It is a presentation about parent management training, given to parents having child with behavioral disturbance. It is a procedure of difficult child management by parents. This training describes about how should parents react and manage their child's undesired behavior. This training describes about psychotherapy to shape child's behavior. It is discussed in Child and Adolescent Psychiatry. Here reinforcement, punishment, reward is used. Ultimate target is to increase positive behavior and diminish negative behavior.

1. Dr. Biplob Kumar Sarkar
MD Psychiatry(on course), Phase B
BSMMU,Dhaka

2. Structure of PMT
 Treatment Sessions
 Outside the Treatment Sessions
 Assessment and Evaluation of Progress
 Participants and Their Roles
 Individualization of Treatment

3. Treatment Sessions
 Weekly
 the core treatment is 12 to 16 weekly sessions
 each session lasting between 45 and 60 minutes.

4. Outside the Treatment Sessions
 In the sessions, parents learn skills, endlessly
 practice how to apply them, and receive reinforced
practice opportunities.
 These skills are then implemented outside the session
and in the home

5. Assessment and Evaluation of
Progress
 Review of the programs at the beginning of each
treatment session;
 Role play to see what the parent actually can do in the
session and does do at home;
 Phone call contacts during the week to see how the
program is working .

6. Participants and Their Roles
 Minimally, PMT involves a therapist and a parent.
 the child is seen in some of the sessions and joins the
parent and the therapist to review the program.
 He or she functions as a coach and trainer who leads
the treatment sessions. The parent or guardian is the
person to be trained.
 Better to two parents to come to treatment, but if
single mother preferred .

7.  Teachers or day-care workers may be involved in the
program if there are problems or behaviors to be
developed at school or day-care centers.

8. Individualization of Treatment
 Treatment is individualized along several
dimensions, including:
o Who participates in treatment (parent plus others)
o Target behaviors focused on in the child
o Settings encompassed by or emphasized in the
behavior-change programs
o Range of techniques that are used
o Details of family life in the home

9. Variations of PMT
Incredible Years Training Series
 focused on children 2 to 8 years of age who are referred
for oppositional and conduct problems.
 The program is called a series because separate
complementary training curricula or modules have
been developed for parents, teachers, and children.
 The program is a video-based intervention of various
modules.

10.  Each of the treatment modules emphasizes videotape
modeling, role play, practice, and feedback from the
therapist or other group members.
 A wide variety of real-life situations are portrayed in
role play
 4 modules, each containing 14 or more tapes of
variable duration

11. Parent–Child Interaction Therapy
for Oppositional Children
 focuses primarily on families of oppositional children
between the ages of 3 and 6
 The treatment is individually provided to the family.
Parents and children are seen in the sessions.
 Coaching of the parent takes place in a playroom and
in the context of the parent playing with the child.

12.  P = praising the child’s behavior
 R = reflecting the child’s statements
 I = imitating the child’s play
 D = describing the child’s play
 E = using enthusiasm

13. Positive Parenting Program
(Triple P)
 The program is aimed at both preventing and
treating behavioral, emotional, and developmental
problems.
 There are different levels or tiers of the program to
provide a continuum of increasing intensity or
strength of treatment for parents of children and
adolescents from birth to age 16

14. Problem-Solving Skills Training and
PMT for Oppositional,
Aggressive, and Antisocial Children
 The interventions added to PMT might be
components that would not stand alone as a separate
treatment.
 PSST develops interpersonal cognitive problem-
solving skills to break down interpersonal situations
into units to solve.

15. Medication and PMT for Attention-
Deficit/Hyperactivity Disorder
 The treatment of attention-deficit/hyperactivity
disorder (ADHD) might be an area where PMT would
have considerable success,
 strong outcome evidence for oppositional defiant
disorder and conduct disorder

16. Multidimensional Treatment
Foster Care
 to treat youth with severe and chronic delinquent
behavior
 children and adolescents referred from mental health,
child welfare service, or juvenile justice systems

17. Limitations of PMT
 Does not eliminate the clinical problem for everyone
 Variable degree of impact , even among those children
who do change.

18. Maintenance of Therapeutic
Changes needed as-
 Children referred for antisocial behavior are at risk for
dysfunction in adolescence (e.g., substance abuse,
criminal activity) and adulthood (e.g., criminal
behavior, antisocial personality disorder in males,
depression in females)

19. Parent Management Training
Manual
Pretreatment Introduction and Orientation
1. Defining, Observing, and Recording Behavior
2. Positive Reinforcement
3. Time Out from Reinforcement extensively role-played
and practiced
4. Attending and Planned Ignoring
5. Shaping and School Program a home-based
reinforcement program to develop school-related
behaviors

20. 6. Review and Problem Solving
7. Family Meeting At this meeting,
8. Low-Rate Behaviors. Parents are trained how to deal
with low-rate behaviors
9. Reprimands
10. and 11. Compromising. The child and parent meet
together to negotiate new behavioral Programs
12. Skill Review, Practice, and Termination

21. PMT SESSION 1 :Defining,
Observing, and Recording Behavior
 What Is a Behavior?
 Chart I: Behaviors and Nonbehaviors
 Positive Opposite Behaviors
 Chart II: Problem Behaviors and Positive
Opposites
 Prompting: Getting Behavior to Happen
 Chart III: Prompting—Getting Behaviors to
Happen
 Weekly Observing Sheet

22. PMT SESSION 2 : Positive
Reinforcement
Handouts
 Four Types of Reinforcers
 Changes in Behavior Occur When . . .
 Helpful Hints to Make the Point Chart Work
 How to Make Your Praise Most Effective
 Point Incentive Chart/Time Out Chart/Attending and
Ignoring Chart
 Weekly Assignment Sheet

23.  Chart I: Four Types of Reinforcers
1. Material Reinforcers: Tangible items such as toys,
clothes, and candy.
2. Privileges or Activity Reinforcers: Time together with
the parent, slumber party, staying up late, chore done
by the parent.
3. Social Reinforcers: Your approval! A smile, a wink, a
hug, and praise.
4. Token Reinforcers: Items given to your child that can
be exchanged for more valuable reinforcers.

