Conducting Parent Management Training
Several evidence-based treatments for child disruptive behavior are variations on parent management training (PMT; Eyberg, Nelson, & Boggs, 2008). These programs are designed to teach parents skills for managing their child’s behavior effectively, decreasing the child’s unwanted behaviors, and increasing the child’s incompatible, prosocial behaviors. (p. 362) Parent training programs have been implemented in children with a range of diagnoses and have targeted populations at risk due to poor parenting as well.
As the PMT field has grown, strategies such as role playing, video modeling, and therapist coaching have been added to teach new parenting skills more effectively, and several treatment formats have been examined. PMT has been administered individually, in group format, in clinics, in schools, and in homes by professionals and paraprofessionals. PMT has also been used in conjunction with other approaches for managing disruptive behaviors, including medications, teacher training in behavior management, and child therapy groups. To reduce children’s comorbid disorders, functional impairments, or family disruptions, PMT has been combined with other treatments, including exposure and response prevention strategies for anxiety and fears, social skills training, academic tutoring, and supportive counseling for parents. The goal of all PMT variations is ultimately the child’s optimal behavioral, social, and emotional health.
Careful child and family assessment is necessary in PMT to determine immediate treatment goals and evaluate treatment progress. Most PMT programs require assessment before treatment begins, and several recommend assessment periodically throughout treatment or at every session. Clinicians typically conduct a clinical interview and administer a broad-band screening instrument (e.g., Child Behavior Checklist or Behavior Assessment System for Children) to identify the scope of the child’s behavior problems, and then evaluate identified areas of concern in more depth. Multiple informants and methods of measurement are used in this process. For treatment planning, parent functioning is often assessed as well. The specific methods and instruments depend on factors such as the settings in which the problem behaviors occur and the age of the child, and they are selected at the clinician’s discretion. For preschoolers, the most commonly used methods are parent rating scales and behavioral observations of the parent–child interaction. With school-age children, parent and teacher rating scales are most common. At middle-school age (12–14 years), teacher-report scales are prominent, with youth self-report frequently used as well. For older adolescents, both parent- and self-report instruments are common, and at this age official records become an important part of assessment of conduct-disordered behaviors (Eyberg et al., 2008).
Parent Skills: Encouraging Positive Child Behavior
Once the initial assessment is complete, PMT may begin by teaching parents strategies for maintaining or increasing positive child behaviors. Skills that parents are taught include:
• Implementing a short daily playtime during which parents provide children with consistent positive feedback. Parents are generally instructed to follow the child’s lead in play and praise the child’s appropriate behavior (e.g., “Thank you for putting the crayons away after you finished coloring”).
• Creating a positive home environment by ensuring children’s safety, providing engaging toys and activities, and establishing consistent rules and routines. Noticing and praising children’s positive behaviors (e.g., cooperation, social skills, persistence, problem solving) throughout the day are further ways to create a positive environment in the home. Ignoring minor annoying misbehaviors and resuming positive attention when the child re-engages in desirable behaviors.
• Using incentive programs or point charts to monitor and reward positive behaviors.
• Setting realistic expectations for children’s behavior through psychoeducation around child development and behavior problems. For children with conditions that may put them at higher risk for behavior problems, such as attention-deficit/hyperactivity disorder, parents may be educated about how (p. 363) the child’s diagnosis affects his or her development and behavior.
• Helping their child develop problem-solving or negotiation skills through incidental or directed teaching and practice opportunities.
Parent Skills: Consistent Consequences for Misbehavior
In PMT, parents are also instructed in how to apply consistent and developmentally appropriate consequences for misbehavior. Specific skills vary depending on the child’s developmental level, but they may include the following:
• Redirection or distraction, typically reserved for children with a receptive language level below 2½ years of age.
• Time-out from positive reinforcement, usually implemented with children ages 2–6 years. This strategy has been associated with the greatest effect sizes in PMT research.
• Removal of privileges or logical consequences, most appropriate for school-age children.
• Behavior charts, also for school-age children who can benefit from delayed consequences.
• Token economies, often implemented with 10- to 12-year-old children.
