Daniel M. Bagner

Parent-Child Interaction Therapy for Disruptive Behavior in Children with Mental Retardation: A Randomized Controlled Trial

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.

Father Involvement in Parent Training: When Does It Matter?

We examined the impact of father involvement on treatment. Participants were 107 families enrolled in parent-child interaction therapy (PCIT), including 56 involved-father (IF) families, 16 uninvolved-father (UF) families, and 35 absent-father (AF) families. All groups showed improvements during treatment to within the average range on the Eyberg Child Behavior Inventory (ECBI), although mothers from AF families reported better treatment outcome than mothers from IF families. Improvements occurred on the Beck Depression Inventory (BDI) and the Parenting Stress Index (PSI) as well, but there were no group differences. At a 4-month follow-up, mothers in IF families maintained treatment gains on the ECBI. In contrast, mothers in AF families reported significant decline at follow-up, although their scores remained within the normal range. Results suggest that father participation in treatment may not affect immediate treatment outcome but may help to maintain the beneficial effects of PCIT.

Outcomes of Parent-Child Interaction Therapy: A Comparison of Treatment Completers and Study Dropouts One to Three Years Later

ABSTRACT Using a quasi-experimental design, this study examined longitudinal outcomes for families previously enrolled in a study of Parent-Child Interaction Therapy (PCIT), a treatment program for young children with disruptive behavior disorders. Comparisons were made between 23 families who completed treatment and 23 families who dropped out of the study before completing treatment, using a structured diagnostic interview, and several parent-report measures. Length of follow-up for both groups ranged from 10 to 30 months after the initial assessment, with the average length of follow-up just under 20 months. Results indicated consistently better long-term outcomes for those who completed treatment than for study dropouts. These results highlight the need to identify salient predictors of treatment engagement and retention to maximize outcomes for young children.

Effect of Maternal Depression on Child Behavior: A Sensitive Period?

OBJECTIVE The purpose of this study was to examine the effect of maternal depression during the childs first year of life (i.e., sensitive period) on subsequent behavior problems. METHOD Participants were 175 mothers participating in the Oregon Adolescent Depression Project (OADP) who met lifetime diagnostic criteria for major depressive disorder (MDD) and completed the child behavior checklist (CBCL) for their first child at some point during the childs first 12 years (mean = 4.91 years). RESULTS Regression analyses indicated that MDD in the sensitive period was a significant predictor of internalizing and total behavior problems on the CBCL while controlling for several demographic variables (e.g., child and mother age, child gender). Maternal depression before pregnancy and during the prenatal period did not significantly predict later child behavior problems, suggesting that the effect was not driven by the presence of previous MDD and was specific to the first year of life. CONCLUSIONS Presence of maternal MDD during a childs first year of life represents a sensitive period and increases the risk of adverse child outcome. The findings suggest the importance of identification, prevention, and early intervention. Future studies should examine these findings in more diverse, heterogeneous samples.

Association Between Overt and Relational Aggression and Psychosocial Adjustment in Undergraduate College Students.

This study examined the relations between overt and relational aggression, social anxiety, loneliness, depressive symptoms, and alcohol and drug use in a sample of 287 undergraduate college students. Consistent with prior work, men reported engaging in more overt aggression than women. Contrary to our predictions, men also reported engaging in more relational aggression than women. Results also indicated that overt and relational aggression were positively associated with social anxiety, loneliness, depressive symptoms, alcohol use, and drug use for the overall sample. Hierarchical regression analyses showed positive relations between overt aggression and alcohol use for men and no relations between relational aggression and any psychosocial adjustment index. For women, overt aggression uniquely predicted social anxiety, loneliness, and depressive symptoms, whereas relational aggression uniquely predicted social anxiety, loneliness, depression, and alcohol and drug problems. Implications of these findings are discussed in terms of the role of peer aggression in students’ psychosocial adjustment.

