Spare the Rod and Spoil the Child

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Spare the Rod and Spoil the Child Relations Among Parenting Style, Corporal Punishment, and Child Aggression
Fussell, Ryan
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[Gainesville, Fla.]
University of Florida
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Master's ( M.S.)
Degree Grantor:
University of Florida
Degree Disciplines:
Clinical and Health Psychology
Committee Chair:
Eyberg, Sheila M.
Committee Members:
Price, Catherine
Pereira, Deidre B.
Janicke, David M.
Graduation Date:


Subjects / Keywords:
Child psychology ( jstor )
Clinical psychology ( jstor )
Developmental psychology ( jstor )
Learning ( jstor )
Mothers ( jstor )
Parenting ( jstor )
Parenting style ( jstor )
Parents ( jstor )
Psychology ( jstor )
Social psychology ( jstor )
Clinical and Health Psychology -- Dissertations, Academic -- UF
child, corporal, parenting, pcit
Electronic Thesis or Dissertation
born-digital ( sobekcm )
Psychology thesis, M.S.


This study examined patterns of child aggression and maternal punishment style in 59 families of 3- to 6-year-olds with Oppositional Defiant Disorder before and after their participation in Parent-Child Interaction Therapy (PCIT). PCIT is an evidenced based treatment designed for 2- to 7-year-olds with maladaptive behavior that focuses on creating a secure attachment and teaching effective discipline techniques. It was hypothesized that physical punishment, maladaptive parenting styles, and child aggression would decrease after PCIT. Maladaptive parenting included both lax and over-reactive parenting styles. Lax parents are permissive and do not hold clear boundaries for their children; whereas over-reactive parents use harsh discipline without adequate nurturance. The first hypothesis was that parents would rate their children as less aggressive on two measures of child behavior, the Child Behavior Checklist (CBCL) and the Eyberg Child Behavior Inventory (ECBI), at the post-treatment assessment. The second and third hypotheses were that parents would use less physical punishment and become less lax and less over-reactive after completing PCIT. Additionally, our final hypothesis was that both lax and over-reactive parents who used physical punishment would rate their children as more aggressive on parent report measures of child behavior. To measure pre-post changes in physical punishment, maladaptive parenting, and child aggression, we used paired-samples t tests. Results indicated that mothers used less physical punishment after completing PCIT than before. Mothers also rated themselves less lax and less over-reactive after treatment. Mothers rated their children s behavior as less aggressive after completing PCIT. Specifically, they reported lower scores on the CBCL Aggression Scale, and less endorsement of the ECBI items hits parents, physically fights with siblings, and physically fights with friends own age. To test possible interactions among variables, we used multiple regression analyses. Analyses of pretreatment scores showed that lax, but not over-reactive, mothers who used physical punishment rated their children as more aggressive on the CBCL and ECBI than parents with more adaptive parenting styles. These analyses provide further support for the efficacy of Parent-Child Interaction Therapy in helping parents develop an authoritative parenting style. ( en )
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Thesis (M.S.)--University of Florida, 2009.
Adviser: Eyberg, Sheila M.
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by Ryan Fussell.

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2009 Ryan E. Fussell 2


To m y parents, my best examples of authoritat ive parentingYou both have given me so much love and support on my road to graduate schoo l, and I could not have done this without you To Susan, Michelle, Sophia, and GabyYou all believed in me from the beginning and provided the footpath. Ill never forget all the guidance you ve provided, not only in the field, but in what it takes to be a strong, conf ident, successful woman 3


ACKNOWL EDGMENTS I wish to thank Dr. Sheila M. Eyberg for her continued mentorship and thoughts on this manuscript. I also would like to thank Dr. Stephen R. Boggs for providing guidance on our Dyadic Parent-Child Interaction Coding System and his weekly therapy supervision. The members of the Child Study Lab have been an i mmeasurable support, and I thank them for their continued dedication to our families. Finall y, I would like to thank the members of my committee David Janicke, Ph.D., Deidre Pereira, Ph.D., and Catherine Price, Ph.D. for their thoughts and suggestions on this manuscript. This study was funded by a generous grant from the National Institute of Mental Health (R01 MH60632). 4


TABLE OF CONTENTS Page ACKNOWLEDGMENTS...............................................................................................................4 LIST OF TABLES................................................................................................................. ..........6 LIST OF FIGURES.........................................................................................................................7 ABSTRACT.....................................................................................................................................8 CHAPTER 1 INTRODUCTION................................................................................................................. .10 2 METHODS...................................................................................................................... .......16 Participants.............................................................................................................................16 Measures.................................................................................................................................17 Procedures..................................................................................................................... ..........20 Assessments.................................................................................................................... .20 Therapy............................................................................................................................20 3 RESULTS...................................................................................................................... .........22 Relations among Physical Punishment, Pa renting Style, and Child Aggression...................22 Maternal Behavior..................................................................................................................22 Child Behavior........................................................................................................................23 4 DISCUSSION................................................................................................................... ......26 Limitations.................................................................................................................... ..........28 Future Directions....................................................................................................................29 APPENDIX A CHILD DIRECTED INTERACTION SKILLS.....................................................................30 B PARENT DIRECTED INTERACTION SKILLS..................................................................34 LIST OF REFERENCES...............................................................................................................36 BIOGRAPHICAL SKETCH.........................................................................................................40 5


