CHRIS: Um . . . I guess I could just hold on to whatever you’re wearing.
PARENT: I think that idea could work very well. Can I remind you to hold my belt loop before we get out of the car?
CHRIS: Yes.
PARENT: But sometimes you get mad when I remind you that parking lots are dangerous.
CHRIS: That’s because I already know parking lots are dangerous. I only get mad if you’re screaming at me to hold your hand.
PARENT: I’m screaming at you because you’re . . . you know what? If you and I agree that you’re going to hold my belt loop in the parking lot from now on, then it won’t matter why I was screaming at you.
CHRIS: What if you forget not to scream at me?
PARENT: I’m going to try very hard not to. If I slip, can you remind me?
CHRIS: Yup.
PARENT: This plan works for you?
CHRIS: Yup.
PARENT: It works for me, too. And if our solution doesn’t work, we’ll talk about it some more and think of another solution.
Often when parents refer to “safety issues” they’re referring to what their child is doing (hitting, throwing things) in the midst of a challenging episode. Again, since a high percentage of challenging episodes are precipitated by an adult using Plan A, using Plan B instead of Plan A should make a major dent in the frequency of safety issues.
QUESTION: Everything I’m reading makes good sense to me, and I get the importance of being proactive. But what if I should find myself in the middle of a challenging episode?
ANSWER: If you should find yourself in the middle of a challenging episode, it’s a pretty sure bet you’re using Plan A. The best advice is to defuse and de-escalate the situation so as to keep everyone safe. If you’re lucky and your child is still, at that moment, capable of rational thought, then Emergency Plan B is an option. If not, then one viable option is to use Plan C at that moment and use Proactive Plan B at the next possible opportunity to solve the problem that set in motion the concerning behaviors in the first place. Concerning behaviors provide very important information about unsolved problems you may have missed or failed to prioritize. That’s perhaps the only useful thing about such behaviors: they let you know there’s still work to be done to prevent the same problem from recurring.
QUESTION: I don’t have time to use Plan B. It takes too long.
ANSWER: You may want to take a look at how long it’s taking you to deal with the concerning behaviors that are caused by Plan A. Most people find that concerning behaviors always take longer to deal with than Plan B would have taken to prevent them. Unsolved problems always take more time than solved problems. Doing something that isn’t working always takes more time than doing something that will work. If you and your child are collaborating on durable solutions, then the amount of time you’re spending using Plan B will decrease over time as problems are solved.
QUESTION: I’m not that quick on my feet. I can’t always decide what Plan to use on the spur of the moment.
ANSWER: It’s only in the heat of the moment that you have to be quick on your feet. Another of the many reasons that being proactive is far preferable.
QUESTION: I started using Plan B with my daughter, and she talked! In fact, she talked so much and I gathered so much information that I started becoming overwhelmed with all the problems we need to solve! Help!
ANSWER: It’s true, sometimes Plan B opens the information floodgates, and you find out there were even more problems to solve than those you identified on the ALSUP. While that can feel overwhelming, it’s good that you’re now aware of all of those unsolved problems. Your goal is to add any new unsolved problems to your list, perhaps reprioritize, and continue the mission of solving one problem at a time.
QUESTION: So, I’m not a failure if I don’t make it through all three steps of Plan B in one sitting?
ANSWER: Not at all! If you didn’t make it past the Empathy step in the first attempt at Plan B, but you now understand what’s making it hard for your kid to meet a particular expectation, I’d say you’ve been quite successful. Just make sure you follow up with the next two steps before too much time passes.
QUESTION: What if my child and I agree on a solution and then she won’t do what she agreed to?
ANSWER: As you’ve read, that’s usually a sign that the solution wasn’t as realistic and mutually satisfactory as you may have first thought. That’s not a catastrophe, just a reminder that the first solution to a problem often doesn’t get the job done. Remember, effective problem solving tends to be incremental; good solutions are usually variants of the solutions that preceded them. It’s also important to remember that Plan B isn’t an exercise in wishful thinking. Both parties need to be able to follow through on their part of the solution. If your child isn’t following through, it’s probably not because she won’t but because she can’t. By the way, kids aren’t the only ones who don’t follow through on unrealistic solutions; adults aren’t very good at it either.
QUESTION: I did it! My child and I did Plan B together and we solved our first problem, and the solution seems to be working so far. Now what?
ANSWER: Well done! You’re on your way to having the problem durably solved, though it sounds like you recognize that the solution may not stand the test of time. What’s next? Move on to another high-priority unsolved problem, and then another. Along the way, be sure to look in the rearview mirror to take stock of the progress you’re making.
QUESTION: I understand how Plan B helps me solve problems with my child. But how are my child’s lagging skills going to get taught?
ANSWER: Great question. The reality is that there aren’t great strategies for directly teaching many of the lagging skills on the ALSUP. However, there is a great technology for enhancing those skills: Plan B. When you’re collaboratively and proactively solving problems, you are indirectly teaching skills.
