Rory

This young man can teach us so much about how he needs to learn.

EXPECTANCY-VALUE THEORY

Expectancy-Value Theory investigates the individual’s expectation that they can succeed at a particular task and the value they place in engaging and completing the task (Urdan & Turner, 2005). Individuals must place value in a particular activity, as they may not be motivated to complete the activity even if they know they can succeed (Urdan & Turner, 2005). Students may experience this within a classroom where they do not value the particular subject even if they are capable of completing the tasks assigned. Therefore, it is the schools responsibility to investigate the areas the student values, which may increase the student’s motivation to stay in school to complete the topic of value.

Studies have found that teacher’s expectations and behaviours influenced student’s achievement expectations and course taking (Urdan & Turner, 2005). Expectations by school staff of defeated and discouraged students may affect learning outcomes of those students depending on whether the expectations were of a positive or negative nature. Staff perceptions also effect the student’s expectations and value of school (Urdan & Turner, 2005). Increasing the positive perceptions by staff toward defeated and discouraged learners may encourage these students to become re-engaged as positive relationships with staff can lead to positive outcomes.

DIR MODEL: DR. Stanley Greenspan

THIS IS A RESPONSE FOR A TEACHER WITH A DIFFICULT CHILD - SUMMARY OF THE DIR MODEL FOR INTERVENTION. IF YOU WOULD LIKE THE ENTIRE RESPONSE PLEASE FEEL FREE TO POST A COMMENT OR EMAIL. crdconsulting@bigpond.com


It sounds like he is quite a challenge. My approach is not to tell you what to do but to offer you a process that may be helpful in determining your course of intervention. Since I do not know the process you have undertaken so far I will present some information as a precursor to a comprehensive intervention.
The DIR model may be appropriate for this child. DIR stands for Developmental, Individual, Relationship model. The D stands for the developmental functional capacities of the child which I will explain to you. The “I” stands for Individual differences such as motor planning, auditory processing etc... and the “R” stands for the Learning relationships the child has access to, parents, teachers, siblings.
The first thing that needs to be investigated is his Functional Emotional Capacities in relation to his development and his individual needs.

There are 9 stages of Emotional development that need to be addressed: Through observation and interaction a reasonable prediction of his level can be attained. The key here is to observe him to bring out the best in him. So in the classroom at this point probably would not be appropriate.

Do you have a guidance officer or a behaviour specialist that can carry out observations as the child is in play with his caregiver?? Is there someone that does home visits that can observe the interaction between the caregiver and the child if the caregiver is prompted to initiate play activities with the child?

1. FUNCTIONAL EMOTIONAL DEVELOPMENTAL CAPACITIES: The core capacities that integrate all areas of functioning into one milestone. Affect is the “team leader” that orchestrates the mental team or mental health of the child. Does the child integrate appropriately his abilities (emotional, language, spatial, sensory modulation, motor skills and planning) to relate to the world in a purposeful and emotionally meaningful way?

The child requires a comprehensive assessment that focuses on where the child is having difficulty but also where the child is excelling (I will explain further). The assessment will determine if the basic foundations for development are present in the child in order to move them from one level to the next. The core capacities progress through the following stages:

1. Stage 1: Shared attention and regulation (purposeful movement, sensory affect motor pattern links sensation coming in with the coordinated motor pattern, experienced based – without pleasurable affect there is no purposeful looking, listening, etc...
2. Stage 2: Engagement: Special interest in the human world, warm smiles and interactions with caregivers, broadening of emotional range, emerging attachments and relationships.
3. Stage 3: Affective reciprocity and gestural communication: Learns cause and effect, social reciprocity, responds to emotional signals, self-regulation, purposeful communication.
4. Stage 4: Complex presymbolic, shared social communication and problem solving, including imitation, social referencing, and joint attention. Increased ability to utilize circles of communication, back and forth communication, sense of self forming, interacting with environment and getting feedback, learning to operate in terms of patterns, forms the ability to have a symbolic world, fixed perceptions and actions are separated and replaced by problem solving, creates images that are multi-sensory and acquires meaning of symbols through many different interactions.
5. Stage 5: Symbolic and creative use of ideas: Use of symbols in pretend play, meaningful use of language, learns new words in problem solving, full engagement through back and forth communication and emotional investment.
6. Stage 6: Logical and abstract use of ideas and thinking, including the capacity for expressing and reflecting on feelings and having insights into self and others.
7. Stage 7-9: Higher level critical thinking, comparative thinking, and internal sense of self.

