See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/275324202

Parent Management Training: Treatment for Oppositional, Aggressive, and

Antisocial Behavior in Children and Adolescents

Article  in  Journal of the American Academy of Child & Adolescent Psychiatry · February 2006
DOI: 10.1097/01.chi.0000190472.31566.ae

CITATIONS READS

9 2,384

2 authors, including:

Denis Sukhodolsky
Yale University
137 PUBLICATIONS   4,740 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Organizational skills training for children with ADHD View project

RDoC and Autism View project

All content following this page was uploaded by Denis Sukhodolsky on 11 October 2017.

The user has requested enhancement of the downloaded file.

BOOK REVIEWS
ADHD and learning disorders, such as Section 504 and In-
dividuals with Disabilities Education Act legislation, as well
as practical ideas for parents on how to get the right services
in school for their children. The appendix contains a useful
listing of parent and professional organizations devoted to
ADHD and learning disorders.
This book is concise, clear, and full of useful clinical tips on
the diagnosis and treatment of ADHD and related disorders.
Perhaps advanced trainees in child and adolescent psychiatry
and child and adolescent psychiatrists may require a more de-
tailed text than this book, but it is an excellent first choice to
learn about ADHD for primary care physicians, pediatricians,
or other mental health professionals such as trainees in psychi-
atry, social work, and psychology, all of whom are just getting
their feet wet in the vast world of child mental health. Indeed,
the first dip will make them want to venture into deeper waters.
Amit Razdan, M.D.
Aradhana Bela Sood, M.D.
Department of Psychiatry
Virginia Commonwealth University
Richmond, VA
DOI: 10.1097/01.chi.0000190471.23942.a8
Disclosure: The author has no financial relationships to disclose.
Parent Management Training: Treatment for Oppositional,
Aggressive, and Antisocial Behavior in Children and Adolescents.
By Alan E. Kazdin. New York: Oxford University Press, 424
pp., $54.50 (hardcover).
Childhood noncompliance, aggression, and antisocial be-
havior are among the most frequent reasons for child and ad-
olescent referrals for mental health services. Fortunately, there
has been a good deal of progress in understanding and treat-
ing childhood aggression over the past 3 decades. Parent
management training (PMT) is one of the best-studied psy-
chosocial interventions for child disruptive behavior; how-
ever, there is a substantial gap between abundant academic
research and scarce availability of PMT in clinical training
and practice. Alan Kazdin addresses this gap by combining
in one volume an overview of theory and research in sup-
port of PMT with a comprehensive, user-friendly treatment
manual.
PMT is a psychosocial treatment in which parents are
taught skills for dealing with their childrenÕs disruptive be-
havior. The broad goals of PMT are to improve parental
competence in dealing with child behavioral problems and
256
&RS\ULJKW‹$PHULFDQ$FDGHP\RI&KLOGDQG$GROHVFHQW3V\FKLDWU\
8QDXWKRUL]HGUHSURGXFWLRQRIWKLVDUWLFOHLVSURKLELWHG
to improve the childÕs adaptive behavior. Some of the parent-
ing skills include frequent praising for appropriate behavior,
communicating directions effectively, and being consistent
with consequences for disruptive behaviors. The interactions
between the therapist and the parent during PMT sessions
emphasize active training. New parenting skills are developed
by modeling, practice, role play, and feedback by the thera-
pist. A theme that parenting skills are acquired through prac-
tice is repeated throughout the book and the reader is warned
that ‘‘merely telling parents what to do cannot develop these
skills’’ (p. 18).
PMT techniques stem from the fundamental principle
of operant conditioning, which states that the likelihood
of behavior to reoccur is increased or weakened based on
the events that follow the behavior. For example, a child is
likely to have another tantrum if previous tantrums have
led to getting his or her way. Furthermore, PMT targets those
parent–child interactions that have been shown to foster dis-
ruptive behaviors. Behaviors such as noncompliance, whin-
ing, or bickering can be reinforced if they result in escape
or avoidance of situations such as homework or room clean-
ing, which could be aversive to the child. Harsh and incon-
sistent discipline, such as excessive verbal scolding and
corporal punishment, has also been shown to increase child-
renÕs aggression.
Positive reinforcement of desirable behavior is at the core
of PMT. Although intuitively appealing, reinforcement prin-
ciples and techniques may be misinterpreted. For example,
when social reinforcement such as attention and praise is dis-
cussed with parents, a common reaction is ‘‘we do it all the
time.’’ However, further discussions often reveal that atten-
tion may be given to disruptive behavior and appropriate be-
havior may go unrecognized by praise. Two chapters of the
book are dedicated to how to make PMT techniques work.
Guidelines for teaching parents how to select and deliver the
right type and amount of potentially reinforcing consequence
are provided. Similarly, effective administration of techni-
ques based on punishment, such as reprimands, taking away
privileges, or doing undesired chores are discussed, and the
limitations of punishment are highlighted. It is noted that
parents who bring their children to treatment for aggression
and noncompliance often use punishment excessively. Rein-
forcement of ‘‘positive opposites’’ is suggested as a strategy for
reducing inappropriate behavior. For example, a child may
earn points for not swearing when frustrated.
PMT has been evaluated in numerous randomized, con-
trolled studies, and several programs of research in different
centers continue to investigate this treatment. Kazdin sum-
marizes research evidence in support of PMT, including
the effects of treatment, mechanisms of change during treat-
ment, and characteristics that may attenuate effectiveness of
treatment. Among some of the most robust findings is that
J. AM . ACAD. CHILD ADOLESC. PSYCHIATR Y, 4 5:2 , FEBRUARY 20 06

