Sunday, January 30, 2011

Validate needs , not feelings

In the moment is generally not a good time for solving problems, but often we can do more than just distracting the child or helping him to calm down. If we can make a child feel understood and validate his needs, we can get the collaborative problem solving process going.

This is the experience of a mom.

'When I have my wits about me (which is rarely), I have noticed that she is more willing and able to hear me if I have made a connection with her BEFORE I give her advice or impose limits. Somehow, if we reach a state of agreement first, it makes it easier for her to accept whatever conditions come next. For example, if she is trying to grab a toy out of my 2 year olds hands, if I tell her not to, I always encounter resistance (to put it mildly). But if I begin with asking, "is that one of your favorite toys that he has? Is that one hard for you to share?" and she answers yes, it somehow puts us on the same page, and makes room for the conversation to continue. It's as if she realizes that I can see her point of view, so she becomes willing to consider mine, and maybe even her little brother's.

If someone is getting hurt, I do the same thing, but with my body between them, so they don't have physical access to each other until after we have come to some understanding.'

Problem solving approaches have talked about validating feelings - I see that you are angry , upset , frustrated when your sister …. Etc . When we show validate feelings in the empathy stage of cps we can actually trigger more anger and upset. Talking about feelings can be valuable in problem solving only in that it helps us externalize our feelings, put them aside and then start solving problems. Feelings cannot contribute to problem solving. Naming of feelings is part of the process where we convert emotional expression into thinking.

' Children can feel in control of themselves and their world when they can use words and describe how they are feeling. If a kid has a vocabulary that describes a full range of emotions he is in more of a position to describe how he is feeling. Many kids when asked how they feel say things like ' good, terrific, bad, awful, or terrible. Very few answer ' happy, sad, frustrated, or afraid. When a kid names his feeling ' I am frustrated ' , he then continues to give the reason – I am frustrated because I have an unmet need, concern etc , he is then in a position to actually do something about it. A child might do something different if he feels sad than if he feels frustrated. Just thinking he feels ' bad, terrible or awful will not help him make an informed decision about his next step. ' - Myrna Shure Thinking parent, Thinking Child

If a kid can identify his needs and concerns we can by-pass the naming of feelings stage. What is important is his needs and concerns. We can solve problems if we can help him articulate his concerns and put them on the table.

Out of the moment - Talking with children about feelings and emotions is important. We can talk about ' what makes me happy , what do you think makes your sister happy , sad , angry , frustrated , disappointed etc This helps kids to consider other peoples' views and feelings.

In the moment , when a kid is struggling with the emotional rush , naming emotions can actually give fuel to them.

So instead of validating feelings, validate concerns and needs.


Wednesday, January 26, 2011

Low Expressed Emotion , Cortisol and weight management

In a previous post I discussed how CPS - collaborative problem solving is conducive to having LEE - low expressed emotion and lowering stress levels.

Low expressed emotion -LEE

LEE is pretty important when it comes to weight management and dieting.

Here is info on how 'cortisol ' effects weight gain.

' Cortisol is a hormone, produced by the adrenal gland when the body is under stress. Your hypothalamus, via the pituitary gland, directs the adrenal glands to secrete both cortisol and adrenaline. Cortisol is released as part of your daily hormonal cycle, but both hormones can also be released in reaction to perceived stress -- both physical and emotional – as part of the body’s fight-or-flight response that is essential for survival. Adrenaline makes you energetic and alert, and increases metabolism. It also helps fat cells to release energy. Cortisol helps your body become even more effective at producing glucose from proteins, and is designed to help quickly increase the body’s energy in times of stress.

It’s not the classic fight-or-flight stress that’s thought to cause weight problems, because in those situations, a stressful event is quickly resolved, and the cortisol released is absorbed into our systems, aided by the increased circulation provided by a pounding heart.

Instead, some experts now believe that the problem for many of us is being in a constant state of stress, for various reasons. This leads to a constant state of excess cortisol production. Excess cortisol stimulates glucose production. This excess glucose then typically is converted into fat, ending up as stored fat.

