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Parent Training / Parent Therapy

Woman crying on sofa while therapist is taking notes

Parent training / parent therapy

Introduction to parent training 

Parent training or parent therapy is a growing area of psychological intervention for parents whose children have been diagnosed with certain mental and behavioural disorders.

Behavioural disorders such as attention deficit hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD) are by far the most studied childhood disorders that benefit from parent training. Quite commonly these disorders occur comorbidly, which means that one child can show symptoms of more than one disorder (e.g. both ADHD and ODD). It has been shown that these children’s behaviour also improves significantly after their parents have implemented the skills learned at training sessions.

Children with autism, eating disorders and anxiety have also been shown to benefit from the changes brought about in parent management as a result of parent training.

As any parent would agree the challenges associated with bringing up any child, whether they suffer from a psychological disorder or not, are numerous and at times overwhelming. Parent training helps parents to manage their stress levels and helps them to develop better coping mechanisms, which in turn provides a healthier more controlled home environment.

Child and parental behaviour can be described as having a bidirectional relationship, in which one influences the other. If children are hyperactive and defiant, then parents can become stressed and angry. The more stressed and angry parents become, the more the child will act out, and so on. This results in a vicious cycle where both parent and child behaviour become worse and more hostile. Parent training sessions can be very successful in stopping this cycle.


What is parent training?

Parent training  / parent therapyParent training (PT) is a programme that is designed to help parents develop the skills necessary to manage their child’s behaviour and development. The techniques learnt in PT allow parents to correctly identify, define and respond to dysfunctional and problematic childhood behaviour.


What is involved in parent training?

Parent training is not a “quick fix” for any situation. Parents are required to attend 75-90 minute sessions once a week for 8-22 weeks depending upon their individual circumstance.

While it is ideal that both parents attend the sessions, it is often not possible. It is important to remember that, no matter what the relationship status of the child’s parents, both mothers and fathers individually have been shown to make a difference to their child’s behaviour. So do not be disheartened about the idea if you are a single parent. Perhaps you could bring a friend who is also experiencing a behavioural problem at home.

There is also group parent training offered by some clinics, where up to ten families can attend the sessions. In some studies it has been shown that these group training sessions are in fact more effective, as the parents from different families can rely on each other for support, guidance and understanding.

Sessions involve role-playing, lecture-style talks by psychologists, discussion and homework. Each session will carry on from the previous with constant revision of the learned skills and information.


How does parent training work?

PT works and is managed in different ways depending upon what problems are faced in the home. There are three main sections:

  • Dealing with behaviour
  • Dealing with eating disorders
  • Dealing with autism

Although the programmes for each are quite separate, there are common underlying focusses of PT, which are consistency, child support, and spending as much quality time with children as possible.


Behavioural problems

Parent training / parent therapyTraining for parents whose child has a behavioural problem is a relatively short-term, focussed therapy (less than one year) that works solely on parents. It is not recommended that children attend the sessions.

In the sessions the parents will learn:

  • About their child’s condition: It is very important that parents understand what their child’s behavioural disorder actually is, what the major symptoms are, and what the child may be feeling.
  • What to expect from their child: Expectations of a child’s development need to be realistic, otherwise the child will feel threatened and may take a “backwards step” in their learning and behaviour. This may lead to disappointment on the parents’ behalf, which will impact on the self-esteem of the child.
  • How to give commands appropriately, both verbally and non-verbally: A firm voice with an appropriate volume and constant eye contact are very important when giving commands.
  • The importance of praise: Just as important as knowing how to deal with disobedient behaviour is to know how to positively reinforce good behaviour. In order for parents to establish a good relationship with their child, is it imperative that they constantly praise good behaviour and encourage children to engage in activities which they enjoy and are good at. Rewards and incentives are also successful tools for encouraging good behaviour.
  • How to reprimand appropriately: When a child first acts out, they should be told straight away not to continue that behaviour. This reprimand needs to be firm and serious, but yelling and shouting should not be necessary. If parents yell and shout, their children will too.
  • When to give warnings and when to take action: Children need to know when they are doing something inappropriate. Therefore it is quite acceptable for parents to give their child a warning. However, one warning is enough. If there are too many warnings given, they will lose meaning.
  • Timeout: An important focus of PT, especially with children under the age of 10, is timeout. Timeout must be consistent, the same amount of time (usually 1 minute/year of age of child), and must be enforced EVERY time the child acts inappropriately. If this is ten times in one hour, then so be it. If it is not consistent then the child will always “push the boundaries” to see when they can get away with bad behaviour.

These skills are revised continuously through the sessions. Parents are involved in role-playing with the psychologist and are required to continuously practise these skills at home.

