What does Behavioral Parent Training therapy involve?
The Center for Child Behavior believes it is important for families to be informed about the therapy they start and that is why we outline various strategies below so that you can make an informed decision before you begin working with our team. Although these strategies for improving child tantrums, homework routines, compliance, etc. may sound straight forward, they can be challenging to implement without guidance and therefore, we recommend seeking treatment from a qualified mental health professional. Sometimes families need just a few sessions, other times families need several months of therapy.
Parent Management Training (PMT) also known as "Parent Behavioral Training" or "Parent Training" is the most effective treatment for children with disruptive behavior problems including Oppositional/Defiant/Conduct related problems and one of the most effective treatments for children with Attention-Deficit/Hyperactivity Disorder (ADHD). PMT is supported by hundreds of scientific research studies showing its effectiveness at improving child behavior and parental stress. This treatment involves a mental health professional meeting with caregivers to teach them strategies to implement at home. It does not often involve meeting one-on-one with the child as the research shows this is usually not effective when trying to change the behaviors of children with these types of challenging behaviors, although there are some exceptions.
There are many strategies taught in Parent Management Training. Below are some of the foundational strategies you will learn when receiving this treatment. Importantly, treatment should not last forever! The Center for Child Behavior’s goal is to teach caregivers effective strategies so that they can implement them on their own successfully!
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Positive Attending – Providing attention to the behaviors you like and want to see more of. For example, if the child is sharing, saying to the child “I love the way you’re sharing” or “Thanks for sharing so nicely with your sister” will actually increase the likelihood that your child shares in the future. The more attention you provide to the behaviors you like, the more they will do them. In order to increase the likelihood that your child will do more of the behavior you give attention to, the best strategy is to give a labeled praise. A labeled praise is telling the child specifically what you like that they did. Instead of “Great job!”, which would be an unlabeled praise, add specifically what you like such as “Great job completing your homework when I asked” or “I love the way you’re sitting still at the table”. Telling the child exactly what you like will increase the likelihood that they do that behavior in the future. Research has consistently shown us that positive attending and labeled praising is one of the most effective ways to improve child behavior, improve child self-esteem, and strengthen the parent-child relationship. Fortunately, positive attending works for older children and teens as well as the little ones.
When-Then Statements – Telling your child or teen that they will get access to the preferred activity/toy/situation after they complete required task. For example, let’s say your child wants to play video games. Using when-then statements would be telling your child, “When you eat your dinner, then you can play video games for 30 minutes”. Requiring them to do the difficult thing first, is almost always more successful than letting them have the fun thing first. If you begin using this strategy and it is different from what you usually require, be prepared that the child will likely become upset, protest, or tantrum. This is predictable and to be expected and it is okay for your child to be upset. In the end, they need to learn to do the things they are required to do, and rewarding them for completing the task afterwards with the fun activity is an effective strategy for doing so.
Transitional Warnings – Providing a warning for transitioning to a new activity. This is especially helpful when transitioning children from preferred to unpreferred activities. For example, “In 10 minutes, it’ll be time for dinner, and you’ll have to turn off the TV” or “In 5 minutes, it’ll be time to get ready for bed”. Sometimes providing multiple warnings for the same transition can be helpful for children who have particular difficulties with transitions (i.e., 10 minute, 5 minute, 1 minute).
Planned Ignoring – Planned ignoring is a tricky strategy. It involves ignoring minor, annoying misbehavior of the child for an extinction burst to occur which means the behavior stops. When a parent uses planned ignoring consistently eventually the behavior stops all together. To properly ignore, you must remove all attention from the behavior including any talking, eye contact, or facial expressions. Sometimes I recommend parents I work with to physically turn away from their child. For example, if your child is whining about wanting more ice-cream for dessert, ignoring would involve not responding to the child’s complaints until the child stops whining. And, to really increase the likelihood that they stop whining over time, you would pair the planned ignoring with a positive attending skills described above. For example, in this case as soon as the child stops whining for ice-cream, you would turn around, give them attention, and offer a labeled praise for something they are doing that you like. Importantly, you should never ignore more serious behavior such as aggression (e.g., hitting, kicking, slapping) or destruction of property. Ignoring can be incredibly difficult for parents, and I highly encourage getting help from a qualified, high quality mental health provider. It’s incredibly important you ignore the behavior all the way through the end of that behavior. In other words: until the behavior stops. If you ignore for a little while and then give in and give attention to the behavior (facial expressions, verbal response), this will actually make the behavior worse in the future and make it harder to stop.
