PMT—also known asbehavioral parent training(BPT) or simplyparent training—helps change parenting behaviors to reduce child disruptive behavior, while improving parent mental health.
PMT has been extensively studied and validated as an intervention that teaches better parenting skills, decreases child oppositional, aggressive and antisocial behavior and emphasizes the “bidirectional” nature of the parent-child relationship. It is particularly effective for children ages 2-17 with moderate-to-severe behavioral difficulties, including:
- Oppositional defiant disorder(ODD)
- Conduct disorder(CD)
Less studied, PMT has also been used to treat disruptive behaviors (aggression, hyperactivity, temper tantrums, difficulty following directions) in children with other conditions, including:
- Attention-deficit/hyperactivity disorder (ADHD)
- Anxiety with behavioral difficulties
- Disruptive mood dysregulation disorder (DMDD)
- Intermittent explosive disorder (IED)
Specifically, PMT teaches positive reinforcementmethods (praise and rewards) for children’s appropriate behaviors, while setting limits (removing attention) for the mostdifficult and inappropriate behaviors. Issue areas can include:
- Improving academic skills
- Improving behaviors in a classroom setting
- Improving social skills
- Improving skills of daily functioning for those with developmental delays
- Preventing delinquent behavior for at-risk youth
- Assisting with organizational and work issues
PMT is a highly effective treatment proven to change behavior over the long-term—that is, reducing negative behavior and increasing positive behavior, until positive behaviorbecomes secondnature to the child (see PMT’s history and core ideas).Early intervention is important, before behavior escalates to the point of failing school, self-harm or hurting others, hospitalization or juvenile detention.
Either alone or in combination with other techniques, PMT has been applied with promising effects to other populations, including children withAutism spectrum disorder (ASD)
PMT is a short-term treatmentprogram with its main focus on providing positive reinforcement for appropriate child behaviors.
PMT is a weekly treatment program typically lasting for several months. Depending on parents’ full participation, PMT may be more difficult to implement when parents are unable to attend weekly sessions, have mental health issues of their own, limited cognitive capacity or partner conflict.
PMT offers step-by-step guidance in the effective use of skills and resources, encouraging positive parenting practices, strong parent engagement and psychoeducation about child behavior. Clinicians trained in PMT practices aim to accomplish the following:
- Engage parents by normalizing and validating parental challenges and stressing the importance of session attendance
- Emphasize structure, consistency and positive reinforcement to extend what is done in session to the home
- Tailor evidence-based concepts to the specific needsof each child and family, through timely feedback, modeling and role play
- Focusing onalleviating distressful symptoms or behaviors, rather than on labels
While it’s natural for parent instinct to take over, many behavioral science concepts are not instinctual, making it challenging for parents. Supplementary resources are often geared to younger children; however, concepts are adaptable for a diverse array of children and adolescents and problems.
- Parents learn to provide social rewards (praise, smiles, hugs) and concrete rewards (stickers, points towards a larger incentive system created collaboratively with the child), so that appropriate behavior becomes second nature to the child.
- In a process called “successive approximations,” parents initially select simple behaviors to reward the small steps their child achieves toward reaching a larger goal.
Parents are also trained to set limits and deal with anxiety and inappropriate child behavior, so that negative behavior significantly decreases.
- For mildly annoying but not dangerous behavior, parents practice such structured techniques as actively ignoring the behavior.
- Following unwanted behavior, parents use thetime-outtechnique, removing attention (which serves as a form of reinforcement) from the child for a specified period of time.
- Parents can also remove their child’s privileges (television, play time), in a systematic way in response to unwanted behavior, as a means of “time out from positive reinforcement”.
Parents are taught different ways to respond to positive versus negative child behavior. Such “differential reinforcement” guides parents to give specific, concise instructions using eye contact, while speaking in a calm manner. Consequences need to be immediate and consistent—and always balanced with encouraging positive behaviors.
Parents learn to observe and monitor their child’s behavior, plus or minus, often recording change on a progress chart. Armed with data, the therapist and parents can set treatment goals and measure further progress.