LIST OF TABLES Table Page 2-1 Demographic Characteristics of Participants.....................................................................17 3-1 Pre to Post Treatment Changes in Maternal and Child Behavior......................................24 6


LIST OF FI GURES Figure Page 3-1 Changes in Parenting Style................................................................................................2 5 3-2 Changes in Child Aggression.............................................................................................25 7


Abstract of Thesis Presen ted to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Master of Science SPARE THE ROD AND SPOIL THE CHILD: RELATIONS AMONG PARENTING STLYE, CORPORAL PUNISHMENT, AND CHILD AGGRESSION By Ryan E. Fussell May 2009 Chair: Sheila M. Eyberg Major: Psychology This study examined patterns of child aggression and maternal punishment style in 59 families of 3to 6-year-olds with Oppositional Defiant Disorder before and after their participation in Parent-Child Interaction Thera py (PCIT). PCIT is an ev idenced based treatment designed for 2to 7-year-olds with maladaptiv e behavior that focuse s on creating a secure attachment and teaching effective discipline techniques. It was hypothesized that physical punishment, maladaptive parenting styles, and child aggression would decrease after PCIT. Maladaptive parenting included both lax and ove r-reactive parenting styles. Lax parents are permissive and do not hold clear boundaries for th eir children; whereas over-reactive parents use harsh discipline without adequate nurturance. The first hypothesis was that parents would rate their children as less aggressive on two measures of child behavior, the Child Behavior Checklist (CBCL) and the Eyberg Child Beha vior Inventory (ECBI), at the post-treatment assessment. The second and third hypotheses were that parents would use less physical punishment and become less lax and less over-reac tive after completing PCIT. Additiona lly, our final hypothesis was that both lax and over-reactive parents who used physi cal punishment would rate their children as more aggressive on parent report measures of child behavior. 8


9 To measure pre-post changes in physical punishment, mala daptive parenting, and child aggression, we used paired-samples t tests. Results indicated that mothers used less physical punishment after completing PCIT than before. Mo thers also rated themselves less lax and less over-reactive after treatment. Mo thers rated their childrens beha vior as less aggressive after completing PCIT. Specifically, they reported lo wer scores on the CBCL Aggression Scale, and less endorsement of the ECBI items hits parents, physically fights with siblings, and physically fights with friends own age. To test possible interactions am ong variables, we used multiple regression analyses. Analyses of pretre atment scores showed that lax, but not overreactive, mothers who used physical punishment rated their children as more aggressive on the CBCL and ECBI than parents with more adapti ve parenting styles. These analyses provide further support for the efficacy of Parent-Child In teraction Therapy in helping parents develop an authoritative parenting style.


CHAP TER 1 INTRODUCTION Physical punishment has been a highly contr oversial topic in the United States for several decades. Although a significant amount of research has addressed the issue of its potential for benefit or harm, conclusions remain contentious One 1999 survey of US parents found that 94% reported spanking their child before the age of 3 or 4 (Larzelere, 2004; Straus & Stewart, 1999), making continued research on physical punishment imperative. The prevalence of childhood a ggression in the United States is also high, representing a large majority of mental hea lth referrals in the United Stat es (Kazdin, Siegal, & Bass, 1990). Research has suggested that aggre ssive behavior, if not treated, te nds to be stable over time, and these children are more likely to develop other psychological disorders, exhibit delinquent behavior, and have significant social difficulties in adolescen ce and adulthood (Serbin & Karp, 2003). Scott, Knapp, Henderson, & Maughn (2001) suggest that aggressive children are consistently viewed in a negativ e light by others, and therefore c ontinue to act in aggressive ways to fit that profile, furthe r contributing to this negative cy cle. Additionally, child aggression and conduct problems have large so cietal and financial costs as well, as these children demand significant resources to address their behavior problems. Due to the many negative outcomes of child aggression, many researchers are currently examining programs that aim to decrease this negative child behavior. Many researchers agree that parenting is one of the most direct influences on child behavior, and has a large impact on the deve lopment of aggressive behavior (Dodge, 2002). Parental physical punishment is one hotly debated potential causal mechanism of child aggression. Studies have shown th at children who have been spa nked at home use more reactive aggression in school (Strassberg, 1994; Dodge, 1994) and exhibit more antisocial behavior two 10


years after punishm ent (Straus, 1997). Other arguments agains t physical punishment are that many children fail to understand th e reason for their parents punishment and, in turn, learn to avoid the punishment instead of truly unders tanding what they did wrong. Some of these children may interpret their parent s punishment as hostile and make negative attributions toward their parent, and some may expr ess these attributions through physical aggression toward their parent (Dodge, Pettit, McClasky, & Brown, 1986). Not all research has found physical punishme nt detrimental to ch ildren. Larzelere and Kuhn (2005) found that non-abusive phys ical punishment led to positive child outcomes such as increased compliance and decreased delinquent behavior in adolescen ce. Baumrind (1996) found that spanking, when combined with other discip line strategies, predicted the best outcomes for children (Baumrind, 1996). Extensive evidence put forth on both sides of the physical punishment controversy suggests th at more refined research de signs and approaches to the question of whether or not physical punishment l eads to negative or positive child outcomes may be needed. The important question may not be wh ether physical punishment leads to negative or positive child outcomes, but rather, under what circumstances physical punishment leads to these outcomes, in particular child aggression? Consider ing that most children in the United States are spanked, but relatively few children develop significant aggressive behavior, the relation sometimes found between physical punishment and a ggressive child behavior is likely mediated by other factors. Baumrind (1996) suggested th at parenting styles, such as permissive, authoritarian, or author itative parenting, provide the context that determines outcomes of spanking as a disciplinary tool. Reid, Webster-S tratton, & Baydar, 2004 s uggested that parents may provide inconsistent parenti ng in response to the stresses associated with child misbehavior, which in turn, can lead to additional child aggression. 11


