父母管理訓練：修订间差异

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'''父母管理訓練'''（英文：Parent Training in Behavior Therapy 、Behavior Management Training for Parents, Parent Behavior Therapy、 Behavioral Parent Training、或 Parent Training）是[[行為治療]]及[[注意力不足過動症#.E8.A1.8C.E7.82.BA.E6.B2.BB.E7.99.82|注意力不足過動症行為治療]]的其中一環。父母管理訓練是一系列的治療方案，教授家長正向[[增強]]的一些方法，來改善學齡前兒童及學齡兒童的行為情形（如<!--侵略、-->[[注意力不足過動症|過動]]、{{le|易怒|Tantrum}}、難以遵照指令）<ref name=Maliken2013>{{cite journal |vauthors=Maliken AC, Katz LF |title=Exploring the impact of parental psychopathology and emotion regulation on evidence-based parenting interventions: a transdiagnostic approach to improving treatment effectiveness |journal=Clin Child Fam Psychol Rev |volume=16 |issue=2 |pages=173–86|date=June 2013|pmid=23595362 |doi=10.1007/s10567-013-0132-4}}</ref>。
'''父母管理訓練'''（英文：Parent Training in Behavior Therapy 、Behavior Management Training for Parents, Parent Behavior Therapy、 Behavioral Parent Training、或 Parent Training）是[[行為治療]]及[[注意力不足過動症#.E8.A1.8C.E7.82.BA.E6.B2.BB.E7.99.82|注意力不足過動症行為治療]]的其中一環。父母管理訓練是一系列的治療方案，教授家長正向[[增強]]的一些方法，來改善學齡前兒童及學齡兒童的行為情形（如<!--侵略、-->[[注意力不足過動症|過動]]、{{le|易怒|Tantrum}}、難以遵照指令）<ref name=Maliken2013>{{cite journal |vauthors=Maliken AC, Katz LF |title=Exploring the impact of parental psychopathology and emotion regulation on evidence-based parenting interventions: a transdiagnostic approach to improving treatment effectiveness |journal=Clin Child Fam Psychol Rev |volume=16 |issue=2 |pages=173–86|date=June 2013|pmid=23595362 |doi=10.1007/s10567-013-0132-4}}</ref>。


父母管理訓練是1960年代由兒童心理學家所提出的，其作法是透過介入、改變父母的行為來改變兒童的破壞性行為<ref name=Forehand2013>{{cite journal |vauthors=Forehand R, Jones DJ, Parent J |title=Behavioral parenting interventions for child disruptive behaviors and anxiety: what's different and what's the same |journal=Clin Psychol Rev |volume=33 |issue=1 |pages=133–45 |date= February 2013 |pmid=23178234 |pmc=3534895 |doi=10.1016/j.cpr.2012.10.010}}</ref>。此訓練是受到[[操作制約]]及{{le|應用行為分析|applied behavioral analysis}}等原理的啟發，一般會維持幾個月，主要是讓父母學習如何針對兒童適當的行為提供正向的強化（例如讚美及獎勵），並且針對不適當的行為，利用一些方式（如轉移注意力等）設定適當的限制。
行為治療是一個能有效幫助罹患[[注意力不足過動症]]的年輕兒童改善[[行為]]、[[自我管理]]和[[自尊]]的療法。患者的父母親在習得相關知識後親自實行能將行為治療的效果發揮到極致。<br/>
<!-- Behavior therapy is effective treatment for attention-deficit/hyperactivity disorder (ADHD) that can improve a child’s behavior, self-control, and self-esteem. It is most effective in young children when it is delivered by parents. -->


