The past, present, and future of behavioral parent training: Interventions for child and adolescent problem behavior.

Abstract

Behavioral parent training has emerged as one of the most successful and well-researched interventions to date in the treatment and prevention of child and adolescent problem behaviors, with extensive empirical support for its clinical utility having been obtained over the last several decades. At this point in time, it is useful to consider the development of behavioral parent training and to review the current status of research and practice in the field. We begin by giving a historical overview of behavioral parent training, followed by a review of the core of these parenting interventions. We then present the current state of the art in behavioral parent training, including challenges frequently faced by clinicians in accessing and implementing these parenting programs. Finally, we turn our attention to the future of parent training research. ********** Behavioral parent training has emerged as one of the most successful and well-researched interventions to date in the treatment and prevention of child and adolescent problem behaviors, with extensive empirical support for its clinical utility (e.g., Kazdin & Weisz, 1998; Lonigan, Elbert, & Bennet-Johnson, 1998; McMahon & Wells, 1998). As a recent meta-analysis of 26 controlled studies by Serketich and Dumas (1996) indicates, behavioral parent training is associated with improvements in child behavior and parent personal adjustment. However, parent training is not uniformly successful, and there remains much to learn about the myriad factors that affect the implementation of these interventions. At this point in time, it is useful to consider the development of behavioral parent training--where advances in the field have led us, and where the field is going. In this article, we will begin by giving a historical overview of how parents came to be involved in the treatment of child problem behaviors, followed by a review of the core that are central to these parenting interventions, including a discussion of developmental and contextual variables. We then present the current state of the art in behavioral parent training, including challenges frequently faced by clinicians in accessing and implementing these parenting programs. Finally, we turn our attention to the future of parent training research. THE PAST: A HISTORICAL OVERVIEW OF PARENTING INTERVENTIONS While parenting interventions for child problem behaviors are largely a product of the last 30 years, their guiding principles were established early in the 20th century. Behavior modification techniques were first developed in the 1920s (Graziano & Diament, 1992). More importantly, researchers at that time began to recognize the integral role that a child's environment plays in the development and maintenance of antisocial behaviors. In their detailed review of thousands of case studies, Healy and Bronner (1926) concluded that family environment, and parenting practices in particular, was perhaps the most important predictor of delinquent behaviors. Based on their findings, they conclude, ... where to direct a strong attack in treatment and prevention of delinquency stands out with striking clearness (p.129)--in other words, parents should be a primary target for intervention with antisocial youth. Given the current climate for treating child problem behaviors, the conclusions of researchers in 1926 seem surprisingly modern. However, these suggestions were not immediately implemented, in part because the psychological treatment of children was not widely practiced. Additionally, treatment of children through the 1950s typically occurred via less empirically-based psychodynamic approaches, employing a traditional one-on-one encounter between the therapist and child, and addressing more global, intrapsychic issues rather than specific behavior problems (e.g., Berman, 1959; Sternbach, 1947). In the early 1960s, however, a paradigm shift in child treatment occurred. …