Parent-Child Interaction Therapy: Managing Challenging Behaviors (Ages 2-7)

Caregivers everywhere can relate to the overwhelming feelings that occur when they are witnessing their child have a meltdown in public or at home. Children with a variety of mental health conditions such as attention-deficit/hyperactivity disorder (ADHD), disruptive mood dysregulation disorder (DMDD), oppositional defiant disorder (ODD), autism spectrum disorder (ASD), trauma, and emotional concerns can exhibit challenging behaviors such as meltdowns, kicking, screaming, arguing, defiance, etc. It is also common for children to test limits. Regardless of best efforts, sometimes, your little one’s big feelings get the best of them. While it is most important that caregivers stay calm in these moments, that can be one of the hardest things to do. We are hard-wired to respond when our children have a need and sometimes that response can escalate the situation. It is worth it as a caregiver to know how to set and hold limits while still maintaining a positive bond with your child. What if I told you that the way you engage in play with your child can help them to listen and mind like champs? Well, that’s the case with Parent-Child Interaction Therapy (PCIT).

What is PCIT?

PCIT is an intensive evidence-based therapy that prioritizes caregiver and child connection in pursuit of a goal for behavior management. It combines caregiver coaching and education with playtime with your child to ensure that both caregiver and child’s engagement is high. It helps families confidently and lovingly reduce and manage behavior that is defiant, disruptive, impulsive, argumentative, attention-seeking, or whiny. It also helps children who have experienced trauma and children who become emotionally dysregulated. It also has over 40 years of a research base to support its efficacy.

How Does it Work?

PCIT is broken into two components, the Child-Directed Interaction (CDI) and the Parent-Directed Interaction (PDI). It typically requires 14-16 weeks of consistent therapy sessions to master skills and develop a new approach to discipline in the family system.

During CDI, caregivers learn to implement important skills while they follow their child’s lead in play. These “P.R.I.D.E. Skills” stand for Praise, Reflections, Imitation, Descriptions, and Enjoyment. Caregivers are also taught to ignore minor misbehaviors and avoid criticisms and questions that could escalate a situation, impact a child’s self-esteem/engagement, or commandeer the lead of play. They practice these skills during daily homework called “Special Time” where 5 min of playtime with your child allows you to integrate and generalize these skills to all types of real-world scenarios. Caregivers master these skills via weekly live-coaching therapy sessions by a trained provider who observes and coaches the caregiver through a 1-way mirror.

As caregivers master these skills, they notice drastic improvements in their child, themselves, and their relationship. Improvements include higher pro-social behavior, self-esteem, engagement, focus, body control, and a stronger caregiver-child bond. And we’re only halfway through!

In PCIT, consistency is key. It is important to remain consistent in daily practices, attending appointments, and use of skills. The importance of consistency is magnified during the PDI phase. Once CDI skills are mastered, families progress to the PDI phase where they learn about the 8-Rules for Effective Commands and a standardized timeout procedure. Caregivers are empowered to make accurate judgments about what situations warrant which skills and how to fluently integrate skills throughout life. Weekly coaching still takes place during therapy where children learn to listen to the first command and receive a consistent system of useful consequences if not. Sessions may even include siblings or may take place in public to ensure a caregiver feels confident using skills in public spaces. Caregivers often report that any lingering behavioral concerns are well-managed following PDI. At the completion of the PDI, a PCIT graduation celebrates the caregiver and child’s accomplishments followed by occasional check-ins occur to ensure consistency. Caregivers report incredible boosts in their confidence and children’s behavior and children report loving to spend quality time with their caregivers!

Is PCIT a Fit for Me and My Child?

The short answer is… maybe! PCIT is one of many options for addressing defiant behavior and emotion dysregulation. Other options include play therapy, talk therapy (although not strongly recommended for 2-7 y.o.), caregiver training, or Applied Behavioral Analysis (ABA) (if behavioral management is a concern for a child with autism). Each of these solutions is excellent and can be highly valuable for the child who needs them. PCIT even incorporates aspects of each into its philosophy. PCIT’s combination of in-vivo coaching, frequent meetings, and providing caregivers with concrete tools make it uniquely suited to address concerns during therapy, at home, and in public. I encourage caregivers to discuss their fit with PCIT with a licensed mental health professional to determine the best path.

Key Takeaways

• PCIT is an evidence-based and caregiver endorsed therapy to address behavioral concerns, trauma, and other challenges. It has decades of research support.
• It works by first helping to build a strong bond with your child then by establishing consistent caregiver responses to challenging behaviors.
• It can be a good fit for children 2-7 with behavioral concerns, but it’s important to discuss this with a licensed provider.

There are a number of considerations to determine what is best for your child. With positive intentions and helpful resources, finding what is right for your family can be made simpler. PCIT has wonderful benefits, and if it is right for you or someone you know, please consider finding a PCIT therapist in your area!

Some Helpful Resources

At Child and Family Development, our providers are here to support parents every step of the way. To learn more, visit this link to schedule a free consultation call for Counseling Services with Dr. Trinity Johnson

PCIT

What is PCIT? | Parent Child Interaction Therapy

References

Campbell, S. M., Hawes, T., Swan, K., Thomas, R., & Zimmer-Gembeck, M. J. (2023). Evidence-Based Treatment in Practice: PCIT Research on Addressing Individual Differences and Diversity Through the Lens of 20 Years of Service. Psychology research and behavior management, 16, 2599–2617. https://doi.org/10.2147/PRBM.S360302