(PS3-54) Development of an Observational Code for Sustained Time-based Child Compliance in the DPICS Clean-up Situation

Abstract Text: Child compliance is a major target outcome of Parent-Child Interaction Therapy (PCIT). The Dyadic Parent-Child Interaction Coding System-IV (DPICS-IV) is used in PCIT to code a child’s immediate compliance to each of the parent’s commands in two structured analog behavior observation tasks: parent-led play (PLP) and clean-up (CU). Large pre to post treatment effect sizes have been found in child compliance using the DPICS-IV. However, the child’s sustained response to the initial command is not captured, strong interrater reliability may be challenging to achieve, and an initial review of 9 PCIT studies found that the effect size for change in pre to post treatment child compliance scores, while generally large, was often notably smaller than the effect size on the parent-report Eyberg Child Behavior Inventory (ECBI). Thus, the current study developed a supplemental coding dimension for sustained child compliance during CU and examined the code’s reliability, validity, and sensitivity to change in a pilot sample. Supplemental sustained compliance coding guidelines based on the presence of clean-up behavior during 5-second intervals were developed and then used to code the 5 minute CU task in which the parent is directed to get the child to clean up all the toys by themself. The present study involves 32 racially and ethnically diverse child-caregiver dyads from a clinical trial of a personalized version of PCIT. The sample was made up of children between 2-7 years old (M = 4.66, SD = 1.33; 34% girls) with disruptive behavior problems and their caregiver (M age = 37.94, SD age = 8.25; 94% female, 6% male). Research assistants independently coded 5-minute segments of the CU task with 25% of tapes double-coded. Interrater agreement of the new sustained compliance code was strong at pre-treatment (93%, κ = 0.86) and post-treatment (96%, κ = 0.88). Initial results suggest that, on average, children spent 61% of the segment engaged in clean-up at pre-treatment compared to 71% at post-treatment, t(27) = 1.65, p = 0.11 (not significant). The correlation between post-treatment ECBI scores and observed compliance was larger for this new sustained code (r = -0.31, p = 0.11) compared to the original DPICS-IV compliance code (r = -0.09, p = 0.66). The new sustained compliance code also showed an improved ability to differentiate between children in the normative (75%) versus clinical (55%) range on post-treatment ECBI scores, t(26) = 1.68, p = 0.10, d = 0.78, compared to the original compliance code (64% versus 67%, t[25] = 0.27, p = 0.79, d = 0.13). Initial results suggest that this supplemental coding method for capturing sustained compliance has strong interrater agreement and may be useful as an additional measure of clinical change/sensitivity.