PCIT CPA Presentation - Family and Developmental ... · 150605 3 Meta’Regression-forDiagnosis-0...
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150605 1 ParentChild Interaction Therapy for Child Disruptive Behaviour Disorders: A MetaAnalysis Michelle A. Ward Jennifer Theule Kristene Cheung University of Manitoba Disruptive Behaviour Disorders ADHD Attention Deficit Hyperactivity Disorder ODD Oppositional Defiant Disorder CD Conduct Disorder http://www.123rf.com/ clipartvector/angry.html Criteria Based on the DSMIVTR ParentChild Interaction Therapy (PCIT) http://www.westchesterparentingcenter.com/pcit.php Eyberg (1988) Previous Research Bradley & Mandell (2005) Interventions for ODD 2 of 7 studies implemented PCIT Thomas & ZimmerGembeck (2007) Interventions for children with behaviour problems 13 of 24 studies implemented PCIT Found large to medium effect sizes for PCIT Gallagher (2003) Systematic review of PCIT across 17 studies Found statistically significant improvements in every study and clinically significant improvements in 14 studies Building on Past Research Incorporated recent research Altered eligibility criteria Samples who have experienced trauma excluded Limited to clinically significant behaviour problems Included unpublished research Explored gender and diagnosis as moderators The Present MetaAnalysis Research Questions: Establish clarity regarding PCIT efficacy Determine efficacy of PCIT with: Boys vs. girls ADHD, ODD, and CD Hypotheses: Medium to large effect size More effective for children with ODD & CD
Transcript of PCIT CPA Presentation - Family and Developmental ... · 150605 3 Meta’Regression-forDiagnosis-0...
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Parent-‐Child Interaction Therapy for Child Disruptive Behaviour Disorders:
A Meta-‐Analysis
Michelle A. Ward Jennifer Theule Kristene Cheung
University of Manitoba
Disruptive Behaviour Disorders
� ADHD ¡ Attention Deficit Hyperactivity Disorder
� ODD ¡ Oppositional Defiant Disorder
� CD ¡ Conduct Disorder
http://www.123rf.com/clipart-‐vector/angry.html
-‐ Criteria Based on the DSM-‐IV-‐TR
Parent-‐Child Interaction Therapy (PCIT)
http://www.westchesterparentingcenter.com/pcit.php
-‐ Eyberg (1988)
Previous Research
� Bradley & Mandell (2005) ¡ Interventions for ODD ¡ 2 of 7 studies implemented PCIT
� Thomas & Zimmer-‐Gembeck (2007) ¡ Interventions for children with behaviour problems ¡ 13 of 24 studies implemented PCIT ¡ Found large to medium effect sizes for PCIT
� Gallagher (2003) ¡ Systematic review of PCIT across 17 studies ¡ Found statistically significant improvements in every
study and clinically significant improvements in 14 studies
Building on Past Research
� Incorporated recent research
� Altered eligibility criteria ¡ Samples who have experienced trauma excluded ¡ Limited to clinically significant behaviour problems
� Included unpublished research
� Explored gender and diagnosis as moderators
The Present Meta-‐Analysis
� Research Questions: ¡ Establish clarity regarding PCIT efficacy ¡ Determine efficacy of PCIT with:
÷ Boys vs. girls ÷ ADHD, ODD, and CD
� Hypotheses: ¡ Medium to large effect size ¡ More effective for children with ODD & CD
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Records identified through primary database search
PsycINFO, PubMed, ERIC, ProQuest
Dissertations and Theses , and Google Scholar
(n = 536)
Records obtained through:
• Backwards & forwards referencing
• Previous reviews • Contact with Dr. Sheila Eyberg
(n = 5)
Records after duplicates removed (n = 473)
Full-‐text articles assessed for eligibility
(n = 67)
Included (n = 12)
Full-‐text articles excluded (n = 52)
• Sample not eligible (n = 23) • Overlapping sample (n = 6) • Follow-‐up study (n = 9) • PCIT modified/shortened (n = 5) • Dissertation later published (n = 3) • Comparison of outcomes presented
ineligible (n = 3) • No direct measure of externalizing
behaviour (n = 2) • PCIT not implemented (n = 1)
PRISMA Flow Diagram (Moher, Liberati, Tetzlaff, & Altman, 2009)
Records identified through primary database search
PsycINFO, PubMed, ERIC, ProQuest
Dissertations and Theses , and Google Scholar
(n = 536)
Records obtained through:
• Backwards & forwards referencing
• Previous reviews • Contact with Dr. Sheila Eyberg
(n = 5)
Records after duplicates removed (n = 473)
Full-‐text articles assessed for eligibility
(n = 67)
Included (n = 12)
Full-‐text articles excluded (n = 52)
• Sample not eligible (n = 23) • Overlapping sample (n = 6) • Follow-‐up study (n = 9) • PCIT modified/shortened (n = 5) • Dissertation later published (n = 3) • Comparison of outcomes presented
ineligible (n = 3) • No direct measure of externalizing
behaviour (n = 2) • PCIT not implemented (n = 1)
PRISMA Flow Diagram (Moher, Liberati, Tetzlaff, & Altman, 2009)
Study Characteristics
� 10 published & 2 unpublished � 11 studies linked to the developer of PCIT
� 11 conducted in USA
� 254 treated & 118 control group participants ¡ Majority White boys
Is PCIT an Effective Intervention?
