The Real World

Imagine This

noreply@blogger.com (Dr. Ross Greene) — Tue, 18 Jan 2011 22:45:00 +0000

Imagine this. You’re the parent or teacher of a child with social, emotional, and behavioral challenges. You know the child’s behavior falls outside the norm (maybe it's even scary or dangerous) and that he’s not getting the help he needs. But you don’t quite understand what’s going on with the child or how you can help. You do know that the child is having a detrimental effect on your household, your marriage, your classroom, his peers, and/or his siblings. You’re desperate for information that will help you understand, that will help you help. If you’re a parent, you decide to make an appointment with your family physician or counselor. If you’re a teacher, you refer the child into your school’s assessment process. After what can be a very long wait, you finally get the information you were waiting for: “He has oppositional defiant disorder.”

Many who are reading this edition of The Real World aren’t having any trouble imagining this scenario. You’ve been there, done that (though the diagnosis may not have been oppositional defiant disorder). On first hearing the child’s diagnosis, you may remember thinking, “Good! I knew there was something going on here. Now he’ll get the help he needs.” But sooner or later you came to realize that the diagnosis really didn’t provide you with very much information at all. What the diagnosis told you is that someone else also thinks the child’s difficulties are beyond the norm. But you didn’t need a diagnosis to tell you that. There’s an excellent chance you already knew.

I’ve often said that parents of kids with behavioral challenges go through two developmental stages (it seems teachers may pass through these stages as well). Phase One: believing that a psychiatric diagnosis is going to give you the information you need to understand and help your child or student. Phase Two: coming to the recognition that a diagnosis didn’t give you the information you needed to understand and help your child or student. Neither oppositional defiant disorder nor the vast majority of other psychiatric diagnoses that are commonly hung on children tell you what you really need to know. Most diagnoses just tell you what deviant behaviors a kid is exhibiting.

The circular thinking inherent in this process isn’t always so obvious, so here goes:

Parent or Teacher: Doctor, why is he throwing tantrums, defying adult rules and requests, and refusing to do what he's told?Doctor: Because he has oppositional defiant disorder.
Parent or Teacher: How do you know he has oppositional defiant disorder?
Doctor: Because he’s throwing tantrums, defying adult rules and requests, and refusing to do as he’s told.

Yet, these days, in the real world, the instant it becomes clear that a child has social, emotional, or behavioral challenges, the quest for the diagnostic holy grail commences. In many school systems, a diagnosis is what a kid needs to access services it’s already clear he needs. In many places, diagnoses influence funding decisions. A diagnosis is what a kid needs for his mental health provider to be reimbursed by an insurance carrier. A diagnosis is what a kid needs for his parent(s) to know that there is a support group comprised of parents whose children exhibit similar behaviors.

But the down-side of diagnoses outweighs the up. Diagnoses pathologize kids. Diagnoses make it explicit that “the problem” resides within the kid. Diagnoses make it clear that it’s the kid who needs fixing, thereby providing justification for many ineffective interventions directed solely at the kid. Diagnoses scare off potential helpers (“He has bipolar disorder! I don’t know anything about bipolar disorder! That’s for someone else to deal with!”). Diagnoses deprive kids of the help they clearly need (“I’m sorry, Mr. and Mrs. Taylor, but your daughter doesn’t meet full diagnostic criteria for Asperger’s disorder, so she doesn’t qualify for our program.”) And, worst of all, diagnoses are distracting. They cause potential helpers to focus more on what a child isdoing rather than on why and when he’s doing it…and on what the potential helpers can be doing to help.

Why is a child exhibiting challenging behavior? The Collaborative Problem Solving approach provides the following answer: Because he or she is lacking the skills not to exhibit challenging behavior.

When does the child exhibit challenging behavior? The CPS model has an answer to that, too: He exhibits challenging behavior when the demands being placed upon him exceed the skills he has to respond adaptively. Would the child prefer to respond adaptively? Of course! Is the child choosing to respond maladaptively? Now why would he choose to do that? If he had the skills to respond adaptively, he would.

And what do challenging kids do when they’re having difficulty responding adaptively to the demands being placed upon them? They exhibit the behaviors that are the basis for the diagnosis they will receive.

Now imagine this. Imagine that we all came to our senses and decided that categories weren’t so important or meaningful after all. Imagine that we all realized that challenging behaviors occur on a spectrum, something I refer to as the Spectrum of Looking Bad. At the “easy” end of the spectrum we’d include behaviors like whining, sulking, pouting, and crying. Moving in the “less easy” direction we’d find behaviors like screaming, threatening, growling, swearing, spitting, biting, kicking, hitting, head-banging, lying, and stealing. Moving still further in the “less easy” direction would be behaviors that are harmful (sometimes fatal) to oneself or others. But we’d recognize that all of those behaviors – irrespective of which ones a kid may be exhibiting – occurwhen the demands being placed on a kid exceed that kid’s capacity to respond adaptively. (Just to normalize this, we all look bad when the demands being placed upon us exceed our capacity to respond adaptively. What do most of us have that challenging kids are lacking? Skills.)

Imagine further: instead of trying to find the “right” diagnosis, we’d instead focus our efforts on identifying the lagging skills of each challenging child and the specific conditions (unsolved problems) in which those lagging skills were being demanded…in other words, the conditions in which the child was “looking bad.” We’d use the Assessment of Lagging Skills and Unsolved Problems to make sure we have the right lenses on, to organize our efforts to help, and to determine what problems need to be solved. We’d rely a lot less on punishment and a lot more on problem-solving. And we’d solve those problems collaboratively (rather than unilaterally). Over time, we’d have a lot of solved problems – and a lot less challenging behavior -- to show for our efforts.

In many places – families, schools, inpatient psychiatry units, therapeutic group homes, and residential and juvenile detention facilities – this is no pipe dream. It’s the reality. Just not enough places…yet.

