Parent-Child Interaction Therapy

PCIT TREATMENT MANUAL SESSION OUTLINES PAGE 1

Parent-Child Interaction Therapy Integrity Checklists and Session Materials I

Sheila Eyberg and Members of the Child Study Laboratory University of Florida 1999

©1999 SHEILA M. EYBERG


Table of Contents THERAPY ORIENTATION SESSION .............................................................................................5 Policy for Cancellations and No Shows ........................................................................................9 CDI Homework Sheet .................................................................................................................10 PCIT Progress Note....................................................................................................................11 Integrity Checklist........................................................................................................................13 CDI TEACHING SESSION ............................................................................................................15 Child Directed Interaction Handout .............................................................................................21 Suggested Toys for CDI..............................................................................................................25 CDI Homework Sheet .................................................................................................................26 PCIT Progress Note....................................................................................................................27 Integrity Checklist........................................................................................................................29 ECBI Graph (Change over Course of Treatment) .......................................................................31 FIRST CDI COACHING SESSION ................................................................................................32 Coaching Guidelines for 1st CDI Coaching Session ....................................................................34 Parent CDI Coding Sheet ...........................................................................................................35 DPICS Coding Sheet for Therapist .............................................................................................36 CDI Homework Sheet .................................................................................................................37 CDI Skills Summary Sheet..........................................................................................................38 PCIT Progress Note....................................................................................................................39 Integrity Checklist........................................................................................................................41 SECOND CDI COACHING SESSION ...........................................................................................43 CDI Mastery Criteria ...................................................................................................................45 Coaching Guidelines for 2nd CDI Coaching Session..................................................................45 Parents are Models for Their Children ........................................................................................46 Parent CDI Coding Sheet ...........................................................................................................48 DPICS Coding Sheet for Therapist .............................................................................................49 CDI Homework Sheet .................................................................................................................50 PCIT Progress Note....................................................................................................................51 Integrity Checklist........................................................................................................................53 THIRD CDI COACHING SESSION ...............................................................................................55 Coaching Guidelines for the 3rd CDI Coaching Session..............................................................58 Getting Support...........................................................................................................................59 Parent CDI Coding Sheet ...........................................................................................................61 Therapist Coding Sheet ..............................................................................................................62 CDI Homework Sheet .................................................................................................................63 PCIT Progress Note....................................................................................................................64 Integrity Checklist........................................................................................................................66 FOURTH AND BEYOND CDI COACHING SESSION ..................................................................68 Kids and Stress...........................................................................................................................71 Parent CDI Coding Sheet ...........................................................................................................73 DPICS Coding Sheet for Therapist .............................................................................................74 CDI Homework Sheet .................................................................................................................75 PCIT Progress Note....................................................................................................................76 Integrity Checklist........................................................................................................................78



PDI TEACHING SESSION ............................................................................................................80 Time Out Diagram.......................................................................................................................89 Eight Rules of Effective Commands in PDI.................................................................................91 Using a Time-Out Room in Your Home ......................................................................................93 CDI Homework Sheet .................................................................................................................94 PCIT Progress Note....................................................................................................................95 Integrity Checklist........................................................................................................................97 FIRST PDI COACHING SESSION ................................................................................................99 Directions for Coaching the First PDI Session ..........................................................................102 Explaining PDI to the Child .......................................................................................................103 First PDI Homework Assignment ..............................................................................................104 PDI Homework Sheet ...............................................................................................................105 CDI Homework Sheet ...............................................................................................................106 PCIT Progress Note..................................................................................................................107 Integrity Checklist......................................................................................................................109 SECOND PDI COACHING SESSION .........................................................................................111 PDI Mastery Criteria..................................................................................................................113 DPICS Coding Sheet for Therapist ...........................................................................................114 Parent CDI Coding Sheet .........................................................................................................116 Parent PDI Coding Sheet..........................................................................................................117 PDI Skills Summary Sheet ........................................................................................................118 CDI Homework Sheet ...............................................................................................................119 PDI Homework Sheet ...............................................................................................................120 PCIT Progress Note..................................................................................................................121 Integrity Checklist......................................................................................................................123 THIRD PDI COACHING SESSION..............................................................................................125 DPICS Coding Sheet for Therapist ...........................................................................................128 Parent CDI Coding Sheet .........................................................................................................130 Parent PDI Coding Sheet..........................................................................................................131 CDI Homework Sheet ...............................................................................................................132 PDI Homework Sheet ...............................................................................................................133 PCIT Progress Note..................................................................................................................134 Integrity Checklist......................................................................................................................136 FOURTH PDI COACHING SESSION..........................................................................................138 Setting Up House Rules............................................................................................................141 CDI Homework Sheet ...............................................................................................................143 PDI Homework Sheet ...............................................................................................................144 PCIT Progress Note..................................................................................................................145 Integrity Checklist......................................................................................................................147 FIFTH PDI COACHING SESSION ..............................................................................................149 Dealing With Your Child In Public Places .................................................................................152 DPICS Coding Sheet for Therapist ...........................................................................................154 Parent CDI Coding Sheet .........................................................................................................156 Parent PDI Coding Sheet..........................................................................................................157 CDI Homework Sheet ...............................................................................................................158 PDI Homework Sheet ...............................................................................................................159 PCIT Progress Note..................................................................................................................160 Integrity Checklist......................................................................................................................162



SIXTH PDI COACHING SESSION ..............................................................................................164 Dealing With Your Child In Public Places ..................................... Error! Bookmark not defined. DPICS Coding Sheet for Therapist ...........................................................................................170 Parent CDI Coding Sheet .........................................................................................................172 Parent PDI Coding Sheet..........................................................................................................173 CDI Homework Sheet ...............................................................................................................174 PDI Homework Sheet ...............................................................................................................175 PCIT Progress Note..................................................................................................................176 Integrity Checklist......................................................................................................................178 PDI COACHING SESSION 7 AND BEYOND .............................................................................180 DPICS Coding Sheet for Therapist ...........................................................................................187 Parent CDI Coding Sheet .........................................................................................................189 Parent PDI Coding Sheet..........................................................................................................190 CDI Homework Sheet ...............................................................................................................191 PDI Homework Sheet ...............................................................................................................192 PCIT Progress Note..................................................................................................................193 Integrity Checklist......................................................................................................................195 GRADUATION SESSION............................................................................................................197 Other Discipline Tools...............................................................................................................199 DPICS Coding Sheet for Therapist ...........................................................................................204 Parent CDI Coding Sheet .........................................................................................................206 Parent PDI Coding Sheet..........................................................................................................207 CDI Homework Sheet ...............................................................................................................208 PDI Homework Sheet ...............................................................................................................209 PCIT Progress Note..................................................................................................................210 Integrity Checklist......................................................................................................................212 APPENDIXES..............................................................................................................................214 CDI Coaching General Guidelines ............................................................................................215 Common CDI Coaching Statements .........................................................................................216 How to Create Great Labeled Praises ......................................................................................217 Practicing Labeled Praise for Positive Opposites......................................................................218 Changing Ineffective Commands to Effective Commands ........................................................219 Teaching PDI to Children with Mr. Bear....................................................................................220 The Turtle Technique................................................................................................................223 Differential Social Attention For ADHD .....................................................................................225 How to Ignore ADHD Behaviors................................................................................................228



THERAPY ORIENTATION SESSION Expanded Session Outline Before This Session 1. When scheduling appointment, encourage parents not to bring their child to this session. 2. Carefully review all information from the preceding assessment session, including the interview, test data, and videotaped parent-child interactions so that you are familiar with the family’s primary concerns, strengths, and deficits. 3. Give both parents the ECBI and ask them to complete the Intensity Scale while in the waiting room. 4. Introduce family to the childcare assistants, if applicable. 5. Materials needed: ECBI, Policy for Cancellations and No Shows, CDI Homework Sheets, Progress Note, Integrity Checklist

Goals of this Session ♦ Establish rapport with the family ♦ Educate parents about the therapy process ♦ Begin to develop therapeutic relationship Note. If the treating clinicians are the same clinicians who conducted the ones who conducted the pretreatment assessment, these goals may have been met during the assessment, and treatment may begin with the CDI Teach Session. Note. In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior

TREATMENT SESSION OUTLINE 1. Introductions and building rapport. To assist in building rapport, have a conversation with parents about their child: ♦ Indicate to parent that you have reviewed all of the information from their pretreatment assessment, noting that their child presents challenging behaviors ♦ Listen and reflect as they comment on these behaviors, or ask them to describe what they see as the child’s most challenging behaviors ♦ Ask them to describe child’s most endearing behaviors ♦ Ask them to describe what they like about their parenting ♦ Encourage parents to expand on their answers and listen actively to their responses



2. Description of Therapy Purpose ♦ Describe primary goals of treatment for the parents: to establish a more positive relationship with their child, and to acquire skills to help manage their child’s behavior. ♦ Ask the parents about their expectations for treatment, what they hope will result from therapy. Clarify any incorrect expectations either on the spot or during the course of providing information during this session. 3. Provide support to the parent for stressors and barriers to treatment Ask about stressors identified in the assessment. If stressors involve barriers to treatment attendance (such as transportation issues), use problem-solving approach to achieve solution. For problems that do not directly affect the family’s ability to participate in treatment, use facilitative listening, and express genuine concern. Let parents know that you will help them get additional services, if needed. [One of your roles as therapist is to identify and prevent factors that might interfere with the parents’ ability to complete homework or might lead the family to discontinue therapy prematurely. In each session it is important to address the parents’ individual concerns briefly, when they arise.] 4. Give overview of PCIT Note. The italicized scripts in this manual are not to be read. They provide a sample of the information to be conveyed in the therapist’s own words. "Parent-child interaction therapy involves two treatment phases. The first phase is called childdirected interaction or CDI. In CDI, we teach you play therapy skills that you will use to change your child's behaviors such as [describe problems of their child that CDI should affect]. The skills that you will learn in this first phase of treatment will help you and your child both feel more positive about each other as you learn to get along in a new way. The second phase is called parent-directed interaction or PDI. PDI involves learning specific discipline techniques that will help your child learn to cooperate and will help decrease [describe problems of child that PDI should change]. Each phase takes about 5 or 6 weeks, although the exact time depends on the individual family." 5. Explain the structure of therapy sessions ♦ Format for the teaching sessions (sample script) “There will be two teaching sessions, one to teach you the basics of the Child Directed Interaction (CDI), and one session to teach you the Parent Directed Interaction (PDI). And the first of these teaching sessions – the one dealing with the CDI phase – is what we’re doing next week. During these teaching sessions, you will be learning lots of new information. For the two teaching sessions, we ask that you not bring [child’s name]. During the teaching session we’ll show you the new skills and practice them with you so that you know how it goes and can ask questions before you actually practice the new skills with [child’s name].”



♦ Format for the coaching sessions (sample script) “After the teaching session, the rest of our sessions will be spent with us coaching you and [child’s name] on the skills and how to use them to increase the positive, cooperative interactions that you have together. In these sessions, you (the parents) will come with [child’s name]. We’ll spend a few minutes at the beginning of the coaching sessions talking about how things went at home during the week. “Then each of you will have the chance to play with [child’s name] while we coach you using the bug-in-the ear device that you used during your assessment sessions. First we’ll just observe you and [child’s name] play for a few minutes and count some of the skills to see what we’ll want to practice most, and then we’ll coach you in how to use the skills to change [child’s name’s] behavior. Then [if 2 parents], you two will switch places, and you’ll have the chance to watch your partner being coached with [child’s name]. That makes it possible for you both to watch your child ‘alone’ with the other parent, and to give helpful feedback to each other. ” “After both of you have practiced with your child, we will all come back to the playroom to talk about the interactions. [If 2 parents: ‘This gives you the opportunity to hear the perspective of the other parent, and may give you insight as to different ways to interact with your child. Also, we sometimes see that a parent’s own skills are improved by watching the other parent’s interactions with their child.’] During this wrap-up time, we (the therapists) will [also] provide feedback and suggestions for further improvement, and together we’ll decide what you want to focus on most in you practice at home.” 6. Explain therapy guidelines “There are some guidelines that we use to make therapy run smoothly.” •

Confidentiality Remind parents of the limits of confidentiality discussed during the intake assessment. Tell parents that you will keep information shared in treatment confidential unless you have a duty to report the information. These situations include information about possible harm to a child or others, such as in the case of abuse, or if you are ordered by a court to share information in response to a subpoena.

•

Positive and constructive feedback Encourage parents to support one another during treatment and give feedback to each other in a positive and constructive way.

•

Attendance policy Discuss the importance of regular attendance to make progress in treatment Ask parents to call ahead to let you know if they must miss a session. Tell them you will try to reschedule the session in the same week, if possible. Give family a copy of the cancellation/no show policy. “If you miss three or more sessions without calling ahead to reschedule, we may have to end treatment, because it will not be effective without regular attendance.”



7. Explain Homework Give each parent a homework sheet

“An important part of treatment is to spend 5 minutes with your child one-on-one each day – for your child it will be “special time” –and play therapy, with you as the therapist. You will learn how to do this, and the 5 minutes each day is “homework” for you – it’s your time to practice the parenting skills that you learn in treatment. Even though 5 minutes doesn’t seem like much time, it is very important to your child’s progress in therapy, and it does take some planning and effort to get it into your daily routine. Is it possible for you to spend 5 minutes alone with your child each day?” •

If parents do not have 5 minutes to commit to their child each day, it may be that this is not the right treatment program for them. If parents have any hesitation about having the time, it needs to be discussed straightforwardly. Use clinical judgment in considering this issue.

•

If parents do not know how they can get alone time with their child (perhaps because of siblings), problem-solve solution(s) that would be feasible. “We want you to spend 5 minutes of one-on-one time with your child every day until our next session. For this week, just do whatever you might ordinarily do together – you can play together with your child’s toys, or read a bedtime story to your child, or go for a walk outside. The important thing will be to figure out the time that will work best for this “special time” so that it can happen every day. Next week we’ll talk about the specific things you will practice during this 5minute time each day.” [Show parents how to complete the homework sheet each day.]



Policy for Cancellations and No Shows Due to the large number of families who want treatment, we must strictly enforce the policy for missed appointments. A family will be withdrawn from treatment if they miss three scheduled appointments without canceling in advance (no shows). Families may cancel appointments 24 hours in advance and reschedule within 5 days without consequence. A family will be withdrawn from treatment if they cancel more than four scheduled appointments with less than 24-hour notice. Whenever a family no shows or calls to cancel, the therapist will try to reschedule another appointment time within the same week if possible, or early the next week, so that the family can attend their regularly scheduled appointment the following week and not delay their progress. A letter of treatment closure will be sent to any family that must be withdrawn from treatment due to missed appointments.

___________________________ Parent Signature

___________________________ Date

___________________________ Parent Signature

___________________________ Date

___________________________ Therapist Signature

___________________________ Date

___________________________ Therapist Signature

____________________________ Date



CDI Homework Sheet Mother ___

Father ___

Child's First Name ____________________

Date

Did you spend 5 minutes in Special Time today? Yes

Monday ________________ Tuesday ________________ Wednesday ________________ Thursday ________________ Friday ________________ Saturday ________________ Sunday ________________


No

Activity

Problems or questions in Special Time


PCIT Progress Note IDENTIFYING INFORMATION Child’s Name: Subject #:

Date of Session: Therapists Present: Supervisor Signature:

ATTENDANCE Number of no-shows/cancellations since last session: _____ Reasons (if known):

Action taken and date(s):

Date(s) of any in-between session phone calls:

TREATMENT SESSION (CHECK ONE) O CDI Teach O CDI Coach #1 O CDI Coach #4 O CDI Coach #5 O PDI Teach O PDI Coach #1 O PDI Coach #4 O PDI Coach #5

INVOLVEMENT IN SESSION Adult family members in attendance 1. 2. 3.

O CDI Coach #2 O CDI Coach #6 O PDI Coach #2 O PDI Coach #6

O CDI Coach #3 O CDI Coach # O PDI Coach #3 O PDI Coach #

Rating of involvement 1= not involved 2=somewhat 3=very involved O1 O2 O3 O1 O2 O3 O1 O2 O3

Percent days practiced

Days with opportunity to practice

Days Since Last Session

Days Practiced

HOMEWORK

Reason for no opportunity

Mother Father Other________________

GOALS FOR THIS SESSION

POSITIVE PROGRESS MADE:

OVER



PROBLEMS DURING SESSION:

PROBLEMS UNRELATED TO CHILD BEHAVIOR DISCUSSED:

ADVICE GIVEN:

HOMEWORK ASSIGNED (SPECIFY HOUSE RULES IF APPLICABLE):

PLANS FOR NEXT SESSION:



Integrity Checklist Participant ID _________

Session Title ___________________ (e.g., CDI Teach)

As you view the tape, place a checkmark under the appropriate column. List these totals in the appropriate blanks below the table. ITEM NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38


NA

X


TOTAL NUMBER OF CHECK MARKS _____ TOTAL NUMBER OF NA's _____ TOTAL NUMBER OF X's ____

Therapist Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________

Integrity Checker Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________



CHILD DIRECTED INTERACTION CDI TEACHING SESSION Expanded Outline Before This Session

1. When scheduling appointment, encourage parents not to bring their child to this session. 2. Carefully review all information from the assessment interview and preceding orientation session, so that you are familiar with the family’s primary concerns, strengths, and deficits and, during teaching, you can emphasize the families strengths and the skills that may be most difficult for the family to learn. 3. Set up age-appropriate treatment toys to occupy the child on the floor if the child comes. 4. Give parents the ECBI Intensity Scale to complete in the waiting room. 5. Materials needed: ECBI, Suggested Toys for CDI, CDI Handout, CDI Homework Sheets, Progress Note, Integrity Checklist, ECBI Graph (Change Over Course of Treatment) 6. Optional Materials: How to Create Great Labeled Praises, Practicing Labeled Praise for Incompatible Behavior Goals of this Session o Continue building rapport with the family o Teach parents the CDI skills o Provide the rationale for each skill in a way that the parents understand why the individual skill and CDI as a whole are important for their child. _____________________________________________________________________________________________ Note: In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior

TREATMENT SESSION OUTLINE 1. Ask parents for homework sheets ♦ Establish expectancy of homework completion at this first session ♦ If they did not bring completed sheets, show concern, and complete homework sheets in session before any other activity ♦ If they brought sheets, regardless of how much they practiced, praise them for completing the sheets ♦ It they brought in completed sheets but did little homework, note that it looks like it was hard for them to find the 5 minutes for [child’s name’s] treatment this week, but that at the end of the session, you will talk with them about some techniques that others have found helpful and help them to create a plan ♦ If they brought completed sheets and practiced at least 5 of 7 days, praise them for their time management and commitment to helping their child, and tell them you will go over the homework in detail at the end, after you have talked about the first phase of treatment.



2. Explain why CDI phase is taught first “Once [child’s name] becomes calmer and starts to enjoy having special CDI time with you, it will be easier for him/her to accept limits and discipline. “Many of the CDI skills you will learn are necessary for PDI to work, and we want them to become automatic habits so you won't have quite so many new things to remember all at once when we begin to focus on the most difficult behavior problems.” 3. Give overview of CDI ♦ Teaches you the kinds of skills that play therapists use with children to build a good relationship with them and help them feel safe and calm ♦ Teaches you how to communicate with preschoolers with limited attention spans ♦ Teaches ways to teach your child without frustration for either of you ♦ Improves your child's self-esteem ♦ Improves your child’s social skills, like sharing, which children need to get along with other children and have friends ♦ Results a secure, warm relationship between you and your child (which often gets strained with oppositional children). 4. Explain the Basic Rule of CDI ♦ The basic rule of CDI is to follow your child’s lead, like play therapists do ♦ The specific rules of CDI apply to the short play therapy sessions (“special time”) that we ask to have with your child each day at home ♦ Some of the rules are good general parenting rules, but CDI is a special therapeutic time, and some of the rules apply only when you have these sessions with your child. At home there are many times when you have to direct your child’s activity. “Next, we’ll talk about the specific rules of CDI.” “We'll start with the things you need to avoid saying during this special time": [For each rule, give parent the definition, examples, rationale. When teaching CDI, it’s good to sit around a table so that you can demonstrate with toys on the table as you talk, and so you don’t have to move when you demonstrate and role-play CDI with the parents] 5. Avoid Commands [“The first rule is to avoid commands”] ♦ Commands try to direct the play by suggesting what the child should do ♦ There are two kinds of commands • Direct: “Sit down.” ”Please hand me the car.” • Indirect: “Would you like to sit down?” “Let’s put the cars away.” ♦ Commands take over the lead of the play ♦ If the child doesn’t obey, the play could stop being fun – CDI is a time when the child is to learn that it’s fun to get along and play together nicely.



6. Avoid Questions ♦ A question asks for an answer from the child ♦ There are different kinds of questions • Questions that ask for information – who, what, where, when, how • Unintentional questions – voice goes up at end of sentence; question tags • Questions that are really hidden commands – “Would you like to clean up?” ♦ Questions take over the lead of the conversation ♦ Questions sometimes suggest disapproval ♦ Questions often suggest you aren’t really listening to your child 7. Avoid Criticism ♦ Criticism is a negative or contradictory statement about the child or his/her actions – “You’re not nice,” or “That doesn’t go that way.” ♦ Criticism points out mistakes rather than providing correction • To correct without criticizing, could say, “It goes this way” ♦ Criticism tells the child what NOT to do (“Stop that,” “Don’t do that!” “Quit it.) ♦ Criticism lowers a child’s self-esteem ♦ Criticism creates a negative interaction 8. Engage parents in recalling the three things to avoid during CDI "Next we'll talk about what to DO --the special skills to use during the CDI play sessions. We call these rules the PRIDE skills to help you remember the" [point to the pride words on the wall or give them handout with list of PRIDE skills] 9. Praise your child's appropriate behavior ♦ Praise compliments a child about his or her behavior ♦ There are two kinds of praise Labeled praise is specific praise; “You choose such pretty colors!” “You're being so careful with that the pen!”, “I like it when you build quietly!” Unlabeled praise is nonspecific: “Good!”, “That's great!”, “Nice job”, “I like that.” ♦ Labeled praise is more effective because it lets child know exactly what you like. ♦ Praise Increases the behavior that it follows ♦ Praise Increases child's self-esteem ♦ Praise adds warmth to the interaction ♦ Praise makes both parent and child feel good!



