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Insights offered
on parent management training
(May 2006
Issue)
In a Calvin and Hobbes comic strip, Calvin quizzed his father on
his credentials for parenthood and was shocked to find that his
dad had none. No test, no degree, no nothing.
The strip is funny but it's also true. Isn't it strange that, for
what is perhaps the most demanding, time-consuming and important
job that exists, just about anyone and everyone can do it…or will
attempt. As Calvin and Hobbes point out, there is no diploma needed…
just a couple of people with nine months (and 18 years) to spare.
No one said parenting is an easy job. From sleepless nights and
endless days to tantrums in the grocery store, potty training and
dinnertime food wars, those first few years can be a nightmare.
Then, after a few years of carpools, PTA meetings and bake sales,
we've got the wonderful teen years to look forward to.
And that's if all goes well.
What happens when it doesn't go well? What happens when the children
in question take tantrums over the line or when anger expresses
itself in violence and severe acting out?
That's when experts need to step in. New England Psychologist's
Catherine Robertson Souter spoke with Alan Kazdin, Ph.D., the
director of the Yale Child Study Center and of the Yale Parenting
Center and Child Conduct Clinic and John M. Musser Professor of
Psychology and Child Psychiatry at Yale, about a parent training
program that he and colleagues have created over the course of 25
years of study, trial-and-error and fact-based experimentation.
Q: Your Parent Management Training was really the first of its
kind. How long has it been around?
A: We developed it in the 1980s. I used to run an inpatient
service at the University of Pittsburgh School of Medicine. The
program charged $1,000 a day to treat children for the most extreme
aggressiveness. We had the most amazing group of people, psychologists,
psychiatrists, nurses, educators. We were young and vibrant. But,
in fact, there was nothing that could be done. So we said, 'Let's
try and develop a treatment. Even if we fail, let's just do something.'
We started working on it, comparing it to the current treatment
being used and continued to evolve it. We got federal funding, some
special awards, a NIH grant to look at it. It came from the necessity
to do something.
Aggression and violence in children is the most expensive mental
health problem in this country. They start out as children and they
continue over the course of their lives in special education and
the juvenile justice system and then the adult justice system. Eighty
three percent of these children will have a psychiatric diagnosis
in adulthood. If they have been punished a lot, they also have higher
rates of deaths from cancer, heart disease and serious respiratory
disease [as adults].
Then there is the suffering. These children are victimizing others
as well. Their aggression has someone else being bullied or stabbed
or a pet being killed or a fire being set.
Q: You work mostly with the parents in this program rather than
with the child. Why is that?
A: Let me tell you a story. A 13 year-old girl was arguing with
her mother recently. The girl went to hit the mom and the mom leaned
over and hit the girl pretty hard. So far nothing too interesting,
mother/daughter anger exchanges. But the girl, instead of turning
around and hitting her mother, went around the living room and took
everything off the wall and trashed the living room. Now that also
isn't so interesting. Here's the reason I tell you this story so
you understand what we are dealing with. The mother got really,
really mad and said to her daughter, 'You can't trash this house.
I bought all of this. I own this house. You can't trash it at all.'
And then the mother proceeded to finish what was not trashed by
the daughter and then went to the other rooms and started throwing
plates and breaking things all over the house. Of course, the police
arrested both of them because it went on and on enough to have neighbors
involved.
So, dealing with children is the least of my problems. There's
a lot of family stuff going on.
Q: It seems to me that there are a lot more children who need
help than there are programs that can treat them.
A: Absolutely, yes. And it's really a very frustrating part
of our work. We do really well here but we have no mechanism to
disseminate this information.
Children are out there getting treated with techniques that are
pretty much known not to do much. The standard therapy for this
problem is general relationship therapy with the child and parent.
We talk about 'why are you angry?' and talk to the child and the
parents - really old fashioned, New Yorker cartoon kind of therapy.
But that's not where the evidence is for this problem. The evidence
is for parent management training. This is not an opinion. The evidence
is there and that's why we are using it.
[In our research,] we have found more than 550 different forms
of psychotherapy being used with children and adolescents. The vast
majority of these treatments, over 90%, have never been studied.
Q: Are parenting books helpful?
A: I've been reading some of the books lately but I have had
to stop because, as a genre, the books are recommending things that
are flat out wrong.
Q: Like what?
A: Like, time outs: 'Make them longer if your child is not responding.
If you have to do a monster time-out, make it for four hours. Or
if your child is having tantrums, sit down and explain to your child
and that will change the aggression.' These things are wildly wrong.
It's wonderful to sit down with your child but it is not an intervention
technique for actually changing the behavior.
It's frustrating to see page after page of advice that violates
what has been established. It's one thing if a scientist has a problem
getting the word out, it's another thing to encounter that the word
that's out there is not just lightly misguided, it's horrible.
Q: You said understanding is not related to changing the behavior.
A: No, not at all. Someone might have a habit or two, whether
it's smoking or whatever and understand fully [the consequences
of the behavior] but that does not change the behavior. Understanding
is one of the weakest psychological interventions we have.
You always want your child to understand because it will develop
vocabularies and it will develop good communication. But, getting
your child to understand will have no impact on tantrums. There
is even a chance, if you do it the wrong way that you can end up
increasing the tantrums.
Q: How do you sum up what parents should be doing?
A: Parent Management Training is all about training parents
to act in different ways. There are some key ingredients. Like playing
a musical instrument, much of therapy is practice - reinforced practice.
Parents know what they don't want the child to do. The focus should
be on what you do want your children to do. The way to get the behavior
is to do certain things before the behavior and then praise and
award points after the behavior.
We call it the ABC method: antecedents (what you do before the
behavior), behavior (shape it) and consequences (what comes after).
You have to do all of these.
The strength of the approach is not in the reward, which is what
some of the books have decided. It's in the setting up of the behavior,
in the gradual approximation of your final goal and its repeated
practice.
So, that's it. With music, you don't sit down and say I'll give
you $5 to knock off this Rachmaninov symphony. No, you have to do
all the steps along the way and at the end of that, you hear the
symphony and you have no idea how you got there.
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