Attention-Deficit / Hyperactivity Disorder (ADHD) Articles
Autism Spectrum Disorder Articles
Conduct Disorder Articles
Oppositional Defiant Disorder Articles
Separation Anxiety Disorder Articles
Mood Disorder Articles
Generalized Anxiety Disorder Articles
Intellectual Disability & Developmental Delay Articles
Parent-Child Interaction Therapy with emotion coaching for preschoolers with attention-deficit/hyperactivity disorder
Chronis-Tuscano, A., Lewis-Morrarty, E., Woods, K. E., O'Brien, K. A., Mazursky-Horowitz, H., & Thomas, S. R. (2016). Parent-Child Interaction Therapy with emotion coaching for preschoolers with attention-deficit/hyperactivity disorder. Cognitive and Behavioral Practices, 23, 67-68.
Abstract: Preschoolers with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for the development of comorbid conduct disorder (CD) and depression. Early predictors of serious adverse outcomes within this population include parenting characterized by high levels of negativity and low levels of positivity, maternal depression, and child emotion regulation (ER) difficulties. Parent–child interaction therapy (PCIT) is an evidence-based treatment for oppositional defiant disorder and CD that has also been shown to improve comorbid child internalizing symptoms and maternal depression by enhancing parenting and improving the parent child relationship. PCIT-emotion development (PCIT-ED) is an adaptation for depressed preschoolers, grounded in developmental literature, which teaches parents to become “emotion coaches” for their children, in an effort to build child ER skills. In this paper, we describe the iterative process by which we implemented and adapted PCIT-ED based on our experiences treating nine children with ADHD. We present three case examples that exemplify our process in adapting the PCIT-ED manual. This work suggests that PCIT with parent emotion coaching (PCIT-ECo) may be a promising treatment approach for young children with ADHD. Future research will need to examine this adaptation relative to standard PCIT to determine whether our integration of parent emotion coaching results in added improvement in child ER, internalizing and externalizing problems, and functional impairment.
Keywords: PCIT; Clinical Disorders; ADHD; Preschool ADHD; PCIT-ED; Emotion Coaching; Treatment Development.
Parent-Child Interaction Therapy for ADHD: A conceptual overview and critical literature review
Wagner, S. M., & McNeil, C. B. (2008). Parent-Child Interaction Therapy for ADHD: A conceptual overview and critical literature review. Child and Family Behavior Therapy, 30, 231-256.
Abstract: Attention-Deficit/Hyperactivity Disorder (ADHD) a chronic disorder beginning in childhood, is identifiable and diagnostically valid during the preschool years. Compared to school-aged children, preschoolers have not received as much attention in the literature. Parent-Child Interaction Therapy (PCIT) is an empirically-supported parent training program for young children with disruptive behaviors that may also be effective in treating ADHD. The purpose of the current article was to explore the theoretical rationale for utilizing PCIT with this population and to conduct a literature review of published PCIT treatment outcome studies that measured ADHD symptoms. The literature demonstrates that children with ADHD have been included in PCIT research and evidence suggests that PCIT may be effective for young children with ADHD. However, future research is needed to specifically examine the effects of PCIT on ADHD.
Keywords: PCIT; Review Articles; Clinical Disorders – ADHD; Attention-deficit/hyperactivity disorder; preschoolers.
Parent and teacher SNAP-IV ratings of attention deficit/hyperactivity disorder symptoms: Psychometric properties and normative ratings from a school district sample.
Bussing, R., Fernandez, M., Harwood, M., Hou, W., Garvan, C., Swanson, J., & Eyberg, S. M. (2008). Parent and teacher SNAP-IV ratings of attention deficit/hyperactivity disorder symptoms: Psychometric properties and normative ratings from a school district sample. Assessment, 15, 317-328.
Abstract: To examine Swanson, Nolan, and Pelham–IV (SNAP-IV) psychometric properties, parent (N = 1,613) and teacher (N = 1,205) data were collected from a random elementary school student sample in a longitudinal attention deficit hyperactivity disorder (ADHD) detection study. SNAP-IV reliability was acceptable. Factor structure indicated two ADHD factors and an oppositional defiant disorder (ODD) factor. Parent and teacher scores varied by gender and poverty status (d = .49-.56) but not age; only teacher scores varied by race (d = .25-.55). Screening and diagnostic utility was evaluated with likelihood ratios (LRs) and posttest probabilities. Parent SNAP-IV scores above 1.2 increased probability of concern (LR > 10) and above 1.8, of ADHD diagnosis (LR > 3). Teacher hyperactivity/impulsivity scores above 1.2 and inattention scores above 1.8 increased probabilities of concern only (LR = 4.2 and >5, respectively). Higher teacher scores for African American children and race differences in measurement models require future study.
Keywords: : PCIT; Clinical Disorders; ADHD; Assessment; Children; Likelihood; Ratios; Norms; SNAP-IV; Reliability; Validity
Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder
Chronis, A. M., Jones, H. A., & Raggi, V. L. (2006). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Clinical Psychology Review, 26, 486-502.
