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Parent-Child Interaction Therapy for Children with Co-Morbid Disruptive Behavior and Mental Retardation

This study examines the effectiveness of Parent-Child Interaction Therapy (PCIT) in improving behavior and reducing parenting stress in children with co-morbid disruptive behavior and mental retardation. Results indicate that PCIT is effective in improving child behavior and reducing parenting stress, suggesting its potential as a treatment option for this population. Further research is needed to assess the effectiveness of PCIT in children with autism and autistic spectrum disorders.

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Parent-Child Interaction Therapy for Children with Co-Morbid Disruptive Behavior and Mental Retardation

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  1. Parent-Child Interaction Therapy for Children with Co-Morbid Disruptive Behavior and Mental Retardation Daniel M. Bagner, MS Sheila M. Eyberg, PhD, ABPP University of Florida The 6th Annual Parent-Child Interaction Therapy Conference January 28, 2006

  2. Acknowledgements • Child study lab, University of Florida • Advanced graduate student therapists • Undergraduate research assistants • Funding sources • NIMH National Research Service Award (F31 MH068947) • APA Society of Clinical Child and Adolescent Psychology (Division 53) • Center for Pediatric Psychology and Family Studies, University of Florida • Children’s Miracle Network, Shands Hospital, University of Florida

  3. Disruptive Behavior • High prevalence in young children • Most common referral reason to mental health services • High degree of impairment and poor prognosis APA, 2000; Loeber et al., 2000

  4. Disruptive Behavior in Children with Mental Retardation (MR) • Limited research • Higher prevalence • 40% with mild and 47% with moderate MR (Jacobson, 1982) • Over half of children with MR referred for conduct problems (Benson, 1985) • Treatment a high national priority

  5. Common Early Interventions for Children with MR • Educational and community activities • Rehabilitation activities • Speech, physical, and occupational therapy Mental health professionals Kobe & Mulick, 1995

  6. Behavioral Treatments for Children with MR • Positive reinforcement and time out most common techniques • Differential reinforcement to reduce behavior problems • Focus on aggressive behaviors Benson & Aman, 1999; Handen, 1998

  7. Parenting Programs • Parenting interventions superior treatment for children with MR • Primarily address parent skill acquisition and support issues • Limited research on parent training interventions specifically addressing disruptive behaviors Handen, 1998; Walters & Blane, 2000

  8. Parent Child Interaction Therapy (PCIT) • Empirically supported treatment for disruptive behavior in preschoolers • Successfully used clinically with children with MR • Effectiveness for children with MR not yet empirically tested

  9. 4 months 4 months 4 months Study Design

  10. Recruitment • Referral sources • Pediatric health care professionals • Physicians, nurses, psychologists • Speech, physical, occupational therapists • Teachers of pre-K ESE classrooms • Parent support groups • Flyers

  11. Inclusion Criteria • 3 - 6 years old • Oppositional defiant disorder • DISC-IV-P and CBCL • Mild or moderate MR • WPPSI-III • Adaptive behavior deficits • Adaptive Behavior Scale • Mother’s intellectual functioning • Wonderlic Personnel Test

  12. Exclusion Criteria • Sensory impairments (deafness, blindness) • Autism spectrum disorders • Childhood Autism Rating Scale • History of psychosis • Families suspected of child abuse

  13. Immediate Treatment (15 families) 4 currently in treatment 5 dropped out 6 completed treatment Participants Waitlist Control (15 families) 3 currently waiting 2 dropped out 10 completed waitlist 3 completed treatment 5 dropped out 2 currently in treatment

  14. Demographics • Child • 75% male • 68% Caucasian • Mean age of child = 4 • Mean FSIQ = 59 (SD = 11.14) • Family • 80% two-parent families • Mean age of mother = 36; father = 39 • Mean yearly income = 34K

  15. Treatment • Average of 12.8 weekly sessions • CDI time limited (6 sessions) • PDI time unlimited • High treatment satisfaction • Therapy Attitude Inventory = 47.60 • Therapists • Advanced graduate students and interns • Weekly supervision • Treatment Integrity • 97% accuracy; 98% interrater reliability

  16. ECBI Change During Treatment

  17. CBCL Externalizing Scale d = -1.60 p = .005 Clinical cutoff

  18. CBCL Total Score d = -1.31 p = .038 Clinical cutoff

  19. ECBI Intensity Scale d = -1.46 p = .003 Clinical cutoff

  20. ECBI Problem Scale d = -1.35 p = .001 Clinical cutoff

  21. PSI-SF Parental Distress Clinical cutoff d = .32 p = ns

  22. PSI-SF Parent-Child Dysfunctional Interaction Clinical cutoff d = -.62 p = ns

  23. PSI-SF Difficult Child d = -.95 p = .087 Clinical cutoff

  24. “Do” Skills During CDI d = 1.25 p = .034

  25. “Don’t” Skills During CDI d = -1.13 p = .001

  26. Percent Compliance (Alpha) During PDI and Clean Up d = 1.11 p = .028

  27. Parent Directed Interaction Before Treatment

  28. Parent Directed Interaction After Treatment

  29. Clean Up Before Treatment

  30. Clean UpAfter Treatment

  31. Conclusions and Future Directions • PCIT effective for children with MR • Parent skill acquisition • Improved child behavior • Decrease in parenting stress • Qualitative improvements in child speech • PCIT for children with autism and autistic spectrum disorders?

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