Reconceptualizing attrition in Parent-Child Interaction Therapy: "dropouts" demonstrate impressive improvements

Purpose: Behavior disorders in early childhood are linked to a variety of negative outcomes for both children and families. Parent-Child Interaction Therapy (PCIT), an evidence-based parent-training program, demonstrates large effect sizes in reducing child problem behavior for dyads who complete treatment; however, a high number of families seeking treatment in community-based settings terminate from PCIT prior to meeting the protocol's strict graduation criteria. The purpose of this study was to examine the impact of PCIT on child behavior problems for families who received at least a small dose of PCIT but not enough to meet the strict mastery criteria required for graduation. Patients and methods: This study employed one of the largest community research samples conducted with PCIT (2,787 children and their families across the state of Oregon, 1,318 with usable data) to determine how PCIT impacts both graduates and early terminators. Results: While families who graduated from PCIT (17.7% of the sample) demonstrated a very large effect size in problem behavior intensity improvements (d=1.65), families who terminated treatment early, but after attending at least four treatment sessions (51.7% of the sample), still showed significant improvements in behavior problems with a medium-to-large effect size (d=0.70). In contrast, very early terminators (those attending fewer than four treatment sessions, 0.3% of the sample), demonstrated little improvement at the time of dropout from services (d=0.12). Conclusion: Though early terminators in PCIT have previously been identified as treatment failures, the present study discusses the reconceptualization of "dropouts" in relation to some positive evidence of treatment outcomes, the implications for community-based service delivery, and possible future directions.