Efficacy of In-Home Parent-Child Interaction Therapy

ABSTRACT

In recent years, there has been much discussion of the efficacy of mental health interventions for children as well as the transportation of empirically-supported treatments (ESTs) to field settings. A logical initial step in this line of research is to examine whether the efficacy of ESTs can be demonstrated in community settings such as in the home environment. The purpose of the study was to examine the efficacy of an in-home Parent-Child Interaction Therapy (PCIT) program using a single-subject, A/B design across five subjects with staggered baselines. Decreases in caregiver use of negative behavior and caregiver-reported child behavior problems were observed for the three families that completed treatment. In addition, completers demonstrated increases in child compliance, caregiver use of positive behavior, and contingent praise. Data regarding caregivers' reported parenting stress and caregiver proportion of direct commands were less convincing. All three dyads completing treatment reported satisfaction with the intervention. Clinical implications regarding the possible benefits of PCIT for improving the effectiveness of home visiting programs are discussed as well as directions for future research.     

Open-Trial Pilot of Parent-Child Interaction Therapy for Children With Autism Spectrum Disorder

In this pilot study, the effectiveness and feasibility of Parent-Child Interaction Therapy (PCIT) for decreasing disruptive behavior was evaluated in 17 young children with Autism Spectrum Disorder (ASD). PCIT is a behaviorally based play therapy which targets the parent-child relationship through live coaching of play interactions and the implementation of consistent discipline techniques. Following an average of 19 sessions, disruptive behavior as measured by multiple indices significantly decreased. Congruently, parents increased positive parental following skills and decreased negative parental leading skills across the course of treatment. In addition, parents reported increased levels of child functional communication and prosocial behavior. High levels of parent acceptability of the intervention were also noted. Effect sizes were medium to large across measured dependent variables, including parent report and behavioral observations. Implications for the clinical use of PCIT within an ASD population and future research with controlled outcome studies are discussed.     

In-Home Parent-Child Interaction Therapy: Clinical Considerations

ABSTRACT

Parent-Child Interaction Therapy (PCIT) is an empirically-supported behavioral parent training program designed to be administered in a clinic or laboratory-based setting. Recently, an empirical investigation revealed that in-home PCIT produced comparable results as the PCIT trials conducted in more controlled environments (this issue). Administering PCIT in a home setting carries both drawbacks and advantages. This article provides an overview of both the positive and negative clinical aspects of conducting in-home PCIT and presents effective solutions to potential treatment barriers.     

Delivering Parent-Child Interaction Therapy in an Urban Community Clinic

Extensive evidence supports the efficacy of Parent-Child Interaction Therapy (PCIT) for reducing behavior problems in young children; however, little is known about the use of PCIT in a community mental health center (CMHC). This paper provides four clinical case examples of families who were referred to and successfully completed PCIT in an urban CMHC. The families were ethnically and socioeconomically diverse and presented with a wide range of treatment concerns and needs (e.g., autism, severe maternal psychopathology, involvement in child protective services, and complex family configurations) in addition to disruptive behavior. Our data and clinical observations suggest that PCIT decreased behavior problems, improved parent-child interactions, and, in some cases, reduced parental stress, with differing levels of change across families. Overall, the cases demonstrate that PCIT can be transported into a CMHC, and they illustrate supplemental services or minor accommodations to the established treatment protocol used to address individual family needs. Issues regarding the balance between fidelity and flexibility in transporting PCIT to a community setting are discussed, and future research topics are recommended.     

Parent-Child Interaction Therapy for Toddlers: A Pilot Study

Parent-Child Interaction Therapy (PCIT) is an evidence-based program used to treat behavioral disorders in early childhood (2–7 years; Eyberg, 1988 Eyberg , S. ( 1988 ). Parent-Child Interaction Therapy: Integration of traditional and behavioral concerns . Child Family Behavior Therapy , 10 ( 1 ), 33 – 46 .[Taylor & Francis Online] , [Google Scholar]). This article describes a modified version of PCIT for young toddlers (PCIT-T) adapted to meet the developmental needs of children aged 12–24 months. A pilot study was conducted to evaluate the effectiveness of PCIT-T with 29 parent-toddler dyads (children aged <2 years) presenting with significant behavior problems, assessed pretreatment and posttreatment. Outcomes for two groups of older children who participated in PCIT (Group 1: 2–3 years, n = 29; Group 2: 3–4 years, n = 29) were also assessed. Results showed PCIT-T to be associated with a range of positive child and parental outcomes including decreased intensity of disruptive child behaviors, increased parental utilization of PCIT parenting skills, decreased parental depressive symptoms, and high levels of consumer satisfaction with the program. This study provides early evidence that a modified version of PCIT can be successfully used to treat behavior disorders in children aged less than 2 years.     

