Über die Autorinnen und Autoren

Robert J. McMahon, PhD, is Professor of Psychology at Simon Fraser University in Burnaby, British Columbia, Canada, where he is also B.C. Leading Edge Endowment Fund Leadership Chair in Proactive Approaches to Reducing Risk for Violence among Children and Youth. To carry out the work of the Chair, he directs the Institute for the Reduction of Youth Violence. He is also a senior scientist at the B.C. Children’s Hospital Research Institute in Vancouver. A clinical psychologist, Dr. McMahon studies the assessment, treatment, and prevention of conduct problems and other problem behavior in children and youth, especially in the context of the family. He is author or editor of more than 250 books, scientific articles, chapters, and reviews; a past Editor-in-Chief of Prevention Science; and a recipient of the Service to SPR Award from the Society for Prevention Research and the Trailblazer Award from the Parenting and Families Special Interest Group, Association for Behavioral and Cognitive Therapies.

Rex L. Forehand, PhD, is Professor of Psychology at the University of Vermont and Regents Professor Emeritus at the University of Georgia. He is also Principal Investigator of a CDC-funded parenting project. Dr. Forehand's publications include two coauthored parenting guides. He is a member of 10 editorial boards.

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Helping the Noncompliant Child

Guilford Publications

Chapter One

In this chapter, we first present some of the necessary requirements for effective parent training, including characteristics of the training setting, who should attend sessions, the parenting skills that are taught, and the methods for teaching those skills. We then present overviews of the parent training program, the use of behavioral criteria to determine success in learning each parenting skill and the structure of sessions, and note the availability of additional training materials for the parent training program. Finally, we describe ethical considerations in the use of parent training to treat child noncompliance, engagement of families in the intervention, and therapist characteristics.

As noted in Chapter 1, we hypothesize that the child's noncompliant, inappropriate behavior is shaped and maintained through maladaptive patterns of family interaction, which reinforce coercive behaviors. As a logical outgrowth of this formulation, our intervention strategy involves teaching parents to change their behavior toward their child so as to incorporate more appropriate styles of family interaction. In the initial part of this chapter, we delineate some of the basic requirements for our parenting program to be effective.

THE TRAINING SETTING

Parent training can occur either in the home or in a clinic setting. There are advantages and disadvantages to each approach. Intervention in the home prevents the need for generalization from the clinic to the home to occur. However, home-based intervention requires substantially more time and expense on the part of the therapist (e.g., travel time and gas expenses). It is also the case that third-party payers typically will not pay for services provided outside of a clinic. As noted earlier, our program is based on a clinic training model, as this appears to be more efficient and therefore most likely to be employed by most mental health professionals. We have also spent substantial time and effort in our research endeavors to examine and facilitate generalization from the clinic to the natural environment (see Chapter 10).

Intervention is initiated and carried out with individual families rather than in groups in a clinic playroom similar to the one used for clinic observations. However, our parent training program has been adapted for use in a group format by several clinical researchers (e.g., Baum, Reyna McGlone, & Ollendick, 1986; Breiner & Forehand, 1982; Long & Forehand, 2000b; McMahon, Slough, & the Conduct Problems Prevention Research Group, 1996; Pisterman et al., 1989).

There are a few fundamental considerations in setting up the clinic playroom in which the parent training program will be conducted. The room should have a chair for each person (i.e., the therapist, parent[s], and child), various sets of age-appropriate toys, and an additional chair that serves as the TO chair. Because children with conduct problems often engage in destructive behavior, we recommend that the furniture be basic, functional, and durable, and that the room be furnished as minimally as possible. If possible, the light switch should either be out of the child's reach or taped or locked in the "on" position.

Toys should be conducive to joint play and facilitative of imaginative play (Cavell, 2000). Examples of such toys are building materials (e.g., Legos, building blocks, Lincoln Logs), crayons or markers with paper and coloring books, a dollhouse with furniture and people, cars and trucks, and farm or zoo animals. Toys that should be avoided include board games, aggression-facilitating toys (e.g., guns), and messy toys (e.g., bubbles, paints) (Hembree-Kigin & McNeil, 1995).

The placement of furniture and toys is also important. Toys should be placed in that part of the room farthest from the door, with chairs for the therapist and parent(s) placed between the toys and the door (see Figure 3.1). This layout (1) provides separate areas for discussion among adults and for toy play and (2) prevents the child from having easy access to the playroom door should the child decide to leave during the session!

In an ideal situation, the playroom is equipped with a one-way window and a radio signaling device such as the "bug-in-the-ear" (a hearing-aid-like device converted to a radio receiver that the parent wears in his or her ear), giving the therapist the ability to unobtrusively talk to the parent from behind the window while the parent interacts with the child. However, these accoutrements are not necessary for the successful implementation of the program.

Sessions are optimally scheduled twice each week, with a session length of 75-90 minutes. We have found the more traditional format of weekly 50-minute sessions to be less successful. A 50-minute session usually does not permit adequate time for homework review, observation of parent-child interaction, and the extensive teaching and practice procedures employed in the program. In addition, weekly sessions increase the likelihood of an unacceptable level of performance decay. If parents are having difficulty implementing a procedure at home, they usually either stop using the skill or, worse, become proficient at using it incorrectly. By attending two sessions each week, parents receive a more constant level of feedback and training. When practical considerations (e.g., distance, insurance reimbursement, scheduling) prevent twice-weekly sessions, we strongly recommend that phone contact occur midway between the weekly sessions.

WHO SHOULD ATTEND SESSIONS

When two parents reside in the home, we encourage both to attend sessions. Two parents consistently implementing the program will be more effective than only one parent! In our clinical experience, both parents attend in about 50% of the cases. Not surprisingly, when only one parent is involved in treatment, it is usually the mother.

When only one parent attends sessions, we encourage that parent to share handouts with the second parent. The two parents also are encouraged to practice the skills together so that they both are using the skills.

In some cases, an extended family member (e.g., the child's grandmother) may be a coparent. In these cases, we encourage the involvement of that person. We have found particularly high levels of coparenting by extended family members in ethnic minority groups (e.g., African American) (Forehand & Kotchick, 1996; Kotchick et al., in press).

PARENTING SKILLS

Which skills can parents most effectively use to modify child noncompliance and other inappropriate behavior? As noted in Chapter 2, parent training interventions have tended to employ a number of similar teaching procedures and parenting skills (Dumas, 1989; Kazdin, 1995; Miller & Prinz, 1990). For young (3- to 8-year-old) children presenting with noncompliance, our research and clinical experience support the teaching of five core skills: giving attends, giving rewards, use of active ignoring, issuing clear instructions, and implementing time outs. These parenting techniques are described in detail in subsequent chapters, and Chapter 10...