Parent-Child Interaction Therapy Courtney Ingalls, MS University of Florida

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 parent- child interaction patterns

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

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

Structure of PCIT Assessment –Measures that guide treatment Parent Report Observation

 Parent Negative Behavior Critical Talk Smart Talk Yell Physical Negative  Child Negative Behavior Critical Talk Smart Talk Yell Physical Negative Whine Non-Compliance Child: (Hits parent) physical negative Parent: You’re mean critical talk Child: AHHHHHHHH yell DPICS Dyadic Parent-Child Interaction Coding System

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 = Medium = Large = Very large = 0.80 – 1.00 Astronomical = > 1.00

Child Problem Behavior and 2-Year Effect Size 2.32 Eyberg et al.

Eyberg Child Behavior Inventory Weekly Intensity Score Dropouts (n = 36) All combined (n = 99) Normative mean Clinical cutoff Criterion to end treatment Completers (n = 63)

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

School Observation Coding System Compliance Funderburk et al., 1998

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

DPICS Parent Verbal and Physical Negative 1.11 Eyberg et al.

Child-Directed Interaction CDI

CDI The Basic Rule Follow the Child’s Lead

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

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

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

Examples  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 No Criticism CDI: The DON’T Rules

What’s left?

CDI: The DO Rules The PRIDE Skills  P raise  R eflect  I mitate  D escribe  E nthusiasm!

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 “The moo-moo is in the barn.” “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 Child Parent Repeating or paraphrasing CDI: The DO Rules

Imitation Doing the same thing the child is doing  Lets the child lead  Teaches parent how to “play”  Shows approval of child’s activity  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 CDI: The DO Rules

 IGNORE annoying, obnoxious behavior  STOP THE PLAY for dangerous or destructive behavior Child-DirectedInteraction DON’T DON’T –Give Commands –Ask Questions –Criticize  DO –Praise –Reflect – Imitate –Describe Enthusiasm Enthusiasm

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

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

COACHING

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

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 Disobey Back to Play YEA!

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

The Chair

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

BACK TO CHAIR CHILD GOES TO TIME OUT ROOM 1 MIN + QUIET CHILD GETS OFF CHAIR CHILD GETS OFF AGAIN The Backup 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.”

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

Praise Obey Back to play!!! Finally! Command

Further Information… PCIT website: –Literature –Measures –Other material

Questions?