Parenting Intervention for Externalizing Behavior Problems in Children Born Premature: An Initial Examination

Objective: To examine the initial efficacy of parent-child interaction therapy (PCIT) for treating behavior problems in young children who were born premature. Method: In this randomized, controlled trial, 28 children between the ages of 18 and 60 months, who were born <37 weeks gestation and presented with clinically significant externalizing behavior problems, were randomly assigned to an immediate treatment (IT) or waitlist (WL) control group. Results: After 4 months, children who received PCIT were reported by their mother to have less attention problems, aggressive behaviors, and externalizing and internalizing behavior problems, and they were observed to be more compliant to maternal commands than children in the WL group. In addition, mothers in the IT group interacted more positively with their child, reported lower parenting stress related to difficult child behavior and demonstrated improved parenting practices compared with WL mothers. Behavior change maintained for 80% of the IT children 4 months after treatment completion. Conclusions: This study demonstrates preliminary efficacy of PCIT for the treatment of behavior problems in young children who were born premature.

Type 1 Diabetes in Youth: The Relationship Between Adherence and Executive Functioning

This pilot study examined the relationship between executive functioning and adherence to diabetes regimen adherence in 130 children with type 1 diabetes. Consistent with our hypothesis, parent report of a childs executive functioning predicts that childs adherence to the diabetes regimen. However, contrary to our prediction, age was not a moderator in this relationship. These results suggest that higher levels of a childs ability to problem solve, self-monitor, and utilize working memory are related to higher rates of adherence regardless of age. These findings emphasize the importance of the assessment of executive functioning for optimal pediatric diabetes care.

Romantic Relational Aggression: What about Gender?

This study examined the relations among romantic relational aggression, social anxiety, loneliness, depressive symptoms, and alcohol and drug use in a sample of 215 undergraduate college students. Consistent with prior work, no gender differences were found in the experience of romantic relational aggression. Results indicated that romantic relational aggression was positively associated with social anxiety (for women only), loneliness, depressive symptoms, and alcohol use and drug use. Implications of these findings for the role of aggression within the context of intimate relationships during college are discussed.

Parent-Child Interaction Therapy and Chronic Illness: A Case Study

We examined the outcome of parent–child interaction therapy (PCIT) for a child diagnosed with Oppositional Defiant Disorder (ODD) and cancer. “Robert,” a 4-year-old Caucasian male, showed significant and meaningful changes in his behavior over the course of 13 weeks of PCIT, and Robert no longer met diagnostic criteria for ODD following treatment. His scores on the Eyberg Child Behavior Inventory and the Achenbach Child Behavior Checklist were in the clinical range before treatment and in the normal range at the conclusion of treatment. His mother also reported dramatic improvements in Roberts behavior during medical visits. Physician and social worker reports were consistent with her report. Such anecdotal data may have implications for the generalization of compliance to the medical setting for children with chronic illnesses. The results of this case study should prompt further investigation of parent-training interventions for children with chronic illnesses and disruptive behavior.

Infant Neurobehavioral Dysregulation: Behavior Problems in Children With Prenatal Substance Exposure

OBJECTIVE: The objective of this study was to test a developmental model of neurobehavioral dysregulation relating prenatal substance exposure to behavior problems at age 7. METHODS: The sample included 360 cocaine-exposed and 480 unexposed children from lower to lower middle class families of which 78% were black. Structural equation modeling was used to test models whereby prenatal exposure to cocaine and other substances would result in neurobehavioral dysregulation in infancy, which would predict externalizing and internalizing behavior problems in early childhood. Structural equation models were developed for individual and combined parent and teacher report for externalizing, internalizing, and total problem scores on the Child Behavior Checklist. RESULTS: The goodness-of-fit statistics indicated that all of the models met criteria for adequate fit with 7 of the 9 models explaining 18% to 60% of the variance in behavior problems at age 7. The paths in the models indicate that there are direct effects of prenatal substance exposure on 7-year behavior problems as well as indirect effects, including neurobehavioral dysregulation. CONCLUSIONS: Prenatal substance exposure affects behavior problems at age 7 through 2 mechanisms. The direct pathway is consistent with a teratogenic effect. Indirect pathways suggest cascading effects whereby prenatal substance exposure results in neurobehavioral dysregulation manifesting as deviations in later behavioral expression. Developmental models provide an understanding of pathways that describe how prenatal substance exposure affects child outcome and have significant implications for early identification and prevention.