Parent management training ( PMT ), also known as parental behavioral training ( CPM ) or just parent training , is a family of treatment programs aimed at changing parenting behaviors, teaching parents positive reinforcement methods to correct pre-school and school-age behavioral problems (such as aggression, hyperactivity, anger, and difficulty following directions ).
PMT is one of the most studied treatments available for disruptive behavior, especially oppositional resistance disorder (ODD) and behavioral disorders (CD); it is effective in reducing child annoying behavior and improving the mental health of parents. PMT has also been studied as a treatment for disruptive behavior in children with other conditions. Limitations of existing research on PMT include lack of knowledge of change mechanisms and the absence of long-term outcome research. PMTs may be more difficult to apply when parents can not participate fully because of psychopathology, limited cognitive capacity, high-conflict conflicts, or inability to attend weekly sessions.
PMT was originally developed in 1960 by child psychologists who studied behavioral changes interfering with children by intervening to change the behavior of parents. This model is inspired by the principles of operant conditioning and behavioral analysis applied. Treatment, which usually lasts for several months, focuses on parents who learn to provide positive reinforcement, such as praise and appreciation, for appropriate behavior of children when setting appropriate limits, using methods such as eliminating attention, for inappropriate behavior.
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Poor parenting, inadequate parental supervision, inconsistent discipline, and parental mental health status, stress or substance abuse all contribute to the problem of early-onset behavior; costs generated for the high society. In the context of developing countries in particular, socio-economic losses of families are a significant predictor of abusive parenting that affects the psychological, behavioral and physical outcomes of adolescents. Negative parenting practices and negative behaviors of children contribute to each other in a "coercive cycle", in which one person begins by using negative behavior to control the behavior of others. The person in turn responds with negative behavior, and the negative exchange increases until a person's negative behavior "wins" the battle. For example, if a child is angry to avoid doing household chores, parents may respond by shouting that the child should do so, in which the child responds with a louder outburst, at which point the parent may succumb to the child. to avoid further disruption. Children's anger is thus strengthened; by making the act, he has reached the ultimate goal to get out of the task. PMT seeks to break patterns that reinforce negative behaviors rather than teach parents to reinforce positive behaviors.
The content of PMT, as well as the order of skills in the training, varies according to the approach used. In most PMTs, parents are taught to define and record observations of their child's behavior, both positive and negative; this may involve using the progress chart. This monitoring procedure provides useful information for parents and therapists to set specific goals for treatment, and to measure child development over time. Parents learn to give specific, concise instructions using eye contact when speaking in a calm manner.
Providing positive reinforcement for appropriate child behavior is the main focus of PMT. Typically, parents learn to appreciate appropriate behavior through social rewards (such as praise, smiles, and hugs) as well as concrete rewards (such as stickers or points toward larger rewards as part of a collaborative incentive system made with children). In addition, parents learn to choose simple behaviors as the initial focus and reward each small step their child achieves to achieve a larger goal (this concept is called "consecutive estimates").
PMT also teaches parents to set appropriate 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 behaviors in children are sometimes referred to as differential reinforcement. For a slightly annoying but harmless behavior, parents practice ignoring behavior. Following undesirable behavior, parents are also introduced with the use of appropriate time-out techniques, in which the parent diminishes attention (which serves as a form of reinforcement) of the child for a certain period of time. Parents also learn to remove their child privileges, such as television or playing time, in a systematic way in response to undesirable behavior. In all of these strategies, therapists emphasize that the consequences should be provided calmly, promptly, and consistently, and offset by encouragement for positive behavior.
In addition to positive reinforcement and boundary arrangements at home, many PMT programs combine collaboration with child teachers to track behavior at school and link it to home gift programs. Another common element of many PMT programs is to prepare parents to manage problematic behavior in situations that are usually difficult for children, such as being in public places.
Training is usually delivered by a therapist (psychologist or social worker) to each family or family group, and is done primarily with parents rather than children, although children can be involved as therapists and parents feel comfortable. Typical training courses consist of 12 core weekly sessions; with programs ranging from four to twenty four weekly sessions.
PMT is underutilized and training for therapists and other providers is limited; it has not been widely used outside of clinical settings and research.
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The theory behind PMT has been "repeatedly validated", and many programs have met the "gold standard criteria for established interventions". All established programs teach better parenting skills and emphasize that parent-child relationships are "two-way".
Specific treatment programs that can be widely characterized as PMT include Parent-child interaction therapy (PCIT), exceptional parenting training (IYPT), positive parenting programs (Triple P), and parenting management training - the Oregon model (PMTO). PCIT, IYPT, Triple P and Helping non-adherent children (HNC) is one of the most commonly used PMTs; according to Menting et al (2013), IYPT "is considered a 'blueprint' for violence prevention."
The cost per family of the group's parental training program to bring the average child into various non-clinical behavior disorders is estimated in 2013 to be US $ 2,500, which Cochrane Cochanters say is "simple compared to long-term, social health , education and legal costs related to childhood behavior issues ".
Effects
Disruptive behavior of children
PMT is one of the most extensively studied treatments for childhood disruptive behavior. PMT tends to have a greater effect for younger children than older children, although the differences between age groups are not statistically significant. Improved mental health of the elderly (depression, stress, irritability, anxiety, and self-esteem) and parental behavior are recorded. Improvements in the behavior of children and parents are maintained up to one year after PMT, although the effect is small; very little research has been done on the durability of the effects of PMT.
