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Program Profile

Parent–Child Interaction Therapy (PCIT)

Evidence Rating: Effective - More than one study Effective - More than one study

Program Description

Program Goals and Target Population

Parent–Child Interaction Therapy (PCIT) was originally developed to help parents reduce children’s disruptive behaviors (e.g., oppositional and defiant behaviors). PCIT has been adapted for and recently evaluated with families in which there is known physical violence. PCIT targets changing parenting practices and parent–child interactions to help prevent the recurrence of physical abuse in abusive families.

 

Program Theory and Components

Based on attachment and social learning theories, and incorporating operant behavioral principles, parents engage in a two-phase training that helps them replace maladaptive interactions with their children with more effective practices.

 

·         In phase 1, Child Directed Interaction, parents are first taught and then coached how to enhance their relationship with their child. They are also taught to increase daily positive interactions by using specific praise, noncontrolling reflection during play, and selective attention.

·         In phase 2, Parent Directed Interaction, parents learn how to give specific commands and discipline practices, such as using timeout.

 

With these two phases, parents are first taught the specific skills didactically in individual sessions and are then coached by providers in multiple parent–child conjoint sessions using a one-way mirror and “ear bugs.”

 

Adaptations for physically abusive parents include participating in a motivational enhancement group before the start of the typical PCIT sessions, listening to testimonials from other successful parent completers, and completing exercises designed to change self-motivational and self-efficacy cognitions. In addition, children participate in a safety and skill-building group that runs concurrently with the parent group. Role-plays are used to further support abusive parents’ identification of children’s age-appropriate behaviors and use of praise. Additional support is given for nonviolent disciplinary strategies.

Evaluation Outcomes

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Study 1

Child Behavior Problems

In the 2003 Nixon and colleagues study, both the Parent–Child Interaction Therapy (PCIT) and the abbreviated PCIT condition (ABB) treatment conditions significantly improved the behavior of the children, compared with the waiting list (WL) group, as measured by the parent reporting of child behavior. These gains were maintained at the follow-up. The independent observation showed PCIT children (but not ABB) to be significantly more compliant than WL children.

 

Parental Behavior, Attitudes, and Discipline

Both treatment conditions reported significantly more satisfaction and control and less reactive discipline than the WL group. This finding was further confirmed through observation of parent–child interactions. Treatment group mothers (PCIT and ABB) gave significantly fewer commands and more praise than the WL group, and maintained these gains at the follow-up. PCIT (but not ABB) mothers gave significantly fewer criticisms than the WL group.

 

Study 2

Rereport of Physical Abuse

Of the total sample in the 2004 Chaffin and colleagues study, 34 percent of participants had a future physical abuse report over a median follow-up period of 850 days. Just under half (49 percent) of the standard community group condition participants presented a new report of physical violence. More than one third (36 percent) of the enhanced Parent–Child Interaction Therapy (EPCIT) group presented a rereport of physical abuse, a result that was not significantly different from the comparison condition. However, only 19 percent of the PCIT treatment group presented with a rereport of physical abuse. This was significantly lower than both the comparison and the EPCIT groups. The PCIT treatment led to less than half the reoccurrence rate for physical abuse.

 

Parent Negative Behaviors

Both the PCIT and EPCIT participants presented significantly reduced parent negative behavior scores from baseline compared with the community group treatment, which showed no improvement at posttreatment. The PCIT treatment was effective in improving negative aspects of parenting that had been present in the sample before the intervention.

