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

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
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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
• Childrens Miracle Network, Shands Hospital,
  University of Florida

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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
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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

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Common Early Interventions for Children with MR

• Educational and
• community activities
• Rehabilitation activities
• Speech, physical, and
• occupational therapy
• Mental health professionals

• Kobe Mulick, 1995

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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

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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
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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

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Study Design
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Recruitment

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

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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
• Mothers intellectual functioning
• Wonderlic Personnel Test

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Exclusion Criteria

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

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Participants
Waitlist Control (15 families)
3 currently waiting
2 dropped out
10 completed waitlist
3 completed treatment
5 dropped out
2 currently in treatment
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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

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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

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ECBI Change During Treatment
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CBCL Externalizing Scale
d -1.60 p .005
Clinical cutoff
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CBCL Total Score
d -1.31 p .038
Clinical cutoff
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ECBI Intensity Scale
d -1.46 p .003
Clinical cutoff
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ECBI Problem Scale
d -1.35 p .001
Clinical cutoff
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PSI-SF Parental Distress
Clinical cutoff
d .32 p ns
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PSI-SF Parent-Child Dysfunctional Interaction
Clinical cutoff
d -.62 p ns
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PSI-SF Difficult Child
d -.95 p .087
Clinical cutoff
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Do Skills During CDI
d 1.25 p .034
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Dont Skills During CDI
d -1.13 p .001
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Percent Compliance (Alpha) During PDI and Clean Up
d 1.11 p .028
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Parent Directed Interaction Before Treatment
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Parent Directed Interaction After Treatment
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Clean Up Before Treatment
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Clean UpAfter Treatment
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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?