Behavioral Parent Training

Ron Prinz. Encyclopedia of Human Relationships. Editor: Harry T Reis & Susan Sprecher. Sage Publications. 2009.

The concept of behavioral parent training, which can be traced back to the early 1960s, refers to the teaching and deployment of parents as therapeutic agents in the treatment of troubled children or of children in need of special assistance. Psychologists and other mental health professionals realized that children’s social, emotional, and behavioral problems were not effectively addressed by meeting with a therapist for 1 or 2 hours per week. Children’s behavior is heavily influenced by the immediate environment around them, including interactions with parents, siblings, peers, teachers, and others. The idea behind parenting training is that parents are often in a better position than anyone else to alter the environmental conditions and situations impinging on their children’s behavior and thereby can promote better child adjustment. Training a parent to be a “therapist” of sorts is a potentially more effective treatment strategy than one-on-one professional counseling or therapy with a young child in part because of the countless hours each week that children spend with their parents and because talking with a child may not in and of itself change the child’s behavior. This entry addresses theoretical foundations of behavioral parent training, summarizes early approaches to parent training, and then describes more recent parent-training interventions.

Theoretical Foundations

Behavioral parent training is grounded in psychological principles of learning, which are readily accessible by parents, teachers, and others who interact with children. The field of behavioral learning has produced a complex body of knowledge about the moment-to-moment interactions between individuals and their environments, which affect observed behavior. Learning principles have been translated into methods of behavior change that professionals could teach to parents and apply to a variety of child problems. Basically, parenting-training methods are used to promote healthy and positive child behaviors, to replace or prevent unhealthy or problematic behaviors, and to teach specific skills with a variety of child populations.

Early Forms of Parent Training

The first forays into behavioral parent training focused on discrete child problems such as frequent and destructive tantrums or abnormally fearful responses. This work with individual parents was part of the budding field of applied behavior analysis in which children’s behavior was observed in social and environmental contexts. The observations were part of what is called functional analysis of behavior to determine which environmental cues and events were maintaining or exacerbating the problematic behavior. A parent participating in behavioral parent training would first keep track of specific events and child behavior, as well as their own behavior, and use the records to help plan the next steps. Parents learned specific child-management techniques that they applied at home while they continued to keep track of progress.

One guiding principle for behavioral parent training is that specific occurrences of behavior are affected by the immediate environmental consequences or events. For parents this means that child behaviors that result in immediate attention from people tend to get strengthened or repeated. For example, behaviors such as tantrums or showing off, which are attempts to gain an audience, get rewarded or “paid off” in a sense by the responses of others. In behavioral parenting training, parents first learn how to observe these kinds of contingent relationships between child behavior and social-environmental response and then how to alter the contingencies for more positive outcomes. For example, parents might be encouraged momentarily to ignore attention-seeking behaviors or to remove their child from situations in which the child could elicit attention from others.

A second guiding principle in behavioral parent training is the concept of differential reinforcement of other behavior (DRO). With DRO, parents and other significant individuals in a child’s world try to respond consistently and positively to constructive behaviors that are incompatible with problematic behavior that needs to be diminished. For example, speaking nicely to siblings and sharing toys and activities with others are behaviors that are incompatible with fighting and bossy behavior and are thus good candidates for the use of DRO by parents. Parents are taught to reinforce such behaviors by commenting positively to the child, publicly recording such instances on a recognition chart, or following episodes of these behaviors with immediate positive consequences (e.g., fun activity, a treat, or another pleasant event).

Other common elements of behavioral parent training include giving clear instructions, using successive approximations to teach or “shape” new child skills, prompting where necessary, and “fading the prompt” to encourage self-reliance in children.

Some of the earliest forms of behavioral parent training focused on the addressing of single problem behaviors in children such as tantrums, mealtime difficulties, fighting with other children, and lack of cooperation with parental instructions. Other early efforts focused on the specific needs of special populations such as developmental disabilities and autism. Behavioral parent training, which augmented other intensive interventions for these populations, addressed the promotion of basic skills such as speech, social interaction, and self-care, and the reduction of problem behaviors such as self-destructive and self-stimulatory acts.

More Recent Forms of Parent Training

Over a 40-year period, behavioral parent training has evolved into a more sophisticated array of parenting interventions that are useful in a number of contexts. Some of the more recent forms of parent training go beyond learning theory and draw on a variety of practical theories about parental cognitions and beliefs, child development, family dynamics, and relationships. The newer versions of behavioral parenting training address a wider array of problems, involve more goal setting and assessment by parents, make use of a greater variety of delivery formats (parent groups, individual family sessions, telephone consultation, video-DVD instruction), and take a more comprehensive approach to family functioning and intervention.