Abstract: Despite the vast literature supporting the efficacy of stimulant medication in the treatment of attention-deficit/hyperactivity disorder (ADHD), several limitations of pharmacological treatments highlight the clear need for effective psychosocial treatments to be identified. A large evidence base exists for behavioral interventions, including parent training and school interventions, which has resulted in their classification as "empirically validated treatments." Additionally, social skills training with generalization components, intensive summer treatment programs, and educational interventions appear promising in the treatment of ADHD. Given the chronic impairment children with ADHD experience across multiple domains of functioning, multimodal treatments are typically necessary to normalize the behavior of these children. The state of the ADHD treatment literature is reviewed, important gaps are identified (e.g., treatment for adolescents), and directions for future research are outlined within a developmental psychopathology framework.
Keywords: PCIT; Clinical Disorders; Adolescent; Attention Deficit Disorder with Hyperactivity; Child; Evidence-Based Medicine; Humans; Psychotherapy.
Parent training through play: Parent-Child Interaction Therapy with a hyperactive child
Johnson, B. D., Franklin, L.C., Hall, K., & Prieto, L. R. (2000). Parent training through play: Parent-Child Interaction Therapy with a hyperactive child. Family Journal-Counseling & Therapy for Couples & Families, 8, 180-186.
Keywords: Keywords: PCIT; Clinical Disorders; ADHD.
Behavior modification in the treatment of ADHD
Eyberg, S. M., Schuhmann, E. M., & Foote, R. C. (1998). Behavior modification in the treatment of ADHD. In B. L. Maria (Ed.). Advanced Therapy in Child Neurology (pp. 90-93). Houston, TX: Decker.
Keywords: : PCIT; Book Chapters; Clinical Disorders; ADHD.
Child-directed interaction training for young children with autism spectrum disorders: Parent and child outcomes
Ginn, N. C., Clionsky, L. N., Eyberg, S. M., Warner-Metzger, C., & Abner, J. P. (2017). Child-directed interaction training for young children with autism spectrum disorders: Parent and child outcomes. Journal of Clinical Child and Adolescent Psychology, 46, 101-109.
Abstract: This study examined the efficacy of the Child-Directed Interaction Training (CDIT) phase of Parent-Child Interaction Therapy for children with an Autism Spectrum Disorder (ASD). Thirty mother-child dyads with children ages 3-7 years with a diagnosis of ASD participated in this randomized controlled study. Following manualized CDIT, statistically significant and meaningful improvements in child disruptive behavior and social awareness as well as maternal distress associated with child disruptive behavior occurred. Across 8 sessions, mothers learned to provide positive attention to their children's appropriate social and play behaviors. Both child and parent changes were maintained at 6-week follow-up. A relatively brief, time-limited, and accessible intervention may be efficacious for improving child and parent behaviors in families of young children with ASD. By decreasing child disruptive behaviors, CDIT may also help to prepare children to benefit further from future interventions.
Keywords: PCIT; Clinical Disorders; Autism Spectrum Disorder.
Open-trial pilot of Parent-Child Interaction Therapy for children with autism spectrum disorder
Zlomke, K. R., Jeter, K., & Murphy, J. (2017). Open-trial pilot of Parent-Child Interaction Therapy for children with autism spectrum disorder. Child & Family Behavior Therapy, 39, 1-18.
Abstract: In this pilot study, the effectiveness and feasibility of Parent-Child Interaction Therapy (PCIT) for decreasing disruptive behavior was evaluated in 17 young children with Autism Spectrum Disorder (ASD). PCIT is a behaviorally based play therapy which targets the parent-child relationship through live coaching of play interactions and the implementation of consistent discipline techniques. Following an average of 19 sessions, disruptive behavior as measured by multiple indices significantly decreased. Congruently, parents increased positive parental following skills and decreased negative parental leading skills across the course of treatment. In addition, parents reported increased levels of child functional communication and prosocial behavior. High levels of parent acceptability of the intervention were also noted. Effect sizes were medium to large across measured dependent variables, including parent report and behavioral observations. Implications for the clinical use of PCIT within an ASD population and future research with controlled outcome studies are discussed.
Keywords: PCIT; Clinical Disorders; Autism Spectrum Disorder; ASD; Disruptive Behavior; Manualized Intervention; Parenting Intervention; Play Therapy.
Examining the efficacy of Parent-Child Interaction Therapy with children on the autism spectrum
Masse, J. J., McNeil, C. B., Wagner, S., & Quetsch, L. B. (2016). Examining the efficacy of Parent-Child Interaction Therapy with children on the autism spectrum. Journal of Child and Family Studies, 25, 2508-2525.
Abstract: Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent–child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent–child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents.
Using a modified Parent-Child Interaction Therapy to increase vocalizations in children with autism
Hansen, B., & Shillingburg, M. A. (2016). Using a modified Parent-Child Interaction Therapy to increase vocalizations in children with autism. Child & Family Behavior Therapy, 38, 318-330.
