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Helping the Noncompliant Child (HNC) is a training program that teaches parents to change maladaptive patterns of interaction with their children. The program is designed for parents of children ages 3 to 8 who have noncompliance or other conduct problems, but it also has been used with other high-risk populations of children and parents. The long-term goals of the parent-training program are 1) secondary prevention of serious conduct problems in preschool and early elementary school-age children and 2) the primary prevention of subsequent juvenile delinquency. Short-term and intermediate objectives include 1) disruption of coercive styles of parent–child interaction and establishment of positive, prosocial interaction patterns, 2) improved parenting skills, and 3) increased child prosocial behaviors and decreased conduct problem behaviors.
A major goal of the program is to break the coercive cycle by establishing a positive, mutually reinforcing relationship between parent and child. The program consists of a series of parenting skills designed to help the parent break out of the coercive cycle of interaction with the child by increasing positive attention for appropriate child behavior, ignoring minor inappropriate behaviors, providing clear instructions to the child, and providing appropriate consequences for compliance (positive attention) and noncompliance (time out). HNC consists of two phases. During phase 1, the Differential Attention Phase, parents learn to increase the frequency and range of social attention to the child and reduce the frequency of competing verbal behavior. In phase 2, Compliance Training, parents are taught to use the Clear Instructions Sequence. Through this sequence, parents are taught to provide direct, concise instructions to the child; parents will then allow the child sufficient time to comply. Parents are then instructed on different paths to follow based on the child’s level of compliance.
HNC places emphasis on helping parents become competent and comfortable with the various parenting skills taught in the program. Sessions are typically conducted with individual families rather than in groups. Parents and children participate in weekly 60- to 90-minute sessions; average number of sessions is 10. Skills are taught using extensive demonstration, role-plays, and direct practice with the child in the training setting and at home. Progression from one skill to the next is based on demonstrated proficiency.
This program has been extensively evaluated by more than 40 studies. Various designs have been employed to examine different questions related to the outcome, generalization, and social validity of the parent-training program. Comparison conditions used in these studies include waitlist control, nonreferred “normal” samples, variations of the basic parent training program, and alternative interventions. Excluding studies employing single-subject designs, sample sizes with clinic-referred samples have ranged from 8 to 55 families. Attrition in the treatment outcome studies was minimal. It was significantly higher (50 percent) for the long-term (4½ to 14 years later) follow-up studies. The children who participated in the evaluations were referred to outpatient mental health clinics for excessive levels of noncompliance and other conduct problem behaviors.
Two primary types of measures have been employed in the outcome evaluation studies: direct observation and parent verbal-report measures. These measures have been collected immediately before and immediately after the intervention, as well as at various follow-up assessments. With respect to direct observation, trained observers collected this data in the home (and, in some studies, in the school) setting, usually in blocks of four 40-minute observations conducted on different days. Various data collection tools have been used in different studies. These tools include the Behavioral Coding System for parent and child behaviors, the Becker Bipolar Adjective Checklist, the Beck Depression Inventory, the Marital Adjustment Test, and the Parent’s Consumer Satisfaction Questionnaire. Data analytic techniques typically employed to assess outcome have most often been repeated-measures analyses of variance or covariance. Repeated-measures multivariate analyses have also been used in some studies.
Short-term effectiveness and setting generalization from the clinic to the home have been demonstrated for both parent and child behaviors—as well as for parents’ perceptions of their children. These improvements occur regardless of families’ socioeconomic status or age of the children (within the 3- to 8-year-old range).
Maintenance or long-term effects of HNC have been documented in several studies, with follow-up assessments ranging from 2 months to 14 years after the end of treatment. A sample of children who had participated in the program 4½ to 14 years earlier was found to be functioning well, relative to a nonreferred “normal” sample. The young adults (ages 17 to 22) who had participated in the program as children reported levels of self-esteem, academic progress, relationship with parents, and delinquency, drug use, and various types of psychopathology comparable with those reported by young adults in the community comparison group. The program has also demonstrated sibling generalization; mothers transferred the skills learned in the parent-training program to untreated siblings who responded by being more compliant to maternal directives. Finally, improvement in child compliance has been shown to be accompanied by decreases in other overt conduct problem behaviors, such as aggression, tantrums, whining, and inappropriate verbal behavior.
Baum, C.G., and Rex Lloyd Forehand. 1981. “Long-Term Follow-Up Assessment of Parent Training by Use of Multiple-Outcome Measures.” Behavior Therapy 12:643–52.
Forehand, Rex Lloyd, and Nicholas Long. 1988. “Outpatient Treatment of the Acting-Out Child: Procedures, Long-Term Follow-Up Data, and Clinical Problems.” Advances in Behavior Research and Therapy 10:129–77.
Humphreys, L.; Rex Lloyd Forehand; Robert J. McMahon; and M. Roberts. 1978. “Parent Behavioral Training to Modify Child Noncompliance: Effects on Untreated Siblings.” Journal of Behavior Therapy and Experimental Psychiatry 9:235–38.
Long, Nicholas, Rex Lloyd Forehand, M. Wierson, and A. Morgan. 1994. “Moving Into Adulthood: Does Parent Training With Young Noncompliant Children Have Long-Term Effects?” Behavior Research and Therapy 32:101–07.
McMahon, Robert J., Rex Lloyd Forehand, and D.L. Griest. 1981. “Effects of Knowledge of Social Learning Principles on Enhancing Treatment Outcome and Generalization in a Parent Training Program.” Journal of Consulting and Clinical Psychology 49:526–32.
Peed, S.; M. Roberts; and Rex Lloyd Forehand. 1977. “Evaluation of the Effectiveness of a Standardized Parent Training Program in Altering the Interactions of Mothers and Their Noncompliant Children.” Behavior Modification 1:323–50.
Wells, Karen C., and J. Egan. 1988. “Social Learning and Systems Family Therapy for Childhood Oppositional Disorder: Comparative Treatment Outcome.” Comprehensive Psychiatry 252:138–46.
Wells, Karen C., Rex Lloyd Forehand, and D.L. Griest. 1980. “Generality of Treatment Effects From Treated to Untreated Behaviors Resulting From a Parent Training Program.” Journal of Clinical Child Psychology 9:217–19.
Robert J. McMahon, Ph.D.
Department of Psychology, P.O. Box 351525
University of Washington
Seattle, WA 98195–1525
Phone: (206) 543-5136
Fax: (206) 685-3157
E-mail: mcmahon@u.washington.edu
E-mail: hreif@preventchildabuse.org
