collaborative problem solving adhd

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Collaborative Problem Solving® (CPS)

At Think:Kids, we recognize that kids with challenging behavior don’t lack the will  to behave well. They lack the  skills  to behave well.

Our Collaborative Problem Solving (CPS) approach is proven to reduce challenging behavior, teach kids the skills they lack, and build relationships with the adults in their lives.

Anyone can learn Collaborative Problem Solving, and we’re here to help.

What is Collaborative Problem Solving?

Kids with challenging behavior are tragically misunderstood and mistreated. Rewards and punishments don’t work and often make things worse. Thankfully, there’s another way. But it requires a big shift in mindset.

Helping kids with challenging behavior requires understanding why they struggle in the first place. But what if everything we thought was true about challenging behavior was actually wrong? Our Collaborative Problem Solving approach recognizes what research has pointed to for years – that kids with challenging behavior are already trying hard. They don’t lack the will to behave well. They lack the skills to behave well.

Learn More About the CPS Approach

Kids do well if they can.

CPS helps adults shift to a more accurate and compassionate mindset and embrace the truth that kids do well if they can – rather than the more common belief that kids would do well if they simply wanted to.

Flowing from this simple but powerful philosophy, CPS focuses on building skills like flexibility, frustration tolerance and problem solving, rather than simply motivating kids to behave better. The process begins with identifying triggers to a child’s challenging behavior and the specific skills they need help developing.  The next step involves partnering with the child to build those skills and develop lasting solutions to problems that work for everyone.

The CPS approach was developed at Massachusetts General Hospital a top-ranked Department of Psychiatry in the United States.  It is proven to reduce challenging behavior, teach kids the skills they lack, and build relationships with the adults in their lives. If you’re looking for a more accurate, compassionate, and effective approach, you’ve come to the right place. Fortunately, anyone can learn CPS. Let’s get started!

Bring CPS to Your Organization

Attend a cps training.

6 out of 10 teachers report reduced stress.

Significant reductions in parents’ stress.

74% average reduction in use of seclusion.

73% reduction in oppositional behaviors during school.

Parents report improvements in parent-child interactions.

71% fewer self-inflicted injuries.

reduction in school office referrals.

Significant improvements in children’s executive functioning skills.

60% of children exhibited improved behavior 

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Collaborative Problem Solving (CPS)

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Becker, K., Chorpita, D., & Daleiden, B. (2011). Improvement in symptoms versus functioning: How do our best treatments measure up? Administration and Policy in Mental Health and Mental Health Services Research, 38 (6), 440–458.

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Ollendick, T. H., Greene, R. W., Austin, K. E., Fraire, M. G., Halldorsdottir, T., Allen, K. B., Jarret, M. A., Lewis, K. M., Smith, M. W., Cunningham, N. R., Noguchi, R. J. P., Canavera, K., & Wolff, J. (2016). Parent management training and Collaborative & Proactive Solutions: A randomized control trial for oppositional youth. Journal of Clinical Child and Adolescent Psychology, 45 (5), 591–604.

Pollastri, A., Epstein, L., Heath, G., & Ablon, J. (2013). The collaborative problem solving approach: Outcomes across settings. Harvard Review of Psychiatry, 21 (4), 188–199.

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Rosen, B. (2020). Collaborative Problem Solving (CPS). In: Lebow, J., Chambers, A., Breunlin, D.C. (eds) Encyclopedia of Couple and Family Therapy. Springer, Cham. https://doi.org/10.1007/978-3-319-15877-8_1160-1

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Language: English | Turkish

The Effectiveness of an Interpersonal Cognitive Problem-Solving Strategy on Behavior and Emotional Problems in Children with Attention Deficit Hyperactivity

Kişilerarası sorun Çözme eğitiminin dikkat eksikliği ve hiperaktivite bozukluğu olan Çocukların davranışsal ve emosyonel sorunları Üzerindeki etkisi, celale tangül Özcan.

1 Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey

Fahriye Oflaz

Tümer türkbay.

2 GGulhane Military Medical Academy, Department of Child and Adolescent Mental Health, Ankara, Turkey

Sharon M. FREEMAN CLEVENGER

3 Gülhane Indiana/Purdue University Center for Brief Therapy, Fort Wayne, Indiana, USA

Introduction

This study was designed to evaluate the effectiveness of the “I Can Problem Solve” (ICPS) program on behavioral and emotional problems in children with attention deficit hyperactivity disorder (ADHD).

The subjects were 33 children with ADHD aged between 6 to 11 years. The study used a pre- and post-test quasi-experimental design with one group. The researchers taught 33 children with ADHD how to apply ICPS over a period of 14 weeks. The Child Behavior Checklist for Ages 6–18 (Teacher Report Form) and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition Text Revision (DSM-IV-TR) Based Disruptive Behavior Disorders Screening and Rating Scale (parents’ and teacher’s forms) were used to evaluate the efficacy of the program. The scales were applied to parents and teachers of the children before and after the ICPS program.

The findings indicated that the measured pre-training scores for behavioral and emotional problems (attention difficulties, problems, anxious/depressed, withdrawn/depressed, oppositional defiant problems, rule breaking behaviors, and aggressive behaviors) were significantly decreased in all children post-training. In addition, children’s total competence scores increased (working, behaving, learning and happy) after the ICPS program.

According to the results, it is likely that, ICPS would be a useful program to decrease certain behavioral and emotional problems associated with ADHD and to increase the competence level in children with ADHD. An additional benefit of the program might be to empower children to deal with problems associated with ADHD such as attention difficulties, hyperactivity-impulsivity, and oppositional defiant problems.

ÖZET

Giriş.

Bu araştırma dikkat eksikliği hiperaktivite bozukluğu (DEHB) tanısı konulan çocuklara uygulanan bir kişilerarası sorun çözme eğitim programı olan “Ben Sorun Çözebilirim (BSÇ)” eğitiminin etkilerini incelemek amacıyla yapılmıştır.

Yöntemler

Araştırma örneklemini DEHB tanısı konulan 6–11 yaş arası 33 çocuk oluşturmuş, tek gruplu ön-son test deseninde, yarı deneysel olarak planlanmıştır. DEHB tanısı olan bu çocuklara 14 hafta boyunca bilişsel yaklaşıma dayalı BSÇ eğitimi uygulanmıştır. Programın etkinliğini değerlendirmek için “Dikkat Eksikliği ve Yıkıcı Davranış Bozuklukları için DSM-IV’e Dayalı Tarama ve Değerlendirme Ölçeği” (anne-baba ve öğretmen formu) ve “6–18 Yaş Grubu Çocuk ve Gençler için Davranış Değerlendirme Ölçeği (öğretmen formu-TRF/6–18)” kullanılmıştır. BSÇ eğitimi öncesi ve sonrasında anne-baba ve öğretmenlerden bu ölçekleri doldurmaları istenmiştir.

