Parent–child interaction therapy

Parent–child interaction therapy (PCIT) is a form of behavioral-parent training developed by Sheila Eyberg for children ages 2–7 and their caregivers. PCIT is an evidence-based treatment (EBT) for young children with behavioral and emotional disorders that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns.[1]

Disruptive behavior is the most common reason for referral of young children for mental health services and can vary from relatively minor infractions such as talking back to significant acts of aggression. The most commonly treated Disruptive Behavior Disorders may be classified as Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD), depending on the severity of the behavior and the nature of the presenting problems. The disorders often co-occur with Attention-Deficit Hyperactivity Disorder (ADHD).[2] It uses a unique combination of behavioral therapy, play therapy, and parent training to teach more effective discipline techniques and improve the parent–child relationship.[3]

Based on Diana Baumrind's developmental theory of parenting, PCIT teaches authoritative parenting, which combines warm, nurturing support and age-appropriate limits.[4] PCIT draws on both attachment and social learning theories.[1]

Stages of PCIT

PCIT is divided into two stages, relationship development (child-directed interaction) and discipline training (parent-directed interaction). Child-Directed Interaction (CDI) focuses on strengthening the parent-child attachment as a foundation for the second phase, Parent-Directed Interaction (PDI), which emphasizes structure and a consistent approach to discipline. Each phase begins with a single didactic session in which parents attend without their child, followed by a series of weekly coaching sessions for each phase.

Child-Directed Interaction

The Child-Directed Interaction (CDI) portion of PCIT aims to develop a loving and nurturing bond between the parent and child through a form of play therapy. Parents are taught a list of "dos" and "don'ts" to use while interacting with their child. They use these skills during a daily play period called special time with their child. The goal of this phase is to build and increase the child’s self-esteem while increasing the positive social behaviors.[5]

PRIDE skills

Parents are taught an acronym of skills to use during special time with their children.

PRIDE stands for the following:

P – Praise
R – Reflect
I – Imitate
D – Describe
E – Enjoyment

This acronym is a reminder that parents should describe the actions of their child, reflect upon what their child says, imitate the play of their child, praise their child's positive actions, and try to enjoy the special time.[6] During the practice, parents are encouraged to avoid questions, commands, and criticism. They also told to combine PRIDE Skills with ignoring attention-seeking behaviors that are not destructive or aggressive. Because PCIT can be used from ages 2 through 7, coaching takes into account the developmental differences at each age and teaches parents to be mindful of those differences. Parents are encouraged to praise and reflect all attempts of their child to verbally communicate, as speech skills are concurrently developing.[7]

Parent-Directed Interaction

The Parent-Directed Interaction portion of PCIT aims to teach the parent more effective means of disciplining their child through a form of play therapy and behavioral therapy. Parents are taught to issue effective commands. Effective commands are direct, positively stated, specific, used only when necessary and age-appropriate. They are given one at a time and in a normal tone of voice, with explanation before the command is given or after the child obey, while providing consistent consequences for the noncompliance and compliance of the child to these commands. [D]

Parents praise the child when compliance occurs, and follow a time-out procedure when the child is noncompliant. During the PDI sessions, parents issue a command during play time and follow through with the appropriate consequence.[7]

Measures

Therapists assess the families’ progress through PCIT in several ways. First, the observation and coding of parent-child interactions, using the Dyadic Parent-Child Interaction Coding System (DPICS), at the start of each session are used both to select the skills to target during the session and to determine when parents have met the criteria for moving from one phase of treatment to the next and for completing treatment. Before each session, parents also fill out the Intensity Scale of the Eyberg Child Behavior Inventory (ECBI), which measures the child’s current frequency of disruptive behavior at home. The therapist graphs the score each week to monitor the child’s progress and at various points in treatment shares this graph with the parents. Finally, in addition to these criteria, treatment does not end until parents express confidence in their ability to manage their child’s behavior and feel ready for treatment to end.[2]

Applications

PCIT has been used with abusive families[8] and oppositional children.[9] It can also be used with maltreated children.[10]

PCIT is a model that has demonstrated success with children with oppositional defiant disorder, that has recently been applied to children with autism with good results.[11][12][13] Currently, a lot of research has been done on how PCIT can be used to keep difficult parenting populations in treatment.[14][15] Also, several adaptations of the PCIT showed good results : PCIT in groups,[16][17] PCIT in school for teachers,[18] or at-home PCIT[19][20]