� Determining PCIT Efficacy: ¡ 2 Separate Meta-‐Analyses
÷ Pre-‐Post Treatment Data:
÷ Treatment-‐Control Data
¡ Cohen’s d ¡ Random Effects Model
Is PCIT an Effective Intervention?
� Determining PCIT Efficacy: ¡ 2 Separate Meta-‐Analyses
÷ Pre-‐Post Treatment Data:
d = 1.65, 95% CI [1.41, 1.90], p < .001
÷ Treatment-‐Control Data d = 1.39, 95% CI [1.05, 1.73], p < .001
¡ Cohen’s d ¡ Random Effects Model
Meta-‐Regression for Gender
0
0.5
1
1.5
2
2.5
3
0 10 20 30 40 50 60 70 80 90 100
Effec
t Size
% of Girls in Sample
Q(1) = 0.03, p = .86
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Meta-‐Regression for Diagnosis
0
0.5
1
1.5
2
0 50 100
Meta-‐Regression for ADHD Moderator
Effec
t Size
% of ADHD in Sample
ADHD Q(1) = 0.19, p = .67
CD
Q(1) = 1.71, p = .19
ODD Q(1) = 0.47, p = .49
0
0.5
1
1.5
2
0 50 100
Meta-‐Regression for CD Moderator
Meta-‐Regression for Diagnosis
Effec
t Size
% of CD in Sample
ADHD Q(1) = 0.19, p = .67
CD
Q(1) = 1.71, p = .19
ODD Q(1) = 0.47, p = .49
Meta-‐Regression for Diagnosis
ADHD Q(1) = 0.19, p = .67
CD
Q(1) = 1.71, p = .19
ODD Q(1) = 0.47, p = .49 Eff
ect S
ize
% of ODD in Sample
0
0.5
1
1.5
2
0 50 100
Meta-‐Regression for ODD Moderator
� PCIT found to be efficacious intervention
� Limitations within the literature: ¡ Few original studies available ¡ Few independent studies available ¡ Sample populations not diverse
÷ Gender ÷ Diagnosis
Major Findings
÷ Ethnicity ÷ Country
Implications
� For Practitioners: ¡ Efficient transfer of information
¡ Evidence-‐based decisions
http://www.clipartbest.com/clipart-‐di8xBM8ie
� For Researchers: ¡ Independent research ¡ Explore diagnoses individually ¡ More diverse populations
References
� American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
� Bradley, M. C., & Mandell, D. (2005). Oppositional Defiant Disorder: A systematic review of evidence of intervention effectiveness. Journal of Experimental Criminology, 1, 343-‐365. doi:10.1007/ s11292-‐005-‐0062-‐3
� Eyberg, S. (1988). Parent-‐Child Interaction Therapy: Integration of traditional and behavioral concerns. Child & Family Behavior Therapy, 10(1), 33-‐46. Retrieved from http://search.proquest.com/ docview/617552407?accountid=14569
� Gallagher, N. (2003). Effects of Parent-‐Child Interaction Therapy on young children with disruptive behavior disorders. Bridges, 1(4). Retrieved from http://sc-‐boces.org/english/IMC/Focus/parent-‐ child_interaction_theory.pdf
� Kazdin, A. E. (2003). Psychotherapy for children and adolescents. Annual Review of Psychology, 54, 253-‐276. Retrieved from http://www.annualreviews.org.proxy1.lib.umanitoba.ca/doi/abs/10.1146/ annurev.psych.54.101601.145105
� Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Götzsche, P. C., Ioannidis, J. P. A., … & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-‐analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ, 339, b2700, doi: 10.1136/bmj.b2700
� Pliszka, S. (2007). Practice parameter for the assessment and treatment of children and adolescents with Attention-‐Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(7), 894-‐921. doi:10.1097/chi.0b013e318054e724
� Thomas, R., & Zimmer-‐Gembeck, M. (2007). Behavioral outcomes of Parent-‐Child Interaction Therapy and Triple P-‐Positive Parenting Program: A review and meta-‐analysis. Journal of Abnormal Child Psychology, 35, 475-‐495. doi:10.1007/s10802-‐007-‐9104-‐9
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Studies Included in Meta-‐Analysis
