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Skowron EA, Nekkanti AK, Skoranski AM, Scholtes CM, Lyons ER, Mills KL, Bard D, Rock A, Berkman E, Bard E, Funderburk BW. Randomized trial of parent-child interaction therapy improves child-welfare parents' behavior, self-regulation, and self-perceptions. J Consult Clin Psychol 2024; 92:75-92. [PMID: 38059943 PMCID: PMC10894622 DOI: 10.1037/ccp0000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
OBJECTIVE We conducted a large (N = 204) randomized, clinical trial to test the efficacy of parent-child interaction therapy (PCIT) on observed parenting, two key drivers of maladaptive parenting-self-regulation and social cognitions, and child behavior outcomes in a sample of child welfare-involved families. METHOD Participants were randomly assigned to standard PCIT (n = 120) or services-as-usual (SAU; n = 84). The sample was characterized by low household income, significant exposures to adverse childhood experiences, and substance abuse. Intention-to-treat analyses were conducted on multiply imputed data followed by secondary per-protocol analyses. RESULTS Significant PCIT effects emerged on (a) increased positive parenting, reduced negative parenting and disruptive child behavior (small-to-medium intention-to-treat effects and medium-to-large per-protocol effects); (b) gains in parent inhibitory control on the stop-signal task (small-to-medium effects); (c) gains in parent-reported emotion regulation and (d) positive, affirming self-perceptions (small-to-medium effects), relative to the SAU control group. PCIT's effects on gains in parent emotion regulation were mediated by reductions in observed negative parenting. No differences in rates of parent commands or child compliance were observed across conditions. Harsh child attributions moderated treatment impact on parenting skills acquisition. PCIT parents who held harsher attributions displayed greater gains in use of labeled praises and declines in negative talk/criticism with their child, than control group parents. CONCLUSIONS This randomized trial presents the first evidence that PCIT improves inhibitory control and emotion regulation in a child welfare parents and replicates other published trials documenting intervention gains in positive parenting and child behavior in child welfare families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Carolyn M. Scholtes
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, United States
| | - Emma R. Lyons
- Department of Psychiatry, Children’s Hospital Colorado, University of Colorado School of Medicine
| | | | - David Bard
- Department of Developmental Behavioral Pediatrics, University of Oklahoma Health Sciences Center
| | - Alexus Rock
- Department of Psychology, University of Oregon
| | | | - Elizabeth Bard
- Department of Developmental Behavioral Pediatrics, University of Oklahoma Health Sciences Center
| | - Beverly W. Funderburk
- Department of Developmental Behavioral Pediatrics, University of Oklahoma Health Sciences Center
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Smith AB, Cooley DT, Mesman GR, John SG, Wilburn EH, Vanderzee KL, Pemberton JR. Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:839-852. [PMID: 38045836 PMCID: PMC10689672 DOI: 10.1007/s40653-023-00573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 12/05/2023]
Abstract
Young children are particularly vulnerable to traumatic events and the development of posttraumatic stress symptoms, including comorbid disruptive behaviors. Fortunately, several evidence-based interventions have been shown to be effective at decreasing both posttraumatic stress symptoms and disruptive behaviors in young children. This paper provides an overview of three such interventions-Child-Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). An illustrative case study is used to compare how each intervention addresses disruptive behaviors, with a focus on theoretical underpinnings, model similarities, and model differences. The models each have empirical evidence for the treatment of disruptive behavior in young children, and therefore, may be appropriate for treating children with a history of trauma exposure and comorbid disruptive behaviors. Child, caregiver, and environmental factors are essential to consider when identifying an evidence-based intervention for this population.
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Affiliation(s)
- Allison B. Smith
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Daryl T. Cooley
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Glenn R. Mesman
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Sufna G. John
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Elissa H. Wilburn
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Karin L. Vanderzee
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
| | - Joy R. Pemberton
- Department of Psychiatry, University of Arkansas for Medical Sciences, 1210 Wolfe Street, Little Rock, AR 72202 USA
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Belanger K, Gennis H, Ottenbreit N, Racine N. Enhancing attachment-based aspects of PCIT for young children with a history of maltreatment. Front Psychol 2023; 14:1229109. [PMID: 38023060 PMCID: PMC10655231 DOI: 10.3389/fpsyg.2023.1229109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Disruptive behavior difficulties, such as aggression, non-compliance, and emotional outbursts, are common among children exposed to maltreatment. Parent-Child Interaction Therapy (PCIT) is an effective parenting intervention for addressing child behavior difficulties, however, treatment retention and engagement among parents remain a concern in the clinical setting. This paper describes how the delivery of an intervention that teaches attachment theory concepts (Circle of Security-Parenting, COS-P) prior to PCIT can increase engagement and retention among parents of maltreated children and inform new coaching practices. A detailed description of how to extend and integrate COS-P concepts with PCIT for maltreated families using specific strategies is provided. Recommendations, limitations, and next steps for research are presented.
