PARENTING MANAGEMENT TRAINING

Parent management training (PMT)- is an adjunct to treatment that involves educating and coaching parents to change their child's problem behaviors using principles of learning theory and behavior modification .

Parent management training (PMT), also known as behavioral parent training (BPT) or simply parent training, is a family of treatment programs that aims to change parenting behaviors, teaching parents positive reinforcement methods for improving pre-school and school-age children's behavior problems (such as aggression, hyperactivity, temper tantrums, and difficulty following directions).[1

It is effective in reducing child disruptive behavior and improving parental mental health.

It has also been studied as a treatment for disruptive behaviors in children with other conditions.

Limitations of the existing research on PMT include a lack of knowledge on mechanisms of change and the absence of studies of long-term outcomes

PMT may be more difficult to implement when parents are unable to participate fully due to psychopathology, limited cognitive capacity, high partner conflict, or inability to attend weekly sessions.

PMT was initially developed in the 1960s by child psychologists who studied changing children's disruptive behaviors by intervening to change parent behaviors.The model was inspired by principles of operant conditioning and applied behavioral analysis.

Treatment, which typically lasts for several months, focuses on parents learning to provide positive reinforcement, such as praise and rewards, for children's appropriate behaviors while setting proper limits, using methods such as removing attention, for inappropriate behaviors.

Early-onset of conduct problems:

Poor parenting inadequate parental supervisiondiscipline that is not consistentparental mental health statusparental mental health statusstress or substance abuse

Negative parenting practices and negative child behavior contribute to one another in a "coercive cycle", in which one person begins by using a negative behavior to control the other person's behavior.That person in turn responds with a negative behavior, and the negative exchange escalates until one person's negative behavior "wins" the battle.

For example, if a child throws a temper tantrum to avoid doing a chore, the parent may respond by yelling that the child must do it, to which the child responds by tantruming even louder, at which point the parent may give in to the child to avoid further disruption.

PMT seeks to break patterns that reinforce negative behavior by instead teaching parents to reinforce positive behaviors.

In most PMT, parents are taught to define and record observations of their child's behavior, both positive and negative.

This monitoring procedure provides useful information for the parents and therapist to set specific goals for treatment, and to measure the child's progress over time.

Parents learn to give specific, concise instructions using eye contact while speaking in a calm manner.

Major focus of PMT

Providing positive reinforcement for appropriate child behaviors

parents learn to reward appropriate behavior through social rewards (such as praise, smiles, and hugs)

concrete rewards (such as stickers or points towards a larger reward as part of an incentive system created collaboratively with the child)

In addition, parents learn to select simple behaviors as an initial focus and reward each of the small steps that their child achieves towards reaching a larger goal .

PMT also teaches parents to appropriately set limits using structured techniques in response to their child's negative behavior. The different ways in which parents are taught to respond to positive versus negative behavior in children is sometimes referred to as differential reinforcement

For mildly annoying but not dangerous behavior, parents practice ignoring the behavior. Following unwanted behavior, parents are also introduced to the proper use of the time-out technique, in which parents remove attention (which serves as a form of reinforcement) from the child for a specified period of time.

Parents also learn to remove their child's privileges, such as television or play time, in a systematic way in response to unwanted behavior.Across all of these strategies, the therapist emphasizes that consequences should be administered calmly, immediately, and consistently, and balanced with encouragement for positive behaviors.

The training is usually delivered by therapists (psychologists or social workers) to individual families or groups of families, and is conducted primarily with the parents rather than the child, although children can become involved as the therapist and parents see fit.

A typical training course consists of 12 core weekly sessions; with different programs ranging from four to twenty-four weekly sessions.PMT is underutilized and training for therapists and other providers has been limited; it has not been widely used outside of clinical and research settings

Childhood disruptive behaviors

PMT is one of the most extensively studied treatments for childhood disruptive behaviors.PMT tended to have larger effects for younger children than older children, although the differences between age groups were not statistically significant.

Improvement in parental mental health (depression, stress, irritability, anxiety, and sense of confidence) as well as parental behavior is noted.Improvements in child and parent behavior were maintained up to one year after PMT, although the effects were small; very few studies have been done on the durability of the effects of PMT.

Parental psychopathology, substance abuse, and maternal depression are associated with less successful outcomes; this may be because the "parents' ability to learn and consolidate the skills being taught" is affected, or parents my not be able to stay engaged in the program or translate the skills acquired to the home.

Furlong et al (2013) concluded that group-based PMT is cost-effective in reducing conduct problems, and improving parental health and parenting skills, but that there is not enough evidence that it is effective on the measures of "child emotional problems and educational and cognitive abilities".

Other childhood-onset conditions

Conflict is high in families of children with attention-deficit hyperactivity disorder (ADHD), with parents showing "more negative and ineffective parenting (eg, power assertive, punitive, inconsistent) and less positive or warm parenting, relative to parents of children without ADHD".[

PMT targets dysfunctional parenting and school-related problems of children with ADHD, such as work completion and peer problems.Pfiffner and Haack (2014) say PMT is well-established as a treatment for school-age children with ADHD, but that questions persist about the best methods for delivering PMT.

A 2011 Cochrane review found some evidence that PMT improves general child behavior and parental stress in treating ADHD, but has limited effects on ADHD-specific behavior.The authors concluded that there was a lack of data to evaluate school achievement, and a risk of bias in the studies due to poor methodology; existing evidence was not strong enough to form clear clinical guidelines with regard to PMT for ADHD, or to say whether group or individual PMT was more effective.

The US National Institute of Mental Health has designated the "gap between evidence-based treatments and community services" as an area critically in need of more research;PMT for disruptive behaviors in children with autism spectrum disorders is an area of ongoing research.

HISTORICAL BACKGROUND OF PMT

Parent management training was developed in the early 1960s in response to an urgent need in American child guidance clinics. Research across a national network of these clinics revealed that the treatments being used for young children with disruptive behaviors, who constituted the majority of children served in these settings, were largely ineffective.

Several child psychologists, including Robert Wahler, Constance Hanf, Martha E. Bernal, and Gerald Patterson,were inspired to develop new treatments based on behavioral principles of operant conditioning and applied behavioral analysis.

Between 1965 and 1975, a behavioral model of parent training treatment was established, that emphasized teaching parents to positively reinforce prosocial child behavior (such as praising a child for following directions) while negatively incentivizing antisocial behavior (such as removing parental attention after the child throws a tantrum).

The early work of Hanf and Patterson hypothesized that "teaching parents the principles of behavioral reinforcement would result in effective, sustainable change in child behavior". Early studies of this approach showed that the treatment was effective in the short-term in improving parenting skills and reducing children's disruptive behaviors. Patterson and colleagues theorized that adverse environmental contexts lead to disruptions in parent practices, which then contribute to negative child outcomes.

Following the initial development of PMT, a second wave of research from 1975 to 1985 focused on the longer-term effects and generalization of treatment to settings other than the clinic (such as home or school), larger family effects (such as improved parenting with siblings), and behavioral improvements outside of the targeted areas (such as improved ability to make friends).

Evidence in support of PMT has not always been rigorously examined; future research should examine the effectiveness of PMT on the families most at risk, address parental psychopathology as a factor in outcomes, examine whether gains from PMT are maintained in the long-term, and better account for variability in outcomes dependent on practices under "real-world" conditions.

Since 1985, the literature on PMT has continued to expand, with researchers exploring such topics as application of the treatment to serious clinical problems, dealing with client resistance to treatment, prevention programs, and implementation with diverse populations.

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