While Parent-Child Interaction Therapy (PCIT) was originally designed to address behavior difficulties for young children, the PCIT model has since been adapted or applied to a wider range of challenges that young children face, including ADHD, anxiety, selective mutism, and trauma.
Since its development in 1970, standard PCIT has been successfully used with the original population of children with inattentive or hyperactive problems, and it has been shown to be effective for a wider range of issues too. Studies and clinical practice over the years have displayed that standard PCIT, with no specific adaptations, can address things like general anxiety concerns and trauma, too. That said, there are some specific adaptations that have been made to PCIT to target different challenges and populations.
PCIT for Trauma
PCIT is a recommended treatment to help children who are experiencing traumatic stress symptoms between the ages of 2 and 7, recognized by the National Child Traumatic Stress Network as a trauma-informed intervention. It’s short-term, evidence-based nature makes it more accessible from a cost and time-management perspective for many families. Many children who have experienced trauma exhibit their distress through behavioral challenges like outbursts, aggression, hyperactivity, and defiance. In addition, some children may have experienced trauma as a result of unsafe or inconsistent caregiving and disciplinary strategies. PCIT provides a safe and consistent framework to enhance the caregiver and child bond through positive strategies, and it provides safe and predictable disciplinary skills for caregivers to use. Kids who have experienced uncertainty find routine and predictability to be soothing, and learning that they can trust their caregiver to respond to behavioral outbursts in a consistent and safe way is healing. An improved parent-child relationship can help children feel safe, which is key for trauma recovery. PCIT for children with traumatic stress symptoms can be a corrective experience in this way. Therapists working with kids and families who are experiencing traumatic stress can incorporate additional information on how trauma impacts the body and behaviors into treatment, so that a greater understanding of the child’s experience is reached. With trauma-informed strategies for responding to a child’s big emotions and coaching them through challenging trauma-related experiences, caregivers can feel more confident in their ability to support their child.
PCIT is also unique because many trauma therapies often exclude offending or perpetrating caregivers from the intervention, while PCIT includes caregivers who have engaged in abuse, maltreatment, or neglect, if they demonstrate a willingness to learn, as long as the assault was not sexual. Offending caregivers are given the opportunity to participate because the treatment program focuses on new, positive, corrective parenting skills that can reduce harm from caregivers to child and increase positive feelings between them.
Additionally, there is current research on developing a specific module of PCIT treatment to address trauma symptoms, called Trauma-Directed Interaction (TDI). This research aims to build on the success of standard PCIT in treating trauma and further develop structure and strategies for addressing trauma related distress in the parent-child context. TDI adds specific sessions to cover psychoeducation about trauma, specific skills for caregivers on communicating and addressing trauma-related distress for children the “SAFE Skills” and building on coping skills for both the child and the caregiver to manage trauma-related reminders or activators.
PCIT for Autism Spectrum Disorders
The use of PCIT for kids on the autism spectrum has been shown to improve behavioral issues, social awareness and the child’s adaptability. Children with autism spectrum disorders (ASD) may display some of the same challenges as kids with behavioral issues, like aggression, irritability, rigidity, and non-compliance. One option for using PCIT for a child on the autism spectrum is to engage with standard PCIT, since the same strategies for reinforcing or decreasing behaviors are effective with all children. Case studies of the use of PCIT with this population have shown that the treatment reduces behavioral challenges and also increases the feeling of secure attachment between parent and child.
If a child on the autism spectrum has different needs than standard PCIT can address, there is a specific treatment plan that can be used which includes tailored adaptations of the treatment. This tailored version of PCIT is especially useful for children with more severe presentations who need challenges addressed that are uniquely consistent with the autism profile. For example, adaptations may include a greater focus on building social and communication behaviors, like helping the child request and verbalize what they want or need and may include modified consequence structures and greater inclusion of emotion coaching.
PCIT for Selective Mutism
There is a specific adaptation of PCIT for selective mutism called PCIT-SM. Selective mutism is an anxiety disorder that makes it difficult for a child to speak with others in specific settings. These kids experience a fear of speaking and an inability to speak appropriately in interactions where they are expected to communicate outside of the home. Often, this fear is rooted in a worry about being embarrassed or negatively judged. Kids with selective mutism are often diagnosed between the ages of 3 and 8, overlapping widely with the age range for treatment with PCIT (2-7). PCIT-SM uses the structure, and some of the same skills as the original PCIT to reduce anxiety and encourage verbalizations. In PCIT-SM, the first phase is still Child Directed Interaction (CDI), in which caregivers learn skills for positive relationships and reinforcement, using praise and attention as superpowers. This phase serves as a base for the second phase, which is where PCIT-SM diverts from the original PCIT. In PCIT-SM, the second phase of treatment is Verbal Directed Interaction (VDI), which introduces skills and a framework for facilitating and reinforcing speech. In this phase, caregivers learn how to use effective prompts, how to respond to non-verbal communication appropriately, how to reinforce child verbal interaction, and how to praise and encourage their child’s brave behavior. Like PCIT, PCIT-SM uses skills coaching and live practice with therapist feedback to help caregivers master the skills and support children as they progress.
PCIT-CALM
The CALM program is an adaptation of PCIT designed to be used for children with social anxiety, specific phobia, excessive worry, and separation anxiety. CALM stands for coaching, approach behavior, and leading by modeling. In a course of PCIT CALM, parents will learn about anxiety and how to parent an anxious child, and they will learn and roleplay CDI skills, similar to other courses of PCIT. The second half of treatment is the DADS stage, which stands for: describe a feared situation, approach a feared situation, direct command for child to approach, and state intent to remain in situation and provide selective attention. The DADS stage is where the therapist and a parent use a collectively created “fear hierarchy” to coach and model approaching scary situations with the child, effectively teaching the child that they can handle doing the things they are nervous about. Throughout this, caregivers are receiving live coaching from the therapist, similar to other models of PCIT, to help them learn how best to support their anxious children.
PCIT Based Teacher Training
Research and clinical practice have found PCIT to be widely effective for improving the parent-child bond and decreasing negative interaction patterns within the family, and an adaptation of the program for teachers has been found to have benefits too. Teacher-Child Interaction Therapy (TCIT) is adapted from PCIT and uses the core principles and goals of PCIT while considering and addressing the unique challenges that a classroom and teacher-student dynamic introduces. TCIT is a professional development program where clinicians who are certified to train PCIT based skills work with teachers to strengthen teacher-child relationship building skills. The skills introduced in TCIT are meant to be useful for working with all kids in a class, not just those who have previously identified needs. The beautiful thing about PCIT skills is that they are effective with everyone, and every child can benefit.
The skills taught in PCIT can be useful for all caregivers, whether parents or not, in enhancing bonds with young children. If you are interested in learning more about PCIT and if a child you know could benefit from treatment, reach out to the Center for Effective Therapy at The Baker Center.
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