PMT may be more difficult to implement when parents are unable to fully participate due to psychopathology, limited cognitive capacity, high partner conflict or inability to attend weekly sessions.
In addition to positive reinforcement and limit-setting in the home, PMT may incorporate collaboration with the child’s teacher to track behavior in school and link it to the rewards program at home.
Also called collaborative and proactive solutions, CPS challenges common beliefs that children with social-emotional-behavioral problems willfully cause problems and fail.Instead, the CPS model understands that behavior problems stem from placing expectations on a child that are incompatible with their skills and ability to succeed.
CPS shifts treatment from a pathological (or problem) lens to a developmental delay lens. Neither punitive nor adversarial, it sees children who struggle with behavioral problems as lacking flexibility, frustration tolerance, emotion regulation or problem solving. Through support, teaching and problem-solving, CPS has been shown to help parents and their children learn positive skills that:
- Reduce conflict and resolve disagreements peacefully
- Improve behavior and understand how behavior affects others
- Strengthen relationships
- Improve communication and take another’s perspective
- Enhance empathy and honesty
CPS engages children in identifying their skill deficits as “unsolved problems” and then participating in solving them. CPS identifies three “plans” of action, with emphasis on Proactive Plan B:
Plan A: the authoritarian approach, in which the parent takes control of the child by imposing rules with consequences. Plan A approaches typically trigger and increase challenging behaviors in children, even to a point of presenting safety risks and concerns. While having expectations is preferable to rigid rules, Plan A makes sense when a child might otherwise hurt him/herself or others.
Plan B: the collaborative problem-solving approach, in which the parent and child together work on problem-solving, learning lagging skills and creating a positive relationship.Plan B can be reactive for emergency or immediate responses to a behavior; or proactive, used in response to a predictable problem—ahead of time—to prevent its recurrence. The ideal is Proactive Plan B, which can be broken down into successive steps:
- Empathy:Parents ask the child questions to achieve the clearest understanding of what’s making it hard for the child to meet a particular expectation.
- Define the problem: Parents express their own concerns or perspectives so the child can understand the importance of expectations being met (such as physical safety, emotional wellbeing of others, education).
- Invitation: Parents and child brainstorm solutions to reach a plan of action that is realistic, mutually satisfactory and durable.
Plan C: the “drop-the-issue” approach, at least for the present, acknowledges the child does not yet have the skill to handle a particular demand. This allows parents to address higher priority behaviors, while lowering expectations for other behaviors in the meantime. Plan C can successfully reduce challenging behaviors.
There are several evidence-based PMT approaches and resources available to families and clinicians, alike. One in particular that CFI emphasizes—and Dr. Adam Weissman helped pioneer at Harvard—is MATCH-ADTC or Modular Approach to Therapy for Children with Anxiety, Depression, Trauma or Conduct problems—which takes a unique “transdiagnostic” approach to child behavior problems and co-occurring symptoms, and provides step-by-step instructions, activities, monitoring forms, tips and handouts.
PMT, and MATCH-ADTC in particular, focuses heavily on positive parenting practices over punishment techniques, especially at the beginning. At CFI, clinicians work closely with parents to use MATCH-ADTC tools effectively and consistently, including:
Home Situations Questionnaire: Helps identify and monitor child behavior issues to work on.
The Four Factor Model of Child Behavior: Helps identify parent-child strengths and challenges—their interactions—toward an enlightened pattern of behavior and interpersonal dynamics in the home.
One-on-one time: Improves parent-child relationship through behavioral play therapy.
Praise: Uses parental attention as the primary motivator for good behavior or misbehavior, especially in younger children.
Active (planned) ignoring: Helps deemphasize mild-to-moderate behaviors that may be annoying, attention-seeking, inappropriate or disruptive, but not rule-breaking or dangerous.
Effective instruction: Provides a greater likelihood of children complying when instruction is clear and given sparingly.
Rewards: Helps children in certain situations get motivated for success through rewards that are convenient, immediate, organized and fair.
House rules: Establishes clear guidelines for expected behaviors to help children “internalize” rules and understand consequences for non-negotiable, non-tolerated behaviors.
