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

1. Parent-Child Interaction Therapy (PCIT) with Puerto Rican families Maribel Matos-Román, Ph.D. University of Puerto Rico PCIT Conference January 26-28, 2006 Gainesville, FL

2. Specific 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.

3. Inclusion 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

4. Inclusion 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

5. Aim 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

6. Aim 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

7. Aim 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

8. Aim 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

9. Screening 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

10. Outcome 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)

11. Results • 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

12. Results • 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

13. Modifications • 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

14. Aim 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

15. Sample Demographic and Clinical Characteristics

16. Results – 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)

17. Results – 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.

18. Intensity Problems

19. Hyperactivity Aggression

20. Hyperactivity ODD

21. Externalizing Aggressive

22. Total Severity

25. SCL - 36 BDI

26. Conclusions • 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. .

27. Research Team • Co-investigators • José J. Bauermeister, Ph.D. • Guillermo Bernal, Ph.D. • Data Analysis • José V. Martínez, Ph.D. • Eduardo Cumba, Ph.D. • Research Assistants • Graduate 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

28. Acknowledgments • Funded by NIMH 5R24MH-49368-11 • Dr. Maribel Matos E-mail: m-matos@uprrp.edu

29. ¡Gracias!