Parent Training Intervention 2

4
Parent-training
Interventions
NICHOLAS LONG, MARK C. EDWARDS,
and JAYNE BELLANDO
Prior to the 1960s, therapy for children typically involved traditional

one-on-one sessions with a therapist addressing intrapsychic issues
rather than specific behaviors (Kotchick, Shaffer, Dorsey, & Forehand,
2004). However, in the early 1960s a paradigm shift started in regard to
psychosocial treatment for children’s behavior problems. This paradigm
shift was the function of several factors (Kotchick et al., 2004) includ-
ing a growing concern that traditional psychodynamic approaches were
not very effective in addressing immediate issues related to children’s
behavior problems nor in changing children’s behavior in the home.
Around the same time period, behavior modification techniques were
beginning to be successfully utilized to change children’s behavior (Wil-
liams, 1959).
The confluence of such factors created momentum for the concept of
therapists training parents to utilize specific behavior management tech-
niques to change their children’s’ behavior. By the mid- to late-1960s the
use of parents as formal behavior change agents for their children’s behavior
started to take hold and the roots of “parent training” were established
(Hawkins, Peterson, Schweid, & Bijou, 1966; Wahler, Winkel, Peterson,
& Morrison, 1965). Although most of the early research in parent training
was conducted by those coming from a behavioral orientation, it should
be noted that the use of parents as change agents was also advocated
by professionals from various orientations including those coming from a
psychodynamic perspective (e.g., Zacker, 1978).
NICHOLAS LONG, MARK C. EDWARDS, and JAYNE BELLANDO • University of Arkansas

for Medical Sciences and Arkansas Children’s Hospital
J.L. Matson et al. (eds.), Treating Childhood Psychopathology 79

and Developmental Disabilities, DOI: 10.1007/978-0-387-09530-1,
© Springer Science + Business Media, LLC 2009
80 NICHOLAS LONG et al.
Gerald Patterson’s (1982) research on coercive parent–child inter-

actions offered a major contribution to the early development of parent
training. His model on reciprocal influences provided an explanation as to
how the behavior of both parents and children contribute to the escala-
tion of child aggression and behavior problems. The model explained how
children use high rates of aversive behaviors to stimulate parental atten-
tion, and in turn, this parental attention reinforces the children’s aversive
behavior. Such parental attention can involve either giving in to the aver-
sive behavior or using coercive tactics (e.g., nagging, yelling) in an attempt
to stop the aversive behavior.
Patterson’s model also helped explain how children’s behavior simul-
taneously reinforces and escalates parental use of coercive tactics through
negative reinforcement. Thus his model of reciprocal influences helped
explain how children’s disruptive behavior can escalate while parent
management tactics become more punitive and coercive. Such coercive
exchanges within the home were believed to be “basic training” for the
development of aggression and disruptive behavior that generalizes to other
settings. The entry into this coercive cycle was considered to be ineffective
parenting, especially in regard to child compliance to parental directions
during the preschool years (McMahon & Wells, 1998).
Since its development in the 1960s, behavioral parent training has
gone through three distinct stages of development (McMahon & Forehand,
2003). The first stage, during the 1960s and early 1970s, focused on the
initial development of a “parent training” intervention model. The parent
training model, based on Tharp and Wetzel’s (1969) triadic model, utilized a
therapist (consultant) who taught the parent (mediator) to reduce the child’s
(target) disruptive behavior (McMahon & Forehand, 2003). The research
conducted during this first stage was largely limited to case studies or single-
case designs. However, during this first stage, evidence was obtained that
demonstrated that, at least in the short-term, parent training interventions
could produce changes in both parent and child behaviors.
At about the same time, researchers also started to examine different
strategies (e.g., written instructions, videotaped instruction, modeling, etc.)
for teaching parents how to use specific behavior management strategies
(e.g., Flanagan, Adams, & Forehand, 1979; Nay, 1975; O’Dell, Mahoney,
Horton, & Turner, 1979; O’Dell, Krug, O’Quinn, & Kasnetz, 1980). Par-
ents could learn to effectively use specific techniques through a variety of
instructional modes. However, there was also the realization that although
parents could be taught basic behavior modification techniques through
various instructional modes, to effectively address significant child behav-
ior problems interventions for parents needed to be more multifaceted
and take into account the complexities of parent–child interactions in the
home (Kazdin, 1985).
The second stage of parent training research, from the mid-1970s
to the mid-1980s, focused on social validity and the generalization of
treatment effects. Issues examined included whether behavior changes
observed in the clinic generalized to the home, whether improvements
were seen in behaviors other than the target behaviors (behavioral gen-
PARENT-TRAINING INTERVENTIONS 81
eralization), and whether behavior changes were maintained over time

(temporal generalization).
The third stage in the development of parent training, from the mid-
1980s to present, has focused primarily on ways to enhance the effective-
ness of parent training. The primary focus of parenting training research
since its beginnings has been in the area of children’s disruptive behav-
ior. This focus has been the result largely due the belief that disruptive
behavior in the home is often inadvertently developed, exacerbated, or
sustained by maladaptive parent–child interactions (Kazdin, 2003; Pat-
terson, 1982). These maladaptive interaction patterns include reinforcing
disruptive behavior, the use of ineffective parental directions, and the fail-
ure to adequately reinforce appropriate behavior. Today parent training is
considered one of only a handful of empirically supported treatments for
children’s externalizing behavior problems (Kazdin, 2005). The following
section summarizes this research base.
AN OVERVIEW OF THE EMPIRICAL SUPPORT

FOR PARENT TRAINING
There have been hundreds of studies that have evaluated programs

designed to train parents to intervene with their children’s problems. The
volume of studies examining the effects of parent training is reflected in
the number of reviews that have been published. From 1972 to 2006,
there have been no less than 17 narrative reviews (Atkeson & Forehand,
1978; Berkowitz & Graziano, 1972; Chronis, Chacko, Fabiano, Wymbs, &
Pelham, 2004; Dembo, Sweitzer, & Lauritzen, 1985; Graziano & Diament,
1992; Johnson & Katz, 1973; Kohut & Andrews, 2004; Mooney, 1995;
McAuley, 1982; Moreland, Schwebel, Beck, & Well, 1982; O’Dell, 1974;
Sanders & James, 1983; Todres & Bunston, 1993; Travormina, 1974; Wiese,
1992; Wiese & Kramer, 1988) and at least four quantitative reviews (Cedar
& Levant, 1990; Lundahl, Nimer, & Parsons, 2006; Lundahl, Risser, &
Lovejoy, 2006; Serketich & Dumas, 1996) that have specifically focused on
parent training outcomes.
In addition to the above reviews, other papers have examined par-
ent training interventions as part of a broader review of psychosocial
treatments for children and adolescents in general (Weisz, Weiss, Han,
Granger, & Morton, 1995) and specific child and family problems, such as
conduct problems (Brestan & Eyberg, 1998; Bryant, Vissard, Willoughby,
& Kupersmidt, 1999; Dumas, 1989; Kazdin, 1987; Miller & Prinz, 1990;
Webster-Stratton, 1991) and ADHD (Chronis, Jones, & Raggi, 2006; Pelham,
Wheeler, & Chronis, 1998).
As indicated by the number of reviews, parent training interventions
are among the most frequently and rigorously studied of the psychosocial
interventions for children. To illustrate the scope of studies, a recent quan-
titative analysis of parent training outcomes with disruptive behaviors
identified 430 studies published in peer-reviewed journals between 1974
and 2003 (Lundahl, Risser, & Lovejoy, 2006). The literature on the effi-
cacy of parent training interventions varies considerably in terms of study

