Parent Management Training for Oppositional and Conduct Problem Children

Julie Feldman and Alan E. Kazdin

Yale University

Reprinted from:
Feldman, J. & Kazdin, A. E. (1995). Parent management training for oppositional and conduct problem children. The Clinical Psychologist, 48(4), 3-5.


I. Description of Treatment

Parent management training (PMT) refers to programs that train parents to manage their child's behavioral problems in the home and at school. PMT has emanated from two lines of work. First, maladaptive parent-child interactions, particularly in relation to discipline practices, have been shown to foster and to sustain conduct problems among children. Second, social learning techniques, relying heavily on principles of operant conditioning, have been extremely useful in altering parent and child behavior. In PMT, parent-child interactions are modified in ways that are designed to promote prosocial child behavior and to decrease antisocial or oppositional behavior.

Treatment sessions include instruction in social learning principles and techniques. The therapist provides a brief overview of underlying concepts, models the techniques for the parents, and coaches parents in implementing the procedures. Procedures and interaction patterns practiced in the sessions are then used in the home. Parents usually are taught how to define, observe, and record behavior at the beginning of treatment because once behaviors (e.g. fighting, engaging in tantrums) are defined concretely, reinforcement and punishment techniques can be applied. The PMT therapist details the concepts and procedures derived from positive reinforcement (e.g., contingent delivery of attention, praise, points) and punishment (e.g., time out from reinforcement, loss of privileges, and reprimands). Reinforcement for prosocial and nondeviant behavior is central to treatment. Parents are taught how to use reinforcement and punishment techniques contingent on the child's behavior, to provide consequences consistently, to attend to appropriate behaviors and to ignore inappropriate behaviors, to apply skills in prompting, shaping, and fading, and to use these techniques to manage future problems. There is an extensive amount of practice and shaping of parent behavior within the sessions to develop skills in carrying out the procedures.

Because the immediate goal of treatment is to develop parenting skills, the therapist begins by having parents apply new skills to relatively simple problems (e.g., compliance, completion of chores, oppositional behavior). As parents become proficient using the initial techniques, the child's most serious problem behaviors at home and in school are addressed (e.g., fighting, poor school performance, truancy, stealing, firesetting). In most PMT programs, the therapist maintains close telephone contact with the parents in-between sessions. These contacts are used to encourage parents to ask questions about the home programs, to provide an opportunity for the therapist to prompt compliance with the behavior-change programs and reinforce parents' use of the skills, to strengthen the therapeutic alliance, and to allow the therapist to problem-solve when programs are not modifying child behavior effectively.


II. Summary of Studies Supporting Treatment Efficacy

PMT is one of the most extensively studied therapies for children and has been shown to be effective in decreasing oppositional, aggressive, and antisocial behavior (for reviews of research, see Dumas, 1989; Forehand & Long, 1988; Kazdin, 1985; Miller & Prinz, 1990; Moreland, Schwebel, Beck, & Wells, 1982). Randomized controlled trials have found that PMT is more effective in changing antisocial behavior and promoting prosocial behavior than many other treatments (e.g. relationship, play therapy, family therapies, varied community services) and control conditions (e.g. waiting-list, "attention-placebo"). Follow-up data have shown that gains are maintained from posttreatment to 1 and 3 years after treatment has ended. One research team found that noncompliant children treated by parent training were functioning as well as nonclinic individuals approximately 14 years later (Long, Forehand, Wierson, & Morgan, 1994). The benefits of PMT often generalize to areas that are not focused on directly during therapy. For example, improvements in parental adjustment and functioning, marital satisfaction, and sibling behavior have been found following therapy. Overall, perhaps no other technique has been as carefully documented and empirically supported as PMT in treating conduct problems.

A unique feature of PMT is the abundance of research on child, parent, and family factors that moderate treatment effects. Moreover, PMT, either alone or in combination with other techniques, has been applied with promising effects to other populations including autistic children, mentally retarded children and adolescents, adjudicated delinquents, and parents who physically abuse their children. The principles and procedures on which PMT relies have also been applied in many settings including schools, institutions, community homes, day-care facilities, and facilities for the elderly.


III. References

A. Background Research

Reviews of the outcome evidence, as well findings related to moderators of treatment, generalization, and maintenance of changes, can be obtained from the following sources:

Dumas, J.E. (1989). Treating antisocial behavior in children: Child family approaches. Clinical Psychology Review, 9, 197-222.

Forehand, R., & Long, N. (1988). Outpatient treatment of the acting out child: Procedures, long-term follow-up data, and clinical problems. Advances in Behaviour Research and Therapy 10, 129-177.

Kazdin, A. E. (1985). Treatment of antisocial behavior in children and adolescents. Homewood, IL: Dorsey Press.

Long, P., Forhand, R., Wierson, M., & Morgan, A. (1994). Does parent training with young noncompliant children have long-term effects? Behaviour Research and Therapy, 32, 101-107.

Miller, G. E., & Prinz, R. J. (1990). Enhancement of social learning family interventions for child conduct disorder. Psychological Bulletin, 108, 291-307.

Moreland, J. R., Schwebel, A.I., Beck, S., & Wells, R. (1982). Parents as therapists: A review of the behavior therapy parent training literature - 1975 to 1981. Behavior Modification, 6, 250-276.

B. Clinical References

Materials that describe the procedures and methods used in training for oppositional and antisocial children can be found in the following sources:

Forehand, R., & McMahon, R.J. (1981). Helping the noncompliant child: A clinician's guide to parent training. New York: Guilford.

Sanders, M.R., & Dadds, M.R. (1993). Behavioral family interventions. Needham Heights, MA: Allyn & Bacon.

Webster-Stratton, C., & Herbert, M. (1994). Troubled families-problem children: Working with parents: a collaborative process. Chichester, England: John Wiley.


IV. Resources for Training

We know of no formal programs where professionals can obtain training in PMT. There are, however, research centers that have long-standing treatment programs and a great deal of information on training. Two programs that have made special contributions to the literature include those of:

Dr. Gerald Patterson
Oregon Social Learning Center
207 East 5th Avenue, Suite 202
Eugene, OR 97401

and

Dr. Carolyn Webster Stratton
Department of Parent and Child Nursing
University of Washington
Seattle, WA 98195

This latter research program has generated and evaluated video-taped versions of PMT that can be used to train professionals and facilitate treatment sessions with parents.


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