10. Reflect appropriate talk ♦ Reflection is repeating/paraphrasing what your child says: “Yes, that’s a blue crayon.” ♦ Allows child to lead the conversation ♦ Shows child you're really listening ♦ Actually helps you learn to listen! ♦ Shows you accept/understand what child is saying ♦ Improves and increases child's speech and language ♦ May feel awkward at first, but becomes natural pretty quickly

11. Imitate appropriate play ♦ Imitation means doing the same thing your child is doing, such as drawing a tree if your child is drawing a tree ♦ Helps you keep your attention/comments focused on what your child is doing ♦ Helps you play right at your child’s developmental level ♦ Lets child lead the play ♦ Makes the play fun for your child ♦ Shows your approval of your child's activity ♦ Teaches child how to play well with others (for example, taking turns). 12. Describe appropriate behavior ♦ State exactly what your child is doing. “You're drawing a sun” ♦ Like a sports announcer, a running commentary ♦ Lets your child lead ♦ Lets your child know you're interested and paying attention to him/her ♦ Let’s child know you approve of what he or she is doing ♦ Models speech and teaches vocabulary and concepts ♦ Holds your child’s attention to the task and teaches child how to hold his/her own attention to a task 13. Be Enthusiastic! ♦ Let your voice show excitement about your child’s appropriate behavior. For example, “You are being SO nice to share with me!” ♦ Lets your child know that you are enjoying the time you are spending together ♦ Increases the warmth of your play 14. Engage parents in recalling the PRIDE skills



15. Discuss what parents should do when child misbehaves during CDI “Children usually like CDI a lot and show good behavior, but what should you do if your child's behavior is not okay and you can’t give commands, questions, or criticisms?! 16. Ignore inappropriate behavior ♦ Serves to decrease ONLY attention-seeking behaviors (yelling, sassing, whining, crying for no real reason); not for hitting, stealing, running, etc. ♦ Any attention, positive or negative, can increase attention-seeking behaviors ♦ Avoid any verbal or nonverbal reaction to inappropriate behavior (e.g., looking at the child, smiling, frowning, etc.) ♦ Once you begin ignoring, you must continue until the behavior stops (explain consequences of stopping ignoring too soon and increasing the negative behavior) ♦ Continue ignoring until your child is doing something appropriate ♦ Praise your child immediately for appropriate behavior. ♦ Helps your child to notice the difference between your responses to good and bad behavior ♦ Ignored behavior gets worse before it gets better, so only ignore if you can continue to ignore when it gets worse ♦ Consistent ignoring eventually decreases many behaviors when combined with attention for positive behaviors 17. Describe how to combine ignoring with the PRIDE skills ♦ While ignoring the negative behaviors, look for any positive behaviors occurring at the same time, and comment on them ♦ If a negative behavior stops, look at the child with a friendly look and comment on what the child is doing that is the opposite of negative behavior: “I’m glad that you said that quietly.” ♦ Any time you see behavior that is opposite to the negative behaviors you have to ignore, give the child BIG labeled praises for the positive opposite. 18. Explain that if a negative behavior cannot be ignored, the parent must stop the play and deal with it ♦ Behaviors that cannot be ignored include • Aggressive behaviors (e.g., hitting, biting) • Destructive behaviors (e.g., breaking crayons in half) ♦ Stopping the play teaches your child that good behavior is required during special time ♦ It shows your child that you are learning to set limits ♦ Tell the child, “Special time is stopping because you hit me. Maybe next time you will be able to play nicely during special time.” ♦ Try to initiate CDI again later in the day, if possible. 19. Model CDI for parents Therapist and co-therapist model what CDI looks like using all the PRIDE skills and ignoring negative behavior (Dos, Don’ts, and Ignoring).



20. Role-play CDI with each parent ♦ Lead therapist coaches primary caregiver (in the room) while the co-therapist pretends to be the child. Focus on positive PRIDE skills (Praise, Reflection, Imitation, Description, and Enthusiasm) for the first few minutes. Make clinically sensitive corrections for commands, questions, and criticism. Then, the co-therapist can introduce some negative behaviors to practice ignoring. ♦ Repeat role-play with other parent ♦ Discuss with parent how it feels to use the skills. Reassure parent that most parents feel awkward in the beginning, and that the skills will become natural with practice. 21. Describe the kinds of toys that are best to use for CDI at home, and why ♦ Quiet toys that don’t have rules are best, so that parents can let the child lead the play without worrying about the child breaking rules ♦ Construction toys, such as Legos, blocks, tinker toys ♦ Play sets, such as farms, houses, towns ♦ Creative toys, such as crayons and paper ♦ Many objects around the house can be excellent creative toys, like pots and pans. ♦ Avoid board games. Structured rules prevent free play. ♦ Avoid pretend-talk toys such as puppets, toy telephones -- you want to communicate directly with your child ♦ Avoid toys that encourage rough play (balls), aggressive play (super-hero figures), or messy play (finger paints). These increase the chance of behavior problems, and you want the special time to be a positive interaction. 22. Ask parents specifically what toys they will use this week 23. Explain how to set up the CDI play session at home ♦ Minimize distractions (siblings, telephone, TV, etc.) ♦ Place two or three appropriate toys in CDI area before starting the session ♦ Let the child choose from your selection once CDI begins 24. Explain the importance of practicing CDI every day for 5 minutes ♦ Long enough to provide therapeutic effect for the child ♦ Long enough for parents to be able to learn the skills ♦ Short enough not to be too time consuming ♦ Short enough that parents will not become frustrated with the concentration required at first to learn the skills ♦ Special time is not a reward -- it should not be withdrawn for misbehavior 25. Ask parents to decide what time of day and what room in their house they will use for their daily practice -- problem-solve with them if necessary to help them commit to a particular time and place 26. Give parents CDI handout, Suggested Toys for CDI, and Praise Worksheet for their review before practice 27.Give homework sheets to parents to record CDI sessions



PARENT-CHILD INTERACTION THERAPY

Child Directed Interaction Handout The “Do” Skills SKILL

REASON

EXAMPLES

Behavioral Description

Lets child lead the play

Describe what your child is doing

Shows interest

• You're making a tower • You drew a square

Teaches concepts

• You are dressing Mr. Potato Head

Models good speech and vocabulary

• You put the girl inside the fire truck

Holds child's attention on the task Organizes child's thoughts about the activity Reflection Repeat or paraphrase what your child says

Lets child lead the conversation Shows interest Demonstrates acceptance and understanding Improves child's speech Increases verbal communication

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: You’re having fun with the blocks

Labeled Praise

Causes child's good behavior to increase

Good job with that tower

Say specifically what you like about what your child is doing or saying

Shows approval

Nice drawing

Increases child's selfesteem

Thank you for sharing

Makes child feel good

I like how gently you’re putting the crayons away


You drew a beautiful tree



Child Directed Interaction Handout (page 2) The “Don’t” Skills

SKILL Avoid Commands

REASON • Commands take the lead away from your child • Commands can lead to negative interactions

EXAMPLES Indirect Commands • Let's play with the farm next. Will you sit down in your chair • Could you tell me what animal this is?

Direct Commands • Give me the pigs. • Please sit down next to me. • Tell me what this letter is.

Avoid Questions

• Questions lead the conversation • Many questions are commands and require an answer • Questions may suggest to your child that you aren’t really listening 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 and Sarcasm

• Critical statements often increase the criticized behavior • Criticism lowers your child's selfesteem • Criticism creates an unpleasant interaction.

That wasn't nice. I don't like it when you climb on the table. Do not play like that. No, sweetie, you shouldn't do that. That’s not the right color for hair. That piece doesn't go there. I’m disappointed in you today.




Child Directed Interaction Handout (page 3) Dealing with Misbehavior in CDI SKILL

REASON

IGNORE negative behavior (unless it is dangerous or destructive) a. Avoid looking at your child, smiling, frowning, etc.

EXAMPLES

• Helps your child to notice the difference between your responses to good and bad behavior

• Child: (sasses parent and picks up toy). Parent: (ignores sass; praises picking up).

• Although the ignored behavior may get worse at first, consistent ignoring improves many behaviors

b. Be silent c. Ignore every time

Behaviors to ignore include • Crying for no reason • Whining • Sassing

d. Expect the ignored behavior to get worse at first e. Continue ignoring until your child is doing something appropriate f.

Praise your child immediately for appropriate behavior

STOP THE PLAY for aggressive and destructive behavior

• Teaches your child that good behavior is required during special time • Shows your child that you are beginning to set limits

• Child: (hits parent). Parent: (CDI STOPS. This can't be ignored.) Special time is stopping because you hit me. Child: Oh, oh, oh Mom. I'm sorry. Please, I'll be good. Parent: Special time is over now. Maybe next time you will be able to play nicely during special time.

Aggressive and destructive behaviors include • Hitting • Biting



Praise Reflect Imitate Describe



Suggested Toys for CDI Creative, constructive toys, like: Building Blocks Legos Tinker Toys Magnetic Blocks Lincoln Logs Constructo-Straws Mr. Potato Head Crayons and Paper Chalkboard and Colored Chalk Erector Set

Toys to Avoid During CDI o Ones that encourage rough play, like: o bats, balls, boxing gloves, punching bag o Ones that lead to aggressive play, like: o toy guns, toy swords, toy cowboys and indians, super-hero figures o Ones that could get out of hand and require limit setting, like: o paints, markers, bubbles, scissors, play dough, hammer o Ones that have pre-set rules, like: o board games, card games o Ones that discourage conversation, like: o books, video games o Ones that lead to parent or child imagining they are someone else, like: o puppets, costumes




Father ___


Date




No

Activity
















Days Practiced

HOMEWORK





OVER ©1999 SHEILA M. EYBERG




ADVICE GIVEN:







As you view the tape, place a checkmark under the appropriate column. List these totals in the appropriate blanks below the table. ITEM NUMBER

NA

X

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 OVER



TOTAL NUMBER OF CHECK MARKS _____ TOTAL NUMBER OF NA's _____ TOTAL NUMBER OF X's _____

Therapist Comments About Session: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________________

Integrity Checker Comments About Session: __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________



ECBI Graph (Change over Course of Treatment)

NAME:________________________________


Session 20

Session 19

Session 18

Session 17

Session 16

Session 15

Session 14

Session 13

Session 12

Session 11

Session 10

Session 9

Session 8

Session 7

Session 6

Session 5

Session 4

Session 3

Session 2

Session 1

Date

250 240 230 220 210 200 190 180 170 160 150 140 130 120 110 100 90 80 70


FIRST CDI COACHING SESSION Expanded Outline Before This Session 1. Remove all toys from the playroom except for three treatment toys 2. Have the parents complete the ECBI in the waiting room 3. Materials needed: ECBI, Parent In-Session Coding Forms, Therapist Coding Forms, CDI Homework Sheets, Parent-Child Interaction Summary Sheets (CDI), Integrity Checklist, Progress Note, ECBI Graph (from CDI Teach Session) Goals of This Session ♦ Strengthen rapport with the family ♦ Continue to provide support ♦ Reinforce the parent(s) for their use of the CDI skills and their progress (remember, this session should focus only on the positive) Note: In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child

______________________________________________________________________________ TREATMENT SESSION OUTLINE 1.Talk with child briefly about therapy ♦ Why the family is coming to therapy ♦ What therapy will be like ♦ The room (explain the bug-in-the-ear and one-way mirror) 2. Ask for homework sheets and review homework 10 -15 minutes ♦ If parents did not bring their homework sheets, or brought them back incompletely filled out, take their sheet (or new sheet) and fill in each day with them ♦ If parents have practiced every day, praise their conscientiousness and genuine efforts to help their child. Let them know you recognize the effort it takes to organize time and add a new event the routine. ♦ If the parents have not practiced every day, spend time teaching parents to problem-solve around this issue. Guide them to make a specific plan for when and where each day they will practice. ♦ When discussing homework activities on parents’ sheets, note appropriateness of the activity/toys for CDI. Either praise their choices, or have them discuss how it worked to use that (inappropriate) activity. Then have them problem-solve until they achieve a solution. ♦ Comment on any notes parent wrote on homework sheet 3. Note that today is the first session in which the new skills will be coded and coached. Describe the procedures. If there are two parents, explain that each will take a turn in the playroom while the other parent observes and codes _____________________________________________________________________________ Note. The parent that is observing will code (tally) the other parent when the therapist does, using a special CDI Parent Coding Sheet with just a few (1 to 5, depending on parent’s ability) key categories. Show them the sheet, and explain briefly how they will code each other. ©1999 SHEILA M. EYBERG


Coding and Coaching With one parent in treatment [Give parent bug-in-the-ear and go into observation room] 4a. Code parent and child in CDI for 5 minutes (on DPICS Coding Forms) Over the bug, explain the coding directions] “Okay, we're going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” 5a. Coach parent with child for about 30 minutes ♦ Give parent labeled praises over bug for all PRIDE skills ♦ Focus primarily on behavioral descriptions ♦ Give only positive feedback today; don’t point out mistakes [See coaching guidelines for this session at end of session outline] With two parents in treatment {Give mother bug-in-ear, go into observation room, and explain directions over the bug] “Okay, we're going to code CDI for the next few minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” [For first minute, show father how to code on his sheet] 4b.Code mother and child CDI for 5 minutes (on Therapist In-Session Coding Forms) while father observes and codes also (on parent coding form). 5b. Coach mother for 15 minutes ♦ Give parent labeled praises over bug ♦ Focus primarily on behavioral descriptions ♦ Give only positive feedback today - ignore mistakes [See coaching guidelines for this session at end of this outline] [Have mother and father switch places] [with father]“Okay, we're going to code CDI for the next few minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” [For first minute, show mother how to code on her sheet] 6b. Code father for 5 minutes (on DPICS Coding Forms) while mother observes and codes (on parent coding form) 7b. Coach father with child for 10 minutes ♦ Use labeled praises in feedback to father over the bug ♦ Focus primarily on behavioral descriptions ♦ Give only positive feedback today - don’t point out mistakes ♦ See coaching guidelines for this session at end of this outline ©1999 SHEILA M. EYBERG


With all families 8. Return to playroom with family. Seat family and retrieve bug.

9. Review summary sheets with parents for about 5 minutes. Focus on parents’ strengths, give reassurance about their performance.

10. Give new homework sheets and encourage parents to focus especially on decreasing questions and increasing reflections during their home practice. (Unless they have already mastered these skills and another category is more important) ________________________________________________________________________ Coaching Guidelines for 1st CDI Coaching Session 1. Label your praises to parents. (e.g., "Good behavioral description" rather than "Good.") 2. Attempt in this session to give only positive feedback to parents; Ignore their errors and respond immediately to incompatible behaviors with praise. Examples ♦ If parents not ignoring bad behavior, wait until one occurs and, before parent has time to say anything, praise the opposite, e.g., "Good ignoring his contradiction." ♦ If parents still using a lot of questions, praise parents often for using a statement instead of a question, or for catching any question they appear to catch. 3. In all CDI coaching sessions, coach all skills as they occur, but in this first coaching session the major emphasis in coaching is on good behavioral descriptions, given in first person. 4. Continue to praise parent for ignoring negative behaviors, and if necessary, praise them for ignoring before they've had a chance not to ignore.



Parent CDI Coding Sheet Date: ____________ Observed parent’s name: ___________________

SKILLS

Your name: _________________

Tally

Behavior Description

Reflection

Labeled Praise

Unlabeled Praise*

MISTAKES Question

Command

Criticism

Comments about parent-child interaction today _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________



DPICS Coding Sheet for Therapist Date___________ Child’s name _________________________________ Mother

Father

Other ______________



O CDI Coach #3 O CDI Coach # O PDI Coach #3 O PDI Coach # ___

CODING CDI IN SESSION POSITIVE

TALLY CODES

TOTAL

TALK (TA) (ID + AK)

MASTERY __

BEHAVIOR DESCRIPTION (BD)

10

REFLECTION (RF)

10

LABELED PRAISE (LP)

10 __

NLABELED PRAISE (UP) AVOID

TALLY CODES

TOTAL

MASTERY

QUESTION (QU)

0

COMMANDS (DC + IC)

0

NEGATIVE TALK (NTA) (CR + ST)

0

POSITIVE

CHECK ONE

IMITATE

SATISFACTORY

NEEDS PRACTICE

USE ENTHUSIASM

SATISFACTORY

NEEDS PRACTICE

IGNORE DISRUPTIVE BEHAVIOR

SATISFACTORY

NEEDS PRACTICE

NOT APPLICABLE

OTHER (SPECIFY)

TURN OVER TO CODE PDI SKILLS IN SESSION




Father ___


Date




No

Activity



Child’s Name: ___________________ Observation of:

Mother

Father

Other

CDI Skills Summary Sheet

Session Date Mastery Behavior Descriptions

10

Reflections

10

Labeled Praise

10

Unlabeled Praise

--

Teaching and Other Talk

--

Questions

0

Commands

0

Critical Comment

0
















Days Practiced

HOMEWORK


Mother Father Other________________ GOALS FOR THIS SESSION






ADVICE GIVEN:









NA

X



Therapist Comments About Session _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________________________________________

Integrity Checker Comments About Session _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________________________________________



SECOND CDI COACHING SESSION Expanded Outline Before the session 1. Remove all toys from the playroom except for three treatment toys 2. Give the parents the ECBI while they are in the waiting room 3. Materials needed: ECBI, “Parents are models for their children” handout, Parent CDI Coding Sheet, DPICS Coding Sheet, CDI Homework Sheets, Parent-Child Interaction Summary Sheets (CDI; from CDI Coach 1), Progress Note, Integrity Checklist, ECBI Graph

Goals for this session ♦ Address the importance of homework ♦ Continue to shape parent(s)’ use of CDI skills, with emphasis on avoiding questions ♦ Instill positive expectations for mastery ♦ If indicated, to discuss the issue of modeling. ____________________________________________________________________________________________ Note: In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior

TREATMENT SESSION OUTLINE 1. Give parent Modeling Handout. Review briefly, unless parent seems to be modeling inappropriate behavior that is relevant to the child’s behavior problems. In that case, discuss in more detail the importance of teaching behavior through modeling, and help parent understand anger management techniques, if relevant. 2. Ask for homework sheets. Review homework for about 10-15 minutes Issues might include: ♦ Frequency of parent's practice at home ♦ Comment parent wrote on homework sheet ♦ Follow-up on any homework problems discussed last session ♦ Changes parents have noticed in child's behavior during CDI ♦ How the child responds to the special time ♦ What CDI skill parent finds hardest to remember, and what tricks they have come up with to help 3. Discuss Not Asking Questions (Unless parents have mastered this skill) Being able to not ask questions is usually the hardest skill to master. In coaching today, we will focus most on avoiding questions. Many parents find it helpful if we just say over the bug, “Question,” as soon as we hear a question, so they can turn it into a statement [give example . Do you think this would be helpful for you?” [Almost all parents will agree this would be helpful. Before leaving, give examples and let them try it, until they are able to change questions to statements easily] ©1999 SHEILA M. EYBERG


Coding and Coaching [Therapists may wish to use a stopwatch to time coding and coaching segments] With one parent in treatment [Give parent bug-in-the-ear and go into observation room. Give CDI directions over bug] “Ok, we're going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” 4a. Code parent and child in CDI for 5 minutes (on DPICS Coding Forms) 5a. Coach parent with child for about 30 minutes ♦ Praise reflections, as clinically indicated ♦ Give a lot of feedback regarding questions ♦ See coaching guidelines for this session at end of session outline With two parents in treatment [Give father bug-in-the-ear and go into observation room. CDI directions over bug] “Ok, we're going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” 4b. Code father and child CDI for 5 minutes (on DPICS Coding Forms) while mother observes and codes (on parent coding form) 5b. Coach father with child for about 15 minutes ♦ Praise reflections, as clinically indicated ♦ Give a lot of feedback regarding questions ♦ See coaching guidelines for this session at end of session outline [Give mother bug-in-the-ear and go into observation room. CDI directions over bug] “Ok, we're going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to your rules.” 6b. Code mother for 5 minutes (on DPICS Coding Forms) while father observes and codes (on parent coding form) 7b. Coach mother with child for about 10 minutes (Co-therapist fills in data from this session on summary sheets for each parent during this time) ♦ Praise reflections, as indicated ♦ Give extensive feedback on avoiding questions ♦ See coaching guidelines for this session at end of session outline



____________________________________________________________________________ Note. It is possible that parents could meet mastery criteria for CDI in this session. If parents both meet CDI mastery criteria in this session, go to #9 in CDI Coach Session #3 Outline to continue. _____________________________________________________________________________

CDI Mastery Criteria During the 5-minute coding interval at the beginning of the session, parents must give 10 behavioral descriptions, 10 reflective statements, 10 labeled praises, and no more than 3 questions, commands, or criticisms. Parents must also ignore non-harmful inappropriate behavior. ______________________________________________________________________________ With All Families 8. Review CDI Summary Sheets with parents for about five minutes. 9. During this review, describe the mastery criteria for CDI, noting which skills have been easiest for them to master and which have been most difficult. 10. Give new homework sheets and ask parents what skill they would like to focus on most during their home CDI practice. In addition to the skill they choose, also encourage parents to focus on labeled praises during their home practice (Unless their labeled praise is already at criterion and another skill needs more emphasis). ______________________________________________________________________________ Coaching Guidelines for 2nd CDI Coaching Session Although in all CDI coaching sessions you will praise all skills as they occur, in this second coaching session the major emphasis in coaching is on decreasing questions and increasing reflections. 1. Praise every reflection that parent gives during coaching If parent is still not adequately reflecting when there is opportunity, tell parent, at least once, something like, "He's saying some good things you could reflect. I want you to reflect the next thing he tells you." (If necessary, help parent make a reflection by stating the reflection yourself, and having the parent repeat what you said. Praise parents when they reflect.) 2. After questions Praise parent if they caught a question and changed it to statement on their own Say "Question" after any question the parent doesn't recognize Praise parent for making an appropriate statement after you say "Question," or give them an appropriate statement if they don't (e.g., "Say 'It is an apple'"), then praise parent if they imitate what you said ("Good changing the question"). If parent does not give questions, praise them at least once for not giving questions.



Parents are Models for Their Children Parents are the most important people in their children’s lives. Children want to be like their parents. Parents are also the most important teachers for children; children learn the most from their parents. Children learn things that their parents teach them on purpose, such as how to tie their shoes and make their beds. They also learn by watching their parents. In this way, parents sometimes accidentally teach their children certain problem behaviors. ♦ Children notice every little thing. They watch their parents constantly. They learn good and bad behaviors by observing and imitating. ♦ Sometimes, parents accidentally do things that they don’t want their children to do, such as yelling or hitting. ♦ This especially happens in frustrating situations when you are angry. And children watch their parents to learn how they themselves should deal with frustrating feelings or conflict with others ♦ Parents who argue loudly when in conflict teach their children to argue loudly to deal with conflicts. ♦ Parents who swear when frustrated teach their children to swear when frustrated. ♦ It is very confusing for children to watch their parents behave in a certain way, such as swearing when angry, and then to be punished for swearing when they are frustrated. ♦ You are a role model for your child ♦ You are your child’s example of how to act in different situations ♦ Your child learns to behave like you



WHAT CAN YOU DO WHEN YOU ARE ANGRY? ♦ If you deal with your anger with behaviors that you do not want to see in your child, do not let your child see those behaviors. ♦ Until you find other ways to deal with your feelings, leave the presence of your child when yelling, swearing, or hitting. ♦ If your anger is directed to your child because of his or her misbehaviors, use the following steps: ♦ Recognize when you are becoming angry with your child, and leave the situation for 60 seconds. ♦ During that time, distract yourself with something else (do not think about what your child did to make you angry). ♦ Remind yourself that you do not have to be angry to handle the problem. Your anger will actually make the situation harder to handle. ♦ Decide how to deal with the situation (refer to the “Rewards and Punishments” handout). ♦ Imagine yourself using the technique you chose in a calm manner. ♦ Return to your child and use the technique. ♦ Congratulate yourself for staying calm! ♦ When you are angry with your child’s behavior, these are some helpful things to remember ♦ You do not need to show anger to let your child know that you disapprove of her behavior; showing moderate disappointment is enough ♦ Your child’s misbehavior does not mean that you are an bad parent ♦ Your child’s misbehavior does not mean that he does not love you or respect you ♦ Parents can also use their modeling role to teach their children lots of good behaviors ♦ Every time you use smiles or hugs or praises with your child, you are teaching your child to use smiles, hugs and praises with you and with others When you deal with conflict in a calm and rational manner, you teach your child to talk through conflict calmly and rationally. This helps your child get along with everyone in your family. It also teaches your child how to get along with people outside the home, such as neighborhood children, relatives, and teachers. Copyright 2003 Eyberg, S.M., Calzada, E., Brinkmeyer, M., Querido, J., & Funderburk, B.W.