Due to the h igh prevalence of externalizing behavior problems, including aggression, in the United States, many therapy programs have been designed and researched to treat these problems efficaciously. Some of the most common types of treatment for externalizing behavior problems in children are pa rent-training or parent-child inte raction programs. Some researchers have shown that these treatments work by teaching parents positive parenting skills, and reducing negative parenting behaviors (Bagne r & Eyberg, 2007; Webster-Stratton, Reid, & Hammond, 2004). Pettit and Bates (1989) suggested th at mothers who lack warmth or support in interactions with their children tend to rate their children as mo re aggressive. Other theories suggest that mothers of aggressive children te nd to disregard children s feelings and make negative comments about their children in play (Landy & Menna, 2001). Additionally, this play allowed the parent to interact with his or her child in a positive environment, without harsh discipline, suggesting that the child may be more likely to comply with parent directives in the future (Gardner, Ward, Burton, & Wilson, 2003). All of these therapies share one thing in common: they seek to disrupt the negative interactions, and introduce positive parenting approaches which are associated with more positive child outcomes (Bagner, et. al., 2007). The purpose of this study was to examine wh ether physical punishment, when combined with a lax or over-reactive parenting style, is related to ch ild aggression. The long-range goal of this research is to modify current treatment protocols to address familial patterns of aggression directly, and intervene in the coercive cycle of aggression between parents and their children by helping parents learn to use eff ective discipline strategies. The treatment protocol that was used in this study is Parent-Child Interaction Therapy (PCIT). Parent-Child Interaction Therapy is an empirically supported treatment for young children with disruptive behavior disorders, which focuses on enhancing the parent-child bond 12


and m odifying maladaptive parent-child interacti ons. PCIT was selected for this project because it is based on Baumrinds theory of parenting styl es: authoritative, author itarian, and permissive. Baumrind proposed these styles after determinin g that parents of preschool age children who were less nurturing, less involved, and used more control and punitive discipline (i.e. authoritative) had children who were unhappy, withdrawn, and mistrustful (Baumrind, 1996; 1991). The strong and consistent relations between certain parenting styles and problematic child outcomes have been shown in many studies (e.g., Azar & Wolfe, 1989; Franz, McClelland, & Weinberger, 1991; Olson, Bates, & Bayles, 1990; Power & Chap ieski, 1986). These studies suggest that to promote optimal child outcomes in treatment, there must be a focus on promoting an optimal parenting style and parent-child interactions. PCIT teaches the parent skills to enhance the parent-child relationship while increasing the childs pro-social behavior s and decreasing the childs ina ppropriate behaviors. PCIT is composed of two phases: Child-Directed Inter action (CDI) and Parent -Directed Interaction (PDI). In the CDI, parents learn skills to follow the childs lead in play using differential social attention, while providing positive attention to pr o-social child behaviors (Boggs & Eyberg, in press) and ignoring negative beha vior. The rationale for implementing CDI first is to strengthen the parent-child relationship in preparation for the PDI procedure In the second phase of treatment, Parent-Dir ected Interaction, parent s learn to shape their childs behavior by giving clea r commands and following through w ith consistent contingency plans for compliance or non-compliance. Many times, when parents attempt to control interactions with their child, they inadvertently create coercive patterns which can negatively affect the relationship. In this cy cle, the childs noncompliance or negative response to a parents command is met with negative attention from th e parent (Patterson, 1982). The coercive cycle 13


continues as the childs m aladaptive behavior in creases, and eventually the parent withdrawals their original command thereby negatively reinforcing the childs negative behavior. Not only is the child reinforced in this cycle, but the pare nts withdrawal behavior is reinforced by a temporary stop in the childs misbehavior. Th e Parent-Directed Interaction interrupts the coercive cycle by teaching the parent to give clear commands followed by consistent consequences, either praise and positive atte ntion for compliance or timeout from positive attention following non-compliance. Over time, th e child learns to immediately comply with parent directives and receives im mediate positive attention from the parent. Eventually this new interaction pattern increases pro-social behavi or from the child and positive and effective parenting strategies, which further reinforces both the parent and child (Hood & Eyberg, 2003). Substantial research has been done on the pos itive outcomes associated with Parent-Child Interaction Therapy. While PCIT has been used both with physically abusive parents, parents with maladaptive parenting styles and aggressive child ren, at the time of this study, there were no studies that specifically addr essed the potential benefit of PC IT to decrease aggression in children and change damaging pare nting patterns in children. This study examined the effects of Parent-C hild Interaction Thera py on parental use of physical punishment, maladaptiv e parenting styles, and child aggression. It was hypothesized that physical punishment, maladap tive parenting styles, and child aggression would decrease after PCIT. Additionally, it was hypo thesized that mothers with e ither a lax or an over-reactive parenting style and who used physical punishment, would rate their children as more aggressive on child behavior measures than parents with more adaptive parenting styles. There are several specific aims for this project. The first aim of the study is to determine whether there are pre to post changes in parent -rated child aggression. Th e dependent variables 14