Research shows that skills learned in PCIT training sessions generalize to the home.[21] PCIT is widely used in the United States, and has also reached Australia,[22] Germany, China,[23] Japan, Hong Kong, Norway,[24] The Netherlands,[15] South Korea, Taiwan, New Zealand, and Cyprus.[25]

Cost-effectiveness

Parent–child interaction therapy has been found to be a cost-effective approach.[26] The way that cost-effectiveness was measured was by comparing ratio of treatment costs to behavior gains, as measured by clinically significant improvement on the CBCL (reduction ranging from 17–61%).[26]

See also

References

  1. 1 2 "What is PCIT?". PCIT International. Retrieved 18 January 2017.
  2. 1 2 Zisser, A.R. & Eyberg, S.M. (2010). Parent-child interaction therapy and the treatment of disruptive behavior disorders. In A.E. Kazdin & J.R. Weisz (Eds.) Evidence-based psychotherapies for children and adolescents, second edition. New York, NY: Guilford Press.
  3. ↑ Parent–Child Interaction Therapy, Hembree-Kigin, T. & McNeil, C., 1995, Springer, NY
  4. ↑ Eyeberg, S.M. (2004). "The PCIT story part I: Conceptual foundation". PCIT Pages, The Parent-Child Interaction Therapy Newsletter.
  5. ↑ Herschell, Amy D.; Calzada, Esther J.; Eyberg, Sheila M.; McNeil, Cheryl B. (2002-01-01). "Clinical issues in parent-child interaction therapy". Cognitive and Behavioral Practice. 9 (1): 16–27. doi:10.1016/S1077-7229(02)80035-9.
  6. ↑ Chase, R. & Eyberg, S.M. (2005).
  7. 1 2 Herschell, Amy D.; Calzada, Esther J.; Eyberg, Sheila M.; McNeil, Cheryl B. (2002-01-01). "Parent-child interaction therapy: New directions in research". Cognitive and Behavioral Practice. 9 (1): 9–16. doi:10.1016/S1077-7229(02)80034-7.
  8. ↑ Ware, Fortson; McNeil, C. (2003). "Parent–Child Interaction Therapy: A Promising Intervention for Abusive Families". The Behavior Analyst Today. 3 (4): 375–85. doi:10.1037/h0099993.
  9. ↑ McNeil, C.B.; Filcheck, H.A.; Greco, L.A.; Ware, L.M.; Bernard, R.S. (2001). "Parent–Child Interaction Therapy: Can a Manualized Treatment Be Functional?". The Behavior Analyst Today. 2 (2): 106–54. doi:10.1037/h0099925.
  10. ↑ Chaffin, M.; et al. (2004). "Parent–child interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports". Journal of Consulting and Clinical Psychology. 72 (3): 500–10. PMID 15279533. doi:10.1037/0022-006X.72.3.500.
  11. ↑ Masse, J.J.; Wagner, S.M.; McNeil, C.B.; Chorney, D.B. (2007). "Parent-Child Interaction Therapy and High Functioning Autism: A Conceptual Overview". Journal of Early and Intensive Behavior Intervention. 4 (4): 714–735. doi:10.1037/h0100402.
  12. ↑ Tempel, Ashley B.; Wagner, Stephanie M.; McNeil, Cheryl B. (2008). "Parent–Child Interaction Therapy and Language Facilitation: The Role of Parent-Training on Language Development". Spl Aba. 2 (3): 216–32.
  13. ↑ Masse, Joshua J.; McNeil, Cheryl B.; Wagner, Stephanie; Quetsch, Lauren B. (2016-04-30). "Examining the Efficacy of Parent–Child Interaction Therapy with Children on the Autism Spectrum". Journal of Child and Family Studies. 25 (8): 2508–2525. ISSN 1062-1024. doi:10.1007/s10826-016-0424-7.
  14. ↑ Fernandez, M.A.; Eyberg, S.M (2005). "Keeping Families In Once They've Come Through the Door: Attrition in Parent–Child Interaction Therapy". JEIBI. 2 (3): 207–14. doi:10.1037/h0100314.
