The Behavioral Parent Training (BPT) (Pelham et al., 1995) is a program aimed to change and enhance the parenting stile and the management of ADHD (e.g., Pelham et al., 1998). As described in Chronis (2004, p. 2) the typical sequence of sessions for Behavioural Parent Training (BTP) is:
The Parent-Child Interaction Therapy (PCIT) is an empirically supported parent-training program for young children with disruptive behaviors that may also be effective in treating ADHD. It is an individualized treatment for individual parents that employs modeling, in-vivo practices and provide on-line feedback.
PCIT is based on both attachment theory and social learning theory (Eyberg, 1988). It is designed to be developmentally-sensitive for preschoolers between ages 2 and 7. It includes a relationship enhancement phase, child-directed interaction (CDI), a behavior management discipline phase and parent-directed interaction (PDI). It is based on data demonstrating mastery of concepts. PCIT training is generally delivered in approximately 10 sessions. The duration depends on parents’ performance. PCIT includes live coaching in the session, which gives parents an opportunity to practice skills with their child and also receive feedback by the coach. The first phase is inspired on play therapy, parents are engaged in play led by the child “which in turn encourages them to create or strengthen their bond with their child, increases their use of positive parenting practices and enhances their child’s social skills. Parents are specifically instructed in the PRIDE skills: Praising the child (labeled praise), Reflecting the child’s statements, Imitating the child, Describing their child’s behavior, and using Enthusiasm throughout their play and in avoiding questions, commands, and criticism. Before parents pass in the PDI phase they have to demonstrate they have learnt the skills.
The second PDI phase teaches parents to provide firm, consistent, and predictable discipline when necessary. This phase starts with instruction of giving effective commands that are both clear and direct so that they let the child know exactly what is expected. (Wagner et al., 2008)
Online resource http://pcit.phhp.ufl.edu
The Barkley’s program is designed for parents of children ages 2–12. The program is supported by research evidence demonstrating “that up to 64% of the families seeking treatment for their child’s ADHD report significant positive changes in their child’s disruptive behavior” (Wagner et al., op. cit., p. 10).
Steps extract from Barkley parent training program (Barkley, 2006):
Program including role-play, videotaped modeling and discussion using a group-based collaborative approach.
The MTA parent training group sessions (Wells et al., 2000) is a part of an intensive psychosocial treatment (14-mouth) composed by a Parent Training component, a School intervention component and a Summer Treatment Program. It includes 27 group sessions (and 8 individual sessions).
Following the original description of the sessions:
1. Structured clinical interview, review of ADHD and introduction to treatment
2. Setting up school/home daily report card
3. Overview of social learning and behavior management principles and review of DRC
4. Attending and “special playtime”
5. Rewarding and ignoring skills in “special playtime” and “catch your child being good”
6. Using positive skills and Premack principle to increase targets: catch child being good and independent play
7. Giving effective commands to children, establishing behavior rules, and attending and rewarding compliance to instructions
8. Time-out procedure
9. Home token economy 1
1.0 Home token economy 2
11. Response cost
12. Planned activities training and setting generalization
13. Stress, anger, and mood management 1
14. Stress, anger, and mood management 2
15. Peer programming in home and school
16. Preparing for the new school year
17. Parent skills for academic/school support at home compliance.
Generalization and integration sessions:
18. Review of attending, rewarding, ignoring skills, review of “special time”
19. Review of commands, house rules, and time-out
20. Review of home token economy and response cost
21. Review of academic support/homework programs at home
22. Planning for the second summer
23. Review of the first scripted parent–teacher meeting
24. Review of the second scripted parent–teacher meeting
25. Review of the third scripted parent–teacher meeting
26. A final review of the scripted parent–teacher meetings
27. Preparing parents to coordinate work with the schools and problem-solving school issues.
The Community Parent Education Program (COPE) (Cunningham et al., 2006) includes 10-Session COPE Workshop for Parents of 4- to 12-Year-Olds with ADHD.
1. Information Night and Introduction to ADHD
2. Attending, Balanced Attending, and Rewards among Siblings
3. Planned Ignoring
4. Token Incentive Systems 1
5. Transitional Warnings and “When–Then”
6. Planning Ahead
7. Token Incentive Systems 2 (Response Cost)
8. Time out from Positive Reinforcement 1
9. Time out from Positive Reinforcement 2
10. Closing session
The UCLA Children’s Social Skills Program (Frankel & Myatt, 1997) is a combined child and parent training aimed to improve social skill abilities of children but also to enhance parent’s compliance during homework tasks the use of positive discipline, price and incentives. The Parent training is described in this session while the social skills training of children is described in the social context section.