Abstract: Parent-Child Interaction Therapy (PCIT) is a manualized behavioral intervention originally developed by Eyberg (1988) to address disruptive behaviors in young children. Although previous research findings support the contention that components of PCIT would positively impact communication, behavior, and adaptive skills (Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Lovaas, 1987; Remington et al., 2007) in children with developmental disabilities, few studies are shown in the literature. In a modified version of PCIT, caregivers completed two phases of intervention with their child diagnosed with Autism Spectrum Disorder (ASD). During the Child-Directed Interaction (CDI) phase, caregivers were taught to conduct mand training, follow-their child’s lead, provide attention for their child’s positive behaviors, and ignore their child’s negative behaviors. During the Parent-Directed Interaction (PDI) phase, caregivers were taught to give effective commands and follow through with demands. The goal of the current study was to determine whether children’s production of vocalizations increased after participation in a modified PCIT program. Data from two participants diagnosed with autism were included in the study. Outcomes of these two case studies show that both children displayed an increase in the total number of vocalizations emitted in the posttreatment observation relative to baseline. Additionally, caregivers of both participants displayed an increased number of positive behaviors in the posttreatment observation relative to baseline.
Keywords: PCIT; Clinical Disorders; Autism Spectrum Disorder; Language; General Outcomes Studies.
Combining Parent–Child Interaction Therapy and visual supports for the treatment of challenging behavior in a child with autism and intellectual disabilities and comorbid epilepsy
Armstrong, K., DeLoatche, K. J, Preece, K. K., & Agazzi, H. (2015). Combining Parent–Child Interaction Therapy and visual supports for the treatment of challenging behavior in a child with autism and intellectual disabilities and comorbid epilepsy. Clinical Case Studies, 14, 3-14.
Abstract: About one in six children has one or more developmental disabilities, which include autism spectrum disorder (ASD) and intellectual disabilities (ID). Individuals with both ASD and ID are at higher risk of epilepsy, and those with younger onset of seizures are at higher risk of both developmental and behavioral disorders. Young children presenting with developmental and behavioral challenges are often very difficult for caregivers to manage, and challenging behavior results in reduced learning opportunities. Finding effective and efficient interventions to address behavioral issues remains a clinical priority to improve overall outcomes for all children and especially those with developmental disabilities. This case study presents the treatment of a 5-year-old girl diagnosed with ASD, ID, and comorbid epilepsy using Parent–Child Interaction Therapy (PCIT) combined with visual supports (VS). Findings from this case report documented (a) an improvement in behavioral functioning in home, school, and community settings; (b) evidence for the effectiveness of parent-mediated intervention; and (c) support for collaboration and care coordination to improve intervention outcomes.
Keywords: PCIT; Clinical Disorders; Autism Spectrum Disorder; intellectual disabilities; epilepsy.
Parent–Child Interaction Therapy and autism spectrum disorder: Adaptations with a child with severe developmental delays
Lesack, R., Bearss, K., Celano, M., & Sharp, W. G. (2014). Parent–Child Interaction Therapy and autism spectrum disorder: Adaptations with a child with severe developmental delays. Clinical Practice in Pediatric Psychology, 2, 68-82.
Abstract: Children with autism spectrum disorder (ASD) frequently present with co-occurring problem behaviors (e.g., noncompliance, aggression), which increase the risk for exclusion from educational programming, social relationships, and community activities. Although behavioral intervention represents a frequently cited and promising approach for addressing challenging behaviors in ASD, there is a pressing need to expand the availability and dissemination of short-term, evidenced-based interventions to meet growing demand in the ASD community. Originally developed for typically developing children, Parent–Child Interaction Therapy (PCIT) represents a well-supported, behaviorally based parent training program shown to hold potential benefit for children with ASD. Questions, however, remain regarding the application of PCIT among children with ASD and pronounced developmental delays. This case study describes the use of PCIT with a child with ASD who presents with limited receptive and expressive communication skills, as well as a history of aggression, tantrums, and noncompliance. Adaptations to the intervention included changes to both phases of the intervention (CDI and PDI). Results indicate that the intervention was associated with acquisition of parenting skills and reduced problem behaviors, suggesting PCIT with modifications may also hold benefit for children with ASD and severe developmental delays.
Keywords: PCIT; Clinical Disorders; Autism spectrum disorders; behavior problems; case study; parent training; Model Adaptation Studies.
The effectiveness of Parent-Child Interaction Therapy for families of children on the autism spectrum
Solomon, M., Ono, M., Timmer, S., & Goodlin-Jones, B. (2008). The effectiveness of Parent-Child Interaction Therapy for families of children on the autism spectrum. Journal of Autism and Developmental Disorders, 38, 1767-1776.
Abstract: We report the results of a pilot trial of an evidence-based treatment-Parent-Child Interaction Therapy (PCIT; Eyberg et al. Psychopharmacology Bulletin, 31(1), 83-91, 1995) for boys aged 5-12 with high functioning autism spectrum disorders and clinically significant behavioral problems. The study also included an investigation of the role of shared positive affect during the course of therapy on child and parent outcomes. The intervention group showed reductions in parent perceptions of child problem behaviors and child atypicality, as well as an increase in child adaptability. Shared positive affect in parent child dyads and parent positive affect increased between the initial and final phases of the therapy. Parent positive affect after the first phase was related to perceptions of improvement in problem behaviors and adaptive functioning.
Keywords: PCIT; Clinical disorders; Affect; Attention Deficit Disorder with Hyperactivity; Attention Deficit and Disruptive Behavior Disorders; Autistic Disorder; Child; Preschool; Depression; Family; Family Therapy; Humans; Male; Parent-Child Relations; Parents; Surveys; and Questionnaires.
