Behavioural problems

Training 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 childs condition: It is very important that parents understand what
their childs 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 childs 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.

Problem-Solving Skills Training (PSST) and Parent Management Training

(PMT) for Conduct Disorder

Brief Program Description

PSST is a therapeutic intervention aimed at teaching children with conduct disorder how
to approach interpersonal situations. Treatment consists of 12 to 20 weekly individual
sessions, approximately 30 to 50 minutes each. Children are taught a step-by-step
approach to solving interpersonal problems. Prosocial behaviors are fostered through
modeling and direct reinforcement. Structured tasks such as games, academic activities,
and stories are used to teach children how to apply what they have learned. Over the
course of treatment, children are encouraged to increase application of lessons to real-life
situations. The program includes a token reinforcement system, but relies more on social
reinforcement. Therapists also teach parents to help their child use the problem-solving
steps.
PMT trains parents to alter their conduct-disordered children's behavior in the home.
Parents are trained to identify, define, and observe problem behaviors and how to change
antecedents, behaviors, and consequences. Treatment consists of 12-16 weekly outpatient
sessions.

Outcomes
PSST and PSST with PMT have been tested on ethnically and socioeconomically diverse
families with boys and girls aged 6 to 14 years old. The treatments have been
administered at inpatient and outpatient clinical settings. In random trials, PSST
participants showed significantly greater decreases in internalizing, externalizing, and
aggression and greater increases in prosocial behaviors and overall adjustment than
participants in nondirective relationship therapy or contact-only controls. These results
persisted at 1-year followup. In a randomized trial, children whose families participated
in both PSST and PMT had fewer internalizing or externalizing behaviors, and were less
aggressive than contact-only controls at posttest and 1-year follow-up.