SKILLS

Your name: _________________

Tally


Reflection

Labeled Praise

Unlabeled Praise*

MISTAKES Question

Command

Criticism




DPICS Coding Sheet for Therapist Date___________ Child’s name _________________________________ Mother

Father

Other ______________





TALLY CODES

TOTAL

TALK (TA) (ID + AK)

MASTERY __


10

REFLECTION (RF)

10

LABELED PRAISE (LP)

10 __

UNLABELED PRAISE (UP) AVOID

TALLY CODES

TOTAL

MASTERY

QUESTION (QU)

0

COMMANDS (DC + IC)

0


0

POSITIVE

CHECK ONE

IMITATE

SATISFACTORY

NEEDS PRACTICE

USE ENTHUSIASM

SATISFACTORY

NEEDS PRACTICE


SATISFACTORY

NEEDS PRACTICE

NOT APPLICABLE

OTHER (SPECIFY)





Father ___


Date




No

Activity
















Days Practiced

HOMEWORK




POSITIVE PROGRESS MADE





ADVICE GIVEN:









NA

X


TOTAL NUMBER OF CHECK MARKS ____ TOTAL NUMBER OF NA's _____ TOTAL NUMBER OF X's _____

Therapist Comments about Session _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________________________________________

Integrity Checker Comments about Session _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________________________________________



THIRD CDI COACHING SESSION Expanded Outline Before the Session 1. Remove all toys from the playroom except for three treatment toys 2. Have parents complete the ECBI while in the waiting room. 3. Materials needed: ECBI, “Getting Support” handout, Parent CDI Coding Sheet, Therapist Coding Sheet, CDI Homework Sheets, Progress Note, Integrity Checklist, Parent-Child Interaction Summary Sheets (CDI; from CDI Coach 1), ECBI Change over Course of Treatment Goals of This Session ♦ Fine-tune the parent(s)’ CDI skills, with an emphasis on labeled praises ♦ Review the parent(s)’ social support network ♦ Help the parent(s) obtain more support if necessary. indicated Note 1 Be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior

Note 2 This may or may not be the final session before the start of PDI. Parents must meet the CDI mastery criteria outlined below before beginning PDI.

TREATMENT SESSION OUTLINE 1. Give parent “Getting Support” Handout. Review briefly, unless this issue is highly relevant to the parent. If highly relevant, spend more time in discussion of this topic, and decrease homework discussion time as needed. Encourage parent to seek support from others in the natural environment. Explore parent’s interest in community support group such as CHADD or Parents without Partners. 2. Ask for homework sheets. Review homework 5 to15 minutes. Three useful questions at this point in treatment: ♦ Do parents find the skills becoming more natural? ♦ Do they find skills generalizing to different times of the day? ♦ Have they noticed any (further) changes in child's behavior? [Note these are framed as leading questions. The intent is to convey these as expectancies]



3.Tell parents that today in coaching we are going to focus on Labeled Praise (unless frequent labeled praise is easy for these parents). •

Point out that any behavioral description can be made into a labeled praise simply by adding a positive descriptor to it.

•

Tell them that during coaching, you will occasionally ask them to change a behavioral description to labeled praise for practice (give examples and practice a “drill” until they understand)

[If parents have no problem with labeled praises, focus this session on their weakest skill] Coding and Coaching [Therapists may wish to use a stopwatch to time coding and coaching segments] With one parent in treatment [Give parent bug-in-the-ear, go into observation room, give CDI directions] “Ok, we're going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” 4a. Code parent and child in CDI for 5 minutes (on DPICS Coding Forms) 5a. Coach parent with child for about 30 minutes • Coach actively • Emphasize parents’ increasing labeled praise • Praise qualities such as timing, genuineness, warmth, teaching, following [See coaching guidelines for this session at end] With two parents in treatment [Give first parent bug-in-the-ear and go into observation room with the other parent] “Ok, we're going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” 4b. Code CDI with first parent and child for 5 minutes (on DPICS Coding Forms) while other parent observes and codes (on parent coding form) 5b. Coach first parent with child for about 15 minutes • Coach actively • Coach labeled praise particularly often • Praise qualities such as timing, genuineness, warmth, teaching, and following [See additional coaching guidelines for this session at end]



Coding second parent. Give bug-in-the-ear to second parent and go into observation room with first parent. Give directions to second parent over the bug: “Ok, we're going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to your rules.” 6b. Code second parent for 5 minutes (on DPICS Coding Forms) while the first parent observes and codes (on parent coding form) 7b. Coach second parent with child for about 10 minutes • Coach frequently • Emphasize increasing parents’ labeled praise • Praise qualities such as timing, genuineness, warmth, teaching, and following With all families [Return to playroom with family. Seat family, and retrieve bug] 8. Review Summary Sheets with parents. Praise all improvements. If parents do not meet criteria to begin PDI 9a. Discuss as appropriate

•

Ask parents what skills they want to focus on in their homework practice this week

•

Ask parents how close they think they are to meeting criteria

•

Encourage them about their progress

If parents do meet criteria to begin PDI 9b. Describe parents’ progress in CDI enthusiastically, and let them know they are ready now to learn (next week) the Parent-Directed Interaction. ♦

Encourage parents to come alone to the PDI Teach session, which will be similar to the earlier CDI Teach session

♦ Let parents know that although today will be the last session that is totally devoted to CDI, the CDI will continue to be practiced in later sessions and in daily homework because it is so important. ♦ Emphasize that discipline is ineffective without the foundation of the CDI relationship – and now that their skills are so good, consistent daily practice before starting the PDI will make it go much more smoothly ♦ Give parents the handout “Kids and Stress,” which would be given in the 4th CDI Coaching Session. This handout can be given at the end of this session for parents moving to PDI, and it can be briefly discussed.



10. Show and discuss with parents the child’s graph of weekly ECBI intensity scores since beginning treatment ♦ If it is declining steadily (typical), things are going as expected, and you want to point out the decline, and link it to the parents efforts ♦ If the graph has a blip or unusual pattern, ask the parent if they know what events contributed to the pattern. If you see a possible connection to events in the family’s life (holiday/stressful event), you may ask them if that seems likely to them. The goal over time is to help parents relate the child’s behavior to what is happening in their interaction with the child. ♦ If the graph is not declining, something is going wrong, and you can express your concern and note that is unusual. Encourage them to talk about what mi)ght be the reason (are they not recognizing real changes, are they not practicing, is something interfering with treatment?) 11. Give new CDI homework sheets.

Coaching Guidelines for the 3rd CDI Coaching Session

1) Coach actively 2) Although in all CDI coaching sessions you will coach all of the PRIDE skills, in this third coaching session the major emphasis in coaching is on increasing parents’ labeled praise. ♦ Try to praise the parent for every labeled praise (“Great labeled praise!) ♦ After unlabeled praises, encourage parents to label it (e.g., "Good praise - label it!") ♦ If the parent’s praises are low, encourage them to change behavioral descriptions into labeled praises (e.g., "Nice description of what she did - turn it into a labeled praise!" (and praise parent when they do, or demonstrate (model) if they have trouble with this skill).

3) Praise the qualitative aspects of the interaction as well as verbalizations in this session. Search for the following behaviors to catch: ♦ Timing that is accurate ♦ Genuineness (tone, gestures) ♦ Warmth in the interaction (gestures of affection) ♦ Imitation (genuine involvement in the child’s game/world) ♦ Changes in the child (e.g., how much calmer s/he is today)



Getting Support Parents of children with behavior problems often experience a great amount of stress. When parents feel stressed, children sometimes respond to this stress with more misbehavior. It is important to deal with the stress you feel as a parent so that you can help yourself and your child have a better relationship with each other and with others. One way to deal with stress is by getting support from other people. Sometimes parents who are dealing with children who misbehave feel alone with their problems. They may think that other parents do not deal with similar problems and do not understand. They may think that others are not interested in such problems. Many times, parents feel too embarrassed to talk about the problems they have with their children because they feel that these problems reflect badly on their parenting abilities. There is no shame in admitting that you are having a hard time managing your child’s behavior, or that you and your child are having problems getting along. Most parents have felt frustrated and unhappy with their children, or unfit as a parent. Chances are, when you share your parenting experiences with someone else, they will understand and want to help. Talking with others about your difficulties helps to relieve stress because it provides you with needed support. How to get support There are several ways to get support from people you know, and sometimes, from other sources. As just mentioned, a good and easy way to get support is by simply talking to your friends and other people you know. Just having someone to confide in will help give you a boost in your parenting efforts. You will also find that other parents experience similar feelings, and that you are not alone. Also, other parents often have good ideas that you may not have considered before about how to deal with certain family situations. If you feel more comfortable keeping the problems you and your child are having within the family, talk with other adults in your family, such as your spouse or your own parent. Or, it may be easier for you to talk with people you do not know. Parent support groups are offered by clinics and organizations. For example, CHADD* provides a support group for parents of children with ADHD that allows parents to learn more about their child’s disorder, and to spend time with other parents who are experiencing similar challenges related to parenting a child with ADHD. *CHADD National Headquarters 499 Northwest 70th Avenue, #109 Plantation, FL 33317 (305) 587-3700, (800) 233-4050 There are some people who may be especially qualified to talk with you about your child’s behavior. Consider talking with your child’s pediatrician or your child’s teacher. Both of these professionals have probably noticed your child’s difficulties, and can offer you a different but important perspective on how your child is doing. Also, pediatricians and teachers probably have experience working through similar issues with numerous other parents. Your PCIT therapist is another good source of support. His or her role is to help you as a family deal with your child’s behavior, and that includes dealing with your feelings, too.



Accepting feedback Getting support from others means that parents have to be open to feedback. People with whom you share your experiences will probably give advice. It may be hard to take advice, especially if you think that the other person cannot truly understand what you are going through. Remember, their advice is meant to help you, and does not suggest blame or criticism of your parenting abilities. This is true even when the advice is about changing something you do as a parent rather than about changing something about your child. Be willing to listen to and consider the advice of others. Asking for help Don’t be afraid to ask for help. Parenting is a challenging job. Many times, you will feel overwhelmed and alone. It is especially at these times that you should ask for help. All parents need help, and asking for help does not mean that you are a bad parent. For example, you may ask your neighbor to watch your kids so you can run errands. You may ask your child’s teacher to help you keep track of your child’s behavior at school by keeping a checklist. Talk with your PCIT therapist about other ways to ask for the kind of help that you need. Taking a Break Now that you know how to ask for help, use this to schedule breaks away from your child. All parents need time away from their child, and taking a break does not suggest that you are an uncaring parent. When parents take breaks from their child, they are likely to have more energy and motivation to deal with family situations, and they are likely to enjoy being with their child more. Taking a break means spending time doing something that you enjoy doing without your child, while a relative, friend, or neighbor cares for your child. Examples include reading a book, watching a movie, exercising, going for a walk, and visiting a friend. Your break can last anywhere from 30 minutes to several hours, or even a weekend away. Try to take a break about once a week, or as regularly as you can manage them. You should especially give yourself a break if you feel yourself becoming overwhelmed with your parenting duties, or if you feel yourself becoming enraged with your child. Remember, you work hard as a parent and you deserve a break! What if that is not enough? Some parents of children with behavior problems have such a great amount of stress that it becomes hard to manage. If you feel that after following the above suggestions, you continue to feel greatly stressed, talk to your PCIT therapist. He or she will be able to talk with you about further treatment options. Your therapist may recommend that you go to therapy by yourself or with your spouse to deal with some of this stress. Your PCIT therapist will be able to help you find a good therapist that will work with you individually or as a couple. Some parents begin individual or couples therapy while still in the PCIT program. In the meantime, continue to follow the above suggestions.

From: Eyberg, S.M., Calzada, E.J., Brinkmeyer, M., Querido, J.G., & Funderburk, B.W. (2002). All parents of preschoolers need support! In L. VandeCreek, S. Knapp, & T.L. Jackson (Eds.). Innovations in Clinical Practice: A Source Book (Vol. 20). Sarasota, FL: Professional Resource Press.




SKILLS

Your name: _________________

Tally


Reflection

Labeled Praise

Unlabeled Praise*

MISTAKES Question

Command

Criticism




Therapist Coding Sheet Date___________ Child’s name _________________________________ Mother

Father

Other ______________





TALLY CODES

TOTAL

TALK (TA) (ID + AK)

MASTERY __


10

REFLECTION (RF)

10

LABELED PRAISE (LP)

10 __


TALLY CODES

TOTAL

MASTERY

QUESTION (QU)

0

COMMANDS (DC + IC)

0


0

POSITIVE

CHECK ONE

IMITATE

SATISFACTORY

NEEDS PRACTICE

USE ENTHUSIASM

SATISFACTORY

NEEDS PRACTICE


SATISFACTORY

NEEDS PRACTICE

NOT APPLICABLE

OTHER (SPECIFY)





Father ___


Date




No

Activity
















Days Practiced

HOMEWORK


Mother Father Other_______________ GOALS FOR THIS SESSION

POSITIVE PROGRESS MADE OVER



PROBLEMS DURING SESSION

PROBLEMS UNRELATED TO CHILD BEHAVIOR DISCUSSED

ADVICE GIVEN

HOMEWORK ASSIGNED (SPECIFY HOUSE RULES IF APPLICABLE)

PLANS FOR NEXT SESSION







NA

X



Therapist Comments about Session _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________________________________________

Integrity Checker Comments about Session _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________________________________________



FOURTH AND BEYOND CDI COACHING SESSION Expanded Outline Before the Session 1. Remove all toys from the playroom except for three treatment toys 2. Have parents complete the ECBI while in the waiting room 3. Materials needed: ECBI, “Kids and Stress” handout, Parent CDI Coding Sheet, DPICS Coding Sheet, CDI Homework Sheets, Progress Note, Integrity Checklist, Parent-Child Interaction Summary Sheets (CDI; from CDI Coach 1), ECBI Change Over Course of Treatment (from CDI Teach Session) _____________________________________________________________________________ Goal of This Session ♦ To get closer to mastery of CDI skills and to motivate parents to focus on mastery _____________________________________________________________________________ Note. This may or may not be the final session before the start of PDI; parents must meet the criteria outlined below before beginning PDI. Continue to use this outline for all subsequent CDI sessions, until parents meet continuation criteria. ___________________________________________________________________________ Note: In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior _____________________________________________________________________________ TREATMENT SESSION OUTLINE 1. Give parents “Kids and Stress” Handouts in 4th CDI coaching session. Review briefly, unless this issue is specifically relevant to the child. 2. Ask for homework sheets. Review homework for about 10-15 minutes. ♦ Potential topics for discussion

•

How do they focus on particular skills at in their home practice?

•

What child behaviors are they trying to increase or decrease during CDI practice?

•

When do they find themselves using CDI skills besides during the play therapy time

3. Tell parents that today in coaching we are going to focus on (whatever skill is still weak). Give parents examples of the skill and engage them in a “drill” for 2 or 3 minutes.



Coding and Coaching With one parent in treatment [Give parent bug-in-the-ear and go into observation room] “Ok, we're going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” 4a. Code parent and child in CDI for 5 minutes 5a. Coach parent with child for about 30 minutes ♦ If there are specific skill problems, create drills during coaching that target theml ♦ Praise qualities such as timing, genuineness, warmth, and following, effect on child With two parents in treatment [Give first parent bug-in-the-ear, go into observation room, and give directions for CDI] “Ok, we're going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with child's name in his/her game according to his/her rules.” 4b. Code first parent and child CDI for 5 minutes (on DPICS Coding Forms) while other parent observes and codes (on parent coding forms) 5b. Coach first parent with child for about 15* minutes ♦ If one parent closer to mastery than the other, consider changing balance of coaching time between parents ♦ If there are specific skill problems, create drills during coaching that target theml ♦ Praise qualities such as timing, genuineness, warmth, teaching, and following, effect on child [Give second parent bug-in-the-ear, go into observation room, and give directions] “Ok, we're going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to your rules.” 6b. Code second parent for 5 minutes (on DPICS Coding Forms) while first parent observes and codes (on parent coding form). 7b. Coach second parent with child for about 10 minutes ♦ If there are specific skill problems, create drills during coaching that target theml ♦ Praise qualities such as timing, genuineness, warmth, teaching, and following, effect on child



With all families [Return to playroom with family, seat family, retrieve bug] 8. Review Summary Sheets with parents. If parents do not meet criteria to begin PDI ♦ . Ask parents which skills seem easiest and hardest, and problem-solve hardest skills. If parents do meet criteria to begin PDI ♦ Tell parents their progress in CDI has been excellent, and they are ready now to learn (next week) the Parent-Directed Interaction – which focuses on teaching children how to obey and includes a discipline component. ♦ Let parents know that their child does not have to come to the next session, which will be similar to the earlier CDI Teach session ♦ Let parents know that although today will be the last session that is totally devoted to CDI, it will continue to be practiced in later sessions and in daily homework because it is so important. Emphasize that discipline is not effective without the foundation of the CDI relationship skills. 9. Review graph of weekly ECBI intensity scores 10. Give new CDI homework sheets

CDI MASTERY CRITERIA Criteria For Beginning PDI Phase of Treatment In a 5-minute observation of CDI, at least: _____ 10 Behavioral Descriptions _____ 10 Reflections _____ 10 Labeled Praises And no more than a total of 3 of the following: _____ Questions _____ Commands _____ Criticisms _____________________________________________________________________________



Kids and Stress Understanding Your Child’s Emotions Upsetting things happen in every family’s life. Sometimes these upsetting things can be big, like when someone close to the family becomes ill or dies, when parents separate, or when a teenage child gets into trouble. Other times these things can seem bigger to the child than to the adult, like when a pet dies or the child starts a new school. Kids and their parents don’t show their feelings in the same ways when something stressful happens. When adults are sad or stressed, they usually are able to know what they Kids and their parents don’t show their feelings in the same ways when something stressful happens. When adults are sad or stressed, they usually are able to know what they are feeling and why they are upset. They may explain to people around them, “I’m really down because my dad is in the hospital,” or “Sorry if I sounded mean—I’m having a hard time because I’m worried that I’ll to lose my job.” Since they can recognize and name their feelings, adults can also do things to help themselves. This can mean getting support from people around them or doing little things for themselves like taking a walk or asking a neighbor to watch the kids for a couple of hours. It is usually pretty easy to tell when a child is happy or excited about something. But kids have different ways of showing that they are stressed. Young children usually don’t It is It is usually pretty easy to tell when a child is happy or excited about something. But kids have different ways of showing that they are stressed. Young children usually don’t have the experience or the words to say things like, “I’m worried because my mom is sad that my grandma is sick, and I’m also kind of mad at my mom for being at the hospital with my grandma.” Kids may not even realize that they are having all of these mixed-up feelings! When young children are stressed, they often show their feelings by changing their behavior. Sometimes little things like not getting to watch their favorite TV show will make When young children are stressed, they often show their feelings by changing their behavior. Sometimes little things like not getting to watch their favorite TV show will make them cry hard or become very angry. Other times, they may start clinging to their parents and refusing to leave them or to go to school. They may fight with their friends or say that nobody likes them. Other kids may start having trouble with things that they used to be able to do. For example, a child who was potty trained may start wetting his pants again, or a child may begin sucking her thumb after having stopped. These behavior changes are kids’ ways of saying, “Hey, Mom and Dad, something is bothering me!” How Parents Can Help There are several ways for parents to help their children to get through hard times. Here are some things you can do: NOTICE changes in your child’s behavior. These changes can show that your child is upset and needs your support. Spend SPECIAL TIME with your child – even just 5 minutes of one-on-one playtime with toys, playing along with your child’s game, talking about whatever he wants. This special time is a wonderful way to calm kids down when they are upset. It helps them feel safe and loved no matter what. Sometimes this special time helps calm parents down, too.



TALK to children about feelings. Teach them the names for feelings and talk to them about how you are feeling. For example: “It makes me feel happy when you are nice to your brother.” “I’m feeling sad right now because Grandpa is sick. “ “It made me angry when that man hit my car.” “I’m feeling nervous because I really want to get this job.” When you tell kids how you are feeling, it lets them know that it is okay to talk about their feelings. Of course, there are some things that kids don’t need to know about. If you are clearly upset about something you don’t think the kids should know about, it is better just to say, “I’m just a little sad (or angry) about something,” than to tell them to leave you alone or try to make them think that you aren’t upset. TELL other people who care for your child what is happening in your child’s life. It can help teachers and babysitters deal with your child better if they know if he or she is upset about something. Here is an example of how a mom helped her son with his feelings Leslie was a single mom. Her 4-year-old son Anthony had an older cousin, Ben, who he was really close to. Ben would take Anthony to the park and play with him at least once a week. Sometimes Anthony even told people that Ben was his dad. One day Ben was in a car accident. He was very badly hurt and was in the hospital in a coma. When Leslie told Anthony that Ben was hurt, he didn’t seem sad right away. He just kept playing with his toy cars. But that night, Anthony got very mad when his little sister bumped into him by accident. He started screaming at her, and punched her in the stomach. Leslie was already upset about Ben herself. She felt very angry that Anthony would make things worse by hurting his sister. It seemed for a minute that he just didn’t care about Ben or about how she was feeling. Leslie told Anthony to sit by himself in the corner for three minutes for hitting. While he was in the corner, he started crying very hard. He didn’t usually cry like that when sent to the corner for misbehavior. Leslie started thinking that maybe Anthony was upset about Ben but didn’t know how to talk about it. After Anthony’s time in the corner was over, Leslie decided it was a good time to have their special time. She thought it would be best to do something quiet. She got out crayons and paper and colored with Anthony. Anthony asked his mom if she would draw a picture of him and Ben. While she was drawing, Leslie said, “I am sad about Ben getting hurt. You must feel sad, too.” Anthony just looked down, but Leslie could see that his face was very sad. She put him on her lap and held him. They finished coloring the picture together, and Leslie told Anthony that she would take it to Ben the next day when she went to see him in the hospital. Eyberg, S.M., Calzada, E., Brinkmeyer, M., Querido, J., & Funderburk, B.W. (2003). Kids and stress: Understanding your child’s emotions. In L. VandeCreek & T.L. Jackson (Eds.). Innovations in clinical practice: Focus on children and adolescents (pp. 171-172). Sarasota, FL: Professional Resource Press.




SKILLS

Your name: _________________

Tally


Reflection

Labeled Praise

Unlabeled Praise*

MISTAKES Question

Command

Criticism




DPICS Coding Sheet for Therapist Date___________ Child’s name __________________

Mother


Father

Other ______________




TALLY CODES

TOTAL

MASTERY __

TALK (TA) (ID + AK) BEHAVIOR DESCRIPTION (BD)

10

REFLECTION (RF)

10

LABELED PRAISE (LP)

10 __


TALLY CODES

TOTAL

MASTERY

QUESTION (QU)

0

COMMANDS (DC + IC)

0


0

POSITIVE

CHECK ONE

IMITATE

SATISFACTORY

NEEDS PRACTICE

USE ENTHUSIASM

SATISFACTORY

NEEDS PRACTICE


SATISFACTORY

NEEDS PRACTICE

NOT APPLICABLE

OTHER (SPECIFY)





Father ___


Date




No

Activity
















Days Practiced

HOMEWORK




POSITIVE PROGRESS MADE





ADVICE GIVEN:









NA

X



Therapist Comments About Session: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________________________________________

Integrity Checker Comments About Session: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _______________________________________________________________



PARENT-DIRECTED INTERACTION PDI TEACHING SESSION Expanded Outline Before Session 1. When scheduling, tell parent that the child does not need to attend this session. 2. Carefully review again all data from the original assessment session, especially the interview, so that you recall the original presenting problems and the parents’ DPICS skills and discipline methods for use in tailoring training examples to the family. 3. Have parents complete the ECBI in the waiting room. 4. Materials needed: ECBI, Time Out Diagram, “Eight Rules of Effective Commands in PDI” handout, “Using a Time-Out Room in your Home” Handout, CDI Homework Sheets, Progress Note, Integrity Checklist, ECBI Change Over Course of Treatment Goals of this Session ♦ Teach the parent(s) all of the steps of the PDI and the rationale for each step ♦ Provide them with a clear understanding of differences in the initial PDI practice sessions and its application after the parents and child have learned it. _____________________________________________________________________________ Note. In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior _____________________________________________________________________________ TREATMENT SESSION OUTLINE 1. Review homework from previous week briefly. 2. Explain how PDI will be taught Today the important steps of the PDI will be explained and demonstrated, and we will role-play the steps. At the end of the session we will give you a handout that outlines all of the steps, so you can read them over throughout the week. You will not actually use the PDI procedure with your child until next week in session when we can coach you through it so it will go exactly right the first time you use it with [child’s name] 3. Present overview of Parent Directed Interaction (PDI) ♦ Unlike CDI, which is 5 minutes a day, you will eventually use PDI only when you need to have your child to do what you say. The PDI will begin with a command and will end when you praise your child for minding. ♦ PDI includes a step-by-step discipline method that emphasizes consistency, predictability, and following through.