As you can see the progress through these stages does not necessarily happen according to a chronological age as your student may not have passed through the initial stage of shared attention and regulation and he is in grade 3. The assessment then determines the stage he is functioning in and the intervention targets those core capacities that can move him along the developmental stages.

2. INDIVIDUAL PROCESSING DIFFICULTIES
How does the child comprehend what he sees, hears, smells etc....The ability of the child to process the sensations that are coming in to the central nervous system. Some examples of individual differences could be: over sensory, under sensitive, auditory/visual processing, tactile, motor planning and sequencing. Are there biological factors that may influence the child’s ability to progress typically through the functional emotional capacities?

3. RELATIONSHIPS
Learning relationships are those relationships where experiences the child has, leads them through the core functional emotional capacities. These relationships are caregiver, teacher, sibling, therapist etc... The learning relationships should be tailored to meet the child at their functional emotional level. Critical foundations may be missing if the child is not met at their level because “the thinking capacity” comes from back and forth emotional signalling and meaningful use of language. The first academic skill is to think not necessarily how to spell or do math tasks. The first foundation for academic work is social and emotional capacities that force thinking. It may not be beneficial at this time for your student to focus on literacy and numeracy but on the ability to engage and interact experiencing pleasurable affect rather than negative.



1.SEMI-STRUCTURED PROBLEM SOLVING INTERACTIONS INVOLVING COGNITIVE, LANGUAGE, SOCIAL AND EMOTIONAL SKILLS:
•If child is able to imitate and use complex problem solving gestures, then semi-structured learning should focus on dynamic problem solving interactions orchestrated by the educator to enable the child to master specific cognitive, social or educational goals
•If child is not yet able to imitate and use complex problem solving gestures, consider more structured exercises to teach specific cognitive, language and social and emotional skills. The initial goal should be mastery of gestural problem-solving interactions and complex imitation
•A cognitive curriculum should involve pragmatic conversations groups, cooperative learning and social stories

2.SPONTANEOUS DEVELOPMENTALLY APPROPRIATE INTERACTIONS MOBILIZING THE SIX FUNCTIONAL EMOTIONAL CAPACITIES
•Includes social interactions with teachers and peers, social games and play dates with “expert peers” ( peers that can function appropriately around the child)

3.MOTOR SENSORY AND VISUAL- SPATIAL ACTIVITIES
•Often recommended: three or more 20 minute sessions per day.
•Sensory integration occupational therapy exercises such as running, jumping, and spinning.
•Perceptual-motor exercises eg. Looking/doing games such as throwing, catching, kicking, tracking
•Visual spatial problem solving such as hide and seek, treasure hunt, flashlight games
•Once child can answer “why” questions consider adding visual – spatial thinking activities
•Once child is pre-academic work, consider adding pre-academic conceptual reasoning, reading and math exercises.

The point is to implement a comprehensive intervention program that involves the areas that I have discussed. The engagement of the student creates an environment where he feels he is competent and can master the tasks he is given. If he feels safe and secure and receives some pleasure in his accomplishments he will probably be willing to exert an effort to continue to achieve the pleasurable affect. The family relationships as you have mentioned are not stable and would eventually hinder the emotional development of this child. A holistic intervention is required to help this family and child attain his greatest potential. If your school is not ready to intervene in this capacity it may be a very difficult process as this child continues down the negative pathway and never develop emotionally. My suggestion to you as well would be to try to develop a relationship with this child before he comes to your class and to remember not to take his non-compliance personally. Find out his strengths, likes, passions, and try to engage him through those things. Use your personality to bring him into an environment where he actually feels that he is competent and happy. I know, not an easy task but remember at the end of the day you can only do what you can do with the resources you have. I hope this helps. If you need more information the DIR/Floortime Model was developed by Dr. Stanley Greenspan and there are many more activities in the book “Engaging Autism”. I know your student is probably not autistic but this approach can be utilized for all children with special needs.

