Skip to main content
Log in

Behavioral Parent Training in Infancy: A Window of Opportunity for High-Risk Families

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

To meet the mental health needs of infants from high-risk families, we examined the effect of a brief home-based adaptation of Parent–child Interaction Therapy (PCIT) on improvements in infant and parent behaviors and reductions in parenting stress. Participants included 60 infants (55 % male; average age of 13.5 ± 1.31 months) who were recruited at a large urban primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Most infants were from an ethnic or racial minority background (98 %) and lived below the poverty line (60 %). Families were randomly assigned to receive the home-based parenting intervention or standard pediatric primary care. Observational and parent-report measures of infant and parenting behaviors were examined at pre- and post-intervention and at 3- and 6-month follow-ups. Infants receiving the intervention were more compliant with maternal commands at the 6-month follow-up and displayed lower levels of externalizing and internalizing behavior problems across post and follow-up assessments compared to infants in standard care. Mothers receiving the intervention displayed a significantly higher proportion of positive and lower proportion of negative behaviors with their infant during play compared to mothers in the standard care group. There were no significant group differences for parenting stress. Results provide initial evidence for the efficacy of this brief and home-based adaptation of PCIT for infants. These findings highlight the benefit of identification and intervention as early as possible to promote mental health for infants from high-risk families.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Abidin, R. R. (1995). Parenting stress index manual, third edition: professional manual. Odessa: Psychological Assessment Resources, Inc.

    Google Scholar 

  • Aguilar, B., Sroufe, L. A., Egeland, B., & Carlson, E. (2000). Distinguishing the early-onset/persistent and adolescence-onset antisocial behavior types: from birth to 16 years. Development and Psychopathology, 12, 109–132. Retrieved from http://journals.cambridge.org.

  • Alink, L. R., Mesman, J., van Zeijl, J., Stolk, M. N., Juffer, F., Koot, H. M., . . . van Ijzendoorn, M. H. (2006). The early childhood aggression curve: development of physical aggression in 10- to 50-month-old children. Child Development, 77, 954–966. doi: 10.1111/j.1467-8624.2006.00912.x

  • Bagner, D. M. (2013). Father’s role in parent training for children with developmental delay. Journal of Family Psychology, 27, 650–657. doi:10.1037/a0033465.

    Article  PubMed  Google Scholar 

  • Bagner, D. M., & Eyberg, S. M. (2003). Father involvement in parent training: when does it matter? Journal of Clinical Child and Adolescent Psychology, 32, 599–605. doi:10.1207/S15374424JCCP3204_13.

    Article  PubMed  Google Scholar 

  • Bagner, D. M., & Eyberg, S. M. (2007). Parent-child interaction therapy for disruptive behavior in children with mental retardation: a randomized controlled trial. Journal of Clinical Child and Adolescent Psychology, 36, 418–429. doi:10.1080/1537441070 1448448.

    Article  PubMed  Google Scholar 

  • Bagner, D. M., & Graziano, P. A. (2013). Barriers to success in parent training for young children with developmental delay: the role of cumulative risk. Behavior Modification, 37, 356–377. doi:10.1177/0145445512465307.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bagner, D. M., Sheinkopf, S. J., Vohr, B. R., & Lester, B. M. (2010). Parenting intervention for externalizing behavior problems in children born premature: an initial examination. Journal of Developmental and Behavioral Pediatrics, 31, 209. doi:10.1097/DBP. 0b013e3181d5a294.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bagner, D. M., Rodríguez, G. M., Blake, C. A., & Rosa-Olivares, J. (2013). Home-based preventive parenting intervention for at-risk infants and their families: an open trial. Cognitive and Behavioral Practice, 20, 334–348. doi:10.1016/j.cbpra.2012.08.001.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bakermans-Kranenburg, M. J., Van Ijzendoorn, M. H., & Juffer, F. (2003). Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin, 129, 195. doi:10.1037/0033-2909.129.2.195.

    Article  PubMed  Google Scholar 

  • Blanton, H., & Jaccard, J. (2006). Arbitrary metrics in psychology. American Psychologist, 61, 27. doi:10.1037/0003-066X.61.1.27.

    Article  PubMed  Google Scholar 

  • Boggs, S. R., Eyberg, S. M., Edwards, D. L., Rayfield, A., Jacobs, J., Bagner, D., & Hood, K. K. (2004). Outcomes of parent-child interaction therapy: a comparison of treatment completers and study dropouts one to three years later. Child and Family Behavior Therapy, 26, 1–22. doi:10.1300/J019v26n04_01.

