collaborative problem solving

Collaborative Problem Solving and Reactive Attachment Disorder

From time to time, I work with a family, caregiver, or child-focused professional who asks me about whether CPS can work for kiddo with this or that diagnosis. Will CPS work with kids with FASD? Will CPS work with kids on the spectrum? How about kids who have ADHD?

The answer is, invariably, yes! CPS works independent of diagnosis because CPS is a technology that we as caregivers and professionals use to address challenging behavior, solve problems, and build skills. 

Today we'll take a look at Reactive Attachment Disorder (RAD), and whether CPS is a good fit for kids who experience attachment challenges. 

RAD in a Nutshell

Reactive Attachment Disorder is a disorder that is diagnosed early in a child's life, and is marked by disturbed social relationships, a history of disruptions to caregiver relationships, and either a persistent inability to respond appropriately to caregivers, or indiscriminate acceptance of comfort and support from adults. It's a popular diagnosis, especially among kids who are involved with the foster and adoptive systems.

Kids who have attachment issues are often observed to struggle to give up control over their environments, connect with caregivers, react poorly to reasonable limits, consistently regulate their bodies and emotions, build healthy social relationships, and engage adaptively in family traditions (like holidays, vacations, etc).

What Doesn't Work

First, let's talk about conventional wisdom - what it is and how it's commonly used to respond to behaviors associated with attachment concerns.

Conventional wisdom is organized around the idea that kids do well if they want to. Under the umbrella of conventional wisdom, kids who have trouble meeting expectations are seen as unmotivated, and the solutions we as adults with are intended to produce motivation to change. 

Evidence, however, teaches us that kids already want to do well, and when things get hard, it's usually because kids are lagging behind in some aspect of their "thinking skills."

Kids who have lots of skills can actually respond pretty well to conventional wisdom approaches to challenging behavior - things like sticker charts, paychecks, groundings, etc. Kids who don't already have lots of skills usually have a really hard time responding successfully and sustainably to these types of approaches. 

There are lots of reasons kids might have lagging skills. Disruptions to caregiver relationships and subsequent attachment issues are certainly things that interrupt typical skill development. 

Conventional approaches don't work well for kids with attachment issues for a couple reasons. Kids with attachment challenges have learned over time that caregivers are simply not reliable. When caregivers are unreliable, they're unsafe, and systems of consequences and rewards designed by unsafe caregivers are also unsafe. When the consequence and rewards system is unsafe, kids are going to be less inclined to participate in it. 

Disruptions to caregiver relationships also impact a child's ability to develop their thinking skills - skills like emotional regulation, being able to communicate their needs appropriately, adapting to changing environments, and being able to understand and correctly interpret social cues. As caregivers, we do a lot to model these skills and help kids practice them as they move closer to mastery. When caregiver relationships are disrupted, often it means that kids don't get a chance to practice these skills - these kids aren't lost to the wilderness, they're just farther behind. 

Why Collaborative Problem Solving Does Work

Let's take a look at the three main ingredients of Collaborative Problem Solving that are baked in to every Plan B conversation:

  1. Empathize. The first step in a Plan B conversation is to empathize with the child's concern. Remember that empathy isn't endorsement, it's understanding. In this first ingredient, we're trying really hard as adults to drill down into the problem and really get a good picture of the issue from the kid's perspective. Empathy, it turns out, is really really good for kids who have attachment issues. It also, it turns out is good for everyone else in the world, but it's also great for kids who have attachment concerns.
  2. Share the adult concern. The second step of a Plan B conversation is to share the adult concern about the problem. In this step, we're inviting the child to appreciate the perspective of another person and develop their own empathy skills. Do kids with attachment issues struggle to take the perspective of other people, especially caregivers? You bet they do. Ingredient two is great practice.
  3. Collaborate. The final ingredient of a Plan B conversation is an invitation to the child to collaborate on a solution to the problem that incorporates both the child's concern and the adult's concern. In this last phase we're engaging the child's problem solving skills, but we're also asking them to again practice their empathy, to practice their perspective taking, and to practice their emotional regulation. But we're also doing more than just practicing skills - we're demonstrating to the child that we as caregivers are just as invested in the child's concern as we are in our own, and are committed to understanding and creating a solution that works for everyone. 