Linking Intervention to Thoughts, Feelings and Actions

Working with challenging children can prove difficult because we cannot always determine the triggers strictly through observation and data collection. We need to incorporate other methods that may provide insight into the student's motivation to behave inappropriately. Remembering that intervention requires a look at both internal and external factors that guide a child's behaviour. The perception and interpretation of events, may influence the response to various situations by the child. Irrational beliefs can play a part in the actual response by the child to an event or circumstance. An individual's behaviour and the context in which it occurs can effect cognition and vice versa. Intervention should then target cognition, feelings and behaviour. Biomedical factors (sensory, neurological) may also be a factor that needs examining.
Interviewing the student can be a tool to understand the student's motivation to engage in inappropriate behaviour. Forms can be found here: http://www.ttac.odu.edu/FBA/Large%20Blue%20Book/L%20Blue%20Book%20Appendix%20C.pdf

Nichols (2001) advocates the interview should first ask questions about the behaviour then shifting to how the student feels about the behaviour and finally concentrating on the thoughts behind the feelings that triggered the response. The interview will be altered depending on the students chronological age, ability to recall facts, expressive language and willingness to divulge essential information.

It is important to note that the "behaviour that has the greatest probability of acheiving what the student wants becomes the most dependable and in turn, most likely response" (Gable, 2004). With this in mind the adults working with challenging children need to find the "pay off" for the student when he/she is acting inappropriately. Peer recognition can be a very powerful motivator versus the child changing their behaviour because you want them to.

Neurologically if the student interacts or engages often enough in inappropriate or appropriate behaviour the constant transmission of that behaviour strengthens the neurological connection with that behaviour. A physiological response occurs in the body and the brain which again chemically reinforces the inappropriate behaviour and the student may actually become "addicted" to the feeling they receive from the behaviour (Gable, 2004). An error in learning could also be responsible for inappropriate behaviour.

Success hinges on persuading the student that he/she can have their needs met by choosing new and appropriate behaviour. Intervention then requires the mixture of cognitive, affective and behavioural domains. However, don't forget that students emotions will tend to outway their cognitive processing so change in emotion or perceived interpretation of an event takes time and commitment.

PROMOTING COGNITIVE SKILLS
1. Alternative thinking - more than one solution to the problem.
2. Means-ends thinking - the ability to recognize it takes a planful approach and multiple steps to get to the desired goal.
3. Consequential thinking - the ability to predict what will happen when one acts, and to do so quickly enough to change that plan if consequences likely will be negative.
4. Teach ways to help the student subject their thoughts to critical self-analysis, the presence of tension, what triggered the tension, and negative or self defeating thoughts with the tension, ways to confront the tension, and ways to substitute a positive thought for the original negative thought.

PROMOTING AFFECTIVE SKILL DEVELOPMENT
1. Teach ways to identify internal "early warning" signs: sweaty palms, flushed, heart rate
2. Stress inoculation exercises: deep breathing, relaxation techniques
3. Concrete strategies to cope with environmental stressors: breaking eye contact, walking away.
4. Teach the student how they behaviour looks and sounds (facial and verbal expresssions)

PROMOTING SELF-CONTROL
1. Teach the student to recognize potentially volatile situations.
2. Teach "placeholder" behaviour: Ways to stall or buy time to think of an appropriate response
3. Teach more than one response to a situation.
4. Teach the student to maintain appropriate behaviour through self-assessment, self-reinforcement, and self-monitoring.

PROMOTING ANGER MANAGEMENT SKILLS
1. Engage in "Perspective Taking" or "social role taking" exercises. Have the student put themselves in someone else's shoes.
2. Need 12 or more treatment sessions and booster sessions at regular intervals
3. Frame instruction so it aligns with student needs and realities.

MANIPULATING THE ENVIRONMENT TO PROMOTE BEHAVIOUR CHANGE
1. Teach the student how to respond to naturally occuring events like: Peer put downs
2. Intervention strategies should depend on the student's strengths and weaknesses in relationship to the nature of the problem and its environmental context.

Encourage all students to prompt and reinforce acceptable behaviour and ignore unacceptable behaviour (taking into consideration the level of safety)
Research shows that students with emotional/behavioural disorders prefer peer-mediated to adult-mediated behavioural supports (Gable, 2004).

TRANSITION PROGRAMS

Effective transition programs require the childcare center, preschool, parents and school to work in partnership to create the most positive experience for the child when they are moving to a new grade or school. Here are some concept to keep in mind when creating transition programs:

1. The focus should be on creating positive relationships with all stakeholders. Encourage meetings with future teachers, parents and current teachers to develop a plan of transition.

2. Facilitate the child's development as a capable learner who is involved in the process of transition. Take the child to the new environment (not just once) so the child can become familiar with the changes that are occurring.