GIVING A COMMAND 4. PDI starts with a command, so we are going to talk first about the kinds of commands that are most effective with children. 5. Commands should be direct rather than indirect ♦ A direct command should make it absolutely clear to the child that s/he is being told to do something ♦ It should not be stated as a question, which could suggest that the child has a choice about obeying it ⇒

Example: “Please sit down,” instead of “Would you like to sit down?”

♦ A direct command should make it clear that the child is the one expected to do the task, not the parent or both parent and child. ⇒

Example: “Put the puzzle away” instead of “Let’s put the puzzle away.”

6. Commands should be stated positively ♦ The command should tell the child what to do instead of what not to do ♦ It is often possible to stop a negative behavior by telling a child to do a positive opposite ⇒

Example: Instead of "Stop running around," say, “Please sit beside me.”

♦ Telling a child not to do something is a criticism of his or her behavior 7. Commands should be given one at a time ♦ Break tasks down into one thing at a time ⇒

Example: Instead of “Put the cars in the box and close it and put the box on the shelf,” say “Put the red car in the box.”

♦ It is hard for young children to remember more than one command at a time ♦ Big commands like “Clean up the playroom”; also contain a string of commands that are hidden – it could mean, “Pick up the crayons from the floor, put the crayons in their box, and put the box on the shelf. ♦ Children must be praised after every command they obey. If commands are strung together, especially if they are hidden, it is hard to know when a command has been obeyed and when to praise. ♦ Avoid using the child’s name before a command (e.g., “Sam, put this here.”). That is really adding an extra, indirect command at the beginning of the direct command that means “Look at me” or “Pay attention and listen to what I am going to say.” If the child doesn’t obey this extra command, parents find themselves getting tense.



8. Commands should be specific ♦ Commands should tell the child exactly what you want him or her to do. ⇒ Examples: "Get down off the table. Please hand me the gum. Use your quiet voice.” ♦ Vague commands, like "Be careful," "Settle down," or "Watch out," are so nonspecific that a child does not know exactly what you want him or her to do. ♦ It isn’t fair to tell a child to do something he or she may not understand. 9. Commands should be age-appropriate ♦ A child must be able to understand the command and be able to do it. ♦ Commands should use simple words ♦ Commands should require behavior the child is physically able to do ⇒

Example: Instead of “Put the azure BMW in the container, say “Put the blue car in this box.”

⇒

Example: (with a 2-year-old) Stay inside the lines when you color that house.

♦ If children are unable to do a task, they sometimes pretend they don’t want to obey. ♦ If children are unable to obey, they may be unfairly punished for disobeying. ♦ To be fair in disciplining, you must be sure your child can understand what you tell him or her to do. 10. Commands should be given politely and respectfully. ♦ Commands should be given in a normal tone of voice ♦ A friendly but matter-of-fact tone increases the chance that your child will listen. ♦ One good way to start a command is with the word, “Please.” ♦ Commands should not be yelled or harsh or sarcastic ♦ Respectful commands prevent your child learning to obey only if yelled at. ♦ Teaching children to obey polite commands prepares them for obeying the teachers’ directions at school 11. Commands should be explained before they are stated, or after they are obeyed ♦ It is important to give children the reason they need to do what you have told them to do – children learn social behavior by being told why they should do certain things. ♦ The timing of reason is critical ♦ The reason should not be given between the command and the obey ♦ Children are usually not paying attention to reasons at this time, especially if they do not want to obey ♦ A reason at this time also interferes with compliance because the child may be distracted and forget what the command was ♦ If children show negative behavior (e.g., whining, “why”) to avoid obeying a command, a reason right then will give attention to the problem behavior (disobeying) rather than obeying ©1999 SHEILA M. EYBERG


♦ Setting up a command with a reason increases the chance it will be obeyed ♦ Example: If you are playing cars with your child and suddenly say, Please put the cars away,“ that command may be less effective than saying while playing, “I just realized that we have to meet Dad for dinner now. Please put the cars away.” ♦ Children listen to reasons given with praise for obeying ♦ Children like to hear reasons for why their behavior is good ♦ Children believe reasons for why their behavior is good ♦ Reasons give children extra attention for obeying ♦ Reasons combine easily with praise and add genuineness to praise ♦ Example: (child obeys command to pick up crayon from floor). “Thank you for picking up the crayon. Now we won’t accidentally step on it and break it. 12. Commands should be used only when necessary ♦ At first, when you are teaching your child to listen and mind you, the commands in the practice session are necessary so that you both can practice with easy commands ♦ What is important now is not that he put the fireman in the truck, but that he listens and obeys you when you tell him to do something. ♦ Too many commands will frustrate a child and create negative feelings. ♦ When you give a direct command, you MUST follow through in order to teach your child to obey you. ♦ Many things we ask children to do may not be too important – and we can let them have choices. (Do you want to come here and listen to a story?) ♦ If a command is not important enough to follow through, it should not be given as a command. ♦ If a command is important, stating it as a direct command will help the child to know that it is important.



AFTER A COMMAND 13. Ask the parents to think of all the possible ways their child could respond to a command, and reinterpret these to the parent in terms of either compliance or noncompliance. 14. Give an example of dawdling and ask the parent how they could decide whether the child is obeying or not. ♦ Explain the five-second rule for dawdling “When your child is dawdling, you must decide if s/he is making a move toward obeying (If the child immediately obeys or disobeys, this rule doesn’t apply – the consequence is clear). While you are trying to decide, say nothing to the child, and silently count to 5 in your head – if the child still hasn’t obviously started obeying by the end of the 5 seconds, that is a disobey.” ♦ Explain that the parent must not repeat the command and must not say anything until the child either obeys or disobeys PRAISE 15. Ask the parents what they would do if their child obeyed right away. As soon as the parents say they would give a labeled praise (if they need help coming to that solution, guide them to it), enthusiastically agree! Give examples that emphasize praise for compliance, such as, "Great job of minding so quickly" and "I like it when you do what I tell you” and “Good listening!” WARNING 16. Instruct the parent to give the chair warning if the child disobeys "If you don't (INSERT COMMAND) you're going to have to sit on the chair." ♦ Explain why parents need to use these exact words every time. ♦ Use the 5-second dawdling rule again after the warning, as needed. ♦ Explain that the parent must not repeat the warning and must not say anything until the child either obeys or disobeys the warning PRAISE 17. Ask parents what they would do if the child obeyed the warning ♦ If parents do not say to give labeled praise, spend some time talking about why labeled praise is important after the child obeys, even if the warning-reminder was needed.



THE TIME-OUT CHAIR 18. Model the chair procedure with an imaginary child while explaining the following procedure for disobedience to a chair warning: ♦ Instruct parent to get up from their chair and guide the child to the chair while calmly saying only: "You didn't do what I told you to do so you have to sit on the chair." ♦ Ask parents what they think the child will do when each parent is taking the child to the chair. Trouble shoot with parents about the concerns they mention. ♦ Model how parents need to get the child to the chair quickly. ♦ Tell them that if the child is resisting, the safest way to get the child there is to place their arms around the child’s chest from behind, and carry the child to the chair – tell them not to pull the child by the arm. ♦ Tell parents that it is important to remain calm at this point – if parents get angry and raise their voice, this will give attention to the child for negative behavior and cause the child to resist more. ♦ [Parents who have anger control problems will need a more extensive discussion of this issue; refer to the modeling handout] 20. After the child is placed on the time-out chair the parent is to say, "Stay on the chair until I tell you that you can get off." 21. Explain the steps of the chair time out procedure ♦ The words were chosen to be the shortest, simplest way to explain the reason the child is going to the chair and what the child must do now ♦ The child has to stay on the chair for exactly three minutes plus 5 seconds of quiet, so the parent must look at the clock immediately ♦ The chair is an effective punishment only if the parent (rather than the child) is the one in control of when the child can get off of it 22. When your child is on the chair, what might s/he do? ♦ If the parents says he'll get off, tell them you'll talk about that in a minute) ♦ The child will probably do everything he can think of to get your attention. Some of these things may be emotionally hard to handle. (He may tell you that he hates you or loves you; he may cry; he may say that he has to go to the bathroom, etc.) ♦ Anything he does on the chair must be ignored [Note. There are some exceptions]



23. When you ignore his negative behavior on the chair: ♦ You must ignore completely; don't look at the child, don’t frown, don’t smile, etc. ♦ At first, when you ignore negative behavior on the chair, it will get worse ♦ If you consistently ignore it, it will stop. ♦ If you don’t consistently ignore it, the chair procedure will not work 24. The child must stay on the chair for 3 minutes, plus 5 seconds of quiet ♦ Three minutes is long enough to be effective ♦ As soon as 3 minutes is up, you should listen for 5 seconds of silence ♦ The 5 seconds of silence is important because a child will think that whatever s/he did just before s/he was allowed off “worked.” This is superstitious learning. It would take a long time for the chilld to un-learn it because it worked once. 25. After the silence, approach the chair and say to the child (therapist continues to "model" while talking): “You are sitting quietly in the chair. Are you ready to come back and [original command]?” ♦ Say this in a neutral tone of voice to emphasize it is really the child’s decision ♦ You must then judge whether the child is saying yes or no -- children usually answer this question with actions instead of words ♦ If child hops right off the chair and goes toward the talk, that probably means "yes" ♦ If child whines and argues, without starting toward the task, that probably means "no" ♦ If child continues to sit silently, after three seconds you can interpret that as "no" ♦ 26. If the child’s answer is "No," tell the child, "Okay, stay here until I say you can get off."(and start the timing over again) 27. If the answer is "yes," lead the child back to the table, point to the task, and say nothing until the child has obeyed or disobeyed. ¡ The child will very likely obey at this point ¡ If the child doesn't obey, take the child back to the chair and matter-of-factly begin the chair

procedure again, “You didn’t do what I told you to do, so you have to sit in the chair.” 28.When the child obeys after being on the chair, simply acknowledge (e.g., “Fine,” and give another, simple command (e.g., “Thank you, now hand me the red one.”) 29. When the child obeys the new command (which most children do), give enthusiastic labeled praise, and tell the child why it pleases you so much when he or she minds you right away.



TIME-OUT ROOM 30. If the child gets off the chair before you have given permission, you will take the child to the time-out room, which is the back-up punishment. ♦ This is a temporary procedure that will teach the child to stay on the chair. ♦ Children quickly learn to stay on the chair if they know that you will (every time) followthrough with the time-out room if they get off the chair. ♦ Once children learn that they cannot get off the chair whenever they want, they will not like to go to the chair. ♦ The chair will then be an effective punishment, alone, and you will rarely need to use the time-out room. 31. Discuss with parent how to determine if the child is on or off the chair ¡

The preferred rule to use is that a child is off the chair if more than 50% of the child’s body weight is supported by the floor

¡

If the time-out chair is not sturdy enough for child movement (e.g., standing) on the chair to be safe, it is acceptable to define “on the chair” as having the child’s bottom on the chair. This definition is more difficult for parents and gives more attention to the child in time-out than ideal.

32. The first time the child gets off the chair, place the child back on the chair while giving the timeout room warning: “You got off the chair before I said you could. If you get off the chair again, you will have to go to the time-out room. Stay here until I say you can get off." ♦ This time-out room warning is given only once (ever). Any time later, if the child gets off the chair, s/he will go to the time-out room immediately, without a warning. 33. After this one warning, if the child gets off the chair again, you will go to the child and take him/her to the time-out room quickly while calmly saying, "You got off the chair before I said you could, so you have to go to the time-out room.” 34. Place the child in the time-out room, close the door, and start the timing. The child stays in the time-out room for one minute plus 5 seconds of quiet. 35. When the time is up, take the child back to the time-out chair, step back out of reach, and say, “Stay here until I say you can get off.” [The procedure continues as described above for the chair time out]



36. Role-play with each parent (lead therapist coaches parent, parent goes through procedure with co-therapist playing the child role: If only one therapist, the therapist both coaches and plays the child role at the same time} ♦ Child obeys right away ♦ Child requires a warning ♦ Child disobeys the warning ♦ Child agrees after three minutes ♦ Child on chair refuses to comply after 3 minutes is up ♦ Child gets off chair before parent gives permission 37. Tell parent that when practicing PDI, the parent must always switch back to CDI for at least 20 seconds after the child obeys a command before starting a new command. 39. Remind parents NOT to begin using PDI at home during the next week ♦ It is important that it go perfectly the first time ♦ We will coach you through it the first time in the lab here next week 38. Give parents PDI Diagram, Effective Command Rules, and Using a Time-out Room in your Home handouts for review only ♦ Briefly describe handouts to parents ♦ Encourage parents to read over the handouts during the week in preparation for the first PDI coach session ♦ Suggest that parents think about where in their house they will place their time-out chair and what room they will use for the time-out room 40. Ask parents to try to learn PDI Diagram by heart to help them feel more confident, but assure them that we will coach them before every step, so they won’t even have a chance to show us how well they know it 41. Prepare parents to schedule extra time for the next session ♦ The session will probably end on time, but it will not end until the child has obeyed the last command given ♦ Occasionally it has taken as long as two hours for a child to decide to obey ♦ Consistency is not convenient at first, but that is when it is most critical 42. Let parents know that you will explain the PDI procedure to their child at the beginning of the next session -- or that they can explain it if they’d prefer. 43. Give CDI homework sheet to each parent ♦ Emphasize the importance of daily CDI, especially this week just before starting PDI ♦ With sophisticated parents, you can explain that “Time out from positive reinforcement” is only effective if the interaction IS positive reinforcement for the child.



Time Out Diagram Example: “Please put the red block in the box.”

COMMAND

Disobey Obey Disobey

“If you don’t [put the red block in the box] you will have to go to the time-out chair.”

Take child to the chair while saying: “You didn’t do what I told you to do, so you have to go to the chair.” Back away from chair and say: Stay here until I say you can get off.” (3 min + 5 sec quiet) Take child back to chair while saying: “You got off the chair before I said you could. If you get off the chair again, you will have to go to the time-out room.” Back away from chair and say: Stay on the chair until I say you can get off.” (this room warning occurs only once) Take child to the time-out room while saying: ”You got off the chair before I said you could, so you have to go to the time-out room.” (1 min + 5 sec quiet) Return child to chair and say: “Stay here until I say you can get off.” (re-start timing 3 min + 5 sec quiet)

LABELED PRAISE

Obey Disobey

LABELED PRAISE

CHAIR

Return child to chair and say: “Stay on the chair until I say you can get off.” (re-start timing 3 min + 5 sec quiet)

Example: “I like it when you do what I tell you to.”

Gets off RETURN TO CHAIR ROOM WARNING

Gets off TIME-OUT ROOM

TIME-OUT CHAIR

Stays On MAY RETURN TO TASK

Take child directly to time-out room while saying: ”You got off the chair before I said you could, so you have to go to the time-out room.” (1 min + 5 sec quiet)

Example: “Good minding.”

CHAIR WARNING

Gets off

Go to chair and say: “You are sitting quietly in the chair. Are you ready to come back and put the red block in the box?” If no, “All right, then stay on the chair until I say you can get off.”

TIME-OUT ROOM

If yes, “All right (Back to table; point; repeat command if necessary) …..

Obey

TIME-OUT CHAIR

ACKNOWLEDGE

Example: “Thank you.”

Etc. SECOND COMMAND

Obey LABELED PRAISE

END PDI

.


Example: Now give me a blue block. Example: Thank you so much for listening right away and giving me the blue block!” Note: If your child does not obey second command, give a warning and continue PDI procedure.


Eight Rules of Effective Commands in PDI

RULE

1. Commands should be direct rather than indirect.

REASON • • •

2. Commands should be positively stated.

• • •

EXAMPLES

Leaves no question that the child is being told to do something. Does not imply a choice, nor suggest that the parent might do the task for the child. Reduces confusion for the young children.

• • •

Tells child what to do rather than what not to do. Avoids criticism of the child’s behavior Provides a clear statement of what the child can or should do.

• Come sit beside me. Instead of o Don't run around the room!

Please hand me the block. Put the train in the box. Draw a circle. Instead of o Will you hand me the block? o Let’s put the train in the box. o Would you like to draw a circle?

• o

3. 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 hands in your pocket. Instead of Stop touching the crystal.

• Put your shoes in the closet. Instead of o Put your shoes in the closet, take a bath, and brush your teeth. • Put your shirt in the hamper. Instead of o Clean your room.

4. Commands should be specific rather than vague.

•

Permits children to know exactly what they’re supposed to do.

• Get down off the chair Instead of o Be careful. • o


Talk in a quiet voice. Instead of Behave!


EFFECTIVE COMMANDS (continued)

RULE

5. Commands should be ageappropriate.

REASON •

Makes it possible for children to understand the command and be able to do what they are told to do.

EXAMPLES • Put the blue Lego in the box. Instead of o Change the location of the azure plastic block from the floor to its container. • o

6. Commands should be given politely and respectfully

• • • •

7. Commands should be explained before they are given or after they are obeyed.

8. Commands should be used only when necessary.


• •

•

Draw a square. Instead of Draw a hexagon.

Increases the likelihood that the child will listen better. Teaches children 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 o Parent: (said loudly) Hand me that block this instant!

Avoids encouraging child to ask “why” after a command as a delay tactic. Avoids giving child attention for not obeying.

o

Decreases the child’s frustration (and the amount of time spent in the timeout chair).

(Child is running around) • Please sit in this chair. (Good time to use command) Instead of o Please hand me my glass from the counter. (Not a good time to use a direct command)

Parent: Go wash your hands. Child: Why? Parent: (ignores, or uses time-out warning if child disobeys). Instead of Child: (obeys). Parent: Now your hands look so clean! It is good to be clean when you go to school.


Using a Time-Out Room in Your Home During the PDI discipline phase of Parent-Child Interaction Therapy (PCIT), a time-out room is used as a back-up whenever your child is unable to stay on the time-out chair. The time-out room is a temporary procedure that teaches your child to stay on the time-out chair. Children quickly learn to stay on the time-out chair once they learn that their parent will consistently follow-through with the time-out whenever they off the chair. Once your child learns that getting off the chair always results in going to the time-out room, your child will rarely get off the chair and the time-out room will rarely have to be used.

How Does It Work? When your child gets off the time-out chair, you should gently but firmly lead your child to the time-out room. While leading your child to the time-out room, you should say, “You got off the chair before I said you could, so you have to go to the time-out room.” Once the child is in the time-out room, the parent should close the door and keep close track of time so that the child stays in the time-out room for 1 minute plus 5 seconds of quiet before the door is opened. The parent should then lead the child back to the time-out chair and say“ “Stay on the chair until I tell say you can get off.” Choosing Your Time-Out Room Your PCIT therapists will carefully discuss with you the possible places that you can safely and effectively used as a time-out room in your home. The time-out room needs to be well lit and have a minimal square footage of 4 feet by 4 feet of clear space. Child-Proofing Your Time-Out Room You also need to child-proof your time-out room so that breakable items or other objects that could harm your child (such as heavy books in a closet) are removed or are out of your child’s reach. Medicines or other poisons should also be removed from the time-out room. If you use a bathroom or utility room, hot water should be turned down to warm so your child cannot get burned by accident. Rooms with breakable glass windows or doors must also be avoided. ©1999 SHEILA M. EYBERG



Father ___


Date




No

Activity
















Days Practiced

HOMEWORK





OVER





ADVICE GIVEN:








NA

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 OVER


X



Therapist Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _______________________________________

Integrity Checker Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ________________________________________



FIRST PDI COACHING SESSION Expanded Outline Before Session 1. Review sample script (see end of this outline) for explaining PDI to the child. 2. While family is in waiting room, give the parents the ECBI to complete. 3. Materials needed: ECBI, stopwatch, “Explaining PDI to your Child” handout, “First Homework Assignment” handout, CDI Homework Sheets, PDI Homework Sheets, Progress Note, Integrity Checklist, ECBI Graph (Change Over Course of Treatment) Goals of This Session ♦ Provide parent(s) with the opportunity to practice the PDI procedure with intensive coaching so that it is implemented correctly the first time the child experiences it ♦ Parents should leave the session with the ability and confidence to implement the procedure exactly as written at home. ♦ Note. In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior

TREATMENT SESSION OUTLINE 1. Collect CDI homework sheets and discuss briefly. 2. Spend about 10 minutes reviewing the time-out procedure, and give parent(s) reassurance/encouragement. 3. Tell parents that even if they have memorized the procedure completely, you will still be coaching them on every step. 4. Explain the time-out procedure to the child (adapt the sample script at the end of this session to the specific child), emphasizing the expectation that he or she must be very quiet while on the chair and must not get off the chair (can demonstrate procedure with Mr. Bear if it seems it would be helpful) [If two parents in treatment, decide with them which parent will start first] 5. Explain briefly the sequence of events for the session (e.g., with each parent, start with brief coaching of CDI, then have parent tell child it's the parent’s turn to choose the game, then give the parent a very simple command to start with, coach them to praise after the child obeys, and then return to CDI briefly. Then have the parent generate a simple command of her/his own, etc.).



______________________________________________________________________________ Note 1 Unless parents volunteer an objection, this PDI situation is a play situation (rather than a clean up situation). The task is important because it is teaching the child to mind. When coaching, follow coaching guidelines at the end of this checklist. Note 2 Coding does not occur in the first PDI session, so that the PDI procedure can be coached right from the beginning. ______________________________________________________________________________________________

Coaching (with ONE parent in treatment) [Give parent bug-in-the-ear and go into observation room. Over the bug, explain the PDI directions] “Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.” 6a. Coach parent for about 40 minutes (or until child has obeyed last command given, if longer). Coaching (with TWO parents in treatment) [Give first parent bug-in-the-ear and go into observation room. Over the bug, explain the PDI directions] “Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.” 6b. Coach first parent for about 20 minutes (or until child has obeyed last command given, if longer). [Give first parent bug-in-the-ear and go into observation room. Over the bug, explain the PDI directions] “Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.” 7b. Coach second parent for at least 10 minutes (and until child has obeyed last command given, if longer).

With all families 8. Following the coaching, review the session with the parents, noting what they did well, what seemed hard to remember, how the child responded, how they felt about the time-out procedure, if it occurred in the session. 9. Discuss homework for the next week ♦ Parents are to continue practicing CDI 5 minutes each day. Give each parent a CDI Homework Sheet to complete and return next week. Remind parents that we will continue to focus on CDI in future sessions along with PDI.



♦ Parents are usually assigned to practice PDI in a daily 5 to 10-minute “play” situation at home following the CDI session. However, if parents need (or wish) additional coaching before they are ready to practicing PDI at home, ask them to wait another week before trying PDI on their own. Will need to explain the reason clearly so they understand the importance of conducting the time out procedure correctly when they start using it at home. •

For parents who are beginning PDI home practice sessions this week •

Remind them to use their CDI skills in between the command-obey-praise sequences

•

Give them the “PDI First Homework Assignment” handout

•

Give them the PDI Homework Sheet, show them how to fill it out, and ask them to complete and return next week.

10. Instruct parents to call you immediately if they have any problem with PDI at home. Parents should NOT wait until next week to tell us if there is a problem.



