Effect of Exposure-Based Parent-Child Interaction Therapy on Early Childhood Compulsive Behaviors

Abstract

Childhood obsessive-compulsive symptoms are being identified with greater prevalence than previously believed. Psychological treatment studies with this population have typically included children older than seven, used cognitive-behavioral therapy with exposure and response-prevention, and involved the child's family in some capacity. Studies, however, have largely ignored children under seven, have used cognitive techniques, despite evidence to suggest that they may not be appropriate or necessary for children under the age of nine, and have infrequently delineated a systematic role for the family in treatment.

Parent-child interaction therapy (PCIT; Brinkmeyer & Eyberg, 2003) is an empirically validated behavior management intervention, originally designed to treat oppositional children through systematic parental involvement, but was adapted to incorporate treatment for young children with obsessive-compulsive symptoms. PCIT has preliminary evidence in treating separation anxiety when tailored to include graduated exposure to feared separation situations as a separate phase of treatment.

An exposure and response-prevention-based modification of PCIT was implemented to treat three boys ages four to eight who presented with compulsive behaviors. For this eight-week, 12-session study, a single-subject repeated measures, within-subject design was utilized. Pre- and posttreatment compulsive behavior was measured at the child's home using coded observations of reassurance-seeking, avoidance, and ritualizing. Baseline assessment of in-session child compulsive behavior and parent behavior occurred over three monitoring sessions at the university clinic and continued throughout treatment by both standardized and modified versions of the Dyadic Parent-Child Interaction Coding System-Third Edition (Eyberg, Nelson, Duke, & Boggs, 2005), a behavioral observation and coding system used in PCIT to continuously measure changes in child behavior and parental mastery of PCIT skills. There were eight treatment and teaching sessions, four of which involved strategies to improve parent-child relationships and four sessions of parent-led exposure and response-prevention.

Observable decreases were noted for child compulsive behaviors and for maladaptive parent behaviors. Parents also demonstrated observable increases from baseline of adaptive behaviors. Due to the age of the children recruited, criteria for inclusion included the presence of compulsive behaviors, such as compulsive counting, rather than a mandatory diagnosis of Obsessive-Compulsive Disorder (OCD); although, this treatment has implications for said OCD population.