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Parent Training May Help Kids with Autism, ADHD and ODD Behave Better

The breaking point for Grapevine mom Cynthia Pearson was an afternoon birthday party with her then 7-year-old daughter, Alana.

“She was bouncing from place to place, grabbing food off of other children’s plates or toys out of their hands,” Pearson recalls.

Alana had been diagnosed with ADHD nine months earlier and although Pearson knew her behavior was typical for kids with ADHD, she was still embarrassed.
“It felt like everyone in the room was looking at me, waiting for me to get control of my kid,” she says.

Her daughter’s humiliating actions left Pearson feeling like she’d lost her parental authority over Alana. But it wasn’t for lack of trying. Since the diagnosis, Pearson and her husband had been working with Alana’s teachers to create a plan for academic improvement and success, but at home, things were different. In fact, things were really bad.

“Bedtime was a nightmare,” Pearson recalls. “Alana would get up 15 to 20 times before we’d both collapse on her bed in sheer exhaustion from what seemed like hours of fighting.”

Alana also wouldn’t sit still. She’d get up from her chair at the dinner table five minutes into the meal. “It felt like we were constantly yelling at her,” Pearson admits.

Friends and family offered suggestions and parenting advice. They’d recommend books and websites to find information on interacting more effectively with her ADHD daughter, but none of those resources seemed to help much.

“We tried rewards, punishments, taking away her toys — all things that work with other kids,” Pearson remembers. “But none of that worked with Alana’s behavioral issues.”

Pearson found an individualized training program through her daughter’s clinical psychologist in Atlanta (where they lived at the time) that utilized behavioral therapy to teach parents how to deal with the challenges of parenting a child with ADHD and other behavior issues such as tantrums and aggression. Each week, the Pearsons (without Alana) met with a clinical psychologist who would take them through specific techniques step by step, like how to ignore undesirable behaviors at the table but rewarding the good. After the session, the Pearsons returned home with instructions to practice the technique daily — at every meal.

“I felt like we finally had the tools to parent Alana effectively,” Pearson says.

To be sure, this parent training isn’t meant to replace the professional therapist. In fact, it’s a broad term used in the behavioral therapy world to define a practice where parents learn how to manage difficult behaviors at home from a trained professional. And though it’s typically recommended for children with autism, ADD or oppositional defiant disorder (ODD), the training can be successful with any diagnosis because it’s a highly individualized program.

It’s important to understand that parent training isn’t just a parenting class with a generalized curriculum, and it’s not meant to shame parents into thinking they’re parenting incorrectly. It’s a tool offered to parents as an extension of the child’s existing behavioral therapy (though there are also stand-alone clinics for parents of kids not enrolled in some form of therapy) and tailored to the needs of each family. Think of it as a hands-on parenting manual for parents of children with special needs and learning differences. Parents bring their child’s behavioral problems, which run the gamut — from aggressive behavior like throwing toys to social issues like asking for additional food with screams — to the session and learn corrective strategies that they can apply beyond the clinic to all areas of their child’s life.

A study published last year in the Journal of the American Medical Association found that children with autism showed marked improvement in behavior after their parents participated in a 24-week structured parent training program created to help manage tantrums, aggression, self-injury and noncompliance. One group of parents of the 180 children ages 3 to 7 studied were taught preventative measures (such as establishing a schedule and encouraging positive responses), reinforcement strategies, how to ignore bad behavior, adaptive daily learning skills (like teaching a child to brush his teeth) and how to implement changes in different environments such as from home to school.

The second group of parents received information covering topics like the causes of autism, how to read psychiatric and medical reports, how to advocate for services at school and known family stressors that come with an autistic child.

At the end of the study 69 percent of the kids from the parent-trained group showed a positive response compared to 40 percent in the parent-educated group.
Which is why Dr. Shahla Ala’i-Rosales, associate professor of behavior analysis at the University of North Texas, who has created parent training programs with her students and partners like Easter Seals North Texas, encourages parents to move beyond educating themselves about their child’s diagnosis and encourages parent training as a part of their therapy.  

“Let me put it this way: Do you want a surgeon who is simply educated on a procedure or do you want a surgeon who has been trained on that procedure?” Ala’i-Rosales asks.