The sessions are organized as follows:
- Encouragement and discouragement of children’s social behavior
- Parent support of social skills
- Group entry and rejection
- The elements of effective praise
- How to have a successful play date
- How children "make fun of teasing”
- Confrontation with adults
- How to decrease physical fighting
The Incredible Years Programme (IY) (Webster-Stratton, 1996) programme is a therapist led parenting intervention that aims to reduce child disruptive behaviour by establishing a positive relationship between parent and child by teaching parents interactive play skills and encouraging praise and reward for positive behaviour. Parents are also taught strategies to deal with child misbehaviour and non-compliance.
More in depth, the IY is a series of programs focused on reinforcement parenting skills (monitoring, positive discipline, confidence) and encourage parents' involvement in children's school experiences in order to promote children's academic, social and emotional competencies and reduce conduct problems. The programs are addressed to different age groups. It includes role-play, movies modeling, and collaborative group-based discussions method appears to be a promising program for families of children with ADHD.
Preschool/Early Childhood program (3-6 ages) includes the following contents:
- Strengthening Children's Social Skills, Emotional Regulation and School Readiness Skills
- Using Praise and Incentives to Encourage Cooperative Behavior
- Positive Discipline - Rules, Routines and Effective Limit Setting
- Positive Discipline - Handling Misbehavior
- School Age programs (4-12 ages)
- Effective communication between adults and children
- Problem solving skills for children and parents
- Promoting Positive and Reducing Inappropriate Behaviors in School Age Children
In a large culturally diverse sample of children aged approximately 4 years old, receipt of IY parenting programme is associated with reduced observed problem behaviour in children and higher levels of positive affect and praise from mothers compared to controls (Reid et al, 2001). In addition, in a sample of pre-school children at risk of developing conduct disorder and ADHD receipt of the IY intervention is associated with improved parent reported ADHD symptoms after controlling for improvements in disruptive behaviour (Jones et al., 2007).
There is little research however examining the effects of the IY programme for children with a primary diagnosis of ADHD. Webster-Stratton (2011) has investigated the effects of the combined parent and child components of the IY programme with parents of children aged between 4-6 with ADHD. Children received the IY dinosaur school training programme, which has components aimed at improving child social and academic competencies and appropriate behaviour in the classroom. Receipt of the combined intervention associated with reductions in parent-report and observed levels of hyperactive, aggressive and defiant child behaviour. Mothers also reported reductions in the use of harsh discipline strategies and were observed to use more praise and be less critical during interactions with their child.
Online resource.http://www.incredibleyears.com/program/index.asp
The 1-2-3 Magic (Phelan, 2010) is a parenting programme in the form of book and videos and aims to provide simple strategies such as time out and rewards in order to improve the parent-child relationship and reduce oppositional behaviour. The 1-2-3 Magic video has been empirically evaluated in one study where the 1-2-3 magic video was delivered in a group format to parents of 3-4 year old children who reported experiencing difficulties with their child’s behaviour. Facilitators then encouraged group discussion about problem solving. Parents reported improved parenting behaviours including less over-reactive and lax parenting and reductions in parent-reported hyperactive behaviour although the effect size is very small possibly because the study did not use a clinical sample (Bradley et al, 2003).
This is the most successful program that the National Attention Deficit Disorder Information and Support Service (ADDISS) uses. It is simple to understand, parents can apply this approach, and perhaps more importantly maintain it effectively after a very short exposure to training. The fact that parents of ADHD children can use this is important as many parents of ADHD children are ADHD themselves and this program provides a structure that they can hold onto and manage to use it effectively.
The New Forest Parenting Programme (NFPP) (Sonuga-Barke, Thompson, Daley, & Laver-Bradbury, 2004) is a parenting programme that has been specifically developed for the management of ADHD in pre-schoolers. In addition to behavioural strategies aimed at helping parents to manage difficult child behaviours, the intervention also includes ideas for games and activities aimed at targeting some of the self-regulatory deficits that are commonplace in ADHD. Ideas include card games such as ‘snap’ and ‘matching pairs’, which may help the child’s working memory and practice their ability to take turns. Supporting the child’s development through parental scaffolding is also a key component of the NFPP.
