Wednesday, August 1, 2012

The Explosive Child

Ross Greene is a doctor of psychology affiliated with Massachusetts General Hospital. He has created a non-profit organization designed at collaboratively working with families and schools to help improve the behavior of children who exhibit explosive and inflexible behavior. Information about his non profit is available at .  Dr. Greene gives many workshops on his approach including one on October 4, 2012 in the Rochester, New York area which I hope to attend. (see ).
The Explosive Child by author Ross Greene, is a wonderful book that details an approach to dealing with problem behaviors in children. While inflexible-explosive children may have a variety of diagnoses ranging from ADHD to ASD to Oppositional-defiant disorder, he has clustered the characteristics of behavior under this global title. Children with this title exhibit the following characteristics:

  1.  difficulty managing and controlling the emotions associated with frustration
  2.  an extremely low frustration threshold- easier to become frustrated
  3.  low tolerance for frustration- it is more intense and less tolerated by the child
  4.  limited capacity for flexibility and adaptability
  5.  tendency to think in concrete, rigid, black and white manner
  6.  persistence of inflexibility and poor response to frustration despite high levels of extrinsic motivation  [emphasis added]
  7.  explosive incidents that come from "no where."
  8.  some issues that he is especially rigid about
  9.  may be fueled by other disorders
  10.  often set off or exasperated by tiredness and hunger                p. 16-18

One of the striking things about these children is that they do not seem to improve significantly under traditional behavior management techniques. Consequences are based on the idea that a rational and coherent child can choose one behavior or another. Dr. Greene has found that for these children, they struggle because they enter a zone where they are not in control of themselves; they are incoherent and consequently they cannot modify their behavior based on thinking. They are developmentally delayed in both flexibility and frustration tolerance and need to be taught how to become both more flexible and how to better manage frustration. They are not acting out for attention, because they do not know who is an authority, or they are not motivated to behave. These children often are upset with themselves for losing control. They know that their behavior marks them and they know who is an authority in their lives. They get to a point where they cannot make a better choice.

Several models of intervention being used at schools such as Positive Behavioral Interventions and Supports (PBIS) and Theraputic Crisis Intervention (TCI) incorporate elements of Dr. Greene's work. They acknowledge that children may not have the knowledge of alternate approaches or the fluency of use of such knowledge to effective self-regulate their behavior. I think this is critical. Intervention needs to occur prior to the breakdown. We need to teach skills and strategies to use in times of challenges. We need to develop tools for recognizing and handling frustration. We need to acknowledge the need for proactive flexibility- we organize their lives. We have it in our power to help them transition with warnings, schedules and collaborative problem solving.

Although it may seem cliche, a key component of the approach is to pick your battles. There are three types of expectations- non-negotiable ones, ones that you can work on and unimportant at the moment ones. The nonnegotiable ones are primarily safety related. There are few of these because the rules are set and cannot be changed and are worth dealing with a meltdown about. Then there are the ones you can work on- THIS MUST BE LIMITED, TOO. You can only address so many things at once. I'll never forget my son's teacher who was rewarding and punishing him for respect. The problem was when she explained the program to me, she actually used the phrase, "really, everything boils down to respect." You cannot use such a vague descriptor because you cannot teach it all at once. Specify the behaviors you are working on. For example using words to appropriately recognize frustration or use either a peer helper or aide to assist with writing to address handwriting challenges. Finally there are the things that are unimportant. They may not always be unimportant, but at the moment, you have put them lower on the prioritization. Carefully identifying key behaviors to focus on at one time allows the time teach the skill. Some things just need to be ignored because the bandwidth to address problems is full.

One quote that really hit me was, " punishing a child to set an example for or to be fair to others- especially when there's no expectation that the punishment will be an effective intervention for the child being punished- makes little sense" (p 284). How often have we heard or thought that we needed to implement a punishment because others needed to see the example? It does not make sense for our children. True, when law enforcement gets involved there may be little choice. Justice is blind and often stupid. In schools and at home we can use a better solution. Punishments are designed to modify behavior, not set examples for others. If there is no likelihood that the result will be modified behavior, the punishment is really likened to abuse. We need to know our kids and treat them as unique individuals. Their history tells us much about how to be successful or unsuccessful. We need to mine that history and use it to help our children.

Although punishments are not necessarily useful, celebrating success is. It provides hope. "I can learn a new skill, make a new friend, do this seemingly impossible thing..." This message is important in preserving or developing the self esteem of children who seem to be at the mercy of their emotions and behaviors. The focus on the baby steps that lead us to better outcomes is essential to having adults that will not be our next prison generation. That is where these kids will end up if we cannot help them.

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