Date of Award
Doctor of Philosophy (PhD)
Karen S. Budd, PhD
Sheldon Cotler, PhD
Jocelyn S. Carter, PhD
Early intervention for young children with behavior problems is important for promoting healthy social/emotional development and reducing the risk of persistent and worsening conduct problems (DuPaul, McGoey, Eckert, & VanBrakle, 2001; Lahey et al., 1995; Shaw, 2013). Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for young children exhibiting behavior problems (Eyberg, Nelson, & Boggs, 2008). PCIT aims to promote parents’ use of positive attention and effective discipline skills with their children (Zisser & Eyberg, 2010). Although substantial research has demonstrated the efficacy of PCIT in research settings, far fewer studies have tested its effectiveness with clinically referred samples in community settings.
Pilot and case studies have shown promise that PCIT can be implemented effectively in community settings and produce clinically meaningful results (Budd, Hella, Bae, Meyerson, & Watkin, 2011; Lyon & Budd, 2010; McCabe & Yeh, 2009; Phillips, Morgan, Cawthorn, & Barnett, 2008). However, attrition tends to be higher and treatment often takes longer in community settings (Budd, Danko, & Legato, 2012; Lanier, et al., 2011). The early stage of treatment in PCIT is particularly important, as most attrition occurs in the first stage as compared to the later stage of treatment (Lanier et al., 2011). Learning more about parents’ trajectories across the early phase of treatment and the associated effects on child behavior change has implications for improving the effectiveness of PCIT and reducing treatment attrition with clinically referred and diverse ethnic, racial, and socio-economic populations.
The current study examined data from 48 young children and their families who were referred to a PCIT program in a university-affiliated, community mental health center. Through use of longitudinal multilevel modeling, this dissertation study is the first to describe trajectories of parental skill acquisition using session-by-session observational data in the early stage of PCIT with a clinically referred sample. As hypothesized, all parents showed significant linear increases in the targeted positive skills (i.e., praise, reflections, and behavioral descriptions) taught during the early stage of treatment, and linear decreases in behaviors to avoid (i.e., negative talk, asking questions, giving commands). Parents’ session-by-session ratings of their child’s behavior problems also showed a significant linear decrease across the first phase of treatment. Importantly, the analyses demonstrated that parents’ increases in positive skill use mediated the decreases in child behavior ratings, whereas parents’ decreases in negative skills use did not show a mediating effect.
Several treatment engagement and demographic factors predicted parental skill acquisition. Specifically, parents who attended weekly sessions gained positive skills and decreased negative behaviors faster than parents with more days elapsed between sessions. Single parents showed slower acquisition of positive skills than parents from two-parent households; however, single parents decreased their negative behaviors at a faster rate. Household income, parents’ racial/ethnic minority status, and initial child severity did not predict differing rates of skill acquisition or child behavior ratings across time. Homework completion also did not emerge as a clear predictor of skill gains. Although completers of the first phase of treatment showed faster progress with decreasing negative behaviors than dropouts, they did not differ in positive skill acquisition rates. In summary, the current study demonstrated a mediating effect of parents' session-by-session trajectory of positive skill acquisition on child behavior ratings across the early phase of PCIT, identified several variables related to parents’ rates of target skill gains, and failed to confirm other variables as predictors of change. Implications for treatment and future research directions are discussed.
Legato, Lauren J., "Early Patterns of Change in Parent-Child Interaction Therapy" (2015). College of Science and Health Theses and Dissertations. 116.