*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-‐216. doi:10.1097/DBP.0b013e3181d5a294
*Brestan, E. V., Eyberg, S. M., Boggs, S. R., & Algina, J. (1997). Parent–Child Interaction Therapy: Parents' perceptions of untreated siblings. Child & Family Behavior Therapy, 19, 13-‐28. doi:10.1300/J019v19n03_02
*Brinkmeyer, M. Y. (2006). Conduct Disorder in young children: A comparison of clinical presentation and treatment outcome in preschoolers with Conduct Disorder versus Oppositional Defiant Disorder (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses. (UMI No. 3234523)
*Chase, R. M. (2005). Parent-‐child Interaction Therapy for Children with comorbid externalizing and internalizing symptoms (Doctoral dissertation). University of Florida.
*Eisenstadt, T. H., Eyberg, S., McNeil, C. B., Newcomb, K., & Funderburk, B. (1993). Parent-‐Child Interaction Therapy with behavior problem children: Relative effectiveness of two stages and overall treatment outcome. Journal of Clinical Child Psychology, 22, 42-‐51. doi:10.1207/s15374424jccp2201_4
*Eyberg, S. M., Boggs, S. R., & Algina, J. (1995). Parent-‐Child Interaction Therapy: A psychosocial model for the treatment of young children with conduct problem behavior and their families. Psychopharmacology Bulletin, 31, 83-‐91. Retrieved from http://search.proquest.com/docview/618907753?accountid=14569
*Floyd, E. M. (2005). Treatment of Oppositional Defiant Disorder in preschoolers with or without comorbid Attention Deficit Hyperactivity Disorder (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses. (UMI No. 3192381)
*Matos, M., Bauermeister, J. J., & Bernal, G. (2009). Parent-‐Child Interaction Therapy for Puerto Rican preschool children with ADHD and behavior problems: A pilot efficacy study. Family Process, 48, 232-‐252. doi:10.1111/j.1545-‐5300.2009.01279.x
*McCabe, K., & Yeh, M. (2009). Parent-‐Child Interaction Therapy for Mexican Americans: A randomized clinical trial. Journal of Clinical Child and Adolescent Psychology, 38, 753-‐759. doi:10.1080/15374410903103544
*McNeil, C. B., Capage, L. C., Bahl, A., & Blanc, H. (1999). Importance of early intervention for disruptive behavior problems: Comparison of treatment and waitlist-‐control groups. Early Education and Development, 10, 445-‐454. doi:10.1207/s15566935eed1004_2
*McNeil, C. B., Eyberg, S., Eisenstadt, T. H., Newcomb, K., & Funderburk, B. (1991). Parent-‐Child Interaction Therapy with behavior problem children: Generalization of treatment effects to the school setting. Journal of Clinical Child Psychology, 20, 140-‐151. doi:10.1207/s15374424jccp2002_5
*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
*Perez, J. C. (2008). Predictors of patterns of change in child disruptive behavior and parenting stress during Parent Child Interaction Therapy and its relation to treatment outcome. (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses. (UMI No. 3334498)
*Querido, J. G. (2003). Early intervention for child conduct problems in head start families (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses. (UMI No. 3105655)
*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
Eligibility Criteria
� Published/prepared before June 2013 (English) � Age 2-‐5 years � Diagnosis of ADHD, ODD, CD � PCIT implemented (not modified) � No Pervasive Developmental Disorders, chromosomal abnormalities, maltreatment
� Compared pre-‐post OR treatment/control � Assessed quantitative relationship between PCIT & behaviour
