Compliance Training

Description of the Strategy

A child's reaction to adult instructions has always been viewed through a developmental lens. If the child is an infant, one assumes that receptive language levels are insufficient to equate nonresponsiveness with willful defiance; a year later, American parents often view the same child's indifference as an annoying yet age-appropriate manifestation of the “terrible twos”; in contrast, a 4-year-old child who angrily shouts “No” and physically resists adult guidance may find himself or herself referred to a professional for treatment. Indeed, there is a point in the social development of children where even the most patient parent can no longer tolerate child disobedience. Consequently, child noncompliance is one of the most common referral problems among parents seeking professional help for their preadolescent children, and for good reason. Developmental psychopathologists have identified sustained child noncompliance as a foundation for serious future misconduct, including oppositional defiant disorder and conduct disorder.

Constance Hanf introduced a breakthrough treatment for noncompliant children in the 1960s at the University of Oregon Medical Center. Hanf's pioneering work conceptualized child noncompliance as a family systems problem, rather than an intrapsychic disorder. Drawing on the behaviorism of B. F. Skinner, the interpersonal emphasis of Harry Stack Sullivan, and the social learning orientation of Julian Rotter, Hanf proposed to “reprogram” the young child's social environment, much as her influential colleague in nearby Eugene, Oregon, Gerald Patterson, was treating 6- to 12-year-old children with well-established aggressive and predelinquent behavior patterns. Reprogramming the social environment meant teaching the child's parents how to promote compliance. Hanf conceptualized two distinct stages of parent training. First, she believed that parents needed to become better at recognizing and socially reinforcing prosocial child behavior. She hypothesized that parent-delivered social reinforcers would become more valued by the child, given an expanded parent repertoire and greater frequency of use, leading to increased frequencies of child prosocial functions, including compliance. Stage 1, or The Child's Game, still forms a substantive component of modern parent-child interaction therapy. In her Stage 1 pilot work with a small set of referred preschool children, Hanf observed that noncompliance often persisted, despite good improvement by parents in child's game skills. Moreover, ignoring noncompliance seemed ineffectual, since many children reacted to parent instructions with unignorable, intense anger. Therefore, Hanf constructed Stage 2, or The Parent's Game, to target noncompliance directly. She defined a set of contingent, increasingly aversive consequences for noncompliance. Specifically, were the child to disobey an instruction, a warning was issued; if the warning was defied, a brief time-out was required; if the child refused to sit on the time-out chair, a spanking was administered.

Although modern parent-child interaction therapy (PCIT) has evolved since the 1960s, the cornerstones are clearly etched with Hanf's two-stage protocol. Two generations of child clinical researchers have chipped away at the many questions implied by the Hanf protocol, yielding some clear answers to many of the apparent research questions. Two among them, Rex Forehand at the University of Georgia and Sheila Eyberg at the University of Florida, produced a generation of students who diligently pursued controlled, empirical strategies to tease out the many effects of Stage 1 and Stage 2 parent training on a variety of dependent variables. A prototype of modern PCIT procedures is as

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