The Effects of Parent Therapy for Disruptive Behaviors: A Review of the Literature

When an individual becomes a parent there is not a secret manual that will provide guidance in decision making for their child. In today’s society one of the largest growing issues among families are problematic behaviors displayed by children in the home (Beveridge, Fowles, Masse, McGoron, Smith, Williamson, 2015). Disruptive behaviors that begin in the home can carry over to the classroom, which causes additional issues. Challenging behaviors can include screaming, biting, hitting, impulsiveness, inattention, self-injury, and noncompliance. Research has shown children who display challenging behaviors at a young age have been shown to have low social and academic outcomes, as they get older (Dunlap et al., 2006; Gilliam, 2005).  When a child is diagnosed with a disability, living in homes with low socioeconomic statuses households, or living in foster care the amount of problematic behaviors occurring in the home substantially increases. As problematic behaviors continue at home the frustration level in parents is growing.  A parent’s reaction to challenging behaviors can determine if a behavior escalates or continues to occur. Due to high frustration levels, there is a possibility parents will react to challenging behaviors by spanking their child and screaming themselves. If problematic behaviors are not corrected it can affect a child’s academically and the relationship they have with their parents. To avoid this, parent interventions and trainings can be put into place to improve a child’s persistent challenging behaviors in the home.

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Literature Review

When an individual becomes a parent there is not a secret manual that will provide guidance in decision making for their child. In today’s society one of the largest growing issues among families are problematic behaviors displayed by children in the home (Beveridge, Fowles, Masse, McGoron, Smith, Williamson, 2015). Disruptive behaviors that begin in the home can carry over to the classroom, which causes additional issues. Challenging behaviors can include screaming, biting, hitting, impulsiveness, inattention, self-injury, and noncompliance.

Research has shown children who display challenging behaviors at a young age have been shown to have low social and academic outcomes, as they get older (Dunlap et al., 2006; Gilliam, 2005).  When a child is diagnosed with a disability, living in homes with low socioeconomic statuses households, or living in foster care the amount of problematic behaviors occurring in the home substantially increases. As problematic behaviors continue at home the frustration level in parents is growing.  

A parent’s reaction to challenging behaviors can determine if a behavior escalates or continues to occur. Due to high frustration levels, there is a possibility parents will react to challenging behaviors by spanking their child and screaming themselves. If problematic behaviors are not corrected it can affect a child’s academically and the relationship they have with their parents. To avoid this, parent interventions and trainings can be put into place to improve a child’s persistent challenging behaviors in the home.

Parent Interventions

Over the years, educators continue to witness students exhibiting problematic behaviors in the classroom. In the world of education, teachers are expressing how challenging behaviors effects students academically. However, challenging behaviors are not limited to the school setting because it is occurring at home from those same students (Joseph, Strain, & Skinner, 2004).  When a young child in a household displays problematic behaviors it can affect the family dynamics, some include attending community activities and being able to follow routines at home (Lucyshyn et al., 2004). Based on the information, it is critical for parents along with, students to be provided with behavior interventions that will improve the home life.

Therefore, Fettig, Schultz, and Sreckovic (2014) conducted a study to determine if coaching parents and implementing a parent intervention using a functional assessment (FA) would decrease problematic behaviors in young children between the ages of 2 and 5 years. When working with young children it is important for family-based practices to be used, which gives families choices, focuses on the family strengths instead of weaknesses, and show the importance of collaboration between the families and other parties involved (McLaughlin, Denney, Snyder, & Welsh, 2012). A functional assessment is an intervention approach that gives families the opportunities to display their strengths and is the reason it was chosen for this study. Fettig, Schultz, and Sreckovic (2014) implemented coaching in their research due to other studies showing an increase when coaching and trainings were used (Fukkink, 2008; Joyce & Showers, 2002).

In Fettig, Schultz, and Sreckovic (2014) study three parents and child dyads participated and all were from the eastern region of the United States. To participate in the study, the children had to be between 2 and 5 years old, display concerning problematic behaviors at home, and identified with a disability. An experimental design using multiple baselines were used to determine if coaching and FA-parent interventions would reduce the amount of problematic behaviors at home. Before conducting a baseline, a functional behavior assessment was conducted by researchers. During this time, the researchers worked diligently with the parents in their homes using observations and interviews to discover the function of the child’s challenging behaviors.

 Then to conduct a baseline Fettig, Schultz, and Sreckovic (2014) observed each dyad in their home and parents were told to interact with their child normally. These observations occurred 3 times per week during specific routines. Prior to beginning the intervention, each parent met with the researchers to collaborate to create an intervention plan. During the meeting, parents were trained on how to apply FA-based strategies. In the parent training stage, Fettig, Schultz, and Sreckovic (2014) discussed why challenging behaviors transpire and how important social emotional development is for young children.

