The Differential Contribution of the Components of Parent-Child Interaction Therapy Emotion Development for Treatment of Preschool Depression

Abstract

Objective: An adaptation of Parent-Child Interaction Therapy (PCIT) with a novel Emotion Development (ED) module has shown efficacy for the treatment of early childhood depression. Children who received PCIT-ED also showed healthy alterations in neural response to reward. We investigated whether the novel ED module made a unique contribution to the treatment of depression and neural response to reward, and whether child-directed intervention (CDI) and parent-directed intervention (PDI) modules (standard elements of PCIT) were also effective.

Method: Dyads who participated in a randomized controlled trial of PCIT that compared the active PCIT-ED to a wait list (WL) condition were assessed at the completion of each module of PCIT-ED (CDI, PDI, ED) or WL time equivalent for child depression and other symptoms, parenting styles, stress, and depression. Event-related potentials during a reward task were obtained at the end of standard PCIT and after the novel ED module.

Results: Study findings showed that the ED module as well as some elements of standard PCIT were effective in reducing child depression and other forms of psychopathology. Changes in the child's neural response to reward and parental response to child emotional expression were specific to the ED module.

Conclusion: Study findings suggest that the novel ED module has added efficacy for the treatment of early childhood depression, as well as unique efficacy in changing neural responses to reward and parenting response to child emotional expression. These findings can inform clinical uses of this treatment in a modular fashion. Future studies are needed that control for session number and order of PCIT-ED modules.

Clinical trial registration information: A Randomized Controlled Trial of PCIT-ED for Preschool Depression; https://ichgcp.net/clinical-trials-registry/NCT02076425" title="See in ClinicalTrials.gov">NCT02076425.

Keywords: affective symptoms; depression; preschool; therapeutics.

Conflict of interest statement

Disclosure: Drs. Luby, Gilbert, Whalen, and Barch and Ms. Tillman report no biomedical financial interests or potential conflicts of interest.

Copyright © 2019 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.. Overview of Study Design

Note: Some sessions took place back to back (two sessions contiguously for a 90 min). BDI = Beck Depression Inventory; CBCL = Child Behavior Checklist; CCNES = Coping with Children’s Negative Emotions; CDI = child directed intervention; C-GAS = Children’s Global Assessment Scale; ED = Emotion Development; ERP = event related potentials; K-SADS = Kiddie Schedule for Affective Disorders and Schizophrenia; PDI = parent directed intervention; Obs = XX; PFC = Preschool Feelings Checklist and Scale

Figure 2.. Estimated Trajectories from Multilevel Models of PFC-Scale Scores (A) and Child Behavior Checklist (CBCL) Depression (B), Anxiety (C), Internalizing (D), and Externalizing T-Scores (E) in Wait List and Therapy Subjects

Note: Solid lines indicate trajectories from baseline to post-emotion development (ED); Dashed lines indicate trajectories of post-hoc multilevel models during the child directed intervention (CDI), parent directed intervention (PDI), and ED modules for measures with a significant overall difference in group trajectory; asterisks identify post-hoc models with a significant time by group interaction after false discovery rate (FDR) correction for multiple comparisons.

Figure 3.. Estimated Trajectories from Multilevel Models of Beck Depression Inventory (BDI-II) Total Score (A) and Parenting Stress Index (PSI) Total Stress Score (B) in Wait List and Therapy Subjects

Note: Solid lines indicate trajectories from baseline to post-emotion development (ED); Dashed lines indicate trajectories of post-hoc multilevel models during the child directed intervention (CDI), parent directed intervention (PDI), and ED modules for measures with a significant overall difference in group trajectory; asterisks identify post-hoc models with a significant time by group interaction after false discovery rate (FDR) correction for multiple comparisons.

Figure 4.. Estimated Trajectories from Multilevel Models of Coping with Children’s Negative Emotions (CCNES) Distress Reactions (A), Punitive Reactions (B), Expressive Encouragement (C), Emotion-Focused Reactions (D), Problem-Focused Reactions (E), and Minimization Reactions Scores (F) in Wait List and Therapy Subjects

Note: Solid lines indicate trajectories from baseline to post- emotion development (ED); Dashed lines indicate trajectories of post-hoc multilevel models during the child directed intervention (CDI), parent directed intervention (PDI), and ED modules for measures with a significant overall difference in group trajectory; asterisks identify post-hoc models with a significant time by group interaction after false discovery rate (FDR) correction for multiple comparisons.

Figure 5.

Neural ERP Response to Win at Baseline, Post-Standard Parent Child Interaction Therapy (PCIT) and Post-PCIT-Emotion Development (ED)