Parent-Child Interaction Therapy for Children with Co-Morbid Disruptive Behavior and Mental Retardation Daniel M. Bagner, MS Sheila M. Eyberg, PhD, ABPP University of Florida The 6th Annual Parent-Child Interaction Therapy Conference January 28, 2006

Acknowledgements Child study lab, University of Florida –Advanced graduate student therapists –Undergraduate research assistants Funding sources –NIMH National Research Service Award (F31 MH068947) –APA Society of Clinical Child and Adolescent Psychology (Division 53) –Center for Pediatric Psychology and Family Studies, University of Florida –Children’s Miracle Network, Shands Hospital, University of Florida

Disruptive Behavior High prevalence in young children Most common referral reason to mental health services High degree of impairment and poor prognosis APA, 2000; Loeber et al., 2000

Disruptive Behavior in Children with Mental Retardation (MR) Limited research Higher prevalence –40% with mild and 47% with moderate MR (Jacobson, 1982) –Over half of children with MR referred for conduct problems (Benson, 1985) Treatment a high national priority

Common Early Interventions for Children with MR Educational and community activities Rehabilitation activities –Speech, physical, and occupational therapy Mental health professionals Kobe & Mulick, 1995

Behavioral Treatments for Children with MR Positive reinforcement and time out most common techniques Differential reinforcement to reduce behavior problems Focus on aggressive behaviors Benson & Aman, 1999; Handen, 1998

Parenting Programs Parenting interventions superior treatment for children with MR Primarily address parent skill acquisition and support issues Limited research on parent training interventions specifically addressing disruptive behaviors Handen, 1998; Walters & Blane, 2000

Parent Child Interaction Therapy (PCIT) Empirically supported treatment for disruptive behavior in preschoolers Successfully used clinically with children with MR Effectiveness for children with MR not yet empirically tested

Study Design IT Time 1 (Pretreatment) Assessment IT Time 2 (Post-treatment) Assessment WL Time 1 Assessment WL Time 2 (Pretreatment) Assessment WL Time 3 (Post- treatment) Assessment 4 months

Recruitment Referral sources –Pediatric health care professionals Physicians, nurses, psychologists Speech, physical, occupational therapists –Teachers of pre-K ESE classrooms –Parent support groups –Flyers

Inclusion Criteria years old Oppositional defiant disorder –DISC-IV-P and CBCL Mild or moderate MR –WPPSI-III Adaptive behavior deficits –Adaptive Behavior Scale Mother’s intellectual functioning –Wonderlic Personnel Test

Exclusion Criteria Sensory impairments (deafness, blindness) Autism spectrum disorders –Childhood Autism Rating Scale History of psychosis Families suspected of child abuse

Participants Immediate Treatment (15 families) 4 currently in treatment 6 completed treatment 5 dropped out Waitlist Control (15 families) 3 currently waiting 10 completed waitlist 2 dropped out 3 completed treatment 5 dropped out 2 currently in treatment

Demographics Child –75% male –68% Caucasian –Mean age of child = 4 –Mean FSIQ = 59 (SD = 11.14) Family –80% two-parent families –Mean age of mother = 36; father = 39 –Mean yearly income = 34K

Treatment Average of 12.8 weekly sessions –CDI time limited (6 sessions) –PDI time unlimited High treatment satisfaction –Therapy Attitude Inventory = Therapists –Advanced graduate students and interns –Weekly supervision Treatment Integrity –97% accuracy; 98% interrater reliability

ECBI Change During Treatment

CBCL Externalizing Scale d = p =.005 Clinical cutoff

CBCL Total Score d = p =.038 Clinical cutoff

ECBI Intensity Scale d = p =.003 Clinical cutoff

ECBI Problem Scale d = p =.001 Clinical cutoff

PSI-SF Parental Distress d =.32 p = ns Clinical cutoff

PSI-SF Parent-Child Dysfunctional Interaction d = -.62 p = ns Clinical cutoff

PSI-SF Difficult Child d = -.95 p =.087 Clinical cutoff

“Do” Skills During CDI d = 1.25 p =.034

“Don’t” Skills During CDI d = p =.001

Percent Compliance (Alpha) During PDI and Clean Up d = 1.11 p =.028

Parent Directed Interaction Before Treatment

Parent Directed Interaction After Treatment

Clean Up Before Treatment

Clean Up After Treatment

Conclusions and Future Directions PCIT effective for children with MR –Parent skill acquisition –Improved child behavior –Decrease in parenting stress Qualitative improvements in child speech PCIT for children with autism and autistic spectrum disorders?