Parent-Child Interaction Parent-Child Interaction Therapy (PCIT) with Puerto Therapy (PCIT) with Puerto

Rican families Rican families

Maribel Matos-Román, Ph.D.University of Puerto Rico

PCIT ConferenceJanuary 26-28, 2006

Gainesville, FL

Specific AimsSpecific Aims

To revise and culturally adapt PCIT for Puerto Rican preschool aged children with a diagnosis of ADHD who also present high rates of behavior problems.

To conduct a randomized controlled pilot study to evaluate the initial efficacy, feasibility, and acceptability of the refined PCIT for children with a diagnosis of ADHD and problem behaviors and their families.

Inclusion criteriaInclusion criteria 4 to 6 years – 11 months of age Parent complaints of significant hyperactivity

and behavior problems No evidence of neurological, pervasive

developmental disorders or significant handicaps

Be a child of a Puerto Rican mother No treatment with stimulant or psychotropic

medication No involvement in other forms of child

psychotherapy and/or pharmacotherapy

Inclusion criteriaInclusion criteria

IQ > 80 (PPVT) ADHD diagnosis, Combined or Hyperactive-

Impulsive Type - NIMH DISC-IV. A score above the 93rd percentile on

hyperactivity and ODD or aggression scales (DBRS or BASC)

Absence of domestic violence and chaotic family environment

No indicators of severe psychopathology on parents

Aim 1Aim 1 Translation of the PCIT manual and handouts Linguistic adaptations Psychoeducational module about ADHD and

behavior problems– Description of hyperactivity and its relationship

to behavior problems– Associated difficulties– Risks and protective factors– Possible etiologies

– Treatment options

Aim 1Aim 1 Nine families

– 9 children 7 M and 2 F; Mean age: 4.9 years; Mean IQ:

104.4, SD = 10.08

– 9 mothers 2 single parents, Mean age: 31.89, SD = 6.31

Range: 25 to 43

Education: 15.6 years (nearly a BA, SD = 1.59;

Range: 14 to 19)

7 worked full-time, 1 part-time, 1 college student

Aim 1Aim 1 Nine families

– 7 fathers (1 stepfather)

Mean age: 32.86, SD = 5.34 Range: 27 to 43

Education: 16.0 years (BA, SD = 3.79; Range: 12

to 23

Full-time jobs

Aim 1Aim 1 Procedures

– Screening and outcome measures (Pre-treatment assessment)

– Psychoeducational sessions (2 sessions)

– CDI and PDI Mean CDI sessions = 7.47 (6 - 9)

Mean PDI sessions= 7.79 (6 - 10)

– Post treatment assessment

– 3-month follow-up assessment

Screening MeasuresScreening Measures Disruptive Behavior Scale for Children (DBRS)

– 9 hyperactivity symptoms, 8 ODD symptoms

Behavioral Assessment System for Children-Parent Rating Scales (BASC-PRS)– Subscales of Hyperactivity and Aggression

Peabody Picture Vocabulary Test (PPVT-HAA)

NIMH DISC IV - Parent Version – ADHD, ODD, generalized anxiety disorder,

separation anxiety disorder, major depression, and disthymia modules

Outcome MeasuresOutcome Measures Eyberg Child Behavior Inventory (ECBI) Child Behavior Checklist (CBCL) BASC, DBRS Home Situations Questionnaire (HSQ) Family Experiences Inventory (FEI) Parent Practices Inventory (PPI) Beck Depression Inventory (BDI) Symptom Checklist – 36 (SCL-36) Treatment and Evaluation Survey (TES) Therapy Attitude Inventory (TAI)

ResultsResults

PCIT feasible to implement and acceptable

High level of satisfaction

– Mean TAI score: 48.67, SD=1.32

– Mothers’ reports of being felt understood, confident,

comfortable, and supported by their therapists.

