The following questions and answers have been prepared by parents to assist you in understanding and helping your child. The ideas and suggestions included in the responses are based on our personal experiences and discussions, as well as our review of the professional literature. They are not to be viewed as or as a substitute for professional advice.

1. How do I know if I should seek out an evaluation for my child? What constitutes a “good” evaluation?

In recent years, we have become accustomed to seeking out evaluations when our children display delays in their physical and/or learning development. However, we are just beginning to recognize that not all children naturally develop social/emotional skills, such as frustration tolerance and flexibility, and that we need to look more closely when delays in these areas occur, as well.

As a parent, you have a very important role as an advocate for your child. If you are concerned about your child’s development and have noticed many of the characteristics included in the description of an explosive child, we encourage you to pursue an evaluation. Don’t be dissuaded by well-intentioned family members, friends and teachers who may not see the difficult behaviors and/or who may try to minimize your worries and dissuade you. Trust your instincts, you know your child best!

If your child is struggling, the sooner that you reach out for help, the sooner your child will be able to receive the help that he or she truly needs. The longer one waits, the more entrenched the child and those involved in his care become in what are often incorrect assumptions about the child. For the child, this often leads to inaccurate labeling, anger at being misunderstood, and poor self-esteem. For the caretakers, this often leads to severe frustration and strain on marital relationships.

The goal of an evaluation is to gain an understanding of the nature of the difficult behaviors that the child is exhibiting, to identify and understand what factors -- such as deficits in executive functions, anxiety and mood issues, language or social delays -- are contributing to the child’s inflexibility and explosiveness. Based on this knowledge, and individualized plan should be developed appropriate to the needs and the child and his or her adult caretakers.

Pediatricians can often recommend a qualified and experienced child psychologist or neuropsychologist who can conduct a thorough assessment of your child. Be sure to select a clinician that has extensive knowledge and experience evaluating behaviorally challenging children. Do not hesitate to ask if they are familiar with the most recent text in this field, The Explosive Child, by Dr. Ross Greene. You may also wish to refer to the list of clinicians that have completed advanced training in the Collaborative Problem Solving (CPS^SM ) approach, which can be found at www.ccps.info (click on the “RESOURCES” tab and scroll down to “Clinicians”. Be sure to let the clinician know what your goals are for the evaluation. (See previous paragraph).

In his book, The Explosive Child, Dr. Greene suggests that the following components should be included in an evaluation:

• Developmental, school and treatment history
• Family psychiatric history
• Behavior checklists: these are completed by parents, teachers and others who have extensive involvement with your child, and can be helpful in determining the degree to which the child’s behavior differs from those of the same age and gender.
• Parental/ Teacher/Caregiver assessments: to obtain different views of the child’s behavior; to determine with whom, in what settings, and under what circumstances the child exhibits difficulties.
• Child interview: the clinician should meet with your child as well – maybe the clinician will notice something you haven’t
• Psychoeducational evaluation: to assess general cognitive functioning, achievement skills, executive functioning, language processing, memory, motor and sensory integration skills.

Should you choose to have a school evaluation done, it is important to keep in mind that such evaluations are focused on determining your child’s eligibility for services. While this determination may be important for your child, such an evaluation is not likely to provide you with the comprehensive understanding of the nature of your child’s struggles.

Journaling can be an extremely valuable tool for sharing information about your child. Be sure to keep records regarding situations, time of day, and with what people your child typically has difficulty. Also be sure to keep careful records regarding medication usage and all school communications.

Finally, a word of encouragement. When you take your child for an evaluation, you are taking an important step for your child, yourself, and your family. With a clear understanding of the factors fueling your child’s explosive episodes, there is much that you can learn to do to enhance your child’s chances for success and bring hope to your family.

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2. Isn’t my child just spoiled? Aren’t his/her outbursts just an intentional way of gaining our attention or persuading us to give in?

In most cases, probably not! There are a number of reasons why a child might have outbursts. Poor parenting and low motivation is only one explanation and is often not an accurate one. However, most parents in our support group report having felt this way at one time or another. It is an understandable conclusion, based upon the way in which many of us were raised. We often cling to this explanation even when our efforts to follow through on strict behavior management programs and typical parenting practices (which have worked with our other children) fail. We simply don’t know what else to do.