  15. 1 2 Abrahamse, Mariëlle E.; Niec, Larissa N.; Junger, Marianne; Boer, Frits; Lindauer, Ramón J. L. (2016-05-01). "Risk factors for attrition from an evidence-based parenting program: Findings from the Netherlands". Children and Youth Services Review. 64: 42–50. doi:10.1016/j.childyouth.2016.02.025.
  16. ↑ Niec, Larissa N.; Barnett, Miya L.; Prewett, Matthew S.; Chatham, Jenelle R. Shanley. "Group parent–child interaction therapy: A randomized control trial for the treatment of conduct problems in young children.". Journal of Consulting and Clinical Psychology. 84 (8): 682–698. doi:10.1037/a0040218.
  17. ↑ Niec, Larissa N.; Hemme, Jannel M.; Yopp, Justin M.; Brestan, Elizabeth V. (2005-01-01). "Parent-child interaction therapy: The rewards and challenges of a group format". Cognitive and Behavioral Practice. 12 (1): 113–125. doi:10.1016/S1077-7229(05)80046-X.
  18. ↑ Tiano, Jennifer D.; McNeil, Cheryl B. (2006-01-01). "Training Head Start teachers in behavior management using Parent-Child Interaction Therapy: A preliminary investigation.". Journal of Early and Intensive Behavior Intervention. 3 (2): 220–233. ISSN 1554-4893. doi:10.1037/h0100334.
  19. ↑ MPH, Rachel Galanter; PhD, Shannon Self-Brown; MPH, Jessica R. Valente; PhD, Shannon Dorsey; PhD, Daniel J. Whitaker; MSW, Michelle Bertuglia-Haley; MSW, Metta Prieto (2012-07-01). "Effectiveness of Parent–Child Interaction Therapy Delivered to At-Risk Families in the Home Setting". Child & Family Behavior Therapy. 34 (3): 177–196. ISSN 0731-7107. doi:10.1080/07317107.2012.707079.
  20. ↑ Ware, Lisa M.; McNeil, Cheryl B.; Masse, Joshua; Stevens, Sarah (2008-06-11). "Efficacy of In-Home Parent-Child Interaction Therapy". Child & Family Behavior Therapy. 30 (2): 99–126. ISSN 0731-7107. doi:10.1080/07317100802060302.
  21. ↑ Naik-Polan, A.T.; Budd, K. (2008). "Stimulus generalization of parenting skills during parent child interaction therapy". Journal of Early and Intensive Behavior Intervention. 5 (3): 71–91. doi:10.1037/h0100424.
  22. ↑ Phillips, Jane; Morgan, Susan; Cawthorne, Karen; Barnett, Bryanne (2008-08-01). "Pilot Evaluation of Parent–Child Interaction Therapy Delivered in an Australian Community Early Childhood Clinic Setting". Australian and New Zealand Journal of Psychiatry. 42 (8): 712–719. ISSN 0004-8674. PMID 18622779. doi:10.1080/00048670802206320.
  23. ↑ Leung, Cynthia; Tsang, Sandra; Heung, Kitty; Yiu, Ivan (2009-05-01). "Effectiveness of Parent—Child Interaction Therapy (PCIT) Among Chinese Families". Research on Social Work Practice. 19 (3): 304–313. ISSN 1049-7315. doi:10.1177/1049731508321713.
  24. ↑ Bjørseth, Åse; Wichstrøm, Lars (2016-09-13). "Effectiveness of Parent-Child Interaction Therapy (PCIT) in the Treatment of Young Children’s Behavior Problems. A Randomized Controlled Study". PLOS ONE. 11 (9): e0159845. ISSN 1932-6203. PMC 5021353 Freely accessible. PMID 27622458. doi:10.1371/journal.pone.0159845.
  25. ↑ "PCIT Around the World". PCIT International. Retrieved 18 January 2017.
  26. 1 2 Goldfine, Matthew E.; Wagner, Stephanie M.; Branstetter, Steven A.; McNeil, Cheryl B. (2008). "Parent–Child Interaction Therapy: An Examination of Cost-Effectiveness". Journal of Early and Intensive Behavioral Intervention. 5 (1): 119–32. doi:10.1037/h0100414.
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