Look, nothing solves attachment issues overnight. Healing from disrupted relationships with caregivers can take years - parents who are taking care of kids with attachment struggles are invested in the long game. The invitation here, though, is to see kids with attachment issues not as a separate species of kid who are entirely dissimilar to their peers who have developed secure attachment with their caregivers, but as kids who are farther behind in their skill development. 

Kids with attachment issues tend to struggle similar things: giving up control, accepting limits, expressing their concerns, interpreting social cues, etc. A lot of parents with RAD kids would say, "yeah, that sounds like my kid!"

But here's the thing: a lot of parents who have kids who don't have attachment issues would look at that list of things RAD kids struggle with and say, "oh yeah, that's my kid, too."

A RAD diagnosis can help build a narrative of a kid's early childhood experience, and for many parents, getting that diagnosis for their kids can really validate the struggle of parenting. Collaborative Problem Solving doesn't ask us to abandon that narrative - it asks us instead to really focus in on the specific skills our kids with RAD are struggling with, and work with them to develop solutions to problems that work for the whole family. It can be a long process, but it's a process that is focused on empathy, relationship, and skill development - three things which kids with RAD often missed out on big time. 

Ed Morales, LICSW, is a clinician and educational consultant based in MinneapolisFor more information about Collaborative Problem Solving and it's application in schools or families, connect with us. 

Minneapolis Public Schools and Collaborative Problem Solving

This August, Minneapolis Public Schools teachers will be invited to an introductory Collaborative Problem Solving training, the first of its kind in the district. In partnership with the summer mental health institute, MPS teachers will be able to learn more about the collaborative problem solving approach to challenging behavior and will leave with solid foundational skills and a working understanding of the skill-based approach to working with challenging kids. 

Collaborative Problem solving has broad applicability throughout our school systems - I'm excited to collaborate with our city's teaching staff!

This training is open only to MPS staff - if that's you, check with your site administrator for more information. The training is scheduled for August 10th. 

They Think I Don't Want Good Days: The Case For Building Skills

Some years ago, I worked with DeNasia, a whip-smart, remarkable young scholar from North Minneapolis. Like many of the young students I work with, DeNasia had quite a rap sheep at her school - a long sequence of disruptive behavior in class followed by detentions, suspensions, and, eventually, a soft expulsion. DeNasia was also one of the most academically talented scholars in the school, and could pass the state exams that virtually no one else could.

DeNasia had a lot of triggers, but the thing that really got her going was when adults came at her life, trying to redirect or admonish her without taking the time to understand the problem. When tested in this way, DeNasia would take the bait every time and respond with the surly attitude that had for so long shaped her reputation in the school. The adults, as often is the case, rarely backed down, and would escalate with DeNasia, throwing verbal haymakers at her while she threw left hooks right back until she found herself subject to the power of the adults in the building and was suspended yet again. 

It got so bad that mom eventually transferred DeNasia out of the school. On her last day, DeNasia got into an argument with another while waiting on the bus for her trip home. She eventually lost her cool and slapped the other student in the head, which got her pulled off the bus and admonished publicly by school administrators. 

While DeNasia and I waited in the office for final call on whether she would be allowed to take school bus home, she told me that teachers tended to personalize her behavior, and that she hated this more than anything. "I didn't get a chance to apologize," she told me. "All the teachers would just say that 'you always do this,' or 'you're always so nasty,' but I'm not. What about all the times I ride the bus and nothing happens? Why they never talk about that? It's like they think I don't want to have good days."

DeNasia wasn't allowed back on the bus that day, and instead spent the end of her last day at school walking a half-mile to the city bus. DeNasia left the school, and last I heard, she'd ended up in a restrictive educational setting that likely to attempted  to address her behavior but but not her tremendous academic gifts. Her reputation, it seemed, followed her. Or perhaps she rebuilt it. 