Understanding Manual-Based Behavior Therapy: Some Theoretical Foundations of Parent-Child Interaction Therapy

ABSTRACT

Manualized therapy has been criticized as being incompatible with behavior therapy. However, the majority of empirically supported, manual-based therapies utilize basic behavioral principles, such as positive reinforcement, to achieve positive change in the target behavior. Parent-Child Interaction Therapy (PCIT), for example, is a manualized treatment that makes extensive use of the empirically-derived behavioral principles of this paradigm. Understanding how and why these fundamental principles operate is essential when attempting to tailor the program ideographically to meet clients' specific needs. The purpose of this article is to provide a model of understanding and evaluating manualized treatments by beginning with a review of the theory and data-driven principles upon which PCIT is based. As a point of illustration, several of the behavioral principles embedded in PCIT, such as reinforcement, punishment, and stimulus control, are highlighted, and clinically relevant examples are presented.     

Parent-Child Interaction Therapy and ADHD: A Case Study With a Hearing Child of a Deaf Father and a Hearing Mother

Parent-Child Interaction Therapy (PCIT) has demonstrated promising evidence in its implementation with deaf and hard-of-hearing (DHH) families. This case study presents the implementation of PCIT with a hearing mother, a deaf father, and their 7-year-old hearing son with Attention-Deficit/Hyperactivity Disorder (ADHD) and oppositional behaviors, using the assistance of certified interpreters. Results documented improvement in child behavior, parenting skills and stress, and parent-child communication. Notably, paternal ratings showed greater improvement across these outcomes than maternal ratings. Overall, PCIT continues to demonstrate its effectiveness as a treatment option for DHH families with children with challenging behaviors. The limitations and implications are discussed.     

Efficacy of Parent-Child Interaction Therapy with Parents with Intellectual Disability

Parents with intellectual disability (ID) face many parenting challenges that may affect their ability to parent effectively, and such deficits are often associated with various poor child outcomes. Research findings are inconsistent for interventions targeting systematic skills for parents with ID. Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment that incorporates performance-based training to enhance parenting ability. This study evaluated implementation of PCIT with parents with ID using a multiple baseline design across behaviors. Results suggest increases in positive parenting behaviors and consistent discipline. However, limitations related to poor maintenance and generalization warrant the need for future research.     

Family Therapy With Irish-Americans

This paper presents a paradigm for understanding the cultural values and family patterns of Irish-American families and offers suggestions for clinical intervention. Families' correspondence to the model described will depend upon their level of acculturation, socioeconomic status, and other contextual factors. The paradigm suggests a number of issues that may create difficulties for the therapist and for the family in therapy. In general, behavioral techniques, Bowen systems therapy, and strategic interventions may be more useful than techniques emphasizing expression of emotions in therapy or direct attempts to alter communication or family behavior in therapy sessions, as used in structural therapy.     

Importance of Therapist Use of Social Reinforcement with Parents as a Model for Parent-Child Relationships: An Example with Parent-Child Interaction Therapy

ABSTRACT

This paper focuses attention on the therapeutic relationship in parent-child therapy by using social reinforcement with parents and children as it relates to Parent-Child Interaction Therapy (PCIT). As in other therapy contexts, it is argued that having the therapist serve as a mediator of social reinforcement facilitates client change, After discussing different aspects of PCIT, we discuss the therapeutic relationship as viewed through other theoretical frameworks. This is followed by a discussion of the role of social reinforcement in the parent-child relationship. We then discuss at methodological and applied levels, the importance of therapist accuracy and consistency in the delivery of reinforcement as a means of changing the parent-child relationship. Next, this is followed by a discussion of the therapist-to-parent-to-child sequential chain of behaviors involved in PCIT. Finally, suggestions for future empirical studies are considered.     

