Despite the dizzying number of parenting books out there, sometimes parents need more support and coaching than a manual can provide. In part that’s because some kids are just more prone to challenging behaviors, and tougher to manage, than others.
Even the most charming of children can get out of control, with parents stuck in ineffectual ruts and the level of frustration and conflict mounting in the family. Sometimes, says Dr. Matthew Rouse, a clinical psychologist at the Child Mind Institute’s ADHD and Behavior Disorders Center, behavior problems are associated with ADHD and other developmental or emotional challenges.
Kids can be noncompliant, ignoring instructions (and even direct orders) no matter how many times they’re reminded. They can be impulsive, oblivious to warnings and the rules they’re breaking. They can be oppositional and may argue back regularly. They may melt down or tantrum when asked to do something they aren’t keen on doing. All of this hurts the parent-child relationship and adds to stress on both sides.
But harried parents don’t have to go it alone. There are a number of evidence-based parent training programs that can help bolster the skills needed to manage children’s behavior calmly and improve the quality of family life.
These programs are offered by psychologists and social workers, and they’ve been tested to determine exactly what techniques are most effective. Ideally, all the adults who spend a significant amount of time with the child should take the training, says Dr. Rouse, acknowledging that that isn’t always possible, so clinicians work with as many family members and other caregivers as they can.
The basics of parent training programs
What all the programs have in common is that they teach parents how to use praise, or positive reinforcement, more effectively, to encourage the behaviors they want to encourage. And they teach parents how to deploy consistent consequences when kids don’t comply. The result is that kids learn to modulate their behavior to meet expectations and enjoy much more positive interactions with their parents.
Where the programs differ is in how instruction is delivered, how parents practice the skills they’re learning, and the pace at which they’re expected to master these new skills. The programs involve 10 or more sessions, and they target different age groups of children.
These programs include:
- Parent-Child Interaction Therapy (PCIT)
- Parent Management Training (PMT)
- Defiant Teens
- Positive Parenting Program (Triple P)
- The Incredible Years.
“All endorse using praise and attention to focus on positive behaviors, and all use time out in one way or another, for consequences,” says Dr. Rouse. Regardless of the pace at which the skills are presented, “the good news is that all of them have a ton of evidence behind them working.”
Dr. Rouse says it’s helpful for parents to understand the differences among the programs so they can pick the one they feel will work best for their family. These treatments can be matched to a child’s age, symptoms and degree of impairment.
Here’s a rundown of these types of training, what makes them different and which families they may work best for.
Parent-Child Interaction Therapy (PCIT)
PCIT works with parents and children together, teaching them skills to interact in a positive, productive way. It is effective for kids between the ages of 2 and 7, and usually requires 14 to 17 weekly sessions.
In PCIT, parents receive live coaching (via a bug in the ear) from a therapist who watches from behind a one-way mirror as they and their child perform a series of tasks, and parents practice specific responses to both desired and undesired behavior.
PCIT is the most practice-intensive, Dr. Rouse says, as parents demonstrate mastery of each skill before going on to the next one. “It starts out with positive interactions, then waits till parents reach mastery of these skills before moving on to discipline strategies to improve oppositional behavior.”
Dr. Rouse says he might propose PCIT if he feels that the parents need a lot of one-on-one attention in terms of how they’re interacting with their child, and “especially if it feels like there have been a lot of coercive negative interactions.” Sometimes it’s very important for parents, he adds, “to learn how to be with their kid in a positive way.”
He adds that he doesn’t always suggest PCIT even if the child falls within PCIT’s age range. “It’s not just age, it’s looking at the situation. If there needs to be a really strong dose of positive interactions as the first thing and the child is under 7, I’ll lean more toward PCIT.”
Parent Management Training (PMT)
In PMT, which is for children ages 3 to 13, parents are usually seen without the child present, although children may be asked to participate in some sessions. Skills to deal more effectively with challenging behaviors are taught and modeled by the therapist and then role-played with parents. After each session, parents are expected to practice the skills at home. Families usually participate in at least 10 sessions.
