Tracking Treatment Progress of Families with Oppositional Preschoolers Jaimee C. Perez, M.S., Stephen Bell, Ph.D., Robert W. Adams Linda Garzarella, B.A., and Sheila M. Eyberg, Ph.D. Department of Clinical and Health Psychology, University of Florida,

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Tracking Treatment Progress of Families with
Oppositional PreschoolersJaimee C. Perez, M.S.,
Stephen Bell, Ph.D., Robert W. AdamsLinda
Garzarella, B.A., and Sheila M. Eyberg,
Ph.D.Department of Clinical and Health
Psychology, University of Florida, Gainesville,
Florida
RESULTS
INTRODUCTION
METHODS
In addition to outcome studies on the efficacy of
psychological interventions, researchers have
recently begun to investigate the trajectory of
change over the course of treatment. Such
research is important for interventions such as
Parent Child Interaction Therapy (PCIT), which
include two phases of treatment with distinct
strategies and objectives for change. The
current study proposes to elucidate the
trajectory of behavior change, as measured by the
Eyberg Child Behavior Inventory (ECBI), across
total number of weeks in treatment, as well as
within both phases of PCIT. The study also
proposes to establish a relationship between
improvement in childrens disruptive behavior and
a decrease in parental ratings of stress, as
measured by the Parenting Stress Index Short
Form (PSI-SF). In the Child Directed Interaction
(CDI) phase, the first phase of PCIT, parents are
taught skills to enhance the effectiveness of
differential social attention, with the main
objective of increasing the childs desirable
behavior via positive attention (labeled praises,
behavioral descriptions of appropriate play) and
decreasing the childs inappropriate behavior via
active ignoring. The expected outcome is that
the childs behavior will begin to improve,
leading to improvement in the quality of the
relationship between parent and child. Early
research on positive attention indicates that it
is effective in changing behaviors, including
increasing study behavior (Hall, Lund, Jackson,
1968), cooperative play (Hart, Reynolds, Baer,
Brawley, Harris, 1968), compliance (Goetz,
Holmberg, LeBlanc, 1975), and attention to task
(Kazdin, 1973 Kazdin Klock, 1973). While some
researchers have found positive attention to be a
necessary factor for the treatment of children
with disruptive behavior disorders (Brestan
Eyberg, 1998 Pelham, Wheeler, Chronis, 1998),
other studies have yielded findings that question
the effectiveness of differential social
attention in decreasing oppositional and
disruptive behavior in children (Herbert et al.,
1973 Roberts, 1985 Roberts, Hatzenbuehler,
Bean, 1981). Hence, the aim of the Parent
Directed Interaction (PDI) phase is to further
reduce childrens problematic behaviors with the
introduction of a mild aversive technique, a
standard time-out from positive reinforcement
procedure. Roberts et al (1981) found that out
of four experimental conditions (attention,
time-out, attention plus time-out, and control)
only the time out condition contributed to an
increase in compliant behavior in his sample.
Similarly, Eisenstadt et al (1993) found that
regardless of order of phase of treatment (CDI
first vs. PDI first), PDI was more effective at
reducing disruptive and noncompliant
behavior. These previous studies suggest that the
skills taught during CDI are effective for
increasing childrens positive behaviors
however, CDI alone may not be sufficient to
reliably decrease undesirable behaviors. Rather,
the skills taught during PDI (e.g., time out) are
probably necessary to address clinically
significant disruptive and noncompliant behavior.
The current study investigates weekly changes in
disruptive behavior across both phases of PCIT.
Consistent with previous literature, we predict
that there will be a significant decrease in the
ECBI Intensity score over the course of PCIT.
Based on the studies reviewed above, we
hypothesize that significant changes in the ECBI
Intensity score will occur during PDI.
Exploratory analyses are predicted to reveal a
significant relationship between parent ratings
of childrens behavior and parent ratings of
stress.
Forty-one families were recruited as part of a
larger study looking at the maintenance of
treatment gains across time in families who have
successfully completed PCIT. Children included
in the study met DSM-IV criteria for Oppositional
Defiant Disorder (ODD) and were between the ages
of 3 and 6 years. During treatment, parents
completed an ECBI and a PSI-SF prior to each
session. For the purpose of this study, only
data collected from the mother was were analyzed.
Mean scores (ECBI Intensity and PSI-SF Total
scores) were calculated for each week/session.
Simple t-test analyses were run to compare scores
at pre- and post-treatment across weeks and
within treatment phase. A Pearson correlation
coefficient was run to analyze the relationship
between the ECBI Intensity score and the PSI-SF
across weeks as well.
t -2.5 (p .0001)
t -5.54, p .0001
RESULTS
t -2.50, p .02
Time series analysis of the mean scores for both
the ECBI Intensity score and PSI-SF total score
show a gradual, yet significant, decline over the
course of treatment. Results of the simple
t-test analyses are presented in the top graph.
Significant correlations were also found between
the pre- and post-treatment ECBI Intensity scores
and the PSI-SF total score, with the significance
of the correlation increasing over the course of
treatment. R values are also provided in the top
graph. Additionally, significant differences
were found within each phase of treatment, with
the ECBI Intensity score decreasing a total of 35
points in CDI and 27 points in PDI. Means and p
values are noted in the bottom graph.
r .76, p.0001
r .55, p.0001
DISCUSSION
X 161
In the present study, the ECBI performed as a
sensitive measure of weekly change in the
intensity of child behavior problems during PCIT.
Consistent with current hypotheses, ECBI scores
declined gradually but significantly over the
course of treatment. In contrast with our
predictions, results revealed similar decreases
in behavior problems during CDI and PDI, with
significant declines in the ECBI intensity scores
across each phase of treatment. These results
challenge previous studies that have questioned
the utility of positive attention as a treatment
for disruptive behavior. As predicted, lower
levels of child behavior problems were associated
with lower levels of parenting stress. This
relationship was significant across all weeks and
grew consistently stronger as the families
progressed in treatment. The current findings
support the utility of the ECBI as a weekly
measure of changes in the intensity of behavior
problems in children. Further, despite the
differing strategies used in CDI and PDI, the
present results suggest that each phase of
treatment provides parenting skills that are
useful in addressing disruptive and noncompliant
child behavior.
p .0113
X 126
X 136
p .0023
X 109
A