PMT produces a reduction in disruptive behavior and im-
provement of the childÕs functioning. There is evidence that
the improvements in child behavior were stable in time and
generalized to other areas such as a reduction of family stress;
however, certain child, family, and socioeconomic character-
istics such as comorbid psychopathology, marital conflicts,
and poverty may negatively affect the effects of PMT. Ne-
glected areas of research are also noted. For example, little
is known about ethnic and cultural issues within PMT. Trans-
portability or dissemination of PMT from research settings to
real world clinical settings has also been poorly studied.
A 120-page PMT manual provided in the book is recom-
mended for families of 7- to 14-year-old children with oppo-
sitional, aggressive, and antisocial behaviors. The manual
consists of a pretreatment introduction session and 12 PMT
sessions delivered on a weekly basis, with each session lasting
from 45 to 60 minutes. The treatment starts with teaching
parents to define and observe behaviors targeted for change.
Training parents to use praise, incentive charts, selective at-
tending and ignoring, time out, and shaping is covered in the
first part of the manual. The second part is dedicated to ad-
dressing serious antisocial behaviors such as physical aggres-
sion, stealing, vandalism, inappropriate sexual activity, and
alcohol and drug use. Parents are taught how to discuss prob-
lem situations effectively, how to set clear rules, and how to
compromise with their child. The manual provides therapistsÕ
narratives and examples of the dialogue written in a colloquial
J. AM. ACAD. CH ILD ADO LESC. PSY CH IAT RY, 45:2, F EBRU ARY 2 006
&RS\ULJKW‹$PHULFDQ$FDGHP\RI&KLOGDQG$GROHVFHQW3V\FKLDWU\
8QDXWKRUL]HGUHSURGXFWLRQRIWKLVDUWLFOHLVSURKLELWHG
View publication stats
B O OK R EV I EW S
style. After each session, the new skill is implemented at home
and then the home practice is discussed in the beginning of
the next session. The manual contains didactic handouts, de-
scriptions of in-session role plays, notes for the therapist, and
homework assignments for parents. Ready-for-use treatment
materials are also available on the publisherÕs Web site.
Overall, the book meets its goal of combining a compre-
hensive review of theoretical background and research evi-
dence in support of PMT with a clinician-friendly manual
and practical knowledge on implementing the treatment. The
book is well balanced with regard to research and clinical in-
formation. Its manual is complemented by useful guidelines
for how to deliver PMT techniques effectively and how to
repair problems that may occur during implementation.
Child mental health professionals interested in evidence-
based interventions for children and their families will enjoy
reading this book and will certainly benefit from its content.
Denis G. Sukhodolsky, Ph.D.
Yale Child Study Center
New Haven, CT
DOI: 10.1097/01.chi.0000190472.31566.ae
Note to Publishers: Books for review should be sent to Andr
e s Martin, M.D.,
M.P.H., Yale Child Study Center, 230 Frontage Road, P.O. Box 207900,
New Haven, CT 06520-7900.
257