There are a number of research studies that have shown that fat cells can, in the presence of too much adrenaline, become resistant to the effects of adrenaline. Eventually, the fat cells become unresponsive to adrenal stimulation to release fat, but through the presence of high cortisol, they’re more responsive to fat storage. At the same time, high levels of circulating cortisol increase the risk of obesity and increased fat storage -- and particularly, abdominal obesity, one of the most dangerous types of obesity, and one that contributes to an increased risk of metabolic syndrome, diabetes, and heart disease'

Tuesday, January 18, 2011

Getting stuck on the Empathy stage of Plan B

Plan B – working with the child in a collaborative way can meet with many challenges on the way , especially in the first step , getting started with the empathy-information gathering stage. The parent introduces the topic with a neutral observation saying ' I have noticed when , that etc ………, what's up. The kid's response of I don't know, silence or I don't want to talk about it can be very unsettling.

When a child says ' I don't know ' , we can try to clarify what this means. Does 'I don't know ' mean - you have some ideas of what is bothering you or what your concerns are but you are having difficulty in finding the words to say it. ? Your child may have difficulty in communicating her concerns because of lagging language processing skills.

Other possibilities of why your child is not responding to the ' what's up question.

It could be that in the past kids have had their concerns ignored and therefore don't have the experience or skills to put their concerns on the table or they have not given it much time or thought. Kids concerns are generally not on the tip of their tongues.

Silence may indicate that they need more time to think. So make them feel comfortable about taking their time, rather than immediately making tentative suggestions or asking questions.

In many instances we have been too vague and general in presenting the unsolved problem, so the child isn't exactly sure what you are trying to get information about. We need to be very specific and give as many details as possible when describing the problem.

The neutral part of the empathy step may have not been very neutral and sounded too much like Plan A , an attempt to impose your solution.

Your kid may think that you are mad at her and she needs a reassurance that you are not. You also want to reassure her that you don't want to impose your solution or force her to comply with your wishes. We can say ' I am not mad at you , I am not going to force you to do anything , I just want to hear your concerns, get your side of the story, hear your perspective '. Sometimes stepping back allows the child to come forward , similar to dancing with a partner. You step back allows your partner to step forward.

We may using Plan B in the moment , emergently rather than proactively. There is little chance of gathering information when there are fireworks, tension , emotional baggage and conflict.

Your child may not yet trust the process and feel that Plan B is just Plan A under a guise of Plan B. The child needs to trust that the process will serve his interests and solve problems to his satisfaction.

It is best to ' connect', enter the child's the world and get a conversation going before getting into Plan B. Conversation that involves sharing feelings about general non-emotive stuff , perspective taking etc .We can reflect on something positive about the child, engage in dialog that shows we understand him and he acknowledges this with a 'yes' answer. We should be in a position we a kid feels good about himself and the relationship with his parent. Doing this over a snack or a treat , giving the process an association of joy can help and open up the child.

If your child is getting stuck we can request permission to ask a few questions. ' If it Ok with you ' we can try and get your perspective on the table by me asking a few questions. All you need to do is answer , yes or know , is this OK ? And we can drill down from there.


Monday, January 17, 2011

Joe Bower , Barry Schwartz , Diana laufenberg on education

A short Ted talk to share with parents and teachers
Education is about learning what to do with information , not just getting information and of course seeing ' mistakes as our friends ' , opportunities for learning.

CPS - collaborative problem solving gives kids a voice to express how they want to impact on the world in a socio-moral way.

I commented on  2 blogs     -  competiton  , measurable outcomes

I shared also a Barry Schwartz Ted talk showing the need to move away from rules and incentives and focus on intuitive wisdom and collaboratibe problem solving


Tuesday, January 11, 2011

Social Skills Training and ADHD

The 2 major studies of treatments for children with ADHD - the MTA study and Abikoff et al have raised serious doubts whether there is any advantage of adding behavioral therapy and social skills training to a well managed medication treatment plan. Children did benefit from all treatments, but there was no advantage of a combined medication and behavioral treatment plan over medication management alone. Alternative outcome analyses of the MTA study , however show that there is a small but significant advantage of combined medication and behavior treatment plans over medication alone. They also note , that parents whose children who received the combined treatment were more satisfied with the treatment than parents who received medication management alone , despite the fact that there were no differences between the groups on child outcomes . Medication and behavior therapies offered in the community were significantly less effective than treatments offered by the studies. This means that efforts must be made to improve medication treatments and behavior therapies offered in the community and a multi-modal approach including many strategies is the best option.