Parent-Child Interaction Therapy and high functioning autism: A conceptual overview
Masse, J. J., McNeil, C. B., Wagner, S. M., & Chorney, D. B. (2008). Parent-Child Interaction Therapy and high functioning autism: A conceptual overview. Journal of Early and Intensive Behavior Intervention, 4, 714-735.
Abstract: Externalizing behaviors are a common component of the clinical presentation of Autism Spectrum Disorders and are typically the initial focus of treatment for children within this population. This article examines the appropriateness of Parent-Child Interaction Therapy (PCIT) as a first-line, gateway treatment for preschoolers with High Functioning Autism who demonstrate co-occurring difficulties with aggressive and noncompliant behavior. Although PCIT has shown initial success in treating children with High Functioning Autism, much of the knowledge is based on clinical case studies thus warranting further empirical research before conclusions can be drawn.
Keywords: PCIT; Clinical Disorders; Autism Spectrum Disorder; High Functioning Autism; Externalizing Behaviors.
Parent training outcomes among young children with callous-unemotional conduct problems with or at risk for developmental delay
Kimonis, E. R., Bagner, D. M., Linares, D., Blake, C. A., & Rodríguez, G. M. (2014). Parent training outcomes among young children with callous-unemotional conduct problems with or at risk for developmental delay. Journal of Child & Family Studies, 23, 437-448.
Abstract: School-aged children with conduct problems and high levels of callous-unemotional (i.e., lack of empathy, guilt, and lack of caring behaviors) traits (CP+CU) tend to yield less benefit from traditional interventions than do their low-CU counterparts, particularly with respect to CP outcomes. To date, little is known about treatment response among young children with CP+CU, particularly those with or at risk for developmental delay. Components of Parent-Child Interaction Therapy (PCIT), a parent training program effective at reducing CP in young children, have compelling theoretical support for addressing core deficits unique to children with CP+CU and have been used successfully with young children with developmental delay. Our first aim was to test the psychometric properties of a measure of CU traits in preschool children with and without developmental delay. Our second aim was to test whether CU traits predicted post-treatment CP after controlling for initial levels of CP. Participants were 63 families of young children (mean age = 3.87 years), with or at-risk for developmental delay, who presented with elevated CP and were treated in a hospital-based outpatient clinic. Results indicated that developmentally delayed children with high levels of CU traits, but not children at-risk for delay due to premature birth, showed significantly poorer CP outcomes following treatment with PCIT than did children scoring low on CU traits, even after controlling for initial CP severity. The implications of these findings with regard to treating and preventing severe disruptive behaviors among young children with CP +CU are discussed.
Keywords: PCIT; Clinical Disorder; Conduct Disorder; Callous-Unemotional Traits; Conduct Problems; Assessment; Parent Training; Psychopathy; Developmental Delay.
Parent-Child Interaction Therapy: A dyadic intervention for the treatment of young children with conduct problems
Bell, S. K., & Eyberg, S. M. (2002). Parent-Child Interaction Therapy: A dyadic intervention for the treatment of young children with conduct problems. In L. VandeCreek, S. Knapp, & T. L. Jackson (Eds.). Innovations in clinical practice: A source book, Volume 20. (pp. 57-74). Sarasota, FL: Professional Resource Press.
Abstract: This contribution describes Parent-Child Interaction Therapy (PCIT) and demonstrates its utility in the treatment of preschool children with conduct problems. Although we focus on children with severe and persistent disruptive behavior disorders, PCIT is implemented clinically with parents and children whose relational dysfunction may involve a range of individual and family problems (e.g., personality disorders, medical or neurological impairments, adjustment disorders, physical abuse, cognitive deficits, or poverty). Severe conduct problems in young children are rarely attributable solely to individual factors; therefore, PCIT seeks to effect behavior change in both participants in the parent-child relationship during early childhood. Epidemiological research suggests that the early development of conduct problems is a predictor of later psychological disorders including delinquency and criminal behavior (Fischer et al., 1984; Wright et al., 1998). Therefore, effectively addressing these problems during early childhood has important implications for the child and for society.
Keywords: PCIT; General Outcome Studies; Conduct.
Parent-Child Interaction Therapy: An effective treatment for young children with conduct problems
Capage, L. C., Foote, R., McNeil, C. B., & Eyberg, S. M. (1998). Parent-Child Interaction Therapy: An effective treatment for young children with conduct problems. The Behavior Therapist, 21, 137-138.
Keywords: PCIT; General Outcome Studies; Conduct.
Oppositional defiant disorder and parent training
Eyberg, S. M., O'Brien, K. A., & Chase, R. M. (2006). Oppositional defiant disorder and parent training. In J. E. Fisher, & W. T. O'Donohue (Eds.). Practitioner's guide to evidence-based psychotherapy. (pp. 461-468). New York, NY: Springer.
Keywords: PCIT; Book Chapters; Clinical Disorders; Oppositional Defiant Disorder; Parental Factors.