Throughout PT, the idea of parent self-blame is dismissed. This will not solve any problems. PT helps to improve parenting skills, not to make parents feel inadequate or unsuccessful.


Eating disorders

Parent training / parent therapyPT for eating disorders is focussed around the following;

  • Parental role modelling: Children are most likely to eat healthier when parents are eating healthy.
  • Establishing good eating and exercising habits: This is the primary focus for younger children with obesity or over-eating, as it is easiest to change habits when children are very young.
  • Encouragement and praise for good eating and exercising: This is imperative in order to change habits, especially for children over the age of eight. Improving child self-esteem is essential in order to change their dietary patterns. If they believe they can do it, they will. This is largely influenced by parent attitude.

Similar techniques exist for under-eating problems (e.g. anorexia nervosa, bulimia). Although these disorders are opposite to over-eating as far as weight is concerned, the general principal is the same. Improved self-esteem will improve eating conditions. Encouraging good eating and being a good role model are the first steps in achieving this.


Autism

PT for autism is very different than for the behavioural PT models. This training is designed to teach parents how to prepare their child for tasks and challenges they will encounter in their daily environments. In order to achieve this, parents are taught how to identify the interests and strong points of their child. This is mainly done through short and frequent sessions of imaginative play with their child.

Through one on one contact, parents learn various methods of intervention that are unique to their child. For example, they may learn that their child is stimulated more by a farm-type creative play than by cars. By engaging in play that is preferred by their child, parents are more likely to see improvements in language and social interaction. It is very important that parents develop realistic expectations of their child’s potential.

Parents will learn how to address:

  • Language: Parents will be taught some verbal exercises they can perform with their child to help language skills. One on one contact will also help parents to better communicate with their child.
  • Sensory: Parents are taught how to identify their child’s sensory and motor strong and weak points, and to adapt to these by concentrating on the strong points. For example, if the child is good at throwing balls but lacks the skill for dressing a barbie, it is more important to concentrate on ball throwing rather than trying to improve the fine motor skill associated with dressing a barbie.
  • Social: Children are more likely to engage socially when they are participating in activities which they enjoy. Parents are taught to identify these activities and concentrate on them during their one on one session with the child.
  • Parent training / parent therapyEducational: Parents will learn how to select appropriate learning tasks for their child. This may be continuing with the imaginative play. Parents are also actively encouraged to involve themselves with the child’s school life. This includes volunteer work, classroom visits, attendance at school meetings and participation in school organisations. The most important interaction that parents should have with the school is communication with the child’s teacher and principal. This way the teachers and parents can work together to assess the child’s development and discuss what areas need to be focussed on, both in the classroom and at home.

It is suggested that 25 hours per week of one on one contact is spent with an autistic child. This is not always possible, though, and parents should try to spend as much time as they can with their child, aiming for at least 15 hours per week.


Effectiveness of parent training

Parent training yields very positive results for behavioural and mental disorders in children. For any parent training, early intervention is the key. Parents with children under the age of 12 have shown the most success in behavioural disorders, and under the age of six for autism and overeating.

There can still be success in children over 12, but the effectiveness is weakened. By the time the children are at adolescent stages, the effectiveness of parent training is significantly reduced. It is very hard to change parenting habits that have spanned 15 years or so, and even harder for the child to accept the changes.


Effectiveness for children with behavioural and eating problems

There have been several studies that have shown parent training to be very effective in improving the behaviour of children, improving parent-child relationships, and reducing stress for parents. This sometimes takes a while to achieve once training has stopped, but do not be disheartened. Keep consistent and keep trying, and your skills will develop and you are very likely to see changes.

Other improvements clinically shown include:

  • Improvement in child self-worth and self-esteem. This is particularly important in eating disorders such as obesity, anorexia and bulimia.
  • Improvement in eating habits for young children who refuse to eat “healthy” food
  • Improvement in child compliance with house rules and school rules
  • Increase in child attention
  • Improvement in child’s self-rated perception of their parents

Parent training / parent therapyVery often the success and effectiveness of PT relies on how much work the parents put in at home. The skills learnt at PT need to be implemented constantly, not just when it suits either the parent or child. This is not always easy.

Sticking to the skills learnt at PT involves determination. In a lot of cases, sacrifices have to be made. If the rules are broken, logical consequences MUST be implemented. Therefore it is advisable that parents never give a warning they would not follow through. If children are behaving badly, they must be reprimanded immediately, not allowed to continue the behaviour.

Above all, consistency is the key! The same rules must be applid every day so the child is very clear about the boundaries of their actions.

It is important to note that the most common therapy for ADHD children is treatment with stimulant medication. There is no rule to say that parent training and stimulant medication cannot be used together to maximally improve child symptoms. In fact, it has been shown that the best results for behavioural disorders are achieved with behavioural therapy in conjunction with medication.