BSÇ eğitimi sonrasında karşı gelme, dikkatsizlik, hiperaktivite/dürtüsellik, anksiyete/depresyon, sosyal içe dönüklük, suça yönelik davranışlar ve saldırgan davranışların azaldığı saptanmıştır. TRF/6–18′nin yeterlilik alanına ilişkin “sıkı çalışma, uyum, öğrenme ve mutlu olma” alt testlerin toplamından oluşan “toplam yeterlilik” alt testinde BSÇ eğitim sonrasında yeterlilik düzeyinin önemli oranda arttığı görülmüştür.

Sonuç

Bu çalışmanın sonuçlarına göre, BSÇ eğitim programı DEHB olan çocukların duygusal ve davranışsal sorunların azaltılmasında ve çocukların yeterlilik düzeylerinin artırılmasında faydalı olabilir. Bu programın bir diğer yararı ise bu çocukların DEHB ile ilişkili sorunlar (dikkat eksikliği, hiperaktivite/dürtüsellik ve karşı gelme sorunları) ile baş etmelerini güçlendirebilir.

Attention deficit hyperactivity disorder (ADHD), which is one of the most prevalent childhood psychiatric disorders, is a neuropsychiatric disorder characterized by developmentally inappropriate levels of activity, distractibility, and impulsivity ( 1 , 2 ).

Behavioral problems in children with ADHD include acting without adequate forethought as to the consequences of their actions and inability to postpone gratification with impulsive decisions and behaviors. ADHD negatively influences social interactions with peers, interpersonal relationships with parents, teachers and peers as well as academic success and social functions ( 2 , 3 ). Children with ADHD face problems such as increased incidence of defiant and aggressive behaviors, and are at higher risk of comorbid disorders (such as oppositional defiant disorder, conduct disorder) compared to typically developing children ( 4 , 5 ). Behavioral problems commonly seen in children with ADHD affect the overall quality of children’s lives ( 2 , 6 , 7 ), and reduce the quality of life of their family members. Specifically, the family experiences overall increased levels of stress, decreased feelings of belonging and competence and disruption of routines and structure ( 2 ). Additional problems include: conflicts and exclusion among peers, inability to manage or prevent anger efficiently, communication/social skill difficulties, inadequate problem solving, and difficulties in relationships ( 2 , 5 , 8 ).

Multifocal treatment programs for children with ADHD may improve outcomes in a more robust manner than medication alone or behavior/cognitive management programs alone. Social skills training programs encourage problem-solving ability and support cognitive and behavioral skills ( 2 , 9 , 10 ). Some cognitive-behavioral approaches consisting of psychosocial treatments result in improved impulse control, increased assessment capability before reaction and enhance considered and tempered actions ( 11 ).

The “I Can Problem Solve” (ICPS) program is based on Interpersonal Cognitive Problem-Solving methods. The basic objectives of this program are developed mainly to deal with the social problems of children ( 12 ). The ICPS is a problem solving approach to prevention of high risk behaviors in children and provide children with assessment abilities to help them solve their problems ( 12 , 13 , 14 ). By strengthening the capacity of children with ADHD to solve problems that lead to socially undesirable behaviors such as physical and verbal aggression, impulsivity, inability to wait, inability to take turns, inability to delay gratification, over emotionality in the face of frustration, inability to maintain friendships, high risk behaviors may be reduced ( 12 ). It should be noted that, children with ADHD need extra support and structured training although other children easily can learn problem-solving skills through these programs and adapt them to real life as well ( 15 ). However, there is limited data relating the ICPS training program for children suffering from ADHD ( 10 , 12 ).

The primary aim of this study was to evaluate the effectiveness of the ICPS program on children with ADHD. It was hypothesized that ICPS program would be useful to decrease behavioral and emotional problems (oppositional defiant problems, attention problems, hyperactivity problems, anxious/depressed, withdrawn/depressed, rule breaking behavior, and aggressive behavior), and would increase the total competence scores (working, behaving, learning and happy) in children with ADHD.

Study Design and Sampling

The main purpose of this study was to evaluate the improvements between pre- and post-ICPS training in measured behavioral and emotional problems in children with ADHD and their competence in term of the effectiveness of the ICPS program. This study was designed as a pre-post-test quasi-experimental design with a single group. The study group consisted of children diagnosed with ADHD in two elementary schools in Ankara/Turkey, between ages of 6 and 11, diagnosed with ADHD according to DSM-IV-TR criteria ( 1 ). The mean age of the participants was 9.1±1.1 years. All of the children were Caucasian. The socio-demographic characteristics of the children such as gender, grade, mother’s and father’s education years, father’s/mother’s profession as well as medication use for ADHD are outlined in Table 1 .

The Socio-demographic characteristics of the participants (n=33)

Inclusion criteria were: the diagnosis of ADHD according to DSM-IV-TR criteria, 6 to 12 years of age, and child/parents volunteered for the research. Exclusion criteria were: the history of head trauma or neurological illness, developmental delay or any other axis I psychiatric disorder except for oppositional defiant disorder, making a change in her/his medications during the study if the child has been taking any medication for ADHD, and failure to attend the training.

Instruments

Data collection and assessment tools used in the research were as follows:

The DSM-IV-TR Based Disruptive Behavior Disorders Screening and Rating Scale

This is a screening and assessment instrument, which was developed based on DSM-IV-TR diagnostic criteria, consists of 9 items inquiring attention problems; 6 items inquiring hyperactivity; 3 items inquiring impulsivity; 8 items inquiring oppositional defiant disorder and 15 items inquiring conduct disorder. The adaptation of this scale to Turkish society, and the validation and reliability analyses were completed in the year 2001. The Cronbach’s alpha was 0.88 for the sub-scale attention problems and 0.92 for the sub-scale disruptive behavior disorder in the reliability analysis ( 16 ).

The Child Behavior Checklist for Ages 6–18 (Teacher Report Form-TRF/6–18)

This form was developed to evaluate 6–18 age group students’ adaptation to school and their faulty behavior through information obtained from teachers in a standardized way. TRF includes 118 items related to behavioral and emotional problems. 93 of these items correspond to the items on the Child Behavior Checklist for Ages 6–18. The scale provides information regarding adaptation as well as basic functions such as school- and student-related information. In the second part of the scale, behavior problems are inquired under the categories “internalizing” and “externalizing”. Within the “internalizing” category, there are withdrawn/depressed, somatic complaints and anxious/depressed subtests, while within the “externalizing” category, there are disobedience to rules and aggressive behaviors sub-tests. There are also sub-tests such as social problems, thought problems, attention problems and other problems that do not belong to either of the two categories ( 17 ). TRF was first developed by Achenbach in 1991, and verification and validation studies in our country were conducted by Erol at al. ( 18 ). The Validity and reliability of the Turkish version of the TRF was 0.82 for Internalizing; 0.81 for Externalizing and Cronbach alpha=0.87 for total problem.