According to Abikoff , medication only helped to reduce negative behaviors but did not enhance positive pro-social behavior. Gains were only maintained while on medication with no gains after an initial improvement. There was also a decline in pro-social behaviors over time consistent with the general population.

In a review of Social skills training with children and young people , Spence – 2003, says that research suggests that SST alone – instruction, modeling, role play , feedback , reinforcement used in association with interpersonal problem solving and social perception skills - is unlikely to produce generalization of skills and significant and long lasting change in social skills and competence. Rather SST is just an important component of multi-method approaches to treatment of emotional, behavioral and developmental disorders including cognitive restructuring, self and emotional regulation methods and contingency management.

To my surprise , selected literature reviews of Interpersonal Cognitive problem solving approaches showed that ICPS had little or no impact on children's behavior. My understanding is that social skills are really based on interpersonal skills. ICPS and CPS –collaborative problem solving promote the language of problem solving , the ability to ask questions which are the foundations of communication, thinking and emotional regulation skills.

The Webster-Stratton et al study of 4-8 year old using the Dinosaur Child Social Skills and Problem Solving training program was successful in improving children's behavior over a spectrum of disorders including ADHD. Webster says that these findings are significant in the light of recent literature that suggests that cognitive- behavioral treatments do not provide significant changes in behavior. Children in the MTA study were older than the kids in her study - 8 years and older as opposed to 4-8 years old. She suggests that treating kids in the 'preoperational stage of thinking before negative thinking , behavioral interactions and reputations have been stabilized yields better responses to behavioral treatments.

While medication continues to play an important role for chronic key ADHD symptoms such as impulsiveness, hyperactivity and inattention ,medication should not be seen as a long term treatment goal and every attempt should be made to reduce dosages by combining medication with behavioral therapies with the ultimate goal of eliminating medication. Seeing ADHD as purely a medical problem pathologizes the child and therefore often obscures the fact that challenging behavior in kids is a complex, transactional phenomenon also involving the child’s interaction partners and environments and therefore underestimates the importance of care givers being trained , so that they contribute to the development of lacking cognitive skills and respond in an appropriate manner .

Back in the 50s, a prominent psychiatrist named Thomas Szasz characterized psychopathology as “problems in living.” ADHD kids have difficulty in handling frustration and demands placed upon their need for flexibility and adaptability. They display many skill deficits -in the main executive functions = planning , sense of time , separation of affect etc , but also language processing skills, social skills, emotional regulation skills and cognitive flexibility . Medication does not teach skills , but enables the child to benefit from learning and give him those extra seconds to process information and be in a better mood.

As mentioned above medication does not enhance pro-social behavior . Medication does not cure ADHD but merely compensates for developmental delays. The cure for ADHD or at least less reliance on medication is likely to come from changes in the brain , the formation of more and more neuron transmitters in the frontal lobes of the brain , a process acknowledges the neuroplasticity of the brain. Dr Gimpel , the author of the book ' How to cure ADHD ' says that BET , brain exercise therapy and CPS – collaborative problem solving effects changes in the brain because they involve cognitive behavior. According to Gimpel ADHD is a cognitive disability , not a behavioral problem . This is the reason that contingency management and behavior modification don't help or at best as Russel Barkley says just compensates for the kid lack of intrinsic motivation and don't help skills to generalize to other areas.

The question I want to answer is why has SST and interpersonal cognitive problem solving ICPS in the selective literature has proved to be not very effective.

In an article Social Problem-Solving can help children with ADHD (2007) Shure and Aberson conclude that for internalization and generalization of newly acquired skills to other settings caregivers – parents , teachers etc need to be the primary teachers of ICPS , the parenting approach is unconditional using problem solving rather than behavior modification and contingency management in the form of rewards, praise and consequences , and the dialog between themselves and children focuses on perspective taking , consequential thinking etc , the language of problem solving.

Research conducted in the 1970s and 1980s before ADHD was widely diagnosed , showed that many kids who displayed symptoms of ADHD benefitted from the ICPS programs when conducted together with parents rather in clinical settings satisfying the conditions mentioned above.