    Article  Google Scholar 

  • Brennan, L. M., Shaw, D. S., Dishion, T. J., & Wilson, M. (2012). Longitudinal predictors of school-age academic achievement: unique contributions of toddler-age aggression, oppositionality, inattention, and hyperactivity. Journal of Abnormal Child Psychology, 40, 1289–1300. doi:10.1007/s10802-012-9639-2.

    Article  PubMed  PubMed Central  Google Scholar 

  • Briggs-Gowan, M. J., Carter, A. S., Irwin, J. R., Wachtel, K., & Cicchetti, D. V. (2004). The brief infant-toddler social and emotional assessment: screening for social-emotional problems and delays in competence. Journal of Pediatric Psychology, 29, 143–155. doi:10.1093/jpepsy/jsh017.

    Article  PubMed  Google Scholar 

  • Briggs-Gowan, M. J., Carter, A. S., Bosson-Heenan, J., Guyer, A. E., & Horwitz, S. M. (2006). Are infant-toddler social-emotional and behavioral problems transient? Journal of the American Academy of Child and Adolescent Psychiatry, 45, 849–858. doi:10.1097/01.chi.0000220849.48650.59.

    Article  PubMed  Google Scholar 

  • Carter, A. S., & Briggs-Gowan, M. J. (2006). ITSEA/BITSEA: infant toddler and brief infant toddler social and emotional assessment examiner’s manual. San Antonio: Harcourt Assessment.

    Google Scholar 

  • Carter, A. S., Briggs-Gowan, M. J., & Davis, N. O. (2004). Assessment of young children’s social-emotional development and psychopathology: recent advances and recommendations for practice. Journal of Child Psychology and Psychiatry, 45, 109–134. doi:10.1046/j.0021-9630.2003.00316.x.

    Article  PubMed  Google Scholar 

  • Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2013). Applied multiple regression/correlation analysis for the behavioral sciences. Mahwah: Routledge.

    Google Scholar 

  • Cote, S. M., Boivin, M., Liu, X., Nagin, D. S., Zoccolillo, M., & Tremblay, R. E. (2009). Depression and anxiety symptoms: onset, developmental course and risk factors during early childhood. Journal of Child Psychology and Psychiatry, 50, 1201–1208. doi:10.1111/j.1469-7610.2009.02099.x.

    Article  PubMed  Google Scholar 

  • Dishion, T. J., & Stormshak, E. A. (2007). Intervening in children’s lives: An ecological, family-centered approach to mental health care. American Psychological Association.

  • Dombrowski, S. C., Timmer, S. G., Blacker, D. M., & Urquiza, A. J. (2005). A positive behavioural intervention for toddlers: parent–child attunement therapy. Child Abuse Review, 14, 132–151. doi:10.1002/car.888.

    Article  Google Scholar 

  • Egger, H. L., & Angold, A. (2006). Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology. Journal of Child Psychology and Psychiatry, 47, 313–337. doi:10.1111/j.1469-7610.2006.01618.x.

    Article  PubMed  Google Scholar 

  • Eyberg, S. M. (2005). Tailoring and adapting parent-child interaction therapy for new populations. Education and Treatment of Children, 28, 197–201. Retrieved from: www.jstor.org/stable/42899841.

  • Eyberg, S. M., Nelson, M. M., Duke, M., & Boggs, S. R. (2005). Manual for the dyadic parent-child interaction coding system (3rd ed.). Unpublished manuscript, Department of Clinical and Health Psychology, University of Florida, Gainesville, FL.

  • Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37, 1–23. doi:10.1080/15374410701820117.

    Article  Google Scholar 

  • Eyberg, S. M., Boggs, S. R., & Jaccard, J. (2014). Does maintenance treatment matter? Journal of Abnormal Child Psychology, 42, 355–366. doi:10.1007/s10802-013-9842-9.

    Article  PubMed  Google Scholar 

  • Feingold, A. (2009). Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis. Psychological Methods, 14, 43. doi:10.1037/ a0014699.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gilliom, M., & Shaw, D. S. (2004). Codevelopment of externalizing and internalizing problems in early childhood. Development and Psychopathology, 16, 313–334. doi:10.1017/ S0954579404044530.

    Article  PubMed  Google Scholar 

  • Gross, D., Fogg, L., Webster-Stratton, C., Garvey, C., Julion, W., & Grady, J. (2003). Parent training of toddlers in day care in low-income urban communities. Journal of Consulting and Clinical Psychology, 71, 261. doi:10.1037/0022-006X.71.2.261.

