Evidence-based behavioral intervention trainings for parents are one of the many techniques that, when effectively implemented, can be associated with sustained behavioral improvements among children with oppositional and disruptive behaviors. (Kazdin, 2017) Use of these interventions can strengthen positive bonds between children and their parents and may also reduce the need for referrals for higher level interventions and treatment referrals and ultimately reducing the use of psychotropic medications in children, particularly when problems are identified early and addressed in a timely manner.
The concepts and tools of validated behavioral management and modification programs can be helpful for both the ‘normative’ and routine parenting issues that arise in most families during the childhood years, but they can also be effective with more entrenched and challenging situations where the child’s symptoms have advance to be in the realm of diagnosable conditions such as oppositional, disruptive behavioral disorders and in complicated ADHD presentations.
Although there are a wide variety of behavior management systems available, they all seek to avoid the common picture of escalating power struggles and affective agitation that occur between adults and children in the course of day-to-day living and to minimize consequent punitive strategies that emerge when negative behaviors persist and frustration fans the fires of conflict between youth and children. Such behavioral programs substitute a framework that reduces punitive responses to unwanted behaviors while offer opportunities to obtain insight as to the causes of conflict. Helping a family begin this journey can promote improved interpersonal responses, decrease conflicts, and facilitate better understanding and cooperation. The reduction of ‘lose-lose’ stalemates between parents and their children can lead to more positive pro-social communication and improved self-esteem for all members of the family, as families work together develop and maintain their child’s pro-social behaviors at home and school.
Today’s newsletter describes one such behavior modification system that is known as Parent Management Training (PMT) that will be highlighted in a free tele-workshop in early January (see flyer below).
PMT relies on positive reinforcement to reinforce desired behaviors and uses a functional analysis approach to understand triggers of problematic behaviors using the “A.B.C. (Antecedent-Behavior-Consequence)” model.
Positive Reinforcement: Parents can increase the likelihood of a “positive opposite” (the opposite of the challenging or undesired behavior) by proactively instructing their child of the desired behaviors prior to the activity in a calm and playful tone of voice accompanied by with supportive gestures.
Concurrently, parents are strongly encouraged to minimize nagging, anticipatory threats or using punitive physical punishment (although all are natural responses) as negative feedback tends to decrease compliance and discourages pro-social behaviors over the long-term.
Antecedents: Encouraging parents to seek an understanding of the antecedents when disruptive behaviors occur is a critical element of PMT and other behavioral intervention programs. This will include having the parents attend to and review the precursors to disruptive incidents to see what situations trigger outbursts. Frustrations of various sorts, including even hunger or thirst, or simply feelings of not being supported or having the attention for caretakers are high on the list of triggers for problem behaviors. Subtle bullying or outright competition and rivalry between siblings are another potential disruptive antecedent leading to hurt feelings and behaviors outbursts. Situations of perceived failure or and frustration with tasks likewise can contribute to problem behaviors and attitudes.
Behaviors: Teaching children alternatives to disruptive behaviors and reinforcing their success in implementing new more positive responses to frustrations are a core feature of all behavioral therapies. PMT promotes the concept of having parents train their children to learn new responses to stressful and painful experiences, by implementing practice trials of how to better respond. This form of at home play ‘therapy’ incorporates exercises of re-enacting a troubling situation in a “tantrum game” format where the youth can be guided toward more helpful and positive responses to stressors and triggers. Guidance and praise are given as constructive alternatives are suggested and enacted with parental support and encouragement. These activities work both to support the child’s sense of parental investment and concern about the child’s frustrations and hurt, and perhaps more importantly, help the parent-child dyad develop more appropriate means of communicating affirmatively about difficulties the child experiences.
Consequences: Building on the theme or positive reinforcement that is intrinsic to all behaviors therapy, PMT highlights the importance of focused and recurrent praise and interpersonal rewards for good improved behaviors. Use of concrete token reinforcements or a reward cumulative point system can be elements that enhance engagement in efforts to reduce negative or oppositional responses. Minimizing the use of punishments (physical or material) is the flip side of the consequences component.
As with many of the behavior modification protocols, the PMT program is a short term intervention (usually 12 sessions), but results are consistent and long-lasting.
- Adams, J., Discipline Without Anger, A Program for Managing Children’s Behavior, ca. 1978
- Kazdin, A.E. (2017). Parent management training and problem-solving skills training for child and adolescent conduct problems. In J.R. Weisz & A.E. Kazdin (Eds.). Evidence-based Psychotherapies for Children and Adolescents (3rd ed., pp. 142-158). New York: Guilford Press.
- Kazdin, A. E., & Rotella, C. (2013). The everyday parenting toolkit: The Kazdin Method for easy, step-by-step, lasting change for you and your child. Boston: Houghton Mifflin.
- Krumhoilz, John D., Krumholz, Helen B,. Changing Children’s Behavior, Prentice Hall, 1972
Special Thanks to Paven Lidstone, M.D., UCSD Child & Adolescent Psychiatry Fellow, for her contributions to this week’s SmartCare Newsletter and for her work in developing the Behavioral Parent Training Workshop.