* * * * * * *

I’ve received numerous emails from people asking me to weigh in on the tragedy that occurred in Tucson, Arizona. I’ve been closely following Gabby Giffords’ amazing day-to-day progress and have dared to imagine her leading a happy, productive life when she leaves the hospital. I’ve been watching how our leaders have responded to the tragedy, some admirably, some less so, and wondering if their newfound civility will last beyond the end of January.

And, yes, I’ve been following what there is to read about Jared Lee Loughner. Though hard information has been lacking – we really don’t know what he was thinking -- it certainly seems reasonably clear that he wasn’t in his right mind when he began shooting. He joins others who have committed similar horrific acts in recent memory: John Hinckley, Mark David Chapman, and those (their names are usually less familiar) who’ve walked into their workplaces or university campuses or schools and killed co-workers or fellow students and faculty.

Speculation has begun about what Jared’s psychiatric diagnosis might be, and apparently there’s an emerging consensus that he must be suffering from a “severe mental illness,” such as schizophrenia or bipolar disorder. But, as Sal Gentile astutely points out in an article for PBS, that really doesn’t tell us anything. It certainly doesn’t tell us why Jared did what he did (most individuals carrying those diagnoses don’t commit violent acts and are at only slightly increased risk for doing so). While his behavior over the past two years was considered odd, scary, and dangerous, he apparently didn’t meet “criteria” for being “arrestable” or “hospitalizeable,” which is why he was able to purchase a gun and do what he did.

It’s always easy after a tragedy to talk about what could have been done to prevent the tragedy in the first place. I’m not going to do that. As things presently exist, I think such horrific events are inevitable. But shouldn't we be giving more thought to whether we can more effectively help those in our society -- kids and adults -- who are lacking skills, have problems they're having difficulty solving, and are having difficulty making it in the mainstream as a result? Failure to do so means we're accepting the status quo...that every month or so, something like what happened in Tucson will happen again. (By the way, in many neighborhoods, the frequency of shootings is far more often than monthly.) It's a tough problem. I wonder if our leaders are up to the task.

Along those lines, I’m also wondering about whether our leaders are aware that while we elect them to represent our views, those views only take on relevance in the context of trying to solve problems. Whether Sarah Palin’s "target graphic" or the vitriol that public figures referred to after the shootings had anything to do with what happened in Tucson, the tone set by that graphic and that vitriol is not conducive to the collaborative resolution of tough problems we need from our representatives.

Ross W. Greene

Lessons from a Tragedy

noreply@blogger.com (Dr. Ross Greene) — Sat, 24 Jul 2010 01:14:00 +0000

Over three years ago, a 16-year old tenth grader named John Odgren stabbed to death a student – his name was James Alenson – in a high school bathroom in a Boston suburb. A few months ago, I testified as an expert witness in John’s murder trial. My role was to try to explain how John came to do what he did on January 19, 2007.

Like many kids in our schools, John had a long history of social, emotional, and behavioral difficulties, starting with early problems in peer interactions (leading to a diagnosis of Asperger’s disorder), along with inattention and hyperactivity (resulting in a diagnosis of ADHD). Like a lot of kids, John’s social difficulties didn’t get better, and he ended up being on the receiving end of some significant bullying, occasionally resulting in fighting and impulsive violent responses (jabbing a peer with a pencil), and causing him to become intermittently depressed (and, at times, suicidal). John received lots of counseling and medicine, and was placed in a variety of alternative settings; in some of these settings, the bullying persisted. In another setting, he became extremely concerned that he was being stalked by a female peer.

As is the case with many kids diagnosed with Asperger’s disorder, John had preoccupations. Early on he developed a fascination with natural disasters, but then his preoccupations took a more troubling turn: first weapons, then Stephen King novels. Indeed, in adolescence, John became increasingly preoccupied with Mr. King’s Dark Tower series, in which bad things happen on a day associated with the number 19. My professional opinion was that this preoccupation, in combination with his history of being bullied and the stalking situation, set the stage for John to become increasingly paranoid and hyper-vigilant about being attacked.

John brought a knife to school on January 19, 2007, quite convinced – my professional opinion again – that he would be attacked. According to the one “witness” to the stabbing (a student who was in a stall in the bathroom, but didn’t see anything) James did absolutely nothing to provoke John. The two had never met before. That they ended up in the same bathroom that morning was tragically coincidental.

Was John in his right mind when he stabbed James? That’s the question the jury was charged with deciding. It’s an issue on which a “jury” of mental health professionals would have had difficulty agreeing. I’m reasonably certain that no other student at the same high school was certain he or she would be attacked on that day by virtue of its association with the number 19. The jury of John’s peers – none of its members, I suspect, diagnosed with Asperger’s disorder -- wasn’t asked to decide whether John stabbed James. John’s attorneys didn’t contest that issue. Rather, the jury was asked to determine John’s state of mind at the time of the stabbing, and was left with two options: guilty…or not guilty by reason of insanity (Massachusetts does not have a “guilty but insane” option). John was found guilty and sentenced to life in prison.

Though I was an expert witness for the defense, I found myself feeling tremendous empathy for James’ parents, who were present for the trial. I can’t begin to imagine their unspeakable pain and heartbreak. Their son is gone. From what I’ve heard and read, James was a gentle, considerate, kind kid. A website has been created to commemorate his life.

I felt empathy for John’s parents as well. Over the years, they took him to countless mental health professionals. They advocated for John to be placed in alternative settings in which they hoped that his difficulties would be well understood and well-addressed. From what I could gather, they did their very best. Their pain and heartbreak is also very real. They were recently interviewed in a Boston newspaper.

The families are left to determine the meaning of this tragedy in their lives.

But what’s the meaning of this tragedy for the rest of us? If we simply write this case off as just another example of “senseless” school violence, then we won’t try to make sense out of what happened. I think we’re compelled to contemplate whether there are lessons in this situation that would prevent something similar from happening again to someone else’s child, and I’m referring here to the parents of both James and John.

