Effectiveness of Parent–Child Interaction Therapy (PCIT) on Caregiver Sensitivity and Insecure Attachment in Preschool Children with Externalizing Behavior Problems

Authors
mahla salajgheh
fatemeh derakhshan
amine jalali
Abstract
The present study aimed to examine the effectiveness of Choice Theory-based training on responsibility and disruptive behaviors among adolescents in Kerman. The study employed a quasi-experimental design with a pretest–posttest control group. The statistical population included all adolescent students in Kerman during the 2024–2025 academic year. A total of 30 participants were selected through convenience sampling and randomly assigned to an experimental group (n = 15) and a control group (n = 15). The research instruments included the Responsibility Questionnaire and the Disruptive Behavior Scale. The experimental group received eight 60-minute sessions of Choice Theory-based training. Data were analyzed using repeated-measures analysis of variance (ANOVA).

The findings indicated that Choice Theory-based training significantly increased responsibility and significantly reduced disruptive behaviors in the experimental group compared to the control group. Based on the results, Choice Theory, with an emphasis on personal responsibility and internal control, can be considered an effective intervention for improving social behaviors and enhancing responsibility in adolescents.
Keywords
Choice Theory
responsibility
Externalizing Behaviors
adolescents
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Ainsworth, M. S., Bell, S. M., & Stayton, D. J. (2019). Infant–mother attachment and social development: Socialization as a product of reciprocal responsiveness to signals. The integration of a child into a social world, 99-135.

Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., & Juffer, F. (2016). Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin, 129(2), 195-215.

Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment. New York: Basic Books.

Benoit, D. (2004). Infant-parent attachment: Definition, types, antecedents, measurement and outcome. Paediatrics & Child Health, 9(8), 541–545.

Bernier, A., Matte-Gagné, C., Belanger, M., & Whipple, N. (2014). Taking Stock of Over Half a Century of Attachment Subtypes: A Focus on Disorganized Attachment and Caregiving Antecedents. Child Development Perspectives, 8(3), 139-145.

Betancourt, T. S., McBain, R., Newnham, E. A., & Brennan, R. T. (2013). Trajectories of traumatic symptoms and social functioning in war-affected youth: A longitudinal study. Child Development, 84(4), 1188-1193.

Chaffin, M., Funderburk, B., Bard, D., Valle, L. A., & Gurwitch, R. (2017). A combined motivation and Parent-Child Interaction Therapy package reduces child welfare recidivism in a randomized iterative fitting trial. Journal of Consulting and Clinical Psychology, 79(1), 84-95.

De Wolff, M. S., & van IJzendoorn, M. H. (2019). Sensitivity and attachment: A meta-analysis on parental antecedents of infant attachment. Child Development, 68(4), 571-591.

Dyregrov, A., & Yule, W. (2016). A review of children’s psychological responses to extreme war-related stressors. Clinical Child and Family Psychology Review, 9(1), 55-69.

Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2018). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child & Adolescent Psychology, 37(1), 215-237.

Fazel, M., Wheeler, J., & Danesh, J. (2015). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365(9467), 1309-1314.

Feldman, R., & Vengrober, A. (2011). Posttraumatic stress symptoms in children exposed to war-related trauma: The mediating role of maternal stress and child’s cortisol. Archives of General Psychiatry, 68(11), 1118-1127.

Gewirtz, A. H., Forgatch, M. S., & Wieling, E. (2018). Parenting practices as mediators of child adjustment following multi-level trauma: Healthy Families-Resilient Christian Study. World Psychiatry, 7(3), 162-171.

Mesman, J., van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2012). Unequal in opportunities, equal in care: Childrearing in diverse contexts. Child Development Perspectives, 6(3), 239-250.

Murthy, R. S., & Lakshminarayana, R. (2006). Mental health consequences of war: A brief review of research findings. World Psychiatry, 5(1), 25-30.

Punamäki, R. L., Isosävi, K., Qouta, S. A., Kuittinen, S., & Diab, M. (2017). War trauma and maternal-fetal attachment predicting maternal mental health and infant development. Journal of Reproductive and Infant Psychology, 35(3), 278-291.

Slone, M., & Mann, S. (2016). Effects of war, terrorism and armed conflict on young children: A systematic review. Child Psychiatry & Human Development, 47(6), 950-965.

Timmer, S. G., Zebell, N. M., Culver, M. A., & Urquiza, A. J. (2010). Parent-Child Interaction Therapy with vulnerable families: It's not just for classic behavioral problems. Child Abuse & Neglect, 34(12), 939-950.

Zisser, A., & Eyberg, S. M. (2010). Parent-Child Interaction Therapy and the treatment of preschool behavior problems. Evidence-based psychotherapies for children and adolescents, 2, 179-193.
Lyons-Ruth, K., Easterbrooks, M. A., & Cibelli, C. D. (1997). Infant attachment strategies, toddler intellectual functioning, and school-age expression of psychopathology. Developmental Psychology, 33(4), 681-692.

Main, M., & Solomon, J. (1986). Discovery of an insecure-disorganized/disoriented attachment pattern. Affective development in infancy, 95-124.