methodology, program features, and participant characteristics. In this
section, we examine the immediate, generalization, and moderator effects
of training parents to intervene with their children.
IMMEDIATE EFFECTS OF PARENT TRAINING
There is substantial evidence that supports the short-term effectiveness

of parent training as a general treatment approach. Lundahl, Risser, and
Lovejoy (2006) conducted a meta-analysis of experimental and quasi-
experimental studies that evaluated the effects of parent training pro-
grams on child behavior, parent behavior, and parent perceptions. This
study examined 63 studies from 1974 to 2003 that included 83 treatment
groups. Overall, this study reported immediate effect sizes of .42, .47, and
.53 for child behavior, parent behavior, and parent perceptions outcomes,
respectively. The magnitude of these effect sizes can be considered
moderate.1 These effect sizes compare favorably to the average effects
of other behavioral (d = .54) and nonbehavioral (d = .30) psychotherapy
treatments (Weisz et al., 1995).
Many of the early reviews focused almost exclusively on behavioral
parent training programs as they represent the majority of studies. Non-
behavioral parent training programs tend to lag behind behavioral pro-
grams not only in number, but also in methodology. For example, of the 63
experimental studies review by Lundahl, Risser, and Lovejoy (2006), only
14 parent training programs had a nonbehavioral focus. In their study,
the behavioral programs were found to have significantly higher meth-
odological rigor than the nonbehavioral programs. There are also other
differences between behavioral and nonbehavioral parent training studies
that make comparisons difficult. The majority of behavioral studies used
clinical samples, whereas the majority of nonbehavioral studies used non-
clinical samples.
Furthermore, parent training programs with different theoretical ori-
entations tend to target different outcomes, making direct comparisons
impossible. Nonetheless, several narrative reviews have examined the
methodology and efficacy of parent training programs from different theo-
retical orientations (i.e., reflective, Adlerian, & behavioral; Dembo et al.,
1985; Mooney, 1995; Todres & Bunston, 1993). All three reviews noted
that few studies met the criteria for well-designed investigations, and the
diverse methodologies precluded direct comparisons of efficacy. All three
reviews reported mixed results, with positive findings following what would
be expected from the specific theoretical orientation. For example, the
Adlerian programs showed a greater percentage of positive findings in the
outcome domain of parental attitudes and perceptions, and behavioral pro-
grams showed a greater percentage of positive findings on child behavior.
1
Cohen (1988) defined effect sizes as small, d = .2, medium, d = .5, and large, d = .8.
The largest subgroup of parent training outcome studies are those that
evaluated programs which train parents in behavioral child management
strategies to address deviant behaviors, such as aggressiveness, temper
tantrums, and noncompliance. Behavioral parent training (BPT) typically
included strategies such as differential reinforcement of other behavior,
extinction, and time-out. An early narrative review was supportive of
the efficacy of BPT with deviant behavior. Atkeson and Forehand (1978)
reviewed 24 studies which included three outcome measures (observa-
tions, parent collected data, and parent completed measures) and reported
positive results in all three outcome domains.
Serketich and Dumas (1996) conducted a meta-analysis of stud-
ies evaluating the effects of behavioral parent training program on child
antisocial behavior and parental adjustment. They analyzed 27 studies
from 1969 to 1992 that included 36 comparisons between experimental
and control groups. In these studies, 22 received some form of indi-
vidually administered BPT and 13 received BPT in a group format. The
average numbers of sessions was 9.53 (SD = 4.17). This study reported
a mean effect size for overall child outcome of .86, which is considered
large (Cohen, 1988). The mean effect sizes for child outcome based on
parent, observer, and teacher were .84, .85, and .73, respectively. The
mean effect size for outcomes of parental adjustment was moderate at
.44. As a result of the favorable outcome evidence, behavioral parent
training for oppositional children has been designated by the American
Psychological Association Task Force as an empirically validated inter-
vention (Chambless et al., 1996).
Several studies have evaluated the efficacy of BPT programs with par-
ents of children with ADHD. Seven of eight studies which compared BPT
with no treatment reported positive findings (Anastopoulos et al., 1993;
Duby, O’Leary, & Kaufman, 1983; O’Leary, Pelham, Rosenberg, & Price,
1976; Pisterman et al., 1989; Pisterman et al., 1992; Sonuga-Barke, Daley,
Thompson, Laver-Bradbury, & Weeks, 2001; Thurston, 1979). However,
the effects of BPT were not found to be superior to a cognitive-behavioral
self-control therapy (Horn, Ialongo, Popovich, & Peradotto, 1987; Horn,
Ialongo, Greenbert, Packar, & Smith-Winberry, 1990) or stimulant medi-
cations (Firestone, Kelly, Goodman, & Davey, 1981; Horn et al., 1991;
Klein & Abikoff, 1997; Pollard, Ward, & Barkley, 1983; Thurston, 1979).
BPT has not been shown to enhance treatment response when com-
bined with medications (Firestone et al., 1981; Horn et al., 1991; Klein &
Abikoff, 1997; Pollard et al., 1983). However, there is some evidence that
suggests that combining BPT with medications may allow for lower doses of
medications (Horn et al., 1991) or lead to enhanced outcomes in functioning
(social skills; improved parent–child relationships; parenting) and consumer
satisfaction (Hinshaw et al., 2000; Multimodal Treatment Study of Children
with ADHD Cooperative Group, 1999). Reviews of parent training interven-
tions with ADHD populations have concluded that more systematic study is
needed but that existing studies provide sufficient evidence to consider par-
ent training an effective treatment for ADHD (Chronis et al., 2004; Kohut &
Andrew, 2004; Pelham, Wheeler, & Chronis, 1998).
BPT has been evaluated with other specific childhood problems.

