Parent Child Interaction Therapy

Question 1

Underlying Theory

Answer 1

• Originally designed to treat children ages 2-8 with disruptive or externalising behavioural problems
• PCIT addresses the negative parent-child interaction patterns that contribute to the disruptive behavioural of young children (Bell and Eyberg, 2002)
• Parents learn to bond with their children and develop more effective parenting styles- Parents learn to model and reinforce constructive ways for dealing with emotions such as frustration.
• In turn children respond to these healthier relationships and interactions
• As a result children typically show reductions in behavioural problems at school (McNeil & Hembree-Kigin, 2010)

Question 2

Techniques and Strategies

Answer 2

• Although PCIT is divided into two stages, relationship development (child-directed interaction) and discipline training (parent-directed interaction), there are also three distinct assessment periods (pre-treatment, mid-treatment, post-treatment).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 will use these skills during a daily play period called special time.PRIDE skillsParents 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.
• 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 behavioural therapy. It can be used with maltreated children.

Question 3

Applications

Answer 3

• Children with emotional and behavioural problems
• Disruptive behaviour most common reason for referral
• Most commonly treated is oppositional defiant disorder and conduct disorder

Question 4

Evidence base

Answer 4

• While PCIT is very effective in addressing certain types of problems, there are clear limitations to its use.
• For the following populations, PCIT may not be appropriate, or specific modifications to treatment may be needed:
  
- Parents who have limited or no ongoing contact with their child


- Parents with serious mental health problems that may include auditory or visual hallucinations or delusions


- Parents who are hearing impaired and would have trouble using the ear bug device, or parents who have significant expressive or receptive language deficits


- Sexually abusive parents, or parents engaging in sadistic physical abuse, or parents with substance abuse issues 


Question 5

PCIT for conduct disorder

Answer 5

Funderburk et al, 1998

Significantly improved observational ratings of compliance and appropriate behavior documented at post-tx in original study (McNeil et al., 1991) were maintained at 12- and 18-month follow up.

Parent ratings of frequency/intensity of behavior problems remained within normal range at 12- and 18-month follow up.

Teacher ratings of behavior problems, hyperactivity and inattention remained within normal range at 12-month follow up, but not at 18-month follow up (still improved over behavior problem control group).

                            Schuchmann et al 1998

All families who received treatment reported higher levels of family satisfaction

Reduction in behavioural problems

Effects maintained 4 months post study

Question 6

PCIT for Anxiety

Answer 6

Choate et al (2005)

• Following treatment with PCIT, clinically significant change in separation anxiety was observed on all measures.
• Disruptive behaviors also decreased following treatment. Treatment gains were maintained at a 3-month follow-up interval.
• These findings suggest that PCIT may be particularly useful for treatment of young children with SAD, the most prevalent yet underresearched anxiety disorder of childhood

Pincus et al (2003)

• Parents learned not to avoid separation situations but rather to utilize CDI and BDI skills during child’s anxiety episodes by praising brave behaviors and reflecting child’s emotions
  • Exposure component necessary when anxiety disorder is
  primary

• First RCT of modified PCIT for Separation Anxiety Disorder