In the last 10 years the collaborative problem solving approach CPS created Dr Ross Greene has become a very popular treatment strategy for kids lacking cognitive skills and who may also have various diagnoses including ADHD. The philosophy is that children do well if they can . Children would prefer to be successful and act adaptively. Their inappropriate behavior describes a situation where the demands for skills of frustration tolerance , flexibility and adaptability outstrip their coping skills. They do not lack motivation but lack skills . Using behavior modification to ' make them wanna act good ' won't help. They are already motivated to do well and the most satisfying reward is being successful. These kids ( all kids) don't need rewards.

The teaching of skills is individualized for the particular child. It involves collaboratively solving real problems rather than teaching skills in a top-down manner . The initial focus is assuring the kid that he is not in trouble , that adults are not interested in imposing their solution and trying to get his concerns and perspectives on the table. The parent then puts his concerns on the table and defines the problem. Then the parent invites the child to engage in brain storming to come up with mutually satisfying solutions that are doable, durable and realistic , and also agreeing to review the situation. In this way real problems are solved , various cognitive skills are acquired and the relationship and trust between care givers and child enhanced.

According to researchers Deci and Ryan quoted at length in Alfie Kohn's book Punished by rewards kids become intrinsically motivated , internalize and integrate values , become active learners and competent when they are self determined . This is facilitated when their autonomy is supported , and they experience supportive and unconditional caring from peers and care givers whom they trust and helped to become competent .

CPS and ICPS support the child's autonomy – that his actions are expressions of his inner being , promote competence as the child is acquiring crucial life skills , and ' relatedness ' – a trusting relationship with caregivers and peers.

Behavioral and social skills treatment programs are characterized by the top-down learning of skills in a classroom accompanied by a behavior modification program with the use of mainly rewards and sometimes consequences. There is no collaboration with kids and their concerns are often ignored. Kids bring report s home of their behavior in school and a similar report is done for behavior in the home. Parental and teacher responses to the report and to behavior in the home and school usually takes the form of criticism, punishment, reward, praise or lecture. The child then experiences acceptance contingent on his academic performance or behavior. Instead of furthering learning and discussion and reinforcing skills , rewards or verbal praise stop the process , the kid is left with a feeling of being judged and the lessons are lost.

The researchers Deci and Ryan have shown that extrinsic motivation even in the form of rewards and praise undermine intrinsic motivation and interest in activities. Rewards can even set up kids for failure , causing the very behaviors they are targeting because kids feel pressured, anxious and controlled. Kids fail to integrate values because they come to believe that they only do good things because of the reward , known as the over-justification effect.    'In a troubling study conducted by Joan Grusec at the University of Toronto, young children who were frequently praised for displays of generosity tended to be slightly less generous on an everyday basis than other children were. Every time they had heard "Good sharing!" or "I’m so proud of you for helping," they became a little less interested in sharing or helping. Those actions came to be seen not as something valuable in their own right but as something they had to do to get that reaction again from an adult. Generosity became a means to an end. Praise and rewards really foster anti-social behavior because they teach the kid to ask what will I get or what will be done to me , what’s in it for me if I do ….. or don't do etc. According to Carl Rogers children who are conditionally accepted begin to view themselves in a negative light. When kids view themselves as essentially good people , they are empowered to act in a pro-social way. The use of rewards sends these kids a message that you don't trust them to succeed or act altruistic without being bribed to be generous or caring.'  - Alfie Kohn

Another reason why social skills training is unsuccessful is that social skills are taught ,' but not the traits of generosity , caring and altruism. Schools are rather competitive with no cooperative learning , kids ranked one against another, and academic and sports achievement glorified with award ceremonies. Schools themselves are under pressure of high stakes standardized testing and little time is left for promoting socio-moral learning or building a caring community of learners. We can't expect kids to internalize conflict resolution skills and values of community when the ' structure ' of school - the competitive nature and zero tolerance discipline policies go against collaborative solving of problems and cooperative learning needed to create a caring community of learners. In fact , since the introduction of zero tolerance discipline policies behavior problems have increased and kids feel less safer in schools.

