In these Sydney primary schools, therapists observe children behind a one-way mirror

A familiar sense of dread seized Erin Stevenson as she watched her six-year-old son, Micah, play happily with a giant scorpion they had built together from magnetic tiles in a brightly decorated playroom.

For years, Micah had responded to his parents’ every mundane daily request with meltdowns, screaming and yelling.

From putting on his shoes to leaving the house: “If it wasn’t Micah’s idea, he wouldn’t do it,” Stevenson said.

“His emotions would get away from him, and he’d lash out physically ... [At times] we would have to sit him on our lap and immobilise him until it passed.”

So when Stevenson told Micah he had to destroy his scorpion creation and pack it away, she braced for the sting in the tail.

It never came. Micah quietly did what Stevenson asked, and with tears welling in both their eyes, he climbed onto his mother’s lap for a hug.

From behind the playroom’s one-way mirror, a therapist – her voice in Stevenson’s ear – watched on.

“That’s the moment I knew what we were doing was effective,” Stevenson said.

Micah is one of 128 children and their families who have undergone a version of the gold-standard treatment for children with disruptive, aggressive or destructive behaviours called Parent-Child Interaction Therapy (PCIT) embedded in south-western Sydney primary schools.

“We’re talking about children with oppositionality, defiance, tantrums when being told to do something, to more severe behaviours like destruction of property at school, aggression towards peers and teachers, violent behaviours, running away from school,” said Professor Eva Kimonis, director of UNSW’s Parent-Child Research Clinic, which leads the project.

Inside the purpose-built clinics at Ingleburn and Condell Park public schools, a therapist with a microphone is positioned behind a one-way mirror, observing a child and their parent in a playroom.

The therapist live-coaches the parent through their interactions via an earbud over 21 one-hour weekly sessions.

“They get this really intensive coaching on how to build a high-quality, positive relationship with the child, and then how to manage disruptive behaviours when they’re happening in a calm, predictable and safe way,” Kimonis said.

It’s the first PCIT program to deliver the intervention in schools. The latest iteration adds teachers to the equation: live coaching for the child’s classroom teacher and training in relationship-building and behaviour management for teachers from kindergarten to year 2.

Participants were aged between three and seven and included children with conduct disorder, oppositional defiant disorder, ADHD and poorly developed empathy and remorse.

There were also autistic children whose clinicians had suggested they fit a profile known as “pathological demand avoidance” (PDA), characterised by an anxiety-driven need to control or avoid demands. Other children had conduct problems, but not to the extent that their behaviour was considered disordered, Kimonis said.

About nine in 10 of the children who completed the program showed improvements in disruptive, aggressive or destructive behaviours so significant that they were no longer considered a problem directly after the final session and three months later.

More than two-thirds of the families enrolled either completed all treatment sessions, remain involved in the program, or stopped early because their child’s behaviour improved, the researchers also reported in the journal Australian Psychologist.

“Adding teachers to the equation really improved outcomes for the kids,” Kimonis said.

Micah dropped his ODD diagnosis after finishing the program, Stevenson said. More than a year later, he can recognise when he is feeling overwhelmed and takes himself to his room for a 10-minute breather.

“It’s not perfect … We have to pick our battles,” she said. “But the skills that we have now mean life is a billion times better.”

The free program, funded by research grants, is a life raft for families who can’t afford private psychologists or face long waitlists for a consultation.

Seventeen public primary schools are involved in the program.

A PCIT clinic will open at St Gertrude’s Catholic Primary School in Smithfield in term 3 and offer the intervention to Catholic schools in the surrounding area.

Sydney Catholic Schools student wellbeing and learning manager Clare McMahon said having classroom teachers involved enhanced the intervention’s effectiveness for children, their families and the wider classroom.

Teachers spend an estimated 15 per cent of lesson time managing disruptive behaviour, according to the Teaching and Learning International Survey.

“Formal teacher education doesn’t include much training on student mental health or behaviour management, but teachers are still expected to be experts in these areas,” said the PCIT study’s lead author, Macquarie University’s Dr Georgette Fleming.

“They dedicated so much time and so many resources to making this project not just possible, but successful.”

The team is now conducting a randomised controlled trial that includes live-coaching teachers in the classroom.

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