Treating Child Disruptive Behavior in High-Risk Families: A Comparative Effectiveness Trial from a Community-Based Implementation

Abstract

Parent management training programs have proven the most effective way to treat child behavior problems. This study reports on an effectiveness trial of a community-based implementation of Parent–Child Interaction Therapy (PCIT) in comparison with the Dutch-developed Family Creative Therapy (FCT). Forty-five children (58 % boys) aged between 32 and 102 months (M = 67.7, SD = 15.9) were referred for treatment, and they and their parent(s) were randomly assigned to PCIT or FCT. Treatment effectiveness was measured primarily by the degree of improvement on child behavior problems, using the Eyberg Child Behavior Inventory. Secondary outcomes included parent and teacher report data and independent observations of parenting skills and child behavior. During the trial, randomization was violated by treatment crossovers (from FCT to PCIT). Intention-to-treat analyzes revealed no significant differences in the primary outcome at 6-month follow-up, but interpretation was hampered by the crossovers. Subsequent treatment-received analyzes revealed significant interaction effects between time and treatment condition, with greater improvements in child behavior and parenting skills for PCIT families compared to FCT families. Analyzes on families that fully completed the PCIT protocol also showed higher treatment maintenance at follow-up. The treatment-received analyzes indicated promising results for the effectiveness of PCIT in treating young children’s disruptive behavior problems in a high-risk population. However, caution in generalizing the conclusions is needed in view of the design difficulties in this study. Suggestions are made for enhancing treatment delivery in daily practice, and clinical implications are noted.

Combinando la terapia de aceptación y compromiso con la terapia de interacción padres-hijos en un niño con graves problemas de conducta

“…Consta de 36 ítems, a través de dos escalas: intensidad y problemas. Los puntos de corte orientativos en población española son puntuaciones superiores a 124 en la escala de Intensidad y a 10 en la escala de Problemas (García-Tornel et al, 1998).Consta de una elevada consistencia interna en sus dos escalas (α > .90) (Colvin, Eyberg, & Adams, 1999;Eyberg & Robinson, 1983;Robinson, Eyberg, & Ross, 1980) y de fiabilidad (r = .75) y validez concurrente (r = .53) (Abrahamse, Junger, Van-Wouwe, Boer, & Lindauer, 2015).…”

Effectiveness of Parent-Child Interaction Therapy (PCIT) in the Treatment of Young Children’s Behavior Problems. A Randomized Controlled Study

“…Except for one study from the Netherlands [ 17 ], PCIT has not been investigated in Europe. Moreover, given the more permissive and democratic parenting styles suggested to be typical of the Nordic countries [ 24 ], parenting programs originating in the U.S.A. may not have the same effect in these countries.…”

“…Promising results have been obtained in studies of ethnic minority populations seeking treatment in usual care [ 27 , 28 ], in treating traumatized children [ 29 ], in the prevention of maltreatment [ 30 ], and for children with mental retardation [ 31 ]. Some of these studies have examined behavioral problems [ 17 , 18 , 27 , 28 , 32 , 33 ].…”

“…In regards to those PCIT-studies who have studied clinic-referred populations with behavioral problems (above), several studies have not offered PCIT as part of their routine services by clinicians usually working in these clinics [ 27 , 28 , 30 – 35 ]. However, a few studies have examined PCIT as part of such routine services in clinic-referred populations who have behavioral problems [ 17 , 18 ].…”

“…Second, in a recent effectiveness trial from the Netherlands, PCIT was compared to Family Creative Therapy (FCT). Both treatments are common therapies in this country and they were conducted by clinicians working in clinics serving the community [ 17 ]. This study was originally planned as a randomized controlled study; despite being promising, the results were difficult to interpret because the randomization was broken by allowing families allocated to the TAU group to switch to the PCIT group if they so desired.…”