Directions for Coaching the First PDI Session With each parent 1. Coach CDI about 3 minutes or until parent seems relaxed (no coding this session). 2. Then tell parent to tell child, "Now I'm going to switch to my game." 3. Coach parent to ignore totally any child fussing in response to this statement and to give a simple direct command. 4. Continue coaching PDI. 5. Try to have parent give at least 5 commands in this session. 6. Encourage parent to relax and use CDI skills (Behavioral Descriptions, Reflections, and Praise) in between each command-obey-praise sequence. 7. Coach parent to ignore all chair behavior and any ignorable irritating behaviors that occur during the coaching period. Coaching Guidelines 1. In this first PDI session, coach actively and continuously – give each PDI statement to the parent before they say it on their own the first time they through each step, to assure that they use the procedure correctly this first time the child experiences it. 2. If the parent needs to ignore a child behavior, attempt to say, "Good ignoring" before the parent has a chance to attend to the behavior. 3. Be directive (nicely) – use brief, direct commands to guide parents in the early use of the PDI procedure. Example "Give another direct command - Good command, say nothing else yet - he did it, praise him for minding - nice labeled praise, now tell him why you like it when he listens – excellent reason, now just go back to CDI for a minute and relax.” 4. Praise all of the parents’ correct commands and follow-through statements. Examples "Great direct command." “Good remembering the labeled praise!” “Nice calm warning.” 5. Be sensitive to parent's feelings -- reflect them, then deal with them, if necessary. Examples "You seemed a little angry with him at the chair. It's hard not to feel angry, but it will get easier as he learns his sassing doesn't work." "You seem kind of upset because she’s crying on the chair. Are you okay? That was hard to do. You did it well. Now just relax and take a few deep breaths."



Explaining PDI to the Child The script below is a sample that presents the ideas that you will convey to the child in the first PDI Coaching Session. Young children typically act as if they are not listening when you explain PDI: they may not look at you when you talk, and that’s okay. They may say something to you that is totally unrelated to what you are explaining. That is okay too. You can ask the child questions about what you are telling him or her (e.g., Do you remember what happens if you don’t mind your mom or dad?), but they may not answer your question. You should not insist that the child “pay attention,” or answer you. Typically children do hear what you are saying, but do not know how to respond. You want to explain the procedure to them so that the parents will feel more comfortable following through with PDI and so that the child has the opportunity to know that their parents will follow through. However, most children need to test this new consistency for themselves. They will learn that their parents mean what they say through experience. Some therapists like to give the child a clear cognitive understanding of the step-by-step PDI procedure before the child experiences it. Using role-play, therapists go through the PDI procedure several times with Mr. Bear, (a child-sized teddy bear who plays the child’s role. Mr. Bear obeys and does not obey a series of commands to provide a demonstration of the consequences to Mr. Bear of obeying and not obeying. An outline of the procedure with Mr. Bear is included in the Appendix. This procedure is interesting to the child, and the child’s reactions to what happens to Mr. Bear will usually allow you know when the child understands the consequences for Mr. Bear. For parents who may have some difficulty remembering the steps of PDI themselves, another advantage of using Mr. Bear is that it help to teach the PDI procedure to the parents in a situation that may be less stressful for them. Some therapists have used Mr. Bear with the parents alone for this purpose, either initially in the PDI teach session or later in PDI if it becomes evident that they need extra training in the use of the PDI procedure. It can be introduced as standard procedure for one parent to practice with Mr. Bear and the co-therapist, while the other parent is being coached by the lead therapist. When using Mr. Bear with a child, therapists must take care that the child does not come to view timeout as a game, which then can make early practice sessions difficult for the parent. It is also important to assess the parents’ reaction to use of Mr. Bear in a role-play situation. Parents may be more comfortable with a clear, straightforward explanation to the child of the procedure. SAMPLE SCRIPT “You and your mom and dad are coming here so we can help you all to get along better. Now, along with your special time, we have a new game. This game is to help you learn to mind your parents. In this new game, your mom or dad will tell you some things to do. It is very important that you do what they tell you. Then you can keep playing and the game will be fun. But if you don't mind your parents, they have to stop playing and put you on the time-out chair [pointing]. After you sit on the chair quietly, they will give you another chance to mind. If you have to sit on the chair, it's very important that you are very quiet and that you don't get off the chair before they say you can. If you get off the chair before they let you, you will have to go the time-out room (show). So it's important not to get off the chair. But if you mind them, you will get to keep playing the game and have fun.”



Parent Directed Interaction First PDI Homework Assignment Directions Begin this practice session right at the end of your 5-minute CDI practice (as long as you have time to follow-through if you need to). These PDI practice sessions should last 10 minutes, unless your child has to go to time-out. If your child has to go to time-out, you must follow-through with the last command you gave. As soon as the time-out is over and you have praised your child for obeying the last command, switch back to CDI for two minutes before ending the practice session. Here is how you can introduce your child to PDI practice at home the first few times you practice “Our special time was fun! Now we are going to practice listening and minding. I’m going to tell you lots of little things to do like “hand me a block” or “draw with the red crayon.” It is very important for you to listen and mind quick-like-a-rabbit. If you mind quick-like-a-rabbit, I will be very proud of you, and we can keep playing. If you don’t mind, you will have to go to time out. “If you go to time-out, you will have to sit there until I say you can get off. You will need to sit quiet-like-a-mouse. If you are not quiet-like-a-mouse, you will have to stay there longer. “You have to stay on the time-out chair until I say you can get off, and you will have to mind. If you get off the time-out chair before I say you can, then you will have to go to the time-out room.” “I think that you will listen and mind. Remember, if you mind quick-like-arabbit, we can keep playing together. . If not, you will have to go to time-out and sit quiet-like-a-mouse. You will still have to listen and mind after timeout. I think that you will be a great listener. Now we can play with any of these toys.”



PDI Homework Sheet (Using PDI in Play Situation Only) Mother

Father

Child’s Name _______________________

PRACTICE Did you practice for 10 minutes in a play situation after CDI? Insert Date YES MONDAY __________ TUESDAY __________ WEDNESDAY __________ THURDAY __________ FRIDAY __________ SATURDAY __________ SUNDAY __________


NO

TIME OUT CHAIR Make tally mark each time child is sent to time-out for disobeying a command during play situation

TIME OUT ROOM Place one mark each time child got off the chair without permission

Comments



Father ___


Date




No

Activity
















Days Practiced

HOMEWORK





OVER





ADVICE GIVEN:








NA

X

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 OVER




Therapist Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _____________________________________________________________________

Integrity Checker Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _____________________________________________________________________



SECOND PDI COACHING SESSION Expanded Outline

Before the Session 1. Scatter some toys on the floor to get child used to this for future sessions. 2. Give the parents the ECBI while in the waiting room. 3. Materials needed: ECBI, stopwatch, DPICS Coding Sheets, Parent CDI Coding Sheets, Parent PDI Coding Sheets, PDI Skills Summary Sheet with baseline data from the assessment session, CDI Homework Sheets, PDI Homework Sheets, Progress Note, Integrity Checklist, “PDI First Homework Assignment” handout (if not given during PDI Coach 1), ECBI Graph, DPICS Summary Sheet for CDI. ______________________________________________________________________________ Goals of this Session ♦ Begin fine tuning parent(s)’ use of the PDI procedure ♦ Begin work on generalization to situations outside the playroom _______________________________________________________________________________ Note: In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior ________________________________________________________________________________________________

TREATMENT SESSION OUTLINE 1. Collect and discuss CDI and (if given) PDI Homework Sheets for about 10 minutes. Coding and Coaching •

Code PDI today only if parent was assigned PDI practice last week

•

Use a stopwatch to monitor time-out length

With one parent in treatment 2a. Coach CDI about 10 minutes •

Give parent the bug, and go to observation to coach CDI “Okay, we're going to coach CDI for a few minutes. Remember to use all your CDI skills.

3a. Code PDI 5 minutes (only if parent was assigned PDI practice last week) [Over the bug, explain the PDI coding directions] “We want to switch to PDI in a second. We’re going to code it today for 5 minutes before we coach PDI. You can tell [child’s name] that now it’s your turn to choose the game. Then begin with a simple command. Okay, we’re starting to code PDI now. [Co-therapist should record data on DPICS summary sheet at end of coding, and should record ECBI data on ECBI graph during] PDI coaching] 4a. Coach PDI about 20 minutes (or 25 minutes, if PDI not coded) ©1999 SHEILA M. EYBERG


With two parents in treatment [Start first with parent who started second last week] 2b. Coach first parent in CDI about 5 minutes •

Give parent the bug, and go to observation to coach CDI “Okay, we're going to coach CDI for a few minutes. Remember to use all your CDI skills.

3b. Code first parent in PDI 5 minutes (only if parent was assigned PDI practice last week) [Over the bug, explain the PDI coding directions] “We want to switch to PDI in a second. We’re going to code it today for 5 minutes before we coach PDI. You can tell [child’s name] that now it’s your turn to choose the game. Then begin with a simple command. Okay, we’re starting to code PDI now. [Co-therapist should record data on DPICS summary sheet at end of coding, and should record ECBI data on ECBI graph during PDI coaching] 4b.) Coach first parent in PDI for 10 minutes (or 15, if PDI was not coded [switch to second parent] 5b. Coach second parent in CDI for about 5 minutes 6b. Code second parent in PDI for 5 minutes (only if PDI homework was assigned last week) [Over the bug, explain the PDI coding directions] “We want to switch to PDI in a second. We’re going to code it today for 5 minutes before we coach PDI. You can tell [child’s name] that now it’s your turn to choose the game. Then begin with a simple command. Okay, we’re starting to code PDI now. [Co-therapist should record data on DPICS summary sheet at end of coding, and should record ECBI data on ECBI graph during PDI coaching] 7b. Coach PDI with second parent for 10 minutes (or 15, if PDI was not coded).

With ALL families 8) Show parents their DPICS Summary Sheets of progress, and describe the mastery criteria to the parents (next page)



______________________________________________________________________

PDI Mastery Criteria During the 5-minute coding at the beginning of the session, parents must •

Give at least 4 commands, of which at least 75% must be “effective,” (i.e., direct, positivelystated, single commands that provide an opportunity for the child to comply or noncomply)

•

Show at least 75% correct follow-through after effective commands (labeled praise after obey and warning after disobey).

•

If the child requires a time out that begins during the observation, the parent must successfully follow-through with the PDI procedure (i.e., the interaction must end with a labeled praise for compliance to the original command). ____________________________________________________________________

9. Explain homework •

CDI homework Assign daily 5-minute CDI sessions as usual and give new CDI Homework Sheet.

•

PDI homework If parents were not given PDI homework last week, begin homework this week. Have them practice a daily 10-minute PDI situation (a play situation) Give and explain the “PDI First Homework Assignment” and PDI Homework Sheet Instruct parents to call you immediately if they have any problem with PDI at home. If this is the parents' second week of PDI homework, have parents practice PDI after CDI in a daily 10-min Clean-Up situation and also use their PDI skills for 2 to 4 carefully selected direct commands each day. Give the PDI Homework Sheet.

10. Begin generalization of PDI skills in clinic. Specifically, tell parents that any time they give their child a command when they are in the waiting room or in the playroom, you want them to follow through. Tell them not to worry about noise in the clinic or about interrupting other people.



DPICS Coding Sheet for Therapist Date___________ Child’s name _________________________

Mother


Father

Other ______________



Coding CDI in Session POSITIVE

TALLY CODES

TOTAL

TALK (TA) (ID + AK)

MASTERY __


10

REFLECTION (RF)

10

LABELED PRAISE (LP)

10 __


TALLY CODES

TOTAL

MASTERY

QUESTION (QU)

0

COMMANDS (DC + IC)

0


0

POSITIVE

CHECK ONE

IMITATE

SATISFACTORY

NEEDS PRACTICE

USE ENTHUSIASM

SATISFACTORY

NEEDS PRACTICE


SATISFACTORY

NEEDS PRACTICE

NOT APPLICABLE

OTHER (SPECIFY)




Coding PDI in Session Command DC or IC?


No Opp

Obey

Disobey

Praise LP or UP?

Chair Warn

Obey

Disobey

Praise LP or UP?

Timeout Chair

Timeout Room



SKILLS

Your name: _________________

Tally


Reflection

Labeled Praise

Unlabeled Praise*

MISTAKES Question

Command

Criticism




Parent PDI Coding Sheet Observed parent’s name ___________________ Your name __________________________ Date _______________ Skill/behavior

Tally CDI Skills (in PDI)

Labeled Praise Unlabeled Praise* Reflection Behavior Description

PDI Skills Direct Commands Indirect Commands Follow-through with labeled praise after compliance Follow-through with warning after noncompliance Took child to time-out chair Took child to time-out room

Comments about the PDI Interaction _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________



PDI Skills Summary Sheet Child’s Name _____________

Mother

Father

Other Caregiver

Session Date Parent Commands Direct Commands (DC) Indirect Commands No Opportunity Commands Child Compliance Child obeys DC Child disobeys DC Parent Responses to Child Compliance to DC (within two statements following compliance) Labeled praise Unlabeled praise No praise Parent Response to Child Noncompliance to DC Chair warning Child Response to Warnings Compliance Noncompliance Parent Response to Compliance after Warning (within two statements following compliance) Labeled praise Unlabeled praise No praise Parent Response to Noncompliance after Warning Takes child to chair Time Out Child stays on chair Child gets off chair Parent takes child to room Minutes in TO room (total) Note. Except for last row, all entries are frequencies of occurrence within 5 minute observation or until last command is obeyed, withever longer. ©1999 SHEILA M. EYBERG



Father ___


Date




No

Activity



PDI Homework Sheet (Using PDI in Clean-up Situation and other Selected Situations) Mother

Father

CLEAN-UP PRACTICE?

TIME OUT CHAIR DURING CLEAN UP

OTHER PDI COMMAND PRACTICE?

Did you practice Clean-Up after CDI?

Make tally mark each time child goes to chair for disobeying command during Clean-Up

Did you practice 2 to 4 other commands?

YES Insert Date MONDAY __________ TUESDAY __________ WEDNESDAY __________ THURDAY __________ FRIDAY __________

SATURDAY __________ SUNDAY __________


Child’s Name _____________________

NO

YES

NO

TIME OUT CHAIR FOR OTHER COMMANDS

TIME OUT ROOM

Make tally mark each time child goes to chair for disobeying other commands

Place one mark each time child got off chair without permission (anytime)


PCIT Progress Note ________________________________________________________________ IDENTIFYING INFORMATION Child’s Name: Subject #:













Days Practiced

HOMEWORK





OVER





ADVICE GIVEN:








NA

X

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 OVER




Therapist Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ________________________________________________________________________________

Integrity Checker Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________________________________________



THIRD PDI COACHING SESSION Extended Outline Before the Session 1. Arrange toys so that one toy is scattered on the table and two toys are scattered on the floor on both sides of the toy box. 2. Give the ECBI to parents in the waiting room. 3. Materials needed: ECBI, stopwatch, DPICS Coding Sheets for Therapist, Parent CDI Coding Sheets, Parent PDI Coding Sheets, CDI Homework Sheets, PDI Homework Sheets, Progress Note, Integrity Checklist, DPICS Summary Sheets (both CDI and PDI), ECBI graph. Goals of this Session ♦ Review the effect treatment has had on the child’s behavior ♦ Continue to fine-tune the parents’ skills in both CDI and PDI ♦ Focus on giving the child more difficult commands (e.g., clean-up) that are likely to be more problematic in real-life situations ___________________________________________________________________________ Note. In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior ____________________________________________________________________________ TREATMENT SESSION OUTLINE 1.

Collect CDI and PDI homework and discuss homework for about 10 minutes. ♦ Ask parents to estimate the percentage of all commands they give that still require warnings (as opposed to being obeyed immediately). ♦ Give parents expectation that this percentage will decrease each week.

2. Tell parents the session today will be like the session last week, except that when we code and coach PDI skills, we will use a clean-up situation instead of a play situation. "So, instead of telling [child’s name] that now it’s your turn to choose the game, tell him/her that now it’s time to put the toys away. Remember to use all the PDI skills you have been practicing, like giving simple commands for one thing at a time.



Coding and Coaching [Use a stopwatch to time coding, coaching, and times in time out] With one parent in treatment 3a. Code CDI for 5 minutes “Okay, we're going to code CDI for the next 5 minutes. Do the best job that you can.”\ 4a. Code PDI for 5 minutes, using Clean-Up directions "Now we are going to switch to using PDI in a clean-up situation. Tell [child's name] that it is time to clean up the toys. Get him to put all the toys in their containers and to put all the containers in the toy box." [After coding, have parent tell the child that the child has done such a nice job of cleaning up that now the child gets to play some more. Have parent let child choose a toy; have parent then dump that toy completely out on the table.] [Co-therapist should record data on DPICS summary sheet at end of coding] 5a. Coach CDI for 15 minutes, focusing on those skills that are not at criterion. 6a. Coach PDI in play for 10 minutes and "Clean-up" for 5 minutes. With two parents in treatment [Start first with the parent who started second last week; give bug to first parent] 3b. Code CDI with first parent for 5 minutes “Okay, we're going to code CDI for the next 5 minutes. Do the best job that you can.” 4b. Code PDI with first parent for 5 minutes, using the Clean-Up directions: "Now we’re going to switch to using PDI in a clean up situation. Tell [child's name] that it is time to clean up the toys. Get him/her to put all the toys in their containers and to put all the containers in the toy box." [Co-therapist should record data on DPICS Summary Sheets at end of coding] [After coding, have parent tell the child that the child has done such a nice job of cleaning up that the child gets extra playtime. Have the parent let the child choose a toy; have parent then dump that toy completely out on the table.] 5b. Coach CDI with first parent for 5 minutes 6b. Coach PDI in play for 10 minutes and Clean-up for 5 minutes. Switch to second parent in playroom 7b. Code CDI with second parent for 5 minutes “Okay, we're going to code CDI for the next 5 minutes. Do the best job that you can.”



8b. Code PDI with second parent for 5 minutes "Now we’re going to switch to using PDI in a clean up situation. Tell [child's name] that it is time to clean up the toys. Get him/her to put all the toys in their containers and to put all the containers in the toy box." [Co-therapist should record data on DPICS Summary Sheet at end of coding] [After coding, have parent tell the child that the child has done such a nice job of cleaning up that now the child gets to play some more. Have the parent let the child choose a toy; have parent then dump that toy completely out on the table.] 9b. Coach CDI with second parent for 5 minutes 10b. Coach Clean-up with second parent until the toys are cleaned up With ALL Families 11. Return to playroom and show parents their DPICS Summary Sheets of Progress in CDI and PDI – describe their changes and refer to mastery criteria for each. Explain homework 12 Assign daily 5-minutes CDI as usual and give CDI Homework Sheet 15. Assign a PDI clean-up session after each CDI session, and give PDI homework Sheet to record the clean-up sessions 16. Tell parents to give 2 to 4 additional direct commands each day outside of the clean-up situation when they have time to follow through with the PDI procedure 19. Have parent discuss good times to practice direct commands (e.g., getting up and bedtime) 17. Tell them now to never use a direct command for any task that isn’t important 18. Tell parents that if they want to suggest that their child do something, but compliance isn’t really important, they should use an indirect command. Then, if the child doesn’t obey, they should not ask the child again. 20. Ask parents to notice during the week if they find any problem behaviors that seem hard to handle by giving positive commands for incompatible (opposite) behaviors, and if so, to list those problem behaviors on the back of the homework sheet.



DPICS Coding Sheet for Therapist Date___________ Child’s name _____________________

Mother


Father

Other ______________




TALLY CODES

TOTAL

TALK (TA) (ID + AK)

MASTERY __


10

REFLECTION (RF)

10

LABELED PRAISE (LP)

10 __


TALLY CODES

TOTAL

MASTERY

QUESTION (QU)

0

COMMANDS (DC + IC)

0


0

POSITIVE

CHECK ONE

IMITATE

SATISFACTORY

NEEDS PRACTICE

USE ENTHUSIASM

SATISFACTORY

NEEDS PRACTICE


SATISFACTORY

NEEDS PRACTICE

NOT APPLICABLE

OTHER (SPECIFY)






No Opp

Obey

Disobey

Praise LP or UP?

Chair Warn

Obey

Disobey

Praise LP or UP?

Timeout Chair

Timeout Room



SKILLS

Your name: _________________

Tally


Reflection

Labeled Praise

Unlabeled Praise*

MISTAKES Question

Command

Criticism




Parent PDI Coding Sheet Observed parent’s name ___________________ Your name __________________________ Date _______________

Skill/behavior


Labeled Praise Unlabeled Praise* Reflection Behavior Description PDI Skills Direct Commands Indirect Commands Follow-through with labeled praise after compliance Follow-through with warning after noncompliance Took child to time-out chair Took child to time-out room

Comments about the PDI Interaction _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________




Father ___


Date




No

Activity



PDI Homework Sheet (Using PDI in Clean-up Situation and other Selected Situations) Mother

Father

Child’s Name _____________________

CLEAN-UP PRACTICE?

Did you practice Clean-Up after CDI? YES Insert Date MONDAY __________ TUESDAY __________ WEDNESDAY __________ THURDAY __________ FRIDAY __________ SATURDAY __________ SUNDAY __________


NO

TIME OUT CHAIR DURING CLEAN UP

Make tally mark each time child goes to chair for disobeying command during Clean-Up

OTHER PDI COMMAND PRACTICE?

Did you practice 2 to 4 other commands? YES

NO

TIME OUT CHAIR FOR OTHER COMMANDS

TIME OUT ROOM

Make tally mark each time child goes to chair for disobeying other commands

Place one mark each time child got off chair without permission (anytime)















Days Practiced

HOMEWORK





OVER





ADVICE GIVEN:








NA

X

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 OVER




Therapist Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________

Integrity Checker Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ________________________________________________________



FOURTH PDI COACHING SESSION Expanded Outline Before Session 1. Scatter toys on floor before session.

2. Give the parents the ECBI while in the waiting room. 3. After collecting the ECBI, review problem areas to identify any potential house rules. 4. Materials needed: ECBI, stopwatch, “Setting up House Rules” handout, Graduation Session Outline (just in case), CDI Homework Sheets, PDI Homework Sheets, Progress Note, Integrity Checklist, DPICS Summary Sheets (for CDI and PDI), ECBI Graph ____________________________________________________________________________ Note: A family may reach criteria for treatment graduation during this session. If their ECBI Intensity Score is within 1/2 standard deviation of the normative mean (raw score < 114) and their DPICS skills were close to criteria at the last session, then it is possible that this will be the graduation session. At the beginning of such a session, mention to parents that their progress has been excellent and ask how they feel about their child’s behavior now. If they indicate confidence in managing their child’s behavior independently, abandon this session outline and go to Graduation Session Outline. ___________________________________________________________________________ Goals of this Session ♦ Provide intensive coaching of the standard PDI procedure ♦ Provide an “over-learning” session for the child ♦ Introduce House Rules variation of PDI if needed ___________________________________________________________________________ Note. In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior ____________________________________________________________________________ TREATMENT SESSION OUTLINE 1. Collect CDI & PDI homework sheets and discuss homework. Ask how child responded to PDI commands at different times of the day. 2. Ask parents to estimate the percentage of all commands they give that still require warnings (as opposed to being obeyed immediately). Compare this to last week's estimate, and problem solve if it is not lower than last week 3. Review changes on ECBI graph with parent. If the graph slopes down fairly steadily since treatment bean, note that this is expected and they are doing a nice job of changing their child’s problem behaviors. If progress is slower than expected note puzzlement, wonder aloud why things are changing so slowly, and explore specific items that may be problematic if indicated. 4. Tell parents that when we coach the PDI skills today, we will end with a clean-up situation. “Today, we will coach PDI practice while you play, but before the PDI practice ends, we will ask you to tell [child's name] that it's time to clean up the room. Remember to use all the PDI skills you have been practicing, like giving direct commands, not repeating commands, following through quickly with labeled praise or the warning, and using exactly the words of PDI with no extra words." NOTE: This session omits coding, to allow time for intensive coaching. ©1999 SHEILA M. EYBERG


Coaching with ONE parent in treatment [Spend 20 minutes coaching the parent, with most of the time focused on the situation (CDI or PDI) that is most difficult for that parent.] [Give parent bug-in-the-ear and go into observation room] 5a. Coach CDI, focusing most on those skills that are not at criterion. “Okay, we're going to coach CDI for the next few minutes. Do the best job that you can.” 6a. Coach PDI (during play), focusing on those skills that are not at criterion. “OK, now we’re going to coach PDI for the next few minutes. Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.” 7a. Give clean-up directions near the end of the coaching session. "Now tell [child's name] that it's time to clean up the toys. Get him/her to put all the toys in their containers and put all the containers in the toy box." Coaching with TWO parents in treatment

[Start first either with the parent who started second last week, or with the parent who is having most trouble learning the therapy skills. If one parent is starting first because of particular difficulty, spend 15 minutes coaching that parent, focused on the situation that needs most work. Spend 5 minutes coaching the second parent.] [If both parents have equivalent skills, coach 10 min each.] 5b. Coach CDI with first parent, focusing most on the skills not at criterion 6b. Coach PDI (in play) with first parent, focusing on the skills not at criterion 7b. Give clean-up directions to first parent near the end of the coaching session "Now tell [child’s name] that it's time to clean up the toys. Get him to put all the toys in their containers and put all the containers in the toy box." Switch to second parent 8b. Coach CDI with second parent, focusing most on those skills that are not at criterion “Okay, we're going to coach CDI for the next few minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” Coach PDI (during play) with second parent, focusing on the skills not at criterion

9b.