3. Develop long term transition plans with the intended schools in the neighborhood.

4. Involve a range of stakeholders in the process.

5. The transition should be well planned and evaluated taking into account any special circumstances or strategies the child may need in order to be successful.

6. Be flexible and responsive. Share information regarding the child's learning styles and strategies so the learning can continue not start from scratch.

7. Base your program on mutual trust and respect allowing for reciprocal communication between all parties.

8. Make sure to take into context the needs of the family, child, and the uniqueness of the community.

Supporting the relationships through the transition period is required and sometimes teachers require release time to meet with new parents and children. Develop a contact list for the parents so they can easily access the individuals or agencies that may be of help to them. Direct your meetings so they are focused and efficient. Questionnaires can be developed for parents to fill out for future teachers.

ASK the CHILDREN what they think is important in their school environment and discuss how they feel about moving to a different environment. Let them take pictures of things they enjoyed and cherished which will allow them an opportunity to create a positive feeling rather than dreading or becoming anxious about their new school or teacher.

INFLEXIBLE-EXPLOSIVE CHILDREN: SUMMARY BY DR. DAVID RABINER ON DR. GREENE

** WHAT ARE THE COMMON CHARACTERISTICS OF INFLEXIBLE-EXPLOSIVE CHILDREN? **

The label "inflexible-explosive" child is not a diagnostic term recognized in DSM-IV, the official diagnostic guide for psychiatric disorders. Instead, it is used by Dr. Greene to capture the key features of children who are extremely difficult for parents to manage. According to Dr. Greene, the key features of such children are the following:1. A very limited capacity for flexibility and adaptability and a tendency to become "incoherent" in the midst of severe frustration.These children are much less flexible and adaptable than their peers, become easily overwhelmed by frustration, and are often unable to behave in a logical and rational manner when frustrated. During periods of incoherence, they are not responsive to efforts to reason with them, which may actually make things worse. Dr. Greene refers to these episodes as "meltdowns" and argues that the child has little or no control over his/her behavior during these episodes.2. An extremely low frustration tolerance threshold.These children often become overwhelmingly frustrated by what seem like relatively trivial events. Because their capacity to tolerate frustration develop more slowly than their peers, they often experiences the world as a frustrating place filled with people who do not understand what they are experiencing.3. The tendency to think in a concrete, rigid, black- and-white manner. These children fail to develop the flexibility in their thinking at the same rate as peers, and tend to regard many situations in an either-or, all-or-none, manner. This greatly impairs their ability to negotiate and compromise. 4. The persistence of inflexibility and poor response to frustration despite a high level of intrinsic or extrinsic motivation. Even very salient and important consequences do not necessarily diminish the child's frequent, intense, and lengthy "meltdowns". As a result, typical approaches of rewarding a child for desired behavior and punishing negative behavior do not diminish the child's tendency to "fall apart". According to Dr. Greene, traditional behavioral therapy approaches for such children often don't work at all and can make things worse.In addition to these key features, Dr. Greene notes that a child's meltdowns often have an "out-of-the-blue" quality, occurring in response to an apparently trivial frustration even when the child has been in a good mood. As a result, parents never know what to expect and things can seem to fall apart at any moment.