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Affiliation(s)
- Kristine Belanger
- Child Abuse Service, Alberta Children’s Hospital, Calgary, AB, Canada
- Luna Child and Youth Advocacy Centre, Calgary, AB, Canada
| | | | - Nicole Ottenbreit
- Child Abuse Service, Alberta Children’s Hospital, Calgary, AB, Canada
- Luna Child and Youth Advocacy Centre, Calgary, AB, Canada
| | - Nicole Racine
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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Fleming GE, Neo B, Kaouar S, Kimonis ER. Treatment Outcomes of Children with Primary Versus Secondary Callous-Unemotional Traits. Res Child Adolesc Psychopathol 2023; 51:1581-1594. [PMID: 37552366 PMCID: PMC10627936 DOI: 10.1007/s10802-023-01112-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Recent efforts to improve outcomes for young children with conduct problems and callous-unemotional (CU) traits involve adapting treatments to meet the unique needs of this subgroup. However, these efforts have ignored accumulating evidence for distinct primary and secondary variants within the CU subgroup. Existing treatment adaptations uniformly target risk factors associated with primary CU traits and no studies have investigated variant-specific patterns of responsiveness to treatment adaptations among young children with CU-type conduct problems. METHOD Participants were 45 families with a 3- to 7-year-old clinic-referred child (M = 4.84 years, SD = 1.08, 84% boys) with conduct problems and CU traits. Primary and secondary CU variants were defined based on baseline parent-rated anxiety scores. All families received Parent-Child Interaction Therapy adapted for CU traits (PCIT-CU) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems and affective outcomes. RESULTS Linear mixed-effects modeling showed that the rate and shape of change over time in conduct problems differed between variants, such that children with secondary CU traits showed deterioration in defiant and dysregulated behaviors from post-treatment to follow-up, whereas primary CU traits were associated with maintained gains. There were no variant differences in rate of improvement in CU traits. Affective empathy did not improve for either variant. Internalizing problems meaningfully improved by follow-up for children with secondary CU traits. CONCLUSIONS Findings suggest that PCIT-CU is a promising intervention for children with conduct problems and primary CU traits, but may require further personalization for children with secondary CU traits. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000280404).
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Affiliation(s)
- Georgette E Fleming
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia.
| | - Bryan Neo
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Silvana Kaouar
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Eva R Kimonis
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
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Campbell SM, Hawes T, Swan K, Thomas R, Zimmer-Gembeck MJ. Evidence-Based Treatment in Practice: PCIT Research on Addressing Individual Differences and Diversity Through the Lens of 20 Years of Service. Psychol Res Behav Manag 2023; 16:2599-2617. [PMID: 37465048 PMCID: PMC10350409 DOI: 10.2147/prbm.s360302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
Parent-Child Interaction Therapy (PCIT) is an intensive parent support program for caregivers and their children who exhibit difficult-to-manage disruptive behaviors. After more than four decades of research supporting its efficacy for reducing children's disruptive behaviors and improving parent-child relationships, PCIT has become one of the most popular and widely disseminated parenting support programs in the world. The evidence for the efficacy of PCIT can be found in many reviews of randomized clinical trials and other rigorous studies. To add to those reviews, our aim was to provide practical guidance on how PCIT can be part of an evidence-based program for families that depends on practitioner expertise, as well as attention to families' diverse needs. To do this, we describe the evolution of PCIT as practiced in a university-community partnership that has continued for over 20 years, alongside a narrative description of selected and recent findings on PCIT and its use in specific client presentations across four themes. These themes include studies of 1) whether the standard manualized form of PCIT is efficacious across a selection of diverse family situations and child diagnoses, 2) the mechanisms of change that explain why some parents and some children might benefit more or less from PCIT, 3) whether treatment content modifications make PCIT more feasible to implement or acceptable to some families, at the same time as achieving the same or better outcomes, and 4) whether PCIT with structural modifications to the delivery, such as online or intensive delivery, yields similar outcomes as standard PCIT. Finally, we discuss how these directions in research have influenced research and practice, and end with a summary of how the growing attention on parent and child emotion regulation and parents' responses to (and coaching of) their children's emotions has become important to PCIT theory and our practice.
