Stimulus Generalization of Parenting Skills during Parent-Child Interaction Therapy.

Abstract

Behavioral parent training is a common approach to addressing externalizing behavior, which is among the most frequent and costly reasons for children's referral to mental health settings (Kazdin, 1997). Parent training focuses on promoting positive interactions and reducing misbehavior by teaching parents to rearrange the social contingencies for their children's behavior. Systematic research beginning several decades ago showed the promise of this approach (e.g., Budd, Green, & Baer, 1976; Eyberg & Johnson, 1974; Forehand & King, 1977; O'Dell, 1974; Patterson & Reid, 1973; Wahler, Winkle, Peterson, & Morrison, 1965). Reviews (Eyberg, Nelson, & Boggs, 2008) and meta-analyses (Maughan, Christiansen, Jenson, Olympia, & Clark, 2005; Serketich & Dumas, 1996) of several contemporary behavioral parent training models indicate that using parents as therapists is efficacious in treatment of disruptive child behavior. Although 95% of parents report beneficial changes following parent training (Atkeson & Forehand, 1978), the strongest evidence of treatment effects comes from independent observations of parent-child interactions. The meta-analysis by Maughan and colleagues (2005) found that parent-report data indicate more positive outcomes than data collected through independent observers. Maughan et al. speculated this discrepancy may be due to an expectation bias on the part of parents. Patterson and Forgatch (1995) found that changes in parents' interactions with their children, as independently observed after parent training, were better predictors of children's future adjustment than parent or teacher reports. These findings suggest that behavioral parent training is an effective intervention; however, its effects may not be as robust as parent reports would lead us to believe. The current research focuses on one model, Parent-Child Interaction Therapy (PCIT), with strong empirical support in the treatment of 2- to 7-year-old children (Gallagher, 2003; Thomas & Zimmer-Gembeck, 2007). PCIT is a manualized, individual intervention, which draws from attachment, social learning, and developmental theories (Brinkmeyer & Eyberg, 2003; Eyberg & Robinson, 1982). Treatment proceeds in two phases: Child-Directed Interaction (CDI), in which parents learn to provide positive attention while following their child's lead in play, and Parent-Directed Interaction (PDI), in which parents use positively-stated commands and behavior management strategies to enhance compliance. As the parent and child play, the therapist provides immediate feedback and support, typically via a bug-in-the-ear device from behind a one-way observation mirror, to refine the parent's use of target skills. The transition from CDI to PDI and from PDI to termination is dictated by parental skill acquisition and child behavior change, as measured by a set of standardized assessment tools. Studies have demonstrated PCIT's effectiveness both immediately following treatment and at follow-up (e.g., Boggs et al., 2004; Nixon, Sweeney, Erickson, & Touyz, 2004; Schuhmann, Foote, Eyberg, Boggs, & Algina, 1998). The extension of behavior changes from the therapy setting to new situations and circumstances is a universal goal of clinical intervention. Conceptually, the transfer of a response to situations beyond those in which training occurs exemplifies stimulus generalization, often referred to as transfer of training (Kazdin, 2001). Presumably, the positive effects of parent training accrue from parents' transfer or generalization of skills (e.g., positive attention, limit setting, consistent use of behavior management procedures) outside the therapy setting. In 1977, Forehand and Atkeson reviewed research on the generality of treatment effects with parents as therapists across time, settings, behaviors, and siblings. They found that, the more rigorous the method of assessment, the less positive the results had been. …