Parenting disruptive preschoolers: Experiences of mothers and fathers
Calzada, E. J., Eyberg, S. M., Rich, B., & Querido, J. G. (2004). Parenting disruptive preschoolers: Experiences of mothers and fathers. Journal of Abnormal Child Psychology, 32, 203-213. https://doi.org/10.1023/B:JACP.0000019771.43161.1c
Abstract: This study examined parental functioning and interactions with young children with Oppositional Defiant Disorder (ODD), with emphasis on differences between mothers and fathers in their responses to their child and in their unique contributions to the prediction of child disruptive behavior. Participants were 53 3- to 6- years olds with ODD who presented for treatment with two parents. Mothers reported more severe disruptive behavior and higher parenting stress than fathers. During parent-child interactions, mothers showed more responsiveness than fathers, even though children were more compliant during interactions with fathers. Regression analyses showed that fathers' parent-related stress was predictive of both mothers' and fathers' reports of disruptive child behavior; mothers' marital satisfaction was predictive of behavioral observations of child compliance with both mothers and fathers. This study revealed several important differences in the experiences of mothers verses fathers of disruptive children and indicates the importance of including the father in the child's assessment and treatment.
Keywords: PCIT; Parental Factors; Preschoolers; Disruptive Behavior; Fathers; Parenting Stress; Marital Satisfaction.
Parent-Child Interaction Therapy for oppositional children
Brinkmeyer, M. Y., & Eyberg, S. M. (2003). Parent-Child Interaction Therapy for oppositional children. In A. E. Kazdin, & J. R. Weisz (Eds.). Evidence-based psychotherapies for children and adolescents. (pp. 204-223). New York, NY: Guilford Publication, Inc.
Keywords: PCIT; Book Chapter.
Treating multi-problem, high stress families: Suggested strategies for practitioners
McNeil, C. B., & Herschell, A. D. (1998). Treating multi-problem, high stress families: Suggested strategies for practitioners. Family Relations, 47, 259-262.
Keywords: : PCIT; Clinical Disorders; Externalizing or Disruptive Behaviors
Management of disruptive behavior in young children
Eyberg, S. M., & Neary, E. M. (2002). Management of disruptive behavior in young children. Infants and Young Children, 14, 53-67.
Abstract: Disruptive behavior tends to worsen with time, but it can be treated effectively. Parent-Child interaction therapy (PCIT), an evidence-based treatment for preschoolers with disruptive behavior and their parents, focuses on changing ineffective parent-child interaction patterns. The first phase, focusing on child-directed interaction, strengthens the parent-child relationship, builds the child's self-esteem, and reinforces the child's prosocial behaviors. The second phase, focusing on parent-directed interaction, introduces parent management training. Treatment is guided by assessment and continues until parents master interaction skills and child behavior problems fall within the normal range. Emerging evidence suggests that treatment gains are maintained for several years posttreatment.
Keywords: PCIT; Externalizing; Disruptive Behaviors; Aggressive Behavior; Behavior Problems; Child; Oppositional; Preschoolers.
Clinical presentation and treatment outcome for children with comorbid externalizing and internalizing symptoms.
Chase, R. M., & Eyberg, S. M. (2008). Clinical presentation and treatment outcome for children with comorbid externalizing and internalizing symptoms. Journal of Anxiety Disorders, 22, 273-282.
Abstract: This study examined the effects of comorbid separation anxiety disorder (SAD) on the expression of externalizing symptoms in children presenting with oppositional defiant disorder (ODD) as well as the treatment effects on anxiety and internalizing symptoms. Participants were 64 children with ODD seen in parent–child interaction therapy (PCIT), including 15 children with comorbid SAD. Children with ODD + SAD did not differ from children with ODD only in disruptive behavior severity at pretreatment assessment, and children with ODD + SAD showed significant decreases in SAD symptoms at post-treatment. Additionally, children with clinical levels of internalizing behavior demonstrated significant reductions in these symptoms, along with reduction of externalizing symptoms targeted in treatment. We discuss the possibility that treatments focusing on parent–child interactions and certain parenting skills may generalize across specific child symptom constellations.
Keywords: : PCIT; Clinical Disorders; Oppositional Defiant Disorder; Separation Anxiety Disorder; Comorbidity; Internalizing Behavior; Externalizing Behavior
The implementation of modified Parent-Child Interaction Therapy for youth with separation anxiety disorder
Pincus, D. B., Santucci, L. C., Ehrenreich, J. T., & Eyberg, S. M. (2008). The implementation of modified Parent-Child Interaction Therapy for youth with separation anxiety disorder. Cognitive and Behavioral Practices, 15, 118-125.
Abstract: Separation Anxiety Disorder (SAD) is the most prevalent anxiety disorder experienced by children, and yet empirical treatment studies of SAD in young children are virtually nonexistent. This paper will describe the development and implementation of an innovative treatment for SAD in young children. First, we will highlight the rationale for developing interventions specifically for SAD in young children. Second, we will describe an existing empirically supported treatment, Parent-Child Interaction Therapy (PCIT; Brinkmeyer, M. Y.,&Eyberg, S.M., (2003)), that may have particular applicability to very young children with SAD and their parents. We present how results from 10 pilot participants were utilized to modify PCIT to better address the needs of children with SAD and their families. The benefits and challenges of implementing this modified version of PCIT are reviewed, along with potential directions for future research in this area.
Keywords: PCIT; Model Adaptation Studies; Clinical Disorders; Separation Anxiety Disorder.
Adapting Parent-Child Interaction Therapy for young children with separation anxiety disorder
Pincus, D. B., Eyberg, S. M., & Choate, M. L. (2005). Adapting Parent-Child Interaction Therapy for young children with separation anxiety disorder. Education and Treatment of Children, 28, 163-181.