    Article  PubMed  Google Scholar 

  • Hays, J. R., Reas, D. L., & Shaw, J. B. (2002). Concurrent validity of the Wechsler abbreviated scale of intelligence and the Kaufman brief intelligence test among psychiatric inpatients. Psychological Reports, 90, 355–359. doi:10.2466/pr0.2002.90.2.355.

    Article  PubMed  Google Scholar 

  • Hedeker, D., & Gibbons, R. D. (2006). Longitudinal data analysis (Vol. 451). Hoboken: Wiley.

    Google Scholar 

  • Heinrichs, N., Bertram, H., Kuschel, A., & Hahlweg, K. (2005). Parent recruitment and retention in a universal prevention program for child behavior and emotional problems: barriers to research and program participation. Prevention Science, 6, 275–286. doi:10.1007/ s11121-005-0006-1.

    Article  PubMed  Google Scholar 

  • Kaiser, A. P., Cai, X., Hancock, T. B., & Foster, E. M. (2002). Teacher-reported behavior problems and language delays in boys and girls enrolled in head start. Behavioral Disorders, 28, 23–39. Retrieved from: http://www.jstor.org/stable/23889147.

  • Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36, 567–589. doi:10.1007/s10802-007-9201-9.

    Article  PubMed  Google Scholar 

  • Keenan, K., & Wakschlag, L. S. (2000). More than the terrible twos: the nature and severity of behavior problems in clinic-referred preschool children. Journal of Abnormal Child Psychology, 28, 33–46. doi:10.1023/A:1005118000977.

    Article  PubMed  Google Scholar 

  • Keenan, K., & Wakschlag, L. S. (2002). Can a valid diagnosis of disruptive behavior disorder be made in preschool children? American Journal of Psychiatry, 159, 351–358. doi:10.1176/appi.ajp.159.3.351.

    Article  PubMed  Google Scholar 

  • Kohlhoff, J., & Morgan, S. (2014). Parent-child interaction therapy for toddlers: a pilot study. Child and Family Behavior Therapy, 36, 121–139. doi:10.1080/07317107.2014.910733.

    Article  Google Scholar 

  • Lavigne, J. V., LeBailly, S. A., Gouze, K. R., Binns, H. J., Keller, J., & Pate, L. (2010). Predictors and correlates of completing behavioral parent training for the treatment of oppositional defiant disorder in pediatric primary care. Behavior Therapy, 41, 198–211. doi:10.1016/j.beth.2009.02.006.

    Article  PubMed  PubMed Central  Google Scholar 

  • Linver, M. R., Brooks-Gunn, J., & Kohen, D. E. (2002). Family processes as pathways from income to young children’s development. Developmental Psychology, 38, 719–734. doi:10.1037/0012-1649.38.5.719.

    Article  PubMed  Google Scholar 

  • Lundahl, B., Risser, H. J., & Lovejoy, M. C. (2006). A meta-analysis of parent training: moderators and follow-up effects. Clinical Psychology Review, 26, 86–104. doi:10.1016/j.cpr.2005.07.004.

    Article  PubMed  Google Scholar 

  • McMahon, R. J., & Forehand, R. L. (2003). Helping the noncompliant child: family-based treatment for oppositional defiant disorder. New York: Guilford Press.

    Google Scholar 

  • Moffitt, T. E., Caspi, A., Harrington, H., & Milne, B. J. (2002). Males on the life-course-persistent and adolescence-limited antisocial pathways: follow-up at age 26 years. Development and Psychopathology, 14, 179–207. Retrieved from http://journals.cambridge.org.

  • Nixon, R. D. V., Sweeney, L., Erickson, D. B., & Touyz, S. W. (2003). Parent-child interaction therapy: a comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Consulting and Clinical Psychology, 71, 251–260. doi:10.1037/0022-006X.71.2.251.

    Article  PubMed  Google Scholar 

  • Olds, D. L. (2002). Prenatal and infancy home visiting by nurses: from randomized trials to community replication. Prevention Science, 3, 153–172. doi:10.1023/A:1019990432161.

    Article  PubMed  Google Scholar 

  • Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., . . . Henderson, C. R. (2004). Effects of home visits by paraprofessionals and by nurses: age 4 follow-up results of a randomized trial. Pediatrics, 114, 1560–1568. doi: 10.1542/peds.2004-0961.