Here’s my take. That tragedies like this one don’t occur more often is largely a matter of luck. There are a lot of kids with social, emotional, and behavioral challenges in our schools, and a lot of them fly under the radar because they aren’t exhibiting the types of behaviors that would cause them to access the school discipline program. We actually know very little about what these kids are thinking. And we often don’t know much about what the kids who are “frequent flyers” in the discipline program are thinking, either. In many cases, we’re too busy talking at them, teaching them lessons they already know, and administering discipline…time after time. Whether well-known or below-the-radar, a lot of these students don’t feel like school is a place where they are heard, where adults understand their concerns or what’s getting in their way. Many of these kids are alienated and hopeless and stopped talking to adults a long time ago.

A strange association, perhaps, but this scenario reminds me a bit of airport security. Most airport screening equipment detects certain things (metal, sharp objects) but not others (for example, explosive powder in someone’s underwear). Thus, airline safety is still largely based on the premise that the vast majority of airline passengers don’t want to blow up the plane. In many schools, safety still hinges largely on the premise that the vast majority of students don’t want to kill somebody. While some schools do have metal detectors, the lagging skills and unsolved problems of students with social, emotional, and behavioral challenges remain undetected and unaddressed. And sometimes our luck runs out.

Of course, there’s an important difference between airport security and school security. Airport screeners don’t have the time to get to know each passenger well. But we do have the time to get to know our students well. It all depends on whether that’s one of our priorities.

Yes, I can see some of the eye-rolling that last sentence may have elicited. I appreciate the fact that educators can’t be all things to all kids and that time is short. I understand the unreasonable demands that are placed on classroom teachers, and that federal and state governments are far more concerned with academics than with the emotional health of our kids. I understand that the 25 percent of India’s population with the highest IQs is greater than the total population of the United States, that India has more honors kids than the U.S. has kids. I understand that the top ten in-demand jobs in the U.S. in 2010 did not exist in 2004, that we are currently preparing students for jobs that do not exist, using technologies that have not yet been invented, in order to solve problems that haven’t yet been identified as problems.

I also understand that we haven’t yet solved a problem that is right in front of us, right now: How to understand and help kids with social, emotional, and behavioral challenges in our schools.

And it’s not because we’re not putting the time in. It took me weeks to go through all of the paper that had accumulated in John’s file (reminding me that there’s an inverse correlation between the amount of paper that accumulates in a kid’s school file and how well he or she is doing). Kids who aren’t doing well accumulate massive amounts of paper: reports, evaluations, placements, behavior plans, support plans, progress notes. Kids who aren’t doing well also accumulate diagnoses. And, as you’ve read, John had his share. All that paper…all those diagnoses…and still…

And it’s not that there weren’t signs of trouble that fateful school year. In the criminal forensics class in which he was enrolled prior to the stabbing (given his history of preoccupations, probably not the ideal curriculum) John announced that he knew how to commit the perfect murder. On several occasions, he’d brought sharp objects to school that year, once chasing a kid down the hallway with one and then declaring that he wouldn’t be killing him that day. Several months into the school year, John began wearing a trench-coat, fedora hat, and sunglasses as his standard garb. Typical adolescent self-expression? Not in this case.

Our students with social, emotional, and behavioral challenges need help we’re often not giving them. We're already devoting the time and effort and dollars. We need to change what we're thinking and doing.

Another school year will be starting soon. If we don’t make it a very high priority to understand what’s going on in the heads of our vulnerable, high-risk students, to solve the problems that are setting in motion challenging episodes, and teach them the skills they’re lacking, then we’re still just relying on luck for our safety.

Post-script:
Coincidentally, this tragedy is back in the news, with John's attorney moving to have John's sentence reduced. If you'd like to read more about this development, you can do so by clicking here.

B is for Bullies (and the Bullied)

noreply@blogger.com (Dr. Ross Greene) — Wed, 07 Apr 2010 00:48:00 +0000

Massachusetts is in the national news again, this time not because of our new U.S. Senator but rather because of the more sobering topic of bullying. This is due, in large part, to the tragic recent deaths of 15-year old Phoebe Prince and 11-year old Carl Walker-Hoover, two kids who were apparently on the receiving end of bullying from other kids at school and ended up taking their own lives as a result.

It goes without saying that suicide isn’t the only tragic consequence of bullying, just one of the outcomes unfortunate and alarming enough to make the headlines, get people to focus on the problem, and –- in Massachusetts at the moment -- energize efforts to pass legislation mandating that schools train staff to be vigilant about bullying and intervene actively and effectively in instances in which it occurs. My reading of the legislation in Massachusetts is that it compels educators to do something about bullying but isn’t specific about what that something should be. So I thought I’d devote this rendition of The Real World to thinking about that a little.

Phoebe Prince’s very unfortunate death prompted calls for the bullies to be severely punished. A parent in the community in which the bullying took place was quoted thusly in the Boston Herald: “There needs to be some punishment for (the bullies). They need to be held accountable. If nothing is done, nothing will change.” Charges were indeed subsequently filed against numerous of those alleged to have done the bullying in Phoebe’s case.

With all due respect, I doubt that punishment is going get the job done, and I'm certain that punishment isn't the best or only way to "hold kids accountable" (though the two terms are often used interchangeably). To go down that route is to make the same mistake we’ve made before (in the form of failed zero tolerance policies) in response to other highly undesirable behaviors we wish kids wouldn't exhibit at school but often do. However, it’s quite true that if nothing is done nothing will change. Kids have disagreements, get mad at each other, notice each others’ differences, and sometimes just plain don’t get along very well, and they need continuous guidance and oversight in handling these situations adaptively rather than treating each other cruelly or ganging up on each other.

The good news is that there are data to suggest that the rates of kids who report being bullied have actually declined, possibly suggesting that, in places where something is being done, the efforts may actually be paying off. But the suicides of Phoebe Prince and Carl Walker-Hoover –- and those that have occurred elsewhere, under similar circumstance, in many places -– tell us we still have quite a ways to go.

