ParentChild Interaction Therapy Sheila Eyberg Ph D Stephen

Parent-Child Interaction Therapy Sheila Eyberg, Ph. D. Stephen Boggs, Ph. D. University of Florida

An Empirically Supported Treatment for Disruptive Behavior Disorders g. ODD (“No!) – Refuse or defy adult requests – Lose temper easily – Annoy others on purpose g. CD (Against the Rules) – Steal things – Destroy things – Start fights/Hurt others g. ADHD (Impulsive, Hyperactive, Inattentive) – Have difficulty staying seated – Have difficulty playing quietly – Have difficulty awaiting turn

Disruptive Behavior Disorders in Preschoolers g. Highly persistent g. Worsen with time g. Strongest risk factor for adolescent delinquency and violent crime g. Prevalence up to 20% g. Costs to society very high g. Can be diagnosed reliably at age 3 g. Can be treated effectively if treated early

Defining Features of Parent-Child Interaction Therapy (PCIT) æ Parent and child together n Theoretically grounded n Emphasis on restructuring interaction patterns n Not time-limited n Assessment-driven g. Scientifically based g. Clinically validated g. Empirically supported d l i h g g C n n i i d h & c t a Co n o e C Par

PCIT Parent and Child Together in Treatment g Focus on changing behaviors of both parent and child g Therapist tailors treatment based on observation of parent-child interactions during treatment g Parent errors in application corrected on -the-spot g Parents can be confident therapist understands their child g Therapists can assess when parents ready to move to next step in treatment g Allows accurate determination of treatment completion

Parent-Child Interaction Therapy (PCIT) n Parent and child together æ Theoretically grounded n Emphasis on restructuring interaction patterns n Not time-limited n Assessment-driven g Scientifically based g Clinically validated g Empirically supported d l i h g g C n n i i d h & c t a Co n o e C Par

Based on Developmental Theory g Baumrind’s Parenting Styles – Authoritarian (high demandingness, low warmth) – Permissive (high warmth, low demandingness) – Authoritative (high warmth, high demandingness) g Nurturance and firm limits both necessary for healthy adolescent outcomes g PCIT draws from both attachment and social learning theory to achieve authoritative parenting

Parent-Child Interaction Therapy (PCIT) n Parent and child together n Theoretically grounded æ Not time-limited n Emphasis on restructuring interaction patterns g Assessment-driven g Scientifically based g Clinically validated g Empirically supported

Not Time-Limited g Termination criteria – Parent-child observations • parent mastery of interaction skills • Child compliance > 75% – Parent ratings of disruptive behavior • Child behavior within ½ SD of normative mean – Parent self-confidence in parenting • Parents feel able to handle problems on their own g Termination = Success

Completers and Dropouts 32% Dropout Efficacy Study

Parent-Child Interaction Therapy (PCIT) n Parent and child together n Theoretically grounded îEmphasis on restructuring interaction patterns n Assessment-driven n Not time-limited g Scientifically based g Clinically validated g Empirically supported Co ding g n t i n h e c Par Coa & ld i h C

Structure of PCIT n Assessment sessions n Teaching sessions – Describing – Modeling – Role-playing g Coaching sessions – Parent wears a Bug-in-the-Ear receiver while playing with child in playroom – Therapist observes and codes parent and child behaviors at start of session – Therapist coaches specific skills from observation room using microphone – Spouses take turns being coached with child and observing spouse’s coaching

Child-Directed Interaction Parent. Directed Interaction g. Parents follow n Play therapy skills n Nonverbal communication of n Parents lead affect n Differential attention n Limit-setting n Consistency n Problem solving n Reasoning

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

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

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

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

The Chair Child stays on chair 3 min plus 5 sec quiet Or doesn’t (OH-OH!) Are you ready to [obey original command]? Command Obey 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 Obey Acknowledge

Finally! Command Obey Praise Back to play!!!