Parents were provided with baseline data and reviewed information from functional behavior assessments. Throughout the training, parents were given strategies to use for a variety of behaviors and discussed how to respond to behaviors, prevention strategies, and worked together to create a behavior support plan. At the end, parents were given the chance to ask questions in regards to the behavior support plan. In the next phase, one of the researchers would provide coaching to each parent during a routine being targeted. The researcher would observe and the coaching sessions were given at the end of the observation.

First, a researcher would provide positive feedback. Second, it would be discussed where improvements could be made to improve challenging behaviors. Third, the researcher would provide modeling if a strategy was used incorrectly. Fourth, parents were given the chance to ask the researchers any further questions they may have. The last phase for Fettig, Schultz, and Sreckovic (2014) intervention was the withdrawal of coaching. After two weeks of providing coaching, researchers no longer gave feedback to the parents and the parents were told to continue implementing behavior support plan.

While analyzing the data, the researchers found all of the children participants displayed challenging behaviors at an elevated level at baseline. Out of the three participants, Jack’s persistent challenging behaviors had the highest mean of 78.7% of intervals. Emma was not far behind with 61.2% and Liam at 56.3%. After completing the intervention Fettig, Schultz, and Sreckovic (2014) examined the results and found the percentage of intervals reduced after intervention, coaching, and withdrawal. The data showed the children participants had a mean score of 65.4% at baseline, 42.1% in the intervention phase, and 20.1% during the coaching phase, and 13.3% when coaching was withdrawn.

When Fettig, Schultz, and Sreckovic (2014) analyzed the data they found it important to note that the biggest behavior changes occurred during the training and coaching phase of the intervention. The researchers found, this to be an indication of when parents implement FA-based strategies with fidelity challenging behaviors tend to decrease. The results of this study provide evidence on an intervention that can possibly work for children and families struggling with behaviors across the country. In addition, the writer found the level of collaboration to be an important indicator in the success of this intervention. It proves that when parents are provided with evidence-based strategies and given necessary trainings persistent challenging behaviors can decrease, which gives a child the opportunity to be success in school and at home with family members.

Young children and their families are not the only groups of individuals that have behavior issues occurring in the home. Transitioning from elementary school to secondary can be a difficult change for children. At this developmental stage, there seems to be a change between a child’s behavior and the relationship they have with their family (Steinberg, 2000). In a recent study, an estimated 13% of young adolescents develop behaviors associated with oppositional defiance disorder and become withdrawn (Roisman, Monahan, Campbell, Steinberg, & Cauffman, 2010). These types of behaviors can be detrimental to the child, family members, and members of the community.

When a child develops oppositional defiance a range of issues can occur, such as, problems with peers at school, drug and alcohol use, and risk taking (Thompson et al., 2011). Previous studies have found evidence that using programs targeting families and the way they react to challenge behaviors has helped children with behavioral issues (Havighurst et al., 2013, Havighurst, Wilson, Harley, Prior, & Kehoe, 2010). A child’s emotional development can depend on how a parent responds to specific emotions (Morris, Silk, Steinber, Myers, & Robinson 2007). Harley, Havighurst, and Kehoe (2015) conducted a study to determine if a prevention program, which targets how to teach parents how to socialize effectively and in return, decreases the externalizing behaviors in children when transitioning to from primary to secondary school.  

In the prevention program intervention study, two hundred and twenty-five primary caregivers participated. Two hundred and twenty four children were included in the study and their ages ranged between 10 and 13 years old. The children participating in the study came from one hundred twenty schools from low to middle socio economical areas in Melborne In the schools, the researchers invited the parents to be a part of a research study, which would provide free parenting programs and a CD voucher for the children.

Harley, Havighurst, and Kehoe (2015) had two groups of participants; one being the control group and the other group would receive the intervention. To determine the impulse control of parents the researchers used a subscale from the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004). For the children and parents, researchers administered The Emotions as a Child Scales (EAC; Magai, 1996; Magai & Oneal, 1997). This tool measured how the parents’ responded to their child’s emotional behavior. When the children were given the tool the child would rate how they felt based on their parent’s reaction.

To determine the amount of conflict in the home, researchers used a Family Conflict Scale (FCS, Arthur, Hawkins, Pollard, Catalano & Baglioni, 2002). FCS determined how conflict was handled in household and the higher the score showed more family conflict. Lastly, to examine participant’s conduct and hyperactivity issues, researchers used subscales from the Strengths and Differences Questionnaire (Goodman, 1997). Once the measures were conducted the Turning in to Teens (TINT) intervention began.

