ParentChild Interaction Therapy Rhea M Chase M S

Parent-Child Interaction Therapy Rhea M. Chase, M. S. Daniel Bagner, M. S. University of Florida

Disruptive Behavior Disorders • Most common reason for referral of young children to mental health services • Prevalence of Oppositional Defiant Disorder and Conduct Disorder estimated to be between 2% and 16% of all children • Poor prognosis

Parent-Child Interaction Therapy (PCIT) • Designed for young children (3 -6) and their parents/caretakers • Work with parents and child together • Live coaching of skills • Emphasis on restructuring parentchild interaction patterns

Child-Directed Interaction Parent-Directed Interaction § Parents follow n Play therapy skills n Differential attention n Increase warmth of parent-child relationship § Parents lead n Limit-setting n Consistency n Predictability n Follow through

Structure of PCIT • Assessment – Measures that guide treatment • Teaching sessions – Presentation of skills – Modeling and role-playing • Coaching sessions – Check in – Therapist codes and coaches – Assign homework

How does coaching work? • Parent wears a Bug-in-the-Ear receiver while playing with child in playroom (therapist can coach while in the room with the parent) • Therapist coaches specific skills • Spouses take turns playing and observing

What families might benefit from PCIT? • Children with conduct problem behavior • Preschool age (3 -6) • At least one parent able to attend weekly sessions with child • Parent(s) willing to practice skills at home

Effectiveness of PCIT

Effect Size Interpretations • • • Small = 0. 20 Medium = 0. 40 Large = 0. 60 Very large = 0. 80 – Astronomical = > 0. 40 0. 60 0. 80 1. 00

Child Problem Behavior and 2 -Year Effect Size 2. 32 Eyberg et al.

Child Compliance and 2 Year Effect Size. 85 Eyberg et al.

Child Deviant Behavior Composite and 2 Year Effect Size . 54 Eyberg et al.

DPICS Parent Verbal and Physical Negative 1. 11 Eyberg et al.

CDI Child-Directed Interaction

The CDI Teaching Session • Parents alone • Presentation of skills § Reasons § “Rules” § Examples t? h g u a y t e h t are y l t c a x e What • Modeling/demonstration • Role-play with parent

CDI The Basic Rule Follow the Child’s Lead

CDI: The DON’T Rules • No commands • No questions • No criticism

CDI: The DON’T Rules No Commands Direct : Sit here Indirect : Could you sit here? • Commands attempt to lead • Risk negative interaction

CDI: The DON’T Rules No Questions ask for an answer • Often hidden commands • Take lead from the child • Can suggest disapproval • Can suggest not listening

CDI: The DON’T Rules • Examples No Criticism § You’re a bad girl § That doesn’t go that way § No Stop Quit Don’t § Points out mistakes rather than correcting them § “That’s wrong” is a criticism § “It goes like this” allows correction without criticism • Lowers self-esteem • Creates unpleasant interaction

What’s left?

CDI: The DO Rules The PRIDE Skills g. Praise g. Reflect g. Imitate g. Describe g. Enthusiasm!

CDI: The DO Rules Praise Unlabeled praise is nonspecific – Good! – That's great! Labeled praise tells child specifically what is good – Thank you for sitting so quietly. • Increases the specific behavior • Increases child's self-esteem • Increases positive parent-child interaction

CDI: The DO Rules Reflection • Repeating or paraphrasing Child “The moo-moo is in the barn. ” Parent “Yes, the cow is in the barn. ” • Allows child to lead the conversation • Shows that parent is listening • Shows that parent understands • Improves and increases child’s speech

CDI: The DO Rules Imitation Doing the same thing the child is doing g. Lets the child lead g. Teaches parent how to “play” g. Shows approval of child’s activity g. Teaches child how to play with others – Sharing – Taking turns

CDI: The DO Rules Description • Telling the child exactly what he or she is • • • doing – “You’re drawing a sun. ” Lets the child lead Lets child know you are paying attention and are interested Shows approval of child’s activity Models speech Teaches vocabulary and concepts Holds child’s attention to the task