Families from economically disadvantaged backgrounds are less likely to benefit from PMT than their more profitable counterparts, but this difference is attenuated if low-income families receive individual care rather than groups. Overall, the PMT delivery group format is less effective than the individual format, and the addition of individual therapy to the child does not improve outcomes. Parental psychopathology, substance abuse, and maternal depression are associated with poor results; this may be because "the parent's ability to learn and consolidate the skills taught" is influenced, or the parent may not be able to remain involved in the program or translate the skills acquired to the home.
Furlong et al (2013) concluded that group-based PMTs were cost-effective in reducing behavioral problems, and improving parental health and parenting skills, but there was insufficient evidence that it was effective at "problem-solving measures emotional child and educational and cognitive abilities ".
Other childhood onset conditions
Although most studies on PMTs examine their impact on disruptive behavior, it has also been studied as an intervention for other conditions.
High conflicts in the families of children with attention-atten- tion hyperactivity disorder (ADHD), with parents showing "more negative and ineffective parenting (eg, empowerment, punishment, inconsistency) and less positive or warm parenting, relative to parents of children without ADHD ". PMT targets dysfunctional care and issues related to school children with ADHD, such as work completion and peer problems. Pfiffner and Haack (2014) say PMT is well established as a treatment for school-aged children with ADHD, but there are still questions about the best methods for delivering PMT. A meta-analysis of evidence-based ADHD treatment in children further supports this, as researchers found broad variability in how PMT was done in previous studies. The analysis also notes that physicians involved in this study often modify training based on family needs. However, this variation does not create a significant difference in the effectiveness of PMT throughout the study. The 2011 Cochrane Review found some evidence that PMT improves general child behavior and parental stress in treating ADHD, but has limited effects on specific ADHD behaviors. The authors conclude that there is a lack of data to evaluate school attainment, and the risk of bias in studies due to poor methodology; The available evidence is not strong enough to form clear clinical guidelines relating to PMT for ADHD, or to say whether the group or individual PMT is more effective.
A 2009 long-term outcome review in children with Tourette syndrome (TS) says that, in children with TS who have other comorbid conditions, PMT is effective in addressing explosive behavior and anger management.
The US National Mental Health Institute has established a "gap between evidence-based care and community service" as areas that critically require more research; PMT for disruptive behavior in children with autism spectrum disorders is an ongoing field of research.
Limitations
There is much support for PMT in the research literature, but some research limitations have been noted. A common concern with implementing evidence-based care in community contexts (as opposed to research) is that the powerful effects found in clinical trials may not generalize populations and complex community settings. To address this problem, the meta-analysis of PMT studies encoded throughout the "real world" criteria found no significant difference in the effectiveness of PMT when it was sent to the clinic versus the population referred to in the study, in routine versus research setting services, or by non-therapists specialists and specialists (such as those who have a direct link to the program developer). The increased attention to the impact of cultural diversity on the outcome of PMT - especially given that the practice of parenting is rooted in culture - was called in the 1990s; 2013 reviews say the emphasis on ethnic and cultural differences is not justified in terms of efficacy.
Another limitation of existing research is that research tends to focus on statistically significant changes rather than clinically (eg, whether the daily functioning of children really improves); no data on the sustainability of long-term treatment effects; and little is known about the process or mechanism through which the PMT improves outcomes.
Training programs other than PMT may be better indicated for "parents with significant psychopathology (such as anger management issues, ADHD, depression, substance abuse), limited cognitive capacity, or those in a very contradictory marital/partnership relationship", or parents is unlikely or unable to attend weekly sessions.
History
Parental management training was developed in the early 1960s in response to an urgent need at an American child counseling clinic. Research across national networks from this clinic revealed that care used for young people with disruptive behavior, which is the majority of children served in this setting, is largely ineffective. Some child psychologists, including Robert Wahler, Constance Hanf, Martha E. Bernal, and Gerald Patterson, were inspired to develop new treatments based on the principles of operant conditioning behaviors and behavioral analysis applied. Between 1965 and 1975, a model of parental care training was established, emphasizing teaching parents to positively reinforce prosocial child behavior (such as praising a child for direction) while negative antisocial behavior incentives (such as eliminating parental attention after a child throws a tantrum ). Initial work of Hanf and Patterson hypothesized that "teaching parents the principles of behavioral reinforcement will result in effective and sustainable change in children's behavior". Preliminary studies of this approach indicate that treatment is effective in the short term in improving parenting skills and reducing child-disturbing behavior. Patterson and his colleagues theorize that an adverse environmental context causes disruption in parental practices, which then contribute to negative outcomes in children.
Following initial PMT developments, a second wave of research from 1975 to 1985 focused on long-term effects and treatment generalizations for non-clinical settings (such as home or school), greater family effects (such as improved parenting with siblings), and improved behavior outside targeted areas (such as increased ability to make friends). Since 1985, the literature on PMT has continued to grow, with researchers exploring topics such as treatment applications for serious clinical problems, dealing with client resistance to treatment, prevention programs, and implementation with diverse populations.
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