The 49 children from two elementary schools were interviewed and examined by a psychiatric practitioner trained in child psychiatry. To exclude other psychiatric disorders, the Children Depression Inventory, the State-Trait Anxiety Inventory and the Learning Disorders Checklist were applied. 37 of the 49 children met the diagnostic criteria for ADHD. The study was introduced to 37 children and their parents in an introductory meeting. Permission and written informed consent were obtained from them (n=37). Parent reports were obtained with the DSM-IV-TR based Disruptive Behavior Disorders screening and assessment scale; teacher reports were obtained with both the DSM-IV-TR Based Disruptive Behavior Disorders Screening and Assessment Scale, and “Child Behavior Checklist for Ages 6–18 (Teacher Report Form)(TRF/6–18).

Due to various reasons, such as being diagnosed with another psychiatric disorder besides ADHD and the failure to attend the training etc., four students were excluded from the study. Finally, the remaining 33 children were taken for evaluation.

The lessons of ICPS were taught to the children in small groups. The children fell into the groups based upon their school and whether they attended morning or afternoon classes resulting in 7–9 children per group. The training program was 14 weeks in length and included 83 structured lessons. Each lesson was completed in approximately 30 minutes twice per week which could be prolonged considering children’s motivation.

The ICPS training program is based on “Interpersonal Cognitive Problem-Solving Strategy”. The ICPS program was developed by Myrna B. Shure (1992) ( 19 ) for purposes of social skills training in children and adolescents. The adaptation of this training to Turkish has been made by Öğülmüş ( 14 ). The training was provided by a primary researcher who had previously been trained exclusively by Öğülmüş. The ICPS program teaches children how to think and how to evaluate their own thoughts. Behaviors are modified by focusing on the thinking processes. The ICPS program encourages children to think about finding as many alternative solutions as possible when they deal with a problem. It teaches children to learn how to think of solutions to a problem and of potential consequences to an act. The ICPS encourages children to do their own thinking instead of offering solutions and consequences ( 12 , 13 , 14 ). ICPS with enhanced critical thinking, creativity, and reasoning skills are concerned more with how a person thinks rather than what a person thinks. ICPS attempt to enhance interpersonal cognitive skills, and thus, lead to successful alterations in overt social behavior ( 12 , 13 , 14 ). The guideline book of ICPS program included 83 structured lessons using pictures, toys, puppets, games, stories, drama, role-plays, and dialogues based on real life conversations. There is a defined goal of each structured lesson in the ICPS program book ( 19 ). The examples of goals of the ICPS lessons are as follows:

To Think About their own Feelings

To learn to identify people’s feelings and to become sensitive to them (other’s feelings) or (to gain the ability to put themselves in other’s shoes)

To increase their awareness that other’s point of view might differ from their own

To recognize that there is more than one way to solve a problem

To learn being assertive without physical and verbal aggression

To learn that different people can feel different ways about the same issue

To think of both alternative solutions and means-ends plans (weighing pros and cons)

To be aware of what might happen next and to learn how to think of solutions to a problem and consequences to an act

To decide for themselves whether their idea was or was not good in the light of their own and others’ feelings and of the possible consequences.

To learn that sensitivity to the preferences of others is also important in deciding what to do in situations which situation?

To increase understanding that thinking about what is happening may, in the long run, be more beneficial than immediate action to stop the behavior

To control impulse, including to delay gratification and to cope with frustrations

Examples of ICPS Dialoguing (Problem-solving process) ( 12 ).

“What happened, what’s the problem, what’s the matter?”

“How do you think she/he feels when.. ?” (e.g., “When you hit him/her?”)

“What happened (might happen) next when you did (do) that?”

“How did that make you feel?”

“Can you think of a different way to solve the problem (tell him/her/me how you feel)?”

“Do you think that is or is not a good idea? Why (why not)?”

Ethical Approval

This study was approved by the local ethics committee of Gülhane Military Medical Academy and School of Medicine, and Ankara Provincial Education Directorate. For ethical considerations, the purposes and methods of the study were explained to the children and their parents. After receiving their consent, the study was started.

Statistical Analysis

SPSS Ver. 13.0 for Windows (SPSS Inc., IL, USA) was used for the statistical analysis. All descriptive statistics were presented as mean ± standard deviation (SD), median and number/percentage universal tests, then normal distribution fit tests (Shapiro-Wilk test) were employed for the data used. Pre- and post-test measurement data were evaluated as dependent variables scores were compared by using the Paired-Samples T-Test or the Wilcoxon Signed-Rank Test (when variances are unequal). The significance level was assumed p<0.05.

The differences between pre-and post-training scores were statistically significant for all subscales of the DSM-IV-TR Based Disruptive Behavior Disorders Screening and Rating Scale ( Table 2 ).

Comparison of the Subscales Scores of the DSM-IV-TR Based Disruptive Behavior Disorders Screening and Rating Scale before and after the ICPS Training

t: Paired-Samples T Test, z: Wilcoxon Signed Rank Test (when variances were unequal),

According to the TRF/6–18 test scores for both pre-and post-training, the all internalizing problem behaviors including “anxious/depressed”, “withdrawn/depressed” and “somatic complaints”, and the all externalizing problem behaviors including “rule-breaking behavior” and “aggressive behaviors” were found to be significantly reduced after the ICPS training ( Table 3 ). The sum of the scores for four adaptive characteristics (“working”, “behaving”, “learning” and “happy”) displays an “adaptive functioning profile” on the TRF/6–18. The difference between competence levels of these sub-tests were found to be statistically significant based on the comparison of these levels for pre- and post-ICPS training (p=0.03). The higher total competence scores indicate the better competence ( Table 3 ).

Comparison of Problematic Behaviors Scores Identified by TRF/6–18 for Pre- and Post-ICPS Training

t: Paired-Samples T Test, z: Wilcoxon Signed-Rank Test (when variances were unequal),

The effectiveness of ICPS training for children with ADHD resulted in significant improvement in ADHD symptoms as well as in such problem areas like internalizing and externalizing behavior problems. These results suggest that ICPS training might reduce problematic behaviors and improve problem-solving skills and behavior among children with ADHD.