In other words, many skills are enhanced just by doing Plan B with your child, irrespective of the specific unsolved problem you’re working on. In the Empathy step, kids practice reflecting on their concerns and expressing those concerns in ways that other people can hear and understand. In the Define Adult Concerns step, kids practice listening to another person’s concerns (what many of us refer to as empathy), taking another person’s perspective, and appreciating how their behavior is affecting others. In the Invitation step, kids get practice at considering a range of solutions to a problem, considering the likely outcomes of those solutions, and shifting from a solution that only works for them to a solution that will work for other people, too. Lots of skills are being taught and practiced with Plan B; and remember: it’s not just the kid who’s getting good at those skills.
Plan B also helps your child build a repertoire of solutions. Here’s what I mean: Because I fly frequently, I am commonly faced with the problem that a delayed or canceled flight will prevent me from reaching my intended destination in time for a speaking engagement. Now, no one has ever sat me down and provided me with direct instruction on what to do if my flight is canceled or delayed. I learned through experience, and those experiences (successful and not so successful) provide the foundation for my “what to do if your flight is delayed or canceled” repertoire. There may be alternate flights on the same airline. There may be alternate flights on a different airline. There may be alternate flights to nearby destinations. There are rental cars. There are trains. Don’t most people have the skills to apply past experiences to problems they face in the present? Yes. But, as evidenced by the meaningful number of fellow passengers I’ve seen exhibit concerning behavior when their flights are delayed or canceled, apparently not all.
By solving problems collaboratively with your child, you are helping your child build a repertoire of solutions. By solving problems proactively, you may be helping your child access solutions that are already in her repertoire but that, when she’s heated up, she’s unable to access.
QUESTION: What’s the role of medication in helping k
ids with behavioral challenges?
ANSWER: There are some kids who are so hyperactive, impulsive, inattentive, irritable, anxious, and/or have such a short fuse and are so emotionally reactive that it’s extremely difficult for them to participate in Plan B until these issues have been satisfactorily addressed. If any (or many) of these issues are making participation in Plan B difficult, then presumably they’re making other aspects of life difficult as well. These are issues for which medication can sometimes be helpful.
Many parents have an instant negative reaction to the idea of medicating their child, and for good reason. These days, too many kids are medicated unnecessarily, too many are on too much medication, and too many are on medication for things medication does not address well. Psychotropic medication isn’t always prescribed with the level of expertise, care, and diligence it deserves. But medication can be helpful for some of the factors contributing to concerning behavior and make it more possible for some kids to participate in Plan B. So, while a conservative approach to medication is totally appropriate, you may not want to rule out the possibility completely. In some kids, medication is an indispensable component of treatment.
Deciding whether to medicate one’s child should be difficult. You’ll need a lot of information, much more than is provided here, especially about side effects. Some medications that are commonly prescribed for kids haven’t been approved for use with kids, nor have many been studied extensively in use with children and adolescents, especially with regard to their long-term side effects. Your doctor should help you weigh the anticipated benefits of medication with the potential risks so you can make educated decisions. Although it’s important to have faith in the doctor’s expertise, it’s equally important that you feel comfortable with the treatment plan they propose, or at least that you’re comfortable with the balance between benefits and risks. If you are not comfortable with or confident in the information you’ve been given, you need more information. If your doctor doesn’t have the time or expertise to provide you with more information, you need a new doctor. Medical treatment is not something to fear, but it needs to be implemented competently and compassionately and monitored continuously. Ultimately, what you’ll need most of all is a competent, clinically savvy, attentive, and available prescribing doctor. You’ll want one who:
Takes the time to get to know you and your child, listens to you, and is familiar with treatment options that have nothing to do with a prescription pad
Knows that a diagnosis provides little useful information about your kid
Understands that there are some things medication doesn’t treat well at all
Has a good working knowledge of the potential side effects of medication and their management
Makes sure that you—and your kid, if it’s appropriate—understand each medication and its anticipated benefits and potential side effects and interactions with other medications
Is willing to devote sufficient time to monitoring your child’s progress carefully and continuously over time
When children have a poor response to medication, it is often because one of the foregoing elements was missing from their treatment.
A discreet approach to medication is also recommended. A lot of kids aren’t eager for their classmates to know that they’re receiving medication to address emotional or behavioral issues. If there’s no way to keep your child’s classmates in the dark, it’s often necessary to educate the classmates about individual differences (asthma, allergies, diabetes, difficulty concentrating, low frustration tolerance, etc.) that may require medicinal treatment. On the other hand, while there’s a temptation for parents to avoid doing so, I typically encourage parents to keep relevant school personnel well-informed about their child’s medication. The observations and feedback of teachers are often crucial to making appropriate adjustments in medication; the goal is to work as a collaborative team.
QUESTION: If I choose to medicate my child, how long will she be on the medication?
ANSWER: That’s very hard to predict. In general, the chemical benefits of medication endure only as long as the medication is taken. However, because of maturation and/or because new skills and improved relationships were developed when the medication was being prescribed, it is sometimes possible to discontinue the medication. Ultimately, the question of whether a child should remain on medication must be continuously revisited.