父母管理訓練是在用於處理破壞性行為（特別是{{le|對立性反抗疾患|oppositional defiant disorder}}及[[品行障碍]]）的方法中，最多被探討的方法之一<ref name=Maliken2013>{{cite journal |vauthors=Maliken AC, Katz LF |title=Exploring the impact of parental psychopathology and emotion regulation on evidence-based parenting interventions: a transdiagnostic approach to improving treatment effectiveness |journal=Clin Child Fam Psychol Rev |volume=16 |issue=2 |pages=173–86|date=June 2013|pmid=23595362 |doi=10.1007/s10567-013-0132-4}}</ref><ref name=Menting2013>{{cite journal |vauthors=Menting AT, Orobio de Castro B, Matthys W |title=Effectiveness of the Incredible Years parent training to modify disruptive and prosocial child behavior: a meta-analytic review |journal=Clin Psychol Rev |volume=33 |issue=8 |pages=901–13 |date=December 2013 |pmid=23994367 |doi=10.1016/j.cpr.2013.07.006 }}</ref><ref name=Michelson2013>{{cite journal |vauthors=Michelson D, Davenport C, Dretzke J, Barlow J, Day C |title=Do evidence-based interventions work when tested in the "real world?" A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior |journal=Clin Child Fam Psychol Rev |volume=16 |issue=1 |pages=18–34 |date=March 2013 |pmid=23420407 |doi=10.1007/s10567-013-0128-0}}</ref>，可以有效的減少兒童的破壞性行為<ref name=Michelson2013>{{cite journal |vauthors=Michelson D, Davenport C, Dretzke J, Barlow J, Day C |title=Do evidence-based interventions work when tested in the "real world?" A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior |journal=Clin Child Fam Psychol Rev |volume=16 |issue=1 |pages=18–34 |date=March 2013 |pmid=23420407 |doi=10.1007/s10567-013-0128-0}}</ref>，並且提昇父母的心理健康<ref name=Furlong2013>{{cite journal |vauthors=Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M |title=Cochrane review: behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Review) |journal=Evid Based Child Health |volume=8 |issue=2 |pages=318–692 |date=March 2013 |pmid=23877886 |doi=10.1002/ebch.1905}}</ref>，也有一些研究是探討用父母管理訓練來治療有其他障礙的兒童。有關父母管理訓練研究的限制包括缺乏對於改變機制的相關知識<ref name=Kazdin2010>Kazdin AE (2010). Problem-solving skills training and parent management training for oppositional defiant disorder and conduct disorder. ''Evidence-based psychotherapies for children and adolescents (2nd ed.),'' 211&ndash;226. New York: Guilford Press.</ref>，以及還沒有長期治療結果的研究<ref name=Furlong2013/>。若父母無法全力參與管理訓練（可能因為個人精神及認知因素、父母高度衝突，或是無法參與每週的課程），要進行父母管理訓練會更加困難<ref name=Pfiffner2014>{{cite journal |vauthors=Pfiffner LJ, Haack LM |title=Behavior management for school-aged children with ADHD |journal=Child Adolesc Psychiatr Clin N Am |volume=23 |issue=4 |pages=731–46 |date=October 2014|pmid=25220083 |doi=10.1016/j.chc.2014.05.014}}</ref>。

Behavior therapy, given by parents and with the support of healthcare providers, teaches children to better control their own behavior, leading to improved functioning at school, home and in relationships. Learning and practicing behavior therapy requires time and effort, but it has lasting benefits for the child.


==家長應該要尋找怎樣的行為治療？（What should parents look for?）==
==家長應該要尋找怎樣的行為治療？（What should parents look for?）==

2017年4月12日 (三) 21:02的版本

父母管理訓練（英文：Parent Training in Behavior Therapy 、Behavior Management Training for Parents, Parent Behavior Therapy、 Behavioral Parent Training、或 Parent Training）是行為治療及注意力不足過動症行為治療的其中一環。父母管理訓練是一系列的治療方案，教授家長正向增強的一些方法，來改善學齡前兒童及學齡兒童的行為情形（如過動、易怒、難以遵照指令）[1]。

