Program

Parent-Child Interaction Therapy for Disruptive Behavior

Feb 16, 2015

OVERVIEW

Parent-Child Interaction Therapy (PCIT) is a parent-training program that aims to decrease disruptive behaviors in young children. Evidence from experimental evaluations of PCIT indicate that young children with disruptive behavior who participate in PCIT are significantly more compliant, less disruptive, have less severe problem behavior in the home, and less conduct and oppositional behavior than children who do not participate in PCIT. Moreover, results from an experimental evaluation indicate that the abbreviated form of PCIT has lasting impacts on children’s functioning that are comparable to those of the standard form of PCIT.  Finally, PCIT has been documented to be effective in populations of young children with disruptive behavior comorbid with mental retardation.

DESCRIPTION OF PROGRAM

Target population: Parents of young children diagnosed with disruptive behavior disorders.

PCIT is a parent-training program for young children diagnosed with disruptive behavior disorders. The first phase of therapy focuses on establishing a secure and nurturing parent-child relationship, and the second phase focuses on enhancing parents’ behavioral management skills to increase their child’s prosocial behaviors and decrease disruptive behaviors. The program manual may be purchased online.

In the standard form of PCIT, parents and their child have weekly one-hour therapy sessions where parents learn and practice specific skills with their child. The duration of PCIT varies on a case by case basis, as PCIT continues until parents feel they have mastered the skills and their child’s behavior improves. There is also an abbreviated format of PCIT where parents learn skills from watching instructional recordings in their home. In addition to the recordings, parents attend five face-to-face sessions that are alternated with five 30-minute telephone consultations with a therapist trained in PCIT.

EVALUATION(S) OF PROGRAM

Nixon, R.D.V., Sweeny, L., Erickson, D.B., & Touyz, S.W. (2003). Parent-child interaction therapy: A comparison of standard and abbreviated treatments for opposituinal defiant preschoolers. Journal of Counsulting and Clinical Psychology, 71(2), 251-260.

Nixon, R.D.V., Sweeny, L., & Erickson, D.B. (2004). Parent-child interaction therapy: One- and two-year follow up of standard and abbreviated treatments for oppositional preschoolers. Journal of Abnormal Child Psychology, 32(3), 263-271.

Evaluated population: A total of 67 Australian children who met the diagnostic criteria for oppositional defiant disorder were randomly assigned to three groups (standard PCIT, abbreviated PCIT, and a wait-list control group). Five children out of the 22 children (23 percent) assigned to the standard PCIT group, three children of the 23 children (13 percent) assigned to the abbreviated PCIT group, and one child out of the 18 children (5.3 percent) assigned to the wait-list control group discontinued treatment. This resulted in a final sample of 54 children (17 children in the PCIT group, 20 children in the abbreviated PCIT group, and 17 children in the control group). For dropouts, the last ECBI score was used in the intent-to-treat analyses. On average, children in the final sample were 46.8 months old at baseline, and 70.4 percent were male and 29.6 percent were female. Attrition analyses indicated that there were no significant differences in demographics or baseline functioning between children who completed the treatment and children who discontinued treatment.

Children in the standard and abbreviated PCIT groups also participated in a follow-up study that assessed children’s functioning at six months, one year, and two years post treatment. At the one-year follow-up, one child from the standard PCIT group dropped out of the study, and at the two-year follow-up one child from the standard condition, and one child from the abbreviated condition dropped out. All analyses based on the follow-up data were intent-to-treat (ITT) analyses.

Approach: Children were randomly assigned to one of three conditions (standard PCIT, abbreviated PCIT, and a wait-list control group) to assess (1) the impact PCIT has on children’s disruptive behavior, and (2) whether an abbreviated form of PCIT is as effective as the standard form of PCIT. Data were collected prior to treatment (pretest), immediately following treatment (posttest), six months months following treatment (first follow-up), one year following treatment (second follow-up), and two years following treatment (third follow-up). Data regarding children’s oppositional behavior, conduct behavior, externalizing behavior, deviant behavior, severity of problem behaviors in the home, and compliance were collected at pretest, posttest, and the first follow-up. Data regarding children’s oppositional behavior, deviant behavior and compliance were collected at the one-year follow-up, and data regarding children’s conduct behavior, externalizing behavior, and presence of Oppositional Defiant Disorder were collected at the two-year follow-up. Data were collected for participants in the standard form of PCIT and the abbreviated form of PCIT at all time-points. For the control group, data were only collected at pretest and posttest, as this group was a waitlist control group that entered treatment following posttest.

