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Copyright 2006 Sheila Eyberg
ODD (“No!)– Refuse or defy adult requests– Lose temper easily– Annoy others on purpose
CD (Against the Rules)– Steal things– Destroy things– Start fights/Hurt others
ADHD (Impulsive, Hyperactive, Inattentive)– Have difficulty staying seated– Have difficulty playing quietly– Have difficulty awaiting turn
An Empirically Supported Treatment for
Disruptive Behavior Disorders
Copyright 2006 Sheila Eyberg
Disruptive Behavior Disorders in Preschoolers
Highly persistent
Worsen with time
Strongest risk factor for adolescent delinquency and violent crime
Prevalence up to 20%
Costs to society very high
Can be diagnosed reliably at age 3
Can be treated effectively if treated early
Copyright 2006 Sheila Eyberg
Parent and child together Theoretically grounded Emphasis on restructuring
interaction patterns Not time-limited Assessment-driven Scientifically based Clinically validated Empirically supported
Defining Features of Parent-Child Interaction
Therapy (PCIT)
Coding
Coaching
Parent & Child
Copyright 2006 Sheila Eyberg
PCITParent and Child
Together in Treatment
Focus on changing behaviors of both parent and child
Therapist tailors treatment based on observation of parent-child interactions during treatment
Parent errors in application corrected on-the-spot
Parents can be confident therapist understands their child
Therapists can assess when parents ready to move to next step in treatment
Allows accurate determination of treatment completion
Copyright 2006 Sheila Eyberg
Parent-Child Interaction
Therapy (PCIT)
Parent and child together Theoretically grounded Emphasis on restructuring
interaction patterns Not time-limited Assessment-driven Scientifically based Clinically validated Empirically supported
Coding
Coaching
Parent & Child
Copyright 2006 Sheila Eyberg
Based on Developmental Theory
Baumrind’s Parenting Styles– Authoritarian (high
demandingness, low warmth)– Permissive (high warmth, low
demandingness)– Authoritative (high warmth, high
demandingness)
Nurturance and firm limits both necessary for healthy adolescent outcomes
PCIT draws from both attachment and social learning theory to achieve authoritative parenting
Copyright 2006 Sheila Eyberg
Parent and child together
Theoretically grounded
Not time-limited
Emphasis on restructuring interaction patterns
Assessment-driven
Scientifically based
Clinically validated
Empirically supported
Parent-Child Interaction
Therapy (PCIT)
Copyright 2006 Sheila Eyberg
Not Time-Limited
Termination criteria
– Parent-child observations
• parent mastery of CDI and PDI skills
• Child compliance > 75%
– Parent ratings of disruptive behavior
• Child behavior within ½ SD of normative mean on the ECBI
– Parent self-confidence in parenting
• Parents feel able to handle problems on their own
Termination = Success
Copyright 2006 Sheila Eyberg
PCIT Dropouts and Completers (N = 100)
0
1
2
3
4
5
6
7
8
1 4 7 10 13 16 19 22 25 28 31
Number of Sessions
Fam
ilies
Dropouts
Completers
Maintenance StudyEyberg & Boggs, 2005
Copyright 2006 Sheila Eyberg
Parent and child together
Theoretically grounded
Emphasis on restructuring interaction patterns
Assessment-driven
Not time-limited
Scientifically based
Clinically validated
Empirically supported
Parent-Child Interaction Therapy (PCIT)
Codin
gParent &
ChildCoaching
Copyright 2006 Sheila Eyberg
Structure of PCIT
Assessment sessions Teaching sessions
– Describing– Modeling– Role-playing
Coaching sessions– Parent wears a Bug-in-the-Ear receiver
while playing with child in playroom
– Therapist observes and codes parent and child behaviors at start of session
– Therapist coaches specific skills from observation room using microphone
– Spouses take turns being coached with child and observing spouse’s coaching
Copyright 2006 Sheila Eyberg
Child-Directed Interaction
Parent-Directed Interaction
Parents follow
Play therapy skills Nonverbal
communication of affect
Differential attention
Parents lead
Limit-settingConsistency Problem solvingReasoning
Copyright 2006 Sheila Eyberg
IGNORE annoying, IGNORE annoying, obnoxious behaviorobnoxious behavior
STOP THE PLAY for STOP THE PLAY for dangerous or dangerous or destructive behaviordestructive behavior
Child-Child-Directed Directed
InteractionInteraction
DON’TDON’T– Give Give
CommandsCommands– Ask Ask
QuestionsQuestions– CriticizeCriticize
DODO– PraisePraise– ReflectReflect– ImitateImitate– DescribeDescribe EnthusiasmEnthusiasm
Copyright 2006 Sheila Eyberg
Parent-Directed InteractionParent-Directed Interaction Effective Commands
Direct (telling, not asking)
Positive (what to DO, not stop doing)
Single (one at a time)
Specific (not vague)
Age-appropriate
Given in a normal tone of voice
Polite and respectful (Please... )
Explained before given or after obeyed
Used only when really necessary
Copyright 2006 Sheila Eyberg
The Command ...
Command
No Opportunity
Whoops!(Start over)
Obey
Labeled Praise
Disobey
Back to PlayYEA!
Copyright 2006 Sheila Eyberg
Back to Play
YEA!
Labeled Praise
The Warning ...
Obey Disobey(UH-OH!)
If you don’t [original command], you’ll have to go to the time out chair
Copyright 2006 Sheila Eyberg
You are sitting quietly. Are you ready to
[obey original command]?
Child stays on chair 3 min plus 5 sec quiet
Or doesn’t(OH-OH!)
ObeyAcknowledge
The Chair
Command
Copyright 2006 Sheila Eyberg
Back to chair
Child goes toTime out room1 min + quiet
Child gets off again
The Backup
“You got off the chair before I said you could. If you get off again,
you’ll go to the Time Out Room .”
Child gets off chair
Copyright 2006 Sheila Eyberg
Yes
You’re sitting quietly. Are you ready to
[Obey Original Command]?
Obey
Acknowledge
The First ObeyChild stays
on chair 3 min
Plus 5 sec quiet