Graziano and Diament (1992) reviewed 186 empirical studies that evalu-
ated the efficacy of BPT with childhood problems. In addition to problems
with conduct and hyperactivity, studies have examined BPT with children
with mental retardation, physical disabilities, autism, overweight, enu-
resis, fears, and other specific behavioral problems. They concluded that
the BPT showed clear positive results for conduct problems and discrete
child behavior problems (e.g., enuresis, fears, weight reduction), some
success with hyperactivity, and mixed results with autism and mental
retardation. For the latter two conditions, they suggested that BPT may
be more effective in improving parent outcomes than child behavior. A
recent randomized controlled trial of parent education and skills training
interventions supports this notion (Tonge et al., 2006). This study showed
significant improvements in the functioning of parents of young autistic
children following treatment relative to the control group.
There have also been some mixed results evaluating BPT with chil-
dren with anxiety disorders. A recent study tested Parent Child Interaction
Therapy (PCIT; a manualized BPT program) with three families of children
with separation anxiety using a multiple-baseline design (Choate, Pincus,
Eyberg, & Barlow, 2005). This study found clinically significant changes in
both separation anxiety and disruptive behaviors. Another study raised the
question of what specific treatment components were active in producing
change in children with separation anxiety (Silverman et al., 1999). This
randomized clinical trial compared interventions that included an expo-
sure-based behavioral parent training component with a control group
offered parent therapeutic support and information. The results showed
improvement in measures of both child and parent functioning across all
groups. These results suggested that generic parent support and educa-
tion is as effective as parent training with an “active” therapeutic compo-
nent for children with separation anxiety.
Lundahl, Nimer, and Parsons (2006) conducted a meta-analysis of
studies evaluating the effects of parent training programs on parent risk
factors related to child abuse and documented abuse. They identified 23
studies from 1970 to 2004 that included 25 parent training treatment
groups. Of the 23 studies, 17 used pre–post only designs. The parent
training interventions used in these studies varied on a number of char-
acteristics, including theoretical orientation (behavioral, nonbehavio-
ral, mixed), location of intervention (home, office, mixed), delivery mode
(group, individual, mixed), and number of sessions. Immediately following
parent training, parents showed moderate improvement in outcome vari-
ables. The average effects sizes were .60 for attitudes linked to abuse, .53
for emotional adjustment, .51 for child-rearing skills, and .45 for docu-
mented abuse. There was a significant difference between the effect sizes
of studies with a control group (d = .30) and those without (d = .62) for the
emotional adjustment outcome variable, suggesting (at least for this vari-
able) that the effects are more in the small to moderate range.
In a recent randomized trial of an enhanced Parent Child Interaction
Therapy program (PCIT; a manualized BPT program) with physically abu-
sive parents (Chaffin et al, 2004), parents receiving PCIT showed significant
reductions in negative parent behaviors in a structured parent–child inter-

action observation compared to the control group. Other measures of child
and parent behavior and parent functioning showed improvements across
both experimental and control groups.
Cedar and Levant (1990) conducted a meta-analysis of studies that
evaluated the efficacy of the Parent Effectiveness Training program (PET;
Gordon, 1970) on the behavior and cognitive adjustment of both children
and parents. Most of the studies were doctoral dissertations rather than
peer reviewed journals. PET is based on a reflective/Rogerian approach
rather than a behavioral orientation and consists of training parents in
the use of active listening, “I” messages, and conflict resolution. Cedar and
Levant examined 26 studies from 1975 to 1990. Their analyses found no to
small effects on outcomes related to child attitudes and behaviors (ds = .12
& .03, respectively), small to moderate effects for child self-esteem (d = .38),
small to moderate effects on parent attitudes and behavior (ds =.41 & .37,
respectively), and large effects on outcomes related to parental knowledge
of course content (d =1.10).
Generalization Effects
It is reasonable to assume that changing parents’ behavior would result
in some generalization of treatment effects across time and settings and to
untreated siblings. Although there is some supporting evidence for such
generalization, confidence in the generalizability of treatment effects would
be increased with additional studies with improved methodology, such as
larger sample sizes, multiple outcome measures, and control groups.
Three of the four meta-analytic studies reviewed above evaluated the fol-
low-up effects of parent training. The long-term effect (interval not reported)
of the PET program showed an attenuation of overall effect over time, from
small to moderate (d = .35) to small (d = .24; Cedar & Levant, 1990). Of the
23 studies that evaluated the efficacy of parent training programs on child
abuse risk factors reviewed by Lundahl, Nimer, and Parsons (2006), five
studies reported follow-up effects for child-rearing behaviors and six stud-
ies reported follow-up effects on parental attitudes and emotional adjust-
ment. The effects were moderate for child-rearing attitudes (d =.65) and
small for emotional adjustment and child-rearing behaviors (ds =.28, .32,
respectively). Both of these reviews did not report separate follow-up effects
for studies that employed control groups at follow-up and those that did
not. Lundahl, Risser, and Lovejoy (2006) reported on the follow-up effects
(1 to 12 months post treatment) of behavioral parent training programs.
They reported the effects of those studies that employed a control group
at follow-up and those that did not. Studies that include a control group
at follow-up can provide a more accurate picture of the long-term impact.
The follow-up impact of the programs that used a control group at follow-
up was shown to maintain in the moderate range for parent perceptions
(d =.45) and to attenuate from moderate in magnitude at post-test to small
at follow-up for child behavior (d =.21) and parenting skills (d = .25).
A couple of recent studies reported follow-up effects of BPT with physi-
cally abusive parents and parents of children with Oppositional Defiant
Disorder. Chaffin and his colleagues (2004) reported follow-up data (median
interval of 2.3 years) in their randomized controlled trial of a BPT program
with physically abusive parents. Forty-nine percent (49%) of parents in the
control group (standard community group intervention) had a re-report for
physical abuse at follow-up compared to 19% of parents assigned to the
BPT group. Reid, Webster-Stratton, and Hammond (2003) reported on a
two-year follow-up of 159 four- to eight-year-old children diagnosed with
Oppositional Defiant Disorder and treated with a behavioral parent train-
ing program (Incredible Years). At posttreatment, 46.2% of participants
who received parent training alone and from 55% to 59.1% who received
parent training in combination with teacher or child training, showed
clinically significant changes (defined as a 20% reduction in ratings of
behavior) at posttreatment compared to 20% of controls. At the two-year
follow-up, the percentage of participants who received the parent training
alone or in combination with teacher or child training who showed clini-
cally significant improvements was 50%, 81.8%, and 60%, respectively. No
control group was used at this two-year follow-up.
There is some support for the generalization of behavioral parent
training treatment effects to untreated siblings. Four studies showed
significant improvements in the untreated siblings observed compliance
(Humphreys, Forehand, McMahon, & Roberts, 1978; Eyberg & Robinson,
1982) and deviant behavior (Arnold, Levin, & Patterson, 1975; Wells, Fore-
hand, & Griest, 1980) at posttreatment. In one study, the improvements
were maintained at a six-month follow-up (Arnold et al., 1975). Eyberg
and Robinson (1982) reported significant improvements in observed par-
ent behavior with untreated siblings and no significant reductions in the
number or intensity of negative sibling behaviors.
Two early studies failed to show generalization of treatment effects
from clinic to school settings (Breiner & Forehand, 1981; Forehand et al.,
1979). However, McNeil, Eyberg, Eisenstadt, Newcomb, and Funderburk
(1991) reported significant improvements in teacher-rated deviant behav-
ior and observations of appropriate and compliant behaviors at school in
ten children treated with a BPT program relative to controls. In this study,
they selected subjects who showed high levels of behavior problems across
home and school settings at pretreatment and who all showed clinically
significant improvements in home behavior after treatment.
Moderator Effects
A number of child, parent, and program characteristics have been
associated with parent training outcomes, such as child age, child IQ,
family’s socioeconomic status, parental social support, parental educa-
tion level, parental functioning, family stress, and ethnicity (see Graziano
& Diament, 1992 for review); however, relatively little research has been
done where these characteristics have been studied as independent vari-
ables. Lundahl, Risser, and Lovejoy (2006) assessed moderator effects of
parent training in their meta-analysis. They found financial disadvantage
to be the most salient moderator of outcomes. Children and parents from
non-disadvantaged families benefited more across the child behavior, parent
behavior, and parental perception outcome constructs compared to dis-

