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Copyright October 2007 Sheila Eyberg Adaptations of Parent-Child Interaction Therapy to Different Needs, Different Groups UF PCIT Training Workshop October, 2007

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Copyright October 2007 Sheila Eyberg Active Skills Training PCIT Proven Effective for Large Stuffed Bears

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Copyright October 2007 Sheila Eyberg Weekly ECBI Intensity Scores Normative mean Clinical cutoff Criterion to end treatment Treatment Completers (n = 64) And All Children Who Complete Treatment

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Copyright October 2007 Sheila Eyberg PCIT is an Evidence-Based Treatment for (strictly speaking) Young children (3 to 6) Disruptive behavior disorders USA or Australian residents Without severe mental impairment (e.g., autism) And their non-cognitively delayed parents Designation based on two well-conducted RTCs Schuhmann et al., 1998 (US study) Nixon et al., 2003 (Australian study)

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Copyright October 2007 Sheila Eyberg PCIT also named one of two Well-Supported and Efficacious Treatments for Child Abuse Designation based on a now classic study Chaffin, M., Silovsky, J., Funderburk, B. et al. (2004). Parent-child interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology, 72, 500510. U.S. Department of Justice - Office for Victims of Crimes

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Copyright October 2007 Sheila Eyberg But (strictly speaking) the Chaffin Study Presented An Adaptation of PCIT for a Special Population Child Abusing Parents Extended child age range up to 12 Age-appropriate CDI activities (e.g., crafts) Age-appropriate back-ups to timeout chair (e.g., loss of privilege) Added group modules at beginning and end Pre-PCIT motivational enhancement group 6 session preparation for treatment involvement Follow-up group meetings 4 sessions of loosely structured problem-solving PCIT protocol was made time-limited (14 wks)

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Copyright October 2007 Sheila Eyberg Observed Parent Negative Behaviors (Criticism, Sarcasm, Negative Touch) Chaffin et al., 2004

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Copyright October 2007 Sheila Eyberg PCIT (Plus 6-week Motivation Enhancement) with Abusive Parents Percent Re-Abuse During 2.5 Years After Treatment Chaffin et al., 2004

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Copyright October 2007 Sheila Eyberg Exciting Results But If you learn PCIT, will it work for child abuse treatment? Or must you also use the motivation protocol? Economically important question for agencies deciding whether to adopt a treatment Another question the study spawns Does PCIT work for 12-year-olds? Unlikely effective for treating conduct-disordered 12-year-olds Another question Would the adaptations made for older children work well with young disruptive children? Empirical question but unlikely

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Copyright October 2007 Sheila Eyberg How Best to Develop a PCIT Adaptation Test standard PCIT in the new population If it does not work, an adaptation unlikely to work If it does work, then you can examine if adaptation improves outcomes Problems with testing adapted PCIT first If it does not work, you dont know if the treatment or the adaptation was the problem If it does work, you dont know if adaptation is needed It can waste expensive research dollars and time First see if adaptation is needed

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Copyright October 2007 Sheila Eyberg A Pilot Study of PCIT for Children with Comorbid ODD and Mental Retardation 3 - 6 years old Oppositional defiant disorder DISC-IV-P and CBCL Mild or moderate MR WPPSI-III Adaptive Behavior Scale Inclusion criteria Bagner & Eyberg, 2007

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Copyright October 2007 Sheila Eyberg Children with Comorbid ODD and Mental Retardation Major sensory impairments in child (deafness, blindness) Childhood autism spectrum disorders Childhood Autism Rating Scale Child history of psychosis Primary caregiver not MR Wonderlic Personnel Test Families suspected of child abuse Exclusion Criteria Bagner & Eyberg, 2007

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Copyright October 2007 Sheila Eyberg Sample Description Child 77 % male 67% Caucasian Mean age = 4.5 yrs Mean FSIQ = 59 (SD = 11.06) Family 73% two-parent families Mean age of mother = 36; father = 38 Hollingshead SES = 41.30 (SD = 14.14) Bagner & Eyberg, 2007

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Copyright October 2007 Sheila Eyberg Study Treatment Characteristics Families randomized to PCIT (n = 15) or Waitlist Control (n = 15) conditions Therapists Advanced graduate students Weekly supervision Average of 12 weekly sessions CDI time limited (6 sessions) PDI not time limited Completion criteria unchanged Treatment Integrity 97% accuracy; 97% interrater reliability High treatment satisfaction Therapy Attitude Inventory = 46.88 Bagner & Eyberg, 2007

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Copyright October 2007 Sheila Eyberg Clinical cutoff Disruptive Behavior Change in Children with Comorbid ODD and Mental Retardation 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, 1-12. n = 8 treatment completers

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Copyright October 2007 Sheila Eyberg Mothers Do Skills During Child-Led Play d = 1.43 p