By Alan E. Kazdin. New York: Oxford University Press, 2005. 410 pp. $54.50 (hardcover).
It was my observation recently that my daughter's fifth-grade class was “overpunished.” Their ability to band together and evade authority intrigued me. Equally interesting was the lack of parental report, even when children came home bruised. My daughter was new to this class. The other children had been together since preschool in a private/parochial school coed class labeled “gifted.” So, I asked her why we (the parents and students) do not even consider talking to the teacher or principal. She put words to my observation, “They will punish all of us, and nothing will get better. We can fix things ourselves as long as they don't know anything.” I then picked up my copy of Parent Management Training, by Alan E. Kadzin, with the hope of finding an explanation and possibly an answer. What I found was much, much more. This book provides a provocative view of authority figures and how they contribute to oppositional, aggressive, and antisocial behavior in children and adolescents.
Parent Management Training contains eight chapters, each with an introductory outline and a summary. Chapters 1 and 2 define parent management training (PMT) and review operant conditioning principles. The book picks up speed in Chapter 3, “From Principles to Techniques, Positive Reinforcement.” The use of positive reinforcement as the main tool for shaping behavior makes punishment and the parents' probability of misusing punishment almost obsolete. Positive reinforcement, even if already used, can be tuned to improve results. Chapter 4 clarifies that punishment is effective when consequences are contingent, immediate, and occur almost every time. The author succeeds in making punishment seem laborious compared with positive reinforcement.
Chapter 5 plunges into treatment. I especially liked this chapter. The author describes how sessions are used for role-playing until the parents improve their technique. “Prompting and delivery of contingent praise are so critical to the program that it is not wise to proceed until the parent achieves some minimal level of performance” (p 124). One or both parents' involvement attains results. Teachers can be involved. Variations of PMT can be used for children aged two to eight years, children with attention deficit disorder, foster children, and parenting classes. The focus is always parent-child interactions at home.
Chapters 6 and 7 move away from the how-to's and look at evidence of success and problems in implementation. Chapter 6, “Evidence: Key Findings, Strengths and Limitations,” asserts that “PMT is among the best evidence-based treatments for children and adolescents” (p 158). The author reviews the current evidence and supplemental treatments. In Chapter 7, the critical problems concerning implementation appear. The chapter assesses parental and professional perceptions, antecedent events, behaviors, and consequences. Some of the discussion is typical of the challenges all parents face when deciding the correct discipline for their child and balancing their preference with the practices of their in-laws.
Chapter 8 is a summary of the book with added commentary about the limitations, fallacies, and future of PMT. The next 200 pages contain sample sessions of PMT. This is my favorite part. The charts and role-playing sessions are both helpful and entertaining. For example, one chart contains “Common Problems to Ignore” including whining, bad table manners, complaining, yelling, inability to play alone, pleadings for the purchase of items in stores, crying, swearing, noisiness, quarreling with siblings, pouting, teasing, and interrupting (p 298). I will certainly have a lot more free time after reading this book.
Parent Management Training is a thought-provoking, thorough book about PMT. Although it stays on topic, its application to inpatient forensic psychiatry and everyday parenting is no stretch for the reader. I have seriously considered passing the book on to the fifth-grade teachers in my daughter's school, but have decided to remain a part of the silent conspiracy. I recommend it, however, to my colleagues, friends, and the general readers of the Journal.
- American Academy of Psychiatry and the Law
