Parent–child interaction therapy
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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.
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 teaches authoritative parenting, which combines warm, nurturing support and age-appropriate limits. PCIT draws on both attachment and social learning theories.
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.
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.
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. 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.
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.
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.
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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. Currently, a lot of research has been done on how PCIT can be used to keep difficult parenting populations in treatment. Also, several adaptations of the PCIT showed good results : PCIT in groups, PCIT in school for teachers, or at-home PCIT
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, China, Japan, Hong Kong, Norway, The Netherlands, South Korea, Taiwan, New Zealand, and Cyprus.
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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