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December 30, 2013

How to tame an out-of-control kid

(Continued)

Edith finished the program after three months. Now, she says, Wayne is a seemingly different child, sitting still in class, advancing a level in reading, trusted by teachers to help out in class. "I feel like I can live now," Edith says.

Jennie reported similar results after graduating from PCIT. Tantrums that had drawn blood and lasted for hours are now mild and over within a couple of minutes. "Rarely do we have to use a timeout, rarely does it go beyond a warning," she says of Alex, who has mild autism. "He just seems so much more like a typical child now. People that know us ask: What did you do?"

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Young children, taking the first steps toward independence, are in many ways naughty by nature. By one estimate, the typical preschooler disobeys 25 to 50 percent of his parents' commands. Psychologists advise professional intervention only once the defiance becomes so disruptive that it upends family life.

"It's when the frequency of the behavior reaches a point where it starts influencing relationships with peers, family and teachers," says Kelly O'Brien, a clinical psychologist. "It's when it becomes multiple times per day over routine requests like getting ready for bed or turning off the computer to go to dinner."

To determine whether PCIT is appropriate, a therapist interviews the family, administers a parent questionnaire and standard child behavior assessment, and watches the parent and child play. Though some children entering PCIT may have already received a diagnosis of attention deficit hyperactivity disorder or oppositional defiant disorder, a psychiatric diagnosis isn't necessary for treatment.

The therapy isn't right for everyone. Psychologists say that children who have been sexually abused by caregivers, and parents who have low IQ, serious mental illness or substance abuse issues are better served by programs that tackle those underlying problems first. Because of PCIT's time demands, parents have to be motivated. "The parent has to be organized enough to make a weekly outpatient therapy appointment," Loya says. "That kind of sounds like a given. But for a lot of folks, that's not the case."

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