Recent research can help us. New studies aimed at understanding difficult children have looked at other explanations. They have shown that children come into the world with differences and that not all children develop uniformly. The research has suggested that in the case of explosive children it is often a lack of skills, rather than a desire for attention or to get one’s way, that leads to their outbursts. When these children are evaluated more closely, what often becomes evident is that, for a variety of reasons these children have failed to develop the critical skills of flexibility and frustration tolerance. In addition, they often lack the ability to shift gears, from whatever they are doing to whatever a parent might be demanding. This explains why more traditional motivational explanations and parenting are often unsuccessful in helping these children. Providing firmer limits or more meaningful consequences cannot address their developmental delays and can actually result in greater levels of frustration.

If we focus on understanding the true nature of the child’s problems, and let go of our old explanations, we can begin to talk about and see our children in a new way. We have a chance to change the way we relate to them. This can make a huge difference in how our children view themselves, in their level of comfort and security and how they respond to the world. Many of the parents in our support group have confirmed this. A number of parents have shared that when their children began to hear -- through their parents’ and teachers’ words and actions -- that they were understood, there were immediate benefits. The children began to see their parents as allies; they were calmer and better able to benefit from opportunities to expand their flexibility and capacity to tolerate frustrations in an adaptive manner.

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3. My child only melts down at home; s/he is fine at school. Isn’t that proof that s/he can control it?

This can be very confusing for parents who are struggling to move away from motivational explanations for their child’s behavior. It is often helpful for them to realize that even though their child may not be melting down at school that does not mean that the child is actually dealing effectively with his/her frustrations at school. They may simply be storing them up. In fact, many of these parents will report that their child explodes the moment they come through the door. While initially these outbursts may appear related to something at home, with investigation they are usually found to be related to frustrations that occurred during the school day or the result of a small frustration that just puts the child over the top after having dealt with numerous frustrations all day long.

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4. I understand that my child isn’t just trying to push my buttons, but how can I help friends, relatives and teachers to understand my child?

Don’t be discouraged! Remember, friends, relatives and teachers are likely to fall into the old standby trap of thinking that the child is choosing to be difficult and just needs a firmer parental approach to conform to demands. After all, just as it was for us, this is often the only explanation and strategy they know. Although it may take some time, once they become aware of other explanations and new strategies, they will often come around. One of the best ways of accomplishing this is through modeling the new parenting techniques. Coupled with your encouragement as they try to respond to your child in a manner that is more responsive to their difficulties, they will be encouraged as they develop a more rewarding relationship with your child.

What else can you do? Many of our parents have found it helpful to recommend or provide appropriate reading material, video or audiotapes for relatives, friends, and teachers. There is a wonderful article available from The National Mental Health and Education Center/ National Association of School Psychologists, www.naspcenter.org, titled “Diffusing Violent Behavior in Young Children…” which along with FAQ 5 provides an overview of the Collaborative Problem Solving^SM approach.

It is critical to achieve a consensus among those involved with the child regarding his/her difficulties and the approach to be used. The chances of helping your child are far greater when a team of adults views the child in a similar fashion and are ready to help when the child gets stuck.

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5. If the more typical behavior management parenting approaches, which are focused on motivating, my child to comply isn’t the answer, then what approach should I use? What is Collaborative Problem Solving^SM?

The Collaborative Problem Solving (CPS^SM ) approach, originated by Dr. Ross Greene, and described in his book The Explosive Child, is a practical alternative approach for dealing with behaviorally challenging children. Many of our parents have found great success with the program. They report that their children are melting down less often, are better able to handle frustrating situations more adaptively, that their relationships with their children have improved, that they feel better about themselves as parents, and that they now have hope where it was previously absent.

While an overview of the approach is provided for your information, we strongly recommend reading the book for a more complete understanding. In addition, it is important to remember that each child is different, and therefore the evaluation and recommendations of a professional that is familiar with your child is suggested before embarking on this or any approach.

Briefly, the CPS^SM approach is based on several critical points:

• that these children are not choosing to be explosive and difficult.
  · that for a variety of reasons, their outbursts are fueled by lagging skills in the domains of flexibility and frustration tolerance.
• that they require a careful assessment to determine (a) the nature of their difficulties, (b) the factors that contribute to their overall level of frustration, and (c) the situations, times and people with which they have the most difficulty.
• that they require an approach that is based upon a shared understanding of these difficulties.
• that these children respond best to interventions that provide opportunities to expand their flexibility and frustration tolerance
• that these children respond best if they view adults as helpers who: understand their difficulties, recognize the need to establish parenting priorities, and are ready to help guide them through frustrating situations.
• that we can provide the best help for these children if we focus our efforts before they become overwhelmed with frustration rather than during or after a meltdown.