** WHAT CAUSES A CHILD TO BE THIS WAY? **According to Dr. Greene, most children who become extremely inflexible and explosive do so because of biologically-based vulnerabilities and not because of "poor parenting". The list of biological vulnerabilities that may predispose children to develop these characteristics include the following:- Difficult Temperament - By nature, some infants come in to the world being more finicky, emotionally reactive, and more difficult to soothe than others. These "innate" aspects of personality are what psychologists refer to as temperament. (Note: It is important to recognize that even very difficult temperaments can be modified over time and this in no way "dooms" a child to a life of ongoing difficulty and struggle.)- ADHD and Executive Function Deficits -Many children with difficult temperaments are eventually diagnosed with ADHD. As discussed in prior issues of Attention Research Update, current theorizing about the core deficits associated with ADHD focus on problems in a crucial set of thinking skills referred to as "executive functions".Although there is not universal agreement on the specific skills that constitute executive functions, most lists would include such things as: organization and planning skills, establishing goals and being able to use these goals to guide one's behavior, working memory, being able to keep emotions from overpowering one's ability to think rationally, and being able to shift efficiently from one cognitive activity to the next.Deficiencies in these skills are believed to help explain not only the core symptoms of ADHD (i.e. inattention and hyperactivity/impulsivity), but also the poor frustration tolerance, inflexibility, and explosive outbursts that are seen in the "inflexible-explosive" children described by Dr. Greene.For example, if a child has difficulty shifting readily from one activity to the next because of an inherent cognitive inflexibility, this child may feel overwhelmingly frustrated when parents say it is time to stop playing and come in for dinner. The child may not intend to be disobedient, but may have trouble complying with parents' demands because of trouble shifting flexibly and efficiently from one mind-set to another. In fact, Dr. Greene argues that most "explosive children" want to behave better and feel badly about their outbursts. He believes they are motivated to change their behavior but lack the skills to do it.- Language processing problems -Language skills set the stage for many critical forms of thinking including problem solving, goal setting, and regulating/managing emotions. Thus, it is not surprising that children with poorly developed language abilities, as is often true in children with ADHD, would have greater difficulty managing frustration.- Mood difficulties -Some children are born predisposed to perpetually sunny and cheerful moods. Others, unfortunately, tend to experience sustained periods of irritability and crankiness for reasons that are rooted largely in biology. This is not just true for children who experience full-blown mood disorders such as depression or bipolar disorder, but can apply to "sub-clinical" mood difficulties as well.Imagine for a moment how you tend to handle things when feeling cranky and irritable. If you're like most people, you probably become frustrated more easily and lose your temper more readily. For children who are prone to these negative mood states, more chronic difficulties with frustration and temper are thus likely to be evident.

** WHAT CAN PARENTS DO? **How can a parent help their "explosive" child become less explosive, develop greater self-control, and thereby create a better quality of life for everyone in the family?According to Dr. Greene, the first step is to develop a clear understanding of the reasons for the child's explosiveness. To the extent that parents - and others - regard a child's explosiveness as reflecting deliberate and willful attempts to "get what they want", the overwhelming tendency will be to respond in punitive ways. Dr. Greene argues convincingly, however, that punishments will not work for a child who lacks the skills to handle frustration more adaptively. That is because when these children are frustrated they are not able to use the anticipation of punishment to alter their behavior. When one's mindset changes from "my child is acting like a spoiled brat" to "my child needs help in learning to deal with frustration in a more flexible and adaptive manner", it becomes easier to move from a punishment-oriented approach to a skills-building approach. At the heart of this effort is what Dr. Greene refers to as the "Basket Approach".

