1 - (SYM 60) Parent-child Interaction Therapy Adapted for Older Children: A Small N Design

Parent-Child Interaction Therapy (PCIT) is an evidence-based behavioral parent training program for disruptive behavior in children ages 2 to 7 years (i.e., through 6 years, 11 months, 29 days; Lieneman et al., 2017). Standard PCIT research has only included a small number of children ages 7 years and older, but its effectiveness generally decreases as children age beyond the 7^th year (Briegel, 2018; Franco et al., 2005). The novel intervention, PCIT Adapted for Older Children (PCIT-OC), was designed for families of children ages 7-10 years. PCIT-OC adapts both traditional PCIT phases of Child-Directed Interaction (CDI) and Parent-Directed Interaction (PDI) to increase acceptability and reduce resistance to limit-setting protocols in older children. The purpose of this small N study was to evaluate the efficacy of the PCIT-OC. Participants included two primary caregivers and their children who were between the ages of 7 and 10 years and met criteria for a disruptive behavior disorder. Children in this study varied in race, gender, and neurodevelopmental abilities. PCIT-OC was delivered weekly in an outpatient setting. The effectiveness of the intervention was assessed utilizing a nonconcurrent multiple baseline design across participants comprised of baseline (A) and intervention (B) phases across participants in a staggered fashion. Visual analyses revealed clear decreasing trends in child problem behavior intensity as measured by the Eyberg Child Behavior Inventory (ECBI) during the intervention. ECBI intensity scores were measured at ½ SD below the clinical cut-off score at the end of CDI and > 1 or >2 SD below the clinical cut-off at the end of PDI. ECBI problem scores showed clear downward trends during PDI for both families but for only one participant during CDI. Parents reported being 100% satisfied, and children reported being 76-88% satisfied via parent and child versions of the Therapy Attitudes Inventory. Ancillary data including changes in parenting skills as measured by the Dyadic Parent-Child Interaction Coding System, child and parent emotion regulation, child irritability, and parenting stress were also collected. As small N designs are relatively rare in behavioral parent training research, this study afforded unique insights about PCIT-OC through case-specific, session-by-session data. Results have potential to expand the availability of evidence-based treatments for older children, a developmental age typically underserved by behavioral parenting interventions.