Child-Directed Interaction

Cheryl B. McNeil, Ph.D.

West Virginia University

Credits

McNeil, C. B., & Hembree-Kigin, T. L. (2010). Parent-Child Interaction Therapy (2^nd ed.). Springer.

Eyberg, S. M., & Funderburk, B. W. (2011). Parent-Child Interaction Therapy Protocol. PCIT International.

Let’s �Check In

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• ECBI
• DPICS

Let’s Talk About Values

There are hundreds of studies showing that PCIT works for families.��However, most of these studies were conducted by White, American researchers with White, American families. Most of the caregivers in these studies were mothers identifying as heterosexual and female. ��Although there is strong evidence that PCIT works for families from diverse backgrounds, it’s important to me that I learn about the ways in which this does or doesn’t fit with your:�

• Family’s values and beliefs
• Parenting history (i.e., the �way you were raised, �previous parenting �practices you’ve tried)
• Community and culture

�Whenever you see this symbol, feel �free to share your thoughts and �feelings about what’s on the slide.

Parent-Child Interaction Therapy

Two Phases of Treatment

Relationship Enhancement

Discipline Techniques

CDI: Building a Strong Foundation

Solid attachment and warm relationship

Structure of Sessions

Progress to PDI �only after achieving goals of CDI

Attendance Policy

• Must have regular attendance to make progress
• Call ahead if you need to miss
• Try to reschedule the same week if possible
• Policy for cancellations and no shows

During CDI…

Why CDI before PDI?

• CDI will make it easier for your child to accept limits and discipline
• CDI is necessary for PDI to be effective

Basics of CDI

Follow Your Child’s Lead

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• Allows your child to receive high-quality attention when well-behaved
• One of the few (if not only) times a day your child gets to take the lead

Basics of CDI

5 Minutes a Day of �Play Therapy

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• In weekly sessions, you will learn how to deliver the therapeutic intervention
• But the intervention takes place in the home!
• The 5 minutes a day is the “medication” of PCIT
• Daily play therapy will lead to achievement of CDI goals needed to progress to PDI

The Don’t Skills

Avoid Commands

Why Avoid Commands?

• Takes lead away from child
• Attempts to direct the play
• Play can stop being enjoyable if child does not obey

Avoid Questions

Why Avoid Questions?

• Questions take lead of conversation
• Can suggest disapproval
• “You put it where?”
• Can suggest you are not listening
• Rapid-fire questioning prevents child from � talking

Avoid Criticism

Why Avoid �Criticism?

• Tells child what not to do instead of � what to do
• Can encourage misbehavior by giving � negative attention
• Suggests disapproval of child’s behavior
• Lowers child’s self-esteem
• Makes play less enjoyable

Can you name all �3 Don’t Skills?

The Do Skills

PRIDE Skills

• Compliments a child on their behavior
• Labeled praises:
• More effective; lets child know exactly what you like
• Behavior that is praised is more likely to be repeated
• Boosts child’s self-esteem
• Make both you and your child feel good!

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• You can improve problem behavior by praising its opposite before the problem behavior occurs
• Be proactive rather than reactive
• Let’s practice!

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Role Play: �Praise

• Reflect your child’s appropriate talk
• Repeat/paraphrase your child’s statements

Child: That crayon is blue.� Parent: Yes, that is a blue crayon!

• Child’s message can be extended, elaborated on, � or gently corrected
• May feel awkward at first!
• After a child’s question, it is better to answer�the question than to reflect it�

• Allow child to lead conversation
• Shows that you are listening
• Shows acceptance and understanding of what child� is saying
• Improves and increases child’s speech

Role Play: �Reflection

• Join in your child’s appropriate play
• Whenever possible, play with the toys your child is playing with
• If your child switches to a new activity, follow along!
• Keep your play at your child’s developmental level

• Helps keep attention and comments focused on your child
• Lets your child lead
• Makes play fun for your child
• Shows approval of your child’s activity
• Teaches your child how to play well with others

Role Play: �Imitation

• A behavior description describes what your child is doing
• You’re racing your cars around the track!
• Not what you are doing
• I’m parking my race car in the garage.
• Not what the toys are doing
• Lightning McQueen takes the lead!
• “You ___” statements
• You are building a tall tower.
• You’re stacking the blue block on top of the red one.
• Tip: Describe what your child’s hands are doing

Imagine you’re a sportscaster giving the play-by-play for your child!