** THE "BASKET" APPROACH **Because "meltdowns" can be so difficult for everyone in the family to endure, the primary objective in working with "explosive children" is to first reduce the frequency of such episodes. Reducing the number of meltdowns from several per day to one per day, and eventually to just a handful per week, can make an enormous difference in the quality of family life and to children developing a sense of being able to control their behavior. Initially, this is accomplished largely by reducing the demands to tolerate frustration that are made on the child by sorting the types of behaviors the create problems into 3 baskets according to how critical it is to change the behaviors or to curtail them when they occur.- Basket A -Some behaviors are so problematic that they must remain off-limits even if enforcing the rule against them will result in a meltdown. Initially, Dr. Greene suggests that the only behaviors to be placed in Basket A are those that are clear safety issues (e.g. wearing a seat belt in the car; not engaging in dangerous or harmful behaviors such as hitting others). This is where parents must continue to stand firm and insist on compliance. Dr. Greene's specific criteria for what goes in Basket A are as follows:1. The behavior must be so important that it is worth enduring a meltdown to enforce:2. The child must be capable of behaving in the way that is expected.For example, Dr. Greene would argue that there is no point insisting that completing assigned homework be placed in Basket A when the child lacks the skills and frustration tolerance to do this consistently.By reducing the number of behaviors for which compliance is non-negotiable to those that are really and truly essential and that the child is capable of performing, the number of exchanges that are likely to set off explosive episodes can be drastically reduced.- Basket B -Basket B - the most important basket according to Dr. Greene - contains behaviors that really are high priorities but are ones that you are not willing to endure a meltdown over. These can include such items as completing schoolwork, talking to parents with respect, complying with reasonable expectations, etc.It is around Basket B behaviors that Dr. Greene believes that critical compromise and negotiation skills can be taught to your child. For example, suppose your child is watching TV and you know it is time to stop and get started on homework. You tell your child to turn off the TV and get started, and he refuses. The temptation here would be to insist on immediate compliance and to threaten punishment (e.g. no TV for the rest of the week) if your child does not comply. But, in Dr. Greene's framework, this is not a safety issue, and thus should not be placed in Basket A. He would ask what is likely to happen if you make such a response? One likely consequence is that your child's frustration will increase, he or she will lose control, and a full-fledged meltdown will ensue. Is this worth it? If standing firm and tolerating this meltdown made it more likely that your child would comply the next time you made such a demand, the answer would be yes. If, however, standing firm and triggering the meltdown does not increase the likelihood of compliance in the future, or reduce the probability of future meltdowns, Dr. Greene would suggest it was definitely not worth it.What to do instead? Dr. Greene argues that these Basket B behaviors provide wonderful opportunities to try and engage your child in a compromise and negotiation process. In the scenario above, the parent could say something like, "I know that it is important to you to keep watching TV. I would like for you to be able to do this, but I also know that you have homework that needs to get done. Let's try to come up with a compromise where you'll get some of what you want, and I'll get some of what I want." The goal here is not only to get the child to give in and do what you want, but to begin teaching your child the compromise and negotiation skills that will contribute to his or her becoming more flexible over time. Dr. Greene points out how this process can be extremely difficult for inflexible-explosive children, and that it is not unusual for them to become increasingly agitated when trying to negotiate a solution.As a parent, if you observe this starting to occur, and sense your child is getting closer to a meltdown, the goal becomes trying to diffuse the tension so that a meltdown does not take place. This can mean offering compromise solutions for the child in an effort to help things calm down. When this does not work, Dr. Greene suggests just letting things go so that the meltdown is avoided. In the example above, should the efforts to negotiate fail and lead the child to the verge of a meltdown the parent might say, "Well, I can see you are getting really upset about this. I appreciate that you tried to work out a compromise with me but we have not been able to come up with a good one yet. So, why don't you just watch a bit more TV for now and we can try again in a little while to work out a good compromise." This can be very difficult to do and many parents along with mental health professionals would be concerned that such actions would result in teaching the child that he or she can get what she wants by refusing to give in and becoming upset. This is what a traditional behavioral therapist would argue. From Dr. Greene's perspective, however, insisting that the child turn off the TV when a compromise was not reached would accomplish little more than triggering a meltdown that would also prevent homework from getting started on and be much more upsetting for everyone. Because of this, he advocates doing your best to help your child develop some much needed negotiation skills, but dropping things when it is clear that an explosion is imminent. Later, when the child has settled back down, you can resume your efforts to negotiate. Developing skills to compromise and tolerate frustration does not happen right away. Dr. Greene points out that progress in these areas can be painstakingly slow, but that over time, the approach he recommends can lead to substantial gains for explosive children.- Basket C -Basket C contains those behaviors that are simply not worth enduring a meltdown over, even though they may have previously seemed like a high priority. By placing a number of previously important behaviors in Basket C, the opportunity for conflict producing meltdowns between parents and their child is greatly diminished.What kinds of things belong in Basket C? This depends on the specifics of each situation but may include such things as what a child will and will not eat, what clothes they wear, how they keep their room, etc. Dr. Greene suggests that the question to ask in determining whether a particular behavior falls into Basket C is "Is this so important that it is really worth risking a meltdown over?" If not, and you've already identified a number of behaviors that seem more important and worth negotiating over (i.e. those in Basket B), then into Basket C it goes.- How does this compare to traditional parenting approaches? - Dr. Greene's approach to dealing with explosive children runs counter to what many parents and professionals believe, i.e, that if a child is not punished, for behaving inappropriately they will never develop the necessary self-control nor be deterred from continuing to misbehave. Thus, Dr. Greene's thesis here is a controversial one and is at odds with traditional behavior therapy approaches that have substantial research support. Dr. Greene suggests, however, that for children whose explosiveness stems from a basic and biologically based inability to manage frustration, Dr. Greene suggests that behavioral interventions may not be effective can actually make things worse by increasing, rather than decreasing, the frequency with which a child loses control.- Isn't this just giving in to a misbehaving child? -Not necessarily. Dr. Greene points out that there is an important difference between giving in and deciding what behaviors are important enough to stand firm on. It remains the responsibility and prerogative of parents to be clear about what is non-negotiable, when compromise is a reasonable way to go, and what things to let slide for the time being. As the child becomes better able to tolerate frustration and learn much-needed compromise and negotiation skills, more and more behaviors can be moved from Basket C into Basket B, thus providing your child with increasing opportunities to practice learning to compromise.-

