On the issues that matter in Malone NY (USA)

—Nina Pierpont, MD, PhD

What about children and teens who are non-compliant—who won’t do as you say?

Defiance, or non-compliance, has many origins and causes.

I find the work of a Harvard psychologist, Dr. Ross Greene, to be very helpful on chronic non-compliance.  His book is called The Explosive Child. (He’s written a more technical version for therapists and teachers called Treating Explosive Kids.)

Greene calls his method Collaborative Problem Solving.

Just how useful is Collaborative Problem Solving?  Juvenile correction facilities in the State of Maine managed to reduce their rates of solitary confinement by 90 percent using Collaborative Problem Solving, once staff and guards were trained in the technique.  Pretty impressive.

At the root of Collaborative Problem Solving is a shift in basic assumptions about defiance.  Instead of seeing non-compliance as an act of willfulness (“he wants to be like that”), it is viewed as a skills deficit (“there are things he doesn’t know how to do, which get in the way of complying”).

Kids want to do well if they can, argues Dr. Greene.  The issue, he says, is to teach them skills, so as not to have to rely solely on ways of motivating them.

Skills teaching means describing, demonstrating, providing opportunities for practice, and helping a person to apply skills during times of stress or crisis, when the skill is most needed and hardest to put into action.  The involved adults need guidelines and practice, too.

Here are several of the skills that may be weak or missing in chronically non-compliant children:

(1) Language skills:  A child or teen may not be able to understand language well enough or fast enough to get the full meaning of what is said to him.  He may have trouble getting his own thoughts and feelings into words.  Children with learning and reading disabilities often have language difficulties.

(2) Executive functions:  These are the planning and thinking skills, which tend to be poor in ADHD, bipolar disorder, and other types of problems.

One executive skill is the ability to suspend emotions temporarily-put them on hold-in order to think through and solve a problem.

Another, called working memory, is the ability to hold a group of ideas in mind while thinking about them.  Specifically, in problem-solving, a person needs to remember similar experiences from the past, think about the needs of different people in the present situation, and project possible solutions forward into the future to see what their outcomes might be.  This is a lot of thinking power.

A third important executive skill, set shifting, is the ability to shift smoothly from one set of rules and expectations to another.  Some people say “no” at first to every request, but come around if left alone with the idea for a few minutes.  (Teachers know that children are more wound up when they come in from recess, and take some time to settle down.  This is set shifting.)

(3) Emotional regulation skills:  This refers to emotional state at baseline, away from conflict or times of frustration.  For instance, a chronically anxious, grouchy, irritable, or sad person is going to have more trouble handling frustration and conflict, and may need treatment for underlying emotional states and needs.

(4) Cognitive flexibility skills:  Some people are black-and-white thinkers.  They think it’s their way or no way, and can’t see how their own needs might be still taken care of by a different plan.  Other people tolerate lots of shades of grey.  They are good at compromising, trying a different way, or taking others’ points of view.  Many people with autism spectrum problems are black-and-white thinkers.

(5) Social skills:  Some people don’t have good antennae for what other people are thinking or feeling, and aren’t good at figuring out by intuition and imitation how to act so other people are comfortable.  People in the autism spectrum have trouble with this.

The goal of Collaborative Problem Solving is to use problems to be solved (when one person wants one thing, and the other person wants another thing) as opportunities to teach a child through the skills deficit (or several deficits) which gets in the way of his problem-solving.  Problems are solved using plan A, B, or C. “A” means the adult’s will prevails, “C” means the child’s will prevails, and “B” is for both.

All the interesting work, of course, occurs in B.  Next time I’ll describe the three plans, and how to achieve B.