Wednesday, November 19, 2008
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Helping Kids (and Parents) Think

According to recent estimates, there are over 12 million children in North America who are dealing with social, emotional, and behavioral challenges. This means there are at least as many parents, teachers, and caregivers who are also dealing with these difficult issues. What makes these situations all the more devastating for these children and their parents, teachers, and caregivers is that such challenges can be hard to diagnose or understand and treat properly. As a result, many children are often unnecessarily reprimanded and punished, isolated, or over-medicated. Worse still, while such treatments may appear to solve the alleged “problem,” they often only mask or even exacerbate it, either by only dealing with a symptom of a larger, deeper issue or by causing new and often more complicated problems like addiction or the loss of the child’s self-esteem.

Fortunately, there is another way to deal with the real issues involved and to allow the troubled children to enjoy time back in rather than endless time outs.

Wellesley resident Dr. J. Stuart Ablon is an Associate Clinical Professor at Harvard Medical School who is on staff in the Department of Psychiatry at Massachusetts General Hospital, where he also serves as the Associate Director of the Collaborative Problem Solving Institute. In these capacities, Ablon and his colleague Dr. Ross W. Greene (the Institute’s director) have become experts on behavioral issues and have developed innovative ways to help what they call “explosive” children who are often inflexible and easily frustrated.

“The term ‘explosive’ was meant to be descriptive of kids who tend to unravel in the midst of frustration much worse than their peers,” Ablon explains, citing work detailed in the books The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children by Ross W. Greene, Ph.D. (Harper Collins, 2005) and Treating Explosive Kids: The Collaborative Problem-Solving Approach by Drs. Greene and Ablon (The Guilford Press, 2005).

Regardless of what they are called, the children who demonstrate these behaviors are clearly in need of support. In fact, their apparent inability to respond to what have heretofore been more typical approaches often left the adults who care for them on the brink of “explosion” as well. In order to help the children and their adult caretakers work together to help each other cope more successfully, Greene and Ablon have been disseminating a revolutionary treatment model they call Collaborative Problem Solving (CPS).

“CPS is an approach to understanding and helping challenging kids,” Ablon explains. According to Ablon, the rationale for the CPS approach is borne out by nearly 30 years of research that clearly suggests that the so-called “explosive” child explodes not because they want to or because they think it will get them what they want (if they can actually determine what that is), but because they have difficulty with skills like tolerating frustration, being flexible, regulating their emotions, and problem solving. As such, Ablon and Greene say that the children need not to be punished, but rather supported, reasoned with, and, perhaps most importantly, respected.

“The philosophy behind our approach is [that] children do well if they can,” Ablon says. “This philosophy is meant to suggest that no child prefers doing poorly to doing well….If he could do well, then he would do well, and if he’s not, something must be getting in his way.” He suggests that, just as some children have disabilities and challenges in other realms of life (reading, learning, and physical development, for example), so too do many have challenges in their cognitive and behavioral development. These challenges might take the form of difficulty identifying and articulating their concerns, taking on other perspectives, generating productive alternatives, anticipating potential and likely outcomes of their behavior, or appreciating the impact of their actions on others.

“We think these kids have a developmental delay of sorts,” Ablon suggests, “almost like a learning disability in these areas.” The answer, therefore, is to deal with these challenges in ways similar to those that are used to deal with other difficulties.

“When adults treat these kids like kids with any other perhaps more recognized form of learning disability,” he continues, “things improve dramatically.”

Before CPS came along, Ablon says that the predominant paradigm in dealing with “difficult” children was to see them as acting out on purpose in order to get things they wanted or to avoid things they did not.

“The focus is most commonly on motivating the child to behave better,” Ablon says, “because the assumption unfortunately is that the child is just not trying hard enough or doesn’t want to behave.” In such scenarios, the parents and caretakers often take on the “bad guy” role as they often come to see no option other than punishment.

“Conventional wisdom also blames [parents] for causing the problem in the first place by not being firm and consistent enough with our kids,” Ablon suggests, citing this as an “interesting assumption” since many parents of “challenging” kids are also parents of “regular” kids as well.