Of course, if you really want to do something about bullying, you need to understand it first. And, like everything else in mental health, diverse explanations have been offered. One very popular explanation is that kids who bully (1) have a strong need for power and negative dominance, and/or; (2) find satisfaction in causing injury and suffering to other students, and/or (3) are often rewarded in some way for their behavior. I've seen this very conceptualization invoked to justify interventions aimed at teaching bullies that they’re not as powerful as they might think and at helping them think twice about whether bullying is satisfying and rewarding...in other words, interventions that have punishment as a hallmark ingredient.

I’ve also heard it said and seen it written that some bullies come from circumstances that make “backing down” simply inconceivable. In such instances, bullying is said to function as an act of self-preservation. For example, in a recent article in the Boston Globe, reporter Lylah Alphonse wrote that some kids become bullies because it may be their only way to assert themselves after years of feeling like victims themselves, either at home or at school.

So, how would bullying be understood within the framework of the Collaborative Problem Solving approach? Might the CPS model offer some useful alternative intervention options beyond punishment?

In the CPS model, bullying would be viewed through the same lenses as other challenging behaviors: as the byproduct of lagging skills and specific unsolved problems.

Bullies are lacking crucial cognitive skills? Yes, indeed. If they had those skills, they wouldn’t be bullying.

What skills do bullies lack? It's always helpful to refer to the Assessment of Lagging Skills and Unsolved Problems (you can find it in The Paperwork section of this website) as our guide. I’ve worked with bullies who had difficulty considering the likely outcomes or consequences of their actions, had difficulty considering a range of solutions to a problem, and had difficulty “using their words” to solve problems. I’ve worked with bullies who interpreted social information in an inflexible, inaccurate manner or had cognitive distortions or biases. Still other bullies I’ve known had difficulty with some basic social skills (starting conversations, entering groups, connecting with people), difficulty seeking attention in appropriate ways, and difficulty appreciating how their behavior was affecting other people. And I’ve crossed paths with many bullies who had difficulty empathizing with others and appreciating another person’s perspective or point-of-view.

What’s the goal of intervention? Collaboratively solve the problems setting the stage for bullying. Of course, to do that we’d need to be more specific. Those familiar with the CPS model would recognize that the term “bully” is too vague to be of much use. If all I know about a kid is that he’s a “bully”, then I really don’t understand the conditions in which “bullying” is occurring, might have a lot of trouble gathering the information I need to truly understand “bullying episodes", and would certainly have trouble making sure the concerns of the “bully” (and the “bullied”) were addressed. In this respect, “bullying” falls into the same bucket as other similarly vague descriptions, like “aggressive", “defiant", “antisocial", “sociopathic", “conduct disordered", and “psychopathic”...all too vague to know what it is that we’re actually working on. I must admit to some confusion about where the category of “bullying” ends and where similarly vague descriptors -- “mean", “bossy", “controlling", and “cruel” -- begin, though I’m pretty certain they all emanate from lagging skills and unsolved problems. I also know that when adults aren’t exactly sure what it is that they’re working on, punishment tends to be the default intervention.

And what specific unsolved problems set “bullying” in motion? Way too many to count. But here are some of those I’ve come across lately: chronic disagreements on the playground or school bus; unresolved anger over a perceived slight; the ongoing perception that one’s peers are more (or less) popular; ethnic differences and misperceptions; unresolved issues and jealousies that can arise in dating relationships.

Why should we solve the problems setting the stage for bullying collaboratively? Because if we simply impose our will on bullies (Plan A)...if we don’t hear their concerns and make sure the solutions take those concerns into account...then, like other unsolved problems to which Plan A is applied, the solution won’t be durable, the problems won’t be solved, and the lagging skills won’t be taught (and we'll run the risk of bullying the bullies and driving the problem further underground). When we apply Plan B – Collaborative Problem Solving -- to the unsolved problems of bullies and the bullied, then we come to a much clearer understanding of the factors setting the stage for their problematic interactions, ensure that the concerns of both parties are addressed, and have a much better shot at solving the problems durably.

If, in our schools, we’re applying community-building programs – like Tribes or Responsive Classroom – then we’re continuously teaching, modeling, and practicing (for all students) how to get along with each other, handle individual differences, and function as a community (what the Response to Intervention folks would call Tier 1). And we're also helping kids recognize that it’s not just the adults who are on the hook for taking action if bullying is occurring. If we’re routinely using Plan B to understand concerns and perspectives, resolve disputes, and solve problems (still Tier 1 here), then we’re continuously modeling and practicing those crucial skills as well, and keeping the lines of communication wide open. If we’re routinely using Plan B at Tier 2 to help kids solve the problems that survive beyond Tier 1, then we have a “safety net” to catch the kids who slip through the Tier 1 cracks. And if we recognize that Plan B isn’t a one-shot-deal, carefully track unsolved problems over the course of a school year, and conceive of CPS as a staff development project, then we stay on top of things over time and foster a disciplinary culture oriented toward problem-solving rather than punitive methods of intervention.

If we feel that we don’t have time to do these things, then nothing changes. And if we – and our legislators -- continue to focus almost exclusively on high-stakes testing, then we’ll make it that much harder for teachers and school leaders to remember that there are stakes that are even higher than academics.

By the way, some kids I know who were on the receiving end of bullying committed violent acts toward others instead of turning the violence on themselves. Interesting how we view the two outcomes so differently. In fact, they’re just two different indicators of problems that were never solved and skills that were never taught.

Give it a Rest

noreply@blogger.com (Dr. Ross Greene) — Thu, 28 Jan 2010 16:04:00 +0000

As noted in a recent column in TIME magazine, a new year means a chance to put to rest some of the tired words and phrases that became popularized during the previous year. In its annual rendition of the List of Words Banished from the Queen’s English for Mis-use, Over-use, and General Uselessness, Lake Superior State University has announced its 15 banned words and phrases for 2010, including tweet, app, toxic assets,too big to fail, and teachable moment. Banned words and phrases from recent years have included favorites such as: sweet! awesome!, chipotle, webinar, surge, and water-boarding. Interesting how the words capture the times.