that will be used to m easure child aggression ar e the aggression subscale of the Child Behavior Checklist and specific aggression items on the Eyberg Child Be havior Inventory. The second specific aim for this study is to determine whether parents use less physical punishment after completing Parent-Child In teraction Therapy. The dependent vari able used for this analysis will be the daily amount of physical punishment on the Daily Discipline Inventory. The third objective of this study was to determine if/ or what types of mala daptive parenting styles parents were using before starting treatment, and whether those parenting styles changed after completing Parent-Child Interaction Therapy. This question will be analyzed using data from the Parenting Scale, a measure of la x and over-reactive parenting. The fi nal aim of the project is to determine whether parents with maladaptive pa renting styles who use physical punishment tend to have children that are more aggressive. This analysis will include the independent variables of physical punishment on the Daily Discipline Inve ntory and parenting styles on the Parenting Scale, and the dependent variables of child aggression as rated on the CBCL and the ECBI. 15


CHAP TER 2 METHODS Participants Participants were 59 families with 3to 6-year-old children who met DSM-IV criteria for Oppositional Defiant Disorder, that were enrolled in a larger st udy examining the efficacy of a maintenance treatment after completion of Pare nt-Child Interaction Therapy. Families were required to have at least one pa rent participate with the child during PCIT. Children (39 boys and 20 girls) were referred to the study by pediatrici ans, child psychiatrists, pediatric neurologists, teachers, day care providers, and self-referrals. Th e mean age of the children was 4.33 years (SD = 1.09). The ethnic composition of the children in the sample was: 44 (75%) Caucasian, 4 (7 %) African American, 2 (3 %) Hispanic, 1 (2%) As ian American, and 8 (14%) Biracial. Children were excluded from the study if they had seri ous developmental or sensory impairments (e.g., blindness, autism), or obtained a standard scor e below 70 on a measure of receptive vocabulary (Peabody Picture Vocabulary Test Third Ed ition; PPVT-III; Dunn & Dunn, 1997). Families were also excluded from the study if the mother received a standard sc ore of less than 75 on a cognitive screening measure (Wonderlic Personne l Test; WPT; Dodrill, 1981). Children were not excluded from participation if they were taking medication to control th eir behavior; however, their dosage had to be stable for one month prior to the pretreatment assessment and they were asked not to change their dosage during treatmen t. Children with a co -morbid diagnosis of Major Depressive Disorder (M DD), Separation Anxiety Disorder (SAD), Conduct Disorder (CD) or Attention Deficit Hyperac tivity Disorder (ADHD) were not excluded. Additionally, the parents were not screened for psychopathology. Only mothers scores were analyzed in this study. The mean age for mothers was 33.96 years (SD = 9.67). The ethnic composition of the mothers was as follows: 51% Caucasian, 2% Hisp anic, and 2% African American. Mean family 16


SES, derived from the Hollingshead (1975) 4-f actor Index of Social Position, was 37.65 (SD = 13.97), with a range from 16 to 66, indicating a wide range of socioeconomi c status within the group. Table 2-1. Demographic Characteristics of Participants Variable N = 59 M/% SD SES 37.65 13.97 Child age (years) 4.33 1.09 Child sex (% male) 66 Child race/ethnicity Caucasian 75 African American 4 Hispanic 2 Asian American 1 Biracial 8 Mother age (years) 33.96 9.67 Measures National Institute of Mental Health Di agnostic Interview Schedule for Children-IVParent (NIMH DISCIV; Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000). Mothers were interviewed using the NIMH-DISC-IV to pr ovide one index in determining a diagnosis of Oppositional Defiant Disorder, an in clusion criterion. The DISC-IV is a structured interview that asks parents about the history, frequency, and severity of the childs problem behaviors. Oneweek test-retest scores have been reported at.79 for ADHD, .54 for ODD, and .43 for CD (Shaffer et al., 2000). Child Behavior Checklist (CBCL; Achenbach, 1991; 1992). To help ensure a more accurate diagnosis of ODD, mothers also completed the Child Beha vior Checklist for 4-18 Year Olds (CBCL/4-18; Achenbach, 1991) or the Chil d Behavior Checklist for 2 to 3 Year Olds 17


