Article Review

Examining the Efficacy of Parent-Child Interaction Therapy

 Abstract

 The problem that is being addressed in this article is about the Autism Spectrum and whether a positive parent-child dynamic will increase compliance, promote changes in behaviors, and build a greater relationship.  The article states that children with autism spectrum display externalizing behaviors during early childhood due to genetic or environmental factors.  Children with Autism Spectrum lack social interaction, activity and interest, and families caring for these children face hardships in trying to maintain relationships, mental health and control the behavioral problems.  However, there is a suggested empirical solution to this mental problem which is the parent-child interaction therapy (PCIT).  The purpose of this article is to examine the efficiency of PCIT using non-concurrent designs.  The study finds that PCIT increases child compliance, reduces disruptive behaviors, improves parenting skills,   and increases a greater relationship satisfaction.

Introduction

 Masse et al (2016) state that challenging behaviors such as aggression, noncompliance or defiant behaviors,   irritability and other disruptive behaviors such as being disobedient, stubborn and physically aggressive are the primary symptoms associated with the autism spectrum disorder.  To address this issue, researchers have focused on evidence-based treatment and empirically supported interventions. Researchers have found that behavioral parent training is a critical and beneficial strategy in reducing disruptive behaviors, foster parent-child relationship, increase compliance and promote greater relationship satisfaction. Parent-child interaction therapy is a component of behavioral parent training and it is a short-term training program that is derived from social learning theory and attachment theory. The purpose of applying the theories is to understand that the purpose of the parent training program is to build relationships and promote discipline.  Both parents and children attend weekly 1-h sessions where the therapist teaches parental skills to the parents and also allow parents to interact with their children and apply skills that have to do to with behavior descriptions. The purpose as to why parents are the primary participants in the training to act as leaders in shaping the child's behavior, maintain focus, create an enriching interaction,  increase parental involvement, and promote positive social behavior.  In general, parent-child interaction therapy is associated with positive outcomes as parents are able to improve the child's communication, build skills, reduce the behavioral problem and externalizing behaviors, and more importantly promote parent-child relationship.

 Purpose of the study

 The aim of the study was to investigate whether the Parent-Child Interaction Therapy is effective on children suffering from autism spectrum.  The authors have found that the diagnostic rate for children behavioral difficulties is high and there is no quality treatment (Mass et al, 2016).  Thus, there is a need for preliminary research concerning the PCIT to understand whether it is effective in reducing disruptive behaviors and hither it increases compliance. The study conducts research on PCIT by incorporating both first phase of treatment where parents interact with their children and the second phase of treatment where in addition to playing with children, parents gain parenting skills which enable them to deliver positive reinforcements, and effective commands.

 Experimental design

 The study used a non-concurrent design that involves the use of several individuals at different intervals to create flexibility, avoid experiment bias and improve validity (Mass et al, 2016). In using the non-concurrent design, the baseline levels were used at the beginning of the study to assess the unknown. In specific, the baselines levels would help in assessing the rate of child compliance, a positive parental report on the reduction of oppositional behavior, positive parenting behaviors, and treatment satisfaction (Mass et al, 2016).   In other words, this was the first hypothesis and the second hypothesis was the child's behavior change.

  Participants

            Participants were children aged 2 and 7 years diagnosed with ASD by a teacher or mental health professional (Mass et al, 2016). These children had receptive language skills but children with organic brain damage, non-English speaking children, children whose Autism rating scores were lower than 29, children whose Autism behavior was 43 and lower, and children whose compliance test was 60% were excluded from the study (Mass et al, 2016). The second group of participants was primary caregivers but caregivers who have organic brain damage and who were non-English speaking were excluded. Three families met the selection criteria and they participated in the study.