You can probably guess where I’m heading here. I’d like to propose the 2010 List of Words and Phrases Banned Because of Mis-use, Over-use, and General Uselessness In Understanding and Helping Behaviorally Challenging Kids. This list captures the times, too, but these words and phrases often lead to very counterproductive outcomes for kids with social, emotional, and behavioral challenges, so putting them to rest is far more urgent.

1. Suspension: If this was an effective intervention, then it wouldn’t be the same kids being suspended over and over again, a pattern that simply fuels their alienation and moves them further outside the social fabric of a school. It’s an obsolete intervention, and it always has been.

2. Detention: Same deal.

3. Expulsion: The ultimate cop-out and a clear sign that we still have the wrong lenses on, still haven’t identified the unsolved problems that are reliably and predictably precipitating a kid’s challenging episodes, and still haven’t started solving those problems collaboratively. That expulsion is the intervention of choice over 100,000 times a year in the U.S. is outrageous.

4. Eligibility-based assessment: If the sole goal of an assessment is to determine whether a child qualifies for special education, there’s an excellent chance the assessment process won’t identify his or her lagging skills and unsolved problems. If an assessment is aimed at assessing a student’s lagging skills and unsolved problems, you’ll know whether special education has anything to offer.

5. Behavior Plan: Shouldn’t this be a Problem-Solving Plan rather than yet another shot at giving a kid the incentive to meet our expectations? If it’s true that Kids do well if they can, then he has the incentive already.

6. Sticker chart: Recently, a challenging kid told me where he thought his parents and teachers should stick their sticker chart, lending new meaning to the term.

7. He needs to take responsibility for his actions: I’ve never been exactly sure what this means, but if a kid is participating in Plan B – trying to solve problems in a way that is mutually satisfactory and reduces the likelihood of challenging behavior – I’m reasonably certain he’s “taking responsibility.”

8. He needs to be held accountable: For many adults, this expression simply means that they intend to add more pain to a kid’s life. My sense is that behaviorally challenging kids have experienced more “added pain” than most of us experience in a lifetime…if pain was going to get the job done, it would have worked a long time ago.

9. We need to teach him a lesson he won’t forget: He hasn’t forgotten the lesson. He’s lacking the skills to consistently perform the lessons he’s been taught.

10. Attention-seeking behavior: We all seek attention, so I’m not sure how this phrase distinguishes challenging kids from the rest of us. Some kids have the skills to seek attention adaptively, and some don’t.

11. He just wants his own way: Another way in which challenging kids are just like the rest of us. Of course, the manner in which challenging kids go about trying to get their own way – screaming, crying, hitting, kicking, biting, spitting, and so forth – is a lot less adaptive than the manner in which other kids have learned to go about getting their own way. What are the challenging ones missing? Skills.

12. His challenging behavior is working for him: No it’s not.

13. He comes from that neighborhood: So do a lot of other kids who are doing well. So let’s focus less on the neighborhood he comes from and starting solving problems and teaching skills.

14. He’s a bully: I’m betting he’s lacking some pretty important social skills. Is the anti-bullying program at your school teaching those skills, or does it mostly involve bullying the bullies?

15a. He has…(insert a childhood psychiatric disorder here): Diagnoses pathologize kids, signify that the problem resides within the kid, and make a lot of adults feel like they can’t help a kid. Diagnoses are nowhere near as informative as lagging skills and unsolved problems, and they don’t tell adults how to help, either.

15b. He’s mentally ill: Ditto.

AND THIS JUST IN: Thanks to legislation making its way through the U.S. House of Representatives, we're closer to adding two more words to the list: restraint and seclusion. This is fantastic news for behaviorally challenging kids. Of course, while the legislation tells schools what not to do anymore, they'll need Collaborative Problem Solving to guide them on what to do instead.

Feel free to use the Comment tab below to nominate other words or phrases you’d like to see put out to pasture or to post a comment on what you’ve just read. And, wherever you live or work, do what you can to get the ball rolling on language that is actually informative and improves the process of helping a challenging kid. Introduce your colleagues (or your significant other, or your mental health professional, or your kid’s teachers) to the Assessment of Lagging Skills and Unsolved Problems. Distribute the Bill of Rights for Behaviorally Challenging Kids. Sign up for the Lives in the Balance email list to start advocating for challenging kids. Tell people about this website. Don’t let them forget about how many challenging kids we continue to lose because their difficulties are poorly understood and poorly treated.

By the way, kudos to New York’s Mayor Bloomberg for getting the ball rolling on treating challenging kids in a way that makes more sense. Just remember, Mr. Mayor, you can change the agency a kid is assigned to, but if you don’t change the lenses through which you’re viewing his difficulties and the interventions that are being applied to help him, the change will be purely administrative...and it won’t change a thing.

Not Forgetting

noreply@blogger.com (Dr. Ross Greene) — Mon, 04 Jan 2010 01:53:00 +0000

The Tiger Woods saga appears, finally, to have moved off the front pages. Because Tiger, like most professional athletes, is in the entertainment business, I guess a lot of folks found his marital indiscretions to be as compelling as his golf game. Of course, the most tragic aspect of the situation -- the part typically given short shrift in situations like this (think John and Kate) -- is the impact Tiger’s actions have had on his two kids.

Without knowing him, it’s hard to say what lagging skills, needs, or attitudinal factors may be implicated in Tiger’s difficulty doing monogamy well. Fortunately, in the case of behaviorally challenging kids, we have the Assessment of Lagging Skills and Unsolved Problems to make the figuring out a part a lot easier. And, lest we forget, figuring out what’s getting in the way for challenging kids is a lot more important.