Challenging behavior is a major obstacle to efficient classroom learning, the culture of the classroom (and home life), and even to the retention of good teachers, who frequently cite ‘challenging behavior’ as the primary reason they leave the profession.

So what do we do about it?

Conventional wisdom directs us to believe that challenging behavior, whether it’s homework completion, defiance, or sneaking out of the house, happens because kids don’t want to do any better. Under the umbrella of conventional wisdom, failing to meet an expectation set by adults is seen a problem of will. And because we see it as a problem of will, we work overtime to try and motivate kids do want to do better. We’ll create token economies, like paycheck systems, and punish kids who don’t comply with expectations with things like detentions and suspensions.

But what if the problem isn’t will at all, but skill? What if challenging behavior is less a well-reasoned, pre-meditated attack on the learning environment and more evidence of a deficit in one or more skills kids need to succeed in the world? What if the kids who struggle the most with challenging behavior are the kids who are trying the hardest, like DeNasia, to have good days?

What if kids already want to do well, but can’t because something is getting in the way?

A few years ago, I had a conversation with Kieyra, an 8th grader in Minneapolis about her school’s discipline system. At that particular school, students who failed to meet behavior expectations were given something like a demerit and sent to an end-of-day detention, and, if they accumulated enough demerits, they were eventually suspended. Kieyra, who rarely, if ever, saw the inside of the detention hall, complained quite pointedly about the kids exhibiting challenging behavior - she saw their behavior as disruptive and interfering with her own education. She also noticed that the school’s approach to discipline rarely changed anything; kids would get sent out of class or suspended, and would return a few days later, wild as ever.

What Kieyra is pointing to is a solution designed to solve the wrong problem. Conventional school discipline systems work to motivate compliance with expectations, which evidence shows us is not the root cause of challenging behavior. We’re solving problems we don’t have, while bigger, badder problems go unchecked.

These bigger, badder problems are problems with what the clinicians at Think:Kids call “thinking skills,” skills which govern our ability to function well in the world.

These thinking skills are organized loosely into a few different categories:

  • Language and communication skills which include things like understanding spoken directions, following conversations, and being able to express their needs or concerns, or tell someone what’s bothering them.
  • Attention and working memory skills, skills like staying with tasks that require sustained attention, tuning out distractions, and considering a range of solutions to a given problem. An example of a working memory exercise is me asking you to remember a sequence of numbers (let’s say 4, 2, 27, 6, 1, 13) and then asking you to repeat them back to me. A more complex working memory exercise is asking you to take the same sequence of numbers and organize them, in your mind, in order from least to greatest. It gets pretty tough pretty quickly.
  • Emotion and self-regulation skills, including skills like managing irritability and disappointment in an age appropriate way, considering likely outcomes or consequences of her actions, and matching their energy level to the needs of the situation.
  • Cognitive flexibility skills, like handling transitions from one task to another, managing deviations from expectations, and the ability to appreciate changing circumstances that might mean a change in plans.
  • Social thinking skills, including paying attention to verbal and nonverbal cues, seeking attention in appropriate ways, and empathizing other points of view.

Think about some of the challenging kids you’ve worked with, and consider whether any of these skills groups resonate with what you saw in the classroom.

Let’s consider something we love to talk about as educators: attention-seeking behavior. How many times have we sat in meetings and heard a team member attribute a challenging behavior to “wanting attention”? And it may well be true - the kiddo who launches a crayon at their peer’s head might just be looking for attention. Unfortunately, that’s where we often stop with our analysis, when the real interesting conversation is just around the corner. Instead of writing challenging behavior off as “attention-seeking,” we have the opportunity to ask the really interesting question: “why”? Why would a student try to get attention in ways that create more trouble for them?

For a lot of kids, the answer to this question is that they don’t know how to get attention in appropriate ways. Other kids struggle to communicate what they actually need, and the end result is a crayon chucked across the classroom. Still other kids have trouble understanding how their behavior impacts others in their environments, and may not quite see why playing tag during math class isn’t always a great idea.