In an empirical evaluation of the NFPP, Sonuga-Barke and colleagues (2001) found that the receipt of the NFPP was associated with reduced parent reported ADHD symptoms and observed ADHD symptoms during a task compared to a waiting list and parent-support and counselling control group that did not provide parents with strategies for behaviour management. In addition, Thompson and colleagues (Thompson et al., 2009) reported that NFPP improved parent-reported ADHD symptoms in a sample of pre-school children with ADHD. A self-help version of the NFPP is also available, which comes in the form of a six-step self-help manual. Receipt of the self-help version of the NFPP has also been shown to reduce parent reported ADHD symptoms and improve parenting efficacy in parents of school-aged children with ADHD (Daley & O’Brien, 2013).
The program’s steps and details are available at http://education.gov.uk/commissioning-toolkit/Content/PDF/New Forest Parenting NFPP.pdf
The Positive Parenting Programme (Triple P) (Sanders, 2000) teaches parents 17 core parenting strategies aimed at promoting a positive relationship between parent and child and strategies such as effective limit setting and discipline techniques to help parents manage misbehaviour. The standard version of the Triple P programme can take place in groups or individually; there is also a self-directed version.
Bor and colleagues (Bor et al., 2002) found that both the standard and enhanced versions of the Triple P programme improved parent reported problem behaviour in this sample. Receipt of the intervention was also associated with less dysfunctional parenting practices as reported by parents.
An enhanced version of the Triple P parenting programme specific for ADHD has also been shown to improve parent report of child disruptive behaviour and parental confidence in their ability to handle child misbehaviour in a sample of children with clinical diagnosis of ADHD aged between 5 and 9 (Hoath & Sanders, 2002).
The Parents Plus (PP) Programs (Sharry & Fitzpatrick, 2008; Sharry & Fitzpatrick, 2009; Sharry, Hampson & Fanning, 2009). The PP Programs are practical and positive video based parenting courses designed to support and empower parents to manage and solve discipline problems and to create satisfying family relationships. There are currently three versions of the program:
1. The Early Years Program for parents of children aged 1 – 6 years
2. The Children’s Program for parents of children aged 5 – 10 years
3. The Adolescents Program for parents of children aged 11 – 16 years
The focus of the PP program is positive, aimed at positively building parents’ strengths and to help them to solve discipline problems themselves. Each program includes 8 – 12 sessions of 2 hours with up to 12 parents in each group. In addition, specific groups for parents of children with ADHD are available. The PP programs focus on the interaction between parent and child. Behavioral change is encouraged by supporting parents to respond differently towards their children. An example of this would be by removing attention for negative behaviour and directing attention towards positive behaviour choices through specific praise. When the gain for misbehavior is reduced and the reward for positive behaviour increased, negative patterns can be stopped and positive ones emerge. There are currently 12 published studies providing evidence for the effectiveness of the Parents Plus Programmes in reducing behavioural problems and parental stress in a variety of contexts and with a variety of age groups (e.g. Coughlin, Sharry, Fitzpatrick, Guerin, & Drumm, 2009; Griffin, Guerin, Sharry, & Drumm, 2010; Hand, Mc Donnell, Honari, & Sharry, 2013).
The Parenting oriented towards solutions: a new way of understanding and coping with ADHD (Malaca, 2008) is a parent-training program consisting of six sessions.
1st session: Participants’ introduction, by choosing one word-card, representing a coping capacity with their child behaviour or an activity that they like to do. At the end of the session parents were asked to rate their child’s behaviour in the last week from 1 to 10 (which 1 represents the worse and 10 the best moment of your child behaviour). The answer to this question will allow the monitoring of the child’s behaviour as it changes during the training program. Home assignment: observe the considered which are the best moments of their child daily behaviour, thinking of how their skills, resources, talents as parents and how child’s characteristics influenced that moments.
2nd session: identification and establishment of goals that can enhance the parents’ strategies on child’s behaviour management.
3rd and 4th session: description of strategies used by parents, and discussion on their understanding of the results, reinforcing the maintenance of the strategies that works with the child and creating a change of the ones that do not work. Solution-focused questions and role-play activities were used for parents to choose and implement the solution that better fits their child.
5th session: parents’ were asked to classify their own progress along the program as well as the child’s behaviour during the last week. Questions such as “What do you have to do/ or not to do in order to come back to the initial situation?” “What do you think that you can do more of or in a different way to improve the results?”
6th session: to move from a problems/difficulties-focused context towards a solutions-centred context was celebrated. Their children shared their own opinions on the solutions and resources that worked better for them – providing feedback on parents’ behaviours.
More details of the above mentioned programs at
http://www.whaamproject.eu/images/documents/FrameworkLicense.html