b) relationships of Emotional Availability Scale dimensions with select Dyadic Parent-Child Interaction Coding System variables with Pearson correlation and matched moderated regression. Internal consistency was .950 (Cronbach's α; N = 50). No significant differences in the six Emotional Availability Scale dimension scores by race/ethnicity emerged. Two Dyadic Parent-Child Interaction Coding System behaviors predicted two Emotional Availability Scale dimensions each for Hispanic and African American mother-child dyads. Results suggest emotional availability similarity among race/ethnic subgroups with few predictive differences of emotional availability dimensions by specific behaviors for Hispanic and African American subgroups.

Assessing child physical abuse: An examination of the factor structure and validity of the Parent-Child Conflict Tactics Scale (CTSPC)

Child maltreatment (CM) is associated with negative outcomes for young children across several areas of functioning. Given limitations in measuring different types of CM using substantiated abuse reports, other assessments may be helpful to inform identification and intervention efforts, such as self-report measures. The Parent-Child Conflict Tactics Scale (CTSPC) is a parent-report measure that provides information regarding the presence and severity of parenting behaviors related to CM subtypes, including physical and psychological abuse. The current study examines the factor structure of the CTSPC as well as its convergent validity with a behavioral observation measure, the Dyadic Parent-Child Interaction Coding System (DPICS). Pre-treatment archival data for 110 parent-child dyads with a substantiated physical abuse incident who were court-mandated to receive treatment as part of a larger study were used. Results demonstrated that a four-factor model best described the structure of the CTSPC, contrary to the theoretically-proposed structure of the measure. Reports on the CTSPC scales were also associated with several parent behaviors measured by the DPICS. Possible areas of improvement for the scale were provided. The current study has implications for further psychometric development of the CTSPC as well as its future use as a measure of parenting behaviors related to abuse.

Comparing Live and Video Observation to Assess Early Parent-child Interactions in the Home

Observation is the ‘gold standard’ for assessing parent-child behavior, however few studies have compared coding live, in real time, versus coding from videotapes in terms of their achievable levels of coder reliability within the field of parent programme research. This is important for practitioners and researchers for whom decisions might be influenced by time and financial constraints, but where outcomes may have real practical and clinical implications. Trained coders in the Dyadic Parent-Child Interaction Coding System Revised, coded 40 half-hour videotapes of 33 parent-toddler dyads interacting in the home on 29 items of dyadic behaviour. Four theorised composite variables were constructed. Videotaped data were compared to data drawn from the same interactions previously coded ‘live’ in the home. Correlations indicated significant agreement between the two modes at the item by item level (p < .001). Wilcoxon Rank tests revealed significant differences (p < .001) between the two modes. Eight items exceeded a ±30% change in median score suggesting clinically relevant differences. Although both methods achieved acceptable levels of inter-rater reliability, video coding achieved higher levels of agreement. Subtle differences exist between the two modes. Whilst neither mode proved superior it is suggested that they should not be used interchangeably.

In the Eye of the Beholder? Parent-Observer Discrepancies in Parenting and Child Disruptive Behavior Assessments

This study examined parent-observer discrepancies in assessments of negative child behavior and negative parenting behavior to shed more light on correlates with these discrepancies. Specifically, we hypothesized that informant discrepancy between observers and parents on child behavior would be larger when parents reported high levels of negative parenting (and vice versa) because high levels of these behaviors might be indicators of negative perceiver bias or patterns of family dysfunctioning. Using restricted correlated trait–models, we analyzed cross-sectional observation (coded with the Dyadic Parent-Child Interaction Coding System) and survey data (Eyberg Child Behavior Inventory and Parenting Practices Interview) of 386 Dutch parent-child dyads with children aged 4–8 years (Mage = 6.21, SD = 1.33; 55.30% boys). Small associations between parent-reported and observed child and parenting behavior were found, indicating high discrepancy. In line with our hypothesis, this discrepancy was higher when parents self-reported more negative parenting or more negative child behavior. Parent-observer discrepancy on negative child behavior was also predicted by child gender. For boys parents reported higher levels of negative child behavior than were observed, but for girls parents reported lower levels of negative child behavior than were observed. These findings suggest that informant discrepancies between observers and parents might provide important information on underlying, problematic family functioning and may help to identify those families most in need of help.