advantaged families. They also found that marital status was a moderator
of child behavior outcomes. Studies with a higher percentage of single
parents (Number of studies (k) = 29) did not show as much change as
studies with a lower percentage of single parents (k = 16). There have been
some mixed results related to child’s age and parent training outcomes in
three quantitative reviews. The Lundahl, Risser, and Lovejoy (2006) and
the Cedar and Levant (1990) meta-analyses found no relationship between
age and positive outcomes, whereas Serketich and Dumas (1996) reported
a positive relationship between age and positive outcomes.
There have been some program characteristics associated with parent
training outcomes, including the format of training and number of ses-
sions. In their meta-analysis, Serketich and Dumas (1996) found a non-
significant correlation between the effect size for the overall child outcome
and the format of the treatment (individual vs. group). Studies have found
individual, group, and self-administered BPT to be equally effective and
superior to a no-treatment control group (Webster-Stratton, 1984; Web-
ster-Stratton, Kolpacoff, & Hollinsworth, 1988).
Lundahl, Risser, and Lovejoy (2006) also found no differences in effect
sizes between face-to-face and self-directed interventions. However, they
reported that among the 20 studies that treated financially disadvantaged
families, individual parent training resulted in significantly greater improve-
ments in child and parent behavior than group parent training. There were
no differences between individual and group treatment in the parental per-
ceptions outcome domain. Lundahl, Nimer, and Parsons (2006) found that
studies whose programs were more than 12 sessions had greater improve-
ments in parental attitudes linked to abuse compared to programs with fewer
than 12 sessions. No differences in child-rearing behavior were found between
programs with low and high number of sessions.
SUMMARY OF THE EMPIRICAL EVIDENCE

OF PARENT TRAINING
There have been a substantial number of studies evaluating parent

training programs from different theoretical orientations and across differ-
ent child problems. As a whole, the research is supportive of the immedi-
ate effectiveness of parent training across many parent and child outcome
domains. Parent training can be considered at least moderately effective
which compares very favorably to the effects found for other psychotherapy
treatments. More specifically, there is sufficient evidence to consider behav-
iorally oriented parent training programs efficacious in treating children
with oppositional and ADHD problems. Although results are mixed and
more studies needed, there is evidence to support the generalization of parent
training effects across time, and some evidence to suggest generalization
across settings and to untreated siblings in some families.
Of course there are limitations in examining the effectiveness of par-
ent training programs in general by relying on the results of meta-analytic
reviews. As stated previously, parent training programs vary significantly
across a number of factors (e.g., theoretical basis, format and content

of the intervention, target behaviors, length of the intervention, etc.) and
some programs are more effective than others.
OVERVIEW OF SELECTED PARENT TRAINING PROGRAMS
As is clear from the review of the empirical support for parent train-
ing, programs vary significantly. In order to provide a better understanding
of some of these differences, as well as more details regarding specific
programs, the next section highlights several selected parent training pro-
grams. In order to impart the greatest understanding of parent training
programs, within the confines of this chapter, some programs are described
in detail and others are briefly summarized.
Parent Programs That Target Externalizing Behavior Problems

Helping the Noncompliant Child (HNC)
Helping the Noncompliant Child is a behavioral parent training program
that targets young children (two to eight years old) who exhibit high levels
of noncompliance to parental directions (McMahon & Forehand, 2003).
The extensive research base and evaluation studies supporting this pro-
gram are thoroughly summarized in McMahon and Forehand (2003) and
in Forehand and McMahon (1981). It is included on several “best practices”
lists for evidence-based treatment programs for conduct problems (Brestan
& Eyberg, 1998), child abuse (Saunders, Berliner, & Hanson, 2004), and
the prevention of substance abuse and delinquency (Alvarado, Kendall,
Beesley, & Lee-Cavaness, 2000; Webster-Stratton & Taylor, 2001). This
clinic-based program involves a therapist working with individual families.
The child attends all sessions with her parent(s). The primary goals of the
program are to improve child compliance to directions and to decrease
disruptive behavior through teaching parents more appropriate ways of
interacting with their child.
The intervention consists of two major phases. During Phase 1, dif-
ferential attention skills are taught that are designed to improve the par-
ent–child relationship as well as increase desirable behaviors. Phase 2
involves compliance training skills that assist parents in dealing with non-
compliance and other problematic behavior. A detailed training manual is
available for therapists (McMahon & Forehand, 2003).
The instructional format for each session follows a standard process
that includes didactic instruction and discussion of a specific skill, the
therapist demonstrating the skill through modeling and role-playing, the
parent practicing the skill with the therapist, the skill is then introduced
to the child, the parent then practices the skill with the child while the
therapist provides cues/feedback, and finally a homework assignment is
given to allow the parent to practice/utilize the skill at home.
Skills addressed in the program include attending, rewarding, ignor-
ing, directions, and time-out. Phase 1 of the program involves teaching
parents the effective use of the skills of attending, rewarding, and ignoring.
Phase 2 involves teaching parents to give effective directions and how to
use time-out appropriately. The clinical program typically takes 8–12 ses-
sions to complete. The number of sessions varies from family to family
because HNC uses a competency-based approach which requires parents
to achieve a certain level of competence with a skill before the next skill is
introduced. Details regarding the specific skills are provided below.
Phase 1 (Differential Attention Skills)