Turning in to Teens consisted of 6 group parenting sessions. In the sessions, parents were instructed on how to responds to challenging behaviors to be able to effectively communicate with their child. Parents were provided with strategies to control their own emotions when there is conflict in the house. During the sessions, parents participated in role-play, exercises, home activities, and each parent received a DVD to watch. Results from the TINT intervention revealed notable decreases in parents’ impulse control when confronted with challenging behavior in the home.

Throughout the intervention, parents learned why their child might be acting out, which changed how they respond. If a parent does not respond in anger to their pre-teen it avoids escalation of emotions (Harley, Havighurst, & Kehoe 2015). In addition, when a child who is struggling emotionally has stable parents it helps their own emotional stability. It is possible parents do not realize the impact their impulses has on their child’s challenging behaviors. The TINT intervention proves if parents are given strategies to control themselves and understand why their child acts a specific way it can improve their overall relationships at home.

Furthermore, parents who have children with development deficits and display hyperactivity behavior issues can go far beyond what a parent expected. Unfortunately, behavior problems can cause chaos in a household. Even more stress is caused on a family when their child is diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). In some cases, parents turn to medications to control their child’s behavior at home and at school. However, medications are unable to train a child to control impulsive and challenging behaviors (Foster, Pelham, & Robb, 2007).  

Hence, Koolaee, Mosalanejad, Navidian, and Shahi (2015) wanted to examine the effect of a group positive parent training to decrease persistent challenging behaviors in children diagnosed with ADHD in Turkmen families. The purpose of the parent-training program was to prevent children from suffering emotional and severe behavioral problems in children ranging from the age of 2 to 13 years old (Sanders, 2003). Also, the program aimed at growing their abilities, skills, and trust with their parents (Sanders, 2003). Only children with ADHD were selected and non-probability sampling was used from a treatment center. Once selected, the participants were asked to complete a Child Behavior Checklist (CBCL) to determine the severity of their behaviors.

Afterward, the participants were broken up into a control group and an experimental group. The 10 parents in the experimental group were given 6 in person group positive parenting training and 2 sessions were conducted over the phone. Children in the experimental group were no longer taking medication. Parents in the control group did not receive any training from researchers, but their children did continue medication provided by a psychiatrist.

Results from Koolaee, Mosalanejad, Navidian, and Shahi (2015) study posttest showed the mean score in the experimental group for challenging behaviors was lower than the control group. These results proved when a positive parenting program is provided it will decrease persistent challenging behaviors in young children diagnosed with ADHD (Koolaee, Mosalanejad, Navidian, & Shahi, 2015). During the study, parents expressed how their attitude altered their feelings of ADHD after collaborating with other parents in the group. By holding discussions in a group with other parents whose children have ADHD showed parents how similar specific behaviors are, which shows the commonality. Therefore, the way parents viewed their child’s ADHD diagnoses changed and were able to accept it better (Rowshandbin 2006).

Moreover, parenting trainings are beneficial for parents and their children. It is important for parents to collaborate and have a better understanding of their child’s disability. When parents learn strategies to aid their child it is not only beneficial at home, but also in an academic setting. By implementing specific behavioral strategies evidence is proving better outcomes for young children’s emotional state.

Attention Deficit Hyperactivity Disorder is not the only disability that displays challenging behaviors in children. A disability that is no stranger to behaviors challenges is Autism Spectrum Disorder (ASD). Autism is known to cause issues with repetitive behaviors, sensory deficits, and lack of social communication (American Psychiatric Association, 2013). A child diagnosed with ASD has a high possibility of displaying persistent challenging behaviors. Some of the problematic behaviors include, tantrums, impulsivity, self-harm, hyperactivity, aggression, and noncompliance (Szatmari, 2006; Simonoff, Pickles, Charman, Chandler, Loucas, Baird, 2008).

In addition, typical problematic behavior exhibited in children diagnosed with ASD causes difficulty for parents in an academic setting, at home, and out in the community (Yianni-Coudurier, Darrou, Lenoir, et al., 2008). These issues can affect the child diagnosed with ASD adaptive skills. When a child is continually protesting and being aggressive in the house a parent may complete tasks for the child, which can cause daily life skills deficits. So, Bearss et al. (2016) conducted a study to examine if parental training on adaptive behavior would impact children with ASD.

To conduct the study, there was a multicenter trial with 180 participants. The participants consisted of children diagnosed with ASD and exhibited moderate to severe behavior issues (Bearss et al. 2016).  The children were between the ages of 3 and 6 years old. Throughout the study parents were given a series of ratings. Bearss et al. (2016) used a variety of measurements, such as, The Irritability subscale of the Aberrant Behavior Checklist, Home Situations Questionnaire-Autism Spectrum Disorder, Vineland II, Improvement Item of the Clinical Global Impressions, and Vineland II.