(CBCL/2-3; Achenbach, 1992). Children were include d in the study only if they obtained a DISC diagnosis of ODD plus a sta ndard score on the CB CL A ggression subscale above 61. Peabody Picture Vocabulary Test (PPVT-III; Dunn & Dunn, 1997). The Peabody Picture Vocabulary Test III is a standardized me asure of receptive vocabulary that was used as the cognitive screening measure for childrens inclusion in the study. Split-half reliability coefficients for children have been reported at .86 to .97, with a medi an of .94. Test-retest reliabilities have ranged from .91 to .94 (Dunn & Dunn, 1997). The PPVT has been highly correlated with the verbal scale of Wechsler Intellig ence Scale for Children at .91(Altepeter, 1980; Carvajal, Hayes, Miller, Wiebe, & Deloise, 1993). Wonderlic Personnel Test (WPT: Dodrill, 1981). The Wonderlic Personnel Test was used to screen for cognitive problems in the mo thers. The Wonderlic has been shown to correlate with the Full Scale IQ of the Wechsler Adult In telligence Scale at .93 (WAIS: Wechsler, 1981). Eyberg Child Behavior Inventory (ECBI, Eyberg & Pincus, 1999). The ECBI is a 36item parent-report measure of disruptive behavior that assesses the severity of child disruptive behavior (Intensity Scale) and th e extent to which the childs be havior is problematic for the parent (Problem Scale). We examined three ite ms (numbers 18, 26, and 27) from the Intensity Scale to assess the degree to which the child is physically aggressive wi th parents, same-age peers, and siblings. Item-to-total reliability has been demonstrated for these items (total r = .55, SD = 0.12). The Intensity Scale of the ECBI yields an internal consistency coefficient with preschoolers of .95 and .93 (Colvin, Eyberg, & Adams, 1999); inter -rater (mother-father) reliability coefficients of .69 and .61 (Eisenstad t, McElreath, Eyberg, & McNeil, 1994); and testretest reliability coefficients of .80 and .85 across 12 weeks and .75 and .75 across 10 months, respectively (Funderburk, Eybe rg, Rich, & Behar, 2003). 18


Parent Daily Report (PDR, Chamberlain & Reid, 1987). The PDR is a 24-hour recall m easure, administered by telephone, which assesses the number of times a child exhibits specific behaviors in the home that are id entified as problematic for the parent. This measure has shown inter-rater, inter-parent, and test-retest reliability, and concurrent validity with direct observation measures (Chamberlain et al., 1987; Patterson, 1982). Therapists called the families on 5 consecutive days to collect pret reatment PDR data, and scores were averaged to determine the mean daily frequency of identified problem behaviors. This same procedure was repeated posttreatment. This measure will not be used as a dependent variable, but rather as an opportunity to see how many times the child exhibite d targeted maladaptive behaviors. Daily Discipline Report (DDI; Webster-Stratton & Spitzer, 1991). The DDI is used in conjunction with the PDR and provides daily instru mentation of discipline procedure used each time the when their child engaged in one of the identified problematic behaviors. For each identified behavior problem endorsed on the PD R the therapist asks, How did you handle this problem? Each response is recorded verbatim and later coded into a specific category (e.g., physical punishment, verbal punishment, privilege removal). Only the physical discipline scores were used for this project. Scores over the 5-day period were averaged to determine a mean daily physical punishment score. This procedure was us ed at pre and post-trea tment as a measure of physical punishment used by parents. Parenting Scale (PS: Arnold, OLeary, Wolff, & Acker, 1993). The Parenting Scale is a self-report measure that assesses parent discipli ne style in response to childrens behavior problems. Parents endorse how much each item re lates to their own beha vior. Two scales from this instrument were used -Laxness and Over-reactivity -to operationally define a mothers parenting style. Laxness is defined as lack of responsiveness to child misbehavior, and over19


reactivity is defined as the propens ity to react excessively to child misbehavior. This instrument has show test-retest reliabili ties from .79 to .84, and correla tes highly with behavioral observation measures of parent-chi ld interactions. The PS was colle cted at pre and post treatment to assess change in parenting style. Procedures Assessments During pre and post treatment assessments, parents completed a demographic questionnaire, parent-report and self-report questionnaires, a child diagnostic interview, and a clinical interview. Additionally, a graduate leve l assessor called the fam ily every day for five days to complete the Daily Discipline Inventory. During this phone call, th e assessor asked if the child exhibited any of the identified problematic behaviors, and if so, what discipline strategy did the parent use in response to the behavior After treatment was completed, parents again completed the outcome measures and Daily Discip line Inventory (for five days) in order to assess any significant changes from the pre-treatment assessment. Therapy Families attended weekly therapy sessions of PC IT at the Child Study Lab with a lead and a co-therapist. Therapists were advanced gradua te students with extensive training in PCIT. Therapists participated in weekly supervisi on sessions with two licen sed psychologists during the course of the study. All therapists follo wed the Individual PCIT Manual to guide each session. All sessions were tape r ecorded, and 50% of all sessions from each family randomly selected and coded for accuracy using treatmen t manual checklists. Fifty percent of the checked tapes were again randomly selected and reviewed independently by a second coder to provide an inter-observer reliability estimate. Treatment integr ity was 97%, with an inter-observer reliability of 97% (range = 79 100%). 20


PCIT is not time-limited, and families continued treatment until they met certain termination criteria: (a) Parents mastered the CD I and PDI skills; (b) Parents reported resolution of their presenting problems; (c) Parents rated their ch ilds behavior within normal limits on the ECBI; and (d) Parents reported f eeling confident in managing th eir childs behavior on their own. The attrition rate for the overall study was 37 %, with the mean numb er of sessions equaling 13.67 (SD = 7.19) for treatment completers. 21


