Academic journal article The Journal of Early and Intensive Behavioral Intervention

Keeping Families in Once They've Come through the Door: Attrition in Parent-Child Interaction Therapy

Academic journal article The Journal of Early and Intensive Behavioral Intervention

Keeping Families in Once They've Come through the Door: Attrition in Parent-Child Interaction Therapy

Article excerpt

Abstract

We review existing studies of attrition in Parent-Child Interaction Therapy (PCIT), an empirically supported treatment for preschool-aged children with disruptive behavior disorders. Variables identified as pretreatment predictors of attrition in a statistically derived search for pretreatment predictors included maternal distress, negative maternal verbal behaviors during parent-child interaction, and therapist verbal behaviors during initial parent-therapist interactions. The most frequently reported reasons provided by mothers for premature termination of treatment were logistical problems such as difficulty finding transportation or sibling child care. Continued study of variables related to attrition in PCIT is essential to retention of a greater number of families in treatment.

Keywords: Attrition, Dropout, Parent-Child Interaction Therapy.

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In this article we review studies of attrition in Parent-Child Interaction Therapy (PCIT), an empirically supported treatment for preschool-aged children with disruptive behavior disorders (DBDs). These disorders, which include Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD), affect as many as 16% of children (APA, 2000) and are associated with significant impairments in social, emotional, and educational functioning (Frick & Loney, 1999). Left untreated, DBDs established during the preschool years tend to persist at least through early adolescence (Campbell, 2002). As many as 45% of children with diagnosed CD between the ages of 4 and 12 years continue to meet criteria for CD four years later. The stability of these disorders increases with age, such that older children with CD are significantly more likely to have symptoms persisting into adolescence (Offord et al., 1992).

The persistence of DBDs carries a high societal price tag. Children with behavior disorders account for a larger percentage of health care costs than children with chronic health conditions, such as asthma, diabetes, or epilepsy (Guevara, Mandell, Rostain, Zhao, & Hadley, 2003). DBDs are the most powerful risk factor for subsequent delinquent behavior, including interpersonal violence, substance abuse, and property destruction (Fagot, Loeber, & Reid, 1988). Thus, other costs of DBDs are associated with treatment of juvenile delinquency through intervention and educational programs, with law enforcement, and with family, security, and emotional damages (Frick & Loney, 1999; Werry, 1997).

From many perspectives, research supports the need for early intervention for DBDs. Parent-Child Interaction Therapy (PCIT), an evidence-based treatment for preschool-age children with disruptive behavior disorders outcomes (Brestan & Eyberg, 1998; Gallagher, 2003; McNeil, Filcheck, Greco, Ware, & Bernard, 2001), is based on developmental theory emphasizing young children's dual needs for nurturance and limit setting in parenting to achieve optimal developmental outcomes (Baumrind, 1967, 1991). Treatment includes two phases: a child-directed interaction (CDI) phase focusing on Relationship-enhancement skills to improve the parent-child relationship and increase the child's social skills and self-esteem; and a parent-directed interaction (PDI) phase focusing on skills for directing the child's behavior when needed and following through with structure and consistency to improve child compliance. Each phase of treatment begin with a didactic session in which therapists describe, model, and role-play the skills with the parents. Coaching sessions then follow, in which therapists observe ongoing parent-child interactions and cue and reinforce parent behaviors that successively approximate the pre-set skill mastery criteria. Parents are required to meet these criteria before moving from one phase of treatment to the next and before treatment graduation (Brinkmeyer & Eyberg, 2003; Eyberg, 2005).

During the Child-Directed Interaction (CDI), parents learn specific verbal behaviors that function to reinforce positive child behavior, such as reflecting the child's talk, describing the child's play, and praising the child's positive behaviors with their parent. …

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