父母管理訓練是1960年代由兒童心理學家所提出的，其作法是透過介入、改變父母的行為來改變兒童的破壞性行為[2]。此訓練是受到操作制約及應用行為分析等原理的啟發，一般會維持幾個月，主要是讓父母學習如何針對兒童適當的行為提供正向的強化（例如讚美及獎勵），並且針對不適當的行為，利用一些方式（如轉移注意力等）設定適當的限制。

父母管理訓練是在用於處理破壞性行為（特別是對立性反抗疾患及品行障碍）的方法中，最多被探討的方法之一[1][3][4]，可以有效的減少兒童的破壞性行為[4]，並且提昇父母的心理健康[5]，也有一些研究是探討用父母管理訓練來治療有其他障礙的兒童。有關父母管理訓練研究的限制包括缺乏對於改變機制的相關知識[6]，以及還沒有長期治療結果的研究[5]。若父母無法全力參與管理訓練（可能因為個人精神及認知因素、父母高度衝突，或是無法參與每週的課程），要進行父母管理訓練會更加困難[7]。

家長應該要尋找怎樣的行為治療？（What should parents look for?）

While these may not be available in all areas, other programs have also been tested and found to work in children with ADHD. The following list of questions can be used to find a therapist who uses a proven approach:

治療師是否
Does this therapist

  • Teach parents skills and strategies that use positive reinforcement, structure, and consistent discipline to manage their child’s behavior?
  • Teach parents positive ways to interact and communicate with their child?
  • Assign activities for parents to practice with their child?
  • Meet regularly with the family to monitor progress and provide coaching and support?
  • Re-evaluate and remain flexible enough to adjust strategies as needed?

哪些事情是家長可以事先預期的？（What can parents expect?）

治療師會定期與家庭成員會晤以觀察進度並提供持續的支持（左對話框）
在會晤中，家長現場實習從治療師那學來的技巧（右對話框）
即便療程結束，家庭成員仍能持續感受到行為的改善以及壓力的減輕（下方橫幅）

Parents typically attend eight or more sessions with a therapist. Sessions may involve groups or individual families. The therapist meets regularly with the family to review their progress, provide support, and adjust strategies as needed to ensure improvement. Parents practice with their child between sessions.

家長將從行為治療中學到什麼？（What will parents learn?）

ADHD患童的家長能在行為治療中學到以上三種核心能力（正向溝通、正向激勵/強化、結構與紀律）

家長們將學會：

  • 透過正向溝通（比如說：願意傾聽孩子的心聲且願意描述自己的心情）來增進親情。
  • 強化好的行為。例如：當孩子出現良好的行為時給予鼓勵並投與溫暖的關注。
  • 建立結構並給予一致的紀律規範。例如：給予孩子明確、實際、有意義的指令、並且不要將注意力投與在孩子不應該出現的行為上。並有效利用
  • Children with ADHD often have many challenging behaviors. A therapist will help parents learn these skills and how to use them effectively with their child.

Technique

Poor parenting, inadequate parental supervision, discipline that is not consistent, and parental mental health status, stress or substance abuse all contribute to early-onset conduct problems; the resulting costs to society are high.[5] In the context of developing countries in particular, family socio-economic disadvantage is a significant predictor of abusive parenting that impacts adolescent's psychological, behavioural and physical health outcomes.[8] Negative parenting practices and negative child behavior contribute to one another in a "coercive cycle", in which one person begins by using a negative behavior to control the other person's behavior. That person in turn responds with a negative behavior, and the negative exchange escalates until one person's negative behavior "wins" the battle.[9]:161 For example, if a child throws a temper tantrum to avoid doing a chore, the parent may respond by yelling that the child must do it, to which the child responds by tantruming even louder, at which point the parent may give in to the child to avoid further disruption. The child's tantrums are thereby reinforced; by throwing a tantrum, s/he has achieved the end goal of getting out of the chore. PMT seeks to break patterns that reinforce negative behavior by instead teaching parents to reinforce positive behaviors.[1]

