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.

Keywords: Behavior problems; Early intervention; Infancy; Parent training; Risk.

Figure 1. Participant flow through trial

Figure 2. Predicted values for intervention and standard care groups for parenting skills

The intervention group shows a significant increase in maternal do skills over time (b = 0.451, p < .01, whereas the control group shows a nonsignificant change in do skills over time (b = 0.047, NS). Significant interaction of group and time (b = −0.403, p < .05) indicates that the intervention group slope is significant different from the control group slope. Intervention and control groups both show significant decreases in maternal don’t skills over time (b = −0.869, p < .001; b = 0.338, p < .05); however the significant group by time interaction (b = 0.532, p < .05) suggests that the intervention group shows a steeper decrease in don’t skills than the control group. These are predicted values controlling for mother age, education, language, and ethnicity.