Positive changes in children’s behavior

Reduction in family stress

Improvement in parent-child relationships

ResultsResults

Treatment gains maintained through 3-month

follow-up

Reliable change index (RCI)

– 89% in ECBI-Intensity and the ECBI-Problem

– 62% in ADHD-Hyperactivity

– 88% in ODD

– 56% in the PPI

– 78% in the FEI

ModificationsModifications

8 sessions for CDI and 9 for PDI

Handout about pharmacological treatment for ADHD

Modification of time-out procedures – Loss of privileges

– Definition of silence

– Duration of time-out

Scripts for CDI and PDI

Aim 2 – Pilot StudyAim 2 – Pilot Study

32 families– Treatment group (TG); n=20– Wait-list group (WL); n= 12

No difference between groups – gender distribution– age– IQ– parents’ education– children’s impairment in adaptive functioning– screening ratings of hyperactivity and

aggressive or ODD behaviors

-1.6356.83 (4.97)53.30 (6.44)C-GAS

-.936.33 (1.23)5.85 (1.53)DBRS – No. ODD symptoms

-1.3217.92 (3.87)16.05 (3.89)DBRS-ODD

-.918.08 (1.16)7.60 (1.60)DBRS-No. Hyp. Symptoms

-1.1122.67 (2.84)21.25 (3.82)DBRS-Hyperactivity

-1.5321.25 (5.50)18.10 (5.74)BASC-Aggression

-.0236.00 (6.49)35.95 (6.94)BASC-Hyperactivity

.3832.08 (6.29)33.05 (7.48)Mother’s age

1.3614.58 (1.31)15.40 (1.82)Mother’s education

-1.23106.67 (7.81)101.95 (13.96)Peabody (IQ)

-.6160.00 (7.47)58.50 (6.37)Age (months)

.046770Gender (% male)

----1220Participants

χ2 /tW-list groupTreatment GroupMeasure

Sample Demographic and Clinical Characteristics

Results – Pilot StudyResults – Pilot Study

Treatment Group (n=19)– Lower levels of hyperactivity

– Less aggressive and ODD behaviors

– Less externalizing behaviors

– Significant reduction in general behavioral problems (ECBI)

– Significant reduction in the behaviors they assessed as problematic (ECBI-Problems)

Results – Pilot StudyResults – Pilot Study– Reduction in the parenting stress (FEI) – Use of adequate parenting practices – Mean CDI sessions: 7 (6 to 9)– Mean PDI sessions: 8 (6 to 10)– High level of consumer satisfaction

Mean TAI scores: 47.77 (SD: 2.93)

Wait-list Group (n= 12)– No significant changes in any measure

ANCOVAs with pretreatment scores as covariates.

ECBI Intensity & Problems

30

40

50

60

70

80

TG WLG TG WLG

T s

co

res

Pre Post Follow Up

Intensity Problems

BASC Hyperactivity & Aggression

0

5

10

15

20

25

30

35

40

TG WLG TG WLG

Ra

w s

co

res

Pre Post Follow Up

Hyperactivity

Aggression

DBRS Hyperactivity & ODD

0

5

10

15

20

25

30

TG WLG TG WLG

Ra

w s

co

res

Pre Post Follow Up

Hyperactivity

ODD

CBCL Externalizing & Aggressive

30

40

50

60

70

80

TG WLG TG WLG

T s

co

res

Pre Post Follow Up

Externalizing Aggressive

Home Situations - Total & Severity

0

4

8

12

16

TG WLG TG WLG

Ra

w s

co

res

Pre Post Follow Up

Total

Severity

Parenting Practices

0

15

30

45

60

75

90

105

120

TG WLG

Ra

w s

co

res

Pre Post Follow Up

Family Stress

0102030405060708090

100

TG WLG

Ra

w s

co

res

Pre Post Follow Up

BDI & SCL - 36

0

10

20

30

40

50

60

70

TG WLG TG WLG

Ra

w s

co

res

Pre Post Follow Up

BDI

SCL - 36

ConclusionsConclusions

PCIT seems to be:

– A responsive family intervention for Puerto Rican families who have preschool- age children with significant behavior problems.

– An acceptable and effective treatment for Puerto Rican parents.

– Efficacious to reduce significantly the behavior problems associated with ADHD and ODD.

.

Research TeamResearch Team

Co-investigators– José J. Bauermeister, Ph.D.– Guillermo Bernal, Ph.D.

Data Analysis– José V. Martínez, Ph.D.– Eduardo Cumba, Ph.D.

Research AssistantsGraduate students•Rosalie Torres•Rocheli Santiago•Ixa Rodriguez•Liliana Torres•Michelle Jurado•Elisabet Avilés•Kenneth Junco

Undergraduate students•Marisol De Jesús•Damaris Cordero•Wilmarie Ríos•Arlene Román

AcknowledgmentsAcknowledgments

Funded by NIMH 5R24MH-49368-11

Dr. Maribel Matos E-mail: m-matos@uprrp.edu

¡Gracias!¡Gracias!