The baskets framework provides a method for making decisions about how you wish to address problems or unmet expectations with your behaviorally challenging child.

• Basket A is when you impose your will. Basket A causes meltdowns. You know that you are in Basket A when what comes out of your mouth is “no,” “you must”, “you can’t”, “1-2-3,” or “it’s my way or the highway”.
• Basket B is the Collaborative Problem Solving basket. Basket B does not cause meltdowns. In Basket B, you and the child are engaged in a process by which you will come up with mutually satisfactory solutions to problems or unmet expectations. It is also Basket B, where you will help promote the communication and problem solving skills the child needs to be more flexible and handle frustrations more adaptively. You know you are in Basket B when what comes out of your mouth is “let’s work it out.”
• Basket C is where the adult is eliminating or reducing the problem expectation. Basket C does not cause meltdowns. Basket C helps adults eliminate unnecessary demands, thereby reducing a child’s global level of frustration and enabling him or her to deal more successfully with the more critical remaining demands. You know that you are in Basket C if nothing comes out of your mouth, except maybe “okay” or “oh”.

Dr. Greene suggests that you will want to try and be in Basket B much of the time. If you are just using Baskets A and C you are really just “picking your battles” and missing an opportunity to help your child develop the lacking skills. It often takes parents time to learn how to execute Basket B. While Basket B is hard to do, meltdowns are harder.

• Basket B consists of three steps: Empathy (+Reassurance), Define the Problem, and Invitation. (Note: If you attended a recent workshop you may be aware that Drs. Greene and Ablon have changed the way they teach Basket B since the book publication. It was previously described as having two steps: (Empathy and Invitation).
• Empathy, which is communicated through reflective listening or the utterance of a simple, “I hear you”, accomplishes two missions: (1) it helps keep the child calm and (2) it ensures that the child’s concern is “on the table.” If empathy is insufficient for keeping a child calm as you’re initiating Basket B, it may be useful to add some reassurance (in other words, reassuring the child that you’re not in Basket A). This is usually accomplished with a statement such as, “I’m not saying ‘No’.”
• Problem Definition (Note: This step has been added since the book publication) is where the adult concern finds its way onto the table. The definition of a “problem” is simply a situation in which adult and child concerns have yet to be reconciled.
• Invitation is where you’re inviting the child to work collaboratively toward a mutually satisfactory resolution of the two concerns (“let’s see if we can solve that problem…let’s work it out.”)

Thus, if a child were to verbalize, “I don’t want to go to bed right now,” here’s how the three steps of Basket B would sound:

• Empathy(+Reassurance): “You don’t want to go to bed right now…I’m not saying you have to.”
• Problem Definition: “I’m just worried that if you stay up too late, you’ll be very tired in the morning when it’s time to get up for school.”
• Invitation: “Let’s think about how we can work that out.”

Dr. Greene now also differentiates between “Emergency Basket B” and “Proactive Basket B.” He has found that given a thorough understanding of the child (an essential aspect of the CPS^SM approach) most meltdowns/explosions are predictable. By using “Proactive Basket B”, we can collaborate with the child to solve the problem when they are calm.

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6. Will I lose my authority as a parent if I use this Collaborative Problem Solving^SM approach?

Definitely not!!! However, this is a very common concern that many of our parents initially struggle with. Be assured, you will still be very much in charge, and in fact many of our parents report feeling much better about themselves when they learn to interact with their child, meeting his/her inflexibility with their own flexibility.

Remember:

• It will be YOU who decides what behaviors go into each basket.
• Because Basket B solutions are mutually satisfactory, your concerns are taken into account.
• The same problems or unmet expectations that could be addressed in Basket A (with a meltdown) can also be addressed in Basket B (without a meltdown).
• Causing meltdowns doesn’t make you an authority figure.

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7. If I use this Collaborative Problem Solving approach, and reduce the overall demand on my child’s frustration tolerance, how will he/she ever be prepared to live in the real world?

This is another common concern that is often raised by newcomers to our parent support group. Remember, reducing demands is what is accomplished by Basket C. Now, Basket C can be very important for some children very early in treatment because they are simply unable to meet all of the demands that are being placed upon them. But Basket B is where your child learns how to be more flexible, how to deal more adaptively with frustration, how to generate solutions to problems, how to figure out what the problem is in the first place, and how to take another person’s needs into account. Which is more crucial for a child to learn to be prepared for the real world: blind adherence to authority (as trained in Basket A) or learning how to come up with mutually satisfactory solutions with other people (as trained in Basket B)? We think Basket B does prepare children for the real world!

