YOUTH WITH/WITHOUT DIFFICULT BEHAVIORS BENEFIT FROM CPS
DON’T SEEM TO LEARN FROM PLAN A
- Expectations with use of predetermined punishments/rewards.
- Poorly understood by child who doesn’t change. Some kids respond but don’t learn problem solving.
- Severely resistant to the imposition of adult will and corresponding explosive outbursts causing upheaval, instability and frustration.
- Incompatible match of child characteristics and the manner by which adult pursues expectations.
- When a person’s threshold of adversity exceeds his skills, the likelihood of violence is heightened.
“Kids (and adults) do well if they can.”
- Behind every challenging behavior is either an unsolved problem, or lagging skill, or both.
- Your explanation of the behavior guide your intervention.
- Reward and punishment do not teach skills of flexibility and frustration tolerance.
THREE PRIMARY DOMAINS
Frustration tolerance, problem solving and flexibility/adaptability.
- Deficits guide intervention options more specifically than knowing the kids diagnosis: ADHD, ODD, reactive attachment disorder, etc.
- Executive, Language Processing, Emotional regulation, Cognitive flexibility, and Social skills.
- Some kids simply aren’t available for academic learning until headway has been made on the challenges that may be impeding learning.
- Factors other than lagging skills that contribute to explosive behavior: sleep issues, current trauma, seizure disorders, food and seasonal allergies, drug or alcohol use, and other complicating medical conditions or reactions to medicine.
Assessment and implementation issues:
- Think Lagging Skills not bad behavior.
- Shifting understanding of behavior away from motivational interpretations.
- Attention, not motivated to do well, wants to be in control, wants things her way, avoid doing something, get something.
- A story is just a story unless you use it to identify a pathway or a trigger.
- Lagging skills explains why motivational strategies do not work.
Being in control (directive) of the case:
- Focus on pathways, prioritizing lagging skills and triggers so that there is focus on one or two concerns at a time, anticipating brick walls or derailment.
- Recognizing adult pathway deficits and responding to them
- Individual training and support for participants before they work together
- Use the ALSUP: (Assessment of Lagging Skills and Unsolved Problems)
Importance of Triggers or activating event:
- Reacting to math assignment when math assignment is thought to be too hard.
- Problems that have yet to be solved.
- EG. Hypersensitivities can be homework, sharing, reading, writing, getting ready for school, focused learning, self-starting, sustained effort and getting along with others.
Adult expectations pursued in a manner that greatly heighten the likelihood of explosive outbursts
Evidenced by increased insistence or pressure to meet adult expectations
Plan A approach:
- List target behaviors needing compliance
- Make list of incentives and punishments
- Develop a currency system to track/monitor behavior and issue rewards/punishment
- May be necessary behavior poses an immediate safety concern.
Implementing CPS, things often get worse before they get better. Change in paradigm, frustration
tolerance, old plan A habits, maintenance needs. Involves willingness to repeat problem solving
sessions that replace blame with empathy and desire to find a plan that meets both adult and child.
Plan B approaches:
- Essential information: Adult works to stay calm and not follow the escalation.
- Dealing with Trigger: Best to focus on trigger solutions first.
- Dealing with Pathways: Plan B helps with the pathways in general
- Executive: dealing with past-future details
- Language: self-expression skills when calm, teach vocabulary to connect feelings
with concerns, develop tools, develop frustration list, phrases to ask for help:
“Something is the matter.” “I can’t talk right now.” “In need help” “I don’t
know what to do.” “I don’t feel right” “This isn’t going the way I thought it would.”
- Emotion: empathy is calming, trust building, safety
- Cognitive Flexibility: Anxiety from lack of frame of reference/mastery, having
child’s knowledge/perspective validated, hearing another’s concerns.
problem solving practice: ask for help, meet halfway/give a little, do it a
- Social Skills: working through something with someone, making plans for real
social situations, acquiring new behavior options
Type 1: Proactive Plan B:
Key steps initiated by adult when all parties are calm. Need to build
trust that talking about problem to find mutually solution is not a Plan A
manipulation. Have a curious attitude. The aim is at trying to find what works. It’s
an experiment. We’ll learn as we go.
Start with Empathy/reassurance
- Neutral observations: I notice homework has been a struggle lately, “What’s up…..”
- What’s wrong with what others are doing?
- For adolescents: “I hear ya” alternative to reflective listening
- Don’t rush, make sure you understand kid’s concern or perspective
- Better to believe the kids perspective than not believe it
- Keep the kid talking.
Define the problem
- Kid concern first, adult concern second
- Requires mutual recognition of concern, not agreement
- Child does not feel blamed – behaviors are not intentional
- System/family problem not the child’s problem
- Don’t mix in solutions with sharing concern
- “Let’s find a mutually satisfying and feasible solution for the problem/concern”
Type 2: Emergency Plan B
- On the spot de-escalation but doesn’t set up a durable plan
- Don’t rely on Emergency Plan B, it will wear you out
- Problems to solve another day.
- Expectation deemed not realistic or necessary at a given time
- Meds can help make the child/youth more available for problem solving
- Inattention and distractibility: Stimulant meds: Ritalin, Dexedrine
- Hyperactivity and impulse control: Stimulant Stratera
- Atypical anti-depressants (Wellbutrin)
- Antihypertensive (Clonidine, Tenex)
- Trycyclic antidepressants (Pamelor, Tofranil, Anafranil)
- Irritability and Obsessiveness
- SSRI antidepressants (Zoloft, Paxil, Celexa, Luvox)
- Extremely Short Fuse
- Atypical antipsychotics (Risperdal, Zyprexa, Seroquil, Abilify)
- Mood Stabilizers (Lithium, Tegretol, Depakote)