• Lets child lead the play
• Shows you are interested and paying attention
• Models speech and teaches vocabulary and concepts
• Shows approval of child’s behavior
• Helps increase child’s attention span and persistence � with activity
• Encourages child to slow down and think about their� actions
• Supports development of child’s self-talk or internal � monologue

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Role Play: �Behavior�Description

• Show that you are happy to play with your child
• Interested, enthusiastic, and playful tone of voice
• Laughter
• Physical affection (e.g., hugs, back rubs)
• Statements indicating your enjoyment
• Increases warmth of your play
• Makes Special Time more fun and meaningful �for your child

“I’m having such a good time playing with you!”

Role Play: �Enjoy!

Can you name all �5 Do Skills?

What if your child misbehaves during CDI?

Two Types of Misbehavior

Ignore �Annoying & Obnoxious Behavior

• Children love attention!
• Behavior that gets most attention is likely to be repeated
• Children prefer negative attention over no attention at all
• Ignoring (i.e., withdrawing your attention) can reduce negative attention-seeking behaviors
• Why it works: maximizes the contrast between your response to…
• appropriate behavior (labeled praise) and
• inappropriate behavior (ignoring)

How to Ignore Negative Attention-Seeking Behavior

1. Ignore: turn body away, avert eye gaze, maintain blank facial expression
2. Distract: move away, play with different toy, enthusiastically describe own play
3. Model the Opposite: demonstrate and describe the appropriate behavior
4. Praise the Opposite: immediately return your attention to the child’s positive behavior and give a labeled praise!

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• Avoid any physical or verbal reactions
• It will get worse before it gets better!
• Continue to ignore until the negative �behavior stops; if you don’t, it will teach �your child to persist in attention-�seeking behavior

Remember: Ignoring should NOT be used to reduce behaviors that are �not done for attention.

Examples:

• Stealing a cookie from the cookie jar
• Running out of the play room to avoid �clean-up
• Dangerous and destructive behavior �(e.g., hitting, kicking, throwing toys)

When NOT to Use �Selective Ignoring

If dangerous/destructive behavior occurs during Special Time, stop play immediately and say, “Special Time is ending, because you [hit me].”

Role Play: �Putting it All Together

Suggested Toys for Special Time

• Creative Toys (e.g., crayons, markers, paper, Play-Doh)
• Constructive Toys (e.g., Lego, Magna-Tiles, Lincoln Logs)
• Toys that Promote Pretend Play (e.g., dishes, utensils, play food, dolls & dollhouse, trains & train tracks)

Toys to Avoid During Special Time

• Toys that encourage rough or �aggressive play (e.g., bats, balls, toy �guns, superhero action figures)
• Toys that require limit setting (e.g., bubbles, glitter, scissors)
• Toys that have predetermined rules (e.g., board games, card games)
• Toys that lead the caregiver or child to talk as if they are someone else (e.g., puppets, dress-up/costume play)

Special Time at Home

• Minimize distractions (e.g., siblings, � television, phone)
• Place 2-3 appropriate toys in Special �Time area
• Once Special Time begins, let your child choose a toy
• When possible, make Special Time predictable and routine

Ending Special Time

• Look for a natural stopping point after 5 minutes
• Refrain from using a timer and stopping abruptly after 5 minutes
• Abrupt end to playtime may result in frustration
• Let child know Special Time is about to end
• Praise child for positive qualities observed during playtime
• Express enjoyment in having shared time together
• Prevent power struggles in 1 of 2 ways:

“I’m going to pick up the toys now. You can help if you want.”

“Special playtime is over now. You can continue playing with the toys if you want, but I have to do some other things right now.”

Daily Practice: �Practice CDI for 5 minutes everyday!

Special Time is not a reward! �Refrain from withdrawing Special Time for misbehavior!

Can you devote 5 minutes of one-on-one time with your child each day?�

Special Time Logistics

• When will you do special time?
• Which room will you use?
• Which toys can you use?
• Siblings in the PCIT age range?

Handouts

• CDI Skills
• Suggested Toys for CDI
• Daily Practice Sheets

Any Questions?