Copyright 2006 Sheila Eyberg Parent-Child Interaction Therapy.

Copyright 2006 Sheila Eyberg

Parent-Child

Interaction Therapy


ODD (“No!)– Refuse or defy adult requests– Lose temper easily– Annoy others on purpose

CD (Against the Rules)– Steal things– Destroy things– Start fights/Hurt others

ADHD (Impulsive, Hyperactive, Inattentive)– Have difficulty staying seated– Have difficulty playing quietly– Have difficulty awaiting turn

An Empirically Supported Treatment for

Disruptive Behavior Disorders


Disruptive Behavior Disorders in Preschoolers

Highly persistent

Worsen with time

Strongest risk factor for adolescent delinquency and violent crime

Prevalence up to 20%

Costs to society very high

Can be diagnosed reliably at age 3

Can be treated effectively if treated early


Parent and child together Theoretically grounded Emphasis on restructuring

interaction patterns Not time-limited Assessment-driven Scientifically based Clinically validated Empirically supported

Defining Features of Parent-Child Interaction

Therapy (PCIT)

Coding

Coaching

Parent & Child


PCITParent and Child

Together in Treatment

Focus on changing behaviors of both parent and child

Therapist tailors treatment based on observation of parent-child interactions during treatment

Parent errors in application corrected on-the-spot

Parents can be confident therapist understands their child

Therapists can assess when parents ready to move to next step in treatment

Allows accurate determination of treatment completion


Parent-Child Interaction

Therapy (PCIT)

Parent and child together Theoretically grounded Emphasis on restructuring

interaction patterns Not time-limited Assessment-driven Scientifically based Clinically validated Empirically supported

Coding

Coaching

Parent & Child


Based on Developmental Theory

Baumrind’s Parenting Styles– Authoritarian (high

demandingness, low warmth)– Permissive (high warmth, low

demandingness)– Authoritative (high warmth, high

demandingness)

Nurturance and firm limits both necessary for healthy adolescent outcomes

PCIT draws from both attachment and social learning theory to achieve authoritative parenting


Parent and child together

Theoretically grounded

Not time-limited

Emphasis on restructuring interaction patterns

Assessment-driven

Scientifically based

Clinically validated

Empirically supported

Parent-Child Interaction

Therapy (PCIT)


Not Time-Limited

Termination criteria

– Parent-child observations

• parent mastery of CDI and PDI skills

• Child compliance > 75%

– Parent ratings of disruptive behavior

• Child behavior within ½ SD of normative mean on the ECBI

– Parent self-confidence in parenting

• Parents feel able to handle problems on their own

Termination = Success


PCIT Dropouts and Completers (N = 100)

0

1

2

3

4

5

6

7

8

1 4 7 10 13 16 19 22 25 28 31

Number of Sessions

Fam

ilies

Dropouts

Completers

Maintenance StudyEyberg & Boggs, 2005


Parent and child together

Theoretically grounded

Emphasis on restructuring interaction patterns

Assessment-driven

Not time-limited

Scientifically based

Clinically validated

Empirically supported

Parent-Child Interaction Therapy (PCIT)

Codin

gParent &

ChildCoaching


Structure of PCIT

Assessment sessions Teaching sessions

– Describing– Modeling– Role-playing

Coaching sessions– Parent wears a Bug-in-the-Ear receiver

while playing with child in playroom

– Therapist observes and codes parent and child behaviors at start of session

– Therapist coaches specific skills from observation room using microphone

– Spouses take turns being coached with child and observing spouse’s coaching


Child-Directed Interaction

Parent-Directed Interaction

Parents follow

Play therapy skills Nonverbal

communication of affect

Differential attention

Parents lead

Limit-settingConsistency Problem solvingReasoning


IGNORE annoying, IGNORE annoying, obnoxious behaviorobnoxious behavior

STOP THE PLAY for STOP THE PLAY for dangerous or dangerous or destructive behaviordestructive behavior

Child-Child-Directed Directed

InteractionInteraction

DON’TDON’T– Give Give

CommandsCommands– Ask Ask

QuestionsQuestions– CriticizeCriticize

DODO– PraisePraise– ReflectReflect– ImitateImitate– DescribeDescribe EnthusiasmEnthusiasm


Parent-Directed InteractionParent-Directed Interaction 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 PlayYEA!


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


You are sitting quietly. Are you ready to

[obey original command]?

Child stays on chair 3 min plus 5 sec quiet

Or doesn’t(OH-OH!)

ObeyAcknowledge

The Chair

Command


Back to chair

Child goes toTime out room1 min + quiet

Child gets off again

The Backup

“You got off the chair before I said you could. If you get off again,

you’ll go to the Time Out Room .”

Child gets off chair


Yes

You’re sitting quietly. Are you ready to

[Obey Original Command]?

Obey

Acknowledge

The First ObeyChild stays

on chair 3 min

Plus 5 sec quiet


Obey

Back to play!!!

Finally!

Explain

Labeled Praise

Command


Generalization Training

House rules Public behavior Siblings

Copyright 2006 Sheila Eyberg Parent-Child Interaction Therapy.

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