As far as this apparent distinction goes, Ablon suggests that no child is “challenging” all the time. “When do they struggle?” he asks. “When you put demands on them that they can’t handle because of a lack of skill.”

As people of all ages deal with difficulties at one time or another, Ablon also suggests that such challenges may not only affect children. “Age really doesn’t play much of a factor,” Ablon says, noting that he has seen people as old as 80 with what he calls “lagging skills.” “It’s really more of a question of where the [person] is developmentally.” For example, while frustration may be normative (or at least accepted) when a child is two (hence the popular term “terrible twos”), evidence of similar behaviors and a lack of learning how to deal with them effectively once the child has physically matured may be a sign of developmental delays. “The older you get without those skills developing,” Ablon says, “the larger the developmental gap is.”

Ablon and Greene have encouraged adults to see the issue of challenging behavior in kids through “a completely different lens” and to even take a new look at their own behaviors as well.

“Most folks are already convinced that what they’ve been doing hasn’t been working,” Ablon suggests, “but they really aren’t sure what else to do instead. When you help folks see that it’s a lack of skills—not motivation—getting in their child’s way, it’s often as if a light suddenly goes on.”

Though Ablon realizes that this apparent breakthrough sounds rather simple, at least on the surface, he points out that the notion that these kids just don’t want to do well is deeply ingrained in our society. As a result, it has been challenging to offer a new way of dealing with challenging children.

“Some initial resistance is fairly typical,” Ablon observes, “but…that is to be expected since what we are suggesting is a major departure from what people are used to thinking about and doing with these kids.”

In fact, Ablon suggests, negotiating that shift in thinking from “he’s doing that on purpose” to “he’s doing the best he can and needs our help” may be the most powerful ingredient in the new approach. “When adults approach these kids with much more empathy and compassion,” he says, “things tend to improve right off the bat.”

As a result, research is beginning to reveal impressive results. The approach has already been shown to be superior to more traditional methods in a study published by Greene and Ablon and colleagues at MGH. And, Ablon says, some of the latest data documents dramatic reductions in disciplinary referrals and actions in schools where CPS is being applied.

“We’ve also shown that the approach can be used to eliminate inhumane practices like restraints and seclusions in therapeutic settings and even reduce recidivism rates in prisons,” he says.

In their continuing effort to spread the word about CPS and to help as many children and adults as they can, Ablon and Greene have launched an interactive Web site (www.thinkkids.org).

Think:Kids is a non-profit organization with the mission to “train adults in a revolutionary new way of helping kids with social, emotional, and behavioral challenges.”

“Think:Kids is an initiative of the Institute,” Ablon explains. “We founded [it] to help get the word out that there is a different way to think about and help challenging kids in our homes and schools.”

With the help of books and other multimedia resources and the Web site, CPS has received support from such high-profile outlets and people as Dateline NBC, Good Morning America, The Early Show, and Oprah Winfrey.

“The media has taken a strong interest in the approach because the problem is so prevalent and the ideas are fairly provocative,” Ablon says. The Institute also trains over 20,000 people a year in CPS.

“Clearly people are interested and desperate for new ideas and approaches,” Ablon says, noting that, despite their significant progress, they still have “a long way to go.”

“School discipline policies are often quite out of date,” Ablon suggests, “and the strategies parents employ at home often haven’t changed all that much since when we were kids.” While so-called “challenging” or “explosive” children may be better off today than they were 25 years ago, Ablon emphasizes that there’s “a ton of” room for improvement.

“That’s why Think:Kids is asking adults to re-think their notions of who these kids are and what they need from us,” he says. In fact, the main goal of Think:Kids is to reframe how people think about developmental and behavioral challenges overall.

“Our goal is for challenging kids to be understood with the same compassion and treated in pretty much the same way as kids with learning disabilities sometime in the next decade or so,” Ablon says. “[We want to] change conventional wisdom about challenging kids and help as many adults as possible understand that there is a more compassionate, accurate, and effective way to understand and help these kids.”

 

 

 

 

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