Behavioral Parent Training in Infancy: A Window of Opportunity for High-Risk Families

Abstract

To meet the mental health needs of infants from high-risk families, we examined the effect of a brief home-based adaptation of Parent-Child Interaction Therapy (PCIT) on improvements in infant and parent behaviors and reductions in parenting stress. Participants included 60 infants (55% male; average age of 13.5 ± 1.31 months) who were recruited at a large urban primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Most infants were from an ethnic or racial minority background (98%) and lived below the poverty line (60%). Families were randomly assigned to receive the home-based parenting intervention or standard pediatric primary care. Observational and parent-report measures of infant and parenting behaviors were examined at pre- and post-intervention and at 3- and 6-month follow-ups. Infants receiving the intervention were more compliant with maternal commands at the 6-month follow-up and displayed lower levels of externalizing and internalizing behavior problems across post and follow-up assessments compared to infants in standard care. Mothers receiving the intervention displayed a significantly higher proportion of positive and lower proportion of negative behaviors with their infant during play compared to mothers in the standard care group. There were no significant group differences for parenting stress. Results provide initial evidence for the efficacy of this brief and home-based adaptation of PCIT for infants. These findings highlight the benefit of identification and intervention as early as possible to promote mental health for infants from high-risk families.

Parent Training and Skill Acquisition and Utilization Among Spanish- and English-Speaking Latino Families

“…Results of the main outcomes have been published elsewhere (Bagner et al 2016). Sixty mother-infant dyads were recruited at a large hospital-based pediatric primary care clinic providing family-centered care to underserved families.…”

“…The Infant Behavior Program is a home-based adaptation of the CDI phase of PCIT (Bagner et al 2016). Similar to standard PCIT, in the first teach session, the therapist taught the parent(s) to follow their infant’s lead in play by decreasing the don’t skills (i.e., commands, questions, and negative statements) and increasing the do/PRIDE skills (i.e., praises, reflections, imitation, descriptions, and enjoyment in the play).…”

“…Specifically, we coded mother do skills (i.e., praises, behavior descriptions, and reflections) and don’t skills (i.e., questions, commands, and negative talk) during a 5-min infant-led play at all assessments to reflect positive and negative parent verbalizations used during infant-led play. The DPICS-III has demonstrated reliability and validity for Spanish-speaking dyads (Bagner et al 2016; Borrego et al 2006; Calzada and Eyberg 2002; Matos et al 2006; McCabe et al 2010, 2012, 2013; McCabe and Yeh 2009). Coders masked to group status were trained to 80% agreement with a criterion tape and coded half of the observations at baseline a second time for reliability, yielding an excellent overall kappa (0.84) for all codes examined in the current study.…”

“…For utilization, we included language as the independent variable to examine the extent to which language predicted the frequency of do and don’t skills at each assessment point. For both acquisition and utilization analyses, we also controlled for maternal education because this variable was significantly correlated to outcome variables in the larger randomized controlled trial (Bagner et al 2016). …”

Behavioral Parent Training in Infancy: What About the Parent–Infant Relationship?

“…Attachment-based interventions have shown efficacy in increasing maternal sensitivity and secure attachment in infancy (Bakermans-Kranenburg et al, 2003). Similarly, research on a home-based adaptation of PCIT for high-risk infants, the Infant Behavior Program (IBP), showed a positive impact on behaviorally based parenting skills and infant behavior (Bagner et al, 2016) but did not examine impacts on attachment-based caregiving behaviors. The existing body of research points to a need to examine the extent to which BPT programs delivered in infancy impact attachment-based caregiving behaviors and the potential mediating role of behaviorally based parenting skills on subsequent changes in attachment-based caregiving behaviors.…”