Because you don’t know what you don’t know. Plano mom Gina Davis took a class on teaching children with learning disabilities as part of her degree in education, but she was at a loss when it came to applying what she learned in school to real life after her son, Ben, was diagnosed with autism at 2.

“He couldn’t wave hello or goodbye or point to objects to share his excitement,” Davis remembers. “And typical milestones like potty training seemed impossible.”
She admits that giving in to her overwhelming emotions and throwing in the towel was tempting, but she stayed focused on finding a solution that would help her cope and deal with these everyday problems. 

“I felt like I needed an internship or other hands-on experience to show me exactly what to do,” Davis admits.
So she turned to parent training at the recommendation of her son’s applied behavior analysis therapist to help with Ben’s major issue: toilet training.

“Ben wasn’t potty trained until he was 5 ½,” Gina recalls. “We had started and stopped the process no less than four times before it finally clicked.”

The secret to eventual success? An extremely detailed and exhausting protocol that required the Davises to spend 12 to 16 hours a day working with Ben on his toilet skills. He would use the potty, receive a reward, leave the bathroom to go play, then use a timer as a reminder to get back to the potty.

“When he finally got it [potty training], we felt like we had accomplished a huge hurdle, and that gave us the confidence to tackle the next set of skills,” Davis says.
That feeling of accomplishment is exactly what Rachel Koelker, a behavior analyst at Child Study Center in Fort Worth, strives for with each of her clients.

“When parents gain the confidence to apply skills they’ve learned in parent training to everyday situations, that’s when we really begin to see progress,” she says. The therapist begins to back away a bit and allow parents to practice.

Ala’i-Rosales says parent training strengthens the relationship between parents and their children and helps parents teach children communication, play and social skills.

“A child [with special needs] doesn’t come into the world with the same social skills as a typical toddler, so there is a disruption in the normal give-and-take relationship,” she explains. Teaching parents how to more effectively interact with their child is one of the best evidence-supported treatment interventions in child psychiatry and key to the child’s overall successful functioning.
Parent training is an integral component in an entire therapy package. Caring for a special needs child with behavioral challenges can be stressful, so Koelker reminds parents who are in the beginning stages of diagnosis and treatment that they must seek help for themselves as they are lining up therapy options for their child.

“Parent training is vital for long-term success,” Koelker insists. “Parents are with their kids for life; providers are there for just a portion of the journey, and problems are going to occur at times when the therapist isn’t present.”
Unfortunately, training as a solution is often overlooked by parents. Koelker reports that since the program opened 7½ years ago only about 25 percent of the parents at Child Study Center take full advantage of the parent training portion of the Autism Services program. She notes, however, that there has been an increase in participation on the last two to three years.

The most obvious impediment is funding. Some insurance companies cover parent training as a part of behavioral services but often parents have to pay out of pocket, though there may now be financial assistance available for parents with kids ages 3-9, who are part of the Easter Seals North Texas Autism Treatment Program through a grant from the Department of Assistive and Rehabilitative Services (DARS). Check the website for more information.

Another issue is that parents don’t understand that they are part of the process. It’s not a drop-off-and-pick-your-kid-up-when-they’re-done program. And even when parents are involved, they rarely realize the amount of work and effort it takes on their part to make the training successful. Or they set the bar too high, get frustrated by the lack of quick results and quit. 

“There is not an immediate payoff,” Koelker explains. “Sometimes it even gets worse before it gets better, and if parents aren’t expecting that, they get turned off by the process.”

But there are so many benefits, Koelker explains. For parent training to be successful, parents need to find the program that’s right for them and their needs.

Start by asking your current provider what evidence-based programs (the ones with success rates and data) are available in your area. Opt for one that’s individualized as opposed to programs designed to be a one-size-fits-all families. And recognize your limitations with time and resources so that you commit to a program that you can feasibly implement.

“Parents need to look ahead 20, 40, 50 years when services aren’t as readily available and think about their plan,” Koelker says. “Parent training is all about planning for the family’s future.”

Pearson has certainly gained a more positive outlook with life with Alana, now 12.

“As we enter the dreaded teen years, I feel like I have a set of tools to rely on when new problems pop up,” Pearson says. “Really, I just feel like I can successfully parent my child.”