Parent-Child Interaction Therapy and Language Facilitation: The Role of Parent-Training on Language Development

Introduction High rates of comorbidity exist between language impairment and behavioral problems in children. Roughly half of language-impaired children are diagnosed with one or more co-occurring behavioral disorders. Interestingly, an estimated average of 71% of children seen clinically for externalizing behavioral disorders are also suggested to have clinically significant language deficits, (e.g., Benner, Gregory, Nelson, Ron, Epstein, & Michael, 2002; Cohen, 2001). The high prevalence rates of these disorders are well established, yet the etiology of the relationship between language impairment and behavior disorders continues to be debated. Processing and language-production difficulties may result in inattentiveness, aggression, or social withdrawal. Behavioral difficulties may also lead children with behavioral problems to be less responsive to adult attention, further delaying the development of language skills. Although both of these causal relations seem plausible, language difficulties and behavioral problems may also be influenced by alternative environmental, biological, or individual characteristics (e.g., parenting style, socioeconomic status, gender). Regardless of causal pathways, language delays put individuals at risk for numerous adverse outcomes (e.g., low educational attainment, aggression). Given the negative consequences of delayed language development, there has been considerable focus on clinical interventions aimed at increasing child verbalization skills. Some of these skills have been addressed specifically within the speech and language literature through clinician-directed and child-centered intervention approaches. However, the uncontested influence of parents in child-language development supports the need for further incorporation of parenting techniques aimed to facilitate language. In particular, parenting interventions targeting young children such as Parent-Child Interaction Therapy may teach parents skills to help foster children's language development. Parent-Child Interaction Therapy (PCIT) is a behavioral parent training program empirically supported for the treatment of disruptive behavior in children 3 to 6 years of age (Eyberg, Nelson, & Boggs, 2008). PCIT's emphasis on direct parent-child practice allows clinicians to coach as parents act as their child's own therapist. The first stage of PCIT, Child-Directed Interaction (CDI), resembles facilitative play as it implements parenting techniques (e.g., praise, reflection, imitation, description) aimed at enhancing the quality of communication within parent-child interactions. Facilitative play is an approach described within the speech and language literature in which clinician-arranged activities provide the child with opportunities to demonstrate target behaviors during natural play (Paul, 2001). The second stage of PCIT, Parent-Directed Interaction (PDI), focuses on discipline and limit-setting. Within both stages of intervention parents are coached and coded through dyadic play situations as they work to reach and maintain a level of skill mastery. Although originally developed to treat disruptive behavior problems, PCIT has been expanded to different clinical populations (e.g., mental retardation, separation anxiety, abuse and neglect, chronic illness; McNeil & Hembree-Kigin, in press). The current paper integrates the language development and PCIT literatures to demonstrate how PCIT may positively affect child language skills. Language Development The enduring nature of childhood language impairment is well established. Longitudinal investigations demonstrate that early-childhood language impairments tend to persist throughout late childhood (e.g., Aram & Nation, 1980; Conti-Ramsden, Botting, Simkin, & Knox, 2001), adolescence (e.g., Aram, Ekelman, & Nation, 1984; Johnson, Beitchman, Young, Escobar, Atkinson, & Wilson et al., 1999; Stothard, Snowling, Bishop, Chipchase, & Kaplan, 1998) and adulthood (e. …