Academic journal article Education & Treatment of Children

Introduction: Innovative Approaches to Parent-Child Interaction Therapy

Academic journal article Education & Treatment of Children

Introduction: Innovative Approaches to Parent-Child Interaction Therapy

Article excerpt

Disruptive behavior problems in children represent a serious, highly prevalent, and costly public health problem (Klein & Mannuzza, 1991). Early intervention is critical to prevent negative developmental trajectories and outcomes. To date, research efforts have yielded a number of efficacious treatments for childhood disruptive behavior. One such intervention is Parent-Child Interaction Therapy (PCIT; Eyberg & Boggs, 1998). Based on Baumrind's construction of authoritative parenting and emphasizing both attachment and social learning theory principles (cf. Foote, Eyberg, & Schuhmann, 1998), PCIT focuses on changing ineffective parent-child interaction patterns.

In the first of two phases of treatment, Child-Directed Interaction (CDI), parents engage their child in a play situation. CDI aims to restructure the parent-child relationship and provide the child with a secure attachment to his or her parent. The development of a secure, stable attachment relationship and healthy parent-child interactions are key to the development of a healthy self-concept, optimal emotional/behavioral regulation, and the ability to be empathic to others (see Grossmann, Grossmann, & Zimmermann, 1999; Hobbs, 1982; Kazdin, 1985). Attachment theory asserts that sensitive and responsive parenting leads the infant to develop a cognitive-affective working model that he or she will be responded to when necessary. Thus, young children whose parents show greater warmth, responsiveness, and sensitivity to the child's signals are more likely to develop a secure working model of their relationship and more effective emotional regulation (Ainsworth, Blehar, Waters, & Wall, 1978). Maladaptive attachment is consistently linked to children's aggressive behavior, low social competence, poor coping skills, low self esteem, and poor peer relationships (Coie et al., 1993; Earls, 1980; Jenkins, Bax, & Hart, 1980; Richman, Stevenson, & Graham, 1982; Rutter, 1980).

The second phase of treatment, Parent-Directed Interaction (PDI), introduces specific behavior management techniques to address disruptive behavior. Patterson's (1982) coercion theory also provides a transactional account of early disruptive behavior (cf. Foote et al., 1998) in which child disruptive behavior disorders are inadvertently established and/or maintained by the parent-child interactions. While not disputing the importance of either the biological underpinnings of behavior or positive parent responsiveness, social learning theorists emphasize the contingencies that shape the dysfunctional interactions of disruptive children and their parents. PDI specifically addresses these processes by establishing consistent contingencies for the child's behaviors that are implemented in the context of the positive parent-child relationship established through the CDI interactions. Treatment is guided by assessment and continues until parents master the interaction skills and child behavior problems fall within the normal range (Neary & Eyberg, 2002).

PCIT outcome research has demonstrated statistically and clinically significant improvements in the disruptive behavior of preschool age children (Eyberg & Robinson, 1982; Schuhmann, Foote, Eyberg, Boggs, & Algina, 1998). These studies have documented the superiority of PCIT to wait-list controls (McNeil, Capage, Bahl, & Blanc, 1999; Schuhmann, Foote et al., 1998), classroom controls (McNeil, Eyberg, Eisenstadt, Newcomb, & Funderburk, 1991), and to parent group didactic training (Eyberg & Matarazzo, 1980) and have compared standard treatment to a PCIT treatment in which the PDI phase of treatment preceded CDI (finding minimal differences) (Eisenstadt, Eyberg, McNeil, Newcomb, & Funderburk, 1993).

PCIT outcome studies have specifically demonstrated important changes in parents' interactions with their child, including increased reflective listening and prosocial verbalization, and decreased criticism and sarcasm at treatment completion (Eisenstadt et al. …

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