CHAP TER 3 RESULTS Relations among Physical Punishment, Parenting Style, and Child Aggression A multiple regression was used to examine relations among physical punishment, parenting style, and child aggression scores at pre-treatment. We used the scores derived from the DDI to create the physical punishment variab le; scores from the PS as our parenting style variables; and the scores from the Aggression scale of the CBCL and the aggression items from the ECBI for our child aggression variable. Resu lts indicated that parents who scored higher on laxness and reported greater use of physical punish ment also reported higher levels of child aggression, = .361, t (56) = 2.163, p < .05. However, there was no evidence to support an interaction between over-reactive pa renting and physical punishment. Maternal Behavior To examine the effects of PCIT on mate rnal behavior, we used paired-samples t tests to analyze preto posttreatment changes in physic al punishment use and parenting style. The daily average number of physical punishment pe r parent on the DDI at post-treatment ( M =0.27; SD = 0.61) was significantly lower than at pretreatment scores (M = 1.69; SD = 2.17), t (58) = 5.02, p < .001, showing that mothers used less physic al punishment after completing PCIT. To address our second hypothesis, we again used paired-samples t tests to examine changes in mothers lax and over-reactive paren ting styles. Mothers po st-treatment scores on Lax parenting ( M = 1.96; SD = 1.12) were significantly lower than their pretreatment Lax parenting scores ( M = 3.11; SD = 0.82), t (58) = 8.128, p < .001. Additionally, Over-reactive treatment scores at post-treatment ( M = 2.21; SD = 0.66) were significantly lower than Overreactive parenting scores at pretreatment ( M = 3.34; SD = 0.76), t (58) = 11.61, p < .001 (See Figure 3-1) 22


Child Behavior Changes in childrens behavior after com ple ting PCIT were analyzed using a pairedsamples t test. Preto posttreatment changes in ch ild aggression were conducted to explore our third hypothesis. Mothers ratings on the CBCL at posttreatment we re significantly lower (M = 57.47; SD = 8.90) than their ratings at the pre-treatment (M = 75.47; SD = 8.63), t (58) = 13.857, p < .001 (See Figure 3-2). On specific ECBI items asking about physical aggression, mothers also rated the frequency of o ccurrence lower after treatment on the following items (where 1 = never and 7 = always): hits parents, ( M pre = 4.08, SD = 1.93; M post = 1.61, SD = 0.79); t (58) = 10.321, p < .001), physically fights with siblings, ( M pre = 3.02, SD = 1.79; M post = 1.47, SD = 0.63); t (58) = 4.804, p <.001), and physically fights with friends own age, (M pre = 3.47, SD = 2.22; M post = 1.49, SD = 0.19); t (58) = 6.836, p < .001). 23


Table 3-1. P re to Post Treatment Changes in Maternal and Child Behavior Variable Pre Post t (58) M SD M SD Maternal Behavior DDI scores 1.69 2.17 0.27 0.61 5.02 Laxness 3.11 0.82 1.96 1.12 8.13 Over-reactivity 3.34 0.76 2.21 0.66 11.61 Child Behavior CBCL 75.47 8.63 57.47 8.9 13.86 ECBI-Parents 4.08 1.93 1.61 0.79 10.32 ECBI-Siblings 3.02 1.79 1.47 0.63 4.80 ECBI-Friends 3.47 2.22 1.49 0.19 6.84 *All changes were significant at p < .01 24


Changes in Parenting Styles0 1 2 3 4 5 laxover AssessmentScore on PS pre post Figure 3-1. Changes in Parenting Style Maternal CBCL Ratings50 55 60 65 70 75 80 85 AssessmentAggression T-Score Pre Post Figure 3-2. Changes in Child Aggression 25


CHAP TER 4 DISCUSSION This study examined patterns of child aggression and parent punishment styles in families participating in PCIT for the treatment of Oppositional Defiant Disorder in preschool-age children. Mothers were found to use less physical punishment, and their parenting style became both less lax and less over-reactive after treatment. These results suggest that mothers entering treatment with permissive or authoritarian parenting styles can benefit from the authoritative parenting techniques learned in PCIT. Additionally, mothers rated their children as less aggressive on two separate measures after completing PCIT. Results suggest that parents w ith a lax parenting style who al so use physical punishment at the pre-treatment assessment tend to rate their ch ildren as aggressive on parent-report measures. Lax parents appear to display features most closely related to Baumrinds (1966) permissive parenting style. Accordingly, these parents have difficult setting limits with their children, which may contribute to the children being exposed to a ggressive models (i.e., on television, another authority figure). This exposure, combined with the negative interaction patterns, could eventually lead to the coerci ve cycle described by Patterson (1982). When lax parents overlook or avoid setting limits for many m ildly disruptive child behaviors, the behaviors escalate to a point where they can no longer be overlooked, and the parent is left with no other option but to spank their child. In this situation, the child lear ns that he or she does not have to immediately comply with parental directives, and the pa rent learns that spanking will decrease the maladaptive behavior. Because this spanking is used sporadically, the physical punishment becomes especially salient for th e child, and the child learns that physical aggression can be used to solve interpersonal problems. Th is finding is consistent with Ba umrinds theory that it is not necessarily physical punishment that leads to negative outcome for children, but rather that when 26


