Parent-Child Interaction Therapy: Theory and Research to Practice

This chapter will focus on the theory behind and research on Parent-Child Interaction Therapy (PCIT), a treatment developed for young children with disruptive behavior problems. We will describe and provide details about PCIT, which is based on both attachment and social learning models, and incorporates an innovative approach to treatment in which therapists coach caregivers “live” via a wireless headset while each caregiver interacts with their child. In addition, we will review research that has examined PCIT with a variety of diverse populations (e.g., children with developmental delay, physical abuse histories, anxiety and depression, and children from underrepresented racial and ethnic minority families), settings (e.g., clinic, home, school) and formats (e.g., individual, group, intensive). Finally, we will present a case study of PCIT with a child younger than 2 years to demonstrate the effectiveness of PCIT and highlight some common challenges and pitfalls that clinicians may face in clinical practice

Changes in Parental Prosody Mediate Effect of Parent-Training Intervention on Infant Language Production

Objective: Parent-training interventions to reduce behavior problems in young children typically coach parents on the content of their speech, but rarely assess parents' prosody during parent-child interactions. Infant-directed speech helps shape the parent-infant relationship and promote language development, which predicts adaptive behavioral outcomes in children. The current study examined (a) the effect of a parent-training intervention on parents' vocal cues in interactions with their infant and (b) whether parental prosody mediated the impact of the intervention on infant language production. Method: Sixty families with 12- to 15-month-old infants (47% female; 95% of Hispanic/Latino ethnicity) participated in the Infant Behavior Program (IBP), a brief home-based adaptation of Parent-Child Interaction Therapy, or received standard pediatric care. Speech analysis was performed on mothers' (n = 40) utterances during infant-led play pre- and postintervention. Infants' number of utterances spoken during play was assessed at pre- and postintervention, and at 3- and 6-month follow-ups. Results: Mothers who received the IBP spoke with greater pitch range and slower tempo postintervention, when controlling for baseline prosody. Change in these vocal cues, which are typical of infant-directed speech, mediated the effect of the intervention on infants' word production after 6 months. Conclusions: Interventions targeting the content of parents' speech during parent-infant interactions may lead to changes in parental prosody, which may be beneficial for infants' language development. Impaired linguistic abilities in infancy are strongly associated with behavior problems in later childhood; thus, these findings highlight a potential mechanism for intervention efficacy in promoting positive socioemotional and behavioral outcomes. What is the public health significance of this article? Interventions targeting parent behaviors in the context of the parent-infant relationship may promote the use of infant-directed speech prosody. Parents' use of these vocal cues may be beneficial for infants' language development, which has been associated with adaptive socioemotional and behavioral outcomes in later childhood

Impact of a Behavioral Parenting Intervention in Infancy on Maternal Emotion Socialization

Research has demonstrated the effect of parent emotion socialization on later child emotion development and behavior. Given these findings, the goal of the present study was to examine the effect of an early parenting intervention on a component of emotion socialization: parent emotion talk. We also examined the indirect effect of behaviorally-based parenting skills on the relation between the intervention and parent emotion talk. Participants were 58 mothers and their 12- to 15-month-old infant. Families were randomly assigned to standard pediatric primary care or a brief in-home intervention targeting parenting skills to promote positive infant behavior. Families completed assessments at baseline, post-intervention, and a 3-month follow-up. Assessments included a 10-min infant-led play task, which was coded for parent emotion talk. Results demonstrated a significant effect of the intervention on parent emotion talk. Specifically, mothers in the intervention group displayed a higher frequency of parent emotion talk at post-intervention. Indirect effects of behaviorally-based parenting skills were significant, demonstrating that increases in behaviorally-based parenting skills at the post-intervention led to increases in parent emotion talk at the follow-up. Findings highlight the effect of a brief, home-based behavioral parenting intervention with infants on maternal emotion socialization

Parent-Child Interaction Therapy for Children with Developmental Delay: The Role of Sleep Problems

Sleep problems are common and associated with externalizing behavior problems in young children, particularly among young children with developmental delay (DD). The aims of the current study, which was a secondary data analysis of 2 previously conducted randomized controlled trials, were to assess whether parent-child interaction therapy (PCIT) led to decreases in child sleep problems and whether initial sleep problems moderated the effect of PCIT on child behavior.Methods:The study participants were 44 children (M = 49.19 months, SD = 13.1) with DD or borderline DD and with co-occurring clinically significant levels of externalizing behavior problems and their mothers (M = 35.9 years, SD = 7.3). These participants were randomly assigned to either an immediate treatment group or a waitlist control group.Results:Findings revealed a significant direct effect of PCIT on decreases in sleep problems. Additionally, moderation analyses revealed that lower levels of child sleep problems at pretreatment were associated with greater improvements in observed child compliance compared with higher levels of child sleep problems at pretreatment.Conclusion:This study extends previous findings by providing support for the preliminary efficacy of PCIT in reducing sleep problems in children with DD and borderline DD and highlighting the role of sleep problems as a factor associated with differential treatment effects in behavioral parenting intervention research

A Step Beyond Maternal Depression and Child Behavior Problems: The Role of Mother–Child Aggression