Pharmacotherapy tends to be a first-line therapy targeting biological implications for children with ADHD. Approved pharmacological agents for the treatment of ADHD include psychostimulants and atomoxetine. Psychostimulant medication has positive effects on children with ADHD in their ability to focus and pay attention in school settings, thereby, resulting in improvement in the overall learning environment. The therapeutic effects of pharmacological agents may be temporary, as symptom reduction occurs only when medication is active in the system. The lack of long-term efficacy has been issue of concern ( 2 , 20 ). Although the effectiveness of psychostimulants for reducing ADHD symptoms have demonstrated efficacy ( 21 , 22 ), there are potential unwanted side effects of pharmacological agents ( 23 , 24 ). Because of worrying about potential and known/unknown negative effects of pharmacotherapy, some children with ADHD may be reluctant to use any medication for ADHD, and may possibly discontinue medication treatments without their prescribers’ knowledge. Furthermore, follow-up studies have demonstrated that ADHD frequently persists into adolescence and adulthood ( 2 , 25 , 26 ). In addition, adults and those in whom ADHD was diagnosed in childhood often continue to suffer ongoing significant behavior problems ( 2 , 9 , 27 ). Accordingly, if these people with ADHD use a medication as the first and only treatment for ADHD, they will have to use the medication throughout life. As a result, non-pharmacological treatment seeking, and the use of complementary are on the rise ( 26 ). In addition, children with ADHD have not only core ADHD symptoms, but have also comorbid disorders that increase complexity of treatment such as anxiety, disobedience to rules, aggressive behaviors, oppositional defiant behaviors and other social problems ( 2 , 4 ). These comorbid conditions and associated features not only add to ADHD’s clinical complexity, but also have significant implications for treatment ( 28 ). Therefore, alternative options, including psychosocial treatment approaches, may have utility for amelioration of ADHD symptoms, and have significance in reversing the risks and long-term outcomes associated with ADHD, especially if combined with medication ( 3 , 9 , 28 , 29 ). However, some studies indicated that treatment with a combination of medicine and psychosocial treatment has little or no better result compared to medicine only treatment ( 20 , 30 , 31 ). The Multimodal Treatment Study of Children with ADHD (MTA) compared four treatment options in a 4-group parallel design. Combination treatment and medication management were both significantly superior to behavioral treatment and community care in reducing the symptoms. In certain conditions (such as oppositional-defiant/aggressive symptoms, internalizing symptoms, teacher rated social skills, parent-child relations, and reading achievement), combined treatment was superior to behavioral treatment and/or community care ( 21 ).

On the contrary, other studies have demonstrated incremental results for adding behavior therapy to psychostimulant medication in terms of reductions of ADHD symptoms ( 32 , 33 ). Similarly, psychosocial interventions such as ICPS have been found to be effective for children with ADHD ( 34 ). In support of this, some studies have reported that, psychosocial therapies provided along with medication had positive effects on comorbid internalizing and externalizing behaviors ( 35 , 36 ). Diller and Goldstein ( 37 ) have emphasized: “more than one hundred studies demonstrate that parent and teacher training programs improve child compliance, reduce disruptive behaviors, and improve parent/teacher-child interactions and a number of short-term studies have scientifically demonstrated the effectiveness of psychosocial interventions for ADHD”.

Problem-solving strategies that is one of psychosocial treatments engages both the cognitive and social skills that arise from daily life experiences. Problem-solving skills are considered an important aspect that effects how one reacts and deals with these problems ( 38 ). ICPS program might be useful for both children with and without medication and may contribute to reductions in problematic behaviors. These strategies may also reduce the severity of comorbid disruptive disorders and emotional problems. ICPS training improve problematic behaviors by engaging children in thinking about their actions, the impact of their behavior on themselves and others, the possible consequences of their actions, and other options they have. However, previous studies evaluating the effectiveness of ICPS program in normal children ( 12 , 39 ) concluded that that non-ADHD children with naturally developed problem-solving thinking skills and behavior strategies benefit from ICPS as well as children with ADHD ( 12 , 38 ). There are limited studies related to children with ADHD in the literature to evaluate the effectiveness of ICPS program which we used in our research ( 12 ). In one of the initial studies with single subject design, Shure (1999) has cited that, Aberson (1996) taught ICPS to parents of 3 children with ADHD (12. ??, problem-solving skills and behavior may be improved through the use of ICPS strategies. It is important to recognize that children with ADHD trained in ICPS might learn how to find alternative ways to express their anger, handle anger, and to recognize consequences of their behavior. However, the above mentioned improvement in social and emotional adjustment lasted 4 years after training ended ( 40 ). In another study ( 10 ), also with single subject design, ICPS was conducted to teach 8 children with ADHD who already had been maintaining treatment with psychostimulant drug. While the researcher was teaching ICPS to 8 children with ADHD at an observation class, their mothers observed the ICPS lessons. The mothers applied the learned strategies to their children and used the ICPS dialogs during problem-solving process at home in real-life situations. It was suggested that ICPS program may make an additional contribution into the children treated with a psychostimulant medication to deal with their problems. In parallel with the emphasized idea of the studies ( 12 , 40 ), our data have shown that both ADHD related symptoms and non-ADHD related symptoms were observed to decrease through the use of ICPS strategies.

It was proposed that children with ADHD would need help in learning those skills and the training should be provided in a controlled setting, although normal children might easily learn problem solving skills ( 15 ). Aberson et al. ( 40 ) emphasized that, such initiatives, if applied under special circumstances, could have significant effects on problematic behaviors in children with ADHD. These special conditions were meant for parents to teach their children the skills, and to implement ICPS childrearing techniques altogether; the child learns to internalize the newly acquired skills, and to adapt them to real life. Children with ADHD may need help to generalize and internalize these skills because they could have difficulty to adaptation these skills for a changing environment and generalizing to conditions in real life. In addition, because, rehearsals through games could complement these techniques, during our study, drama and envisaging techniques were used in order to enhance and generalize the acquired skills.

The limitations of this study include: small sample size and the absence of a control group. Other significant limitations of the study could be regarded as not making a comparison with other treatment modalities and, the grading scales used were based on declaration rather than being objective. The present study was planned in a pre-posttest quasi-experimental design with one group. Further research comparing ICPS with other treatment modalities and different factors are needed.

Conclusions

ICPS training based on Interpersonal Problem Solving skills may reduce the level of problems in behaviors of children with ADHD and increase the quality of interpersonal communications. Although American Pediatrics Academy ( 41 ) stated that, psychosocial interventions were found to be effective in treating mild and moderate symptoms of such cases as in the ADHD treatment guidebook published, there is not sufficient evidence for this treatment to be applied alone. Hence, integrated and multimodal treatment approaches may be more convenient hypotheses. ICPS training is relatively easy to learn and to utilize in school settings, and may be conveniently used by most disciplines working with children. Consequently, it is thought that, the ICPS is beneficial training for children with ADHD in order to modify problematic behaviors that interfere with quality of learning, socialization and overall quality of life.

Process of the study

Conflict of interest: The authors reported no conflict of interest related to this article.

Çıkar çatışması: Yazarlar bu makale ile ilgili olarak herhangi bir çıkar çatışması bildirmemişlerdir.

Attention-deficit/hyperactivity disorder with oppositional defiant disorder in Swedish children - an open study of collaborative problem solving

Affiliation.

• 1 The Gillberg Neuropsychiatry Centre at the Sahlgrenska Academy, University of Gothenburg, Sweden.
• PMID: 22375727
• DOI: 10.1111/j.1651-2227.2012.02646.x

Aim: To evaluate collaborative problem solving (CPS) in Swedish 6-13-year-old children with attention-deficit/hyperactivity disorder and oppositional defiant disorder (ODD).

Methods: Seventeen families completed 6-10 sessions of CPS training. Primary outcome measures were SNAP-IV [attention-deficit/hyperactivity disorder (ADHD) and ODD scores] and Clinical Global Impression-Improvement (CGI-I) scores at baseline, post-intervention and 6 months later. Secondary outcome measures were the Conners' 10-item scale and the Family Burden of Illness Module (FBIM).

Results: All 17 participants completed the intervention. The whole group had significant reductions in SNAP-IV ODD, ADHD, total Conners' and FBIM scores, both at post-intervention and at 6-month follow-up. Eight of the children, although significantly improved on ODD scores and the Conners' emotional lability subscale at post-intervention, had almost no improvement in hyperactivity/impulsivity. Post-intervention, this group received stimulant medication for their ADHD. CGI-I scores of much improved or very much improved were reached by 53% (9/17) of all at post-intervention, and by 81% (13/16) at 6-month follow-up.

Conclusion: Collaborative problem solving significantly reduced ODD, ADHD and emotional lability symptoms. A subgroup improved in their ADHD symptoms only after adding stimulant medication.

© 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.

Publication types

• Research Support, Non-U.S. Gov't
• Attention Deficit Disorder with Hyperactivity / complications
• Attention Deficit Disorder with Hyperactivity / therapy*
• Attention Deficit and Disruptive Behavior Disorders / complications
• Attention Deficit and Disruptive Behavior Disorders / therapy*
• Follow-Up Studies
• Problem Solving*

Coming up next! Our 2-Day Virtual Training  on Collaborative & Proactive Solutions with Dr. Ross Greene on May 30 & 31! REGISTER HERE →

To end punitive, exclusionary discipline, we’re going to need new lenses, practices, and policies. you’re in the right place..

We are in the midst of a societal and public health crisis. We are losing our most vulnerable kids, largely due to perspectives that are outdated and counterproductive, and disciplinary practices that are punitive and exclusionary.

With each time-out, detention, suspension, expulsion, paddling, restraint, seclusion, and arrest at school, there are children who aren’t getting the help they need and are being pushed away from caregivers who could instead be helping them.

The cost to all of us is profound. Overwhelmed, discouraged educators. Frustrated, desperate parents. Expensive placements. Disenfranchised, marginalized, alienated kids. A pipeline to prison.

It doesn’t have to be this way. That’s why Lives in the Balance offers a wide array of training options and free resources on Dr. Ross Greene’s evidence-based Collaborative & Proactive Solutions (CPS) model…right here on this website. And why we advocate for change all over the world.

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An Innovative Approach for Helping ‘Explosive & Inflexible Children’

By: david rabiner, ph.d..

—————————————————————————————————————————————————— “This article was originally published in Attention Research Update, an online newsletter written by Dr. David Rabiner of Duke University that helps parents, professionals, and educators keep up with new research on ADHD and related areas.  You can sign up for a complementary subscription at www.helpforadd.com ” ——————————————————————————————————————————————————

One of the most challenging problems for parents to deal with are explosive outbursts in their child. Such outbursts occur with distressing regularity in some children – regardless of whether the child also has ADHD – and can contribute to an extremely difficult home environment.

A number of years ago I cam across a book called ‘The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, “Chronically Inflexible” Children’ that I found to provide some very useful ideas for addressing these issues. The book is authored by Dr. Ross Greene, a clinical psychologist from Harvard Medical School. Dr. Greene’s approach impressed me as a thoughtful and respectful way to deal with the behavioral volatility and emotional outbursts that often add to the challenges faced my many parents of children with ADHD.

** 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 on 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 there is currently a larger trial underway. When these results become available, I will make sure to report them in Attention Research Update.

For those of you who would like to learn more about these interesting ideas, there is an excellent web site at www.livesinthebalance.org/ where you can find a wide range of additional information on this approach. Another excellent site to visit developed by Dr. Greene is at http://cpsconnection.com/ I believe you will find these sites to be worth visiting.

(c) 2014 David Rabiner, Ph.D.

(Published with the author’s permission.)

To view HUNDREDS of articles and videos on ADD/ADHD , go to addrc.org

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Dr. Ross Greene

Originator of the Collaborative & Proactive Solutions Approach

Welcome to the world of New York Times bestselling author Dr. Ross Greene and Collaborative & Proactive Solutions (CPS)! Dr. Greene is a clinical psychologist, and he’s been working with children and families for over 30 years. His influential work is widely known throughout the world.

This website was launched to celebrate the release of Dr. Greene’s newest book, Raising Human Beings. While he’s already a household name in families of behaviorally challenging kids, in this much-anticipated book he extends his work to all kids and all families. The book was released in August, 2016!

If you’re unfamiliar with Dr. Greene and CPS, you’re going to learn a lot on this website. And there are links to other websites to help you learn even more.

All content © Dr. Ross Greene

Celebrating 25 Years

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6 Truths About Child Behavior Problems That Unlock Better Behavior

Standard parenting models tell us to reward behaviors you want to encourage, and punish behaviors you don’t. dr. ross greene says that strategy only slaps a band-aid on an unsolved problem. here, learn the basics of his cps model for getting to the root of your child’s challenging behaviors..

Child behavior problems aren’t a sign of insubordination, disrespect, or rudeness. They are a red flag you are inadvertently ignoring. They are telling you that your child is seriously struggling to meet your expectations, potentially because of a condition such as attention deficit hyperactivity disorder (ADHD), and he or she doesn’t know how to move forward.

This is the central premise of the collaborative and proactive solutions (CPS) model for treating challenging behavior. Described in depth in my books The Explosive Child (#CommissionsEarned) ,  Lost at School (#CommissionsEarned) ,  Lost & Found (#CommissionsEarned) , and  Raising Human Beings (#CommissionsEarned) , the CPS model is an empirically-supported, evidence-based treatment approach that focuses on identifying the  skills  your child is lacking and the  expectations  he or she is having difficulty meeting. It is a new, collaborative and proactive approach to solving a problem most parents face daily.

The six key tenets of CPS model are as follows.

1. Emphasize problems (and solving them) rather than behaviors (and modifying them).

Many parents, educators, and mental health clinicians focus primarily on a challenging behavior and how to stop it. The CPS model sees “bad” behavior as a signal — a sign that the child is communicating, “I’m stuck. There are expectations that I’m having trouble meeting.” Meltdowns , for the most part, indicate a problem upstream, just as a fever often indicates an infection elsewhere in the body.

If you treat a fever without looking for the ailment causing it, the recovery is often only temporary. Similarly, if you try to change a behavior without identifying the unsolved problem sparking it, the outburst is bound to happen again.

[ Get This Free Download: Your 10 Toughest Discipline Dilemmas – Solved! ]

In this model, caregivers are problem solvers, not behavior modifiers.

2. Problem solving is collaborative, not unilateral.

Solving problems is something you’re doing with your child rather than to him. In traditional discipline models, adults often decide the solution and then impose it on a child – especially when the child is exhibiting challenging behaviors that need to stop now.

Instead, position yourself as your child’s partner. Generally, children are delighted to give input and signoff on ideas designed to solve the problem.

3. Problem solving is proactive, not emergent.

Solving problem behavior is all about timing. An intervention should not occur reactively, in the heat of the moment. It should be planned and implemented before the outburst occurs.

[ Click to Read: 10 Tips for Dealing with an Explosive Child ]

Kids typically don’t blow up or melt down out of the blue. Many parents and clinicians spend their time trying to answer “whats.” What disorder is my child showing symptoms of? What underlying condition could this behavior indicate? These questions could lead to a diagnosis, which can be helpful.

But, they don’t answer the more important questions of why and when is this kid experiencing problems? These two questions can help caregivers understand the root cause of the problem.

4. Understanding precedes helping.

There is no shortage of diagnostic categories used to explain difficult behavior, but only two descriptions really matter: Children are either lucky or unlucky in how they communicate the difficulties they face with meeting expectations.

Lucky communicators do the following:

• Use their words

These ways of communicating rarely get a child put in time out, deprived of privileges, or in trouble at school . They often elicit empathy from caregivers.

Unlucky communicators do the following:

These behaviors are likely to result in a timeout, detention, or suspension, and are far less likely to elicit empathy from caregivers.

Challenging kids are challenging because they lack the skills to communicate in a way that is not challenging.

Caregivers take a giant leap forward when they come to view a child’s difficulties through the prism of lagging skills and unsolved problems. Compassion starts to shine through.

They stop saying things like:

• “He’s pushing my buttons.”
• “He’s making bad choices.”
• “He could do it if he tried.”

Instead they say, “He’s lacking skills. There are expectations he is having difficulty meeting.”

5. Kids do well if they can.

All children want to do well, and they will if it’s possible. If they aren’t doing well, then something must be getting in the way.

The biggest favor a potential helper (a parent, educator, or mental health professional) can do for an unlucky kid is to finally figure out what is getting in his or her way:

• What are the child’s lagging skills?
• What expectations is the child having trouble meeting?
• What are his unsolved problems?

This is a very different mentality from, “kids do well if they want to.” There are a lot of clichés applied to unlucky kids to justify the belief that they want to do poorly: attention seeking, manipulative, coercive, unmotivated, limit testing. They are not true; they simply justify the belief that the child doesn’t want to succeed.

6. Doing well is preferable.

The difference between a lucky kid and an unlucky kid is not that the well-behaved child wants to do well and the poorly behaved child doesn’t. Unlucky kids often want to do well even more than well-behaved, lucky children; you can tell because they are working so hard trying to get there.

Some kids have been so over-corrected and over-punished for so long that they decide doing well is not in the cards for them. When parents or caregivers apply these six key themes, they often find hiding under all of the behavioral challenges a child who always wanted to succeed, but was just having a really hard time getting there.

[ Get This Free Download: 13 Parenting Strategies for ADHD Kids ]

This advice came from “Beyond Rewards & Consequences: A Better Parenting Strategy for Teens with ADHD and ODD,” ADDitude webinar lead by Ross W. Greene, Ph.D., in June 2018 that is now available for free replay here .

Ross W. Greene, Ph.D. , is a member of ADDitude’s  ADHD Medical Review Panel .

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Helping the Behaviorally Challenging Child

Compliance is about Skill, Not Will

(714) 695-1057

There's much to see and learn here. Please, take your time, look around, and learn all there is to know about HBCC. We hope you enjoy our site and take a moment to drop us a line, take a training, attend a support group or champion rethinking challenging behaviors with us.

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Frequently asked questions.

Reach out to us at [email protected] or leave a message @ 714-695-1057

HBCC teaches a revolutionary, social, skill-building , evidence-based approach that promotes the understanding that challenging kids lack the skill, not the will, to behave well. Through coaching, training, therapy, parent support and referrals to services that support connection, collaboration and inclusion. HBCC champions rethinking challenging behaviors beyond the medical model, into the social model, and amazing results are happening. 

Social Model Thinking        

• Child is valued
• Strengths and needs defined by self & others
• Identify barriers and develop solutions
• Outcome based programs designed  
• Resources are made readily available to ordinary services
• Training includes parents
• Relationships nurtured
• Society evolves
• Child included
• Diversity welcomed   
• Professionals re-trained

Medical Model Thinking

• Child is faulty, needs fixing
• Diagnosis focused
• Impairment becomes focus of attention
• Monitoring and behavior modification therapy imposed
• Segregated and alternative services
• Ordinary needs put on hold
• Society remains unchanged 
• Re-entry conditional 
• Permanent exclusion if non-compliant
• Conventional training utilized

Classes Alternate from  

• Weekday Evenings 7pm - 9pm
• Weekday Mornings 10am - Noon
• Saturday Mornings 10am - Noon
• 6-weeks in length
• 2 hours each session (w/5 min break)
• Each class builds on the previous weeks class
• Tustin continuously and on-going
• Chino Hills frequently
• South Orange County occasionally
• Pasadena (soon) 

No. The ideal is that both parents take the class. It may not always be possible to take the class together due to childcare, etc. Each parent can attend their own class series, depending on schedules. Discounts apply whenever taking the course for the same child.

Single parents taking the course are encouraged to build a community of supporters. It is highly beneficial to hear the approach firsthand, so grandparents, caregivers, stepparents and significant others are all encouraged to take the course when it works for their schedules.

Yes, HBCC also hosts trainings for educators and professionals.  HBCCs primarily provides support, coaching and trainings for parents, guardians and caregivers. To bring Educators & Parents Together as Allies we have an Educator/Clinician Committee that is peer-to-peer and provides trainings and support. Please go to the Educators Clinicians Trainings section of this website.   

The parenting class at HBCC is in-person and limited to 10 families per class. Parents, caregivers and guardians appreciate the company of being with others going through a similar situation in-person. They find out they are not alone! There are options for online trainings, please call or email us regarding those options if online is what you want.

The course includes:

• a weekly digital PowerPoint
• parent handouts
• weekly worksheets
• step-by-step guidance
• weekly email summaries
• parent coaching during class
• optional: follow-up coaching at the end of the course

Yes, HBCC provides parent behavior coaching during the course and/or after the course. Someone can work with you individually or group coaching. 

A Road Map for Parents

Parents, Do You...

• Have a child with concerning behaviors, such as aggression, tantrums or defiance?
• Attempt to discipline your child, only to end up arguing or engaged in a power struggle?
• Feel overwhelmed or exhausted by the demands of parenting a neurodivergent child?
• Feel like you've tried "everything," wondering why rewards & consequences haven't worked?
• Notice your child becoming academically or socially disengaged, not wanting to go to school?
• Get calls from school about your child's behavior?
• Experience guilt, shame, or doubt about your parenting?
• Struggle to manage your own emotional response to your child's challenging behavior?

Children with concerning and challenging behaviors are often misunderstood.

Myth: Children with challenging behavior are unmotivated, attention-seeking, lazy, out-of-control, poorly parented or defiant.

Fact: Children with challenging behaviors often have diagnosed or undiagnosed neurological, developmental, or learning differences. Many have behavioral health challenges or Adverse Childhood Experiences (ACEs). Sometimes just the way the world responds to challenging behaviors is an ACE. Children of the families we serve often have a diagnosis that may include ADHD, ASD, Dyslexia, Anxiety, Depression, DMDD, ODD, Attachment Disorder, etc. Some have no diagnosis at all. The good news? The approach we teach is appropriate for EVERY child, youth and young adult.

Compliance is about skill, not will.

HBCC programs are grounded in the Collaborative Problem Solving ® (CPS) approach.  CPS is owned and developed by Think:kids, a program in the Department of Psychiatry at Massachusetts General Hospital in Boston.

CPS leads to significant positive outcomes including:

• Reductions in challenging behavior
• Reductions in adult-child stress
• Improved adult-child relationships
• Improved problem-solving skills

The Road Map for parenting, teaching and treating children, teens, and young adults with concerning, difficult-to-manage behaviors, developmental challenges and/or mental health concerns can be overwhelming for parents.

Simply speaking, you know something's wrong, but you don't know why or what to do about it. You feel stressed, angry, confused, even scared. You reach out to professionals and find that their language is filled with long unfamiliar terms, and you get advice on approaches that haven't worked or make matters worse. Even professionals and educators don't always know what to do beyond a Token Economy based on behavior charts filled with rewards, consequences and ignoring based on a Behavior Management approach. 

The Token Economy based approach works for a large majority of kids -- kids who have the ability to be thoughtful, flexible, and intentional with their behaviors -- but this Behavior Management approach doesn't work for kids who struggle with emotional regulation, flexibility and problem solving. No matter no matter how consistently you implement a reward system, set boundaries, and impose consequences, temperatures continue to rise with this population.

You may find that the standard conventional approach is like pouring gas on a fire when you remind your child of consequences, or equally stressful, like pouring salt on a wound when they don't get the reward - yet again.

Emotional dysregulation is increasingly recognized as a challenge for many children and teens. No longer considered just "bad behavior", it's clear that staying in control can be a struggle for some youth despite their best intentions.  But what is a parent to do?  Expectations still have to be met, right?

The answer is 100% right !  When kids are dysregulated, parents can become dysregulated, and families are often thrown into chaos.  Parents describe "walking on eggshells" or "feeling held hostage" in their efforts to manage challenging behaviors and find moments of calm.

CPS can't make impossible possible however it can make the possible more possible.

Some of you have spent years frustrated, chasing down services, being told you are doing the intervention wrong – instead of being told you are using the WRONG intervention .

You don't want to use a shovel, when you need a wheel.

The decade of the brain and the new neuroscience confirms an evidence-based, skill-building, truly trauma-informed, social-emotional, inclusive approach like CPS is what is needed.  

Give your child and yourself the equity you deserve! 

It helps to know a bit about what factors contribute to the development of good regulation -- that's why Helping the Behaviorally Challenging Child (HBCC) was founded.

As Parent Coaches we take you on a journey to understand what is going on, what has typically been done about it, why that isn't working and how to help your child keep their behavior within an acceptable range, communicate and express their feelings, develop executive function, cognitive flexibility, and social skills.

Wanting answers to resolve the challenging situation in your life is not too much to ask and it shouldn't be so difficult to find options other than a behavior modification system using a token economy of rewards, consequences and ignoring "bad" behavior. 

If the "behavior modification" approach is NOT working, it is often blamed on the parent's implementation as the reason why the approach is not working.

Parents hear over and over...

• "be consistent"
• "follow through with consequences"
• "set boundaries"
• "let your child know they may not get away with bad behaviors"
• "tell them to make good choices" 
•  "tell your child NO firmly and stick to it" 
•  "use a sticker chart to motivate your child" 

These are simplified statements to a complicated issue because rewards, consequences and ignoring were never meant to teach complex thinking skills -- a token economy is an extrinsic motivator for a child who has access to skills that allow them to think about what sets them off and consider expectations, rules and personal goals. That is why conventional parenting advice works for so many ... but not a child with chronic challenging behaviors .... your child is that left-handed child in a right-handed world.  While the majority of kids are right-handed your left-handed child deserves to be taught skills about flexibility, working memory and the ability to monitor their own feelings and behavior so they can develop good reasoning, planning and organizational skills.

Discipline without relationship leads to rebellion. 

HBCC helps parents, caregivers and family members with a Road Map that makes a tough job easier!  

HBCC has grown over the years and is now composed of multiple CPS Certified individuals who are committed to helping transform children's lives by deepening their world's understanding of their behaviors and promoting effective interventions that focus on connection, collaboration, and inclusion.

As Certified Collaborative Problem Solving(CPS)® parent coaches and mentors, we are here to help you become your child’s Case Manager to confidently understand the road you are traveling and what your choices are to maximize the potential of your child and the entire family.  

CPS is based on the premise that challenging behaviors occur when demands and expectations exceed one's capacity to respond appropriately.  

