Parent management training (PMT) involves educating and coaching parents to change problematic child behaviors using behavior modification techniques. PMT teaches parents positive reinforcement methods to improve behaviors like aggression and tantrums in preschool and school-aged children. PMT has been shown to reduce disruptive child behaviors and improve parental mental health. It was initially developed in the 1960s based on principles of operant conditioning to change parenting behaviors through positive reinforcement of appropriate child behaviors and limiting attention for inappropriate behaviors. Treatment typically involves parents learning these techniques over several weekly sessions focused on monitoring, reinforcing positive behaviors and using time-outs or removal of privileges for negative behaviors.

1. PARENTING MANAGEMENT
TRAINING

2. Parent management training (PMT)- is an
adjunct to treatment that involves educating
and coaching parents to change their child's
problem behaviors using principles of learning
theory and behavior modification .

3. Parent management training (PMT), also
known as behavioral parent training (BPT) or
simply parent training, is a family of treatment
programs that aims to change parenting
behaviors, teaching parents
positive reinforcement methods for improving
pre-school and school-age children's behavior
problems (such as aggression, hyperactivity,
temper tantrums, and difficulty following
directions).[1

4.  It is effective in reducing child disruptive
behavior and improving parental mental
health.
 It has also been studied as a treatment for
disruptive behaviors in children with other
conditions.
 Limitations of the existing research on PMT
include a lack of knowledge on mechanisms
of change and the absence of studies of long-
term outcomes

5.  PMT may be more difficult to implement
when parents are unable to participate fully
due to psychopathology, limited cognitive
capacity, high partner conflict, or inability to
attend weekly sessions.

6. PMT was initially developed in the 1960s by
child psychologists who studied changing
children's disruptive behaviors by intervening to
change parent behaviors.
The model was inspired by principles of operant
conditioning and applied behavioral analysis.

7. Treatment, which typically lasts for several
months, focuses on parents learning to provide
positive reinforcement, such as praise and
rewards, for children's appropriate behaviors
while setting proper limits, using methods such
as removing attention, for inappropriate
behaviors.

8. Early-onset of conduct
problems:
 Poor parenting
 inadequate parental supervision
 discipline that is not consistent
 parental mental health status
 parental mental health status
 stress or substance abuse

9. Negative parenting practices and negative child
behavior contribute to one another in a
"coercive cycle", in which one person begins by
using a negative behavior to control the other
person's behavior.
That person in turn responds with a negative
behavior, and the negative exchange escalates
until one person's negative behavior "wins" the
battle.

10. For example, if a child throws a temper tantrum
to avoid doing a chore, the parent may respond
by yelling that the child must do it, to which the
child responds by tantruming even louder, at
which point the parent may give in to the child
to avoid further disruption.

11. PMT seeks to break patterns that reinforce
negative behavior by instead teaching
parents to reinforce positive behaviors.
In most PMT, parents are taught to define
and record observations of their child's
behavior, both positive and negative.
This monitoring procedure provides useful
information for the parents and therapist to
set specific goals for treatment, and to
measure the child's progress over time.

12. Parents learn to give specific, concise
instructions using eye contact while speaking
in a calm manner.

13. Major focus of PMT
 Providing positive reinforcement for
appropriate child behaviors
 parents learn to reward appropriate behavior
through social rewards (such as praise,
smiles, and hugs)
 concrete rewards (such as stickers or points
towards a larger reward as part of an
incentive system created collaboratively with
the child)

14.  In addition, parents learn to select simple
behaviors as an initial focus and reward each
of the small steps that their child achieves
towards reaching a larger goal .

15. PMT also teaches parents to appropriately set
limits using structured techniques in response to
their child's negative behavior.The different
ways in which parents are taught to respond to
positive versus negative behavior in children is
sometimes referred to as differential
reinforcement

16. For mildly annoying but not dangerous
behavior, parents practice ignoring the
behavior. Following unwanted behavior, parents
are also introduced to the proper use of
the time-out technique, in which parents
remove attention (which serves as a form of
reinforcement) from the child for a specified
period of time.

17. Parents also learn to remove their child's
privileges, such as television or play time, in a
systematic way in response to unwanted
behavior.
Across all of these strategies, the therapist
emphasizes that consequences should be
administered calmly, immediately, and
consistently, and balanced with encouragement
for positive behaviors.

18. The training is usually delivered by therapists
(psychologists or social workers) to individual
families or groups of families, and is conducted
primarily with the parents rather than the child,
although children can become involved as the
therapist and parents see fit.