Attending. Attending is a skill that parents can use to help increase their
child’s desirable behaviors. It also helps lay the groundwork for a more posi-
tive parent–child relationship. After discussing, modeling, and role-playing
the skill with the parent(s) the therapist helps the parent master the skill
through practicing it in what is called the “child’s game.” This is a time where
the child selects the play activity (e.g., playing with blocks) and the parent is
nondirective. The parent is taught to simply describe a child’s activity while
eliminating directions and questions addressed to the child. This practice
allows the parent to master the skill of attending that will later be used to
increase desirable behavior. This skill is the focus of the intervention until the
parent demonstrates competence. This competence is assessed using specific
behavioral criteria recorded during a structured observation.
Rewarding. The second skill involves teaching the parent to praise or
reward the child’s positive behavior. This skill is taught using the same
instructional procedures and is practiced using the “child’s game.” The
types of rewards that are taught consist of labeled verbal (e.g., “I really
like it when you pick up your toys!”) and physical (e.g., hug, pat) rewards.
Parents are taught to focus on and reward prosocial behaviors rather than
negative behaviors. The parent has to demonstrate competence before the
next skill is introduced.
Ignoring. The third component of the initial phase of the program
involves teaching a parent to ignore minor unacceptable behavior, such
as whining and fussing. Again, the standardized instructional procedures
are used. The parent is taught an ignoring procedure that involves no eye,
physical, or verbal contact when minor unacceptable behaviors occur.
Differential Attention Plans. After the parent has mastered the skills
of attending, rewarding, and ignoring, the therapist assists the parent in
targeting specific child behaviors to increase using differential attention.
Parents use the skills taught in Phase 1 to implement differential attention
plans with guidance provided by the therapist.
Phase 2 (Compliance Training Skills)

The second phase of the program consists of teaching parents two
primary components of disciplinary skills: how to give effective instructions
to the child and how to use a time-out procedure appropriately.
Giving effective instructions. Parents are taught the elements of giving
effective instructions/commands to their child. The parent practices giving
instructions to their child within the “parent’s game.” Unlike the “child’s
game” which is used to teach Phase 1 skills and involves the parent being
nondirective, the “parent’s game” involves the parent taking direction of
the activities (e.g., the parent issues frequent instructions/commands
while directing the activity). The therapist provides feedback to the parent
regarding the directions being issued (e.g., how they could be improved).
The parent is also taught to attend to or praise their child’s compliance to
their directions.
Time-out. Parents are taught a specific time-out procedure to use
with their child. The child is also informed about the time-out protocol
within the session. The therapist provides guidance to the parent in terms
of issues related to time-out. The therapist then helps the parent utilize a
clear instruction sequence that guides the parent in how to manage com-
pliance and noncompliance to parental directions.
Standing rules. Once the parent is effectively implementing the clear
instruction sequence at home, the use of standing rules is introduced.
Standing rules are typically “If … then … ” statements (i.e., rules that
specify the consequences for specific behavior). The therapist assists the
parents in developing appropriate standing rules.
Extending the skills. The therapist discusses with the parents how
they can use the skills they have been taught to manage their child’s
behavior outside the home.
SELF-ADMINISTERED AND PARENTING CLASS

ADAPTATIONS OF HNC
Given early evidence that parents could be effectively taught child

management skills through written instructions (O’Dell, Krug, Patterson,
& Faustman, 1980; O’Dell et al., 1982) a booklet was written for parents
that provided them with information on the core skills taught in the HNC
program. An initial evaluation of this booklet in a randomized study found
that the booklet appeared to be effective in helping parents learn the basic
skills and utilize them to improve their children’s behavior (Long, Rickert,
& Ashcraft, 1993). This led to a book, Parenting the Strong-Willed Child,
being written for parents that contains a self-guided approach to learning
the core skills of HNC (Forehand & Long, 2002).
A six-week parenting class program (total of 12 hours) has also been
developed based on the HNC program and the Parenting the Strong-Willed
Child book. During each weekly 2-hour class, one of the core skills is taught
to parents as well as an additional topic. Additional topics discussed in the
class include creating a more positive home, improving communication,
developing more patience, building positive self-esteem, and problem solving.
A recent evaluation of this parenting class suggested that the class can
lead to improved parenting, reduced child behavior problems, and reduced
parenting stress (Conners, Edwards, & Grant, 2007).
It should be noted that both the self-guided and parenting class for-
mats are intended for parents whose children have relatively mild problems
whereas the clinical HNC program is intended for parents whose children
have more significant behavior problems.
Other Parent Programs That Primarily Target Externalizing

Behavior Problems
There are numerous other evidence-based parent-training programs
that have been found to be effective in reducing children’s externalizing
behavior problems. Three of these programs will be briefly discussed.
Parent-Child Interaction Therapy (PCIT)

PCIT (Brinkmeyer & Eyberg, 2003) is similar in many ways to the
Helping the Noncompliant Child (HNC) program. This similarity is a func-
tion of the fact that both programs were developed from the early work of
Constance Hanf (1969). Both programs focus on young children with dis-
ruptive behavior, have two phases, and are delivered to individual families
by a therapist. The two phases in PCIT are: child-directed interaction, and
parent-directed interaction. Training is provided through didactic instruc-
tion, modeling, role-playing, and coaching. In PCIT, children attend most
but not all of the sessions with their parents. Only the parents attend
a single teaching session at the beginning of each phase. During these
teaching sessions the parents are taught all of the skills for that phase
(whereas in HNC the skills are taught sequentially within each phase).
PCIT also emphasizes the role of traditional play therapy as part of their
child directed interaction phase. There is extensive evidence supporting
the effectiveness of PCIT (see Brinkmeyer & Eyberg, 2003).
The Incredible Years (TIY)