That, of course, is the problem: sometimes we forget. I’ve heard it said that we find the lives of our celebrities to be riveting because they provide some useful life lessons for the rest of us, and I suppose Tiger’s “transgressions” have given us some food for thought in the Dishonesty, Deception, and Betrayal departments (with some additional flourishes thrown in to keep us titillated). But we wouldn’t want to become so consumed by the entertainers and life’s other distractions that we lose sight of tragedies occurring right in front of us. There are many to choose from, but here’s the ongoing tragedy I think about most: despite everything we’ve done for a very long time to try to stem the tide, despite all the hard work of so many people, we’re still struggling to reach and help way too many behaviorally challenging kids and their families and teachers. That’s why rates of dropping out of school, teen pregnancy, substance abuse, gang involvement, and incarceration remain tragically high.

If we want to change things for the better for our most vulnerable kids, we’re going to have to focus a lot less on whether it was Tiger’s golf-club-wielding wife or his steering wheel that did damage to his lip that fateful evening and a lot more on figuring out what we can do differently so we can stop doing damage to challenging kids in our schools through application of counterproductive disciplinary procedures that have the primary effect of alienating those kids who most desperately need to be drawn back into the social fabric of our schools.

We’ll also have to focus less on whether Alabama or Texas ends up ranked number one in college football and instead devote the same passion and energy that we apply to rooting for our favorite sports teams to helping the “underdogs” in our schools.

We’ll have to tone it down a little on recognizing, admiring, and venerating the feats of people who are good at throwing or catching a football and ramp it way up on recognizing, admiring, and venerating the feats of the people in the trenches who are going deep to help and advocate for challenging kids (stay tuned to this website for further developments along these lines).

We’ll have to think less about whether the Indianapolis Colts should have tried harder to preserve a perfect season, and instead think about whether we’re prioritizing and doing the right things to preserve the futures of the kids at greatest risk for being lost.

We’ll have to be a little less preoccupied with Jimmie Johnson, Jeff Gordon, and Danica Patrick, and preoccupy ourselves with how to steer things in the right direction for the many other Jimmies and Jeffs and Danicas who have little chance of winding up in the winner’s circle because their behavioral challenges are so poorly understood and treated.

So it’s clearly a matter of getting our priorities straight. But there are other reasons many kids are still slipping through the cracks, though it's definitely not because we don’t know who they are. We can identify the kids at greatest risk for poor outcomes at very early ages. We know who they are. It’s also not because there aren’t lots of people trying hard to help. These kids and their families are often well-known to social service and law enforcement agencies and school staff. And it’s not because we aren’t spending enough money on them. These are already some of the most expensive kids in our society.

One major factor is our failure to systematically keep track of our vulnerable kids -- across agencies and systems -- to make sure they’re getting what they need and coordinating the efforts of the different people and agencies trying to help them. We have complicated mathematical algorithms for keeping track of Tom Brady’s passing efficiency; we have similarly complex equations for calculating Derek Jeter’s on-base plus slugging (OPS) percentage. But in most places we still do a very poor job of carefully monitoring the Toms and Dereks at high risk for poor outcomes. Perhaps most important, it’s clear that the Smorgasbord Approach to intervention – having lots of different people involved in helping a kid and family – doesn’t seem to be working very well. It’s fine to have lots of chefs working on the same dish, but if there are no cohesive themes -- no shared set of lenses -- regarding how kids come to be challenging or what ought to be done to help them be less challenging, then the different ingredients aren’t going to work well together and the consumers are going to feel they’re being fed confusing, often contradictory information.

Many of the key themes can be drawn from the Bill of Rights for Behaviorally Challenging Kids on this website:

- Challenging kids lack crucial cognitive skills; they’re challenging because they’re lacking the skills not to be challenging

- Like all of us, challenging kids are challenging under certain conditions: when the demands being placed upon them exceed their capacity to respond adaptively

- These conditions – called “unsolved problems” – are generally highly predictable and can be identified and addressed proactively

- Challenging behavior is not due to poor motivation, the seeking of attention, manipulation, limit-testing, or coercion

- Parents of behaviorally challenging kids are not passive, permissive, inconsistent, noncontingent disciplinarians

- Diagnoses pathologize kids and do not help us understand the true factors underlying challenging behavior

And much of what we should be doing to help them be less challenging is highlighted on this website as well:

- Unsolved problems are best addressed by engaging kids and their adult caregivers in a process of Collaborative Problem Solving (CPS), through which realistic, mutually satisfactory solutions can be agreed upon and lagging skills taught

- Solving problems in this way keeps kids engaged, maintains relationships, and enhances communication

- Imposition of adult will – including the use of reward and punishment procedures – does not solve problems durably, does not keep kids engaged, does not enhance relationships and communication, often sets the stage for challenging behavior, and pushes kids further away

It's very hard work, and it takes time. But, as you may know, the above themes and interventions have been applied in some pretty exciting places already. The juvenile detention system in Maine is an excellent example. Not long ago, the system was identified by Amnesty International as one of the worst in the country. Now it’s winning awards for leading the way on how to do it instead. Along the way, the recidivism rate has plummeted from around 60 percent to around 15 percent. The CPS model provided many of the themes and intervention ingredients; the rest was the vision, creativity, and relentless dedication of the people working in that system. The goal – yes, now I’m dreaming, but that’s where it starts -- is to view Maine’s juvenile detention system as a microcosm for what’s possible in other systems and in entire communities. Change the lenses. Identify the kids and their lagging skills and unsolved problems. Start solving problems collaboratively and teaching skills. Build relationships. Keep track of the kids and of what everyone who’s trying to help them is doing. Don’t stop.