The Implementation of Modified Parent-Child Interaction Therapy for Youth with Separation Anxiety Disorder

Separation Anxiety Disorder (SAD) is the most prevalent anxiety disorder experienced by children, and yet empirical treatment studies of SAD in young children are virtually nonexistent. This paper will describe the development and implementation of an innovative treatment for SAD in young children. First, we will highlight the rationale for developing interventions specifically for SAD in young children. Second, we will describe an existing empirically supported treatment, Parent-Child Interaction Therapy (PCIT; Brinkmeyer, M. Y., & Eyberg, S.M., (2003)), that may have particular applicability to very young children with SAD and their parents. We present how results from 10 pilot participants were utilized to modify PCIT to better address the needs of children with SAD and their families. The benefits and challenges of implementing this modified version of PCIT are reviewed, along with potential directions for future research in this area.     

Parent-Child Interaction Therapy for ADHD: A Conceptual Overview and Critical Literature Review

ABSTRACT

Attention-Deficit/Hyperactivity Disorder (ADHD), a chronic disorder beginning in childhood, is identifiable and diagnostically valid during the preschool years. Compared to school-aged children, preschoolers have not received as much attention in the literature. Parent-Child Interaction Therapy (PCIT) is an empirically-supported parent training program for young children with disruptive behaviors that may also be effective in treating ADHD. The purpose of the current article was to explore the theoretical rationale for utilizing PCIT with this population and to conduct a literature review of published PCIT treatment outcome studies that measured ADHD symptoms. The literature demonstrates that children with ADHD have been included in PCIT research and evidence suggests that PCIT may be effective for young children with ADHD. However, future research is needed to specifically examine the effects of PCIT on ADHD.     

Therapist Experiences and Attitudes About Implementing Internet-Delivered Parent-Child Interaction Therapy During COVID-19

It has been widely recognized that access to mental health treatment is imperative to address current and long-term stressors for children and parents during COVID-19. Internet-delivered Parent-Child Interaction Therapy (iPCIT, previously referred to as I-PCIT) is a strong model for remote service delivery during social distancing restrictions due to its empirical base. However, this treatment modality was not widely implemented before COVID-19, likely due to barriers to providing telehealth services. This mixed methods study conducted a follow-up survey to gather therapist experiences (N = 223) in delivering iPCIT during COVID-19, including qualitative data on the benefits and challenges to delivering iPCIT. The vast majority of therapists (82%) indicated that they transitioned to deliver PCIT via telehealth in response to COVID-19. PCIT caseloads decreased slightly from the first survey to the COVID-19 follow-up survey, but the racial and ethnic composition of caseloads were not significantly different between the two surveys. Of the 183 therapists who transitioned to deliver PCIT via telehealth, 82% expressed interest in continuing to provide iPCIT following the COVID-19 pandemic. Reported benefits of iPCIT included decreased barriers to access and the ability to practice skills within the naturalistic home environment. Challenges to iPCIT were primarily issues with technology as well as other logistical barriers, which could limit engagement for some families. Findings from this study may be beneficial in improving future implementation of iPCIT during and post-COVID-19.     

在家庭自由游戏和智力任务游戏中亲子交往行为特征

本研究采用家庭录像观察,考察了53名4岁儿童及其父母在自然的家庭环境中的两个情境———自由游戏和完成拼图任务的智力游戏情境中儿童与其父母交往的行为特征和互动类型。结果发现:(1)在儿童4岁时,在家庭自由游戏情境中母亲的各种行为均显著多于父亲的各种行为,这表明在游戏过程中,母亲是儿童主要的交往对象。在拼图游戏情境中,除了父亲和母亲在商量和交流行为上没有显著差异之外,母亲的其他行为显著多于父亲的其他行为。儿童在这两个游戏情境中均表现出较多的顺从行为。(2)在自由游戏情境中,亲子互动类型包括四种:父母交流-儿童不交流型、母亲高控-儿童顺从型、父亲控制-儿童不顺从型和母亲不交流-儿童交流型。拼图游戏情境中,亲子互动类型有四种:父母放任-儿童独立型、父母控制-儿童顺从型、母子交流型和父亲控制-儿童顺从型。     

PACHIQ-R: the Parent-Child Interaction Questionnaire--revised

The PACHIQ (Parent-Child Interaction Questionnaire) is designed to help clinicians and researchers assess how parents view relationship with their children (PACHIQ-Parent version), and how children evaluate their relationship with their parents (PACHIQ-Child version). The items in this questionnaire refer to both interpersonal behavior and feelings. Conceptually, the PACHIQ is based on learning theory and structural systems theory. The development of the PACHIQ was described by Lange, Blonk and Wiers (1998). The present article reports additional psychometric data obtained in the development and validation of a revised, shorter version of the questionnaire (PACHIQ-R). We present norm tables for families with children who are referred for psychological treatment, and norm tables for families in the normal Dutch population. The PACHIQ-R displays a two-factor structure with factors interpreted as Conflict Resolution and Acceptance. The parent version of the PACHIQ-R contains 21 items, the child version 25 items.     

