15 November 2014

Resolving Behavioural Difficulties in Children using Collaboration

Recently I went to a professional development workshop with Dr Ross Greene, who is a guru from the USA who specialises in working with kids with behavioural problems. He has worked with kids with ADHD, Oppositional Defiance Disorder, Conduct Disorder and other emotional difficulties. He has also worked in prisons, schools and youth detention centres in order to help staff manage behavioural difficulties in these populations.

Dr Greene’s basic premise is that “kids do well if they can do well”. Often parents and teachers can assume that “a child does well if they want to do well” and therefore see a child’s misbehaviour as deliberate or manipulative. Dr Greene argues that although there may be some secondary gains to misbehaviour, kids misbehave when their skills can’t meet the demands of the environment. He states that kids that often misbehave have lagging skills and therefore lack the ability to deal with the situation in an adaptive and appropriate way. These lagging skills include executive skills (e.g. foresight, problem solving and planning), language processing/communication skills, emotion regulation skills, cognitive flexibility skills and social skills. Not having these skills to an age-appropriate level results in certain situations, where these skills are required, becoming triggers for explosive behaviour. Dr Greene calls these triggers unsolved problems. Common unsolved problems include making the transition from one task to another, doing home-work, difficulty handling the word “no” and dealing with not getting their own way.  Some of the ways that kids might respond to these situations are to sulk, scream, kick, kit, swear or throw things. No matter what the problem behaviour is, Dr Greene argues that the same approach should be taken to respond to it.

He describes three main approaches to responding to a child’s behaviour: Plan A is a unilateral approach where the parent is inflexible about their request being met with compliance; Plan B is a collaborative approach where there is compromise and discussion about the best solution; Plan C is centred around what the child wants and usually involves the parent ‘giving in’. Although there are some situations where Plan A or Plan C might be helpful or appropriate, Plan B is the approach of choice because it not only teaches the child about boundaries but allows the parent to coach the child in using the skills which they are lacking.

Plan B involves three main steps:

Step 1: The empathy step

In this step the parent needs to listen and gather information from the child about their concerns and feelings and provide validation and acknowledgement. It is essential that this is done prior to the parents own concerns being expressed and might involve asking questions, active listening and labelling of the child’s emotions.

Step 2: Define adult concerns step

The parent then needs to introduce their own concerns into the conversation. This usually involves saying “the thing is..” or “my concern is…” and then explaining what you are finding difficult or your concern about the child or their behaviour. This might involve explaining why their behaviour is dangerous or why you have imposed a limit.

Step 3: The invitation step

The goal of the invitation step is to invite the child to solve the problem in a way that is mutually satisfactory to both the parent and child. The parent should invite the child to solve the problem with them and see if they can come up with ideas on how to help things improve, or what an appropriate consequence for misbehaviour should be. The discussion should be collaborative and aim to provide boundaries but also to coach your child in the skills that they are lagging.

Dr Greene argues that this approach is extremely effective in helping families to get along better and to allow ‘explosive’ children to learn the skills to deal with problems in adaptive ways. We have used this approach with many children at Mindright and found it effective and invaluable in treating behavioural problems with the children and teenagers that we see.

Dr Rani Ellison-Clinical Psychologist