Parent-Child Interaction Therapy (PCIT) with Puerto Rican families Maribel Matos-Román, Ph.D. University of Puerto Rico PCIT Conference January 26-28, 2006 Gainesville, FL

Specific Aims To revise and culturally adapt PCIT for Puerto Rican preschool aged children with a diagnosis of ADHD who also present high rates of behavior problems. To conduct a randomized controlled pilot study to evaluate the initial efficacy, feasibility, and acceptability of the refined PCIT for children with a diagnosis of ADHD and problem behaviors and their families.

Inclusion criteria 4 to 6 years – 11 months of age Parent complaints of significant hyperactivity and behavior problems No evidence of neurological, pervasive developmental disorders or significant handicaps Be a child of a Puerto Rican mother No treatment with stimulant or psychotropic medication No involvement in other forms of child psychotherapy and/or pharmacotherapy

Inclusion criteria IQ > 80 (PPVT) ADHD diagnosis, Combined or Hyperactive- Impulsive Type - NIMH DISC-IV. A score above the 93rd percentile on hyperactivity and ODD or aggression scales (DBRS or BASC) Absence of domestic violence and chaotic family environment No indicators of severe psychopathology on parents

Aim 1 Translation of the PCIT manual and handouts Linguistic adaptations Psychoeducational module about ADHD and behavior problems – Description of hyperactivity and its relationship to behavior problems – Associated difficulties – Risks and protective factors – Possible etiologies – Treatment options

Aim 1 Nine families – 9 children  7 M and 2 F; Mean age: 4.9 years; Mean IQ: 104.4, SD = – 9 mothers  2 single parents, Mean age: 31.89, SD = 6.31 Range: 25 to 43  Education: 15.6 years (nearly a BA, SD = 1.59; Range: 14 to 19)  7 worked full-time, 1 part-time, 1 college student

Aim 1 Nine families – 7 fathers (1 stepfather)  Mean age: 32.86, SD = 5.34 Range: 27 to 43  Education: 16.0 years (BA, SD = 3.79; Range: 12 to 23  Full-time jobs

Aim 1 Procedures – Screening and outcome measures (Pre- treatment assessment) – Psychoeducational sessions (2 sessions) – CDI and PDI  Mean CDI sessions = 7.47 (6 - 9)  Mean PDI sessions= 7.79 (6 - 10) – Post treatment assessment – 3-month follow-up assessment

Screening Measures Disruptive Behavior Scale for Children (DBRS) – 9 hyperactivity symptoms, 8 ODD symptoms Behavioral Assessment System for Children- Parent Rating Scales (BASC-PRS) – Subscales of Hyperactivity and Aggression Peabody Picture Vocabulary Test (PPVT-HAA) NIMH DISC IV - Parent Version – ADHD, ODD, generalized anxiety disorder, separation anxiety disorder, major depression, and disthymia modules

Outcome Measures Eyberg Child Behavior Inventory (ECBI) Child Behavior Checklist (CBCL) BASC, DBRS Home Situations Questionnaire (HSQ) Family Experiences Inventory (FEI) Parent Practices Inventory (PPI) Beck Depression Inventory (BDI) Symptom Checklist – 36 (SCL-36) Treatment and Evaluation Survey (TES) Therapy Attitude Inventory (TAI)

Results PCIT feasible to implement and acceptable High level of satisfaction – Mean TAI score: 48.67, SD=1.32 – Mothers’ reports of being felt understood, confident, comfortable, and supported by their therapists. Positive changes in children’s behavior Reduction in family stress Improvement in parent-child relationships

Results Treatment gains maintained through 3-month follow-up Reliable change index (RCI) – 89% in ECBI-Intensity and the ECBI-Problem – 62% in ADHD-Hyperactivity – 88% in ODD – 56% in the PPI – 78% in the FEI

Modifications 8 sessions for CDI and 9 for PDI Handout about pharmacological treatment for ADHD Modification of time-out procedures – Loss of privileges – Definition of silence – Duration of time-out Scripts for CDI and PDI

Aim 2 – Pilot Study 32 families – Treatment group (TG); n=20 – Wait-list group (WL); n= 12 No difference between groups – gender distribution – age – IQ – parents’ education – children’s impairment in adaptive functioning – screening ratings of hyperactivity and aggressive or ODD behaviors

MeasureTreatment GroupW-list group χ 2 /t Participants Gender (% male) Age (months)58.50 (6.37)60.00 (7.47)-.61 Peabody (IQ) (13.96) (7.81)-1.23 Mother ’ s education15.40 (1.82)14.58 (1.31)1.36 Mother ’ s age33.05 (7.48)32.08 (6.29).38 BASC-Hyperactivity35.95 (6.94)36.00 (6.49)-.02 BASC-Aggression18.10 (5.74)21.25 (5.50)-1.53 DBRS-Hyperactivity21.25 (3.82)22.67 (2.84)-1.11 DBRS-No. Hyp. Symptoms7.60 (1.60)8.08 (1.16)-.91 DBRS-ODD16.05 (3.89)17.92 (3.87)-1.32 DBRS – No. ODD symptoms5.85 (1.53)6.33 (1.23)-.93 C-GAS53.30 (6.44)56.83 (4.97) Sample Demographic and Clinical Characteristics

Results – Pilot Study Treatment Group (n=19) – Lower levels of hyperactivity – Less aggressive and ODD behaviors – Less externalizing behaviors – Significant reduction in general behavioral problems (ECBI) – Significant reduction in the behaviors they assessed as problematic (ECBI- Problems)

Results – Pilot Study – Reduction in the parenting stress (FEI) – Use of adequate parenting practices – Mean CDI sessions: 7 (6 to 9) – Mean PDI sessions: 8 (6 to 10) – High level of consumer satisfaction  Mean TAI scores: (SD: 2.93) Wait-list Group (n= 12) – No significant changes in any measure ANCOVAs with pretreatment scores as covariates.

IntensityProblems

Hyperactivity Aggression

Hyperactivity ODD

ExternalizingAggressive

Total Severity

BDI SCL - 36

Conclusions PCIT seems to be: – A responsive family intervention for Puerto Rican families who have preschool- age children with significant behavior problems. – An acceptable and effective treatment for Puerto Rican parents. – Efficacious to reduce significantly the behavior problems associated with ADHD and ODD..

Research Team Co-investigators – José J. Bauermeister, Ph.D. – Guillermo Bernal, Ph.D. Data Analysis – José V. Martínez, Ph.D. – Eduardo Cumba, Ph.D. Research Assistants Graduate students Rosalie Torres Rocheli Santiago Ixa Rodriguez Liliana Torres Michelle Jurado Elisabet Avilés Kenneth Junco Undergraduate students Marisol De Jesús Damaris Cordero Wilmarie Ríos Arlene Román

Acknowledgments Funded by NIMH 5R24MH Dr. Maribel Matos

¡Gracias!