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Evaluation Methodology

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Study 1

The 2003 Nixon and colleagues study is a random trial of Parent–Child Interaction Therapy (PCIT) to measure its effects on problem children of preschool age in Australia. The study recruited families with preschool-age children exhibiting behavioral difficulties through local family mental health teams, preschools, early childhood centers, and newspapers. The families were interviewed and screened to be candidates. The final sample (n= 54 families) was randomized into three conditions: a standard PCIT intervention (n= 17); an abbreviated PCIT condition (ABB) that offered material through videotapes (n= 20), telephone, and face-to-face sessions in a shorter treatment format; and a waiting list (WL) control condition (n= 17). Participants were eligible if they scored in the clinical range of the Eyberg Child Behavior Inventory (ECBI), if the child met the criteria for oppositional defiant disorder (ODD), and the primary referral problem consisted of disruptive behavior that was present for at least 6 months. Participants were excluded if the behavior was a result of organic pathology, trauma, or history of severe mental or physical disability, and if they were receiving medication as behavioral treatment. An additional social validation group (SV) with nonproblem preschoolers (n= 21) was also recruited for comparison. Children in this group were accepted if they did not present behavioral problems in the ECBI and did not present with ODD.

 

The clinical trial group (that is, excluding SV) was made up of 38 boys and 16 girls, with the average age of 46.75 months. Fathers and mothers had 6 years or less of high school education and incomes within the range of $23,000 to $40,599 (US). There were no significant demographic differences among the four groups (PCIT, ABB, WL, SV), except for clinical group mothers having less education than SV mothers.

 

The PCIT group received twelve 1- to 2-hour weekly sessions, for a total of 15½ hours. The ABB group received 9½ hours of treatment consisting of five face-to-face sessions, half-hour telephone consultations, and use of videotapes for the child relationship and discipline skills phases of treatment. Both conditions included a 1-hour booster session (in person) at 1 month posttreatment.

 

The study uses Diagnostic and Statistical Manual of Mental Disorders (DSM–IV) Structured Interview for Disruptive Behavior Disorders to determine the presence of ODD. Parents reported child behavior using the ECBI, the Child Behavior Checklist, and the home situations Questionnaire—Modified. Additional instruments were used to assess parenting attitudes and discipline methods. Independent observations of child–parent behavior were conducted in the clinic using the Dyadic Parent-Interaction Coding Systems 2. Measurements were taken at baseline, at posttreatment, and at 6-month follow-up. Differences between groups were examined using analysis of variance.

 

Study 2

Chaffin and colleagues (2004) conducted a randomized trial experiment on the PCIT intervention to treat physically abusive parents. Participants were parent–child dyads (abusive parent and abused child) referred by the child welfare system. Participants were eligible if 1) both parent and child were available to participate together and parental rights were not terminated nor was abdication of parental role initiated, 2) the abusive parent met an IQ criteria (greater than 70), 3) the child was between ages 4 and 12, 4) the parent was not reported to welfare services as a perpetrator of sexual abuse, and 5) the parent provided voluntary informed consent to participate. The participating dyads (n= 110), consisted of the abusive parent and abused child (although nonabusive parents and nonabused children could be included as collateral participants, but their data was not collected). Sixty-five of the parents in the study were female, and the average age was 32 years. At the pretreatment, one third were married, 26 percent were never married, and 18 percent were divorced. More than half were white, 40 percent were African American, and 4 percent were Hispanic. Forty-eight percent of the sample had a high school level of education, and 22 percent had some college. The median household size was four persons, with a median of three children per household. Sixty-two percent of participant households were below the poverty line for that geographic region (according to the U.S. Census Bureau). On average the abusive parent had two previous reports of child abuse and two reports of child neglect.

 

Participant dyads were randomized into three conditions: a PCIT treatment condition (n= 42), an enhanced PCIT (EPCIT) with individualized services treatment (n= 33), and treatment as usual condition (n= 35). There were no significant differences among the groups. The PCIT group received 6 group sessions of motivational enhancement and orientation, 12 to 14 sessions of PCIT, and 4 follow-up group sessions concentrating on implementation of PCIT skills. The EPCIT condition offered the same PCIT treatment and individualized services emphasizing parent depression and substance use through individualized home visits. The standard community group treatment consisted of orientation, parenting skills, and anger management developed and delivered by a community-based nonprofit agency. All three conditions saw treatment administered over 6 months.

