By Dr. Jenna Zucchi, Psy.D.
Young children start actively exploring and learning from their environment beginning in toddlerhood and during preschool. Exploration and high activity levels may be developmentally appropriate for children as they enhance their individuality. However, this development may also be met with moodiness, aggression, and frequent limit testing, the youth may refuse to comply with requests, or ignore pleads of “no!” by adults. Disruptive behaviors including aggression, oppositionality, impulsivity, and rigidity occur in almost 25% of preschool age children and is the number one reason for referral to mental health services (Lavigne et al., 1996). Parents may not know what is “normal” for their child, but often bring them for treatment after removal of privileges, yelling, bargaining and pleading, and grounding are no longer effective.
Parent-child interaction therapy (PCIT) was developed by Sheila Eyberg for younger children and their caregiver. PCIT is an empirically-supported treatment and was founded for treating young children with emotional and behavioral disorders. PCIT is also established to treat behavioral concerns related to neurologic impairment, developmental disorders, chronic illnesses, mood and anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and trauma. Maladaptive parent-child attachments are consistently associated with low self-esteem, poor social skills, poor coping abilities, and aggression in addition to parental stress. PCIT emphasizes improving and strengthening the relationship between the parent and child by changing interaction patterns. Based on Baumrind’s developmental research, this treatment combines attachment and social learning theories to change parent-child interactions by teaching parents specific skills via a combination of behavior therapy and play therapy to promote positive parenting practices and child outcomes.
PCIT teaches sensitive and responsive parenting. This style of parenting fosters safety and security in the child allowing the child to more effectively regulate emotions and behaviors. Caregivers learn specific skills during the first phase of treatment; child-directed interaction (CDI), to provide the child with a secure attachment. During CDI, the child leads the play as the parent learns to provide nondirective PRIDE skills. PRIDE skills include praising appropriate behaviors, reflecting talk to show approval and understanding, imitating the play by joining in the activity, describing appropriate behaviors within the play, and lastly enjoying the play by showing enthusiasm. The second phase of treatment begins after the parent masters the CDI. Parent-directed interaction (PDI) encourages behavioral strategies to establish consistent contingencies for child behavior, in essence, shaping new patterns. The parent learns consistent approaches to giving commands and redirecting behaviors while simultaneously incorporating the PRIDE skills to reinforce any appropriate behaviors. They are also taught a specific procedure that utilizes time-outs when a command is not followed. This procedure creates predictability for the child as they learn they can obey to end the time-out. During PCIT, the parent learns to ignore inappropriate behaviors and stops the play if faced with dangerous behaviors. As children learn and enjoy the relationship with their parent, they become better able to tolerate limits and are more resistant to outbursts.
Disruptive behaviors continue to be a high-priority concern as it is extremely prevalent and can progress into greater impairments and increasingly problematic behaviors later in life. PCIT has been shown to have positive changes and lasting impacts on the child’s and family’s functioning. Children are significantly more compliant, less disruptive, have less severe problem behaviors in the home, and are less oppositional. Additionally, research suggests that parenting stress decreases and there are significant improvements in warmth in the relationship. PCIT is just one type of treatment for disruptive behaviors and it can be combined with various other types of interventions to promote greater compliance among youth.
Neary, E. M., & Eyberg, S. M. (2002). Management of disruptive behavior in young children.
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Lavigne, J. V., Gibbons, R. D., Christoffel, K. K., Arend, R., Rosenbaum, D., & Binns, H., et al. (1996). Prevalence rates and correlates of psychiatric disorders among preschool children. Journal of the American Academy of Child and Adolescent Psychiatry, 35(2), 204–214.