CDI: The DO Rules Enthusiasm • Conveying excitement by voice and gesture – “Wow!! You finished that SO quickly!” • Lets the child know the parent enjoys being with the child • Makes the play more fun for the child (and parent) • Adds a quality of warmth to the interaction

DO Child-Directed Interaction – Praise – Reflect – Imitate – Describe Enthusiasm DON’T – Give Commands – Ask Questions – Criticize æIGNORE annoying, obnoxious behavior æSTOP THE PLAY for dangerous or destructive behavior

Homework “Special time” g 5 minutes a day g Practice, play, and therapy g

Homework Good activities: Not-so-good activities: Toys with no rules Board games Construction toys Messy activities (like fingerpaint) Play sets Creative Toys Aggressive toys (like guns or action figures) Pretend-talk toys

COACHING

CDI Coaching • PRIDE (basic) – Great reflection! – Good labeled praise! • Following – Good following his lead. – Describe what she’s doing. – Be sure to watch what she’s doing closely.

CDI Coaching • Noticing positive behaviors – Wow -- she picked up the one she dropped • Attending to positive behavior – Wow -- you caught her being good! • Ignoring negative behavior – That was great ignoring his back talk

CDI Coaching • Catching child doing positive opposites – NICE praising his polite talk • Touch, proximity – That’s nice the way you touch him when you praise him • Genuineness – That sounded like you meant it • Parent self-efficacy – You got him to play quietly! – Nice job of getting him back to the table.

CDI Coaching • The treatment goals – Good teaching! – He seems a lot calmer today – She seems to be sharing more -- that will help her make friends at school. – You seem be having fun playing with your son. – You’ve got these skills down pat!

CDI Coaching • Developmental expectations – Describe the colors so he can learn them. – He’s still too young to understand logic • Child’s motivations -- or lack of motivations – He seems to throw the puzzle pieces when doesn’t understand where they go. – I think he just doesn’t know how to ask for your help.

Why Coach? – Parents think they already do these things – Verbal habits are ingrained – Coaching (therapist feedback) makes parents aware of what they say – Coaching (child’s feedback) makes parents aware of the immediate effects – Coaching heightens parent’s attention and motivation

Why Coach? – Coaching provides parent support in actual difficult situations – Coaching demonstrates to parents (convinces parents) that change is possible – Coaching can help parents not to give up – Coaching is efficient -- makes it possible to address relevant problem areas and not spend time on areas that are not problems

CDI ROLE PLAY

Parent-Directed Interaction

PDI: Effective Commands • Direct (telling, not asking) • Positive (what to DO, not stop doing) • Single (one at a time) • Specific (not vague) • Age-appropriate • Given in a normal tone of voice • Polite and respectful (Please. . . ) • Explained before given or after obeyed • Used only when really necessary

The Command. . . Command No Opportunity Whoops! (Start over) Obey Labeled Praise Back to Play YEA! Disobey

The Warning. . . If you don’t [original command], you’ll have to go to the time out chair Obey Disobey (UH-OH!) Labeled Praise Back to Play YEA!

The Chair

The Chair Or doesn’t (OH-OH!) Child stays on chair 3 min plus 5 sec quiet Are you ready to [obey original command]? Command Obey No Acknowledge

The Backup CHILD GETS OFF CHAIR ROOM WARNING “You got off the chair before I said you could. If you get off again, you’ll go to the Time Out Room. ” CHILD GETS OFF AGAIN CHILD GOES TO TIME OUT ROOM 1 MIN + QUIET BACK TO CHAIR

The First Obey Child Stays on Chair 3 Min plus 5 Sec Quiet Are you ready to [Obey Original Command]? Yes Acknowledge Obey No

Command Finally! Obey Praise Back to play!!!

House Rules § PDI uses running commands § House rules are standing commands – Aggressive behavior – Destructive behavior § The Procedure – Label behavior for child – Explain rule to child – No chair warnings

Public Misbehavior § Procedure – Make plan before leaving home – Describe desired behavior – Take along “time out chair” – Discuss back-ups

PRACTICING PDI

Further Information… • PCIT website: www. pcit. org – Literature – Measures – Other material

Thank you! Questions?