a review of a treatment model for children with problem behaviors...
Disruptive Behaviors Defined
Disruptive Behaviors in children can be defined broadly as based upon the symptoms of Oppositional Defiant Disorder and Conduct Disorder as specified in the DSM-IV. These symptoms might be aggression, non-compliance, disruptive classroom behaviors, or delinquency. Research indicates that Disruptive Behaviors emerge from a combination of many child and family factors. Child factors such as temperament or hyperactivity combine with family effects like poverty, stress, anger, or single-parent status, to reinforce child Disruptive Behaviors. Furthermore, Social-Learning Theory asserts that child behavior problems are inadvertently established and maintained by dysfunctional parent-child interactions.
Breaking the Coercive Cycle
Through this cycle of reinforcement, the negative behaviors of these children often increase, as does the escalation of the parent’s discipline strategies. The strong relationship between certain familial situations and child Disruptive Behaviors suggests that a successful treatment should focus on changing parent-child interactions. Parent-Child Interaction Therapy (PCIT) is a short-term treatment for children ages 2-12 that places that emphasis on improving the quality of the parent-child relationship.
Structure of PCIT
PCIT takes place with the parent in a playroom with their child and the therapist behind a one-way mirror communicating to the parent through an earpiece. In the first phase of PCIT, parents are taught specific skills to re-structure their relationship with their child while decreasing any Disruptive Behaviors. Parents are coached to recognize their children’s many positive qualities. When there are behavioral concerns, as parents grow to appreciate their children more, they tend to pay more attention to their positive characteristics, and in turn children become more eager to please and seek negative attention less often. This first phase is particularly appropriate when there has been a separation of child and parent, such as is found when a child is placed into protective custody, foster care, adoption, and in custody disputes.
In the second phase of treatment parents learn to use specific behavior management techniques as they play with their child. This phase is introduced only after families have successfully mastered the first phase of treatment. The clinician works with the parent on managing specific behaviors by using effective time-out procedures, re-direction, rewards and consequences.
Several questionnaires are used at the beginning, middle, and end of the family’s program to gauge improvement in the areas identified by the parent. Each session is also “coded” to graph the parent’s use of the five primary skills and the time-out method taught in PCIT. The program can be conducted in the family’s home, as well as with or without siblings.
Outcome Research
Research has shown that families who have completed PCIT have significant improvements in the parent-child interactions and behavioral problems of children at home and in school. Parents also report a high level of satisfaction with the PCIT treatment program, less personal distress, and more confidence in their ability to manage their child’s behaviors.
Implications for Practitioners
In today’s climate of managed care, clinicians are challenged to utilize short-term, evidenced-based treatment models. After approximately 4 therapy hours, marked improvements can be seen in several areas of family interaction. An average family can expect to invest about 10-16 therapy hours before graduating from the program.
The presence of Disruptive Behaviors in preschoolers predicts anti-social behaviors in adolescence. Given the poor prognosis of untreated Disruptive Behaviors in young children, the utilization of PCIT, one of the only evidence-based and early intervention models, seems not only necessary, but best-practice for young children experiencing behavioral problems.
For more information contact:
Sarah Carlson LMFT
Lisa Andrews LPC
970-472-1207