TIY training series (Webster-Stratton & Reid, 2003) is a comprehen-
sive program that has intervention components for parents, teachers, and
young children (two to eight years old). TIY is an extremely well-evaluated
program (see Webster-Stratton & Reid, 2003). The goals of the parent-
training component are to promote parent competencies and strengthen
families. This is a videotape modeling/group discussion program. The
BASIC parenting training program takes 26 hours to complete (13 weekly
2-hour group sessions). The videotapes used in the program contain 250
short vignettes (one to two minutes each) of modeled parenting skills.
The vignettes are show to groups of 8 to12 parents with a therapist lead-
ing group discussion. The program focuses on teaching parents how to
enhance the parent–child relationship through the use of child-directed
interactive play, to use praise, and to use incentives. The program also
teaches parenting techniques such as monitoring, ignoring, use of effec-
tive directions, time-out, and natural and logical consequences.
Webster-Stratton has also developed an ADVANCE parent training
program (Webster-Stratton & Reid, 2003). This is a 14-session videotape-
based program that can be used following completion of the BASIC pro-
gram. The ADVANCE program has four primary components: personal
self-control, communication skills, problem-solving skills, and strength-

ening social support and self-care.
Triple P
Triple P (Positive Parenting Program) developed by Sanders (Sanders &
Ralph, 2004) is a unique parent-training program. Developed in Australia
and currently being used around the world, Triple P is a multilevel parent-
training program that targets children 2–12 years old. The program has
five levels. Level 1 is a universal parent information strategy that makes
general parenting information available to all parents through the use of
various strategies including tip-sheets and promotional media campaigns.
Level 2 consists of a brief one- or two-session primary healthcare-based
parenting intervention targeting children with mild behavior problems.
Level 3 is a four-session more intensive parenting intervention that targets
children with mild to moderate behavior problems. Level 4 is an eight- to
ten-session individual or group parent-training program targeting children
with more significant behavior problems. Level 5 is an enhanced behav-
ioral family intervention program that is utilized for significant behavior
problems that are complicated by other factors (e.g., marital conflict, high
stress).
Parent Programs That Target Internalizing Behavior Problems

As discussed previously, the vast majority of parenting programs have
been developed to address children’s externalizing behavior problems.
However, a limited number of parenting programs have been developed
to specifically address internalizing behavior problems. These parent pro-
grams, unlike the programs for externalizing problems, are often used in
an adjunctive manner to interventions that involve working with the child
directly. This reflects the belief that: (1) although parenting may be a con-
tributing factor to children’s internalizing problems it typically plays a less
central role than it does with externalizing problems; and, (2) other inter-
vention approaches working directly with children (e.g., cognitive-behavior
therapy) have been found to be effective.
In several studies researchers have found that the risk for the develop-
ment of internalizing disorders in children is associated with parent–child
interactions that involve parental overcontrol, less granting of autonomy,
and low maternal warmth (Hudson & Rapee, 2001; Rapee, 1997; Sique-
land, Kendall, & Steinberg, 1996). Child anxiety may also result in parental
distress and changes in parenting practices including changes in terms
of parental expectations and demands that may maintain or exacerbate
children’s anxious and avoidant behaviors through negative reinforcement
(Kendall & Ollendick, 2004). Therefore, although cognitive-behavioral ther-
apy has been found to be an effective treatment for childhood anxiety dis-
orders, researchers have recommended the involvement of parents in the
treatment process as a way to improve outcomes (Barrett & Farrell, 2007).
Barmish and Kendall (2005) reported several common components of
parent-focused interventions for childhood anxiety:
Removing the reinforcement of children’s anxious behavior. This included

teaching parents contingency management strategies to extinguish avoidant
behavior and expressions of fear and to reward courageous behavior. Specific
strategies included planned ignoring, verbal praise, privileges and tangible
rewards.
Modeling appropriate behavior. This included teaching parents how to
gain greater awareness of their own anxious behaviors and how to become
better models for the children. Parents were also taught problem-solving
skills, how to restructure their cognitions, and to engage in appropriate
responses to anxiety-provoking situations.
Reducing family conflict. This included teaching parents specific
strategies to improve communication, parent–child relationships, and
reduce conflict.
Other. Other techniques used by some programs included teaching par-
ents about the etiology of anxiety (and the role of the family), relaxation training,
and how to build a support network with other parents of anxious children.
Barmish and Kendall (2005) conducted a review and meta-analysis
of nine controlled studies that have involved parents in the treatment of
child anxiety. Unfortunately, there was large variability across the stud-
ies including such factors as the content of parent sessions, number and
format of sessions, and who attend the parent sessions. This variabil-
ity precluded any definitive conclusions to be drawn. The reported effect
sizes for CBT treatment without parental involvement ranged from small
to medium for self-reported data to large for parent-reported measures.
When the treatment programs involved parents, the effect sizes ranged
from small to large for self-reported measures to large for diagnostician
and parent-reported measures.
FRIENDS for Life Program

One program that targets internalizing behavior problems is The
FRIENDS For Life Program (Barrett & Farrell, 2007; Barrett & Shortt,
2003), which targets childhood anxiety, and includes a parent component.
This treatment program, which was initially designed to be a group-based
intervention (it has also been adapted for individual clinical use), has a
primary child-focused cognitive-behavioral component. That is, the pri-
mary focus is working with children directly to address their dysfunctional
cognitions. The parent and family skills component is designed to be run
in a group format for approximately 6 hours (typically four 1.5 hour ses-
sions). The major focus of the parent/family skills component (Barrett &
Farrell, 2007; Barrett & Shortt, 2003) is to:
- Encourage parenting strategies including attending to and reinforc-
ing their children’s coping, approaching behaviors, and parental
modeling of appropriate coping behavior to their children
- Teach parents self-awareness and appropriate management of their
own stress and anxiety.
- Increase parents’ awareness of at-risk time for their children, how

they can coach their children to cope, and reinforcing their chil-
dren’s appropriate attempts to cope.
The parent component follows along with the FRIENDS components for
the children. Barrett and Farrell (2007) have outlined the specific strat-
egies of the parent component for each component as indicated by the
FRIENDS acronym as summarized below.
Feelings. Parents are encouraged to focus on their own responses
to fear and anxiety and on learning the skills of anxiety awareness. The
importance of accepting individual differences, particularly in response to
feelings, is discussed.
Remember to relax. Have a quiet time. Parents are taught relaxation skills
and are encouraged to practice and coach other family members. Parents are
also encouraged to ensure that the family has regular periods of quiet time.
Parents are also encouraged to reinforce relaxation practice in children. Par-
ents are supported and encouraged to spend quality time with their children.
I can do it! I can try my best! Parents are encouraged to become aware
of their own cognitive style and how their responses to stress model opti-
mism or pessimism to their children. Parents are encouraged to use positive
thoughts and to notice and reward their children for positive thoughts.
Parents are also asked to use positive prompts (e.g., “You can do it, you’ve
done it before”) with their children.
Explore solutions and coping step plans. Parents are taught how to
help their child develop coping step plans (based on a fear hierarchy). They
are given examples of coping step plans and rules to help ensure the success
of coping step plans.
Now reward yourself! You’ve done your best! Parents are encouraged
to notice brave/confident behaviors and reward approach behaviors.
Parents are also taught to ignore complaining and avoidance behaviors.
Don’t forget to practice. Parents are taught to encourage their child to
use their FRIENDS plan. They are also encouraged to role-play with their
children how to utilize the skills to handle upcoming challenges.
Smile! Stay calm for life. Parents are encouraged to help their children
recognize they have effective strategies for overcoming challenges they will
face.
Parent Programs That Target Developmental Disorders