QUESTION: What about homeopathic and natural remedies?
ANSWER: Some parents feel better about using such remedies instead of prescribed medication, and some kids benefit from them. But it’s important to apply the same standard to homeopathic and natural remedies as we would to prescribed medication. Don’t stick with it if it’s not helpful, or if the intervention is doing more harm than good, or if there are other interventions that might be more effective.
QUESTION: My child has significant communication delays. I’m wondering if Plan B is truly realistic for her.
ANSWER: Since all of the examples of Plan B you’ve read so far depict kids with half-decent communication skills, it’s no wonder you’re wondering. So, let’s focus for a while on how one would go about solving problems collaboratively without the aid of the spoken word. The good news is that these kids are already communicating; what makes life more difficult is that they’re not communicating through what is the preferred modality for many caregivers (the spoken word). But Plan B can be adjusted for kids with compromised communication skills so that you can identify unsolved problems, gather some information about the concerns related to these unsolved problems, and participate with your kid in the process of generating and evaluating solutions.
A useful reference point, by the way, is infants. Infants may have any variety of unsolved problems: hunger, difficulty being away from mom and/or dad, difficulty sleeping away from mom and/or dad, difficulty eating, difficulty digesting food, difficulty establishing a regular sleep cycle, difficulty self-soothing, difficulty dealing with the sensory world (lights, noises, heat, cold, etc.), but they don’t have the words to tell us about them. They are communicating, but they are doing so in ways that don’t involve spoken words. If you think about it carefully, we actually do collaborate with infants on solutions: after caregivers try to figure out what the infant is communicating and then apply solutions aimed at addressing the infant’s concerns, we are completely dependent on the feedback provided by the infant to determine whether the concern has been addressed or not. All without words. If we can do that with infants, we can do that with kids (and adults) of any age who are unable or severely limited in their ability to communicate through use of the spoken word.
Let’s think about what it would look like to engage a kid in solving problems collaboratively without the use of many (or any) words.
IDENTIFYING UNSOLVED PROBLEMS
The first goal remains the same: create a list of the unsolved problems that are reliably and predictably precipitating concerning behaviors. While grunting and growling and screaming are less explicit than words, they are occurring under highly specific conditions, and your observations about those conditions will help you generate a list of unsolved problems.
As an example, Roger was an adolescent boy whose expressive language skills were delayed but who was able to understand much of what was being said to him. His caregivers hadn’t yet put much energy into identifying the conditions in which challenging episodes were occurring. Once they gave some thought to it, they found that his unsolved problems included being hot, being tired, feeling sick, being hungry, thinking someone was mad at him, being surprised, feeling that people were talking too much, and having difficulty with an academic task. They wrote those unsolved problems down on an index card, and whenever Roger would start to become agitated, they would recite the possibilities to him to find out which might be the cause. The adults soon memorized the items, thereby eliminating the need for the index card, and Roger eventually memorized the possibilities as well. Over time, Roger began verbalizing
problems. For example, instead of screaming and pounding his fists, he’d say, “I’m hot.” While this was certainly an improvement, most of the problem solving still occurred in the heat of the moment. So, the adults put some energy into identifying the specific conditions in which each of the unsolved problems was likely to occur, and then began engaging Roger in the process of coming up with solutions ahead of time. There was still an occasional need for figuring out what was troubling Roger in the heat of the moment, but with lots of proactive solutions in place, that need diminished greatly over time.
Of course, specific concerns such as “I’m hot” only apply to situations in which a kid is hot. It can also be useful to teach a more generic “problem vocabulary” that a kid can use across many situations to alert adults to the fact that there’s a problem. An especially good phrase is “something’s the matter.” Having a kid say “something’s the matter” is far preferable to having the kid demonstrate that something’s the matter (by biting, hitting, screaming, or swearing). Teaching this phrase begins by providing the kid with direct instruction on the use of those simple words and having adults say “looks like something’s the matter” whenever it looks like something’s the matter. Of course, that’s what’s happening in the heat of the moment. It’s then important for the adults to identify unsolved problems that are accounting for times when the kid is saying “something’s the matter” so as to solve those problems proactively. The child won’t have need of their new phrase so often as you solve the problems that were causing something to be the matter.
We adults overestimate the linguistic skills we use to let people know we’re frustrated or stuck or overwhelmed. But most adults lean on a few key phrases. By teaching them to kids, we’re helping to raise them to the same communication level as the rest of us.
Kia is a three-year-old girl diagnosed with an autism spectrum disorder. She was using very few words to communicate. The initial goal for Kia was the same as for Roger: find a way to establish a basic vocabulary for unsolved problems. There are various technologies that could have helped, but Kia’s speech-and-language therapist chose to use Google Images to depict in pictures, placed on a laminated card, the unsolved problems that were reliably and predictably precipitating her concerning behaviors. They included being hot, being cold, being hungry, being thirsty, and something not going the way she thought it would. Here’s a reproduction of what that looked like:
The Explosive Child Page 11