The content of PMT, as well as the sequencing of skills within the training, varies according to the approach being used. In most PMT, parents are taught to define and record observations of their child's behavior, both positive and negative. This monitoring procedure provides useful information for the parents and therapist to set specific goals for treatment, and to measure the child's progress over time.[6]:216[9]:166 Parents learn to give specific, concise instructions using eye contact while speaking in a calm manner.[9]:167

Providing positive reinforcement for appropriate child behaviors is a major focus of PMT. Typically, parents learn to reward appropriate behavior through social rewards (such as praise, smiles, and hugs) as well as concrete rewards (such as stickers or points towards a larger reward as part of an incentive system created collaboratively with the child).[6]:216 In addition, parents learn to select simple behaviors as an initial focus and reward each of the small steps that their child achieves towards reaching a larger goal (this concept is called "successive approximations").[6]:216[9]:162

PMT also teaches parents to appropriately set limits using structured techniques in response to their child's negative behavior. The different ways in which parents are taught to respond to positive versus negative behavior in children is sometimes referred to as differential reinforcement. For mildly annoying but not dangerous behavior, parents practice ignoring the behavior. Following unwanted behavior, parents are also introduced to the proper use of the time-out technique, in which parents remove attention (which serves as a form of reinforcement) from the child for a specified period of time.[10]:128 Parents also learn to remove their child's privileges, such as television or play time, in a systematic way in response to unwanted behavior. Across all of these strategies, the therapist emphasizes that consequences should be administered calmly, immediately, and consistently, and balanced with encouragement for positive behaviors.[9]:168

In addition to positive reinforcement and limit setting in the home, many PMT programs incorporate collaboration with the child's teacher to track behavior in school and link it to the reward program at home.[6]:216[10]:151 Another common element of many PMT programs is preparing parents to manage problem behaviors in situations that are typically difficult for the child, such as being in a public place.[10]:151

The training is usually delivered by therapists (psychologists or social workers) to individual families or groups of families, and is conducted primarily with the parents rather than the child, although children can become involved as the therapist and parents see fit.[9]:162 A typical training course consists of 12 core weekly sessions;[6]:215 with different programs ranging from four to twenty-four weekly sessions.[5]

PMT is underutilized and training for therapists and other providers has been limited; it has not been widely used outside of clinical and research settings.[11]

Programs

The theory behind PMT has been "repeatedly validated", and many programs have met the "gold-standard criteria for well-established interventions".[1] All of the established programs teach better parenting skills and emphasize that the parent-child relationship is "bidirectional".[1]

Specific treatment programs that can be broadly characterized as PMT include Parent–child interaction therapy (PCIT),[1] the Incredible Years parent training (IYPT),[3] Positive parenting program (Triple P),[1] and Parent management training – Oregon model (PMTO).[12] PCIT, IYPT, Triple P and Helping the non-compliant child (HNC) are among the most frequently used PMTs;[1] according to Menting et al (2013), IYPT "is considered a 'blueprint' for violence prevention".[3]

The per family cost of group parent training programs to bring an average child into a non-clinical range of behavioral disruption was estimated in 2013 to be US$2,500, which according to the authors of a Cochrane review was "modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems".[5]

What if a therapist is trying something different?

Parents have the greatest influence on their young child’s behavior. Only therapy that focuses on training parents is recommended for young children with ADHD because young children are not mature enough to change their own behavior without their parents' help. Some therapists may use play therapy or talk therapy to treat young children with ADHD. Play therapy provides a way for children to communicate their experiences and feelings through play. Talk therapy uses verbal communication between the child and a therapist to treat mental and emotional disorders. Neither of these has been proven to improve symptoms in young children with ADHD.