Direct Commands – In order to get your child to listen to you more frequently, it’s best if you use what we call direct commands. Direct commands involve telling the child exactly what you want them to do. For example, “please pick up your toys and put them in the bin” or “Put your shoes on”. It’s often more effective to give an explanation before the command such as “It’s time to go to the store. Please put on your coat”. Directly telling your child what you want them to do using direct commands will increase the likelihood that they listen. In contrast, indirect commands involve asking or suggesting that the child do something. For example, “Let’s put the toys away” or “Can you put your coat on?” These are less effective in getting children to listen to you, especially when you want your child or teen to comply quickly. Indirect commands often involve having to repeat yourself over and over, which increases parent stress and can be exhausting.
Time-out from preferred activities – So what do we do when your child does not listen to your command? One of the most effective consequences for a child is removal of a preferred activity or “time out”. This strategy can be used for all ages elementary and middle school through high school. Depending on the age, you’ll utilize this strategy a little differently. For younger children ages 3-7, you may choose to literally put them in a timeout chair which is often how we conceptualize a timeout. Timeout should range from 5-10 minutes depending on the age of the child and involve no fun activities or attention from other people. If your child gets off the timeout chair during the timeout, you should place your child back on the chair and state that the timeout has now started over. When the child has served the correct amount of time on the timeout chair and they are calm, you can then remove them from the timeout. If they are screaming or crying or saying mean things to others in the room, they should not be removed from timeout. This is because if they are removed from the chair when they scream loudly, you may accidentally reinforce this behavior and increase the likelihood that they will scream during future timeouts to try to get off of the chair.
For older children and teens, a timeout chair is probably not going to be as effective and isn’t developmentally appropriate. However, you can still use timeout from preferred activities such as video games, hanging out with friends, playing outside, etc. Depending on the severity of the behavior and the age of the child, you may want to restrict their ability to do the fun thing for 1 hour or up to 1 day. It is strongly recommended that you don’t restrict or ground them for weeks at a time and certainly do not threaten them with this consequence. Doing so often backfires and leads to worse behavior and/or a lack of motivation to behave well. Again, working with a high quality, qualified, mental health professional will be important to navigate these nuances depending on your child and family.
*Please note that if you are receiving Parent-Child Interaction Therapy (PCIT), the timeout procedure is more complex than the description above.
Reward or Incentive Systems – Incentive systems are ways to reward your child for appropriate behavior and is another way to provide attention to good behavior that you want to occur more frequently. There are several different types of incentive systems including reward charts or token economies and these systems can be extremely simple or made to be more complex. The goal of these systems is to decide upon a few behaviors that you want to improve in your child. When the child engages in the behavior(s) they get a small daily reward. Rewards can be something they are already getting prior to using the incentive system. For example, maybe you already give your child 1 hour of video game time each day. Instead of just giving it to them for free, they have to earn it by making their bed, putting their clothes in the hamper, and putting their toys away, for example. Once they complete the tasks, they get the reward. It’s important to pair the good behavior with a reward in the same day. It’s also a good idea to have a weekly reward given during the weekend for completing a certain number of the behaviors/goals throughout the week. For example, a trip to the park or having a friend come over.
If you want to learn more about these strategies, please schedule an appointment here: Contact. We love working with parents to improve these skills, improve child behavior, and family functioning. We look forward to meeting and speaking with you.