Behavioral Parent Training in Infancy: What about the Parent-Infant Relationship?

Introduction: Behavioral parent training (BPT) is efficacious in reducing child externalizing problems and increasing positive parenting behaviors. Similarly, attachment interventions with a behavioral focus show efficacy in enhancing maternal sensitivity. Despite overlap in these intervention approaches, the literature for BPT and attachment interventions has evolved separately, particularly with respect to outcomes. Only two studies to our knowledge have examined the impact of BPT on attachment-related constructs, but only measured maternal sensitivity with preschoolers. We build on the literature by examining the impact of the Infant Behavior Program (IBP), a home-based adaptation of Parent-Child Interaction Therapy for infants, on maternal sensitivity, warmth, and intrusiveness. In addition to predicting an association between maternal behavioral parenting skills and maternal behaviors, we hypothesized families randomly assigned to receive IBP would show significantly higher levels of maternal sensitivity and warmth and lower levels of intrusiveness after the intervention than families randomly assigned to standard care.

Methods: Sixty mother-infant dyads were randomly assigned to receive the IBP (n = 29) or standard care (n = 31) and were videotaped during a 5-minute infant-led play at baseline and post-intervention two months later. Infants were between 12 and 15 months (M = 13.47, SD = 1.31). The majority of mothers were Hispanic (90%) and reported income below the poverty line (60%). Coders masked to intervention condition coded maternal behavior on three scales (warmth/positive affect, sensitivity/responsivity, and intrusiveness) using the Early Parenting Coding System (EPCS), as well as maternal positive (praises, reflections, and behavior descriptions) and negative (questions, commands, and criticisms) parenting skills using Dyadic Parent-Child Interaction Coding System-Third Edition (DPICS-III).

Results: Maternal behaviors coded with EPCS were moderately correlated with parent positive and negative parenting skills coded with DPICS at baseline (r = 0.42 – 0.47). We conducted analyses of covariance (ANCOVA) to examine group differences in maternal behaviors at post-intervention controlling for baseline scores. Compared to mothers receiving standard care, mothers receiving the intervention displayed significantly higher levels of warmth (F(1, 43) = 25.34, p < .001; d = 1.52) and sensitivity (F(1,43) = 26.18, p < .001; d = .1.59). A significant intervention effect was not found for maternal intrusiveness (p = 0.69; d = .0.77).

Conclusions: This study provides evidence that BPT leads to increases in maternal behaviors indicative of secure attachment during a critical developmental period. These findings have significant implications for examining mechanisms of change in behavioral interventions targeting externalizing problems in early childhood.