Tracking Treatment Progress of Families with Oppositional PreschoolersJaimee C. Perez, M.S., Stephen Bell, Ph.D., Robert W. Adams

Linda Garzarella, B.A., and Sheila M. Eyberg, Ph.D.Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida

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INTRODUCTION METHODSForty-one families were recruited as part of a larger

study looking at the maintenance of treatment gains across time in families who have successfully completed PCIT. Children included in the study met DSM-IV criteria for Oppositional Defiant Disorder (ODD) and were between the ages of 3 and 6 years. During treatment, parents completed an ECBI and a PSI-SF prior to each session. For the purpose of this study, only data collected from the mother was were analyzed. Mean scores (ECBI Intensity and PSI-SF Total scores) were calculated for each week/session. Simple t-test analyses were run to compare scores at pre- and post-treatment across weeks and within treatment phase. A Pearson correlation coefficient was run to analyze the relationship between the ECBI Intensity score and the PSI-SF across weeks as well.

DISCUSSION

RESULTSIn addition to outcome studies on the efficacy of

psychological interventions, researchers have recently begun to investigate the trajectory of change over the course of treatment. Such research is important for interventions such as Parent Child Interaction Therapy (PCIT), which include two phases of treatment with distinct strategies and objectives for change. The current study proposes to elucidate the trajectory of behavior change, as measured by the Eyberg Child Behavior Inventory (ECBI), across total number of weeks in treatment, as well as within both phases of PCIT. The study also proposes to establish a relationship between improvement in children’s disruptive behavior and a decrease in parental ratings of stress, as measured by the Parenting Stress Index – Short Form (PSI-SF).

In the Child Directed Interaction (CDI) phase, the first phase of PCIT, parents are taught skills to enhance the effectiveness of differential social attention, with the main objective of increasing the child’s desirable behavior via positive attention (labeled praises, behavioral descriptions of appropriate play) and decreasing the child’s inappropriate behavior via active ignoring. The expected outcome is that the child’s behavior will begin to improve, leading to improvement in the quality of the relationship between parent and child. Early research on positive attention indicates that it is effective in changing behaviors, including increasing study behavior (Hall, Lund, & Jackson, 1968), cooperative play (Hart, Reynolds, Baer, Brawley, & Harris, 1968), compliance (Goetz, Holmberg, & LeBlanc, 1975), and attention to task (Kazdin, 1973; Kazdin & Klock, 1973).

While some researchers have found positive attention to be a necessary factor for the treatment of children with disruptive behavior disorders (Brestan & Eyberg, 1998; Pelham, Wheeler, & Chronis, 1998), other studies have yielded findings that question the effectiveness of differential social attention in decreasing oppositional and disruptive behavior in children (Herbert et al., 1973; Roberts, 1985; Roberts, Hatzenbuehler, & Bean, 1981). Hence, the aim of the Parent Directed Interaction (PDI) phase is to further reduce children’s problematic behaviors with the introduction of a mild aversive technique, a standard time-out from positive reinforcement procedure. Roberts et al (1981) found that out of four experimental conditions (attention, time-out, attention plus time-out, and control) only the time out condition contributed to an increase in compliant behavior in his sample. Similarly, Eisenstadt et al (1993) found that regardless of order of phase of treatment (CDI first vs. PDI first), PDI was more effective at reducing disruptive and noncompliant behavior.

These previous studies suggest that the skills taught during CDI are effective for increasing children’s positive behaviors; however, CDI alone may not be sufficient to reliably decrease undesirable behaviors. Rather, the skills taught during PDI (e.g., time out) are probably necessary to address clinically significant disruptive and noncompliant behavior. The current study investigates weekly changes in disruptive behavior across both phases of PCIT. Consistent with previous literature, we predict that there will be a significant decrease in the ECBI Intensity score over the course of PCIT. Based on the studies reviewed above, we hypothesize that significant changes in the ECBI Intensity score will occur during PDI. Exploratory analyses are predicted to reveal a significant relationship between parent ratings of children’s behavior and parent ratings of stress.

t = -2.5 (p = .0001)

In the present study, the ECBI performed as a sensitive measure of weekly change in the intensity of child behavior problems during PCIT. Consistent with current hypotheses, ECBI scores declined gradually but significantly over the course of treatment. In contrast with our predictions, results revealed similar decreases in behavior problems during CDI and PDI, with significant declines in the ECBI intensity scores across each phase of treatment. These results challenge previous studies that have questioned the utility of positive attention as a treatment for disruptive behavior. As predicted, lower levels of child behavior problems were associated with lower levels of parenting stress. This relationship was significant across all weeks and grew consistently stronger as the families progressed in treatment.

The current findings support the utility of the ECBI as a weekly measure of changes in the intensity of behavior problems in children. Further, despite the differing strategies used in CDI and PDI, the present results suggest that each phase of treatment provides parenting skills that are useful in addressing disruptive and noncompliant child behavior.

RESULTSTime series analysis of the mean scores for both

the ECBI Intensity score and PSI-SF total score show a gradual, yet significant, decline over the course of treatment. Results of the simple t-test analyses are presented in the top graph. Significant correlations were also found between the pre- and post-treatment ECBI Intensity scores and the PSI-SF total score, with the significance of the correlation increasing over the course of treatment. R values are also provided in the top graph. Additionally, significant differences were found within each phase of treatment, with the ECBI Intensity score decreasing a total of 35 points in CDI and 27 points in PDI. Means and p values are noted in the bottom graph.

Trajectory of Change Across PCIT

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r = .55, p=.0001

r =.76, p=.0001

t = -5.54, p = .0001

t = -2.50, p = .02

X = 161

X = 126

p = .0113

X = 136

X = 109

p = .0023