I had the pleasure of speaking in December at three conferences where people who care for and about vulnerable kids -- judges, police and parole officers, educators, parents, mental health professionals, people working in juvenile detention and social service agencies – came together to try to find ways to do something more for vulnerable, challenging kids. On December 4th, I participated in the Maine Rising conference in Augusta, inspired by Chief Justice Leigh Saufley, Karen Baldacci (the state’s First Lady), and Peter Pitegoff, Dean at the University of Maine Law School, and organized by the Maine Juvenile Justice Advisory Group, the U of M Law School, and the Muskie School of Public Service. Admirably, Maine is looking for ways to reduce the number of kids referred into juvenile detention, to dramatically reduce its dropout rate, and to create more and better community resources for kids besides detention. A few days later I participated in a conference with similar goals in Wells, Maine, sponsored by Keeping Maine’s Children Connected, NAMI of Maine, and the York County Jurisdictional Team Planning, and centering on the themes of connection, collaboration, and continuation. (Those who attended this conference deserve special recognition because of the weather they endured to get there.) And on December 11th, I was in Rochester, New York, speaking at a conference organized by the Youth Services Quality Council of Rochester and Monroe County, with a very similar focus.

There are people trying to change things for the better in many places. And it’s not just at the local and state level, it’s at the federal level, too. CLICK HERE to view what’s being done legislatively to eliminate the use of restraint and seclusion in our public schools, and HERE to read about efforts to deal with runaway teens in a more compassionate fashion.

And yet, we still have a lot of work to do. I saw the movie Blind Side -- the “feel-good” movie of the holiday season – a few weeks ago. A very nice story, and true no less. But I’m still not feeling so good. See, it’s not about entertainment. It’s about the real world. We can't forget that there are still too many kids who aren’t in the huddle. We’re either a big tent or we’re not.

If you need help moving your system or community in the right direction, Lives in the Balance is here to help. Let us know how we can assist you. And if you want to post a comment (anonymously, if you wish) on the above thoughts, just click below

Compassion Fatigue

noreply@blogger.com (Dr. Ross Greene) — Tue, 10 Nov 2009 02:01:00 +0000

In findings recently reported by Public Agenda, 40 percent of K-12 classroom teachers in the U.S. were characterized as “disheartened.” These teachers voiced high levels of frustration about disorder in the classroom (nearly 75 percent cited discipline and behavior problems as major issues), felt there was an undue focus on testing, and experienced their principals as unsupportive. While some educators I know expressed surprise that the percentage of disheartened teachers wasn’t higher than 40 percent, the news wasn’t all bad: the other 60 percent of teachers were characterized as either “contented” or “idealists”. Not coincidentally, the contented teachers were more likely to report excellent working conditions and were teaching in middle- or higher-income schools, whereas more than half of the disheartened teachers were working in low-income schools.

It’s possible that these findings tell us more about differences between schools than about differences among teachers. All public schools are fixated on high-stakes testing these days, and all schools have students with social, emotional, and behavioral challenges. But some schools have a substantial percentage of students at risk for doing poorly on testing, and it is often these same schools that have disproportionately large numbers of behaviorally challenging students. These students sometimes come from very unfortunate circumstances (trauma, neglect, family dysfunction, etc.) and exhibit a wide variety of maladaptive behaviors: hyperactivity, poor impulse control, inattention, inflexibility, poor tolerance for frustration, poor problem solving, social skills deficits, irritability, anxiety, eating disorders, substance abuse…the types of things one would see in a mental health clinic. Of course, there’s the rub, since schools weren’t designed to be mental health clinics and teachers aren’t typically trained as mental health professionals.

What happens when a teacher needs to be responsive to the needs of many students with diverse academic difficulties while simultaneously addressing the myriad needs of students exhibiting maladaptive behavior, but has little or no training in understanding and handling kids’ behavioral challenges, feels pressured by high-stakes testing, has significant time constraints, and feels unsupported by school leaders? One can only imagine that this combination heightens the likelihood that a teacher with become disheartened.

I was recently reading about a phenomenon known as compassion fatigue, and found myself pondering its possible relevance to disheartened teachers. Compassion fatigue refers to a decrease in a person’s capacity to empathize with those who are suffering. While compassion fatigue has most often been connected with those caring for soldiers with combat stress, teachers have been identified as another population in which the phenomenon occurs. Symptoms can include feelings of incompetence, self-doubt, a decrease in productivity, and a pervasive negative attitude. Compassion fatigue can affect entire organizations and systems, with characteristics including high absenteeism, cynicism, inflexibility, friction among staff and between staff and administrators, strong reluctance toward change, inability of staff to believe that improvement is possible, lack of a vision for the future, and a resistance to helping people who are suffering.

In disheartened teachers, I can see compassion fatigue cutting in two directions. If a teacher is experiencing a reduced capacity for compassion, then that would be a particularly ominous development for students with behavioral challenges. That’s because, in many places, there often isn’t an overabundance of compassion for these students in the first place. And, in providing an automatic, rote response (typically involving punishment) to challenging behavior, the prototypical school discipline program only makes things worse. Because detentions, suspensions, and other punishments are frequently ineffective for the students to whom they are most frequently applied, such procedures don’t relieve the suffering of these students or the suffering of their classmates, parents, and teachers (though their popularity is at least partly attributable to the brief respite they provide to teachers and classmates when disruptive students are temporarily removed from the classroom).

But teachers are also on the receiving end of our society’s collective compassion fatigue. There aren’t many people who truly understand the demands being placed on teachers in our most troubled schools or who have an appreciation for the resulting (often unaddressed) legitimate concerns of teachers in those schools. The Public Agenda report tells us that there are a lot of teachers who are suffering. I can think of nothing more disheartening than having legitimate concerns that never get addressed.

Of course, parents of behaviorally challenging kids already know what it’s like to be on the receiving end of compassion fatigue. It’s not uncommon for parents to be blamed in one way or another for their children’s challenging behavior, perhaps especially at school. If a child is challenging at school it’s a pretty sure-fire bet he’s challenging at home as well. So his parents are suffering, too. Blaming them only increases their suffering, increases the likelihood of adversarial interactions, and makes it harder to work together to make things better. I wonder what percentage of parents of behaviorally challenging kids would qualify as disheartened! And many such parents know well how hard it is to stay the compassionate course when a kid’s behavioral challenges remain misunderstood and unresolved.