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8. Isn’t this Collaborative Problem Solving very time consuming? I just want my child to comply like other children do?

In the long run, most parents find that using the CPS^SM approach saves time. While they will spend more time proactively solving problems, they will spend less time dealing with and recovering from meltdowns.

With motivational strategies, the goal of treatment is to induce compliance with adult directives. CPS^SM, on the other hand aims to teach children lacking cognitive and emotional skills so that children can successfully resolve conflicts peacefully, make good decisions, and learn how to think for themselves (skills for success in life).

Many parents find themselves faced at one point or another with negative feelings towards their child. This was not the child that they expected to have or hoped for, and the toll it takes on family life can be excruciating.

These negative feelings often raise a great deal of guilt for parents. Moving forward typically requires a period of acknowledging the feelings, grieving for the loss of the “dream/vision” followed by creation of a new realistic vision for the child. With acceptance, the parent and child can then develop a positive relationship where learning can occur to meet the specific needs of the child, helping him/her to develop lacking skills and build upon strengths.

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9. I am getting stuck in Basket B. It doesn’t seem to be working? What am I doing wrong?

There are several reasons why this might occur:

• You may be waiting until things get heated up and then applying Emergency Basket B. In most families, the same problems are causing meltdowns on a daily basis, which means these problems are highly predictable. Since the problems are predictable, you’ll be much better off trying to resolve them in Proactive Basket B, well before things get heated up.
• You may not really be in Basket B…in fact, if a meltdown was the end result, there’s an outstanding chance you were Basket A. Time to go back and review the three entry steps for Basket B (empathy, define the problem, invitation) – did you really use the three steps and in the correct order?
• If your child is accustomed to your being in Basket A, there’s a good chance it’s going to take a while before they become accustomed to your being in Basket B. In other words, they may still get heated up in your early attempts to use Basket B because they’re just accustomed to getting heated up whenever is difficult problem is broached. Once they begin to trust that you’re really doing things differently now, the calming effects of Basket B should take hold.

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Dr. Greene suggests that consequences can be very useful as an instrument of motivation or of teaching children right from wrong. However he is cautious about their use, particularly for these children and explains his concern as follows:

• These children typically already know that their behavior is inappropriate, but when frustrated lose the ability to access and utilize the information.
• These children typically are already motivated to not behave this way, which is often expressed in their remorse after an episode.
• Consequences are not effective in teaching the lacking cognitive skills that precipitate meltdowns in the first place.
• Threats of punishment and/or prior punishment experiences don’t help these children learn to stay calm enough to be able to think clearly in the midst of frustration, and can actually accelerate the disintegration, by increasing their frustration.
• Punishment tends to shift the frustration from the problem to the parent and can shut down communication, a vital tool for expanding the child’s skills.

He recommends that the use of consequences be carefully considered,
based on the following criteria:

• Would the child benefit from the additional motivation that consequences can provide? Will it enhance their performance?
• Are the consequences worth the potential price of fueling a meltdown?
• Are you willing and able to enforce the consequences?
• Will the consequences, administered at the back end of a meltdown be accessible and meaningful to the child the next time he becomes frustrated? In other words, the next time the child becomes frustrated will s/he be able to stay calm and recall that he received a punishment last time he got frustrated and used profanity, think through clearly that they don’t want this to happen again, realize that they need to think of a different way to handle their emotions, come up with some possibilities, consider the effects of each idea, select and follow through on the decided course of action?

If you feel a child should repair damage caused during a meltdown, Dr. Greene suggests having discussions with the child after coherence has been fully restored about “making amends.” Since most meltdowns involve an adult being in Basket A, it’s not clear that the child should be the only one making amends!

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11. What about medication or natural treatments?
Many of our parents find that medication or natural alternatives can be helpful as part of an overall plan, that includes the CPS^SM approach. They report that medications/alternative treatments can help with such things as: mood instability, attention problems, anxiety, etc... Because some of the medications have potential and sometimes serious side effects, they suggest being as informed as possible. For information about medications and questions to ask, refer to:
www.whatmeds.com or
www.aacap.org/publications/factsfam/psychmed.htm
Information about alternative treatments is available at:
www.adhd-depression-relief.com
www.omegabrite.com
www.brainplace.com

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12. What about teachers, coaches, etc.? Should I tell them about my child’s difficulties?

