Time-Out with Young Children: A Parent-Child Interaction Therapy (PCIT) Practitioner Review

Time-out is a component of many evidence-based parent training programmes for the treatment of childhood conduct problems. Existing comprehensive reviews suggest that time-out is both safe and effective when used predictably, infrequently, calmly and as one component of a collection of parenting strategies—i.e., when utilised in the manner advocated by most parent training programmes. However, this research evidence has been largely oriented towards the academic community and is often in conflict with the widespread misinformation about time-out within communities of parents, and within groups of treatment practitioners. This dissonance has the potential to undermine the dissemination and implementation of an effective suite of treatments for common and disabling childhood conditions. The parent-practitioner relationship is integral to the success of Parent-Child Interaction Therapy (PCIT), an evidence-based treatment which involves live coaching of parent(s) with their young child(ren). Yet this relationship, and practitioner perspectives, attitudes and values as they relate to time-out, are often overlooked. This practitioner review explores the dynamics of the parent-practitioner relationship as they apply to the teaching and coaching of time-out to parents. It also acknowledges factors within the clinical setting that impact on time-out’s use, such as the views of administrators and professional colleagues. The paper is oriented toward practitioners of PCIT but is of relevance to all providers of parent training interventions for young children.

Barriers to Clinician Implementation of Parent–Child Interaction Therapy (PCIT) in New Zealand and Australia: What Role for Time-Out?

Background: Parent–Child Interaction Therapy (PCIT) is an effective parent training approach for a commonly occurring and disabling condition, namely conduct problems in young children. Yet, despite ongoing efforts to train clinicians in PCIT, the intervention is not widely available in New Zealand and Australia. Methods: We undertook a cross-sectional online survey of clinicians in New Zealand and Australia who had completed at least the 40-h initial PCIT training, to understand the barriers they encountered in their implementation efforts, and the extent to which attitudes toward time-out influenced implementation. The overall response rate was 47.5% (NZ: 60%; Australia: 31.4%). Results: Responses suggested that participants generally viewed PCIT as both acceptable and effective. Australian participants reported seeing significantly more clients for PCIT per week than those in NZ (Medians 0 and 2, respectively; χ2(1) = 14.08, p < 0.001) and tended to view PCIT as more effective in treating disruptive and oppositional behaviour (95% CI: −0.70, −0.13, p = 0.005). Participants currently seeing PCIT clients described it as more enjoyable to implement than those not using PCIT (95% CI: −0.85, −0.10, p = 0.01). Thirty-eight percent of participants indicated that they adapt or tailor the standardised protocol, primarily by adding in content relating to emotion regulation, and removing content relating to time-out. Participants generally felt that they had fewer skills, less knowledge, and less confidence relating to the Parent-Directed Interaction phase of PCIT (which involves time-out), compared with the Child-Directed Interaction phase. Conclusion: While we had hypothesised that time-out represented an intra-intervention component that detracted from implementation success, results suggested that clinician concern over the use of time-out was present but not prominent. Rather, the lack of access to suitable equipment (i.e., one-way mirror and ear-piece) and difficulties associated with clients attending clinic-based sessions were barriers most commonly reported by clinicians. We suggest that future research might consider whether and how PCIT might be “re-implemented” by already-trained clinicians, moving beyond simply training more clinicians in the approach.

Predictors of Parent Engagement in Community-Based Parent–Child Interaction Therapy: A Brief Report

Despite substantial empirical support, correlates of retention and success in community-based parent–child interaction therapy (PCIT) implementation are not well defined. Widespread application of PCIT necessitates improved understanding of intervention components relating to family outcomes beyond highly controlled research trials. Using data collected as part of routine care, this study examined homework completion, time in intervention, and parent perceptions of pre-intervention behavioral issues as predictors of PCIT completion in a community-based sample. Subjects included 78 parents (49 women and 29 men) of 45 children (20 girls, 25 boys; mean age = 5.53 years) participating in PCIT in an outpatient behavioral health clinic in a small Midwestern U.S. city. Unlike previous controlled trials, homework completion did not predict child behavior growth or intervention completion. Reasons for early termination were examined thematically, and parent stress emerged as a possible avenue for future intervention in helping parents successfully complete PCIT. The issue of intervention dosage was also explored to see if families who prematurely terminated from PCIT still evidenced gains in child behavior.

Reliability and Validity of Behavior Observation Coding Systems in Child Maltreatment Risk Evaluation: A Systematic Review

Performing child maltreatment risk assessments is a challenging task that calls for valid and reliable measures. In child protection proceedings, mental health professionals conduct maltreatment assessments that often form an important basis for judicial decision making. Because parent–child interaction is a key construct in maltreatment risk evaluations, observational assessment measures are crucial. This systematic review aims to identify observational coding systems of parent–child interaction that are applicable for psychological evaluations of the risk of child maltreatment. The goal is to examine the potential of observational coding systems to discriminate behavior of parents who have versus have not engaged in child maltreatment. A systematic literature search led to the inclusion of 13 studies published in the United States and Europe that were then analyzed in detail. Across the 13 studies, this review identified 11 unique observational coding systems. Results are summarized systematically for study characteristics and outcomes. Additionally, the main characteristics of the observational coding systems are identified and analyzed, including the age range of the child, observation tasks, measured constructs, and reliability. The discussion focuses on the strengths and weaknesses of the individual observational coding systems in the context of child maltreatment risk assessments.

Socioeconomic disadvantage and parental mood/affective problems links negative parenting and executive dysfunction in children born very preterm

Poverty increases the risk of poorer executive function (EF) in children born full-term (FT). Stressors associated with poverty, including variability in parenting behavior, may explain links between poverty and poorer EF, but this remains unclear for children born very preterm (VPT). We examine socioeconomic and parental psychosocial adversity on parenting behavior, and whether these factors independently or jointly influence EF in children born VPT. At age five years, 154 children (VPT = 88, FT = 66) completed parent-child interaction and EF tasks. Parental sensitivity, intrusiveness, cognitive stimulation, and positive and negative regard were coded with the Parent-Child Interaction Rating Scale. Socioeconomic adversity spanned maternal demographic stressors, Income-to-Needs ratio, and Area Deprivation Index. Parents completed measures of depression, anxiety, inattention/hyperactivity, parenting stress, and social-communication interaction (SCI) problems. Parental SCI problems were associated with parenting behavior in parents of children born VPT, whereas socioeconomic adversity was significant in parents of FT children. Negative parenting behaviors, but not positive parenting behaviors, were related to child EF. This association was explained by parental depression/anxiety symptoms and socioeconomic adversity. Results persisted after adjustment for parent and child IQ. Findings may inform research on dyadic interventions that embed treatment for parental mood/affective symptoms and SCI problems to improve childhood EF.