The role of parents in the treatment of children with developmental dis-
orders has significantly changed over the past several decades. Parents have
moved from being minimally, if at all, involved in their children’s treatment
to being integrally involved. This transition has been especially significant for
some disorders such as autism. In the not too distant past, parenting style
(cold and rejecting) was considered to be the cause of autism (Bettleheim,
1967). Fortunately, autism is no longer considered an emotional problem
related to parenting but rather a neurodevelopmental disorder for which
parents can play an important role in helping interventions succeed.
The literature on parent training for children with developmental dis-

orders and specifically autism has, for the most part, developed separately
from the parent training literature for areas such as disruptive behavior
disorders (Brookman-Frazee, Stahmer, Baker-Ericzen & Tsai, 2006). In
reviewing the literature on parent training and autism spectrum disor-
ders (ASD) Brookman-Frazee and colleagues (2006) identified some gen-
eral differences when compared to more traditional parent training studies
for disruptive behavior disorders. They report that parent groups for ASD
tend to be smaller and that studies often include single case examples,
single case design, and more descriptive reports. Programs for ASD tend to
include more modeling of behaviors for parents. They also tend to include
more home treatment components and fewer strictly didactic components
for parents.
The degree of parental participation varies significantly across treat-
ment programs for ASD and other developmental disabilities. The level
of parental involvement is discussed below for some of the most popular
treatment programs for ASD.
Planned Activities Training (PAT)

Planned Activities Training (Lutzker & Steed, 1998) is a parent-training
approach that focuses on antecedent prevention of challenging behav-
iors. Unlike many other parent-training approaches that rely primarily on
contingency management techniques, PAT teaches parents to plan and to
structure activities in order to prevent challenging child behaviors. PAT
has been used successfully to reduce inappropriate behaviors with vari-
ous groups including children with developmental disabilities (see Lutzker
& Steed, 1998). PAT involves teaching parents time-management skills,
how to choose activities, how to explain activity rules, incidental teach-
ing, feedback, and reinforcement. This training of parents is provided by a
therapist across five structured sessions with an individual family. Train-
ing initially involves teaching parents to use the techniques for activities
that are not problematic. As parents master the techniques more prob-
lematic activities and settings are targeted. Training involves extensive
modeling, parent practice, and performance feedback. Training sessions
are typically conducted in family homes and in settings where challenging
behaviors occur.
Parent Involvement in Lovaas’s Treatment Program

for Autism
The early applied behavior analysis (ABA) interventions focused on the
child and did not involve the parents. However, in an early study by Lovaas
and his colleagues (Lovaas, Koegel, Simmons, & Long, 1973) it was noted
that children who were discharged back to families who were eager to par-
ticipate in treatment did much better in maintaining skills (or improving
skills) learned during the one-year treatment program (Lovaas, 2003). This
anecdotal evidence was seminal in Lovaas’ understanding of the need for
parental involvement with the children diagnosed with autism. However,
the extensive demands of parental implementation of an ABA intervention
(for at least 40 hours a week) requires a lifestyle change that is impossible

for many parents.
It should be noted that the effectiveness of using parents for the deliv-
ery of an ABA program is not clear. A recent study compared the outcomes
of ABA intervention provided by parents with that provided by students
(Smith, Groen, & Wynn, 2000). At four-year follow-up the children enrolled
in the student therapist group made more gains than the children in the
parent therapist groups on IQ tests, visual spatial skills, and in specific
aspects of language. There is some evidence to suggest that parents who
participate in parent training for their children with autism continue to
use some of the behavioral techniques they were taught, but many tend
to stop using the complete set of operant learning procedures including
ongoing formal data collection (Harris, 1986).
Pivotal Response Training (PRT)

Pivotal Response Training (PRT) was developed as a modified behavio-
ral intervention for children with autism (Koegel, O’Dell, & Koegel, 1987).
PRT focuses on addressing pivotal areas of functioning that can lead to
widespread collateral changes in other behaviors (Koegel, Koegel, & Brook-
man, 2003). Although specific target behaviors are determined based on
individual needs, much of the focus is on communication skills and social
communication interactions. PRT differs from traditional operant train-
ing in several ways including: (1) that it allows the child to take the lead
in what toys/stimulus items are used in a session, (2) it rewards goal-
directed attempts at correct responses, and (3) it uses more direct/natural
reinforcers in training. PRT has been found to change not only the target
behaviors but also improve the affective relationship between parent and
child, resulting in lower stress during family interactions, and improve
positive communication (Koegel, Bimbela & Schreibman, 1996). The addi-
tion of a parent support group to the standard parent-training program
has been found to improve the performance of parents in the use of the
PRT techniques (Stahmer & Gist, 2001).
In Koegel’s PRT, parents serve as key coordinators and interventions
for the program. Initially, the individually tailored parent-training program
focuses on introducing basic behavioral interventions (e.g., antecedents,
behavior, and consequences), characteristics of the pivotal area of motiva-
tion, and identifying learning opportunities in the natural environment
(Koegel, Koegel, & Brookman, 2003). The training program involves exten-
sive parent practice with clinician provided feedback on parent implemen-
tation of each procedure. Specific skills taught to parents (Koegel, Koegel,
& Brookman, 2003) include:
- How to present clear instructions and questions, use child-selected
stimulus materials, and use direct natural reinforcers
- How to intersperse previously learned tasks with new acquisitions
tasks (interspersing maintenance trials)
- How to reinforce a child’s attempts to respond to instructional mate-

rials or natural learning opportunities
Koegel’s research indicates that most parents reach criterion (80% correct
use of the motivational procedures within the natural environment) within
25 hours of training.
TEACCH Program (Treatment and Education of Autistic

and related Communication-handicapped Children)
The TEACCH program, developed by Eric Schopler and his colleagues
at the University of North Carolina at Chapel Hill, can be conceptualized
as a network for the state of North Carolina that provides services for
children with autism, education and support for families, research and
training for professionals, as well as a base for international education,
research, and training. It is not a single intervention. Working with the
families of individuals with autism is a major component of this program
(Marcus, Kunce, & Schopler, 2005).
The initial work of Eric Schopler was a direct response to the psy-
choanalytic theories of the 1960s that parents were the cause of a child’s
autism. Some of his earliest research looked at parents of children with
autism and found that these parents did not have thought disorders as
originally reported in the literature (Schopler & Loftin, 1969a, 1969b).
His early research also found that parents of children with autism were
able to accurately evaluate the variations their children’s developmental
progress and that these evaluations were consistent with standardized
testing results (Schopler & Reichler, 1972). These studies were seminal in
incorporating parent involvement and parent report as part of the evalua-
tion and treatment of the child with autism.
Education, training, and parent support are included in the core mis-
sion statement of the TEACCH model. The key values of the TEACCH model
include: (1) respecting the parent’s knowledge of their child, (2) respecting
the individuality of each family, (3) respecting the love parents have for
their child, (4) respecting the resilience of parents in finding solutions in
the face of intense stress, (5) respecting the contributions parents make
in advocating and developing new services, and (6) respecting the needs
of parents for accurate information, emotional support, comprehensive
services, and professional guidance for their child with autism (Mesibov,
Shea, & Schopler, 2006).
The TEACCH program involves parents at various levels (Marcus,
Kunce, & Schopler, 2005). Parents are educated about autism, trained
to work directly with their child, and to participate in advocacy efforts.
Specific training efforts, in working with their child, include helping them
establish positive routines through structured teaching. The TEACCH pro-
gram utilizes a collaborative model in working with parents. The exact
content of parent training efforts varies based on the child’s stage of devel-
opment and individual family needs.
Stepping Stones Triple P (SSTP)

