Parent Child Interaction Therapy for Children with Disruptive Behavior and Developmental Disabilities

By McDiarmid, Melanie D.; Bagner, Daniel M. | Education & Treatment of Children, May 2005 | Go to article overview

Parent Child Interaction Therapy for Children with Disruptive Behavior and Developmental Disabilities


McDiarmid, Melanie D., Bagner, Daniel M., Education & Treatment of Children


Abstract

Children with developmental disabilities (DD) often present with comorbid disruptive behavior problems that may negatively affect their education, treatment, and social interactions. Therefore, treatments that reduce disruptive behavior in children with DD are critical. Three characteristics strongly suggest that PCIT is an appropriate treatment choice among children with DD: PCIT shares several features with treatments that have demonstrated efficacy for children with DD in single case design studies; PCIT needs little modification to be effective with children with DD; and PCIT is an evidence-based treatment for disruptive behavior in typically developing children. Techniques for adapting PCIT for children with DD are presented. Further research is suggested to augment anecdotal evidence for the effectiveness of PCIT with this population.

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Developmental disabilities (DD) refer to any chronic physical or mental condition of childhood that results in the child acquiring cognitive and adaptive skills at a slower rate than same-aged peers (Coleman, 1999). The most common conditions include mental retardation (MR), pervasive developmental disorders (e.g., autism), cerebral palsy, and spina bifida (myelomeningocele). Although children with primary sensory deficits (i.e., blindness or deafness) also may be classified as developmentally disabled, their treatment needs are unique and largely outside the scope of this discussion. Conditions associated with DD display varied etiologies, including genetic syndromes, metabolic disorders, exposure to environmental toxins, and perinatal complications. Some degree of cognitive deficit is associated with all of these conditions, as are difficulties in other areas of functioning (e.g., motor development, social interactions, language; Levy, 1996).

Disruptive behaviors are often a concern and source of stress among parents of young children with and without DD. In typically developing children, particularly preschoolers, behaviors such as noncompliance, aggression, rule-breaking, and property destruction, are among the most frequent reasons for referral for psychological treatment. It is estimated that between 2% and 16% of children meet criteria for a disruptive behavior disorder such as Oppositional Defiant Disorder or Conduct Disorder, depending on the population studied (Loeber, Burke, Lahey, Winters, & Zera, 2000). Without treatment, these behaviors can escalate into more serious delinquent and antisocial behavior (Loeber, Green, Lahey, & Kalb, 2000). In contrast, several researchers have shown success in treating these behaviors in typically developing preschoolers.

Children with DD are more likely to display disruptive behaviors than their typically developing peers. For example, an estimated 40% of children with MR display some degree of disruptive behavior in childhood. In one study, nearly half of all clinic-referred children and adolescents with MR were referred due to disruptive behavior. The association between DD and disruptive behavior may have several explanations. Disruptive behavior may be due to frustration based on discord among the child's needs, skills, and environmental demands. A primary example of this phenomenon occurs when children become frustrated at their inability to verbally express their needs, resulting in aggression or temper tantrums. Children's disruptive behavior may also have an organic cause, such as seizure activity or thyroid dysfunction. Medication side effects are another potential etiology that must be considered for children with DD and disruptive behavior. Finally, the child's disruptive behavior may be associated with a psychiatric diagnosis. While diagnoses of Oppositional Defiant Disorder, Conduct Disorder, or Attention Deficit Hyperactivity Disorder are most common among children with disruptive behavior, depressive or anxiety disorders may also be present.

Disruptive behavior alone is associated with several negative outcomes such as school problems and later delinquency. …

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