Behavioral parenting training programs and interventions that have proven to be effective have several attributes in common:

  • Action focused: More than just talk, parents actually do things during the program and carry out activities at home.
  • Problem-solving oriented: Specific challenges faced by parents are addressed; they work toward solutions to the identified problems and build on child and family strengths.
  • Specific parenting strategies: Strategies are specific, concrete, and practical so that parents can add to their repertoire of parenting practices.
  • Collaborative goal setting: Parents set the child and family goals; the intervention professional provides guidance but works collaboratively.
  • Consultative rather than prescriptive: Intervention professional is a consultant rather than a “boss.”
  • Adoption of positive frame: Program is nonjudg-mental about the parent, looks to build on parent and child competencies, emphasizes expanding positive child behaviors to displace problematic behaviors, and is optimistic, encouraging, and patient in its delivery.

Although these attributes reflect considerable commonality across programs and interventions, there is also some variability in approach by different behavioral parent training programs. Two well-known programs, each with impressive evidence of effectiveness, illustrate some of the variation. The first is Parent-Child Interaction Therapy (PCIT), which was developed by Sheila Eyberg and colleagues at the University of Florida. PCIT is a clinic-based therapy program for parents of children ages 3 through 8 with oppositional defiant disorder and related problems. In PCIT, parents learn how to become more positive in the use of praise and differential attending (responding to desirable child behaviors and ignoring undesirable behaviors) and in the avoidance of counterproductive criticism. Parents also learn how to manage misconduct situations better. From behind a one-way mirror, therapists watch parents interacting with children and coach them through the use of electronic communications (e.g., bug-in-the-ear, a receiver that is put in the parent’s ear into which the therapist provides instructions and tips so that the parent can hear it, but the kid cannot). Parents participating in PCIT receive intensive practice and coaching in the clinic and then carry out specific procedures at home with their children. PCIT offers a cogent method of helping parents who are faced with challenging child behaviors.

For example, PCIT has all parents go through the same two procedures no matter what their concerns are. The first procedure is a play situation in which the parents orient towards child-directed activity. During the child-directed procedure, parents cannot make requests or ask questions but instead must focus solely on attending to and describing-praising any nonnegative behaviors on the part of the child. The second procedure is a parent-directed situation in which the parent is seeking to have the child do something the parent is requesting. This parent-directed activity provides an opportunity for the therapist to coach the parent in how to administer clear instructions and includes calm, straightforward steps for handling noncompliance and promoting cooperation.

A very different approach to parenting intervention, which builds on behavioral parent training, can be found in the Triple P—Positive Parenting Program. Developed by Matthew Sanders and colleagues at the University of Queensland, Triple P is actually a system or suite of parenting programs organized in multiple levels of increasing intensity to match the varying needs of families. Triple P is applicable to both the prevention and the treatment of children with social, emotional, and behavioral problems. This approach was designed for reaching the larger population of parents via many settings (e.g., schools, health centers, clinics, home visiting, daycare centers, preschools, churches, community centers) and formats (e.g., brief consultation, parent groups, intensive intervention with an individual family, mass media). Triple P covers a wide variety of common developmental and behavioral topics (e.g., mealtime, bedtime, tantrums, fears, separation anxiety, homework, etc.) and more serious problems (e.g., aggression-violence, bedwetting, bullying, depression). The main interventions within the Triple P system focus on parents of children birth to 12 years throughout the population, and other variants of Triple P are intended for parents of young children with developmental disabilities, parents who are at elevated risk to engage in abusive parenting, and parents of teenagers.

For example, Triple P parent training is organized around the specific goals that parents wish to achieve with their children. Together, the service provider and the parent figure out what is maintaining any problem behaviors or what is interfering with healthy child development and then craft a parenting strategy. The Triple P provider exposes the parent to a broad array of evidence-based parenting strategies and then helps the parent choose the strategy or strategies that fit the parent’s style preference, the child’s developmental level, and the particulars of the presenting situation.

Variants of behavioral parent training have been applied to many areas and problems including but not limited to developmental disorders (e.g., autism, Asperger syndrome, Down syndrome), childhood aggression, attention-deficit hyperactivity disorder, bedwetting, adolescent substance abuse, childhood anxiety problems, school refusal, early-childhood preparation for school, families going through divorce, families dealing with bereavement, chronically ill children, parents who have engaged in child abuse, foster parent preparation, and issues faced by newly formed stepfamilies. In the area of child mental health treatment, behavioral parent training represents the single most successful modality in terms of efficacy and benefits. Overall, behavioral parent training has made considerable strides in 50 years to prove useful to many families across a wide variety of settings and contexts.