“I like it because there’s a new skill that’s taught at every module,” Dr. Rouse says, “so if the family really goes home and implements what was talked about in session, you could teach them all the important skills that they need to know within four or five sessions. From that point on it’s kind of tinkering, refining and tightening up everything.”
Dr. Rouse says he’ll choose to use PMT if there’s a premium on “more change more quickly.” This can be because the situation seems particularly urgent, such as really severe tantrums or aggressive behaviors.
Since PMT is appropriate for all ages, it’s a good choice when kids are too old for PCIT. But he’d also recommend it for a 4-year-old if he feels that the parent-child interaction is actually pretty good, but there might be other things going on, such as anxiety, extreme impulsiveness or explosive anger.
However, he notes that PMT, which establishes a token economy with point charts used to reinforce positive behaviors, can be tougher for younger kids to grasp, especially if they’re cognitively delayed. “It’s sometimes hard for them to understand that they’re earning points that they can then spend on things. But if a kid is able to make the connection that they’re earning these stars for behavior and that these stars get them a reward, then I think it’s appropriate.”
Dr. Rouse adds that some clinicians do training for parents of teenagers 13-18 based on a method outlined by Drs. Russell Barkley and Arthur Robin in a manual called Defiant Teens. (There’s a version directed at parents called Your Defiant Teen, by the same authors.)
The first half of this program involves only parents, and focuses on teaching more effective tools for interacting with their teenager, specifically for handling noncompliance or defiant behavior. But since teenagers are more autonomous than younger children and less influenced by their parents’ guidance, the program also includes training for the adolescent to help him become a participant in changing the family dynamic. In the second half, parents and teenagers are both trained in problem-solving communication. The aim is to provide family behavioral resources to help each family member develop more effective problem-solving, negotiation and communication skills and to correct any unreasonable beliefs that might be impeding their interactions.
Positive Parenting Program (Triple P)
Triple P’s focus is on equipping parents with information and skills to increase confidence and self-sufficiency in managing child behavior. It can be utilized with a wide age range of children from toddlerhood through adolescence.
Dr. Rouse says there are different levels of intervention depending on how severe the case is, with “more of a whole blanket system of improving parenting on many different levels.”
First, for parenting basics, there’s a four-session treatment that can be given in doctor’s offices that include social workers or other mental health professionals for integrated care.
But for families with more severe behavior problems, there’s a 12-session parent-and-child-focused treatment. It incorporates what Rouse calls “the best of PMT and PCIT” by having some sessions in which the clinician is meeting one-on-one with parents and talking about skills and strategies, and some sessions where kids are included and the therapist can do live coaching.
The Incredible Years
The Incredible Years offers small-group-based training for parents of kids from infants through age 12. The programs are broken into four age groups (baby, toddler, preschool and school age) and they range from 12 to 20 weeks.
There is also specialized training designed for high-risk socioeconomically disadvantaged families, and for families with children diagnosed with ADHD and oppositional defiance disorder (ODD).
Dr. Rouse describes the Incredible Years as “in between PMT, where they’re giving you everything up front, and PCIT, where skills are added only after earlier ones have been mastered.”
There’s a different topic for parents each session. The program starts with a focus on improving parent-child relationships and positive attachment before moving on to consistent routines, rules, and limit-setting. Finally it covers child management strategies such as ignoring, redirection, logical and natural consequences, time to calm down and problem solving.
For children from four to eight years old, Incredible Years offers children’s groups that focus on helping them acquire emotion regulation strategies and social skills.
Research shows that the kids’ group works well at improving pro-social behavior and decreasing disruptive behaviors, Dr. Rouse notes, “but when you add the parenting part it really boosts the effectiveness of it.”
Dr. Rouse says one of the great things for parents is that they learn not only from therapists but from each other. “They hear what others tried. It also normalizes what they’re seeing in their kids.”
He adds that the Child Mind Institute runs concurrent parents’ and children’s groups for families with kids from 6 through 8 yeas old (first through third grade). “We have two group members who have started setting up play dates,” he said, “building friendships.”