com bined with maladaptive parenting styles, it can have detrimental effects for children. Future research should also examine the changes in positive parenting behaviors (i.e. praise) and whether parents are using thes e positive strategies in place of physical discipline. While contention remains about the effects of physical punishment on child outcomes, the fact is that the majority of parents in the Un ited States are spanking their children. Because some studies suggest that spanking can lead to negative outcomes (Strassberg, 1994; Dodge, 1994; Straus, 1997), it is imperative that treatments are designed that provide alternate discipline strategies for parents. PCIT does not directly target physical punishment in its protocol, but these results support literature that states that if you increase the amount of positive parent-child interactions, and decrease the negative interac tions (i.e. harsh punishment), it can have positive effects for both the parent a nd child (Bagner, et al., 2007). The high rate of childhood aggression in th e United States underscores the need for treatments that can effectively target aggressi ve behaviors in pre-school children in order to prevent future maladaptive behavior. Many studies ha ve shown that PCIT is effective in reducing disruptive behavior in young child ren (Zisser & Eyberg, in press) While there have been many studies that have shown that parent-training prog rams are effective in decreasing child aggression, to this date, there have been no studies that have directly addressed the relationship between PCIT participation and decreases in child aggression. The focus of this study on aggression adds to the literature specific info rmation on the effectivene ss of PCIT for reducing aggressive behavior in young children, which sugge sts that children may become less aggressive after their participation. Mother s not only rated their children lower on the aggression scale of the CBCL after treatment, but also endorsed lowe r frequencies of specifi c physically aggressive acts including hitting parents, si blings, and peers. Results from this study suggest that Parent27


Child Intera ction Therapy is an effective ther apy for intervening in the coercive cycle and thereby decreasing inconsistent discipline and child aggression. Limitations Some limitations in this study should be considered in inte rpreting the results. This study was a secondary data analysis from a single group of treated families, and because of this, we were unable to compare these finding to a randomized control group without treatment. It is possible that other factors associat ed with PCIT, or just the time differential, could be associated with the changes in physical punishment use, parenting st yle, and child aggression. The analyses included data only from mothers. As we considered mothers the primary disciplinarian, we did not use father data on pa renting or use of physi cal punishment in the analyses. However, it is possible that the use of physical punishment or a maladaptive parenting style by the father, or other pare ntal figures in the home could a ffect the childs behavior. This consideration could be especia lly important for the lax mother s because the child could be learning aggressive tactics from others in the home. Future studies should analyze data on the fathers use of physical punish ment and parenting style. This study used only parent-report methods to assess parenting variables and child behavior. Any parent-report measure may be infl uenced by response sets, respondent biases, and motivation, especially because the parent was re porting to their therapist about their childs behavior. Multiple methods of measuring a cons truct can provide greater confidence in the results. Measuring spanking, in particular, can be a sensitive issue in some cultural groups, although most parents in our samp le described spanking as one of their typical discipline techniques during the pretreatment assessment. The DDI provided an the most accurate measure of spanking because it was measure every day in response to specific behaviors, and alternative methods of assessing spanking frequency are no t likely to improve on the validity of parent 28


report. Future studies m ay seek to measure aggressive acts during the assessment or at school to obtain and objective measure of the childs behavior. Future Directions This study also highlighted the value of assessing parenting style during treatment screening for PCIT. The identification of lax or over-reactive parents may help guide treatment intervention by narrowing the types of parent beha viors that need to be targeted. Lax parents have difficulty setting appropria te limits and consistent cont ingency schedules. Therefore lax parents may need more emphasized coaching to deliver and follow through with the PCIT skills. Over-reactive parents tend to use harsh discipline skills while providing little nurturance to their children. Therapists working with these parents may need to provide psycho-education regarding normative child behavior and appropriate expecta tions. Additionally, there may be other factors (i.e. environment, other family members) that contribute to the development of ineffective parenting styles. Future research should ex amine the mechanisms from which maladaptive parenting styles are developed, and what may be done in treatment to mi nimize their effects. 29


APPENDIX A CHILD DIRECTED INTERACTION SKILLS PRIDE R ULES REASON EXAMPLES PRAISE your child's appropriate behavior Causes your child's good behavior to increase Lets your child know what you like Increases your child's self-esteem Makes you and your child feel good Good job of putting the toys away! I like the way you're playing so gently with the toys. Great idea to make a fence for the horses. Thank you for sharing with me. REFLECT appropriate talk Lets your child lead the conversation Shows your child that you are listening Demonstrates that you accept and understand your child Improves your child's speech Increases verbal communication between the both of you Child: I drew a tree. Parent: Yes, you made a tree. Child: The doggy has a black nose. Parent: The dog's nose is black. Child: I like to play with the blocks. Parent: These blocks are fun. IMITATE appropriate play Lets your child lead Shows your child that you approve of the activity Shows that you're involved Teaches your child how to play with others and Child: I put a nose on the potato head. Parent: I'm putting a nose on Mr. Potato Head too. Child (drawing circles on a piece of paper) Parent: I'm going to draw circles on my paper just like you. 30


take tu rns Increases the child's imitation of the things that you do DESCRIBE appropriate behavior Lets your child lead Shows your child that you are interested Teaches your child concepts Models speech for your child Holds your child's attention on the task Organizes your child's thoughts about the activity You're making a tower. You drew a square. You are putting together Mr. Potato Head. You put the girl inside the fire truck. Be ENTHUSIASTIC Lets your child know that you are enjoying the time you are spending together Increases the warmth of the play Child (carefully placing a blue lego on a tower). Parent (gently touching the child's back): You are REALLY being gentle with the toys. MORE RULES REASON EXAMPLES Avoid COMMANDS Takes the lead away from your child Can cause unpleasantness Indirect Commands: Let's play with the farm next. Could you tell me what animal this is? Direct Commands: Give me the pigs. 31