The finding that schools become less safe as a result of adopting zero-tolerance policies will sound paradoxical only to those readers who believe that threats and punishment can create safety. In reality, safety is put at risk by such an approach. A safe school environment is one where students are able to really know and trust – and be known and trusted by – adults. Those bonds, however, are ruptured by a system that’s about doing things to students who act inappropriately rather than working with them to solve problems. “The first casualty” of zero-tolerance policies “is the central, critical relationship between teacher and student, a relationship that is now being damaged or broken in favor of tough-sounding, impersonal, uniform procedures. ' –     Safety from the inside out - Alfie Kohn

In conclusion :  There are areas such as chronic impulsiveness and hyperactivity were medication is the most effective treatment but should not be the long term treatment goal. The fact that medication treatment in the community is not optimal is even more reason to improve social skills training. SST needs to be given to kids by caregivers – teachers and parents and modeled in an environment where problems are solved collaboratively rather than using reward, consequences and punishments. I think we need to examine the environment and make it more conducive to pro-social behavior , making school a learning community where kids and teachers care about one another instead of the competitive environment that prevails in schools.

Instead of teaching kids how to behave and giving them skills , we should focus more on understanding kids, seeing the world through their eyes and then helping them acquire skills.

The most valuable reward in teaching ( both academic and socio-moral learning )  is hearing a student say :

  '  Thank you for understanding me '

Thursday, January 6, 2011



This past week I was 'welcomed to the club' by friends who are already grandparents. It was wonderful to have a new family member , a little boy 3.556 kg , a pretty calm little fellow just like his father. (grandfather )

I heard it been suggested that we should first be grandparents and then parents. My understanding is that being a grandparent is all about bonding and relationship. I have seen how grandparents who get this right have a more respectful style of communication, ask questions , try to stimulate interest and curiosity and hear what the kid has to say , encourage him to express his opinion , give reasons for his choices, express motives behind behavior . The art of communication is in the listening . Grandparenting is being a good listener trying to see the world through the young kids eyes , and just directing conversation with dialog questions.

These grandparents understand that trust and bonding is the cornerstone of the relationship. Parents get it wrong by thinking that the relationship is about setting boundaries and limits, getting compliance and having control over the child. For many parents it takes time to realize that we are very much limited on how much we can control kids and even if we do succeed it is at a cost.

Alfie Kohn recommends that when we reflect on how we should respond to our kids , we should put the relationship first. This is the litmus test of any response - did any learning take place , was trust , bond and relationship enhanced . Sometimes we have to say No and make a decision that our kids are not so happy about , then we need to work very hard and securing and mending the relationship.

It is generally accepted that the reason that grandparents have a better relationship with kids than do parents is that they don't have to discipline or educate them. This is faulty thinking. Parenting is not a choice between authoritarian/authoritative or permissive approaches. In order to deal with issues or teach a kid , you don't have to make them feel bad. In any case feel-bad education might get short term compliance , but does not facilitate intragration and commitment to values. Because there is no emotional baggage in the relationship , grandparents are in a better position to deal with problems in a collaborative way and find solutions. Grandparents can set limits but the question is how do they do it? They invite the kid to participate in cps which results in a kid committed to the values underlying the boundary or limit.

One of the problems of parents having a ' united front ' against the kid is that we put obstacles in the way of dialog and communication. When one parent is struggling with a kid ,has reached a dead-end with emotions and tension a little high , the other parent can step in, and from a more neutral place continue to work with the child on the problem.

Grandparents can fill this role as well. Recently a dad gave a kid the ultimatum ' my way or the highway ' . His wife supported her husband. So like in war when a kid is faced with a ' united front ' , he had 2 options ' fight or flight ' , so he took off and went to his grandparents. If his grandparents would not have accepted him , he might have run off to friends . Even if he went back home and suffered the humiliation , his parents might have won the battle but have lost the war for the heart and trust of their son. Fortunately the grandparents were able to reconcile the kid with their parents and all learned an important lesson , that ' might' is not right , but just makes things worse.

I would like to end off with an answer given to what is so grand about grandparenting ?

In no particular order grandparenting is an opportunity to play, to 'fall in love' again, and to appreciate the magic of a developing mind. Grandparents can share the things they're passionate about with a new audience; see the world in a new way through younger eyes; experience music, nature, reading, gardening, theater and other interests in conjunction with a curious young mind.

And this is what collaborative problem solving is all about - appreciating the magic of a developing mind.

So the bottom line is – emulate grandparents and enjoy the magic of a developing mind.