Abstract: Separation Anxiety Disorder (SAD) is currently the most prevalent, yet most under-researched anxiety disorder in childhood. To date, there have been few studies investigating the efficacy of interventions for young children with SAD. The primary purpose of this paper is to describe the process of tailoring Parent Child Interaction Therapy (PCIT) for young children aged 4-8 with SAD. The paper provides a theoretical rationale for using PCIT to treat young children with SAD. The first randomized clinical trial for young children with SAD is then described. The paper focuses on the process of adapting PCIT to make it most relevant for children with SAD. The specific challenges and rewards of conducting PCIT with anxious children and their parents are presented.
Keywords: PCIT; Model Adaptation Studies; Clinical Disorders; Separation Anxiety Disorder; Intervention; children; anxiety.
Parent-Child Interaction Therapy for treatment of separation anxiety disorder in young children: A pilot study.
Choate, M. L., Pincus, D. B., Eyberg, S. M., & Barlow, D. H. (2005). Parent-Child Interaction Therapy for treatment of separation anxiety disorder in young children: A pilot study. Cognitive and Behavioral Practice, 12, 126-135.
Abstract: Research suggests that Parent-Child Interaction therapy (PCIT) works to improve the child’s behavior by changing the child-parent interaction. PCIT has been effective in treating disruptive behavior in young children. This article describes a pilot study to apply PCIT to the treatment of separation anxiety disorder (SAD). A multiple-baseline design was used with 3 families with a child between the ages of 4 and 8 who had a principal diagnosis of SAD. Following treatment with PCIT, clinically significant change in separation anxiety was observed on all measures. Disruptive behaviors also decreased following treatment. Treatment gains were maintained at a 3-month follow-up interval. These findings suggest that PCIT may be particularly useful for treatment of young children with SAD, the most prevalent yet under-researched anxiety disorder of childhood. The results of this study support research delineating the important contribution of family factors to anxiety in childhood. Several mechanisms are proposed that may account for the dramatic decrease in separation-anxious behaviors seen in children during PCIT, including increased levels of child control, increased social reinforcement of brave behaviors, improved parent-child attachment, and decreased levels of parent anxiety. Results of this study provide promising initial evidence that PCIT may be efficacious for treating young children with SAD. A randomized clinical trial is warranted to further elucidate the efficacy of PCIT for treatment of SAD in young children.
Keywords: PCIT; Model Adaptation; Separation Anxiety Disorder.
A novel early intervention for preschool depression: Findings from a pilot randomized controlled trial
Luby, J., Lenze, S., & Tillman, R. (2012). A novel early intervention for preschool depression: Findings from a pilot randomized controlled trial. Journal of Child Psychology and Psychiatry, 53, 313-322. https://doi.org/10.1111/j.1469-7610.2011.02483.x
Abstract: Validation for depression in preschool children has been established; however, to date no empirical investigations of interventions for the early onset disorder have been conducted. Based on this and the modest efficacy of available treatments for childhood depression, the need for novel early interventions has been emphasized. Large effect sizes (ES) for preschool psychotherapies for several Axis I disorders suggest that earlier intervention in depression may also be promising. Therefore, a novel form of treatment for preschool depression, Parent-Child Interaction Therapy Emotion Development (PCIT-ED) was developed and tested.|A preliminary randomized controlled trial (RCT) was conducted comparing PCIT-ED to psycho-education in depressed 3- to 7-year-olds and their caregivers. A total of 54 patients met symptom criteria for DSM-IV major depressive disorder and were randomized, 19 patients completed the active treatment (n = 8 dropouts) and 10 completed psycho-education (n = 17 dropouts).|Both groups showed significant improvement in several domains, with PCIT-ED showing significance in a greater number of domains. An intent-to-treat analysis suggested that PCIT-ED was significantly more effective than psycho-education on executive functioning (p = .011, ES = 0.12) and emotion recognition skills (p = .002, ES = 0.83).|The RCT proved feasible and suggests an individual control condition should be used in future trials to minimize differential dropout. These pilot data, although limited by power, suggest that PCIT-ED may be a promising early intervention for depression. Larger scale randomized controlled trials of PCIT-ED for depressed preschoolers are now warranted.
Keywords: PCIT; Model Adaptation Studies; Child; Preschool; Depressive Disorder, Major; Emotions; Family Therapy; Feasibility Studies; Female; Humans; Male; Parent-Child Relations; Parents; Pilot Projects; Play and Playthings; Program Evaluation; Treatment Outcome.
Parent-Child Interaction Therapy emotion development: A novel treatment for depression in preschool children
Lenze, S. N., Pautsch, J., & Luby, J. (2011). Parent-Child Interaction Therapy emotion development: A novel treatment for depression in preschool children. Depression and Anxiety, 28, 153-159.
