Susan S. J. Morgan

Pilot evaluation of parent–child interaction therapy delivered in an Australian community early childhood clinic setting

Objective: Parent–child interaction therapy (PCIT) is a short-term, evidence-based parent training intervention used widely in the treatment of behaviourally disordered preschool-aged children. Outcome studies have shown PCIT to be associated with lasting improvements in child and sibling behaviours and in the interactional styles, stress levels, confidence, and psychological functioning of parents. To date, however, all outcome studies have been conducted in university research clinic settings, and therefore understanding about the effectiveness of PCIT applied in a real-world setting has been limited. The present study evaluated the effectiveness of PCIT delivered to families in an Australian community-based early childhood clinic. Method: Participants included 43 families with children aged 19–52 months who were referred for treatment of disruptive child behaviours and who completed PCIT treatment at the Karitane Toddler Clinic, in Sydney, Australia. Parents provided pre- and post-treatment ratings of child behaviours, parental stress, parental psychopathology and parental attitudes to therapy. Results: At the end of the programme, clinically and statistically significant improvements were seen in child behaviours and parental well-being, and parents reported high levels of satisfaction with treatment. Conclusions: Implications for the implementation of PCIT programmes in community-based settings are discussed and areas of further research are identified.

Emotion Regulation Strategies and Parenting Practices among Parents of Children With Clinic-Referred Conduct Problems

SYNOPSIS Objective. This study examined the cognitive-affective strategies used by parents of young children with conduct problems to regulate emotions. Key questions concerned the extent to which these emotion regulation strategies are associated with positive and negative parenting practices and predict quality of parenting through interplay with parental depression. Design. Participants were families of toddlers (n = 84) referred to a tertiary-level health service for the treatment of disruptive behavior problems. Parenting practices were indexed through observational coding of parent–child interactions and self-report data on multiple dimensions of positive and negative parenting. Parents self-reported their use of cognitive reappraisal and expressive suppression—the two emotion regulation strategies that are most robustly associated with psychosocial functioning in adults. Results. Associations between emotion regulation strategy and quality of parenting were moderated by parental depressive symptom severity, with distinct effects seen for positive and negative parenting practices. In terms of positive parenting, more frequent use of cognitive reappraisal was associated with increased use of labeled praise among parents with lower levels of depressive symptoms, whereas parents who had higher levels of depressive symptoms engaged in less such praise regardless of how frequently they used reappraisal. In terms of negative parenting, frequent use of cognitive reappraisal and expression suppression were associated with reduced levels of negative parenting, but only among parents with high levels of depression. Conclusions. These findings add to growing support for the integration of emotion regulation strategies into family process models of early-onset conduct problems and related clinical interventions.

Life-Enhancement Situations Coach Session

The purpose of the life-enhancement coach session is to help parents generalize and apply their previously mastered CDI-T and PDI-T skills (e.g., PRIDE skills, CARES steps, under-reaction, redirection, guided compliance, directive language stimulation coaching) to everyday, real-life situations that arise in the lives of toddlers and their families. It is critical that therapists empower parents by guiding them to apply previously learned developmental knowledge and mastered skills to such situations. Additionally, the ongoing importance of CDI-T and PDI-T skills during at-home practice provides the foundation of this phase of the intervention.

Parent-Directed Interaction-Toddler

The most fundamental aspect of PDI-T lies in the basic understanding that this phase of treatment is meant to teach listening skills, rather than implement consequences for noncompliance. Toddlers are in the process of learning the necessary abilities to comply with demands. Therefore, noncompliance is conceptualized as a lack of applicable listening skills. In turn, such skill deficits must lead to the increased provision of appropriate opportunities to learn listening skills. Listening skills are taught using a guided compliance procedure, commonly used in applied behavior analysis to help children of varying abilities learn called the “Tell-Show-Try Again-Guide” procedure.

Child-Directed Interaction-Toddler

The basic premise of PCIT-T is centered upon building a strong, positive relationship between a parent and toddler that, in turn, is used to teach young children a variety of emotion regulation, language, and social skills. Do and don’t skills are presented, and parents learn to use their positive attention to manage and shape their toddler’s behaviors. This is taught in the context of play-based parent-child interactions where parents learn to tune into, predict, and respond to young children’s needs and natural cues, thereby preventing difficult behavior achieving the goal of an enhanced and rewarding parent-child interaction.

Core Elements and Treatment Goals of PCIT-T

Reviews required therapeutic interventions consistent with the implementation of the PCIT-T model. This includes integration of emotion regulation skills with the acronym of CARES developed from attachment theory used for both toddlers and caregivers. Strategies of cognitive behavioral theory are also reviewed with the skills taught to caregivers with the acronym PRIDE in addition to other specific skill-based interventions. Specific treatment goals are presented in table form with the corresponding intervention that targets the area/description for desired change.

Treatment Overview and Implementation of the Current Protocol

Review of Parent-Child Interaction Therapy with Toddlers (PCIT-T): Improving Attachment and Emotion Regulation as a novel treatment approach adapted from Parent-Child Interaction Therapy, an evidence-based parent-training treatment for children with behavior problems. The current approach is designed to be used with toddlers between the ages of 12 and 24 months when problem behaviors often manifest. The following outline is a clinician’s session-by-session treatment guide.

The Application of PCIT to the Toddler Age Group

Presents the variety of adaptations made to standard PCIT as well as discussing other models for early childhood intervention that target treatment to the toddler age range over the past 15 years. Research data from the preliminary version of PCIT-T implemented in Sydney, Australia, are discussed pertaining to outcomes of externalizing and internalizing behavior, emotional availability, use of positive parenting verbalizations, caregiver emotion availability, and the impact on infant attachment patterns using the strange-situation procedure.

Conceptualizing PCIT-T as an Emotion Regulation Treatment for Toddlers

PCIT-T serves as an interactive process, whereby each member of the therapy team models, reinforces, and supports each other during the live application of skills with one another. The coach provides a secure emotional base for the parent, who is in turn able to provide the same support to the child. This sequence is often referred to as the parallel process. To effectively implement the parallel process, the coaches and parent’s ability to accurately read, interpret, and respond to the underlying function behind a child’s dysregulated behavior is essential, hence the development of the CARES model and in vivo coaching.

Behavioral Assessment in PCIT-T

PCIT-T is a data-driven treatment approach. The ongoing collection of clinical data is necessary to inform ongoing treatment. Given the two primary treatment targets of (1) decreasing toddlers’ behavior difficulties and (2) improving parenting skills, assessment measures are required. Specific recommendations are provided regarding use of pre−/mid−/post assessment measures and include the use of the Dyadic Parent-Child Interaction Coding System (DPICS) as implemented in standard PCIT.