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.     

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.     

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.     

Predictors of Client Attrition in a University-Based Community Counseling Clinic

The purpose of this study was to investigate how symptom distress, social role, interpersonal relationships, gender, age, number of supports, and education level predict client attrition in a community sample. Using binary logistic regression and cross-sectional data, the authors examined the predictive impact of 8 variables on adult client attrition in a university-based community counseling clinic. Results indicated that education level, interpersonal relationships, and number of supports significantly predicted attrition. In this sample, gender, age, symptom distress, social role, and race did not significantly predict attrition. Implications for clinical assessment and counseling practice are discussed.     

The Contribution of the Dyadic Parent-Child Interaction Coding System (DPICS) Warm-Up Segments in Assessing Parent-Child Interactions

This study evaluated the inclusion of uncoded segments in the Dyadic Parent-Child Interaction Coding System, an analogue observation of parent-child interactions. The relationships between warm-up and coded segments were assessed, as well as the segments’ associations with parent ratings of parent and child behaviors. Sixty-nine non-referred parent-child dyads engaged in the observation. Parents completed measures about their parenting and children's behaviors. Significant differences were observed between the first situation's warm-up and coded segments, whereas minimal differences were found for the second situation. Findings suggest that the second warm-up segment may not be necessary for optimal assessment of parent-child interactions.     

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 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.     

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.     

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.     

Improved Perceptions of Emotion Regulation and Reflective Functioning in Parents: Two Additional Positive Outcomes of Parent-Child Interaction Therapy

The purpose of this study was to test whether Parent-Child Interaction Therapy (PCIT), a widely used effective therapy for children’s externalizing behaviors and parenting problems, was associated with improvements in parents’ emotion regulation and reflective functioning. We also investigated whether these improvements had unique associations with children’s improvements in externalizing and internalizing symptoms. Participants were 139 Australian children aged 29 to 83 months and their caregivers; all were referred for child externalizing behavior problems coupled with parenting skill deficits or high parent stress. All data were gathered via a questionnaire completed prior to and after completion of PCIT. Significant improvements were found in parents’ self-reported emotion dysregulation and capacity to use cognitive reappraisal for emotion regulation. There was also improvement in parents’ self-report of children’s symptoms, parenting practices, and reflective functioning in the form of prementalizing, which measured a low capacity to understand the emotional world of the child. Multiple regression showed that improvements in cognitive reappraisal, prementalizing, and negative parenting practices were associated with improvement in children’s symptoms. The findings extend the existing evidence for PCIT as an effective parenting intervention, adding parents’ perceived emotion regulation and reflective functioning to the list of positive outcomes from PCIT. Improved emotion regulation and reflective functioning, unique from changes in parenting practices, could be mechanisms that help explain why PCIT has been associated with improvements in children’s externalizing behaviors.     

亲子互动中游戏参与方式、情感交流和儿童心理理论的关系

本研究通过亲子互动游戏观察来考查亲子游戏参与方式、情感交流与儿童心理理论发展的关系。实验结果如下:第一,控制了年龄因素后,儿童的亲子游戏参与方式中的主动参与和建议游戏两种方式与儿童心理理论发展之间存在显著的相关;而对于母亲来说,指导游戏的参与方式和儿童心理理论发展存在显著相关。第二,控制了年龄因素之后,儿童情感交流方面的分享积极情感和心理理论发展之间存在显著相关。而母亲这方面的指标和儿童心理理论发展没有显著相关。文章对上述结果进行了分析讨论。     

亲子沟通观察研究的编码方案及其整合

在亲子沟通观察研究中对观察资料的编码和分析方法有许多种,文章介绍了行为类型编码、行为序列编码、言语内容编码、沟通结构编码等四类主流编码方案,并评析了每种方案的特点和应用背景;最后,指出未来亲子沟通研究编码方案的整合可以考虑如下三个思路:在行为分类基础上进行言语内容分析、从行为序列中发现沟通模式、一般趋势描述和典型个案分析相结合。     

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.     

社会负性环境对流动和留守儿童问题行为的影响：亲子和同伴关系的调节作用

使用问卷法对4279名流动、留守和农村普通儿童的亲子、师生和同伴关系、社会负性环境和问题行为的调查发现：（1）小学流动儿童的轻度问题行为得分显著高于留守儿童和普通儿童,小学流动和留守儿童的重度问题行为显著高于普通儿童;中学流动儿童的轻度问题行为得分依次显著高于普通儿童和留守儿童;（2）普通和留守儿童的亲子、师生关系和社会环境显著好于流动儿童;（3）亲子关系在社会负性环境对流动和普通儿童的问题行为的预测中起调节作用;同伴关系在社会负性环境对留守和普通儿童问题行为的预测中起调节作用。     

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。     

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

Abstract

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.     

Exposure to Community Violence: Defining the Problem and Understanding the Consequences

Exposure to community violence has emerged as a major risk factor for the development of emotional and behavioral problems in children and adolescents. In the past decade, there has been a proliferation of research within the fields of medicine, sociology, and psychology documenting the rates and consequences of exposure to community violence. This interdisciplinary growth has led to a great deal of variability within the field of exposure to community violence, making it difficult to glean general conclusions regarding rates and impact of exposure. This review advances the current understanding of exposure to community violence by integrating findings across disciplines as well as reviewing the few studies that have provided initial explanatory information regarding mediators and moderators of the relationship between exposure to community violence and its associated outcomes.     

Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center

Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.     

婚姻关系、亲子关系对3～6岁幼儿心理行为问题的影响

采用CBCL量表、自编的婚姻关系和亲子关系问卷调查了6所城市幼儿园的457名3～6岁幼儿,结果发现：(1)本研究中3～6岁幼儿心理行为问题的检出率为15．10％;(2)3-6岁幼儿的心理行为问题主要表现为交往不良、攻击性等外部行为问题;(3)没有心理行为问题的幼儿家庭其婚姻关系在性格相容、问题解决和性生活方面显著优于有心理行为问题的幼儿家庭,但在经济条件方面则相反;(4)婚姻关系和亲子关系则呈显著的正相关,并共同影响幼儿的心理行为问题。