A Retrospective Examination of the Impact of Pharmacotherapy on Parent-Child Interaction Therapy

Abstract

Objective: Parent-child interaction therapy (PCIT) is an evidence-based approach for children aged 2-7 years with disruptive behavior problems. This study examined the effectiveness of PCIT with and without concurrent pharmacotherapy. Methods: A convenience sample was collected from a retrospective chart review of preschool-aged children treated with PCIT at the Mayo Clinic Young Child Clinic between 2016 and 2020. Quantitative and qualitative data were abstracted from all patients. The sample was divided into two groups based on psychotropic medications status (medicated and unmedicated) at the initiation of PCIT. Effectiveness of treatment was assessed with the change in Eyberg Child Behavior Inventory (ECBI) score. The change over time in ECBI score was compared between the two PCIT groups with and without concurrent pharmacotherapy using a linear mixed model. Results: Of the 62 youth, 38.71% were females. Mean age was 4.71 ± 1.17 years. The mean baseline ECBI score was 148.74 ± 30.86, indicating clinically significant disruptive behaviors. The mean number of PCIT sessions was 6.59 ± 3.82. There was no statistically significant difference in ECBI scores between the two groups at pre-PCIT (medication group: 149.68, standard error [SE] = 11.61 vs. unmedicated group: 147.92, SE = 10.93, p = 0.8904) and at post-PCIT (medication group: 116.27 [SE = 11.89] vs. unmedicated group: 128.86 [SE = 11.57], p = 0.3464). There was a statistically significant improvement in ECBI scores for both groups after completing therapy (medication group = -33.41 [-22.32%], SE = 6.27, p < 0.0001; d = 1.144; unmedicated group = -19.06 [-12.88%], SE = 5.78, p = 0.0022; d = 1.078). Conclusions: PCIT reduced disruptive behaviors in this sample of young children regardless of concurrent pharmacotherapy. Future prospective studies should consider one particular pharmacological agent and long-term outcomes of treatment. PCIT and certain pharmacological treatments could have complex and important bidirectional priming effects for both treatments.

Keywords: attention-deficit/hyperactivity disorder; behavior management training; disruptive behavior disorders; early childhood; parent–child interaction therapy; pharmacotherapy.

FIG. 1.

Adjusted LSM (LSM ± SE) for disruptive child behavior (ECBI score) from the group by time period tests of simple effects from the linear mixed model. LSM were adjusted for age, ADHD, and number of PCIT sessions received. No significant group differences were observed at pre-PCIT (p = 0.8904) and at post-PCIT (p = 0.3464). A significant improvement (decrease) was observed in disruptive behavior (adjusted ECBI scores) from pre-PCIT to post-PCIT for both the psychotropic medication group (LSM decrease = −33.41 [SE = 6.27], p < 0.0001) and the nonpsychotropic medication group (LSM decrease = −19.06 [SE = 5.78], p = 0.0022). A higher ECBI score represents greater disruptive behavior. ADHD, attention-deficit/hyperactivity disorder; ECBI, Eyberg Child Behavior Inventory; LSM, least squares means; PCIT, parent–child interaction therapy; SE, standard error.