Abstract: Psychotherapies with known efficacy in adolescent depression have been adapted for prepubertal children; however, none have been empirically validated for use with depressed very young children. Due to the centrality of the parent-child relationship to the emotional well-being of the young child, with caregiver support shown to mediate the risk for depression severity, we created an Emotional Development (ED) module to address emotion development impairments identified in preschool onset depression. The new module was integrated with an established intervention for preschool disruptive disorders, Parent Child Interaction Therapy (PCIT). Preliminary findings of an open trial of this novel intervention, PCIT-ED, with depressed preschool children are reported. PCIT was adapted for the treatment of preschool depression by incorporating a novel emotional development module, focused on teaching the parent to facilitate the child's emotional development and enhance emotion regulation. Eight parent-child dyads with depressed preschoolers participated in 14 sessions of the treatment. Depression severity, internalizing and externalizing symptoms, functional impairment, and emotion recognition/discrimination were measured pre- and posttreatment. Depression severity scores significantly decreased with a large effect size (1.28). Internalizing and externalizing symptoms as well as functional impairment were also significantly decreased pre- to posttreatment. PCIT-ED seems to be a promising treatment for preschoolers with depression, and the large effect sizes observed in this open trial suggest early intervention may provide a window of opportunity for more effective treatment. A randomized controlled trial of PCIT-ED in preschool depression is currently underway.
Keywords: PCIT; Model Adaptation Studies; Clinical Disorders; Affect; Child; Depressive Disorder/Psychology; Depressive Disorder/Therapy; Mood Disorders; Mother-Child Relations; Behavior Therapy; Humans.
Early childhood depression
Luby, J. L. (2009). Early childhood depression. American Journal of Psychiatry, 166, 974-979.
Abstract: Although empirical evidence has recently validated clinical depression in children as young as age 3, few data are available to guide treatment of early childhood depression. Considering this gap in the literature, a novel dyadic psychotherapeutic model, Parent Child Interaction Therapy-Emotion Development, based on a well-known and effective manualized treatment for disruptive preschoolers, is currently being tested for use in depression. To balance safety and efficacy, dyadic developmental approaches are currently recommended as the first line of treatment for preschool depression. In the absence of data on the safety and efficacy of antidepressants in preschool depression, these agents are not recommended as a first- or second-line treatment at this time. This article provides an illustrative case example of preschool depression, outlines key considerations in differential diagnosis, and describes this novel form of treatment. It also clarifies parameters for the rare situations in which antidepressants may be tried when psychotherapeutic options fail and depression is severe and impairing.
Keywords: PCIT; Clinical Disorders; Depression
Treatment of preschool bipolar disorder: A novel Parent-Child Interaction Therapy and review of data on psychopharmacology
Luby, J. L., Stalets, M. M., Blankenship, S., Pautsch, J., & McGrath, M. (2008). Treatment of preschool bipolar disorder: A novel Parent-Child Interaction Therapy and review of data on psychopharmacology. In B. Geller, & M. DelBello (Eds.). Treatment of bipolar disorder in children and adolescents (pp. 270-286). New York, NY: Guilford Press.
Abstract: Converging data from numerous research groups have established the construct validity of bipolar disorder arising in children 6 years of age and older (e.g., Biederman et al., 2004; Birmaher et al., 2006; Geller, Tillman, Craney, & Bolhofner, 2004). However, to date there have been very few systematic investigations of whether preschool-age children can manifest formal DSM-IV criteria for bipolar disorder or whether mania symptoms can even arise at this early stage of development. Several compelling published case studies have described the clinical characteristics of putative mania in preschool children (Mota-Castillo et al., 2001; Pavuluri, Janicak, & Carbray, 2002; Tuzun, Zoroglu, & Savas, 2002). Retrospective chart reviews have also suggested that clinical mania can present during the preschool period (Tumuluru, Weller, Fristad, & Weller, 2003). Although these data are compelling and suggestive, the lack of standardized diagnostic measures, appropriate comparison groups, and blind raters used in the assessments limits the scientific conclusions that can be drawn. However, objective evidence of early alterations in the behavior of the preschool-age offspring of parents with bipolar disorder has been provided (Hirshfeld-Becker et al., 2006). In a study of the young children of adults with bipolar disorder, higher rates of observed behavioral disinhibition were found in preschoolers who had a parent with bipolar disorder compared with low-risk controls. These findings demonstrate that behaviors suggestive of the kind of emotional dysregulation that might be expected to be associated with a prodrome of later mania are evident in preschoolers at high risk for the disorder by virtue of having an affected parent. These findings are strengthened by the use of observational data scored by raters blind to the diagnostic status of the caregivers, thus providing objective evidence that is not affected by potential parental distortion.
Keywords: PCIT; Book Chapters; Clinical Disorders
Extending Parent-Child Interaction Therapy for early childhood internalizing problems: New advances for an overlooked population
Carpenter, A. L., Puliafico, A. C., Kurtz, S. M. S., Pincus, D. B., & Comer, J. S. (2014). Extending Parent-Child Interaction Therapy for early childhood internalizing problems: New advances for an overlooked population. Clinical Child and Family Psychology Review, 17, 340-356.
Abstract: Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent– child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent–child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention— such as the PCIT-SM (selective mutism) Program for young children with SM—are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider potential solutions, including modular treatment formats and innovative applications of technology.
Keywords: PCIT; Clinical Disorders; Anxiety; Child Anxiety; Child Depression; Selective Mutism.