24.  Chart II: Changes in Behavior Occur When . . .
1. The reinforcers increase the strength of the positive
behavior. If they do not, you may need to choose
different reinforcers.
2. The reinforcer should occur immediately after the
positive behavior.
3. Your child must perform the desired behavior before
receiving any reinforcers.
4. For new behaviors to occur, the reinforcer needs to
follow the behavior every time.

25.  Chart III: Helpful Hints to Make the Point Chart
Work
 Chart IV: How to Make Your Praise Most Effective
 Role-Play Explaining the Chart

26. PMT SESSION 3:
Time Out from Reinforcement
 It is a mild procedure that involves removing the child
from the opportunity to receive attention or other
rewards when he engages in undesired behavior.
 The child is sent to a boring or non-reinforcing place
for a brief period of time immediately after a problem
behavior occurs.

27. During session
 Correct explanation and use of time out.
 Proper room selection for time out. Be sure the parents
understand that the door should never be locked.
 Role-playing time out with the child before using it.
 Using time out immediately.
 Using time out rather than threatening its use.
 Telling the child what was done wrong before sending
the child to time out.

28.  Praising the child who goes to time out without having
a tantrum.
 Informing the child that he will lose privileges if he
does not go to time out.
 Correcting or cleaning up things broken or messed up
on the way to time out or while in time out.
 Giving positive reinforcement for desired behavior.

29. PMT SESSION 4
Attending and Planned Ignoring
 Rules for Attending and Ignoring
 Attending and Ignoring Exercise
 Worksheet for Attending and Ignoring
 Common Problems to Ignore
 Point Incentive Chart /Time Out Chart /Attending and
Ignoring Chart
 Weekly Assignment Sheet

30. PMT SESSION 5
Shaping and School Program
 “Shaping is the process of teaching a new behavior by
reinforcing small steps toward that behavior.
 Session:
 Guidelines for Shaping
 School Program Form
 Shaping Worksheet
 Guidelines for Homework Program
 Home Program
 Parent Guidelines for School Problems

31.  Guidelines for Building a Positive Relationship with
Teachers and School Personnel
 Point Incentive Chart/Time Out Chart/Attending and
Ignoring Chart
 Weekly Assignment Sheet

32. PMT SESSION 6
Review and Problem Solving
 Program Review Checklist
 Review of Techniques
 Point Chart /Time Out Chart /Attending and Ignoring
Chart/School Program
 Cards for Problem Solving
 Weekly Assignment Sheet

33. PMT SESSION 7
Family Meeting
 To observe how the parents and the child interact
 To reinforce parent compliance, consistency, and
positive behavior
 To give the parents feedback on how they are doing
 To confirm that the programs are being carried out
correctly.

34. PMT SESSION 8
Low-Rate Behaviors
 To prepare parents for occurrences of low-rate
behaviors(stealing, shoplifting, destroying propety etc)
 To provide parents with a means of handling these
behaviors, should they occur.

35. session
 Low-Rate Behaviors
 Low-Rate Rules
 Low-Rate Behavior Worksheet
 Program Presentation Guidelines
 Commonly Asked Questions
 Point Chart /Time Out Chart /Attending and Ignoring
Chart/School Program
 Weekly Assignment Sheet

36. PMT SESSION 9
Reprimands
 “A reprimand is a form of punishment. It is usually a
verbal expression of disapproval. However, gestures
such as frowning, glaring, and head shaking also
signal disapproval. The most powerful reprimand
combines both a verbal statement and a gesture of
disapproval.
Objectives
 To teach parents how to implement reprimands
effectively.

37.  Rules for Using Reprimands
 Problem Behaviors Appropriate for Reprimands
 How to Give a Reprimand (role play)
 Point Chart/Time Out Chart/Attending and Ignoring
Chart/School Program
 Weekly Assignment Sheet

38. PMT SESSION 10
Compromising
Objective
 To teach the parents a strategy for resolving conflicts
within the family
 To teach the parent and child a strategy for resolving
conflicts.
 To guide them through appropriate communication
about one problem area.
 2 sessions

39. 1 st session
 List of Negotiable and Nonnegotiable Issues for ages 7-
8 and 9-13+
 Steps and Rules for Compromising
 Example of a Mediation Session
 Point Chart/Time Out Chart/Attending and Ignoring
Chart/SchoolProgram
 Weekly Assignment Sheet

40. 2 nd session
 Steps and Rules for Compromising
 Compromising on a Hypothetical Problem
 Compromising on a Real-Life Problem
 Point Chart/Time Out Chart/Attending and Ignoring
Chart/School Program
 Weekly Assignment Sheet

41. PMT SESSION 12:
Skill Review, Practice, and
Termination
 Completing a final evaluation of all programs.
 Practicing applying techniques to manage behavioral
problems.
 Allowing the parent to teach and train the therapist as
part of role reversals.
 Summarizing parents’ involvement in treatment.
 Addressing any termination issues.

42. Thank You