"The child escalates, the parent escalates and before you know it they're screaming at each other."
Photo: Darrell J. Rohl
For young children prone to frequent high-level meltdowns, one of the most effective treatments involves teaching parents to rewire the relationship via play therapy, says Dr Cheryl McNeil, aka the Toddler Whisperer.
In Parent-Child Interaction Therapy (PCIT), parents and caregivers are coached in real time to rewire the day-to-day mechanics of the relationship with their challenging child.
First developed in the 1970s by Oregon psychologist Sheila Eyberg, it's been used in New Zealand since 2010.
It has been shown to be effective with 2 to 7-year-olds whose behaviour is in the 95th percentile in terms of defiance, aggression, temper tantrums and hyperactivity and who don't respond to more traditional or typical methods.
So why do some kids get locked into such challenging behaviour?
Trauma such as family violence and maltreatment can contribute, as can a parent's postpartum depression, family separation and the child being on the autism spectrum.
But sometimes kids can still struggle without an apparent cause in the background, McNeil says.
PCIT works by training parents to be like 'super parents' who can do their own play therapy.
"We're teaching them exactly what to say and exactly what to do to manage children who have not responded to average parenting."
In a typical session, the parent will sit on the floor with the child and some toys. A therapist observes the play behind a one-way mirror and provides real-time coaching via an earpiece. (If there are two caregivers they take turns).
Photo: Westchester Parenting Center
Parents are taught to use the five PRIDE skills – Praise, Reflect, Imitate, Describe, Enthusiasm.
"They learn to be very sensitive caregivers and highly reinforcing to their children, noticing all the children's strengths. What do they do well? What's positive? Giving the child very stimulating attention and reinforcing attention when they're behaving well."
Praise is specific and given at a very high rate, McNeil says.
"I love the fact that you're sharing toys with me. You're doing a good job of being very gentle with the cars. That's nice the way you asked me nicely for that toy."
Reflection is a form of active listening, she says.
"They really hear what their child says and say it back to them to let the child know they are interested in what they have to say and understand."
Also central to the PCIT is 'behavioural description' – a somewhat unusual technique which involves providing a running commentary of what the child is doing in their play.
"You're pushing the red block. You're putting it on top of the green block. You're taking Mr Potato Head for a walk."
Describing the child's play is a way of giving them positive attention for good behaviour. They'll then be less likely to misbehave in order to receive negative attention, she says.
At home, for five minutes a day, parents practise this "unconditional positive regard" with the child.
Once the relationship between them is strengthened, it's time for the second phase – setting limits, doing compliance training and teaching the child to respect the parent.
In this stage, the child is told in advance that they're practising listening today and what the consequences will be if they don't listen to the parent.
The parent then gives a simple play command – i.e. "Please hand me a green block" – and if the child listens, they'll be coached to give specifically labelled praise.
"I love it when you listen. Good job following directions."
When a child is extremely defiant, hyperactive and aggressive, a lack of respect for authority is often the central issue, so PCIT puts a lot of emphasis on compliance training, McNeil says.
It can be easy for children who have special needs in terms of attention span and behaviour and their parent to get into a 'coercive' pattern of throwing threats at each other.
In these cases, specialised skills are required, she says.
"We really have to coach the parent very actively on what to say and what to do to react very differently to some of the challenging behaviours that they get from the child so we can develop new habits, positive habits."