Next, the interventions consisted of Parent Training and Parent Education Program. Bearss et al. (2016) wanted to determine which intervention was more effective in improving adaptive skills in children with ASD. During the parent training (PT) parents were given 60 to 90 minute sessions and a home visit from 16 to 24 weeks (Bearss, Johnson, Smith, et al., 2015). PT sessions were provided to the primary parent or guardian using role-play with trained therapist, direct instruction, homework, video demonstrations, and direct instruction. Providing homework assignments gave the parents an opportunity to implement new techniques.

Some sessions offered parent’s strategies to be used at home, such as, planned ignoring, visual schedules, strategies to encourage compliance, and positive reinforcements for inappropriate behavior. Towards the end of the PT intervention sessions were aimed towards generalizing and maintaining improvements. The PT intervention was structured in a specific way to reduce challenging behaviors and to promote skill acquisition in the child (Bearss, Johnson, Handen, et al., 2015). Another intervention used during the adaptive skills study was a Parent Education Program (Bearss et al. (2016). 

This program was an active intervention that included 60 to 90 minute session on an individual basis for a 24-week span. The Parent Education Program (PEP) contained a script and manual for the therapist, along with, parent handouts. Unlike the PT, parent education program only provided information and resources, but did not provide instruction in behavior management. Results showed, children in the parent training group demonstrated greater gains in all of the Vineland II domains in compared to the children in the parent education program.

While analyzing the data, the writer believes the PT group of children showed gains due to the fact parents were provided with more resources. During the PEP parents were not given any type of instruction on how to respond to behaviors. However, in the PT group parents were given an abundance of techniques and strategies. Also, they were provided with the opportunity to apply what they learned. Regardless of a disability or not, it is crucial to provide parents with resources when they are working with children with a variety of behavioral issues. Evidence proved that the parents who were provided with instruction on behavior management had better results than parents who were not.

Additionally, even as children and families continue to struggle with challenging behaviors not all are receiving the necessary help. An estimated 3% of youth who haven mental health issues are receiving help (Kataoka et al. 2002; Lavigne et al. 2009). Some of the reasons parents are not seeking help for the child can be due to childcare for siblings or lack transportation to centers (Larson et al. 2013). Based on the lack of children receiving help for problematic behaviors there is a clear need for behavior interventions that are effective for children and their families.  

Thus, researchers conducted a study to compare a clinic-based Parent-Child Interaction Therapy (PCIT) to a home-based Parent-Child Interaction Therapy (PCIT; McNeil and Hembree-Kigin, 2010). Incorporating a home-based therapy eliminates certain barriers that families face when having to go to a clinic (Fernandez and Eyberg 2009; Lavigne et al. 2010). Families received two sessions each week of PCIT and wraparound case management service, which is another service to help eliminate difficulties of receiving treatment (Bruns et al. 2015). The intervention was composed of two different phases, a discipline phase (Parent Directed Interaction [PDI]) and an enhancement phase (Child Directed Interaction [CDI]). To build the parent and child relationship, in the CDI parents participate in playtime with the child.

The child takes the lead during CDI and inappropriate behaviors are ignore while a response is given to positive behaviors. Now, in PDI parents are learning how to be consistent with their rewards and give commands to their child. In the PCIT study, participants were from “Brining Evidence-based Services and Treatment (B.E.S.T) for Young Children and their Families” (Beveridge et al. 2015). Once the intervention began one therapist was allocated for each family, along with, a behavioral assistant who answered any questions or concerns a parent had. Each primary caregiver was provided with coaching inside their home but therapists were instructed to ignore the child even if the child tried to communicate with them (Ware et al. 2008).

Results from the PCIT study showed, both home-based and clinic-based PCIT showed a change in behavior. As the researchers analyzed the data in PCTI study it showed both groups showed increases in CDI-do skills. However, home-based therapy showed a quicker increase in improvements. Overall, this study gives insight into how one type of therapy can be adapted to allow families who have less resources to get superior help with their child’s disruptive behavior. It is important for different types of settings to be tested to give more access to parents and children in need of behavioral supports.

Overall, behavior issues are occurring in the classroom and at home. When behaviors are not corrected in the home it carries over to other areas and begins affecting the child in all aspects of their life. Many times, parents are unaware of the resources to aid them in helping their child. When given the correct interventions and trainings it can help the home life tremendously. The writer’s suggestions towards parents are ask for help if your child is having challenging behaviors in the home. If teachers are having disruptive behavior from a child in their classroom it is important for the teacher to collaborate with the parent. A suggestion from the writer would be to have a behavior intervention plan at home and school and done with fidelity.

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