Adapting Parent-Child Interaction Therapy to treat anxiety disorders in young children
Puliafico, A. C., Comer, J. S., & Pincus, D. B. (2012). Adapting Parent-Child Interaction Therapy to treat anxiety disorders in young children. Child & Adolescent Psychiatric Clinics of North America, 21, 607-619.
Abstract: Anxiety disorders are prevalent in children 7 years and younger; however, these children generally do not possess developmental skills required in cognitive behavior treatment. Recent efforts have adapted parent-child interaction therapy (PCIT), originally developed for disruptive and noncompliant behavior, for young children with anxiety. This article reviews the principles underlying PCIT and the rationale for adapting it to target anxiety symptoms. The authors describe two related treatment approaches that have modified PCIT to treat anxiety: (1) Pincus and colleagues' treatment for separation anxiety, and (2) Puliafico, Comer, and Albano's CALM Program for the range of early child anxiety disorders.
Keywords: PCIT; Clinical Disorders; Anxiety; Parent Training; Preschool; Review Articles.
Barriers to success in parent training for young children with developmental delay: The role of cumulative risk
Bagner, D. M.,& Graziano, P. A. (2013). Barriers to success in parent training for young children with developmental delay: The role of cumulative risk. Behavior Modification, 37, 356-377.
Abstract: The purpose of this study was to examine the effect of cumulative risk on dropout and treatment outcome in parent training. Participants were 44 families of young children (mean age of 49.59 months) who presented with elevated externalizing behavior problems and developmental delay or borderline developmental delay. All families were offered to receive Parent-Child Interaction Therapy (PCIT), an evidence-based, behavioral parent-training intervention, at a hospital-based outpatient clinic. Cumulative risk was calculated as a sum of risk variables, including socioeconomic disadvantage (poverty, low maternal education), family structure (single-parent household), and maternal risk characteristics (minority status, lower intelligence, and parental distress). Families with higher cumulative risk scores, especially those with three or more risks, were more likely to drop out of treatment and display diminished treatment response in child behavior and parenting skills compared with families with lower cumulative risk scores. However, only two individual risk factors (i.e., minority status and family structure) predicted dropout, and one individual risk factor (i.e., maternal education) predicted outcome. These findings suggest that it can be useful to conceptualize risk factors as having a cumulative, in addition to individual, influence on parent-training interventions for children with developmental delay and have significant implications for clinical practice. It is important for clinicians to regularly assess for risk factors, and future research should examine ways in which clinicians can improve retention and outcome of parent training in the presence of multiple risk factors.
Keywords: PCIT; Attrition Studies; Adult; Behavior Therapy; Behavioral Symptoms; Child; Child, Preschool; Developmental Disabilities; Female; Humans; Infant; Male; Parent-Child Relations; Parents; Patient Dropouts; Risk Factors; Treatment Outcome.
Parent-Child Interaction Therapy for disruptive behavior in children with mental retardation: A randomized controlled trial
Bagner, D. M., & Eyberg, S. M. (2007). Parent-Child Interaction Therapy for disruptive behavior in children with mental retardation: A randomized controlled trial. Journal of Clinical Child and Adolescent Psychology, 36, 418-429.
Abstract: This article presents results of a randomized controlled trial examining the efficacy of Parent-Child Interaction Therapy (PCIT) for treating disruptive behaviors of young children (ages 3 to 6) with mental retardation (MR) and comorbid oppositional defiant disorder. Thirty families were randomly assigned to an immediate treatment (IT) or waitlist (WL) control group. Results indicated that IT mothers interacted more positively with their children after treatment than WL mothers, and their children were more compliant after treatment. On parent-report measures, IT mothers reported fewer disruptive behaviors at home and lower parenting stress related to difficult child behavior than WL mothers after treatment. Whether evidence-based treatments for disruptive behavior require modification before application to children with MR is discussed.
Keywords: : PCIT; Clinical Disorder; Conduct Disorder; Attention Deficit and Disruptive Behavior Disorders; Child; Child, Preschool; Comorbidity; Consumer Behavior; Cooperative Behavior; Family Therapy; Female; Follow-Up Studies; Humans; Intellectual Disability; Male; Mother-Child Relations; Parent-Child Relations; Personality Assessment; Treatment Outcome.
Parent Child Interaction Therapy for children with disruptive behavior and developmental disabilities
McDiarmid, M. D., & Bagner, D. M. (2005). Parent Child Interaction Therapy for children with disruptive behavior and developmental disabilities. Education and Treatment of Children, 28, 130-141.
Abstract: Children with developmental disabilities (DD) often present with comorbid disruptive behavior problems that may negatively affect their education, treatment, and social interactions. Therefore, treatments that reduce disruptive behavior in children with DD are critical. Three characteristics strongly suggest that PCIT is an appropriate treatment choice among. Children with DD: PCIT shares several features with treatments that have demonstrated efficacy for children with DD in single case design studies; PCIT needs little modification to be effective with children with DD; and PCIT is an evidence-based treatment for disruptive behavior in typically developing children. Techniques for adapting PCIT for children with DD are presented. Further research is suggested to augment anecdotal evidence for the effectiveness of PCIT with this population.
Keywords: PCIT; Clinical Disorders; Externalizing or Disruptive Behaviors; Preschool Children; Parents; Developmental Disabilities; Intellectual Disability; Child Behavior Disorders; Child Health Services; Child Development.