DOES THIS APPROACH WORK? RESULTS FROM A RECENT STUDY -Dr. Greene's approach will resonate with some people and be sharply criticized by others. However, the hallmark of a scientist is a willingness and desire to test one's theories through empirical research and I was thus quite pleased to recently come across a study published several years ago by Dr. Greene in which he tested the approach described above against more traditional behavioral parent training therapy with a sample of oppositional defiant children who also had symptoms of a mood disorder (Greene et al. [2004]. Effectiveness of collaborative problem solving in affectively dysregulated children with oppositional-defiant disorder: Initial findings. Journal of Consulting and Clinical Psychology, 2004, 72, 1157-1164).Participants in this study were parents of 50 children with ODD - for a description of diagnostic criteria for ODD see www.helpforadd.com/oddcd.htm - who also had at least sub threshold features of either childhood bipolar disorder or major depression. In addition, about two-thirds of the children were diagnosed with ADHD and many were being treated with medication.The parents of these children were randomly assigned to 1 of 2 interventions designed to help them bring their child's behavior under better control: the collaborative problem solving model developed by Dr. Greene or a more traditional behavioral parent training program developed by Dr. Russell Barkley, one of the world's leading authorities on ADHD.Dr. Barkley's parent training program is a highly structured behavior management program that lasted for 10-weeks. The focus is on teaching parents more effective discipline and behavior management strategies and sessions were attended primarily by parents, although children participated occasionally as well.Families assigned to the Collaborative Problem Solving (CPS) treatment were educated about the biological factors contributing to their child's aggressive outbursts, the "baskets" framework described above, and about the use of collaborative problem solving as a means for resolving disagreements and defusing potentially conflictual situations so as to reduce the likelihood of aggressive outbursts. As with Barkley's parent training program, sessions were attended primarily by parents. The number of sessions attended by parents ranged from 7-16 and the average length of treatment was 11 weeks. - RESULTS -At the conclusion of treatment, parents in both groups reported a significant decline in their child's level of oppositional behavior. At 4-months post-treatment, however, the gains reported by families who received traditional parent training were beginning to erode while those who received Greene's Collaborative Problem Solving therapy reported that gains were fully sustained. Specifically, 80% of children in the CPS condition were reported to be either very much improved or much improved by their parents compared to only 44% in the traditional parent training program.Parents in the CPS condition also reported that they were experiencing significantly less stress, that their children were more adaptable, and that hyperactive-impulsive symptoms were reduced. They also felt more effective at setting limits for their children and that communication with their child had improved. Significant improvements on these dimensions were not evident.-

SUMMARY and IMPLICATIONS -The approach developed by Dr. Greene for developing self-control in children prone to emotional outbursts and melt-downs represents an important shift from traditional behavioral treatment methods. It is based on the premise that when this behavior has a strong biological underpinning, as he feels is true for many children, the use of punishments and rewards are not likely to be effective. Instead, he advocates that parents work to remove sources of frustration from their child's life, become clear about what behaviors they truly need to take a stand on, and focus helping their child develop the ability to negotiate, compromise, and manage their affect. Because melt-downs can be so painful for everyone to endure, parents are taught to avoid making demands on their child that would be likely to trigger a melt-down unless it is absolutely necessary.This will be regarded by many as a controversial approach, but results from a preliminary test suggest that these ideas may have real value for children and families. Because this is only an initial study, however, it is clear that more work needs to be done, and I am hopeful that a larger trial that tests the value of Dr. Greene's treatment suggestions will be published shortly.For those of you who would like to learn more about these interesting ideas, Dr. Greene maintains a web site at www.explosivechild.com where his published books and videos/DVDs are available. There is also a web site at www.cpsinstitute.org where you can find additional excellent information on Dr. Greene's collaborative problem solving approach.

GAMES FOR RESPONDING TO SOCIAL SIGNALS

These are suggestions from Dr. Serena Weider for activities to help a child read and respond to social signals more naturally.

1. Charades based games like: Charades for Kids, Step On It or Kids on Stage.

2. Pretending: Eating, dancing

3. Pantomime Games: Games without words or gestures without words

4. Scavenger Hunts: Use clues that are both verbal and non-verbal: Pointing or using clues as a collaborative method for a team of players.

5. Hide and seek: Where two children work together to find another.

6. Doing real tasks together: Washing the car: What needs to happen first then second...

7. Build from the foundation of the individual child: Not top down. Encourage back and forth interaction that is enticing, warm and pleasurable.