“OK, now we’re going to coach PDI. Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.” 10b. Give clean-up directions to second parent near the end of the coaching session. "Now tell child's name that it's time to clean up the toys. Get him to put all the toys in their containers and put all the containers in the toy box."



With ALL families 11. Review remaining problems, and consider if they would respond to running commands for positive opposites or if a standing command, i.e., house rule, is needed (10 minutes) ♦ If a house rule is appropriate, ♦ Explain the house rules procedure to the parents ♦ Discuss the operational definition of the targeted behavior and whether the child understands exactly what the word for this behavior means ♦ Explain labeling. If indicated, have the parents label the behavior for the child every time it occurs, for 3 days, prior to making a house rule for it. ♦ Give parent House Rules Handout. _____________________________________________________________________________ Note. If the parents have achieved or come close to achieving mastery on CDI and PDI skills criteria and their child has no behavior that require a house rule, the public behavior procedures (see PDI coaching session 5) can be substituted for the house rules procedure and homework #14. Review Homework 12. CDI homework sheet--have parents continue daily 5-minute CDI at home. 13. PDI homework sheet--have parents continue daily PDI clean-up sessions after CDI sessions, and have them use PDI as necessary for running commands at other times, as necessary. 14. If applicable, on the PDI homework sheet, write in the new house rule in the house rule column and show parents how to record it.



Setting Up House Rules What kinds of behaviors may need a house rule? • • • •

Behaviors that are aggressive Your son hits you when you don’t give him what he wants Behaviors that are destructive Your daughter throws toys when she’s angry Negative behaviors that happen “all of a sudden,” before you have a chance to give a command for a “positive opposite” behavior Your daughter yells at her baby brother and frightens him when he gets in her way “Sneaky” behaviors that you don’t discover until after they have happened Your son repeatedly eats the desserts in the refrigerator prepared for dinner guests

How to set up a house rule 1. Decide what behavior you want your child to stop Example: Saying mean things to her sister, like “I hate you,” or “You’re ugly” 2. Choose a word for the behavior that your child understands Example: “Picking on your sister” 3. If you’re not sure your child knows what you mean, label the behavior for 2 or 3 days before you start giving time outs for it Example: “When you say things like that, that’s picking on your sister.” 4. Explain the new house rule to your child “You’ve been nice to your sister this morning, and I like that. But sometimes you forget. I am starting a new house rule to help you remember. It goes like this, “Any time you pick on your sister, you’ll have to go to the timeout chair. But if you remember to be nice to your sister, like this morning, you won’t have to go to the chair.” How to use the house rule • • • • • • •

Your child does not get a warning if he breaks a house rule - If he does the problem behavior, take him immediately to the timeout chair for 3 minutes plus 5 seconds of quiet Take your child to the chair every time he does the behavior. On the way to the chair, say nothing except, “You [picked on your sister], so you have to sit on the timeout chair.” When you leave, say only “Stay on the chair until I say that you can get off.” If your child gets off the chair, take him to the timeout room for 1 minute plus five seconds of quiet. After your child’s time in the room is up, take him back to the timeout chair for 3 minutes plus 5 seconds of quiet. When you leave, say only “Stay on the chair until I say that you can get off.” After your child’s time on the chair is up, say, “You can get off of the chair now.” Do not give a command or discuss the bad behavior. As soon as possible, praise the “good opposite.” “You’re being so nice to your sister. She thinks you are the best big brother in the world.”

To begin another house rule • You may begin a new house rule after your child is going to time out less than twice a day for the first rule. When this happens, that first rule is no longer an “active” house rule. It is still a house rule, though, and your child should still go to timeout when he breaks it. ©1999 SHEILA M. EYBERG


•

Your child should have not more than two “active” house rules at a time.



CDI Homework Sheet Mother ____

Father _____

Child's Name ____________________

Date

Did you practice for 5 minutes this day? Yes

Monday ______________ Tuesday ______________ Wednesday ______________ Thursday ______________ Friday ______________ Saturday ______________ Sunday ______________


No

Activity

Problems or Questions during this Special Time


PDI Homework Sheet (with Running Commands and House Rules) Mother

Father

Insert Date MONDAY ________ TUESDAY ________ WEDNESDAY ________ THURDAY ________ FRIDAY ________ SATURDAY ________ SUNDAY ________


Child’s Name _____________________

POSITIVE COMMAND PRACTICE?

TIME OUT CHAIR FOR RUNNING COMMANDS

TIME OUT CHAIR FOR HOUSE RULES

Did you practice PDI for running commands in clean-up and other times if needed?

Make a tally mark each time child is sent to time-out chair for disobeying positive, running command

Make tally mark each time you send child to chair for disobeying a house rule

YES

NO

TIME OUT ROOM

Place one mark each time child got off chair without permission (any time)















Days Practiced

HOMEWORK





OVER





ADVICE GIVEN:








NA

X

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 OVER




Therapist Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ____________________________________________________

Integrity Checker Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _______________________________________________________



FIFTH PDI COACHING SESSION Expanded Outline Before the Session 1. Scatter some toys on the floor to get child used to this for future sessions. 2. Give the parents the ECBI to complete in the waiting room. 3. After collecting the ECBI, review problem areas to identify potential house rules. Any problems that remain may be suitable as house rules if they have not yet responded to PDI. 4. Materials needed: Stopwatch, ECBI, “Dealing with your Child in Public Places” Handout, Graduation Session Outline, DPICS Coding Sheets for Therapists, Parent CDI Coding Sheets, Parent PDI Coding Sheets, CDI Homework Sheets, PDI Homework Sheets, Progress Note, Integrity Checklist, DPICS Summary Sheets (for PDI and CDI), ECBI Graph. ____________________________________________________________________________ Note. A family may reach the criteria for treatment graduation during this session. If their ECBI Intensity Score is within 1/2 standard deviation of the normative mean (raw score < 114) and their DPICS-II skills were close to criteria at the last session, then it is possible that this will be the graduation session. At the beginning of such a session, mention to the parents that their progress has been excellent and ask how they feel about their child’s behavior now. If they indicate confidence in managing their child’s behavior independently, abandon this session outline and go to Graduation Session Outline. ____________________________________________________________________________ Goals of This Session ♦ Address public behavior ♦ Add another house rule if indicated ♦ Begin preparing families for graduation ♦ For families not close to graduation criteria, focus on CDI and PDI skills that remain ____________________________________________________________________________ Note. In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior ___________________________________________________________________________ TREATMENT SESSION OUTLINE 1. Explain to parent(s) that today's session will begin with coding and coaching, and then we'll take time to discuss the homework at the end of the session. Coding and Coaching With one parent in treatment 2a. Code CDI for 5 minutes “OK, now we’re going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.”



3a. If parent's CDI skills do not meet mastery criteria, coach CDI for 10 minutes, focusing on those skills that are not at criterion. ⇒ If CDI skills okay, skip coaching. 4a. Code PDI for 5 minutes “Now we’re going to code PDI for the next 5 minutes. Do the best job that you can. 5a. If parent’s PDI skills do not meet mastery criteria, coach PDI for 10 minutes, focusing on those skills that need improvement, and using clean-up directions. ⇒ If PDI skills okay, skip coaching. With two parents in treatment [Start first with either the parent who started second last week, or with the parent who is having most trouble learning the therapy skills.] First parent 2b. Code CDI with first parent for 5 minutes 3b. If parent's CDI skills do not meet mastery criteria, coach CDI for 10 minutes, focusing on those skills that are not at criterion. If CDI skills okay, skip coaching 4b. Code PDI with first parent for 5 minutes “OK, now we’re going to code PDI for the next 5 minutes. Be sure to do the best job that you can.” 5b. If parent’s PDI skills do not meet mastery criteria, coach PDI for 10 minutes, focusing on those skills that need improvement, and using clean-up directions. If PDI skills okay, skip coaching Second parent 6b. Code CDI with second parent for 5 minutes 7b. If parent's CDI skills do not meet mastery criteria, coach CDI for 10 minutes, focusing on those skills that are not at criterion If CDI skills okay, skip coaching 8b. Code PDI with second parent for 5 minutes 9b. Coach PDI with second parent for 5 minutes using clean-up directions



With ALL families 10. Review DPICS Summary Sheets of CDI and PDI Progress in session 11. Review ECBI Graph with parents, and discuss parent and therapist expectations. .Problem solve if indicated. 12. Collect CDI and PDI homework sheets and discuss. ♦

If a house rule is being used in this family ♦ Discuss how the first house rule procedure worked during the week..If problem not significantly decreased, discuss to identify reason, correct implementation problem, and continue this first house rule if feasible.. ♦ Add a second house rule if there has been progress on the first house rule behavior and there is a second problem appropriate for treatment with a house rule. ♦ On the PDI homework sheet, write in all house rules in the house rule column and ask parents to record them each day.

13. Introduce Public Behavior - the procedure for dealing with misbehavior in public places ♦ Ask how the child behaves now in public (e.g., stores, restaurants, visiting the home of a parent's friend). ♦ Engage parent in discussion of how their child is or can be prepared for public outings in advance to reduce misbehavior, and what rewards parents can use for good public behavior. ♦ If the parent has difficulty with public behavior, describe the variation of PDI that can be used for dealing with disruptive behavior in public. ♦ Have parents discuss what they could use in public as the “time-out chair (e.g., a sit-upon, a newspaper), and what they could use as a back-up, should it be needed. ♦ Give parent Public Behavior Handout to review before the next session, in which the therapist will accompany the parents and child to a public place (such as the health center gift shop or cafeteria – or a walk down the hall past a vending machine) to coach parents in the public behavior procedure. 14. Give CDI homework sheet--have parents continue daily 5-minute CDI sessions. 15. Give PDI homework sheet--have parents now use PDI throughout the day, only for necessary running commands. _____________________________________________________________________________ Note. If the family have met our criteria for graduation, but the parents do not yet feel confident that they can manage on their own, the therapists will continue to deal with any remaining problems while helping the parents to recognize that the skills they have learned and used at home to bring their child’s behavior to within normal limits are skills that will continue to be effective in managing future problems. Therapists will explore the parents’ remaining concerns and emphasize the parents’ problem-solving skills training in the final sessions. ____________________________________________________________________________



Dealing With Your Child In Public Places If your child has behavior problems, it can be hard to take him places like the grocery store or the doctor’s office. Sometimes children will do things that make parents feel bad, like whining, yelling, or saying mean things. And sometimes when parents tell them to stop, kids just act worse. Strangers may turn and watch the child, and the parents may feel embarrassed. So sometimes kids can get away with doing things in public that they would not be allowed to do at home. Here are some things to do to help your child be good out in public.

Make a Plan Before You Leave the House Tell your child where you will be going, and how you want him to act.

☺ “We are going to Wal-Mart. I want you to stay right by me and talk nicely.” If there are things that you know your child will probably do, like whining, tell your child that if he whines on this outing, he will get a small punishment (tell him what the punishment will be, like no TV for the evening).

☺ “If you don’t stay by me or if you whine, you will not get to watch TV tonight.” Always give the punishment if your child does not do what you told him. If he is good, praise him and maybe even give him a little something special.

☺ “You stayed right by me in the store, and you talked so nicely, so we’re going to stop and get an ice cream cone on the way out.” Sometimes when parents are busy trying to get things done, they forget to praise their kids when they’re being good. But taking the time to praise your child will mean you have to spend less time dealing with bad behavior.

☺ “I like how quietly you stood and waited while I talked to the lady behind the counter. That’s my big girl!” Don’t push your child too hard. Most kids can’t be good in public for more than a couple of hours (or less for some kids). If you see that your child is getting tired, hungry, or bored, it is a good idea to go home or at least take a break. Try not to take your child out past his bedtime or during times that he is usually taking a nap. Try to plan some part of your trip that will be fun for your child. For example, if you are at the mall, you could walk through a store your child enjoys, like a pet store or toy store. Even though this takes more of your time, it will give your child something to look forward to and help him act better.

☺ “We have to go to the doctor’s office today. After the doctor’s office, we will stop for lunch at the McDonald’s with the Playland that you like. Then we will go to the grocery store.” Bring along small toys, books, and snacks to help keep your child from getting bored and hungry.



Effective Ignoring ♦ Ignoring can be really hard for parents to do in public. You may feel bad about ignoring your child in front of strangers because they may think you do not care about your child. Or, you may feel bad about how your child is acting and want to make him stop right away. Sometimes it may seem easier just to give the child what he wants. Jane and her daughter Tasha are at the grocery store in the checkout line. Tasha says, “Mom, can I have a candy bar?” Jane says, “No, because it’s almost time for dinner.” Tasha yells, “But mom, I want one! I’m hungry! You’re a mean mom!” She starts to cry and stomp her feet. People are looking over at Jane and Tasha. Jane feels embarrassed. So she buys Tasha the candy bar so she will be quiet. The next time Jane and Tasha go to the grocery store, Tasha knows what she has to do to get a candy bar. She just has to yell and cry until her mom feels bad and buys it for her. ♦ When you ignore your child when he acts up in public, your child learns that he is not going to get his way by yelling and crying. Your child will probably “test” you, to see if you can keep this control even if he whines, screams, or lies on the floor and kicks. But if you keep ignoring him, your child will know that crying and yelling don’t work any more. ♦ Remember that the longer you and your child have been dealing with this problem, the longer it might take to show your child that you are in control. So, you may have to ignore him more than once before he gets the point. Public Time-out ♦ Public time out is the same as time out at home, with a few small changes. ♦ Before going out, tell your child that you are going to use time out in the place you are going. Explain that time out will be the same as time out at home. ♦ Keep a small blanket or placemat with you to use as the “time-out chair,” so that time-out can be done anywhere. ♦ When you need to choose a time out spot, choose a place where there is nothing fun for the child to do and where the child is not likely to get attention from others. ♦ Some parents have put their children on benches in the mall, the front steps during church, or the corner of a grocery store. When their car is close, some parents find they can put the child in the back seat with the windows half open, while they lean against the car. But if it is very hot outside, this is not a good thing to do unless the windows are completely down. ♦ Always watch your child when she is in time out. ♦ Talk with your PCIT therapist about any problems that come up.




Mother


Father

Other ______________




TALLY CODES

TOTAL

TALK (TA) (ID + AK)

MASTERY __


10

REFLECTION (RF)

10

LABELED PRAISE (LP)

10 __


TALLY CODES

TOTAL

MASTERY

QUESTION (QU)

0

COMMANDS (DC + IC)

0


0

POSITIVE

CHECK ONE

IMITATE

SATISFACTORY

NEEDS PRACTICE

USE ENTHUSIASM

SATISFACTORY

NEEDS PRACTICE


SATISFACTORY

NEEDS PRACTICE

OTHER (SPECIFY)



NOT APPLICABLE




No Opp

Obey

Disobey

Praise LP or UP?

Chair Warn

Obey

Disobey

Praise LP or UP?

Timeout Chair

Timeout Room


Parent CDI Coding Sheet Date: ____________ Observed parent’s name: _______________

SKILLS

Your name: ____________________

Tally


Reflection

Labeled Praise

Unlabeled Praise*

MISTAKES Question

Command

Criticism




Parent PDI Coding Sheet Observed parent’s name ___________________ Your name __________________________ Date _______________

Skill/behavior








Father ___


Date




No

Activity




Father



Child’s Name _____________________





YES

NO



TIME OUT ROOM
















Days Practiced

HOMEWORK





OVER





ADVICE GIVEN:








NA

X

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 OVER








SIXTH PDI COACHING SESSION Expanded outline Before the Session 1. Scatter some toys on the floor to get child used to this for future sessions. 2. Give the family the ECBI while in the waiting room. 3. After collecting the ECBI, review problem areas: Any problems on the ECBI that may remain should be assigned as a house rule (or otherwise discussed directly) during this session. 4. Materials needed: Stopwatch, ECBI, Graduation Session Outline (just in case), DPICS Coding Sheets, Parent CDI Coding Sheets, Parent PDI Coding Sheets, CDI Homework Sheets, PDI Homework Sheets, Progress Note, Integrity Checklist, DPICS Summary Sheets (for PDI and CDI), ECBI Graph. ___________________________________________________________________________ Goals of this session ♦ Address public behavior ♦ Have parent use problem solving techniques to determine which PCIT techniques to apply to specific problems that remain ♦ Continue to prepare families for graduation ♦ If families are not close to DPICS graduation criteria, this session should emphasize fine-tuning CDI and PDI skills that remain problematic for the family __________________________________________________________________________ Note. A family may reach the criteria for treatment graduation during this session. If their ECBI Intensity Score is within 1/2 standard deviation of the normative mean (raw score < 114) and their DPICS skills were close to criteria at the last session, then it is possible that this will be the graduation session. At the beginning of such a session, mention to the parents that their progress has been excellent and ask how they feel about their child’s behavior now. If they indicate confidence in managing their child’s behavior independently, abandon this session outline and go to Graduation Session Outline. ___________________________________________________________________________ Note: In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior ___________________________________________________________________________

TREATMENT SESSION OUTLINE 1. Tell parent(s) that today's session will begin with coding and coaching, and then we will take time to discuss the homework at the end of the session.



Coding and Coaching With one parent in treatment 2a. Code CDI for 5 minutes “OK, now we’re going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” 3a. If parent’s CDI skills are not at mastery level, coach CDI for 5 minutes, focusing on those skills that are not at criterion. ♦ If skills okay, skip coaching. 4a. Code the regular PDI for 5 minutes “OK, now we’re going to code PDI for the next 5 minutes. Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.” 5a. If parent's PDI skills are not at PDI mastery level, coach the Clean Up situation for 5 minutes, focusing on those skills that are not at criterion. ♦ If skills okay, skip coaching. With two parents in treatment [Start first with either the parent who started second last week, or with the parent who is having most difficulty learning the therapy skills] 2b. Code CDI with first parent for 5 minutes “OK, now we’re going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child’s name] in his/her game according to his/her rules.” 3b. If CDI criterion skills were not met, coach CDI with first parent for 5 minutes, focusing on those skills that need improvement. ♦ If skills okay, skip coaching 4b. Code PDI with first parent for 5 minutes “OK, now we’re going to code PDI for the next 5 minutes. Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.” 5b. If PDI criterion skills were not met, coach the Clean Up situation with the first parent for 5 minutes, focusing on those skills that need improvement ¡ If skills okay, skip coaching



Switch parents 6b. Code CDI with second parent for 5 minutes. 7b. If CDI skills are not at mastery criteria, coach CDI with second parent for 5 minutes, focusing on those skills that are not at criterion. ♦ If skills okay, skip CDI coaching 8b. Code PDI with second parent for 5 minutes “OK, now we’re going to code PDI for the next 5 minutes. Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.” 9b. If PDI criterion skills were not met, coach the Clean Up situation with the first parent for 5 minutes, focusing on those skills that need improvement ¡ If skills okay, skip coaching

With ALL families (20 – 40 minutes) Public behavior coaching 10. Describe the in vivo outing that is planned (e.g., walk through the hospital gift shop) 11. Review the public behavior procedure with the parents, including •

What they can use for the “time out chair” (e.g., a mat)

•

What they will use as a back-up if child gets off the mat (e.g., women’s room just outside gift shop)

•

What they will use as a small reward if child does not need time out during outing

•

Which parent wants to practice procedure first (spouse and co-therapist will follow and observe parent and coach during the trip through gift shop)

•

What they think will be important to tell child in preparation for the outing (reinforce their appropriate ideas, and guide them to think about any they might have forgotten)

12. Ask parent to prepare the child in playroom, before starting ¡ Coach each parent during the outing

Return to playroom 13. Discuss the outing and assign 3 public behavior practice outings during next week 14. Collect CDI and PDI homework sheets and discuss ¡ Check on CDI compliance and how “PDI as needed” is going ¡ Check how the instituted house rules are working

•

Have parents use problem-solving methods to determine if any house rules need to be modified or added (no more than two active house rules at a time)



15. Give CDI and PDI homework sheets, and assign daily 5-minute CDI sessions, continued use of PDI for necessary running commands, and the use of any house rules determined. ________________________________________________________________________ Note. To enhance generalization, the therapist may choose to allow the child’s siblings to attend the next session. Siblings should only be included if the identified child is progressing well with other aspects of the program. Note. If the family have met criteria for treatment graduation, but the parents do not yet feel confident that they can manage on their own, the therapists may continue to deal with any remaining problems. __________________________________________________________________________



Dealing With Your Child In Public Places If your child has behavior problems, it can be hard to take him places like the grocery store or the doctor’s office. Sometimes children will do things that make parents feel bad, like whining, yelling, or saying mean things. And sometimes when parents tell them to stop, kids just act worse. Strangers may turn and watch the child, and the parents may feel embarrassed. So sometimes kids can get away with doing things in public that they would not be allowed to do at home. Here are some things to do to help your child be good out in public.

Make a Plan Before You Leave the House Tell your child where you will be going, and how you want him to act.

☺ “We are going to Wal-Mart. I want you to stay right by me and talk nicely.” If there are things that you know your child will probably do, like whining, tell your child that if he whines on this outing, he will get a small punishment (tell him what the punishment will be, like no TV for the evening).

☺ “If you don’t stay by me or if you whine, you will not get to watch TV tonight.” Always give the punishment if your child does not do what you told him. If he is good, praise him and maybe even give him a little something special.

☺ “You stayed right by me in the store, and you talked so nicely, so we’re going to stop and get an ice cream cone on the way out.” Sometimes when parents are busy trying to get things done, they forget to praise their kids when they’re being good. But taking the time to praise your child will mean you have to spend less time dealing with bad behavior.

☺ “I like how quietly you stood and waited while I talked to the lady behind the counter. That’s my big girl!” Don’t push your child too hard. Most kids can’t be good in public for more than a couple of hours (or less for some kids). If you see that your child is getting tired, hungry, or bored, it is a good idea to go home or at least take a break. Try not to take your child out past his bedtime or during times that he is usually taking a nap. Try to plan some part of your trip that will be fun for your child. For example, if you are at the mall, you could walk through a store your child enjoys, like a pet store or toy store. Even though this takes more of your time, it will give your child something to look forward to and help him act better.

☺ “We have to go to the doctor’s office today. After the doctor’s office, we will stop for lunch at the McDonald’s with the Playland that you like. Then we will go to the grocery store.” Bring along small toys, books, and snacks to help keep your child from getting bored and hungry.