 

The study used several instruments to measure the effects of the intervention. In addition to the follow-up detection of child maltreatment using the statewide child welfare database over a median follow-up time of 850 days (using unique identifiers for the family and the individual abusive parent and matched manually), the following instruments were used in an assessment package at pretest and posttest:

 

  • A demographic questionnaire
  • The Child Abuse Potential Inventory
  • The Child Neglect Index
  • The Abuse Dimensions Inventory
  • The Dyadic Parent–Child Interaction Coding System
  • The Behavior Assessment System for Children
  • The Beck Depression Inventory
  • The Diagnostic Interview Schedule Alcohol and Drug Modules and Antisocial Personality Disorder Module
  • The Kaufman Brief Intelligence Test

Physical abuse rereporting was analyzed using survival analysis. Questionnaires were administered at pretest and posttest and examined using t–tests.
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Cost

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There is no cost information available for this program.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Nixon, Reginald D.V., Lynne Sweeney, Deborah B. Erickson, and Stephen W. Touyz. 2003. “Parent–Child Interaction Therapy: A Comparison of Standard and Abbreviated Treatments for Oppositional Defiant Preschoolers.” Journal of Consulting and Clinical Psychology 71(2):251–60.

Study 2
Chaffin, Mark, Jane F. Silovsky, Beverly Funderburk, Linda Anne Valle, Elizabeth V. Brestan, Tatiana Balachova, Shelli Jackson, Jay Lensgraf, and Barbara L. Bonner. 2004. “Parent–Child Interaction Therapy With Physically Abusive Parents: Efficacy for Reducing Future Abuse Reports.” Journal of Consulting and Clinical Psychology 72(3):500–510.
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Additional References

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These sources were used in the development of the program profile:

Butler, Ashley M., and Sheila M. Eyberg. 2006. “Parent-Child Interaction Therapy and Ethnic Minority Children.” Vulnerable Children and Youth Studies 1(3):246–55.



Chaffin, Mark, Beverly Funderburk, David Bard, Linda Anne Valle, and Robin Gurwitch. 2011. “A Combined Motivation and Parent–Child Interaction Therapy Package Reduces Child Welfare Recidivism in a Randomized Dismantling Field Trial.” Journal of Consulting and Clinical Psychology. 79(1):84–95.

Chaffin, Mark, Linda Anne Valle, Beverly Funderburk, Robin Gurwitch, Jane Silovsky, David Bard, Carol McCoy, and Michelle Kees. 2009. “A Motivational Intervention Can Improve Retnetion in PCIT for Low-Motivation Child Welfare Clients.” Child Maltreatment. Published online.

Herschell, Amy D., Esther J. Calzada, Sheila M. Eyberg, and Cheryl B. McNeil. 2002. “Parent–Child Interaction Therapy: New Directions in Research.” Cognitive and Behavioral Practice. 9, 9–16.
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Program Snapshot

Age: 3 - 12, 23 - 44

Gender: Both

Race/Ethnicity: Black, American Indians/Alaska Native, Asian/Pacific Islander, Hispanic, White, Other

Geography: Suburban

Setting (Delivery): Inpatient/Outpatient, Other Community Setting

Program Type: Conflict Resolution/Interpersonal Skills, Family Therapy, Individual Therapy, Parent Training, Victim Programs, Children Exposed to Violence, Violence Prevention

Targeted Population: Victims of Crime, Children Exposed to Violence, Families

Current Program Status: Active

Listed by Other Directories: Child Exposure to Violence Evidence Based Guide, Model Programs Guide

Researcher:
Reginald D. V. Nixon
Associate Professor
School of Psychology, Flinders University
GPO Box 2100
Adelaide 5001
Phone: 618.8201.2748
Fax: 618.8201.387
Website
Email

Researcher:
Mark Chaffin
Professor of Pediatrics
University of Oklahoma Health Sciences Center
P.O. Box 26901, CHO 3406
Oklahoma City OK 73190
Phone: 405.271.8858
Email

Training and TA Provider:
Child Study Laboratory Department of Clinical and Health Psychology University of Florida
P.O. Box 100165
Gainesville FL 32610
Website