By Mary Margaret Gleason, MD and Greta L. Doctoroff, PhD |
September 1, 2006
In randomized controlled trials, the BASIC program has demonstrated clinically significant improvements in parenting practices and child conduct problems, including remission from oppositional defiant disorder.34-36 Similarly, the ADVANCE program is associated with notable improvements in parent-child interaction, communication, problem solving, and child adjustment.37
Parent-child interaction therapy (PCIT) is an individualized, relationship-focused intervention based on behavior theory for children aged 2 to 6 years who are referred for disruptive behavior disorders.38 PCIT has been effectively adapted for use in high-risk populations, including children with physically abusive parents.39 In PCIT dyadic sessions, parents receive live coaching from the therapist behind a one-way mirror using a "bug-in-the-ear" microphone. Parent collaborative teaching sessions are followed by in-session and at-home practice. PCIT uses a 2-stage model to target parent behaviors: (1) child-directed behavior play therapy skills (ie, praise, reflection, imitation, description) and effective reinforcement, and (2) parent-directed interaction techniques, including effective commands, consistent limit setting, ignoring, and time-out. Growing research evidence supports the efficacy of PCIT in improving parenting skills and providing clinically significant reductions in oppositional and aggressive behavior.40
Efficacy and safety data regarding the use of psychopharmacologic treatment in children under 5 years are lacking.41 These agents are used with caution in this age group and should be considered only after a trial of appropriate psychotherapy is unsuccessful. On the other hand, parental psychopharmacologic treatment when indicated can be very useful in combination with dyadic interventions.
Infant psychiatry offers exciting opportunities in clinical and research settings. The specialty requires true integration of biologic, psychological, and social intervention strategies--with collaboration across disciplines. Infant psychiatrists can intervene early to promote current and future healthy development and relationships and treat a wide range of psychopathology in infants. The growth and development of this specialty, like early childhood development itself, is rapid and holds extraordinary potential to promote family mental health and treat psychopathology.
Dr Gleason is a clinical assistant professor in the department of psychiatry and human behavior at Brown Medical School in Providence, RI, and at the Institute of Infant and Early Childhood Mental Health at Tulane University Health Science Center in New Orleans as well as a research fellow in child psychiatry at Rhode Island Hospital in Providence.
Dr Doctoroff is a clinical psychology research fellow in the department of psychiatry and human behavior at the Brown Medical School and at the Bradley Early Childhood Clinical Research Center at Rhode Island Hospital.Both authors report that they have no conflicts of interest regarding this article.
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