INTRODUCTION:

The influence of parenting practices on the child’s adjustment and academic readiness makes parenting interventions important in the early childhood. Children are at risk for adjustment problems when they enter school with social, emotional or behavioral problems. Effective parenting interventions can prevent these problems and strengthen parenting practices by increasing parental confidence. One of the family based parenting interventions is Parent Child Interaction Therapy (PCIT).

What is Parent-Child Interaction Therapy (PCIT)?

Parent-child interaction therapy (PCIT) is a family-centered and empirically-supported treatment approach for abused and at-risk children ages 2½ to 12 and their biological or foster caregivers. It is designed for families with children who are experiencing a broad range of behavioural, emotional and family problems.

PCIT places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns. It was first proposed by Eyberg et al in 1995 as a manualized parent coaching intervention for children that is based on the assumption that improving the parent child interaction will result in improvement in both child and family functioning ^{1, 2}. PCIT is developed based on various theories such as attachment theory, social learning theory, family systems theory, communication theory, cognitive behavioural principles etc.

During PCIT, therapists coach parents specific skills while they interact with their children. Therapists guide parents by sitting behind a one-way mirror and coaching through an “ear bug” audio device. Parents are taught specific ways to praise children's appropriate behaviour and to ignore undesirable behaviors by providing consistent, appropriate positive and negative consequences following the child's behaviour. They also learn to give clear, age-appropriate instructions thereby establishing a nurturing and secure relationship with their children.

Why PCIT in child care?

The goals of PCIT are to improve the quality of the parent-child relationship and, both child and family functioning ^{1, 2}; decrease the child behavior problems with an increase in prosocial behaviors; improve parenting skills, including positive discipline and reducing parenting stress. The characteristic feature of this approach is the use of live coaching and the treatment of both parent and child together.

Components of PCIT

PCIT consists of two components:

1. Child-directed interaction (CDI)

Child Directed Interaction (CDI) is similar to play therapy in which parents engage their child in a play situation with the goal of strengthening the parent-child relationship. They learn to decrease the negative aspects of their relationship with their child and to develop and increase positive and supportive communication consistently as they are encouraged to use skills represented in the acronym “PRIDE” i.e., Praise the child; Reflect the child’s Statements; Imitate the child’s play; Describe the child’s behaviour; Enthusiastic play. Parents are also taught to ignore inappropriate behaviour (unless dangerous or destructive), avoid giving commands and criticizing.

Suggested Toys for CDI include creative, constructive toys, like building blocks, magnetic blocks, construction-straws, crayons and paper, chalkboard, colored chalk etc. Certain toys should be avoided during PCIT. E.g. toys such as bats, balls, boxing gloves, punching bag (encourages rough play), toy guns, toy swords, super-hero figures (facilitate aggressive play), paints, markers, bubbles, scissors, play dough, hammer (require limit setting by parents), board games, card games (with pre-set rules), books, video games (discourage conversation), puppets, and costumes (make parent/child imagine that they are someone else).

2. Parent-directed interaction (PDI)

Parent Directed Interaction (PDI) resembles clinical behavior therapy in that parents learn to use specific behavior management techniques as they play with their child (pcit.phhp.ufl.edu). Parents are taught time out procedures and how to manage children’s behavior in real world settings. They also learn to use effective commands and specific behavior management techniques. In this component, parents are taught and "coached" the elements of effective discipline and child management skills. Specific skills include the following: be specific with commands; state every command positively; be respectful and polite; give essential commands only; have neutral tone of voice; use time out procedure.

In both components of the therapy, parents are given the opportunity to practice these skills until mastery is acquired and the child's behavior is improved which may require 14 to 20 sessions, each lasting about 1 hour.

Who require PCIT?

· Children between the ages of 2 and 12 years of age

· Children exhibiting chronic behavioral problems at home, school, preschool, or daycare such as:

o defiance

o oppositional behaviors

o refusing to follow directions

o acting out and disruptive behavior in school settings

o aggression toward parents, siblings, and/or other children in the home

o swearing

o constantly argue with parents/ care givers

o frequent temper tantrums

· Children who may be on medication to manage their behavioral problems

· Children who are shy, withdrawn or have low self-esteem

Contraindications

PCIT is contraindicated when the following exist:

Ø Severe, untreated adult psychopathology

Ø Severe marital discord

Ø Children too young or old for PCIT

Ø Severe ADHD

Ø Parents/caregivers who are known perpetrators of sexual abuse

Characteristics of PCIT

v Strong theoretical base

v Problem solving approach: focuses on parenting/child behaviour problems and develop appropriate solutions.

v Action based: Activities are included in the intervention to improve parenting skills and child behaviour.

v Collaborative goal setting: Parents identify behaviour/relationship problems and set goals to achieve with the help of the care giver.

v Specific parenting strategies: parents are taught specific, practical and concrete parenting strategies.

v Positively oriented: PCIT focuses on improving relationships and behaviour.

v Consultative: Care giver is a consultant in PCIT.

v Comprehensive: PCIT considers parent and child together for the intervention.