Please sit down next to me Look at this. Avoid QUESTIONS Leads the conversation Many questions are commands and require an answer May seem like you aren't listening to your child or that you disagree We're building a tall tower, aren't we? What sound does the cow make? What are you building? Do you want to play with the train? You're putting the girl in the red car? Avoid CRITICAL STATEMENTS Often increases the criticized behavior May lower your child's self-esteem Creates an unpleasant interaction That wasn't nice. I don't like it when you make that face. Do not play like that. No, sweetie, you shouldn't do that. That animal doesn't go there. 32


BEHAVIOR MANAGE MENT REASON EXAMPLES IGNORE negative behavior (unless it is dangerous or destructive) a. avoid looking at the child, smiling, frowning, etc. b. be silent c. ignore every time expect the ignored behavior to increase at first continue ignoring until your child is doing something appropriate d. praise your child immediately for appropriate behavior Helps your child to notice the difference between your responses to good and bad behavior Although the ignored behavior may increase at first, consistent ignoring decreases many behaviors Child: (sasses parent and picks up toy) Parent: (ignores sass; praises picking up) STOP THE PLAYTIME for aggressive and destructive behavior Teaches your child that good behavior is required during special playtime Shows your child that you are beginning to set limits Child: (hits parent) Parent: (CDI STOPS. This can't be ignored.) Special playtime is stopping because you hit me. Child: Oh, oh, oh mom. I'm sorry. Please, I'll be good. Parent: Special playtime is over now. Maybe next time you will be able to play nicely during special playtime. Reprinted with permission from 33


APPENDIX B PARENT DIRECTED I NTERACTION SKILLS RULE REASON EXAMPLES Commands should be direct rather than indirect Leaves no question that the child is being told to do something. Does not imply a choice, or suggest the parent might do the task for the child. Is not confusing for young children. Please hand me the block. Put the train in the box. Draw a circle. Instead of: Will you hand me the block? Lets put the train in the box. Would you like to draw a circle? Commands should be positively stated Tells child what "to do" rather than what "not to do." Avoids criticism of the childs behavior Provides a clear statement of what the child can or should do. Come sit beside me. Instead of: Don't run around the room! Put your hands in your pocket. Instead of: Stop touching the crystal. Commands should be given one at a time Helps child to remember the whole command Helps parent to determine if child completed entire command Put your shoes in the closet. Instead of: Put your shoes in the closet, take a bath, and brush your teeth. Put your shirt in the hamper. Instead of: Clean your room. Commands should be specific rather than vague Permits children to know exactly what theyre supposed to do. Get down off the chair. Instead of: Be careful. Talk in a quiet voice. Instead of: Behave! 34


RULE REAS ON EXAMPLES Commands should be age-appropriate Makes it possible for children to understand the command and be able to do what they are told to do. Put the blue Lego in the box. Instead of: Change the location of the azure plastic block from the floor to its container. Draw a square. Instead of: Draw a hexagon. Commands should be given politely and respectfully Increases likelihood child will listen better. Avoids teaching child to obey polite and respectful commands. Avoids child learning to obey only if yelled at. Prepares child for school. Child: (Banging block on table) Parent: (in a normal tone of voice) Please hand me the block. Instead of: Parent: (said loudly) Hand me that block this instant! Commands should be explained before they are given or after they are obeyed Avoids encouraging child to ask why after a command as a delay tactic. Avoids giving child attention for not obeying. Parent: Go wash your hands. Child: Why? Parent: (ignores, or uses timeout warning if child disobeys). Child: Obeys Parent: Now your hands look so clean! It is so good to be all clean when you go to school! Commands should be used only when necessary Decreases the childs frustration (and the amount of time spent in the time-out chair) [Child is running around] Please sit in this chair. (Good time to use command) Instead of: Please hand me my glass from the counter. (Not a good time to use a direct command) Reprinted with permission from 35


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40 BIOGRAPHICAL SKETCH Ryan Emily Fussell graduated with a Bachelor of Science degree in human development and a Bachelor of Arts degree in psychology in June 2006 from the University of California, Davis. After graduating from college Ms. Fussell worked as a community health representative doing in-home Parent-Child Interaction Therapy in Sacramento, CA. She then changed coasts and attended the University of Florida where she obt ained a Master of Scien ce degree in clinical and health psychology. She is currently pursuin g doctoral degree in clinical and health psychology, with a specialization in clinical child psychology, at th e University of Florida. Her research interests include pare nt-child interactions, child abuse outcomes and prevention, and attrition in filial therapies. She is also an assessor and therapist for Project SHAPE, a NIMHfunded grant, examining Parent-C hild Interaction Th erapy in group and individual formats for children with Attention-Deficit/Hyperactivity Disorder.