Parent–child interaction therapy
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Parent–Child Interaction Therapy (PCIT) is a form of behavioral-parent training developed by Dr. Sheila Eyberg for children ages 2–7 and their caregivers. It is related to the work of Rudolf Dreikurs who applied theories of individual psychology to parent-child interactions. PCIT is an evidence-based treatment (EBT) for young children with emotional and behavioral disorders that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns. 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). 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. Based on Diana Baumrind's developmental theory of parenting, PCIT draws on both attachment and social learning theories to achieve authoritative parenting. The authoritative parenting style has been associated with fewer child behavior problems than alternative parenting styles.
PCIT outcome research has demonstrated statistically and clinically significant improvements in the conduct-disordered behavior of preschool age children. After treatment, children’s behavior is within the normal range. In addition to significant changes on parent ratings and observational measures of children’s behavior problems, outcome studies have demonstrated important changes in the interactional style of the fathers and mothers in play situations with the child.
Stages of PCIT
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).
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.
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.
It can be used with maltreated children.
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.
PCIT has been used with abusive families and oppositional children. PCIT has been shown effective with physically abusive parents, aiding in the reduction of future abuse reports. PCIT is a model that has demonstrated success with children with oppositional defiant disorder that has recently been applied to children with autism. Currently, a lot of research has been done on how PCIT can be used to keep difficult parenting populations in treatment. Research shows that skills learned in PCIT training sessions generalize to the home. PCIT is widely used in the United States, and has also reached Australia, Germany, Japan, Hong Kong, Norway, The Netherlands, South Korea, Taiwan, and New Zealand.
Parent–child interaction therapy has been found to be a cost-effective approach. 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%).
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