The Triple P (Positive Parenting Program; Sanders, 1999), which utilizes
behavioral family interventions and parent management training, has
been modified for use with children with autism (Roberts, Mazzucchelli,
Studman & Sanders, 2006). Stepping Stones Triple P (SSTP) modifies the
original program by including material sensitive to families of children
with disabilities. It also covers issues relevant to this population and addi-
tional factors that could contribute to behavioral issues (i.e., problems
with communication skills).
A randomized control trial of SSTP (Roberts, Mazzucchelli, Studman &
Sanders, 2006) with parents of children with autism found that the SSTP
program resulted in a decrease in child behavior problems. Parenting
changes included mothers becoming less overreactive and fathers becom-
ing more effective in their discipline strategies. Raters found parents to be
more positive in their praising of children’s behavior. These results were
maintained at a six-month follow-up.
The modification of existing parent training for uses with different
populations, as described above, is a trend that will most likely increase
in the future.
CONCLUSION
From its early development in the 1960s, parent training has made
great strides. It has grown from an intervention focused on helping parents
to address specific child behaviors to a method of intervention used for a
variety of child problems and disorders. No other psychological therapy
for children has been as extensively studied (Kazdin, 2005). Meta-analytic
reviews of the parent-training literature suggest that parent training is at
least moderately effective. These results are very favorable when compared
to the effects found for other psychotherapy approaches. Such research
findings have resulted in parent training being considered one of the rel-
atively few empirically supported treatments for children’s externalizing
behavior problems. The use of parent training in other areas of childhood
psychopathology and developmental disorders is less well established but
is rapidly gaining support.
Unfortunately, parent training is not a panacea nor is it consistently
effective. Much work remains to be conducted to fully understand factors
that impact the effectiveness of parent training interventions. A greater
understanding is needed of how contextual factors such as ethnicity/cul-
ture, socioeconomic status, parental psychopathology, and various family
stressors relate to parent training interventions. Parent-training interven-
tions certainly need to better address issues related to ethnicity and cul-
ture, which are known to affect parenting, if treatment outcomes are to be
maintained in our increasingly diverse society.
At this stage of the development of parent-training interventions, more
effectiveness trials are needed (the primary focus to this point in time
has been on efficacy trials) (Weisz & Kazdin, 2003). That is, there is a
growing need to move beyond assessing treatment outcomes in controlled

research settings to assessing outcomes when parent-training interven-
tions are used in “real world” clinical settings. Related to this issue is the
need to study how to most effectively train clinicians in parent-training
approaches. Most research studies to date (efficacy trials) have utilized
therapists who are extensively trained over long periods (e.g., graduate
students who are trained over years in a particular parent-training pro-
gram). How can therapists at the community-level be trained to a level of
proficiency that will maintain the effectiveness of the intervention? It is
questionable whether traditional continuing education methods (e.g., writ-
ten manuals, one- to two-day training workshops with no ongoing training
support or supervision) are adequate. Perhaps newer technologies (e.g.,
Web-based tutorials and/or booster training sessions, Web-based group
supervision) will be used to assist in training efforts.
Finally, there is a need for research involving direct comparisons of
different parent-training interventions to determine which approaches are
most effective under which conditions. At the present time, there are many
parent-training interventions that have been demonstrated to be effective;
however, it is often difficult for clinicians to know which approach is best
for a specific family with whom they are working.
In conclusion, parent training has come a long way but still faces
many challenges as this approach to intervention continues to evolve. The
future of parent training looks bright as researchers and clinicians will
continue to use, improve, and study this very promising intervention for
treating and preventing child problems.
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4

Prior to the 1960s, therapy for children typically involved traditional

NICHOLAS LONG, MARK C. EDWARDS, and JAYNE BELLANDO • University of Arkansas

J.L. Matson et al. (eds.), Treating Childhood Psychopathology 79

Gerald Patterson’s (1982) research on coercive parent–child inter-

eralization), and whether behavior changes were maintained over time

AN OVERVIEW OF THE EMPIRICAL SUPPORT

There have been hundreds of studies that have evaluated programs

cacy of parent training interventions varies considerably in terms of study

IMMEDIATE EFFECTS OF PARENT TRAINING

There is substantial evidence that supports the short-term effectiveness

BPT has been evaluated with other specific childhood problems.

reductions in negative parent behaviors in a structured parent–child inter-

behavior, and parental perception outcome constructs compared to dis-

SUMMARY OF THE EMPIRICAL EVIDENCE

There have been a substantial number of studies evaluating parent

across a number of factors (e.g., theoretical basis, format and content

OVERVIEW OF SELECTED PARENT TRAINING PROGRAMS

Parent Programs That Target Externalizing Behavior Problems

Phase 1 (Differential Attention Skills)

Phase 2 (Compliance Training Skills)

SELF-ADMINISTERED AND PARENTING CLASS

Given early evidence that parents could be effectively taught child

Other Parent Programs That Primarily Target Externalizing

Parent-Child Interaction Therapy (PCIT)

The Incredible Years (TIY)

self-control, communication skills, problem-solving skills, and strength-

Parent Programs That Target Internalizing Behavior Problems

Removing the reinforcement of children’s anxious behavior. This included

FRIENDS for Life Program

- Increase parents’ awareness of at-risk time for their children, how

Parent Programs That Target Developmental Disorders

The literature on parent training for children with developmental dis-

Planned Activities Training (PAT)

Parent Involvement in Lovaas’s Treatment Program

(for at least 40 hours a week) requires a lifestyle change that is impossible

Pivotal Response Training (PRT)

- How to reinforce a child’s attempts to respond to instructional mate-

TEACCH Program (Treatment and Education of Autistic

Stepping Stones Triple P (SSTP)

growing need to move beyond assessing treatment outcomes in controlled

randomized, controlled trial with a community sample. Journal of the American

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