  • Olds, D. L., Sadler, L., & Kitzman, H. (2007). Programs for parents of infants and toddlers: recent evidence from randomized trials. Journal of Child Psychology and Psychiatry, 48, 355–391. doi:10.1111/j.1469-7610.2006.01702.x.

    Article  PubMed  Google Scholar 

  • Patterson, G. R. (2002). The early development of coercive family process. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Pons, J. I., Flores-Pabón, L., Matías-Carrelo, L., Rodríguez, M., Rosario-Hernández, E., Rodríguez, J. M., . . . Yang, J. (2008). Confiabilidad de la Escala de Inteligencia Wechsler para Adultos Versión III, Puerto Rico (EIWA-III). Revista Puertorriqueña de Psicología, 19, 112–132. Retrieved from: http://pepsic.bvsalud.org.

  • Pons, J. I., Matías-Carrelo, L., Rodríguez, M., Rodríguez, J. M., Herrans, L. L., Jiménez, M. E.,… Yang, J. (2008). Estudios de validez de la Escala de Inteligencia Wechsler para Adultos Versión III, Puerto Rico (EIWA-III). Revista Puertorriqueña de Psicología, 19, 75–111. Retrieved from: http://pepsic.bvsalud.org

  • Qi, C. H., & Kaiser, A. P. (2003). Behavior problems of preschool children from low-income families review of the literature. Topics in Early Childhood Special Education, 23, 188–216. doi:10.1177/02711214030230040201.

    Article  Google Scholar 

  • Reitman, D., Currier, R. O., & Stickle, T. R. (2002). A critical evaluation of the parenting stress index-short form (PSI-SF) in a head start population. Journal of Clinical Child and Adolescent Psychology, 31, 384–392. doi:10.1207/S15374424 JCCP3103_10.

    Article  PubMed  Google Scholar 

  • Reyno, S. M., & McGrath, P. J. (2006). Predictors of parent training efficacy for child externalizing behavior problems – a meta-analytic review. Journal of Child Psychology and Psychiatry, 47, 99–111. doi:10.1111/j.1469-7610.2005.01544.x.

    Article  PubMed  Google Scholar 

  • Romeo, R., Knapp, M., & Scott, S. (2006). Economic cost of severe antisocial behaviour in children–and who pays it. The British Journal of Psychiatry, 188, 547–553. doi:10.1192/bjp.bp.104.007625.

    Article  PubMed  Google Scholar 

  • Rubin, D. B. (1976). Inference and missing data. Biometrika, 63, 581–592. doi:10.1093/biomet/ 63.3.581.

    Article  Google Scholar 

  • Sanders, M. R., Cann, W., & Markie-Dadds, C. (2003). The triple P-positive parenting programme: a universal population-level approach to the prevention of child abuse. Child Abuse Review, 12, 155–171. doi:10.1002/car.798.

    Article  Google Scholar 

  • Schafer, J. L., & Graham, J. W. (2002). Missing data: our view of the state of the art. Psychological Methods, 7, 147. doi:10.1037/1082-989X.7.2.147.

    Article  PubMed  Google Scholar 

  • Schuhmann, E. M., Foote, R. C., Eyberg, S. M., Boggs, S. R., & Algina, J. (1998). Efficacy of parent-child interaction therapy: interim report of a randomized trial with short-term maintenance. Journal of Clinical Child Psychology, 27, 34–45. doi:10.1207/ s15374424jccp2701_4.

    Article  PubMed  Google Scholar 

  • Shaw, D. S., Keenan, K., & Vondra, J. I. (1994). Developmental precursors of externalizing behavior: ages 1 to 3. Developmental Psychology, 30, 355–364. doi:10.1037/0012-1649.30.3.355.

    Article  Google Scholar 

  • Shaw, D. S., Owens, E. B., Giovannelli, J., & Winslow, E. B. (2001). Infant and toddler pathways leading to early externalizing disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 36–43. doi:10.1097/00004583-200101000-00014.

    Article  PubMed  Google Scholar 

  • Shaw, D. S., Gilliom, M., Ingoldsby, E. M., & Nagin, D. S. (2003). Trajectories leading to school-age conduct problems. Developmental Psychology, 39, 189–200. doi:10.1037/ 0012-1649.39.2.189.

    Article  PubMed  Google Scholar 

  • Shaw, D. S., Dishion, T. J., Supplee, L., Gardner, F., & Arnds, K. (2006). Randomized trial of a family-centered approach to the prevention of early conduct problems: 2-year effects of the family check-up in early childhood. Journal of Consulting and Clinical Psychology, 74, 1–9. doi:10.1037/0022-006X.74.1.1.

