Behavior Management Program
Professional help is often sought by parents who are experiencing difficulty managing their young children’s externalizing behaviors such as extreme tantrums and aggression1.
In many behavior management training, the parent is trained as the primary therapist for their own child2. One well-established child behavior therapy approach has been to work with parents in groups. As part of the training, parents typically receive lectures, discussions, and reading assignments. They observe their children’s behaviors at home, record it, and then present their findings to the therapists.
This group treatment approach encourages mutual sharing and feedback in a non-threatening environment and utilizes professional time efficiently.
However, researchers often found little or no difference in outcomes using this type of treatment program.
A New Type of Parent-Child Therapy
In 1969, Hanf presented a new type of parenting training with important changes. It consisted of two stages, labeled the Child’s Game and Parent’s Game3.
Instead of working in groups, this model of intervention involved working directly with the parent-child pairs, modeling in practice, and providing immediate feedback to parents.
To assess treatment effects adequately, this training includes parent reports as well as child therapist observation4.
Since then, this model of behavioral intervention has been widely used to treat challenging behaviors in children. It was also modified to be used in treating a broad range of childhood disorders such as oppositional defiant disorder and conduct disorder5.
In the 1970s, Dr. Sheila Eyberg adapted this model into Parent-Child Interaction Therapy (PCIT) for families with children showing disruptive behaviors 6.
What is PCIT therapy
Parent-child Interaction Therapy is a behavioral parent training that uses a two-stage approach – parent-directed interaction and child-directed interaction. This evidence-based treatment is based on social learning and parent-child attachment theories. It is suitable for children aged 2 to 6 years. The ultimate goal of this approach is to reduce negative behaviors in children by improving parenting skills and parent-child positive interactions.
PCIT has been adapted to help parents and children with Autism spectrum disorder, attention deficit hyperactivity disorder, anxiety disorder, and extreme aggression7.
PCIT Therapy Age Range
PCIT therapy is suitable for children aged two to six years. During this period, parents have the greatest influence on their behavior and emotional development. Peer influence during the preschool years is minimal. It is one of the only times when parents can have such a profound impact on their child’s behavior7.
How does PCIT work
There are two sequential stages in PCIT: child-directed interaction (CDI) and parent-directed interaction (PDI).
In each stage, parents receive teaching sessions to learn specific skills, followed by live coaching sessions.
During a therapy session, the PCIT therapists show parents how to interact with their children through presentation, discussion, live modeling, and role-playing.
Coaching sessions involve the therapist observing the parent-child dyad in a play situation through a one-way mirror and coaching the parent to respond positively, consistently, and predictably to the child’s behaviors using a bug-in-the-ear device.
The parent is provided with real time feedback and assistance in improving interaction skills.
Child-directed interaction (CDI)
Child-directed interaction is the first phase of PCIT in which parents follow their children’s lead.
During the CDI phase, the parent learns to restore positive feelings and foster a positive relationship using traditional play therapy.
The two sets of PCIT skills to use are the “Do” skills and the “Avoid” skills.
Do skills are summarized in PRIDE – praise, reflect, imitate, describe, and enthusiastic.
Positive child behaviors are reinforced using the PRIDE skills while minor negative behaviors are ignored.
Avoid skills are behavior to avoid – commands, questions, criticism, and sarcasm8.
Parent-directed interaction (PDI)
During the second phase, the parent learns new skills to increase child compliance and reduce inappropriate behaviors that are too harmful to be ignored.
The parent plays the role of a behavior therapist by leading the child’s activity. They learn to give clear and effective commands by providing consistent consequences, such as praise for compliance and time out for non-compliance.
The parent is further asked to practice in the daily 5-minute parent-child play interaction9.
Is it effective
Studies show that these evidence-based interventions result in a marked decrease in child behavior problems and negative parent behavior.
There are significant improvements in the lives of children and families.
In addition to fewer behavioral problems, parents reported better family dynamics and a more positive attitude toward their children.
They expressed high satisfaction with the PCIT program, believing their child’s behavior had improved directly as a result of it.
In the dyadic parent training, observation and immediate feedback worked better than self-reporting in group settings or feedback from self-reporting.
The positive changes in parent behavior and reduction in negative parenting practices also contributed to children retaining their prosocial behaviors.
The parents were more satisfied (and reinforced) with relatively short treatment sessions in which they received exclusive child and mother personal attention than they would with longer therapist contact in the traditional group therapy that is less personally relevant.
Overall, researchers found robust declines in children’s externalizing behavior and self-reported parenting stress.
Outcomes of parent-child interaction therapy included more positive interactions and increased quality of the parent-child relationship compared with traditional behavior therapy10.
- 1.Thomas R, Abell B, Webb HJ, Avdagic E, Zimmer-Gembeck MJ. Parent-Child Interaction Therapy: A Meta-analysis. Pediatrics. Published online September 1, 2017. doi:10.1542/peds.2017-0352
- 2.Berkowitz BP, Graziano AM. Training parents as behavior therapists: A review. Behaviour Research and Therapy. Published online November 1972:297-317. doi:10.1016/0005-7967(72)90054-x
- 3.Hanf C. A two stage program for modifying maternal controlling during mother-child (MC) interaction. Presented at: Western Psychological Association Meeting; 1969; Vancouver, BC.
- 4.O’Dell S. Training parents in behavior modification: A review. Psychological Bulletin. Published online 1974:418-433. doi:10.1037/h0036545
- 5.Forehand R, King HE. Noncompliant Children. Behav Modif. Published online January 1977:93-108. doi:10.1177/014544557711006
- 6.Eyberg SM, Robinson EA. Parent‐child interaction training: Effects on family functioning. Journal of Clinical Child Psychology. Published online June 1982:130-137. doi:10.1080/15374418209533076
- 7.McNeil CB, Hembree-Kigin TL. Parent-Child Interaction Therapy. Springer US; 2010. doi:10.1007/978-0-387-88639-8
- 8.Funderburk BW, Eyberg S. Parent–child interaction therapy. History of psychotherapy: Continuity and change (2nd ed).:415-420. doi:10.1037/12353-021
- 9.Eyberg SM, Matarazzo RG. Training parents as therapists: A comparison between individual parent-child interaction training and parent group didactic training. J Clin Psychol. Published online April 1980:492-499. doi:10.1002/jclp.6120360218
- 10.Leung C, Tsang S, Sin TCS, Choi S yan. The Efficacy of Parent–Child Interaction Therapy With Chinese Families. Research on Social Work Practice. Published online January 16, 2014:117-128. doi:10.1177/1049731513519827
- 11.Schuhmann EM, Foote RC, Eyberg SM, Boggs SR, Algina J. Efficacy of Parent-Child Interaction Therapy: Interim Report of a Randomized Trial with Short-Term Maintenance. Journal of Clinical Child Psychology. Published online March 1998:34-45. doi:10.1207/s15374424jccp2701_4