Effective Ignoring ♦ Ignoring can be really hard for parents to do in public. You may feel bad about ignoring your child in front of strangers because they may think you do not care about your child. Or, you may feel bad about how your child is acting and want to make him stop right away. Sometimes it may seem easier just to give the child what he wants. Jane and her daughter Tasha are at the grocery store in the checkout line. Tasha says, “Mom, can I have a candy bar?” Jane says, “No, because it’s almost time for dinner.” Tasha yells, “But mom, I want one! I’m hungry! You’re a mean mom!” She starts to cry and stomp her feet. People are looking over at Jane and Tasha. Jane feels embarrassed. So she buys Tasha the candy bar so she will be quiet. The next time Jane and Tasha go to the grocery store, Tasha knows what she has to do to get a candy bar. She just has to yell and cry until her mom feels bad and buys it for her. ♦ When you ignore your child when he acts up in public, your child learns that he is not going to get his way by yelling and crying. Your child will probably “test” you, to see if you can keep this control even if he whines, screams, or lies on the floor and kicks. But if you keep ignoring him, your child will know that crying and yelling don’t work any more. ♦ Remember that the longer you and your child have been dealing with this problem, the longer it might take to show your child that you are in control. So, you may have to ignore him more than once before he gets the point. Public Time-out ♦ Public time out is the same as time out at home, with a few small changes. ♦ Before going out, tell your child that you are going to use time out in the place you are going. Explain that time out will be the same as time out at home. ♦ Keep a small blanket or placemat with you to use as the “time-out chair,” so that time-out can be done anywhere. ♦ When you need to choose a time out spot, choose a place where there is nothing fun for the child to do and where the child is not likely to get attention from others. ♦ Some parents have put their children on benches in the mall, the front steps during church, or the corner of a grocery store. When their car is close, some parents find they can put the child in the back seat with the windows half open, while they lean against the car. But if it is very hot outside, this is not a good thing to do unless the windows are completely down. ♦ Always watch your child when she is in time out. ♦ Talk with your PCIT therapist about any problems that come up.




Mother


Father

Other ______________




TALLY CODES

TOTAL

TALK (TA) (ID + AK)

MASTERY __


10

REFLECTION (RF)

10

LABELED PRAISE (LP)

10 __


TALLY CODES

TOTAL

MASTERY

QUESTION (QU)

0

COMMANDS (DC + IC)

0


0

POSITIVE

CHECK ONE

IMITATE

SATISFACTORY

NEEDS PRACTICE

USE ENTHUSIASM

SATISFACTORY

NEEDS PRACTICE


SATISFACTORY

NEEDS PRACTICE

NOT APPLICABLE

OTHER (SPECIFY)






No Opp

Obey

Disobey

Praise LP or UP?

Chair Warn

Obey

Disobey

Praise LP or UP?

Timeout Chair

Timeout Room



SKILLS

Your name: _________________

Tally


Reflection

Labeled Praise

Unlabeled Praise*

MISTAKES Question

Command

Criticism












Father ___


Date




No

Activity




Father



Child’s Name _____________________





YES

NO



TIME OUT ROOM
















Days Practiced

HOMEWORK





OVER





ADVICE GIVEN:








NA

X

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 OVER








PDI COACHING SESSION 7 AND BEYOND Expanded Outline Notes about moving into graduation ♦ This and subsequent sessions are similar: the relative amount of time in the session spent on coaching parents toward skill criteria versus discussion of the applications of skills and practice to any remaining child problems is determined by the data Until parents' interaction skills are at mastery level, most of the session time should be spent coaching, and most of the discussion time should focus on discussing specific skills (reviewing summary sheets, working on "in-session exercises" to drill specific skills, etc.) Once parents have mastered the basic PCIT interaction skills, most of the session time should be used to help parents apply problem-solving skills to determine how PCIT skills (including house rules and public behavior) can be used to solve any remaining child problems [including sibling problems]. If parents' skill level is the major focus, the session will begin with coding and coaching; if application of the skills to specific problems is the major focus, the session will begin with discussion and problem solving ♦ Parents’ ECBI scores typically decline steadily each week during treatment with only minor variations from the linear trend, and their DPICS scores typically show a steady improvement. Once the ECBI intensity scores are within ½ standard deviation of the normative mean (< 114) and the parents’ DPICS skills have reached mastery criteria, then Convey that they have learned the CDI and PDI skills so well that they have changed/learned to manage [specify the child’s presenting problems] Congratulate the parents If they indicate that they feel ready to end treatment, agree ♦ In 2-parent families, therapists strive to have both parents must achieve mastery criteria in the DPICS CDI and PDI situations and progress together through treatment steps. However, if the primary caregiver has met the criteria and has mastered the house rules procedure (or have no problems with aggressive/destructive child behavior), the child’s behavior is within normal limits on the ECBI, and the primary caregiver feels confident in managing the child’s behavior, then the family may graduate from treatment. Families may be ready for graduation as the fourth PDI coaching session. If parents who meet graduation criteria don't spontaneously indicate readiness to terminate treatment, elaborate on their progress and give them examples of how they are already using the principles to solve new problems. Let them know that it will always be important to have daily CDI sessions and to use PDI whenever they give important directions to their child, and that their child's behavior will continue to improve. Ask if they've thought about/talked about being ready to end weekly treatment sessions. ♦ If parents’ seem hesitant to end treatment despite skill mastery and child behavior within the normal range, you may suggest spacing the sessions out (e.g., every other week) until the parents gain more confidence in their own abilities, which will be a major target of remaining sessions. You may also reassure parents that if problems come up after treatment ends, they may always call for a booster session to get things back on track.\



Before the Session 1. .Review prior week and plan session. Review carefully any remaining problems and the previous week's interaction data to determine how close family is to graduation criteria. Plan whether to start with skills training or discussion of homework. Plan any special techniques you might use to move family forward in problem areas. 2. Give parents the ECBI in the waiting room before their session begins. 3. Materials needed: Stopwatch, ECBI, DPICS Coding Sheets, Parent CDI Coding Sheets, Parent PDI Coding Sheets, CDI Homework Sheets, PDI Homework Sheets, Progress Note, Integrity Checklist, DPICS Summary Sheets (for PDI and CDI), ECBI Graph. 4. If this is a Graduation Session, bring a blue ribbon and graduation certificate Goal of this Session ♦ Address whatever issues are preventing this family from meeting graduation criteria __________________________________________________________________________ Note: In each session, be alert for parent expressions of personal distress. These may occur during the initial homework discussion, or during discussion at the end of the session. In each session, it is important to spend a small amount of time (< 5 min) attending to parent personal stressors. Use facilitative listening skills to express concern. For integrity check: Discussed or inquired about issue unrelated to child behavior

____________________________________________________________________________ OPTION A ♦ This option is for parents who are having difficulties with their skills in session ♦ Start with coding and coaching “In today's session, we will begin with coding and coaching, and then we'll take time to discuss the homework at the end.” With one parent in treatment (10-20 minutes) 1a. Code CDI for 5 minutes “OK, now we’re going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing while you follow along with [child's name] in his/her game according to his/her rules.” 2a. If parent’s CDI skills are not at mastery level, coach CDI for 5 minutes, focusing on those skills that are not at criterion ♦ If skills okay, skip coaching 3a. Code regular PDI for 5 minutes “OK, now we’re going to code PDI for the next 5 minutes. Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.”



Option A (continued) 4a. If parent's CDI skills are not at PDI mastery level, coach the Clean Up situation for 5 minutes, focusing on those skills that are not at criterion "Now tell [child’s name] that it's time to clean up the toys. Get him/her to put all the toys in their containers and put all the containers in the toy box." ♦ If skills okay, skip coaching With two parents in treatment (20-40 minutes) [Start first either with the parent who started second last week, or with the parent who is having most difficulty learning the therapy skills] With first parent 1b. Code CDI with first parent for 5 minutes “We’re going to code CDI for the next 5 minutes. Try to use all the skills you've been practicing as you follow along with [child's name] in his/her game according to his/her rules.” 2b. If CDI criterion skills were not met, coach CDI with first parent for 5 minutes, focusing on those skills that need improvement: If skills okay, skip coaching. 3b. Code PDI with first parent for 5 minutes “We’re going to code PDI for the next 5 minutes. Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.” 4b. If PDI criterion skills were not met, coach the Clean up situation with the first parent for 5 minutes, focusing on those skills that need improvement. "Now tell [child's name] that it's time to clean up the toys. Get him to put all the toys in their containers and put all the containers in the toy box." With second parent 5b. Code CDI with second parent for 5 minutes

“We’re going to code CDI for the next 5 minutes. Use all the skills you've been practicing as you follow along with [child's name] in his/her game according to his/her rules.” 6b. If CDI skills are not at mastery criteria, coach CDI with second parent for 5 minutes, focusing on those skills that are not at criterion. If skills okay, skip coaching. 7b. Code PDI with second parent for 5 minutes “We’re going to code PDI for the next 5 minutes. Tell [child’s name] that it is your turn to choose the game. You may choose any activity. Keep him/her playing with you according to your rules.” 8b. If PDI skills are not at mastery criteria coach the Clean Up situation for 5 minutes, focusing on the specific skills that need improvement.



Option A (continued) WITH ALL FAMILIES IN OPTION A [Discussion focuses on how to improve parents' observed CDI or PDI skills, with less attention to child’s behavior at home] 9. Review DPICS Summary Sheets, and role-play skills not at criterion with the parent(s) 10. Collect both CDI and PDI homework sheets and comment on how many days practiced. If lack of enough practice is a problem, guide parents through problem-solving. 11. Have parent continue/modify any existing house rules and public behavior, as applicable. IF IN OPTION A, GO TO #12 (a or b) ___________________________________________________________________________ TREATMENT SESSION OUTLINE OPTION B •

This option is for parents who need more in-depth discussion of homework and its generalization/application to specific problem behaviors/situations, rather than skills training

•

Depending on family's need for any coaching, the session can start with maximally 40-minute discussion with one-parent family and 30 minute discussion with two-parent family “Today we will spend most of our time discussing how the CDI and PDI skills can be applied to the remaining problems on the ECBI, and then we'll take time to code CDI and PDI at the end to make sure their skills are still progressing/maintaining.”

1. Collect CDI Homework Sheets and comment. Give homework sheets for continued daily 5minute CDI sessions at home. 2. Collect PDI Homework Sheets and comment. Ask again approximately how many commands still require warnings. (Warnings should decrease 10% to 20% each week. If this is not occurring, there is some problem in the home practice. Have parents review the steps they use in PDI at home to discover the problem and solve it. 3. Assign parents to practice combining CDI and PDI in specific difficult situations at home, such as getting up time, bedtime, and dinnertime. Use PDI homework sheets to record daily practice of a combined situation. 4. Discuss public behavior homework. Continue structured homework situations if needed. 5. Discuss progress on house rules applicable for this family. Continue tracking, modifying, or adding house rules as necessary. On the PDI Homework Sheet, write in all house rules in the house rule column and have parents continue to record them each day.



Option B (continued) [In Option B, brief coaching after coding is optional and depends on clinical judgment; consider need and time. Coding is now conducted at the end of each session] Coding and Coaching With one parent in treatment 6a. Code CDI for 5 minutes 7a. Code PDI for 5 minutes 8a. Coach Clean-up until toys are cleaned up "Now tell [child’s name] that it's time to clean up the toys. Get him to put all the toys in their containers and put all the containers in the toy box." With two parents in treatment [Start first with the parent who started second last week] 6b. Code CDI with first parent for 5 minutes 7b. Code PDI with first parent for 5 minutes 8b. Code CDI with second parent for 5 minutes 9b. Code PDI with second parent for 5 minutes 10b. Coach Clean-up with second parent until toys are cleaned up. "Now tell [child’s name] that it's time to clean up the toys. Get him to put all the toys in their containers and put all the containers in the toy box." WITH ALL FAMILIES IN OPTION B 11. Review DPICS Summary Sheets with parents briefly. IF IN OPTION B, GO TO #12 (a or b) _____________________________________________________________________________ TREATMENT SESSION OUTLINE OPTION C ♦ This option is for the situation when the primary problems remaining are sibling issues ♦ A sibling between ages 2 and 8 may participate in this session with the target child ♦ Begin discussion with all family members present\ “Today we’ll begin by telling the children how this session will go. We want to practice both CDI and PDI with the children playing together with you. [or with two parents] One of you will be coached with the two children while the other observes with us from the observation room; and then you two will switch places half way through the session].”



Option C (continued)

1. Ask parents to describe how familiar the sibling is with CDI and PDI, and let children listen and comment if they wish ♦ Siblings usually know at least how it works because they have seen their parents practice it with their brother or sister. 2. Ask parents to explain to the children what they will be doing today – to tell them that today the three of them will play together and the parents will be helping to teach the children to get along together nicely, so if either child is not cooperative, either one might have to go to time out here at the clinic. But if the children listen and mind their parents, they will get to play together the whole time with these new toys. ♦ If the parents have not used PDI directly with the sibling, ask them to explain the timeout procedure to the sibling before they begin

3. With only one parent, coach the parent for 30-35 minutes with the two children in a combination of CDI and PDI (i.e., CDI unless there is a need to direct the behavior of one child or the other to maintain sibling cooperation in the game). With two parents, coach each parent for 15 minutes. [Note. The therapist needs to coach parents to target their PCIT skills on increasing cooperative child behaviors and decreasing uncooperative child behaviors] 3. After coaching, have parents discuss what they learned from being coached or watching their partner being coached with the children. Focus discussion on the specific CDI or PDI skills that seemed most helpful in avoiding conflict and what skills seemed most helpful for encouraging cooperative behaviors. 5.Collect the CDI and PDI homework sheets from the previous week and comment. Give new homework sheet to continue individual CDI, PDI, and house rules with the target child. 6. Assign parents to have two practice sessions of play with the two children together in the combination game, as practiced in the treatment session. Families in option C go from here to 12a or b



All Families ___________________________________________________________________________ IF THIS IS NOT A GRADUATION SESSION 12a. Confirm next appointment time ____________________________________________________________________________ IF THIS IS A GRADUATION SESSION 12b. Congratulate family 13b. Give child a blue ribbon for good behavior 14b. Give parents a certificate of completion 15b. Stress importance of continuing to use the PCIT skills they have learned --CDI in daily sessions and continuing to use PDI and house rules to maintain and continue to improve the child's positive behavior 16b. Give parents the Other Discipline Tools Handout and describe its use briefly 17b. Convey positive expectancies for the future 18b. Schedule the first post-treatment assessment with the family, if applicable. 19b. Schedule a booster session with the family ¡ Normally the booster will occur after 3 months, but this can be sooner if indicated

20b. Let the family know that they can call you if problems come up (even though you think they have the skills to solve most problems before they get to the phone!)




Mother


Father

Other ______________




TALLY CODES

TOTAL

TALK (TA) (ID + AK)

MASTERY __


10

REFLECTION (RF)

10

LABELED PRAISE (LP)

10 __


TALLY CODES

TOTAL

MASTERY

QUESTION (QU)

0

COMMANDS (DC + IC)

0


0

POSITIVE

CHECK ONE

IMITATE

SATISFACTORY

NEEDS PRACTICE

USE ENTHUSIASM

SATISFACTORY

NEEDS PRACTICE


SATISFACTORY

NEEDS PRACTICE

NOT APPLICABLE

OTHER (SPECIFY)






No Opp

Obey

Disobey

Praise LP or UP?

Chair Warn

Obey

Disobey

Praise LP or UP?

Timeout Chair

Timeout Room



SKILLS

Your name: _________________

Tally


Reflection

Labeled Praise

Unlabeled Praise*

MISTAKES Question

Command

Criticism












Father ___


Date




No

Activity




Father



Child’s Name _____________________







YES

NO

TIME OUT ROOM
















Days Practiced

HOMEWORK





OVER





ADVICE GIVEN:








NA

X

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 OVER




Therapist Comments about Session __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _________________________________________________________________________________




GRADUATION SESSION Expanded Outline Overview The final treatment session is entered from another session outline. To enter the graduation session, a child’s parents will have scored within ½ standard deviation of the normative mean on the ECBI Intensity Scale (raw score < 114) completed at the beginning of the session, they will have indicated that they feel confident that they can manage their child’s behavior on their own they, and they will have achieved or been very close to achieving graduation criteria on the DPICS interactions recorded during the previous week’s session. In this session, the parent-child interactions will be coded. If parents do not meet graduation criteria on this measure, they will return to the regular session outline. On the DPICS, both parents must meet graduation criteria unless the primary caregiver has achieved the criteria AND the family EITHER have no problems with public behavior and aggressive behaviors requiring house rules OR the family have successfully applied the house rules and public behavior procedures in the course of treatment (this could be as early as the 4th PDI coaching session). If the family meet graduation criteria, this session outline includes the steps for completing the last treatment session. Materials needed: ECBI, Blue ribbon, Graduation Certificate, stopwatch, DPICS Coding Forms, Parent CDI Coding Sheet, Parent PDI Coding Sheet, Progress Note, Integrity Checklist, Parent Child Interaction Summary Sheets for both CDI and PDI, ECBI Graph. ________________________________________________________________________________ Goals of the Graduation Session ♦ Assess graduation criteria ♦ Complete the final steps of treatment ♦ Convey a sense of pride and confidence in the parents ability to manage their child’s behavior effectively and to continue to do so after treatment has ended ♦ Review remaining study procedures with the family ________________________________________________________________________________ GRADUATION SESSION OUTLINE 1. Let parents know how pleased you are with the progress their child has made. Tell them we want to examine the child's behavior further to see how close we are to completing treatment with a high probability that the behavior changes will last. 2. Code 5 minutes of CDI and 5 minutes of PDI using Clean-Up directions with first (or only) parent. 3. Code 5 minutes of CDI and 5 minutes of PDI using Clean-Up directions with second parent if there are two parents.



DETERMINING IF THE FAMILY MEET DPICS CRITERIA FOR GRADUATION In 2-parent families, both parents must achieve mastery criteria in the DPICS CDI and PDI situations unless the primary caregiver has met the criteria and the family have learned and practiced the house rules and public behavior procedures or have no problems with aggressive/destructive behavior or public behavior.

4. If the parents meet mastery criteria in both DPICS situations, congratulate the parents on their excellent PCIT skills. 5. Give child a blue ribbon for good behavior. 6. Give parents a certificate of completion. 7. Stress importance of continuing to use the skills of CDI in daily special time with the child and using PDI and house rules calmly and regularly to maintain the child's good behavior and

continue to improve emotional adjustment. 8. Give parents Other Discipline Tools Handout and explain its purpose briefly

9. Schedule the first post-treatment assessment with the family, if applicable. 10. Schedule a booster session with the family [Normally the booster session will occur after 3 months, but this can be sooner if indicated]

11. Let the family know that they can call you if problems come up (even though you think they have the skills to solve most problems before they get to the phone!)



After PCIT ~

Other Discipline Tools In PCIT, you have learned to use timeout to deal with your child’s most difficult behavior problems. After treatment is over, timeout will continue to work for you and your child as long as it’s not used too often. If you have to use timeout more that five times a day, something is probably going wrong. You should call or come in to talk to your therapist if this happens. To avoid having to put your child in timeout too often, you should try not to have too many active house rules. Having more than 2 or 3 house rules at a time is too hard for a child to remember. It is best to have house rules just for serious problem behaviors (like hitting). Children who have attention problems often misbehave without even meaning to (like yelling, or running in the house). For these less serious behavior problems, it is best to use other types of discipline besides timeout and house rules. Here are some other discipline tools you can use to help your child behave~

Increasing the Special Time You Spend with Your Child If your child seems angry or upset a lot of the time, it often helps to give your child more special time alone with you. When your child is getting lots of warm, good attention, he will be less likely to behave badly. Distracting Sometimes if your child is starting to act up you can stop the negative behavior by distracting your child. To do this, ignore the bad behavior and get your child’s attention focused on something else. For example, if your child begins to play roughly with her toys (e.g., banging or throwing them), ignore her behavior, move to a quieter toy (such as coloring), and try and get her interested in the new activity (e.g., “I have so much fun coloring with you. Daddy will love to see your pretty picture.”) Special Ignoring This tool is like a house rule for small but annoying problems. Special ignoring starts by having a meeting with your child at a calm time. During the meeting, tell your child exactly what behavior you want to stop. Explain to your child that every time your child does that behavior, you will either turn away or walk away. For example, if your child whines a lot or sasses, have a meeting with her and tell her that, from now on, any time she whines or sasses, you will walk away.



1. Rewarding the Opposite of the Problem Behavior Decide what behavior is the opposite of the problem behavior (for example, sitting quietly is the opposite of making too much noise, and sharing toys is the opposite of grabbing toys). Then, give attention and praise to the good opposite behavior as much as you can. It is best to “catch” your child doing the good opposite behavior before he even has the chance to do the bad behavior. For example, if your child fights too much with his sister, try to catch him playing nicely with his sister. Whenever you “catch” your child playing nicely with his sister, NOTICE IT and give your child lots of praise for this good behavior (“Thank you for playing so nicely with your little sister. She thinks you are the best brother in the whole world”). You can also give rewards for positive opposites now and then. (“Wow! You guys got along the whole time since dinner! That deserves ice cream before bed!”) Using an If-Then Plan For school-aged children, you can create rewards for certain things you want them to do. You should choose what you want to see your child do more, and pair it with a special treat your child truly enjoys. For example, if your child really likes riding his bike, then you could tell him, “If you finish your math homework, then you may ride your bike.” If you want your child to do some bad behavior less often, you should choose the opposite good behavior. For example, if you want your child to stop eating crumbly snacks in the living room, you can say, “If you sit at the table, then you can have the potato chips.” If your child is used to having these treats without having to “earn” them, he may really be mad about these new rules. Make sure the rule is important. If it is, then stick with it! Do not let your child have the “then” before completing the “if.” That is, the child who won’t sit at the table should not get the snack, now or later.

R2. emoving Fun Time or Toys Loss of fun time means that your child is not able to do something that she enjoys because of her bad behavior. Examples include loss of TV time, loss of Nintendo or computer time, loss of telephone use, or loss of getting to go to a sleepover. Taking away toys for younger children teaches them that there are consequences for naughty behavior. Choose an activity that your child likes when deciding what to take away, but don’t make your child lose the activity for too long. Young children should usually not lose fun time or toys for more than one day. Teenagers should not lose privileges for longer than one week.

Sticker Chart ©1999 SHEILA M. EYBERG


Sticker charts work best for children between the ages of 5 and 8. They work best for rewarding chores or behaviors that you want your child to do everyday. This is how you set this up~ Step 1 Make a list of chores or behaviors that you want your child to do everyday Work with your child in making the list. The more your child is involved, the more likely it is that your child will understand the list and work hard at earning stickers. Be very specific when listing the behaviors. For example, if your child’s room is messy because he throws clothes on the floor, you should list behaviors like, “Put clothes away,” instead of, “Clean bedroom”. If you want your child to get ready for school on time, you might list, “Dressed before 7:15” and “Backpack packed before 7:30” instead of listing, ” “Ready for school by 7:30.” List behaviors in positive terms--that is, list behaviors you want your child to do more, not behaviors that you want to stop. For example, you would list: ”Walk in the house” instead of “No running in the house.” Step 2 Decide how many stickers your child needs to earn in one day to get a reward For example, if you have 6 behaviors on your list, your child may have to earn 4 stickers to get a reward. Try to set the amount at something you think your child CAN do if he tries. Later, if it seems like your child is not having to work to earn the reward, you can raise the number of stickers he needs to earn it. You can also give “bonus” stickers when your child does a chore very well or when she independently shows good behavior that is not on the list. Step 3 Talk to your child about possible rewards that she can earn each day Some examples would be staying up ½ hour later, having extra TV or computer time, or getting to have a popcorn snack before bed. Your child will like the sticker system more if allowed to help choose the rewards. Sometimes, what parents think are good rewards, a child might think are not really worth working for. Parents may agree or disagree with the child’s ideas for a reward. Unless it is “out of the question,” try to go with it! You will need to change the rewards every week or two so that your child does not lose interest in them. Along with daily rewards, some parents also have weekly rewards for a total number of stickers earned. For example, if the chart had 6 behaviors each day (42 possible stickers in a week), you might give a weekly reward, like going to the park on Sunday if your child earned 28 stickers or more during the past 7 days.