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Affiliation(s)
- Shawna M Campbell
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Tanya Hawes
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Kellie Swan
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Rae Thomas
- Tropical Australian Academic Health Centre, Townsville, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Melanie J Zimmer-Gembeck
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
- Griffith Centre for Mental Health, Griffith University, Gold Coast, QLD, Australia
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Williams DR, Chaves E, Karp SM, Browne NT. Clinical review: Implementation of trauma informed care to optimally impact the treatment of childhood obesity. OBESITY PILLARS (ONLINE) 2023; 5:100052. [PMID: 37990746 PMCID: PMC10662032 DOI: 10.1016/j.obpill.2022.100052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/15/2022] [Indexed: 11/23/2023]
Abstract
Background Traumatic events that occur in infancy, childhood, and adolescence can be impactful over the course of a lifespan. Adverse childhood experiences (ACEs) are associated with chronic health problems and mental illness, and can negatively impact educational and job opportunities. There is a growing body of evidence about the relationship between ACEs and the risk of childhood obesity. Trauma informed care (TIC) is an approach to patient care both at the clinical and organizational level that is responsive to the impact past trauma can have on an individual. Methods This clinical review will focus on the impact of toxic stress from trauma on the child through threats to normal physiology, including the manifestation of obesity through energy regulation pathophysiology, followed by a discussion of TIC principles. Available resources and how trauma informed principles can be used in practice are discussed using case study methodology. Results TIC programs recognize the impact of trauma on both patients and clinicians. TIC implementation includes application of TIC four assumptions and six key principles out-lined by Substance Abuse and Mental Health Services Administration's guidance. Clinicians supported by well-designed systems recognize that disclosure is not the goal of TIC; instead, broad trauma inquiry, proceeding to risk and safety assessment if indicated, and connection to interventions is the focus. Best practice communication allows clinicians to access information without retraumatizing the patient with ongoing repetition of their trauma experience. Conclusion Combining the pillars of obesity treatment (i.e., nutrition, physical activity, behavior therapy, medical management) with the tenets of TIC (realize, recognize, respond, resist re-traumatization) affords patients holistic, intentional care and family support. The desired outcomes of TIC align with goals of obesity treatment in children, namely improvement of health and quality of life, sense of self (e.g., body image and self-esteem), and prevention of negative health outcomes.
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Affiliation(s)
- Dominique R. Williams
- The Ohio State University College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA
| | - Eileen Chaves
- Neuropsychology & Pediatric Psychology, The Ohio State University, College of Medicine, Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LAC, Suite 5F, Columbus, OH, 43215, USA
| | - Sharon M. Karp
- Vanderbilt University School of Nursing, 461 21st Ave South, Nashville, TN, 37240, USA
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Druskin LR, Han RC, Phillips ST, Victory EJ, Aman E, Tiano J, Stokes J, McNeil CB. The Dissemination of Parent-Child Interaction Therapy in West Virginia during the Opioid Epidemic and COVID-19 Pandemic: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15085. [PMID: 36429803 PMCID: PMC9690909 DOI: 10.3390/ijerph192215085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
The devastating impact of the opioid crisis on children and families in West Virginia was compounded by the COVID-19 pandemic and brought to light the critical need for greater mental health services and providers in the state. Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for child externalizing symptoms that teaches parents positive and appropriate strategies to manage child behaviors. The current qualitative study details barriers and facilitators to disseminating and implementing PCIT with opioid-impacted families across West Virginia during the COVID-19 pandemic. Therapists (n = 34) who participated in PCIT training and consultation through a State Opioid Response grant were asked to provide data about their experiences with PCIT training, consultation, and implementation. Almost all therapists (91%) reported barriers to telehealth PCIT (e.g., poor internet connection, unpredictability of sessions). Nearly half of therapists' cases (45%) were impacted directly by parental substance use. Qualitative findings about the impact of telehealth and opioid use on PCIT implementation are presented. The dissemination and implementation of PCIT in a state greatly impacted by poor telehealth capacity and the opioid epidemic differed from the implementation of PCIT training and treatment delivery in other states, highlighting the critical importance of exploring implementation factors in rural settings.
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Affiliation(s)
- Lindsay R. Druskin
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
| | - Robin C. Han
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
| | - Sharon T. Phillips
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
| | - Erinn J. Victory
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
| | - Emily Aman
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
| | - Jennifer Tiano
- Department of Psychology, Marshall University, Huntington, WV 25755, USA
| | - Jocelyn Stokes
- Department Behavioral Medicine and Psychiatry, School of Medicine Eastern Division, West Virginia University, Martinsburg, WV 25401, USA
| | - Cheryl B. McNeil
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA
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Utilizing Parent-Child Interaction Therapy with Trauma-Directed Interaction in a Young Male in Out of Home Care Who Had Experienced Trauma. Clin Case Stud 2022. [DOI: 10.1177/15346501221130532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Child abuse and neglect in young children can lead to trauma-related stress symptoms that can be challenging to manage. Parent-Child Interaction Therapy (PCIT), a strong evidence-based behavioral parent training program used for young children with behavior issues, has been used in its traditional form with increasing frequency with children and families who have trauma histories, with clinicians tailoring PCIT to use with children who have experienced trauma. Trauma-Directed Interaction (TDI) is a new systematic adaption to the standard PCIT parent training program that has the potential to help treat trauma in younger children. TDI includes several trauma-informed techniques that are added to a course of standard PCIT treatment including psychoeducation regarding trauma, recognition of feelings, and emotional regulation. This case study illustrates the use of a manualized trauma adaptation to PCIT (TDI) with a three-year-old boy who had a history of child maltreatment and his caregiver. This case provides a summary of the progression of this intervention and the results obtained. Results from the case indicated that TDI treatment was effective in not only reducing child trauma and behavioral symptoms but also in reducing mild caregiver mental health concerns. The next steps for TDI treatment and need for further research are discussed.
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