• Problem-solving strategies, best for older school-age children and adolescents.
Strategies for Teaching Parents
PMT programs vary in how they teach parents to implement these skills. The best method for a particular family may depend on the therapist’s aptitude, the treatment setting, or the parent’s preference. However, a meta-analysis of the research literature found that the largest treatment effects were associated with providing parents with immediate feedback as they interacted with their child (Kaminski, Valle, Filene, & Boyle, 2008). Strategies for teaching parents new skills include:
• Direct instruction, a didactic approach that describes each skill to parents, its implementation, and its rationale.
• Modeling, or demonstrating the skill with the target child or another individual, with the goal of showing parents how they might implement the skill with their own child in a similar situation.
• Role playing to engage parents in practicing new skills in a contrived setting, allowing the clinician to provide feedback and encourage problem solving.
• Discussing parents’ experiences in using the skill to elucidate parent-perceived difficulties and promote parent problem solving.
• Video modeling to enable parents to observe more realistic parenting situations and discuss how they could implement the skills in similar situations with their child.
• Using bug-in-the-ear technology to cue and give immediate feedback to parents on their use of the skills as they interact with their child.
Parent Management Training Programs
Several manualized PMT programs have demonstrated efficacy in reducing children’s disruptive behavior (Eyberg et al., 2008). These include the following:
• Helping the Noncompliant Child (HNC) is a secondary prevention program for noncompliant children (ages 3–8 years) and their parents. The program incorporates modeling, role playing, and in-vivo feedback to help parents change how they interact with their child.
• Incredible Years (IY) Parent Program is designed for parents of children between birth and age 12, is delivered in a group format, and incorporates video modeling strategies for parent discussion, as well as role play. Children usually are seen separately in a child-focused group.
• Parent-Child Interaction Therapy (PCIT) treats disruptive behavioral disorders in 2- to 7-year-olds seen with their parents. Parents are coached via bug-in-the-ear technology in the use of authoritative parenting strategies as they play with their child. (p. 364)
• Parent Management Training Oregon Model (PMTO) teaches parents of disruptive children (ages 3 to 12) to monitor their child’s behaviors and then implement appropriate behavior modification techniques.
• The Positive Parenting Program (Triple P) offers a range of parenting interventions for children ages 0 to 17, ranging from public health applications for all families, to intensive treatment for children with severe behavior problems and their parents.
• Problem-Solving Skills Training and Parent Management Training is a program developed for children up to age 13 that combines PMT with training in problem-solving skills for children. In this model, PMT is implemented through modeling and role playing as the parent learns to observe and reinforce positive behaviors (e.g., using social praise, token economy, or point charts), shape children’s behaviors, and apply consistent consequences for negative behaviors.
The evidence available for each PMT program may be limited by its intended population and research samples. When selecting a program, clinicians need to consider the population for which a treatment was designed and for which efficacy has been demonstrated. Many PMT programs have shown efficacy in varied ethnic and cultural populations, diagnostic groups (e.g., hyperactivity, abuse and neglect, mental retardation, anxiety), and settings (e.g., home, school, clinic, hospital).
References and Readings
Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37, 215–237.Find this resource:
Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36, 567–589.Find this resource:
Kazdin, A. E. (2008). The Kazdin method for parenting the defiant child: With no pills, no therapy, no contest of wills. Boston, MA: Houghton Mifflin.Find this resource:
McMahon, R. J., & Forehand, R. L. (2003). Helping the noncompliant child: Family-based treatment for oppositional behavior (2nd ed.). New York: Guilford Press.Find this resource:
McNeil, C. B., & Hembree-Kigin, T. L. (2010). Parent-child interaction therapy (2nd ed.). New York: Springer.Find this resource:
The Incredible Years. (2012). Parents, teachers, children training series. Retrieved January 2013, from www.incredibleyears.com
Triple P Positive Parenting Program. (n.d.). Retrieved January 2013, from www.triplep.net
Weisz, J. R., & Kazdin, A. E. (2010). Evidence-based psychotherapies for children and adolescents (2nd ed.). New York: Guilford Press.Find this resource: