Behavior problems (e.g., noncompliance, aggressive behaviors) or problems with emotion regulation (e.g., tantrums) are arguably the most common reasons parents bring their children to treatment. The severity of these behaviors often results in diagnostic labels such as Oppositional Defiant Disorder (ODD), Intermittent Explosive Disorder, Conduct Disorder, or ADHD. Unfortunately, children with these behaviors also are often labeled as "bad children," wearing out even empathic caregivers, teachers and other adults and resulting in more angry, reactive behaviors from the adults.
The most common empirically supported treatments (ESTs) used to help children with severe behavioral problems are Parent Management treatments (e.g., Parent-Child Interaction Training (PCIT; Sheila Eyberg), Helping the Noncompliant Child (Nicholas Long & Rex Forehand), and Defiant Children (Russell Barkley)). These treatments have shown efficacy in many randomized controlled trials and are hypothesized to work through their use of behavioral principles (e.g., rewards, positive attention, and sometimes punishment). Though these treatments are largely successful, there are still many children who do not respond to Parent Management treatments.
Over the last ten years, doctors Ross Greene and Stuart Ablon have developed a new approach for treating these children called the Collaborative Problem Solving (CPS) approach (described in their 2006 book Treating Explosive Kids). Greene and Ablon's approach is not based on the assumption that children have "learned" to misbehave or the assumption that they intend to defy adults. Instead, they assume that behavior/emotion regulation problems in children are the result of "lagging cognitive skills" (http://thinkkids.org) or deficits in executive functions. Executive functions are functions modulated primarily by the frontal cortex and they allow people to plan, think critically, solve problems, pay attention, transition between tasks, etc. Thus, the CPS approach assumes that children behave well if they can, and that when behavior problems occur, they occur because the child is frustrated by not being able to complete required tasks...or simply because they don't understand the expectations adults have for them!
Greene and Ablon stress that we must "rethink children." We need to realize they are unable to meet expected standards rather than assuming they are simply non-compliant. The CPS approach emphasizes showing empathy toward a child when he or she encounters a "trigger" (or events that generally lead to noncompliance/a temper tantrum) and collaborating with the child to resolve problems. Therefore, those who use CPS are encouraged to figure out a child's trigger(s) so they can prevent noncompliance or meltdowns by using problem-solving. While often conceptualized as a cognitive approach, CPS depends upon the capacity to form, manage and maintain well-regulated, empathic relationships.
There are three main goals of CPS (Greene, Ablon, & Martin, 2006): first, help adults figure out which cognitive deficiencies are contributing to behavior problems; second, help adults recognize "three common options for handling problems" (pg. 611); and third, help parents and children learn to solve problems collaboratively. Greene et al. suggest that most parents either impose their will ("Plan A") or give in ("Plan C") to solve problems. Greene et al. recognize that Plans A and C sometimes work but suggest that Plan B works best. Plan B involves a parent or caregiver being able to recognize times when a child is prone to be difficult, empathize with the child, and then ask the child for input on how to make difficult situations less problematic.
CPS is a relatively new approach. However, current research (including a randomized controlled trial; Greene et. al., 2004) suggests that CPS is just as effective as Parent Management techniques, if not more effective in some regards (e.g., long term treatment effects). Based on the current level of research on this approach, CPS can at least be regarded as "possibly" or "probably" efficacious based on Chambless and Hollon's (1998) system of classifying empirically supported treatments. A set of very positive outcomes have resulted in a variety of settings where CPS has been implemented.
Check out the Collaborative Problem Solving website, where you can find the articles referenced above plus many more resources:
http://thinkkids.org
References:
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal
of Consulting and Clinical Psychology, 66(1), 7-18.
Greene, R. W., Ablon, J. S., & Martin, A. (2007). Use of collaborative problem solving to
reduce seclusion and restrain in child and adolescent inpatient units. Psychiatric
Services, 57(5), 610-612.
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, 72(6), 1157-1164.
Redistributed from childtraumaacademy.org e-Newsletter
