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.
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.