As you might expect, I’m thinking Collaborative Problem Solving (CPS) has something to offer in addressing some of the primary concerns of disheartened teachers. To be sure, CPS isn’t a cure for all that ails schools, but it can definitely move things in the right direction when it comes to student behavior problems and disorder in the classroom. It can help adults better understand challenging behavior…not as the byproduct of passive, permissive, inconsistent, noncontingent parenting but rather as the result of a developmental delay in some key cognitive skill areas, including flexibility/adaptability, frustration tolerance, and problem solving. CPS can help parents and teachers understand that challenging behavior occurs when the demands of the environment exceed a kid’s capacity to respond adaptively (of course, that’s when all of us behave maladaptively). But CPS can also help adults understand that challenging behavior is highly predictable and occurs under certain conditions (these are called unsolved problems), thereby facilitating proactive, planful intervention (rather then the reactive, emergent interventions that typify many school discipline programs). CPS provides a process (called Plan B) through which information can be gathered from challenging students so these unsolved problems are well understood and durably solved (so they don’t precipitate challenging behavior anymore). And CPS can also provide a mechanism for ensuring that the concerns of teachers, administrators, and parents are heard, clarified, understood, and addressed, too. Simply put, CPS provides the right lenses, a means of getting organized, and the skills to make things better…and you don’t need to be a mental health professional to get good at it.

If we started making greater headway with the behaviorally challenging kids in our schools, we’d have a lot more time and energy to prepare for high-stakes testing (and a lot fewer disheartened teachers). But if we’re focused primarily on high-stakes testing, we’ll continue losing vast numbers of behaviorally challenging kids (and the numbers of disheartened teachers will remain unchanged). There’s hard work ahead…but you’re working hard already…and nothing is more heartening than seeing the light at the end of the tunnel. As noted on the website of the Compassion Fatigue Awareness Project, healing an organization takes time, patience, commitment, and a group effort.

Need help on the journey? That’s why I created Lives in the Balance. If you can, be sure to listen in on (and even participate in) my radio program for educators every Monday at 3:30 Eastern time (or listen to the archived version any time you want…details on the home page of this website). A radio program specifically geared toward parents starts in January 2010. If there are other forms of support that you’d find helpful, be sure to let me know about them by using the Contact page on this website.

Nobel Prizes

noreply@blogger.com (Dr. Ross Greene) — Wed, 14 Oct 2009 01:10:00 +0000

My original plan for this first The Real World installment was to complain. I know our new President here in the U.S. hasn’t been in office for very long, and I also understand that he’s operating under very difficult circumstances and has some very big fish to fry: the economy, health care reform, finance reform, Iraq, Afghanistan, Pakistan...the list is long, and I don’t envy the man, though he seems up to the task. Still, I was going to complain anyway, because I was disappointed that Mr. Obama’s speech to America’s school-kids a few weeks ago wasn’t as controversial as his political opponents had feared. I was having trouble imagining that Mr. Obama would say anything especially troubling; but, I must admit, I had been musing about the stir he would have caused if he’d said something about the need to focus more on the most misunderstood kids in our schools: those with social, emotional, and behavioral challenges. The kids who consume massive amounts of energy and time at school but who are rarely mentioned in the national school improvement conversation.

The new Secretary of Education, Arne Duncan, has been disappointing along similar lines. Most of his public commentary has ignored students with behavioral challenges, too, except for an admirable call for them to be physically restrained and secluded less. Sadly, it seems to have taken the brutal murder of a high school kid in Chicago to get everyone’s attention, but Mr. Obama, Mr. Duncan, and the Attorney General, Eric Holder, were in the Windy City recently to announce new major initiatives to reduce school violence and bring alienated kids back into the fabric of schools. The President has asked for $25 million to fund this initiative, and that seems like a good start.

The problem is that the money could well be spent on the same old programs and initiatives that have failed to reach our most challenging kids. If we don't help school personnel understand challenging kids better...if we’re not solving the problems that have set the stage for these kids to become alienated in the first place...if the kids don’t come to see adults as helpers (rather than as the enemy)...then I don't have great hope that any amount of money will do the job. I wonder if the President, Mr. Duncan, or Mr. Holder has heard of Collaborative Problem Solving...how it’s been shown to be remarkably effective in reducing the use of physical, chemical, mechanical restraint and locked-door seclusion in the most difficult of settings and with the most difficult of alienated, challenging kids...and how it has a track record for dramatically reducing suspensions, detentions, and discipline referrals in schools. Even if they hadn't heard of CPS beforehand, they have now: a copy of this segment has been sent to all three, along with a certain book.

President Obama seems like the kind of man who would embrace Plan B. In the words of Joe Klein (of TIME magazine), our new President favors “diplomacy over bellicosity,” and what a breath of fresh air that is. Enough of a breath, by the way, for him to have been awarded a Nobel Prize. He also seems like the kind of man who would care deeply about the kids who continue to slip through the cracks in our schools, and who would understand the futility of current school discipline practices and zero tolerance policies. Those practices and policies didn't make a whole lot of sense for the 6-year old boy in Delaware who was suspended from school recently (and threatened with 45 days at an alternative school) for bringing his Cub Scout utility knife/fork/spoon to school...and he's not even a challenging kid. How come this is only news -- how come we only appreciate the absurdity -- when those policies and practices are applied to a well-behaved kid? Such practices make even less sense when they are zealously, vigorously, righteously, and perpetually applied to kids who are challenging! In keeping with the mission of Lives in the Balance, the folks at that Cub Scout’s school -- who I'm certain have the best of intentions -- are now aware of the CPS model, too.

I'm not in a position to award Nobel prizes. But I'd like to give "Noble Prizes" to every teacher, parent, and staff member who is using Plan B (instead of bellicosity) in their homes, schools, inpatient units, residential facilities, and prisons. You all are doing noble, admirable work in the trenches on a daily basis, usually unrecognized. Some of you – those who’ve been willing to be videotaped – can be seen (and heard) in the Voices of CPS section of this website. Keep up the good work. A lot of kids are being helped through your tireless efforts.