 Dependent variables and independent variables

 The data collected was reliable sink the study used a screening instrument known as ABC.  The dependent variables were the relationship enhancement between parent and their children and children compliance (Mass et al, 2016). The independent variables which affected the dependent variables were accurately implemented by the therapists. The latter coached parents or they gave them instructions. For example, at the beginning of the therapy, parents received 20 instructions on how to interact with children and therapists recorded compliance rate with respect to the compliance responses (Mass et al, 2016).  Again, the therapists provided the parents with 30 instructions to increase validity and compliance rate was regarded as successful if it was 57%. In addition, the independent variables were accurately implemented since therapies observed child behaviors in different areas such as verbal communication and child's compliance.

 Research procedures

 A non-concurrent design measured child compliance in different baseline sessions.   Given that three families participated in the study, each family received 3 baseline sessions, 5 baseline sessions, and 4 baseline sessions respectively (Mass et al, 2016). Parent-child interaction therapy was initiated and parents received training in an in-room format.  The therapist started by giving child-directed interaction (parents were taught to interact with their children to improve their skills) and then parent-directed interaction (parents were taught parenting skills such as coaching and effective commands) within a period of weekly 1-h sessions.

 

Summary of the results

            The results showed that the rate of child's compliance increased with the use of treatment at different intervals.  For example, in one family, the child participated in different baselines sessions and in each session there was an improvement of 25.67% during child-directed interaction and there was an improvement of 60.88% in parent-child interaction (Mass et al, 2016).  The results show that in all the three families that participated in the study, children showed gradual improvement. The improvement was influenced by parent-child interaction and the ability of the parents to coach and command their children thereby reducing the behavioral problems (Mass et al, 2016). Parents also showed an increase in positive parenting behavior and satisfaction across treatment phases.

 Generalizability of the intervention

 In general, the study finds that parent-child interaction therapy is effective in children suffering from autism spectrum disorder. When the therapist provide both child-directed interaction and parent-directed interaction, effectiveness is achieved (Mass et al, 2016). This means that therapy is given across different domains and in each domain, there is an improvement such as positive parenting, coaching skills, child compliance, and behavioral changes.  Generally, the parent training programs help children change antisocial behavior and more importantly, it promotes parent-child communication.

 Implication of the study

 The study has shown empirical evidence that parent-child interaction therapy is associated with clinical success especially in children on ASD.  In the clinical setting especially in the ASD population, it is important to apply this intervention to help both children and parent manage the mental condition (Mass et al, 2016). This intervention is effective to address the family and children needs as parents will learn about the parenting skills and as a result, the children will develop positive behaviors.

 Limitations and future directions

The study has a lot of limitations. The first apparent limitation is the use of non-concurrent design. The design is not effective as it brings threats to the validity due to the use of varying independent variables, and due to the variation in independent variables. In the future, it is important to use concurrent designs to save time and evaluate complete data sets. Second, when commencing the study,   children with high-functioning autism were excluded from the study (Mass et al, 2016).  The researchers did not explain the meaning of the term and the associated symptoms.  In the future, it is important to classify the severity of symptoms to differentiate between high functioning and low functioning.  In addition, the Compliance Test was unreliable and it could be better if the study used a longer follow-up period to assess long-term effects (Mass et al, 2016). In the future, rather than using a short-term program, it is important to employ a long-term program to understand the long-term impact of treatment.

 

Conclusion

 Parent-child interaction has given promising results that children with ASD can improve behavior. Therapists, mental health professionals, and educational psychologists should focus on implementing the intervention in the clinical setting to teach parents the parenting skills and behavioral approaches and more importantly, reduce the children's internalizing disorder and build a greater relationship with parents. Note that untreated autism spectrum may lead to behavioral problems such as poor academic performance, lack of social interaction and related issues. Thus, it is important to consider behavioral parent training as an evince-based treatment to benefit the parents and children.

 

 

 

 

 

Reference

 Masse, J. J., McNeil, C. B., Wagner, S., & Quetsch, L. B. (2016). Examining the efficacy of

parent–child interaction therapy with children on the autism spectrum. Journal of Child

and Family Studies, 25(8), 2508-2525.