HBCCs founder has presented this course on Helping the Behaviorally Challenging Child since 2007, reaching thousands of parents. She was that challenging kid herself!  She and her husband have two boys, 21 months apart. One is neurodivergent and the other is neurotypical.  

HBCC has learned from each and every family that has participated in the course over the many years and one thing that is predictable across all families: their challenging child’s behaviors are being misunderstood and it’s time to STOP blaming parenting as the reason for non-compliance and START applying what neuroscience knows about lagging skills that leads to challenging behaviors.   

Challenging behaviors such as swearing, blurting out, yelling, avoiding, eloping, not sitting still, refusal, etc., not only frustrate adults, but challenging children are also punished chronically for their developmental delays and lagging skills with an intense program of rewards, consequences and ignoring which is exhaustingly for everyone. 

If a child could do well, they would do well! 

Let HBCC help you on a journey to understanding your challenging child through a compassionate, collaborative, social emotional learning lens! 

HBCC’s curriculum has been fine-tuned across the years in response to parent input to help YOU get results. 

HBCC follows up Parenting Classes with Parent Coaching to help you navigate the Sea of Options with Coaching, Training & Therapy.

HBCC offers a monthly Support Club for Women & Men to grow together in this grassroots movement. 

HBCC is located in the heart of Old Town Tustin, in the Heart 4 Kids Coaching, Training & Therapy Building .

There are mental health educators, school support advocates, therapists, psychiatrists, clinical psychologists and more in HBCC's educator/clinician trained community. More and more parents are asking for trained CPS professionals everyday so more and more services providers are being trained in this approach that understands, follows and incorporates the Collaborative Problem Solving(CPS)® approach.

HBCC helps you find and build your team.

If you have made it this far, this information is most likely speaking to YOU!

Parents have little time to take a parenting class. Especially when so many parenting classes have failed them, taking another one can seem like a waste of precious time. Don't quit before the miracle! 

HBCC IS YOUR ANSWER -- glad you found us!

The journey to a healthier happier life begins with YOU taking the first step and signing up for a parenting course!   

(Week 1) What is getting in the way?  Why do challenging children sometimes struggle to meet day-to-day expectations.  What has typically been done about what is getting in the way? 

(Week 2) What are the Five Thinking Skills needed to meet expectations? What is Collaborative Problem Solving®(CPS) ?

(Week 3) What are the unsolved problems behind the behaviors?  Dives into Collaborative Problem Solving and the 3 options for responding to unmet expectations. 

(Week 4) Looks through a truly trauma-informed lens to cover how to practice addressing problems proactively - before things become escalated between you and your child.  How CPS reduces challenging behaviors, improves relationships and teaches critical skills.

(Week 5) Practice what you've learned through watching roll playing moderated in the class setting. 

(Week 6) Wraps up the course with an in-depth Q&A, videos, role playing and more videos.

Are you looking to:

• Reduce meltdowns & defiance?
• Stop the power struggles?
• Teach lagging thinking skills, durably?
• End the chronic noncompliance?
• Solve unsolved problems?
• Improve communication?
• Build connection?

HBCC offers:

• 6-week in-person Parenting Classes
• Monthly Parent Support Club for Women & Men
• On-going Parent Coaching & Mentoring
• 2-Hour Overview
• On-going workshops
• CPS Advocacy to Bring Parents & Educators Together as Allies 

Educator/Clinician Trainings

• Parents ask "who is going to train the educators/clinicians?
• Educators/Clinicians ask "who is going to train the parent? 
• See the Educator/Clinician Training Tab on the menu bar above

HBCC can help you climb what may seem like an impossible mountain!

If this describes YOUR situation, please take the time to watch the videos provided below and explore this website some more.

What is Collaborative Problem Solving®?

Collaborative Problem Solving®(CPS) is an evidence-based approach developed by Think:Kids, a program based in the Department of Psychiatry at Massachusetts General Hospital in Boston, MA.

CPS is a big shift when it comes to understanding your child's challenging behaviors and what to do about it.

CPS is proven to reduce challenging behavior, increase compliance, improve family relationships and help your child build the skills they lack. 

www.thinkkids.org 

HBCCs Story

Take a moment and listen to the story from the Founder and CEO of HBCC, Debra Ann Afarian -- be sure to watch to the end, past the credits.

New Possibilities In Parenting

What if behavioral challenges are about something completely different than what you think they are? Mara James of Extraordinary Lives Foundation (ELF) interviews HBCC founder, Debra Ann Afarian on her "Let's Talk Wellness" podcast.  Debra Ann shares her powerful story and how it inspired her to help other parents understand and empower their children. 

Inspirational Interview

Jill Stowell of Stowell Learning Center speaks with HBCC Founder, Debra Ann Afarian, who has a message of experience, strength and hope!

Key Points:

✔️ A child's challenging behaviors are NOT the parents' fault.

✔️ Practical guidance for meeting your child exactly where they are. 

✔️ Compassionately move your child to a place of self-control & success. 

✔️ Learn how to stop the adult/child power struggles & implement Collaborative Problem Solving®. 

Trainings in Collaborative Problem Solving®

Cps certified coaches & mentors.

HBCC provides an effective, evidence-based, parent/caregiver classes where you will learn how to partner with your child to identify the triggers for their challenging behavior and work together to produce a game plan for how to handle problems BEFORE they happen.  Take the first step to reduce adult/child power struggles and conflict today by signing up for a parenting/caregiver class or join our FREE monthly support club or call for a FREE consultation with an HBCC Think:Kids Certified CPS® Parent Coach or Mentor to learn more or do all of these!  

CPS strengthens relationships and teaches skills! 

#HBCC #CuriousNotFurious #PraiseApproximationToTheGoal #IncrementsEveryoneCanHandle #CPSapproach #SkillNotWill #2e #KidsDoWellifTheyCan #ChildBehavior #BehaviorManagement #MentalHealthAwareness #ADHDawareness #ADHDsupport #neurodiversity #SmartAndQuirky #ADHDparenting #DisciplineWithoutRelationshipLeadsToRebellion

#ASDparenting #ASDsupport #ASDawareness #ChallengingBehaviors 

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145 W. Main Street, Suite 260, Tustin, California 92780

 Helping the Behaviorally Challenging Child (HBCC) is a California Nonprofit Public Benefit Corporation whose mission is to enable children experiencing behavioral health challenges to lead more productive and inclusive lives.  We work to transform these children's lives by deepening adults’ understanding of their behaviors, and promoting effective interventions that focus on connectedness, collaboration, and inclusion. 

© 2024 Helping the Behaviorally Challenging Child 501(c)(3)

Non-Profit I.D. #46-3240447 - All Rights Reserved.

Contact Us @ (714) 695-1057 or [email protected]