Lagging skills tend to travel in packs: where there’s one, there’s probably a handful. Kids who struggle with cognitive flexibility often struggle with social thinking skills. Kids who have a hard time managing their irritation often struggle to talk about what they need. It’s not unusual to sit down to make a list of lagging skills and end up writing all of them down. And that’s okay - our kids are a work in progress, much like we are. What’s more: the process of thinking about lagging skills helps us remember that our kids are a work in progress, and a kiddo acting like a monster might just be a sign that they’re struggling to express themselves, and not a signal that they’re, you know, a sociopath.

What to do about skills...

It’s one thing to suggest challenging behavior is about skill, and another thing to talk about what we actually do about the problem of skill.

I’ve got great news - we can build skill and solve challenging behavior at the same time, with collaborative problem solving.

  1. Empathize with the student to gather information about the student’s concern or perspective about the problem at hand. In this first stage of the process, put on your detective hat and ask clarifying questions, make educated guesses, and practice reflective listening so you really get an idea of how the student sees the problem. And as you work hard to suss out the student’s concern, you might just find yourself surprised by what you learn. I do. All the time.
  2. Share the adult’s concern, to make sure it’s on the table. It’s important to start with the student’s concern for a variety of reasons, but once you have a pretty good idea of what’s going on for the student, it’s time to bring your concern into the conversation. As you think about your concern, think about where it’s grounded. Are you concerned about health? Safety? Learning? The student’s impact on others? Why is this even a concern for you? Sometimes when we go through the process of clarifying our own concerns, we discover that we don’t really have a clear idea of why we have the concern, and that’s important to acknowledge, too.
  3. Collaborate on solutions with the student so that their concerns and the adult’s concerns are addressed. Here, you want to start by brainstorming, and you want to start with the student. Ask them to come up with the first idea, and remember that any idea is a good idea. Once something’s on the table, you can evaluate the proposal with the student: does it work for the student? Does it work for the adult? Is it even possible? If we do it, will it bring up any other concerns? Remember than no solution is a good solution unless both sets of concerns are addressed.
  4. Try it out. Once you have a list of possible solutions, pick one and try it out. You’ll probably find that the first solution doesn’t work, but that’s okay. If a solution doesn’t work the first time around, it just means you get more time to practice problem solving skills with the student, and we can all use more practice. And if it does work the first time, great! Have some cake!

That time thing...

To say that today’s educators find themselves pressed for time would be a gross understatement. In a world of standardized testing, performance-based incentive pay, and constantly shifting institutional priorities, teachers just don’t have a whole lot of time for, well, anything. The idea of sitting down with a student and collaborating around solutions to their challenging behavior can seem pretty unappetizing, given the demands on a teacher’s schedule. It’s important to remember, though, that durably solving a problem can never take longer than dealing with the symptoms of the problem. Not ever. Never! Investing now to solve the problem long-term will pay off big time down the road, and not even particularly far down the road.

The other thing about time is this: the number one reason educators deviate from their lesson plans is responding to challenging behavior. Reflect for a moment on how often you have to stop teaching to address some shenanigans - maybe you’ve got that one kid that you have to redirect every class... or maybe every other minute. 20 seconds here, 20 seconds there, and it adds up quick. Solving the problem requires some focused time and attention, but once the problem’s solved, you’re done with it. And even better, as you get better at problem solving, and the kids get better at problem solving, the process will go faster and faster.

Skill, not will... 

For generations, we’ve been fighting the wrong behavior battle. Conventional wisdom has us trying to motivate kids to do better, and to that end we’ve developed all sorts of complex systems to pursue that end - token economies, pay-for-grades, detentions and suspensions and more.

But our kids want to do well. They’ve always wanted to do well. And when they can’t do well, there’s something in the way. It’s never as simple as “he just doesn’t want to.” DeNasia wanted to have good days, desperately so, but there were things getting in the way. Sometimes lots of things.

The sooner we can focus our attention on building skill instead of motivating compliance, the sooner we can become even more powerful forces for positive transformation in the lives of our young people.

Thumbnail Photo: NYTimes.

Ed Morales, LICSW, is a school social worker in Minneapolis. For more information about consultation, trainings, and other support for your school or family, please reach out at ed@socorro.care