1. 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

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

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

11. Inclusion Criteria 3 - 6 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

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

13. 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

14. 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

15. Treatment Average of 12.8 weekly sessions –CDI time limited (6 sessions) –PDI time unlimited High treatment satisfaction –Therapy Attitude Inventory = 47.60 Therapists –Advanced graduate students and interns –Weekly supervision Treatment Integrity –97% accuracy; 98% interrater reliability

16. ECBI Change During Treatment

17. CBCL Externalizing Scale d = -1.60 p =.005 Clinical cutoff

18. CBCL Total Score d = -1.31 p =.038 Clinical cutoff

19. ECBI Intensity Scale d = -1.46 p =.003 Clinical cutoff

20. ECBI Problem Scale d = -1.35 p =.001 Clinical cutoff

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

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

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

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

25. “Don’t” Skills During CDI d = -1.13 p =.001

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

27. Parent Directed Interaction Before Treatment

28. Parent Directed Interaction After Treatment

29. Clean Up Before Treatment

30. Clean Up After Treatment

31. 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?