Results: Results from the experimental evaluation indicate that immediately following treatment (posttest) children in the standard PCIT and the abbreviated PCIT groups had significantly less oppositional behavior and conduct behavior than children in the control group. Additionally, compared with the control group, children in the standard PCIT group had significantly less severe behavior problems in the home, and were more compliant. However, there were no significant differences between either of the two treatment groups (standard PCIT and abbreviated PCIT) on any of the outcomes. Analysis of follow-up data (6-months, one-year, two-year) indicate that there were no significant differences on any outcome between children in the standard PCIT and abbreviated PCIT groups.

Bagner, D.M. & Eyberg, S.M. (2007).  Parent-child interaction therapy for disruptive behavior in children with mental retardation: A randomized controlled trial. Journal of Clinical Child & Adolescent Psychology, 36:3, 418-429.

Evaluated population: Thirty mothers and their 3- to 6-year-old child who met diagnostic criteria for both oppositional defiant disorder and mild or moderate mental retardation were evaluated. The average age of the child was 4.5 years. Approximately 77 percent of the sample was male, and 60 percent met diagnostic criteria for mild mental retardation. The majority of the sample (67 percent) was White/Caucasian, followed by Black/African American (17 percent), multiracial (13 percent), and Hispanic/Latino (3 percent). Children were excluded from the study if they had major sensory impairments or autism spectrum disorders, or if the family was suspected of child abuse.

Approach: Families were screened for eligibility after being referred by pediatric health care professionals or teachers, or were self-referred. Eligible families were randomized to either a treatment (15 families) or a waitlist control group (15 families). Treatment sessions were conducted approximately once a week for four months and families who completed the treatment attended an average of 12 sessions. Outcome data were collected at baseline (pretest), and four months after baseline (posttest). There was a notable attrition in the treatment group (47 percent of the sample). All analyses are ITT analyses.

Results: Children assigned to the PCIT group were rated by parents as having lower levels of externalizing behavior (effect size = 1.08), less frequent disruptive behavior (effect size = 1.5), and less total problem behaviors on the Child Behavior Checklist (effect size = 0.97). No significant impacts were found for the severity of problem behavior as measured by the Eyberg Child Behavior Inventory. Mixed results were found on the parenting stress index, with a positive impact found for the difficult child scale, but not the parental distress or dysfunctional parent-child interactions.

SOURCES FOR MORE INFORMATION

References

Bagner, D.M. & Eyberg, S.M. (2007).  Parent-child interaction therapy for disruptive behavior in children with mental retardation: A randomized controlled trial. Journal of Clinical Child & Adolescent Psychology, 36:3, 418-429.

Eyberg, S. & Child Study Lab. (1999). Parent-child interaction therapy: Integrity checklists and session materials. Retrieved from http://pcit.phhp.ufl.edu/measures/indiv percent20pcit percent20manual percent20feb percent202010.pdf

Nixon, R.D.V., Sweeny, L., Erickson, D.B., & Touyz, S.W. (2003). Parent-child interaction therapy: A comparison of standard and abbreviated treatments for opposituinal defiant preschoolers. Journal of Counsulting and Clinical Psychology, 71(2), 251-260.

Nixon, R.D.V., Sweeny, L., & Erickson, D.B. (2004). Parent-child interaction therapy: One- and two-year follow up of standard and abbreviated treatments for oppositional preschoolers. Journal of Abnormal Child Psychology, 32(3), 263-271.

Zisser, A., & Eyberg, S.M. (2010). Treating oppositional behavior in children using parent-child interaction therapy. In A.E. Kazdin & J.R. Weisz (Eds.) Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 179-193). New York: Guilford.

Website: http://www.pcit.org/

KEYWORDS: Children (3-11),Preschool,Males and Females (co-ed), Clinic/Provider-based, Manual is Available, Parent Training/Education, Family Therapy,  Parent-Child Relationship, Other Behavioral Problems

Program information last updated 2/16/2015.

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