From the Guidelines
Parent-focused interventions for aggressive children should begin with evidence-based programs like Parent Management Training (PMT), which teaches parents specific techniques to manage aggressive behavior, including consistent discipline, positive reinforcement for good behavior, and effective communication, as recommended by the American Academy of Child and Adolescent Psychiatry 1. These approaches are based on the principles of contingency management methods, which have been shown to be effective in reducing aggressive behavior in children 1. The key components of these interventions include:
- Reducing positive reinforcement of disruptive behavior
- Increasing reinforcement of prosocial and compliant behavior
- Applying consequences and/or punishment for disruptive behavior
- Making parental response predictable, contingent, and immediate Parents should establish clear rules and consequences, using time-out procedures (typically 1 minute per year of age) rather than physical punishment, and provide daily positive attention through "special time" (10-15 minutes of child-directed play) to strengthen the parent-child relationship 1. For severe aggression, a mental health professional may recommend a comprehensive approach that includes cognitive-behavioral therapy for the child alongside parent training, and in cases with underlying conditions like ADHD, medications such as methylphenidate or guanfacine might be considered under medical supervision 1. It is essential to note that these interventions work by helping parents provide consistent structure and reinforcement, teaching children emotional regulation skills, and addressing any underlying neurobiological factors contributing to aggressive behavior, with improvements typically seen over weeks to months of regular practice.
From the Research
Evidence-Based Interventions
- Parent management training (PMT) is a well-investigated treatment technique for children and adolescents with oppositional, aggressive, and antisocial behavior 2
- PMT and cognitive-behavioral therapy (CBT) are two forms of behavioral interventions that have received extensive support in randomized controlled trials for treating anger, irritability, and aggression in children and adolescents 3
- A transdiagnostic approach to CBT for anger and aggression has been described, and studies of this approach are currently underway 3
Key Components of Effective Interventions
- Improving aversive patterns of family interactions that engender children's disruptive behavior is a key component of PMT 3
- Targeting deficits in emotion regulation and social problem-solving that are associated with aggressive behavior is a key component of CBT 3
- Dyadic regulation, or the ability of mothers and children to regulate their interactions, may be an important process associated with treatment success for aggressive youth 4
Enhancing Treatment Outcomes
- Enhancing common and placebo factors, such as bonding of the parent to the therapist and credibility of the intervention, may optimize therapeutic change in PMT 5
- Parent participation in parent training programs, such as the Incredible Years Parent Training Program, can lead to decreased parental stress, increased parental confidence, and positive changes in children and parent-child relationships 6
- Supporting parents and providing them with a sense of acceptance and non-judgment can facilitate self-reflection and positive change in themselves, their children, and their relationships with their children and other family members 6