結論（Summary）

行為治療需要時間與付出，但行為治療對於孩子將有終身的影響。

參考資料

  1. ^ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Maliken AC, Katz LF. Exploring the impact of parental psychopathology and emotion regulation on evidence-based parenting interventions: a transdiagnostic approach to improving treatment effectiveness. Clin Child Fam Psychol Rev. June 2013, 16 (2): 173–86. PMID 23595362. doi:10.1007/s10567-013-0132-4. 
  2. ^ Forehand R, Jones DJ, Parent J. Behavioral parenting interventions for child disruptive behaviors and anxiety: what's different and what's the same. Clin Psychol Rev. February 2013, 33 (1): 133–45. PMC 3534895 可免费查阅. PMID 23178234. doi:10.1016/j.cpr.2012.10.010. 
  3. ^ 3.0 3.1 3.2 Menting AT, Orobio de Castro B, Matthys W. Effectiveness of the Incredible Years parent training to modify disruptive and prosocial child behavior: a meta-analytic review. Clin Psychol Rev. December 2013, 33 (8): 901–13. PMID 23994367. doi:10.1016/j.cpr.2013.07.006. 
  4. ^ 4.0 4.1 Michelson D, Davenport C, Dretzke J, Barlow J, Day C. Do evidence-based interventions work when tested in the "real world?" A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior. Clin Child Fam Psychol Rev. March 2013, 16 (1): 18–34. PMID 23420407. doi:10.1007/s10567-013-0128-0. 
  5. ^ 5.0 5.1 5.2 5.3 5.4 Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M. Cochrane review: behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Review). Evid Based Child Health. March 2013, 8 (2): 318–692. PMID 23877886. doi:10.1002/ebch.1905. 
  6. ^ 6.0 6.1 6.2 6.3 6.4 6.5 Kazdin AE (2010). Problem-solving skills training and parent management training for oppositional defiant disorder and conduct disorder. Evidence-based psychotherapies for children and adolescents (2nd ed.), 211–226. New York: Guilford Press.
  7. ^ Pfiffner LJ, Haack LM. Behavior management for school-aged children with ADHD. Child Adolesc Psychiatr Clin N Am. October 2014, 23 (4): 731–46. PMID 25220083. doi:10.1016/j.chc.2014.05.014. 
  8. ^ Meinck, Franziska; Cluver, Lucie Dale; Orkin, Frederick Mark; Kuo, Caroline; Sharma, Amogh Dhar; Hensels, Imca Sifra; Sherr, Lorraine. Pathways From Family Disadvantage via Abusive Parenting and Caregiver Mental Health to Adolescent Health Risks in South Africa. The Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine. 2016-10-25. ISSN 1879-1972. PMID 27793729. doi:10.1016/j.jadohealth.2016.08.016. 
  9. ^ 9.0 9.1 9.2 9.3 9.4 9.5 Forgatch MS, Patterson GR (2010). Parent management training — Oregon model: An intervention for antisocial behavior in children and adolescents. Evidence-based psychotherapies for children and adolescents (2nd ed.), 159–78. New York: Guilford Press.
  10. ^ 10.0 10.1 10.2 Barkley RA (2013). Defiant children: A clinician's manual for assessment and parent training. New York: Guilford Press.
  11. ^ Jones DJ, Forehand R, Cuellar J, et al. Harnessing innovative technologies to advance children's mental health: behavioral parent training as an example. Clin Psychol Rev. March 2013, 33 (2): 241–52. PMC 3566281 可免费查阅. PMID 23313761. doi:10.1016/j.cpr.2012.11.003. 
  12. ^ Eyberg SM, Nelson MM, Boggs SR. Evidence-based psychosocial treatments for children and adolescents with disruptive behavior (PDF). J Clin Child Adolesc Psychol. January 2008, 37 (1): 215–37. PMID 18444059. doi:10.1080/15374410701820117. 

[1] [2] [3]

  1. ^ Behavior therapy for young children with ADHD
  2. ^ ADHD Homepage→ Free Materials
  3. ^ VitalSigns by the CDC for ADHD
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