Previous researchers have identified problematic mother–child interaction patterns as a potential pathway through which maternal depressive symptoms impact child behavior problems, but could not establish the temporal precedence of these associations. This longitudinal study investigated mother–child aggression as a mechanism in the association between maternal depressive symptoms that occurred during infancy and subsequent child behavior problems among high-risk families. Two hundred thirty-four socioeconomically disadvantaged families were recruited from neighborhoods with high rates of family violence. During infancy (12–18 months), early childhood (4 years), and middle childhood (6 years), mothers reported their current depressive symptoms and use of psychological and physical aggression with their child. During early and middle childhood, mothers reported their children’s behavior problems. Using path analyses, a temporal process was identified in which mother–child aggression during early childhood mediated the association between maternal depressive symptoms during infancy and higher levels of externalizing behavior problems during middle childhood. Mother–-child aggression did not mediate the association between maternal depressive symptoms during infancy and higher levels of internalizing behavior problems during middle childhood. Early maternal depressive symptoms that occur during infancy are important risk factors for subsequent mother–child aggression, which, in turn, contributes to more child externalizing behavior problems. Therefore, screening mothers for depressive symptoms and providing intervention and prevention services to improve mother–child interactions may be crucial to preventing the exacerbation of externalizing behavior problems. Additional research is needed to identify pathways to child internalizing behavior problems

Effect of Therapist Coaching Statements on Parenting Skills in a Brief Parenting Intervention for Infants

Behavioral parenting interventions have been shown to decrease early childhood behavior problems by improving parenting skills. Few studies have examined the impact of therapist coaching statements on parenting skill acquisition, especially among ethnic minority families and non-English-speaking families. In this study, we examined therapists’ use of responsive and directive coaching statements during the first coaching session in a brief parenting intervention, the Infant Behavior Program (IBP), on changes in parenting skill acquisition. Participants were 24 mothers of 12- to 15-month-olds, with elevated levels of behavioral problems from primarily Latinx and low-income backgrounds. Mothers who heard more responsive coaching from their therapist showed greater increases in positive parenting skills. Spanish-speaking therapists used fewer responsive coaching statements and more commands, however, language spoken did not moderate the effect of these statements on changes in parenting skills. Responsive coaching statements in English and Spanish had a positive impact on parenting skill acquisition

Predicting BMI in young children with developmental delay and externalizing problems: Links with caregiver depressive symptoms and acculturation

Background: Caregiver depression is associated with increased risk for childhood obesity. However, studies assessing the relation between caregiver depression and childhood obesity have focused primarily on typically developing, school-aged children and have not examined the influence of cultural factors. Objectives To evaluate the association between caregiver depressive symptoms and body mass index (BMI) scores in young children with developmental delay (DD) and externalizing behavior problems, as well as the moderating role of acculturation and enculturation on this association. Methods: We examined the association between caregiver depressive symptoms and child BMI scores in 147 3-year-old children with DD and elevated levels of externalizing behavior problems. Caregivers of all participating children self-identified as coming from cultural minority backgrounds. We also examined the association between caregiver depressive symptoms and child BMI across levels of caregiver acculturation and enculturation. Results: Higher levels of caregiver depressive symptoms were associated with higher child BMI scores (b = .189, p = .001). Acculturation significantly moderated the association between caregiver depressive symptoms and child BMI scores (b = .21, p = .01), such that the association was stronger for more acculturated caregivers. Enculturation was not a significant moderator. Conclusions: Caregiver depressive symptoms may confer elevated risk for child obesity when caregivers are highly acculturated to the United States, suggesting clinicians should consider levels of acculturation to optimize services for children and families from cultural minority backgrounds

Parent Training and Skill Acquisition and Utilization Among Spanish- and English-Speaking Latino Families

In the U.S., there is a growing Latino population, in which parents primarily speak Spanish to their children. Despite the evidence that language preference is associated with level of acculturation and influences parenting practices in these families, no study has compared how Spanish- and English-speaking Latino families acquire and utilize the skills taught during parent-training programs such as Parent-Child Interaction Therapy (PCIT). Twenty-seven mother-infant Latino dyads received a home-based adaptation of the Child-Directed Interaction (CDI) phase of PCIT as part of a larger randomized control trial. Most infants were male (63%), and their average age was 13.7 months (SD = 1.43). Most families (52%) lived below the poverty line. The Dyadic Parent-Child Interaction Coding System-Third Edition (DPICS-III) was employed to evaluate PCIT skills at baseline and post-treatment, as well as at 3- and 6-month follow-up, assessments. We conducted multiple linear regression analyses among Spanish-speaking (55%) and English-speaking (45%) families to examine differences in acquisition and utilization of do and don’t skills at each assessment while controlling for mother’s education. Results yielded no group differences in the acquisition rate of do or don’t skills at any time point. However, Spanish-speaking mothers used significantly more don’t skills than English-speaking mothers at each assessment. Specifically, Spanish-speaking families used significantly more commands at baseline, post-treatment, and the 6-month follow-up assessments, as well as more questions at post-treatment and at the 6-month follow-up assessments. These findings highlight the importance of addressing cultural values such as respeto to ensure culturally robust parent-training programs for Latino families

Infant-directed language following a brief behavioral parenting intervention: The importance of language quality

Behavioral parenting interventions decrease early childhood behavior problems and increase positive parenting skills. However, few studies have examined the impact of low intensity interventions for infants at risk for behavior problems on changes in parent language. This study examined the effect of a brief parenting intervention, the Infant Behavior Program, on changes in parent linguistic input and its influence on infant language. Participants were 58 mothers and their12- to 15-month-olds, with elevated levels of behavioral problems. Mothers and their infants were from primarily Hispanic and low-income backgrounds. Mother-infant dyads were randomly assigned to receive the Infant Behavior Program or standard pediatric primary care. Mothers receiving the Infant Behavior Program provided more linguistic input, which indirectly influenced infant language, and suggest targeting infants at risk for behavior problems can have a broader impact on language development