19. A typical training course consists of 12 core
weekly sessions;with different programs
ranging from four to twenty-four weekly
sessions.
PMT is underutilized and training for therapists
and other providers has been limited; it has not
been widely used outside of clinical and
research settings

20. Childhood disruptive behaviors
PMT is one of the most extensively studied
treatments for childhood disruptive behaviors.
PMT tended to have larger effects for younger
children than older children, although the
differences between age groups were not
statistically significant.

21. Improvement in parental mental health
(depression, stress, irritability, anxiety, and
sense of confidence) as well as parental
behavior is noted.
Improvements in child and parent behavior were
maintained up to one year after PMT, although
the effects were small; very few studies have
been done on the durability of the effects of
PMT.

22. Parental psychopathology, substance abuse,
and maternal depression are associated with
less successful outcomes; this may be because
the "parents' ability to learn and consolidate the
skills being taught" is affected, or parents my
not be able to stay engaged in the program or
translate the skills acquired to the home.

23. Furlong et al (2013) concluded that group-based
PMT is cost-effective in reducing conduct
problems, and improving parental health and
parenting skills, but that there is not enough
evidence that it is effective on the measures of
"child emotional problems and educational and
cognitive abilities".

24. Other childhood-onset
conditions
Conflict is high in families of children
with attention-deficit hyperactivity
disorder (ADHD), with parents showing "more
negative and ineffective parenting (eg, power
assertive, punitive, inconsistent) and less
positive or warm parenting, relative to parents
of children without ADHD".[

25. PMT targets dysfunctional parenting and
school-related problems of children with ADHD,
such as work completion and peer problems.
Pfiffner and Haack (2014) say PMT is well-
established as a treatment for school-age
children with ADHD, but that questions persist
about the best methods for delivering PMT.

26. A 2011 Cochrane review found some evidence that
PMT improves general child behavior and parental
stress in treating ADHD, but has limited effects on
ADHD-specific behavior.
The authors concluded that there was a lack of data
to evaluate school achievement, and a risk of bias in
the studies due to poor methodology; existing
evidence was not strong enough to form clear
clinical guidelines with regard to PMT for ADHD, or
to say whether group or individual PMT was more
effective.

27. The US National Institute of Mental Health has
designated the "gap between evidence-based
treatments and community services" as an area
critically in need of more research;PMT for
disruptive behaviors in children with autism
spectrum disorders is an area of ongoing
research.

28. HISTORICAL BACKGROUNDOF PMT

29. Parent management training was developed in
the early 1960s in response to an urgent need in
American child guidance clinics. Research across
a national network of these clinics revealed that
the treatments being used for young children
with disruptive behaviors, who constituted the
majority of children served in these settings,
were largely ineffective.

30. Several child psychologists, including Robert
Wahler, Constance Hanf, Martha E. Bernal, and
Gerald Patterson,were inspired to develop new
treatments based on behavioral principles
of operant conditioning and applied behavioral
analysis.

31. Between 1965 and 1975, a behavioral model of
parent training treatment was established, that
emphasized teaching parents to positively
reinforce prosocial child behavior (such as
praising a child for following directions) while
negatively incentivizing antisocial behavior
(such as removing parental attention after the
child throws a tantrum).

32. The early work of Hanf and Patterson hypothesized
that "teaching parents the principles of behavioral
reinforcement would result in effective, sustainable
change in child behavior". Early studies of this
approach showed that the treatment was effective
in the short-term in improving parenting skills and
reducing children's disruptive behaviors.Patterson
and colleagues theorized that adverse
environmental contexts lead to disruptions in
parent practices, which then contribute to negative
child outcomes.

33. Following the initial development of PMT, a
second wave of research from 1975 to 1985
focused on the longer-term effects and
generalization of treatment to settings other
than the clinic (such as home or school), larger
family effects (such as improved parenting with
siblings), and behavioral improvements outside
of the targeted areas (such as improved ability
to make friends).

34. Evidence in support of PMT has not always been
rigorously examined;future research should
examine the effectiveness of PMT on the
families most at risk, address parental
psychopathology as a factor in outcomes,
examine whether gains from PMT are
maintained in the long-term,and better account
for variability in outcomes dependent on
practices under "real-world" conditions.

35. Since 1985, the literature on PMT has continued
to expand, with researchers exploring such
topics as application of the treatment to serious
clinical problems, dealing with client resistance
to treatment, prevention programs, and
implementation with diverse populations.

36. Thanks for your attention!
God bless!