Parent-‐Child Interaction Therapy (PCIT)
CDI
• Child-‐Directed Interaction Phase • Child guides play session • Maximize positive communication
PDI
• Parent-‐Directed Interaction Phase • Parent guides play session • Reinforcement & Consequences for behaviour
Pre-‐Post Results
S tudy nam e S ubgr oup within study Com par ison Outcom e S tatistics for each study S am ple size S td diff in m eans and 95% CI
S td diff S tandar d Lower Upper in m eans er r or V ar iance lim it lim it Z-Value p-Value Tr eated Contr ol
B agner et al. B lank Treated P re vs. P ost Combined 2.391 0.560 0.313 1.294 3.488 4.273 0.000 11 11
B restan, E . V ., E yberg, S . M., B oggs, S . R., et al.B lank Treated P re vs. P ost Combined 1.176 0.450 0.202 0.294 2.058 2.614 0.009 13 13
E isenstadt, T. H., Eyberg, S ., McNeil, C. B ., et al. B lank Treated P re vs. P ost Combined 1.793 0.353 0.125 1.100 2.486 5.073 0.000 24 24
E yberg, B oggs, & A lgina B lank Treated P re vs. P ost Combined 1.731 0.536 0.287 0.682 2.781 3.233 0.001 10 10
Matos et al. B lank Treated P re vs. P ost Combined 1.856 0.378 0.143 1.114 2.598 4.904 0.000 20 20
McCabe, K ., & Y eh, M. B lank Treated P re vs. P ost Combined 1.466 0.370 0.137 0.741 2.192 3.960 0.000 19 19
McNeil, C. B ., Capage, L. C., B ahl, B ., et al. B lank Treated P re vs. P ost Combined 1.605 0.387 0.150 0.846 2.364 4.144 0.000 18 18
McNeil, C. B ., E yberg, S ., E isenstadt, T. H., et al.B lank Treated P re vs. P ost Combined 1.622 0.527 0.277 0.590 2.654 3.081 0.002 10 10
Nixon et al. B lank Treated (S TD) P re vs. P ost Combined 1.282 0.382 0.146 0.533 2.032 3.354 0.001 17 17
Querido B lank Treated P re vs. P ost Combined 0.775 0.865 0.749 -0.921 2.472 0.896 0.370 4 4
S chuhmann et al. B lank Treated P re vs. P ost Combined 1.401 0.400 0.160 0.617 2.185 3.503 0.000 17 17
Four Dissertations B lank Treated P re vs. P ost Combined 2.346 0.408 0.166 1.546 3.145 5.752 0.000 33 29
1.652 0.124 0.015 1.408 1.895 13.275 0.000
-4.00 -2.00 0.00 2.00 4.00
Favour s A Favour s B
S tudy nam e S ubgr oup within study Com par ison Outcom e S tatistics for each study S am ple size S td diff in m eans and 95% CI
S td diff S tandar d Lower Upper in m eans er r or V ar iance lim it lim it Z-Value p-Value Tr eated Contr ol
B agner et al. B lank Treated P re vs. P ost Combined 2.391 0.560 0.313 1.294 3.488 4.273 0.000 11 11
B restan, E . V ., E yberg, S . M., B oggs, S . R., et al.B lank Treated P re vs. P ost Combined 1.176 0.450 0.202 0.294 2.058 2.614 0.009 13 13
E isenstadt, T. H., Eyberg, S ., McNeil, C. B ., et al. B lank Treated P re vs. P ost Combined 1.793 0.353 0.125 1.100 2.486 5.073 0.000 24 24
E yberg, B oggs, & A lgina B lank Treated P re vs. P ost Combined 1.731 0.536 0.287 0.682 2.781 3.233 0.001 10 10
Matos et al. B lank Treated P re vs. P ost Combined 1.856 0.378 0.143 1.114 2.598 4.904 0.000 20 20
McCabe, K ., & Y eh, M. B lank Treated P re vs. P ost Combined 1.466 0.370 0.137 0.741 2.192 3.960 0.000 19 19
McNeil, C. B ., Capage, L. C., B ahl, B ., et al. B lank Treated P re vs. P ost Combined 1.605 0.387 0.150 0.846 2.364 4.144 0.000 18 18
McNeil, C. B ., E yberg, S ., E isenstadt, T. H., et al.B lank Treated P re vs. P ost Combined 1.622 0.527 0.277 0.590 2.654 3.081 0.002 10 10
Nixon et al. B lank Treated (S TD) P re vs. P ost Combined 1.282 0.382 0.146 0.533 2.032 3.354 0.001 17 17
Querido B lank Treated P re vs. P ost Combined 0.775 0.865 0.749 -0.921 2.472 0.896 0.370 4 4
