Poor parenting, inadequate parental supervision, discipline that is not consistent, and parental mental health status, stress or substance abuse all contribute to early-onset conduct problems; the resulting costs to society are high. In the context of developing countries in particular, family socio-economic disadvantage is a significant predictor of abusive parenting that impacts adolescent's psychological, behavioural and physical health outcomes. Negative parenting practices and negative child behavior contribute to one another in a "coercive cycle", in which one person begins by using a negative behavior to control the other person's behavior. That person in turn responds with a negative behavior, and the negative exchange escalates until one person's negative behavior "wins" the battle.: 161  For example, if a child throws a temper tantrum to avoid doing a chore, the parent may respond by yelling that the child must do it, to which the child responds by tantruming even louder, at which point the parent may give in to the child to avoid further disruption. The child's tantrums are thereby reinforced; by throwing a tantrum, she/he has achieved the end goal of getting out of the chore. PMT seeks to break patterns that reinforce negative behavior by instead teaching parents to reinforce positive behaviors.The content of PMT, as well as the sequencing of skills within the training, varies according to the approach being used. In most PMT, parents are taught to define and record observations of their child's behavior, both positive and negative; this may involve the use of a progress chart. This monitoring procedure provides useful information for the parents and therapist to set specific goals for treatment, and to measure the child's progress over time.: 216 : 166  Parents learn to give specific, concise instructions using eye contact while speaking in a calm manner.: 167 Providing positive reinforcement for appropriate child behaviors is a major focus of PMT. Typically, parents learn to reward appropriate behavior through social rewards (such as praise, smiles, and hugs) as well as concrete rewards (such as stickers or points towards a larger reward as part of an incentive system created collaboratively with the child).: 216  In addition, parents learn to select simple behaviors as an initial focus and reward each of the small steps that their child achieves towards reaching a larger goal (this concept is called "successive approximations").: 216 : 162 PMT also teaches parents to appropriately set limits using structured techniques in response to their child's negative behavior. The different ways in which parents are taught to respond to positive versus negative behavior in children is sometimes referred to as differential reinforcement. For mildly annoying but not dangerous behavior, parents practice ignoring the behavior. Following unwanted behavior, parents are also introduced to the proper use of the time-out technique, in which parents remove attention (which serves as a form of reinforcement) from the child for a specified period of time.: 128  Parents also learn to remove their child's privileges, such as television or play time, in a systematic way in response to unwanted behavior. Across all of these strategies, the therapist emphasizes that consequences should be administered calmly, immediately, and consistently, and balanced with encouragement for positive behaviors.: 168 In addition to positive reinforcement and limit setting in the home, many PMT programs incorporate collaboration with the child's teacher to track behavior in school and link it to the reward program at home.: 216 : 151  Another common element of many PMT programs is preparing parents to manage problem behaviors in situations that are typically difficult for the child, such as being in a public place.: 151 The training is usually delivered by therapists (psychologists or social workers) to individual families or groups of families, and is conducted primarily with the parents rather than the child, although children can become involved as the therapist and parents see fit.: 162   A typical training course consists of 12 core weekly sessions,: 215   with different programs ranging from 4 to 24 weekly sessions.PMT is underutilized and training for therapists and other providers has been limited; it has not been widely used outside of clinical and research settings.