If your child struggles with meltdowns both inside and outside the home, you will definitely want to share information. It is important for your child that everyone involved in his or her care be on the same wavelength. Your child’s progress is dependent upon this consistency. Our group has found that there’s a greater chance of achieving this goal when information is shared. One does need to be careful to keep the information brief so as not to overwhelm or scare away these potential adult helpers. Generally, just a brief statement that your child has difficulty with flexibility and frustration tolerance, that you have found the following two things helpful, and that you would like to keep in touch with them is sufficient. To receive a detailed sample information packet, email Beth@fcbcsupport.org.

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13. What about siblings?

Raising siblings is a difficult task that can become extremely challenging when one of the siblings is explosive. Concerns about handling sibling rivalry and the effect of the explosive child’s behavior on the “other siblings”, are often major concerns for parents. A number of strategies suggested by other parents as well as, Dr. Greene in The Explosive Child might be helpful:

• Help the “other siblings” understand why your explosive child behaves the way s/he does, how to avoid explosive interactions, and what you are doing to try to improve things. Let him/her know that you understand how difficult it is for him/her and that you will help him/her cope. EDUCATE AND EMPATHIZE.
• Be clear that you will not tolerate his/her teasing the explosive child as a way of getting back. Educate the “other siblings” about the fact that in your family parenting is geared to what each child needs and that “fair” does not always mean “equal”. Examples where you highlight something that your “other sibling” needs help with and how you provide that help are very useful to illustrate your point.
• Our parents have found it vital to emphasize to their “other siblings” that they do not need to be “perfect”, that they can have a “bad” day or a problem, too. Often, the other sibling can feel that they must not add to Mom and Dad’s worries. Let them know that you will be there for them should they have a problem, and then make the time to do so.
• Use the baskets to help your children solve problems they are having with each other.
• Sometimes you may need to seek professional help for the “other sibling” and/or to help both siblings learn how to interact successfully.

A number of our parents report finding success when utilizing these suggestions. Ideally, the strategies allow the “other sibling” to grow into a very empathic, understanding individual, and enable the explosive child to get the help that he/she needs to become more flexible.

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14. How can I reduce the strain of raising this child?

It takes an enormous amount of patience and energy to parent one of these children. Therefore, be sure to take good care of yourself by pursuing your own interests, taking some alone time for you and your spouse, and by seeking out supports. Remember that you can’t help your child when your emotional tank is on empty. Reward yourself with a pat on the back when you have worked hard, and don’t beat yourself up if you haven’t handled a situation as well as you would have liked. Remember, it is a learning process, allow yourself to make mistakes. Recognize and be accepting of any negative feelings that you might have for what they are – a necessary part of the struggle to gain understanding and acceptance of your child. They are likely not what you expected when you thought about becoming a parent!!! Remember to use humor whenever you can and to laugh often. Identify and celebrate with your child their positive qualities. Help them to find other adults in their life that can serve as “cheerleaders” or “personal coaches” for them. Together, you and your child will grow.

Here are a few more suggestions from other parents:

• Don’t put your child into situations that you know he can’t handle. It’s a recipe for disaster and you’ll have to clean up the mess! Often this means making personal sacrifices and accommodations, but it is well worth it in the end. You and your child will be better off for it. It can be reassuring to remind yourself that it is likely that it will not be this way forever, that as your child progresses he will be able to handle more situations and without so much effort and planning.
• Frustrating situations that come as a surprise tend to be the most difficult for these kids to handle. Therefore, when you are able to anticipate that a frustrating situation may arise, it is helpful to make your child aware. Many of these children do much better when they have the opportunity to prepare themselves. You can discuss and even role-play possible ways of dealing with the anticipated situation.
• Often, explosive children respond negatively to parental requests. Many parents have found that their children are more receptive to written notes or check-off lists than verbal commands. When using this strategy, it is important to remember that you will still need to be flexible and to tailor it to their abilities.
• Remember to celebrate even the small attempts your child makes to be more flexible and to work with you to solve problems. Knowing that you understand how difficult it is for him and that you appreciate his effort will encourage him to keep on trying.
• Keep a list of your child’s great qualities on your night table to read before going to be each night. After a rough day, it can help you begin the next day with a fresh start.
• Don’t be discouraged by the to-be-expected ups and downs in your child’s progress. It is often helpful to anticipate these, so that you are not caught off guard and disappointed.