S chuhmann et al. B lank Treated P re vs. P ost Combined 1.401 0.400 0.160 0.617 2.185 3.503 0.000 17 17
Four Dissertations B lank Treated P re vs. P ost Combined 2.346 0.408 0.166 1.546 3.145 5.752 0.000 33 29
1.652 0.124 0.015 1.408 1.895 13.275 0.000
-4.00 -2.00 0.00 2.00 4.00
Favour s A Favour s B
Treatment-‐Control Results
Study name Subgroup within study Comparison Statistics for each study Std diff in means and 95% CI
Std diff Standard Lower Upper in means error Variance limit limit Z-Value p-Value
Nixon et al. Blank Treated (STD) vs. Control Post Combined 0.750 0.357 0.127 0.051 1.450 2.103 0.035
Bagner et al. Blank Treated vs. Control Post Combined 2.309 0.522 0.272 1.286 3.332 4.425 0.000
Brestan, E. V., Eyberg, S. M., Boggs, S. R., et al. Blank Treated vs. Control Post Combined 1.113 0.475 0.226 0.181 2.045 2.341 0.019
Eyberg, Boggs, & Algina Blank Treated vs. Control Post Combined 0.936 0.567 0.321 -0.174 2.046 1.652 0.099
Matos et al. Blank Treated vs. Control Post Combined 1.760 0.427 0.183 0.923 2.598 4.121 0.000
McNeil, C. B., Capage, L. C., Bahl, B., et al. Blank Treated vs. Control Post Combined 1.829 0.430 0.185 0.987 2.672 4.256 0.000
McNeil, C. B., Eyberg, S., Eisenstadt, T. H., et al. Blank Treated vs. Control Post Combined 1.621 0.530 0.281 0.583 2.659 3.060 0.002
Querido Blank Treated vs. Control Post Combined 1.255 0.823 0.678 -0.359 2.868 1.524 0.127
Schuhmann et al. Blank Treated vs. Control Post Combined 1.192 0.405 0.164 0.398 1.985 2.944 0.003
1.391 0.172 0.030 1.053 1.729 8.065 0.000
-4.00 -2.00 0.00 2.00 4.00
Favours A Favours B
Random Effects Weights (Treatment Vs. Control)
Meta Analysis
Study name Subgroup within study Comparison Statistics for each study Std diff in means and 95% CI
Std diff Standard Lower Upper in means error Variance limit limit Z-Value p-Value
Nixon et al. Blank Treated (STD) vs. Control Post Combined 0.750 0.357 0.127 0.051 1.450 2.103 0.035
Bagner et al. Blank Treated vs. Control Post Combined 2.309 0.522 0.272 1.286 3.332 4.425 0.000
Brestan, E. V., Eyberg, S. M., Boggs, S. R., et al. Blank Treated vs. Control Post Combined 1.113 0.475 0.226 0.181 2.045 2.341 0.019
Eyberg, Boggs, & Algina Blank Treated vs. Control Post Combined 0.936 0.567 0.321 -0.174 2.046 1.652 0.099
Matos et al. Blank Treated vs. Control Post Combined 1.760 0.427 0.183 0.923 2.598 4.121 0.000
McNeil, C. B., Capage, L. C., Bahl, B., et al. Blank Treated vs. Control Post Combined 1.829 0.430 0.185 0.987 2.672 4.256 0.000
McNeil, C. B., Eyberg, S., Eisenstadt, T. H., et al. Blank Treated vs. Control Post Combined 1.621 0.530 0.281 0.583 2.659 3.060 0.002
Querido Blank Treated vs. Control Post Combined 1.255 0.823 0.678 -0.359 2.868 1.524 0.127
Schuhmann et al. Blank Treated vs. Control Post Combined 1.192 0.405 0.164 0.398 1.985 2.944 0.003
1.391 0.172 0.030 1.053 1.729 8.065 0.000
-4.00 -2.00 0.00 2.00 4.00
Favours A Favours B
Random Effects Weights (Treatment Vs. Control)
Meta Analysis
Study Characteristics
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Study Characteristics Limitations
� Limitations of moderator analysis ¡ Few studies ¡ Restricted range ¡ Insignificant heterogeneity
� Treatment fidelity & attrition not assessed
� Publication Bias
Strengths
� Exhaustive Database Search � High Inter-‐Rater Reliability � Altered Eligibility Criteria
¡ Excluded Case Studies & Certain Populations ¡ Apples & Oranges problem
Random Effects Model
Distribution of True Effect Sizes
Mean of Distribution
