The Effects of ParentChild Interaction Therapy on Separation Anxiety Disorder and Internalizing Symp

1
The Effects of Parent-Child Interaction Therapy
on Separation Anxiety Disorder and Internalizing
Symptoms Rhea M. Chase, B.A. and Sheila M.
Eyberg, Ph.D. Department of Clinical and Health
Psychology, University of Florida

• DEMOGRAPHIC INFORMATION
• Original N 100 36 Attrition rate
• Mean age 4.80 years (range from 3 to 6 years)
• Sex 31 girls, 69 boys
• Race 76 Caucasian (76)
• 8 African American (8)
• 1 Asian (1)
• 3 Hispanic/Latino (3)
• 12 Bi-racial (12)

METHOD One hundred families with children
diagnosed with ODD, ranging in age from three to
six years, participated in a treatment outcome
study examining the maintenance of treatment
gains in PCIT. Each family participated in a
pre-treatment evaluation that included assessment
of comorbid child diagnoses as well as rates of
child externalizing and internalizing behaviors
on the CBCL. When families completed treatment,
they participated in a post-treatment evaluation
that included the measures administered at the
pre-treatment evaluation.
WHY PCIT FOR ANXIETY? Data from an ongoing study
of PCIT for children with ODD permits an
exploration of the comorbidity of externalizing
and internalizing disorders on childrens
response to treatment. Specifically, this study
examined two groups of children those who met a
diagnosis of SAD, and those who had clinically
significant internalizing scores on the Child
Behavior Checklist (CBCL). Each of these two
groups were compared to children without a
similar indicator of anxiety. Some researchers
have suggested that PCIT may be an effective
treatment for anxiety in young children with
Generalized Anxiety Disorder (GAD) and Separation
Anxiety Disorder (SAD). Specifically, while
strengthening the parent-child relationship, the
CDI phase of PCIT allows the parent to model
positive coping skills for the child. Further,
the development of SAD has traditionally been
associated with insecure attachment, and PCIT has
been found to increase attachment security within
the parent-child dyad (Floyd Eyberg, 2003).
Thus, PCIT may lead to a decrease in SAD
symptoms. The presence of disruptive behavior
disorders in young children has been linked to
parenting skills deficits such as low levels of
warmth and harsh disciplinary techniques. Low
levels of warmth and high levels of criticism
have also been associated with the development of
anxiety disorders in children. Low levels of
warmth and harsh, inconsistent discipline have
been associated with depression in children, as
well. PCIT effectively targets negative
parenting behaviors in families of children with
disruptive behavior, and is therefore likely to
decrease these same parenting behaviors in
families of children with internalizing problems
and, in turn, decrease the internalizing problems
of the children. Indeed, one study found that
children showed statistically significant
decreases in CBCL internalizing scores at both
mid- and post-treatment (Eisenstadt, Eyberg,
McNeil, Newcomb, Funderburk, 1993). However,
none of the children in that study had clinically
significant levels of anxiety at pre-treatment.
More recently, however, a pilot study examined
PCIT with three children with a primary diagnosis
of SAD (Choate, Pincus, Eyberg, Barlow, in
press). All three children showed significant
reduction in anxiety symptoms after treatment,
along with lower rates of disruptive behavior.

• RESULTS
• To determine whether symptoms of SAD decreased
  significantly during treatment for children
  diagnosed with SAD (n 14), a two way repeated
  measures ANOVA was conducted with time (pre- and
  post-treatment) and diagnostic group (presence or
  absence of comorbid SAD) as independent variables
  and number of SAD symptoms as the dependent
  variable. A significant group by time interaction
  was found F (1,55) 18.93, p lt .001. Planned
  contrasts showed that children meeting diagnostic
  criteria for SAD at pre-treatment had significant
  reductions in their SAD symptoms at
  post-treatment, p lt .001, whereas children in
  the non-SAD group showed no significant change in
  SAD symptoms. Of the children diagnosed with SAD
  before treatment, 80 no longer met diagnostic
  criteria for SAD after treatment.
• Children who met the clinical cutoff (T score gt
  70) on the CBCL internalizing scale (n 14)
  were compared with children who did not (n 47).
  A two way repeated measures ANOVA was conducted
  with time (pre- and post-treatment) and presence
  or absence of clinically elevated CBCL
  internalizing behavior scores as the independent
  variables. The ANOVA revealed a significant time
  by group interaction, F(1,59) 8.36, p lt .01.
  Post hoc analyses indicated that both groups
  demonstrated statistically significant decreases
  in internalizing scores. Of the children who met
  the clinical cutoff before treatment, 93 no
  longer met the cutoff after treatment.
• All children demonstrated a significant decrease
  in number of ODD symptoms during treatment,
  F(1,59) 143.08 , p lt .001, and in their scores
  on the CBCL externalizing scale, F(1, 60)
  196.31, p lt .001.
• Although there was substantial overlap, these
  two groups were not the same.

• HYPOTHESES
• It is hypothesized that children with co-morbid
  ODD and SAD at pre-treatment will show a
  significant reduction in SAD symptoms at
  post-treatment.
• It is also hypothesized that children with
  clinically significant levels of internalizing
  behavior at pre-treatment will demonstrate a
  significant reduction in their internalizing
  scores at post-treatment, to within normal
  limits.

• CONCLUSIONS
• These results suggest that PCIT offers an
  effective approach for treating the anxiety as
  well as the disruptive behavior in young children
  with comorbid ODD and SAD.
• Children with clinical levels of internalizing
  behavior problems before treatment demonstrate a
  significant drop in these problems after
  treatment. This suggests that PCIT may be an
  effective treatment option for a wide range of
  internalizing problems.