    Article  PubMed  Google Scholar 

  • Shaw, D. S., Connell, A., Dishion, T. J., Wilson, M. N., & Gardner, F. (2009). Improvements in maternal depression as a mediator of intervention effects on early childhood problem behavior. Development and Psychopathology, 21, 417–439. doi:10.1017/ S0954579409000236.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shelleby, E. C., & Shaw, D. S. (2014). Outcomes of parenting interventions for child conduct problems: a review of differential effectiveness. Child Psychiatry and Human Development, 45, 628–645. doi:10.1007/s10578-013-0431-5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thomas, J. M., & Guskin, K. A. (2001). Disruptive behavior in young children: what does it mean? Journal of the American Academy of Child and Adolescent Psychiatry, 40, 44–51. doi:10.1097/00004583-200101000-00015.

    Article  PubMed  Google Scholar 

  • Thomas, R., & Zimmer-Gembeck, M. J. (2012). Parent-child interaction therapy: an evidence-based treatment for child maltreatment. Child Maltreatment, 17, 253–266. doi:10.1177/1077559512459555.

    Article  PubMed  Google Scholar 

  • van Lier, P. A. C., Vitaro, F., Barker, E. D., Brendgen, M., Tremblay, R. E., & Boivin, M. (2012). Peer victimization, poor academic achievement, and the link between childhood externalizing and internalizing problems. Child Development, 83, 1775–1788. doi:10.1111/j.1467-8624.2012.01802.x.

    Article  PubMed  Google Scholar 

  • van Zeijl, J., Mesman, J., Stolk, M. N., Alink, L. R., van Ijzendoorn, M. H., Bakermans-Kranenburg, M. J., . . . Koot, H. M. (2006a). Terrible ones? Assessment of externalizing behaviors in infancy with the child behavior checklist. Journal of Child Psychology and Psychiatry, 47, 801–810. doi: 10.1111/j.1469-7610.2006.01616.x.

  • Van Zeijl, J., Mesman, J., Van, IJzendoorn M. H., Bakermans-Kranenburg, M. J., Juffer, F., Stolk, M. N., . . . Alink, L. R. (2006b). Attachment-based intervention for enhancing sensitive discipline in mothers of 1- to 3-year-old children at risk for externalizing behavior problems: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74, 994–1005. doi: 10.1037/0022-006X.74.6.994.

  • Webster-Stratton, C., & Hammond, M. (1990). Predictors of treatment outcome in parent training for families with conduct problem children. Behavior Therapy, 21, 319–337. doi:10.1016/S0005-7894(05)80334-X.

    Article  Google Scholar 

  • Webster-Stratton, C., & Reid, M. J. (2010). The incredible years parents, teachers, and children’s training series: A multifaceted approach for young children with conduct disorder. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents. New York: Guilford Press.

    Google Scholar 

  • Wechsler, D. (1997). Wechsler adult scale of intelligence (3rd ed.). San Antonio: Pearson.

    Google Scholar 

  • Wechsler, D. (1999). Wechsler abbreviated scale of intelligence. San Antonio: Pearson.

    Google Scholar 

  • Whiteside-Mansell, L., Ayoub, C., McKelvey, L., Faldowski, R. A., Hart, A., & Shears, J. (2007). Parenting stress of low-income parents of toddlers and preschoolers: psychometric properties of a short form of the parenting stress index. Parenting: Science and Practice, 7, 26–56. doi:10.1080/15295190709336775.

    Article  Google Scholar 

  • Zisser, A., & Eyberg, S. M. (2010). Treating oppositional behavior in children using parent-child interaction therapy. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (Vol. 2, pp. 179–193). New York: Guilford Press.

    Google Scholar 

Download references

Acknowledgments

This work was supported by a career development award from the National Institute of Mental Health to the first author (K23MH085659). We thank Drs. Alice Carter, Paulo Graziano, and Jeremy Pettit for their consultation and feedback on this manuscript and all participating families for their commitment to our research program.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel M. Bagner.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest related to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bagner, D.M., Coxe, S., Hungerford, G.M. et al. Behavioral Parent Training in Infancy: A Window of Opportunity for High-Risk Families. J Abnorm Child Psychol 44, 901–912 (2016). https://doi.org/10.1007/s10802-015-0089-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-015-0089-5

Keywords

Navigation