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December 30, 2013

How to tame an out-of-control kid

Edith, a retired Capitol Hill staffer from Washington, was at the end of her rope last year over the mayhem her 5-year-old great-grandson Wayne was causing at preschool. "I was on speed dial" at the school, says Edith, who is raising two of her great-grandchildren. "He was hitting kids, destroying the classroom, tearing the ABCs off the wall, just terrorizing the building."

The principal begged her to seek help, and Edith soon enrolled Wayne — and herself — in an emerging psychological treatment for out-of-control preschoolers called Parent-Child Interaction Therapy (PCIT). The program has been slowly making its way into clinics across the country after years of randomized trials that have won it recognition as one of the most effective treatments for young children prone to frequent and destructive meltdowns.

Unlike traditional play therapy, in which a therapist plays with the child while the parent stays in a waiting room, PCIT takes aim at both child and parent (or chief caregiver) and at the day-to-day mechanics of their relationship. Its premise is simple: that the best way to help children with titanic tempers is to coach parenting in real time.

Parents who enroll in PCIT get their own personal trainer: a social worker or psychologist who dispenses guidance through a wireless earpiece. In a typical session, the therapist retreats behind a one-way mirror and instructs parents — sometimes even feeding them lines to say — as they play with and learn to discipline their children. The live feedback catches ineffective parenting habits in their tracks and helps parents hew to PCIT's somewhat rigid script, which combines effusive praise and attention for good behavior with a clear system of warnings and timeouts for bad.

"It gave me a sense of 'someone's got my back,' " says Edith, who entered PCIT with Wayne at a mental health clinic in August 2012. (Like other parents quoted in this article, Edith asked that only her first name be used.)

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