O'Connor, T. G., & Zeanah, C. H. (2003). Attachment disorders: Assessment, etiology, and treatment. The Lancet, 362(9381), 389-395.

Van IJzendoorn, M. H., & Kroonenberg, P. M. (1988). Cross-cultural patterns of attachment: A meta-analysis of the Strange Situation. Child Development, 59(1), 147-156.

Zeanah, C. H., Danis, B., Hirshberg, L., Benoit, D., Miller, D., & Heller, S. S. (2022). Disorganised attachment associated with partner violence: A research note. Journal of Child Psychology and Psychiatry, 40(5), 777-786.




Abner, J. P., & Eyberg, S. M. (2020). Parent-child interaction therapy: A training manual. Unpublished manuscript, University of Florida.

Ainsworth, M. S., Bell, S. M., & Stayton, D. J. (2019). Infant–mother attachment and social development: Socialization as a product of reciprocal responsiveness to signals. The integration of a child into a social world, 99-135.

Bakermans-Kranenburg, M. J., van IJzendoorn, M. H., & Juffer, F. (2016). Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin, 129(2), 195-215.

Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment. New York: Basic Books.

Benoit, D. (2004). Infant-parent attachment: Definition, types, antecedents, measurement and outcome. Paediatrics & Child Health, 9(8), 541–545.

Bernier, A., Matte-Gagné, C., Belanger, M., & Whipple, N. (2014). Taking Stock of Over Half a Century of Attachment Subtypes: A Focus on Disorganized Attachment and Caregiving Antecedents. Child Development Perspectives, 8(3), 139-145.

Betancourt, T. S., McBain, R., Newnham, E. A., & Brennan, R. T. (2013). Trajectories of traumatic symptoms and social functioning in war-affected youth: A longitudinal study. Child Development, 84(4), 1188-1193.

Chaffin, M., Funderburk, B., Bard, D., Valle, L. A., & Gurwitch, R. (2017). A combined motivation and Parent-Child Interaction Therapy package reduces child welfare recidivism in a randomized iterative fitting trial. Journal of Consulting and Clinical Psychology, 79(1), 84-95.

De Wolff, M. S., & van IJzendoorn, M. H. (2019). Sensitivity and attachment: A meta-analysis on parental antecedents of infant attachment. Child Development, 68(4), 571-591.

Dyregrov, A., & Yule, W. (2016). A review of children’s psychological responses to extreme war-related stressors. Clinical Child and Family Psychology Review, 9(1), 55-69.

Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2018). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child & Adolescent Psychology, 37(1), 215-237.

Fazel, M., Wheeler, J., & Danesh, J. (2015). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: A systematic review. The Lancet, 365(9467), 1309-1314.

Feldman, R., & Vengrober, A. (2011). Posttraumatic stress symptoms in children exposed to war-related trauma: The mediating role of maternal stress and child’s cortisol. Archives of General Psychiatry, 68(11), 1118-1127.

Gewirtz, A. H., Forgatch, M. S., & Wieling, E. (2018). Parenting practices as mediators of child adjustment following multi-level trauma: Healthy Families-Resilient Christian Study. World Psychiatry, 7(3), 162-171.

Mesman, J., van IJzendoorn, M. H., & Bakermans-Kranenburg, M. J. (2012). Unequal in opportunities, equal in care: Childrearing in diverse contexts. Child Development Perspectives, 6(3), 239-250.

Murthy, R. S., & Lakshminarayana, R. (2006). Mental health consequences of war: A brief review of research findings. World Psychiatry, 5(1), 25-30.

Punamäki, R. L., Isosävi, K., Qouta, S. A., Kuittinen, S., & Diab, M. (2017). War trauma and maternal-fetal attachment predicting maternal mental health and infant development. Journal of Reproductive and Infant Psychology, 35(3), 278-291.

Slone, M., & Mann, S. (2016). Effects of war, terrorism and armed conflict on young children: A systematic review. Child Psychiatry & Human Development, 47(6), 950-965.

Timmer, S. G., Zebell, N. M., Culver, M. A., & Urquiza, A. J. (2010). Parent-Child Interaction Therapy with vulnerable families: It's not just for classic behavioral problems. Child Abuse & Neglect, 34(12), 939-950.

Zisser, A., & Eyberg, S. M. (2010). Parent-Child Interaction Therapy and the treatment of preschool behavior problems. Evidence-based psychotherapies for children and adolescents, 2, 179-193.
Lyons-Ruth, K., Easterbrooks, M. A., & Cibelli, C. D. (1997). Infant attachment strategies, toddler intellectual functioning, and school-age expression of psychopathology. Developmental Psychology, 33(4), 681-692.

Main, M., & Solomon, J. (1986). Discovery of an insecure-disorganized/disoriented attachment pattern. Affective development in infancy, 95-124.

O'Connor, T. G., & Zeanah, C. H. (2003). Attachment disorders: Assessment, etiology, and treatment. The Lancet, 362(9381), 389-395.

Van IJzendoorn, M. H., & Kroonenberg, P. M. (1988). Cross-cultural patterns of attachment: A meta-analysis of the Strange Situation. Child Development, 59(1), 147-156.