Comparative Effectiveness of Parent-Child Interaction Therapy Based on Trauma Exposure and Attrition

Objective: To determine whether Parent-Child Interaction Therapy (PCIT) is as effective at reducing behavior problems for children with a history of trauma and for those who do not complete therapy. Method: Retrospective chart review of patients between 2.5 and 6.5 years of age who participated in PCIT between January 1, 2012, and December 1, 2019, at a child advocacy center within a large Midwestern children's hospital was performed. Demographics, trauma history, and Eyberg Child Behavior Inventory (ECBI) and parenting confidence scores were collected. Changes in child behavior and parenting confidence over time were compared between patients with and without trauma exposure using separate generalized estimating equation models for those who did and did not complete PCIT. Results: Of the 212 PCIT participants, 116 (54.72%) had a trauma history and 96 (45.28%) did not, and 98 (46.23%) completed PCIT and 114 (53.77%) did not. Patient demographics were fairly diverse and representative of the region. Patients with trauma exposure were significantly less likely to complete PCIT (38.79%) than patients without trauma exposure (55.21%). ECBI intensity scores significantly decreased over time among both patients who did and did not complete PCIT. The change in ECBI intensity scores over time did not differ between patients with and without trauma exposure regardless of whether or not they completed PCIT. Parenting confidence significantly improved over time regardless of trauma exposure or attrition. Conclusions: Standard PCIT can be used effectively with children with trauma exposure and results in significant improvement even for those who do not complete therapy. Clinical Impact Statement Although Parent-Child Interaction Therapy (PCIT) has been used with families with trauma histories since its inception, it is frequently overlooked as an effective treatment option to address behavior problems in children who have experienced trauma. This study evaluated whether PCIT was as effective at reducing behavior problems for children with a history of trauma and for those who dropped out of therapy early. Of the 212 patients who participated in PCIT, 55% had a history of trauma and 54% dropped out of therapy early. Behavior significantly improved over time among children who did and did not finish PCIT. Improvement was similar for children with and without trauma exposure.