Aspects of Consumer Satisfaction With Brief Family Therapy

In an evaluative study of brief family therapy, 279 families were administered a Family Satisfaction Questionnaire in their own homes, six months after treatment terminated. This questionnaire was designed to assess several aspects of the families' satisfaction with services received. The identified patient in all families was a child with academic and/or behavioral problems at school. A variety of outcome measures were also obtained both at treatment termination and at the six-month follow-up. Families were generally satisfied with the overall services received but expressed widely varying degrees of satisfaction with various aspects of treatment. Very little dissatisfaction was expressed regarding the availability of services (less than 7 per cent), but a sizeable proportion of families (45 per cent) did not feel that the services provided were comprehensive and adequate. Despite concerns regarding comprehensiveness and adequacy of the service, the majority of families were functioning well at the time of follow-up as assessed by a number of independent measures. Global satisfaction should not be regarded as the only index of treatment effectiveness, as many families who were dissatisfied experienced successful treatment outcomes.     

Cognitive-Behavioral Therapy With An East Indian Family*

This article discusses the use of the cognitive-behavioral approach to family therapy with an immigrant Indian family residing in the United States. Issues of acculturation and the emancipation of a young adolescent female are addressed as conflicts arise between her and her parents. The use of cognitive-behavior therapy (CBT) is presented as a flexible mode of treatment because it allows for the modification of schemas in a way that is respectful to cultural underpinnings and allows the family the freedom to change in a manner that does not compromise their cultural values. Further discussion is directed toward the cultural variables that may be accommodated by the CBT approach and the elements that make the approach adaptable, particularly in cases involving Indian culture.The authors thank Eric Frey of Lehigh University for his assistance with the literature review.     

Treatment Outcome for Low Socioeconomic Status African American Families in Parent-Child Interaction Therapy: A Pilot Study

The course and efficacy of parent-child interaction therapy (PCIT) were examined in 18 socioeconomically disadvantaged African American families of preschoolers with disruptive behavior disorders. Mothers reported significant improvements in child disruptive behavior but not in maternal depressive symptoms or parenting stress. Attrition was 56%, most often occurring after pre-treatment assessment but before treatment began. Results suggest that PCIT may lead to positive behavior changes for disadvantaged young African American children when families complete treatment. Recruitment, engagement, and retention remain significant problems requiring further study. Reduction of parenting stress also requires study in this population.     

Parent-Child Interaction Therapy for Puerto Rican Preschool Children with ADHD and Behavior Problems: A Pilot Efficacy Study

This study evaluates the initial efficacy of the Parent-Child Interaction Therapy (PCIT) for Puerto Rican preschool children aged 4–6 years with a diagnosis of attention-deficit/hyperactivity disorder (ADHD), combined or predominantly hyperactive type, and significant behavior problems. Thirty-two families were randomly assigned to PCIT ( n =20) or a 3.5-month waiting-list condition (WL; n =12). Participants from both groups completed pretreatment and posttreatment assessments. Outcome measures included child's ADHD symptoms and behavior problems, parent or family functioning, and parents' satisfaction with treatment. ANCOVAs with pretreatment measures entered as covariates were significant for all posttreatment outcomes, except mother's depression, and in the expected direction ( p <.01). Mothers reported a highly significant reduction in pretreatment hyperactivity and inattention and less aggressive and oppositional-defiant behaviors, conduct problems assessed as problematic, parenting stress associated with their child's behavior, and an increase in the use of adequate parenting practices. For the WL group, there were no clinically significant changes in any measure. Treatment gains obtained after treatment were maintained at a 3.5-month follow-up assessment. PCIT seems to be an efficacious intervention for Puerto Rican families who have young children with significant behavior problems.