Step 4 Make a sticker chart (see the example on the last page) Be sure to include The behaviors you want to increase The days of the week Space to add up the total stickers the child earns each day The number of stickers your child needs to earn each day, and during the whole week, to get the rewards What the rewards will be during this week Step 5 Remind your child about the sticker chart and what he needs to do to earn stickers Have your child help you put sticker on the chart throughout the day. For younger children, it is best to give them the sticker as soon as they do the behavior as an immediate reward. School-age children may be able to wait until the end of the day to fill in the whole chart. Praise your child when he earns stickers, but avoid criticism if he has had a hard day (Remember, losing the reward will be punishment enough).

See the sticker chart that Taylor and his mom made on the next page

Many parents continue to feel that they can handle things on their own after treatment has ended. Sometimes, though, things get worse at home after treatment ends, and parents start to feel overwhelmed again by the problems. You may call your PCIT therapist at [ ] at any time after finishing treatment if you feel the need for more help.



Taylor’s Chart Weekday Good Behavior

Pack backpack by 7:30.

MON

TUES

WED

THURS

FRI

Earned stickers go here

Talk nicely to brother on the drive to school.

Weekend Good Behavior

Put dirty clothes in laundry pile (Saturday). Take turns when playing video games with brother.

Work on homework for ½ hour or more after school

Put your church clothes on by 10:00 (Sunday)

Chew with mouth closed during dinner.

Chew with mouth closed during dinner.

Take out garbage before 8:00. Extra good behavior

BONUS Total number of stickers earned for the day.

SAT

SUN

----------

---------

Take out garbage before 8:00. Extra good behavior BONUS Total number of stickers earned for the day.

If you earn 3 stickers in one If you earn 4 stickers in one day, your reward will be Mom will read a chapter from “Lassie” before bed.

weekend day, your reward will be Dad will play ball with you outside for an hour.

If you earn 25 stickers this week, your reward will be rent a video game on Sunday night.




Mother


Father

Other ______________




TALLY CODES

TOTAL

TALK (TA) (ID + AK)

MASTERY __


10

REFLECTION (RF)

10

LABELED PRAISE (LP)

10 __


TALLY CODES

TOTAL

MASTERY

QUESTION (QU)

0

COMMANDS (DC + IC)

0


0

POSITIVE

CHECK ONE

IMITATE

SATISFACTORY

NEEDS PRACTICE

USE ENTHUSIASM

SATISFACTORY

NEEDS PRACTICE


SATISFACTORY

NEEDS PRACTICE

NOT APPLICABLE

OTHER (SPECIFY)






No Opp

Obey

Disobey

Praise LP or UP?

Chair Warn

Obey

Disobey

Praise LP or UP?

Timeout Chair

Timeout Room



SKILLS

Your name: _________________

Tally


Reflection

Labeled Praise

Unlabeled Praise*

MISTAKES Question

Command

Criticism

Comments about parent-child interaction today ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________;







Comments about the PDI Interaction

_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________




Father ___


Date




No

Activity




Father



Child’s Name _____________________





YES

NO



TIME OUT ROOM
















Days Practiced

HOMEWORK









ADVICE GIVEN:








NA

X

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 OVER








Appendixes A. General CDI Coaching Guidelines B. Optional Treatment Materials



CDI Coaching General Guidelines To help parents learn CDI quickly, try to provide a comment after every parent verbalization. Comments should be positive rather than critical. It may be helpful to tell the parent directly what to say at times, such as “Please say, 'I like it when you let me build with you" or “Say: ‘good one to choose!'" If a parent is having difficulty learning a particular skill, rather than pointing out their error repeatedly, it may be useful to introduce an “experiment:" Say something like, “I want to try an experiment. For the next two minutes, I want to concentrate just on praising. Try to see how many praises you can give in the next two minutes. Ready… Go ahead." Then enthusiastically count aloud after each praise they give. If they seem to have difficulty finding praiseworthy behaviors, suggest behaviors they can praise. If they seem to have difficulty creating a praise statement, suggest it for them: “Maybe you could say, ‘Nice drawing!’” When the parent .follows your suggestion, count it! For example, “Three! She likes your praise! Now find something else you can praise.” Parents generally go through a progression of acquiring the skills. Initially they feel most comfortable describing and imitating the play. As they work on eliminating questions, their rate of reflections slowly increases. Labeled praise is usually the last skill they master. In addition to coaching specific verbalizations, good coaching includes attention to the qualitative aspects of the interaction, such as physical closeness and touch, good eye contact, genuineness in tone, expressions of enjoyment and enthusiasm in the interaction, and promoting cooperative play. For example, “That sounded very genuine.” End the play session by telling the parent something like, “Time for special time to be over. Please tell (Johnny) how much you enjoyed playing with him and how good he is at . . . (playing quietly, drawing, working carefully, etc.)." Encourage parents to provide physical praise during these closing remarks (pat, hug, etc.).



Common CDI Coaching Statements Labeled Praises Good ignoring.

Nice eye-contact.

Great teaching!

Good catching that question!

Terrific enthusiasm!

Nice physical praise.

Good encouraging his creativity.

Good answering his question.

Excellent labeled praise!

That’s nice imitation of his play.

Good idea to set an example for gentle play.

Nice timing on giving him back your attention.

Gentle Correctives Oops, a question!

A little leading.

Was that a command?

Looks like a frown.

Sounds a little critical.

Might be better to say…

Did you catch that?

You’re getting a little ahead of her now.

Directives Try to label it.

What can you praise now?

Can you reflect that?

Say “Nice manners!”

Praise her for sharing.

More enthusiasm!

Now make it a statement.

You can answer her question.

Try holding it for her.

How about a hug with that praise?

Say it again, but drop your voice at the end.

Let’s ignore until he does something neutral or positive.

Observations He is enjoying playing with you.

He loves your praise.

She’s sitting nicely now.

Now he’s imitating YOU.

He’s learning how to take turns in a conversation today.

That’s good practice for her fine motor skills.

That praise is good for her selfesteem.

She’s handling frustration a little better now.

He’s talking more now because you’re reflecting.



How to Create Great Labeled Praises WAYS TO PRAISE IT . . .

PRAISABLE BEHAVIORS . . .

That’s a great way to . . .

play gently with the toys

You’re doing a nice job of . . .

using your indoor voice

I like it when you . . .

share the blocks

It’s neat that you remembered to . . .

put away the cars first

What a wonderful idea to . . .

draw a picture for sister

Thank you for . . .

asking politely

Nice job of . . .

sitting still

How sweet of you to . . .

make one for me too

You should be proud of yourself for . .

minding so quickly

I’m proud of you for . . .

keeping on trying

You are so smart to . . .

fix it all by yourself

I’m so happy with you for

doing what I asked you

Super . . .

manners!

You’re so polite to . . .

say thank-you

Good . . .

listening!

I like it when you . . .

talk like a 6-year-old

Good girl for . . .

waiting your turn

It’s nice that you are . . .

sitting at the table with me

It’s so cool that you’re . . .

putting the cows to bed on time

I love you . . .

Always!



Practicing Labeled Praise for Positive Opposites PROBLEM BEHAVIOR Disobeying

Minding

LABELED PRAISE Thank you for minding.

Grabbing toys

Asking politely for toys

Good job of asking politely.

Yelling

Swearing

Playing “deaf”

Being bossy

Excessive talking

Whining

Throwing toys

Hitting parent when told no

Wandering around the room


OPPOSITE BEHAVIOR


Changing Ineffective Commands to Effective Commands CUT IT OUT!

Put your hands in your lap.

Get the pink pigs and close the toy box and sit over here to play.

First get out a pink pig.

Will you please put that away?

Please put that away.

Hand a red one. The blue ones are too big. The red ones are the little ones.

These little red blocks will make a pretty house. Those blue blocks are too big for my house. Hand me a red one.

Behave.

Give me the hammer.

(To a 3-year-old child) Put that sticker by the vertical line.

(To a 3-year-old child) Put that sticker by the line that goes up and down right here.

Stop drawing on the walls.

Draw on the paper.

Don’t put that chimney on. Be a good boy today. Clean up all those toys. Can you draw a snowman here? Mind me. Put the cars in this pile and put the trucks back in the toy box. Quit yelling. Would you like to go to time out? Don’t pick up your candy off the dirty floor. Take it apart. We have to go home now, so everything has to be cleaned up. I don’t want you crawling under the table. Stop that noise. Don’t touch the chalk.



Teaching PDI to Children with Mr. Bear The use of Mr. Bear to teach PDI to the child originated in the UC Davis PCIT group for the treatment of physically abused children with disruptive behavior. We have found this teaching method useful clinically with some families. RECOMMENDED SESSION OUTLINE

1. Set up an age appropriate treatment toy that can be easily used for teaching PDI skills (blocks, farm animals, car garage) 2. The therapist is present in the therapy room and interacting with the parent(s), child, and Mr. Bear during the first part of the session 3. Begin session with one parent interacting with the child and Mr. Bear and the other(s) observing 4. Use play talk for Mr. Bear’s voice INTRODUCING MR. BEAR 1. Begin by introducing Mr. Bear and the child to each other 2. Explain to the child why Mr. Bear is in the session “I brought in Mr. Bear today because we are going to do something different. We are going to practice minding today with Mr. Bear.” 3. The therapist should begin playing with Mr. Bear. Make sure to involve the child in the play. MR. BEAR COMPLIES 1. Once the child appears comfortable with Mr. Bear in the playroom, give a command to Mr. Bear. Example: “Mr. Bear, please hand me the red car”. 2. (Moved by the therapists hands) Mr. Bear complies with the therapist’s command. 3. Praise Mr. Bear for complying. Point out that Mr. Bear minded right away. Example: “Mr. Bear, thank you for handing me the red car. I like it very much when you mind me right away. That makes me so happy.” 4. Practice a command that involves the parent or child Examples: “Mr. Bear, please hand Mrs. Doe the cow.” 5. Have Mr. Bear comply with the command and then praise him for complying. Example: “Thank you Mr. Bear for handing Mrs. Doe cow”. 6. Continue to play and practice compliance with the therapist, parent, and child for a few minutes.



MR. BEAR NEEDS A WARNING

1. Have Mr. Bear comply with the command and then praise him for complying. Example: “Thank you Mr. Bear for handing Mrs. Doe cow”. 2. Give Mr. Bear a command, and have Mr. Bear not obey. 3. When Mr. Bear does not comply, point this out to the child and let him know that Mr. Bear is going to get a warning. Example: (Turn to child and say) “Uh oh, Mr. Bear isn’t doing what I asked. Since he is not doing what I asked, I am going to give him a warning.” 4. Turn to Mr. Bear and give the warning (the same wording taught to parents in PDI). “Mr. Bear, if you don’t (insert command), you will have to go to the time-out chair”. 5. Have Mr. Bear comply this timeShow the child that complying is a good thing!! Example: “Good choice Mr. Bear, I like it that you minded me and (insert command). That way you don’t have to go to time out and we can stay here and have fun. MR. BEARS GOES TO THE TIME OUT CHAIR

1. Give Mr. Bear a command. 2. Point out to the child that Mr. Bear is not complying. Example: “Uh-oh. Mr. Bear is not listening again” 3. Give Mr. Bear the timeout warning. Mr. Bear still does not comply. 4. Tell the child that Mr. Bear has to go to time out. Example: “Mr. Bear didn’t listen to me and do what I asked. He needs to go to time out.” 5. Put Mr. Bear on the chair and say the following: “Mr. Bear, you didn’t do what I told you to do so you have to sit on the chair. Stay on the chair until I say you can get off.” 6. Come back and explain to the child why Mr. Bear had to go to time out. Example: “Mr. Bear had to go to time out because he didn’t mind me. I asked him to (insert command) and he didn’t do it. Then I gave him one warning. I said ‘Mr. Bear, if you don’t (insert command), then you have to sit on the time-out chair,’ and he still didn’t listen, so I sent him to time out.” 7. Once Mr. Bear is in the chair, point out appropriate time out behavior to the child. Example: “Mr. Bear is sitting so nicely in the chair like I told him to. He’s not kicking, or wiggling in the chair, and he’s not making any noise. He’s acting nicely on the chair so I’m going to ask him if he’s ready to (insert command).” 8. Ask Mr. Bear if he’s ready to (insert command) and have him comply. Give a simple acknowledgment. 9. Give Mr. Bear another command, have him comply, and give him lots of praise this time. Point out that Mr. Bear complied RIGHT AWAY and THE FIRST TIME!! ©1999 SHEILA M. EYBERG


PRACTICE WITH THE PARENT AND MR. BEAR

1. Explain to the child that now it’s the parent’s turn to play with Mr. Bear. 2. Have parent(s) go through giving commands and have Mr. Bear obey or not obey in the following sequence: ⇒ Comply-praise ⇒ Noncomply-warning-comply-praise ⇒ Noncomply-warning-noncomply-time out 3. Coach parent throughout and explain to the child why Mr. Bear is getting praise, warning, time out Examples: “Mr. Bear has to go to time out because he didn’t listen to your mommy” “Your dad asked Mr. Bear to (insert command) and he didn’t, so he had to go to time out” “Mr. Bear is sitting very quietly in time out” “When voices come out of Mr. Bear’s mouth, he has to sit in time out longer” HAVE CHILD PRACTICE WITH MR. BEAR 1. Explain to the child that now its their turn to play with Mr. Bear 2. Have child go through giving commands and have Mr. Bear: ⇒ Comply-praise ⇒ Noncomply-warning-comply-praise ⇒ Noncomply-warning-noncomply-time out ⇒ If necessary, prompt child to give Mr. Bear a command 3. Coach child throughout and explain to the child why Mr. Bear is getting praise, warning, sent to time out Example: “You put Mr. Bear in time out because he didn’t mind you PARENT AND CHILD PRACTICE ALONE

1. Therapist tells child it’s now time for the parent and child to play together (therapist leaves the room) 2. 2. Parent and child continue to practice compliance/time out with Mr. Bear while therapist coaches the parent via “the bug” 3. The parent reminds the child why Mr. Bear is praised/given a warning/sent to time out 4. Encourage the child to participate in the “disciplining”



The Turtle Technique Read this story to the child Once there was a young turtle named Tim. Tim used to get very angry all the time. Sometimes he would get so angry that he would hit people. Then he would get into trouble and feel bad. One day Tim met a wise, old turtle. The old turtle told Tim that he used to get very angry, too. “But then,” he said, “I learned a new thing to do that helped a lot.” “What?” asked Tim. “I pull my head and my hands and feet into my shell like this,” said the old turtle. “Then I take deep breaths until I feel better. I don’t come out of my shell until I’m sure I won’t hit anybody. The next day, Tim went to school. One of the other young turtles called him stupid. Tim felt himself getting very angry. Then he remembered what the wise old turtle had told him. He curled into his shell and took deep breaths until he felt calm. Then he went on with his day and did not let the other turtle bother him. Tim’s teacher told him what a good turtle he was, and he felt very proud of himself. From then on, Tim used the Turtle Technique whenever he felt very angry. He made many new friends and his mom and dad were very proud of him.

Tell the child, “You can use the Turtle Technique, too, when you feel angry. Let’s practice.” Practice technique with child and discuss when to use it (use specific examples of situations that you know the child finds difficult). Show the child and parent the Turtle Technique reinforcement sheet (next page) and discuss possible rewards with them.



Calm Down Turtle

Child gets to color in 1 section of the turtle every time he/she practices the Turtle Technique. Child gets to color in 4 sections of the turtle if he/she uses the technique to calm down when he/she is mad. 4 sections = small reward ______________________________ Whole turtle = big reward ______________________________



Differential Social Attention For ADHD Good Ways to Respond to Positive and Negative Behaviors in the Child Directed Interaction

Young children who have ADHD tend to be impulsive, hyperactive, and inattentive. As a result, a lot of their behavior can seem like misbehavior -- but it is really just a reflection of their diagnosis. Here are some examples:

Impulsive Behavior ♦ ♦ ♦ ♦ ♦ ♦

Interrupting your conversation Grabbing toys out of your hands Answering before you finish your question Starting to do something before you finish giving the directions Not waiting their turn Having trouble waiting

Hyperactive Behavior ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

Running around the room Becoming very “wound up” during playtime Playing roughly with toys Dropping things Knocking things over Bouncing in their chair Fidgeting when they should be sitting still Talking too loudly/yelling

Inattentive Behavior ♦ ♦ ♦ ♦ ♦ ♦

Daydreaming when they should be listening Paying attention to something else when they should be listening Making noises (such as humming) when they should be quiet Not finishing what they start Forgetting what they were saying or doing Changing activities quickly

Many people find these behaviors annoying or irritating, so parents often want to do something to stop them from happening. Because these behaviors are part of your child’s disorder, however, punishing your child will usually not work. It often just upsets everybody more. A simple way you can deal with these ADHD behaviors is to ignore them. If you ignore these behaviors, you won’t accidentally cause your child to do them more. (Even these ADHD behaviors can get worse if children get rewarded by attention when they do them.) Children with ADHD need to get rewarded by attention when they do things that are NOT impulsive, hyperactive, or inattentive. (They should also not get attention if they misbehave on purpose, of course!).



What is NOT an ADHD Behavior? When you ignore your child’s ADHD behaviors, that can be a lot of behavior. You don’t want to ignore your child completely! Yet it is harder to notice behavior that is NOT ADHD because it is quieter and calmer, and it doesn’t bother you. It takes practice to notice other behaviors in children with ADHD. Here are some non-ADHD behaviors: ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡

Playing quietly Waiting your turn Looking at your mom when she talks to you Sitting very still Using your indoor voice when you are indoors Walking when you are inside Keeping your feet on the floor Keeping your hands to yourself Asking politely Sticking with something that is hard Finishing things

When you take away attention from your child for ADHD behaviors, you must give it back for nonADHD behaviors. When you give attention for a non-ADHD behavior that is exactly the opposite of their problem behavior, you are giving attention to POSITIVE OPPOSITE behavior.

Here’s How you Ignore ADHD Behaviors ¡ Avoid making any verbal or non-verbal reaction to your child’s ADHD behavior (don’t look,

smile, laugh, frown at your child – act as though it really isn’t happening) ¡ Once you begin ignoring, you must continue to ignore until the behavior stops ¡ As soon as the behavior stops, you pay attention to good behavior, especially the positive

opposite

Here’s How you Pay Attention to Positive Opposites ¡ As soon as an ADHD behavior stops, look at the child with a friendly look and comment on

what the child is doing that is the opposite of ADHD behavior ¡ Any time you see behavior that is opposite to the ADHD behaviors that are hardest for your

child to control, give the child BIG labeled praises

Example of using Attention and Ignoring in CDI for Impulsive Behaviors ¡ Your child grabs a block out of your hands while you are building with him.

1. Ignore the grabbing – just turn away, pick up a different toy out of your child’s reach, and pay attention to your own toy. 2. Out of the corner of your eye (or ear), watch (listen) for ANY good behavior, especially anything that is the opposite of impulsive behavior. 3. As soon as you find a good behavior, give your child immediate attention for it: “You’re sitting in you chair nicely while we play.” 4. Keep giving your child positive attention as long as no further impulsive behavior occurs: “And you’re putting pieces on your house carefully. That’s a good way to make a strong house.” 5. Pay special attention for any occurrence of a positive opposite -- in this case that might be asking for a block you are holding instead of grabbing it. 6. Give your child HUGE labeled praises for a positive opposite: “Thanks for asking me so nicely! Here’s the block you want. I like sharing with you when you ask politely. ” ©1999 SHEILA M. EYBERG


Examples of using Attention and Ignoring in CDI for Hyperactive Behaviors ¡ Your child gets over-stimulated and starts running around the playroom

1. Ignore this behavior – play a game of your own with the toys at the table. 2. (You do need to make sure your child is safe, so without letting your child know you are paying any attention, you need to notice if your child is doing anything dangerous – usually this will not be the case). 3. Wait until your child calms down, and then give very obvious attention to what your child is doing: “I like it when you come over to play with me. I like to play with you.” ¡ Your child begins to play roughly with the toys

1. Ignore the way your child is handling the toys. 2. Wait until your child plays nicely with the toys again, and give positive attention: “You’re playing gently with the toys. I like how careful you’re being.” ¡ Your child begins to fidget in his chair during playtime

1. Ignore your child’s fidgeting – don’t comment on it. 2. Be on the lookout for any time your child is not fidgeting while you play. 3. Praise your child every time you catch him/her sitting still: “You’re sitting nice and still. I can tell you’re really paying attention.

Examples of using Attention and Ignoring in CDI for Inattentive Behaviors ¡ Your child becomes distracted from building a log house when one of the logs drops to the

floor. Your child dives to the floor to get the log and begins rolling recklessly on the floor with the log, pretending it is a rifle and making loud explosive noises as he rolls. 1. Ignore the child’s behavior because it is too “wild” for indoor play. 2. Continue to put logs on the house and describe your own behavior. 3. If the child returns to the play table where you are building, praise positive opposite behavior: “I’m glad you came back to play table.” 4. Continue to look for positive opposites to describe and praise, which may help to hold your child’s attention to a constructive task: “You look curious about where I’ll put this chimney. Thanks for coming back to finish the house with me. You’re a good builder.” ¡ Your child becomes distracted by a mural on the wall while the two of you are building a Lincoln Log house 1. In CDI, the basic rule is to follow the child’s lead – the child’s interest in the mural is an acceptable behavior. 2. Follow the child’s lead and pay attention to what he is saying about the mural.

When you Can’t Ignore There are times you cannot ignore your child’s behavior -- is when it is dangerous, destructive, or aggressive. Keep in mind, however, that most ADHD behaviors are just annoying, not hurtful. Some examples of behaviors that cannot be ignored: ♦ Child begins climbing on furniture -- could hurt himself if he fell ♦ Child runs out of the playroom – could get lost ♦ Child pounds hard toy on observation window – could crack window ♦ Child begins hitting mother – could hurt mother If these behaviors occur during your special CDI time with your child, simply turn to the child and tell him or her that special time is over and why. These situations usually require PDI skills.



How to Ignore ADHD Behaviors During the Child Directed Interaction BEHAVIOR MANAGEMENT

IGNORE hyperactive, impulsive, inattentive behavior (unless it is dangerous or destructive) •

Avoid giving your child any attention, such as looking at the child, smiling, frowning, commenting on the child’s behavior

•

Ignore the annoying behavior every time it occurs

•

Expect the ignored behavior to increase at first

•

Continue ignoring annoying behavior once you start ignoring it

•

REASON

•

Ignoring helps your child to notice the differences between your reaction to annoying and your reactions to positive behavior

•

Although the ignored behavior may increase at first, consistent ignoring decreases many behaviors

•

Praising the positive opposite behavior lets your child know what he or she can do to please you – and to win your attention


Impulsive Behaviors Child: (grabs blue crayon out of parent’s hand) Parent: (looks away as if nothing happened) Child: Can I have the red? Parent: Thanks for asking nicely. That makes me want to share with you Hyperactive Behaviors Child: (running around the room with a toy airplane) Parent: (ignores) Child: (Finally settles down and plays at the table) Parent: I like it when you play with me at the table. Inattentive Behaviors Parent and Child: (playing together with Mr. Potato Head at the table) Child: (starts flicking Legos off the table) Parent: (ignores “off-task” behavior and talks to self, describing own play with Mr. Potato Head) Mr. Potato Head, you look funny wearing these big red lips! Child: (stops flicking Legos and giggles at Mr. Potato Head) Parent: I’m glad you’re paying attention to Mr. Potato Head.

Praise your child immediately (and any time) for behavior that is opposite of an annoying behavior

STOP THE PLAY for dangerous, aggressive and destructive behavior

EXAMPLES

•

Teaches your child that good behavior is required during special playtime

•

Shows your child that you are beginning to set limits

Child: (becomes very wound up and starts climbing on the table) Parent: (STOPS CDI -- this can’t be ignored.) Special time is stopping because you are climbing on the table. That is dangerous.