Effectiveness for autistic children

With continued one on one interaction as a result of parent training, autistic children have shown improvements in:

  • Language
  • Social interaction
  • IQ

Improved parent gaze and imaginative play by the child have been shown with consistent and intense interaction.


Cost of parent training

Any therapy is expensive and parent training is no different. However, the financial costs are often outweighed by the substantial improvements in quality of life. Remember, skills are not objects. You cannot “run out” of them. If you adhere to the recommendations of your counsellors, you will have these skills for life and they will only improve the more you use them. If you look at PT this way, it actually works out to be a relatively cheap therapy for problems at home. Improvement in behavioural disorders can also reduce the cost of associated medications.

For more information, speak to your doctor or psychologist.

More information

ParentingFor more information on various aspects of parenting, see Parenting.

 

References

  1. Lifford KJ, Harold GT, Thapar A. Parent-child relationships and ADHD symptoms: A longitudinal analysis. Journal of Abnormal Child Psychology. 2008; 36(2): 285-96.
  2. Preschool attention deficit disorder: New studies show that both drugs and parent training can be effective. The Harvard Mental Health Letter. 2007; 24(3): 1-3.
  3. Brown RT, Amler RW, Freeman WS, Perrin JM, Stein MT, Feldman HM, et al. Treatment of attention-deficit/hyperactivity disorder: Overview of the evidence. Pediatrics. 2005; 115(6): e749-57.
  4. Costin. Attention deficit hyperactivity disorder and comorbid anxiety: Practitioner problems in treatment planning. Child and Adolescent Mental Health. 2002; 7(1): 16-24.
  5. Danforth. The outcome of group parent training for families of children with attention-deficit hyperactivity disorder and defiant/aggressive behavior. Journal of Behavior Therapy and Experimental Psychiatry. 2006; 37(3): 188-205.
  6. Fabiano GA. Father participation in behavioral parent training for ADHD: Review and recommendations for increasing inclusion and engagement. Journal of Family Psychology. 2007; 21(4): 683-93.
  7. Costin J, Lichte C, Hill-Smith A, Vance A, Luk E. Parent group treatments for children with Oppositional Defiant Disorder. Australian e-journal for the Aadvancement of Mental Health. 2004; 3(1): 1-8.
  8. Costin. Parent management training as a treatment for children with oppositional defiant disorder referred to a mental health clinic. Clinical Child Psychology and Psychiatry. 2007; 12(4): 511-24.
  9. Benson P, Karlof KL, Siperstein GN. Maternal involvement in the education of young children with autism spectrum disorders. Autism. 2008; 12(1): 47-63.
  10. Crockett JL, Fleming RK, Doepke KJ, Stevens JS. Parent training: Acquisition and generalization of discrete trials teaching skills with parents of children with autism. Research in Developmental Disabilities. 2007; 28(1): 23-36.
  11. McConachie H, Diggle T. Parent implemented early intervention for young children with autism spectrum disorder: a systematic review. Journal of Evaluation in Clinical Practice. 2007; 13(1): 120-9.
  12. Solomon R, Necheles J, Ferch C, Bruckman D. Pilot study of a parent training program for young children with autism: The PLAY Project Home Consultation program. Autism. 2007; 11(3): 205-24.
  13. American Dietetic A. Position of the American Dietetic Association: Individual-, family-, school-, and community-based interventions for pediatric overweight. Journal of the American Dietetic Association. 2006; 106(6): 925-45.
  14. Zucker NL, Marcus M, Bulik C. A group parent-training program: A novel approach for eating disorder management. Eating & Weight Disorders. 2006; 11(2): 78-82.
  15. Dretzke J, Frew E, Davenport C, Barlow J, Stewart-Brown S, Sandercock J, et al. The effectiveness and cost-effectiveness of parent training/education programmes for the treatment of conduct disorder, including oppositional defiant disorder, in children. Health Technology Assessment. 2005; 9(50): iii,ix-x,1-233.
  16. Bulik. Outcome of anorexia nervosa: Eating attitudes, personality, and parental bonding. International Journal of Eating Disorders. 2000; 28(2): 139-47.
  17. Humphrey. Structural analysis of parent-child relationships in eating disorders. Journal of Abnormal Psychology. 1986; 95(4): 395-402.
  18. Jones K, Daley D, Hutchings J, Bywater T, Eames C. Efficacy of the Incredible Years Basic parent training programme as an early intervention for children with conduct problems and ADHD. Child Care, Health and Ddevelopment. 2007; 33(6): 749-56.

Dates

Posted On: 11 July, 2008
Modified On: 13 March, 2014

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