Program Goals
Early childhood behavior problems occur in as many as 15 percent of young children (Carter, Briggs–Gowan, and Davis 2004). If the issues persist, they can lead to severe school-age conduct problems (Shaw et al. 2003), later difficulties in academic functioning and peer victimization (van Lier et al. 2012), and increased risk for more severe adult psychopathology (Moffitt et al. 2002). The Infant Behavior Program is a brief, home-based adaptation of the Child-Directed Interaction phase of Parent–Child Interaction Therapy that is designed to be more accessible to families with high-risk infants ages 12–15 months. The goal is to decrease infants’ externalizing problems by actively coaching caregivers to follow their child’s lead in play.
Program Components/Key Personnel
The Infant Behavior Program maintains the core features of Parent–Child Interaction Therapy while adapting it to address the developmental needs of infants. The program consists of roughly six sessions, about 1–1.5 hours each, which are delivered weekly at the participating family’s home. In the first teach session, the therapist teaches the parent or parents to follow their infant’s lead in play by decreasing “don’t” skills and increasing “do” skills. “Don’t” skills are commands, questions, and negative statements, and “do” skills involve parents using PRIDE skills: Praising the infant, Reflecting the infant’s speech, Imitating the infant’s play, Describing the infant's behavior, and expressing Enjoyment in the play. Parents are taught to direct the PRIDE skills in response to their infant’s appropriate play and to ignore disruptive behaviors such as hitting or whining (Bagner et al. 2013). Following the teach session are about five coaching sessions during which the therapist provides live coaching to parents while they play with their infant. In addition to standard coaching practices, therapists incorporate various strategies that are developmentally appropriate for infants. For example, given infants’ lower receptive language abilities, parents are encouraged to use non-verbal praise (e.g., clapping) along with verbal praise to enhance reinforcement for appropriate behaviors. Consistent with research on Parent–Child Interaction Therapy for children with developmental delay (Bagner and Eyberg 2007), parents are also encouraged to repeat appropriate infant vocalizations. Outside of sessions, parents are instructed to practice the skills they learned with their infant during 5 minutes of “special time” every day. Parents are also asked to complete weekly logs documenting frequency of practice.
The therapists delivering the intervention are doctoral students in clinical psychology who are trained by a Parent–Child Interaction Therapy Master Trainer. After the teach session, the therapists conduct a 5-minute observation at the start of each subsequent session to coach the parent or parents in their use of the skills. In each session, the therapist problem-solves with the family ways to optimize in-home coaching, such as choosing an appropriate location for the session and developing ways to minimize distractions (e.g., turning off the television) (Bagner et al. 2016).
Program Theory
Patterson’s coercion model is a theoretical underpinning of behavioral parent training and supports interventions with young children, including the Infant Behavior Program. It suggests that behavior problems are established and maintained in infancy as a result of early parenting behavior (Patterson 2002). Therefore, the transition into the second year of life (i.e., 12 to 15 months) is an ideal opportunity to intervene as parents begin to face challenges with their infant’s increased mobility and desire to exert independence, but before problems continue (Bagner et al. 2016; Egger and Angold 2006).