Benefits of PCIT

· Reduces behavior problems among young children.

· Improves the parent-child relationship through positive parenting attitudes ³

· Reduces stress ⁴

· Decreases the risk for Child Physical Abuse and breaks the Coercive Cycle⁵

Limitations of PCIT

PCIT may not be effective or appropriate when children are very young, or parents have limited or no contact with the child or have serious mental or physical problems. It is also ineffective when parents are sexually abusive.

Application of PCIT in nursing

PCIT is a useful intervention for nurses while dealing with children having behavioural problems and/or children at risk of or undergoing maltreatment. Various research studies have shown that improved parenting skills ^3,6,7, reduction in behaviour problems of children^{1-
3, 8 -13}, and better quality parent-child relationship⁸ as the best outcomes of PCIT. The effect of PCIT on child behaviour is found to be long lasting¹⁴ with reduction in the risk of child abuse and maltreatment⁴. It has also shown to be effective in treating other issues such as separation anxiety, depression, self-injurious behavior, attention deficit hyperactivity disorder (ADHD), and adjustment following divorce ^{15, 16}.

CONCLUSION:

PCIT is an innovative parent-training strategy. It is also found to be successful with child maltreatment. Though there are challenges to the wide spread use of it this intervention is extremely useful in building nurturing relationships in the family thereby providing healthy environments for children. Behavioural problems of children reduce when parents develop positive attitude and nurturing relationship with them.

REFERENCES:

1. Eyberg SM, Robinson A. Parent-child interaction training: Effects on family functioning. Journal of Clinical Child Psychology. 11; 1982:130-137.

2. Foote R, Eyberg SM, and Schuhmann E. Parent-child interaction approaches to the treatment of child behavior disorders. In TH Ollendick and RJ Prinz (Eds.) Advances in Clinical Child Psychology, Plenum Press, New York.1998; 20.

3. Hembree-Kigin TL, and McNeil CB. (1995). Parent-child interaction therapy.: Plenum Press, New York. 1995

4. Timmer S G, Urquiza A J, Zebell N M, McGrath, J M. Parent-child interaction therapy: Application to maltreating parent-child dyads. Child Abuse & Neglect. 29(7); 2005: 825-842.

5. Chaffin M, Silovsky JF, Funderburk B, Valle LA, Brestan EV, Balachova T, et al. Parent-child interaction therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology. 72(3); 2004: 500–510.

6. Brestan EV, Eyberg SM, Boggs SR, Algina J. Parent-child interaction therapy: Parents' perceptions of untreated siblings. Child and Family Behavior Therapy. 19(3); 1997: 13-28.

7. Chaffin M, Silovsky JF, Funderburk B, Valle LA, Brestan EV, Balachova T, Jackson S, etal. Parent-Child Interaction Therapy with physically abusive parents: Efficacy for reducing future abuse reports. Journal of Consulting and Clinical Psychology. 72(3); 2004.

8. Boggs SR, Eyberg SM, Reynolds LA. Concurrent validity of the Eyberg Child Behavior Inventory. Journal of Clinical Child Psychology. 19; 1990: 75-78.

9. Brinkmeyer M. and Eyberg SM. (2003). Parent-child interaction therapy for oppositional children. In A.E. Kazdin and J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents Guilford, New York. 2003; 204-223.

10. Gallagher, N. Effects of parent-child interaction therapy on young children with disruptive behavior disorders. Bridges: Practice-Based Research Syntheses. 1; 2003: 1-17. Available from www.evidencebasedpractices.org/bridges/bridges_vol1_no4.pdf

11. McNeil C, Eyberg S, Eisenstadt T, Newcomb K, Funderburk B. Parent-child interaction therapy with behavior problem children: Generalization of treatment effects to the school setting. Journal of Clinical Child Psychology. 20; 1991: 140-151.

12. Nixon RD, Sweeny L, Erickson DB, Touyz SW. Parent-child interaction therapy: A comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Consulting and Clinical Psychology. 71(2); 2003: 251-260.

13. Schuhmann EM, Foote R, Eyberg SM, Boggs S, Algina J. Parent-child interaction therapy: Interim report of a randomized trial with short-term maintenance. Journal of Clinical Child Psychology 27; 1998: 34-45.

14. Hood KK, Eyberg SM. Outcomes of Parent-Child Interaction Therapy: Mothers' reports of maintenance three to six years after treatment. Journal of Clinical Child and Adolescent Psychology. 32(3); 2003: 419-429.

15. Johnson BD, Franklin LC, Hall K, Prieto LR. Parent training through play: Parentchild interaction therapy with a hyperactive child. The Family Journal: Counseling and Therapy for Couples and Families. 8; 2000: 180-186.

16. Pincus DB, Choate ML, Eyberg SM, Barlow DH. Treatment of young children with separation anxiety disorder using parent-child interaction therapy. Cognitive and Behavioral Practice. 12; 2005: 126-135.

Received on 03.01.2013 Modified on 20.01.2013

Asian J. Nur. Edu. & Research 3(1): Jan.-March 2013; Page 18-20