Think:Kids : Seeing red? 4 Steps to Try Before Responding

Attention skills include our ability to ignore distractions and focus on a specific task or activity. Working memory relates to our ability to hold many pieces of information in our heads at one time. Skills like these are crucial for all forms of planning and organization, not to mention problem-solving.

Dr. J. Stuart Ablon, founder and director of Think:Kids, explains Attention and Working Memory Thinking Skills, and shares examples of how when kids struggle with these skills it can lead to challenging behavior.

Many people still believe that the key to managing our behavior is making sure that we're just trying hard enough to behave well. But the reality is that our behavior, whether we are a child, an adolescent, or an adult, our behavior is determined by our skill, not our will. There is half a century of research that has shown us, in fact, what types of skills we humans need to be able to effectively manage our behavior. One of those areas is what we refer to as attention and working memory skills. These are skills that are critical when it comes to managing our behavior. When I talk about attention skills, what I'm talking about is things like staying focused on things that may not be particularly thrilling or interesting to us and filtering out or ignoring distractions to be able to maintain that focus. And in fact, shifting our focus from one task activity or topic to another when we're asked to do so.

Now, when I describe it this way, you can see why attentional skills are so crucial, particularly for school-aged kids, because school-aged kids spend a lot of their life being told by parents and teachers and things like this, what to do when and what to focus on when. And let's be honest. Oftentimes, we're asking them to focus on things that aren't particularly thrilling for them. And, you know, it's a fallacy that kids, for instance, diagnosed with attention deficit hyperactivity disorder (ADHD), can't focus their attention on anything. That's actually not true. In fact, many of them can exquisitely focus on things that are really interesting to them. They can sort of hyper-focus. But the big challenge for all of us adults is making ourselves focus on something that we might not particularly want to at that moment in time. I mean, I know there are things that you can put in front of me at any time of day or night, and I'll be particularly engaged and interested, and other things are going to be much harder for me because I'm not so interested.

That's when we really have to employ our attentional skills. Now, when I'm talking about working memory, what do I mean by that? , what I mean is what neuropsychologists often call the cognitive shelf in our brain. In other words, the place that we can take a piece of information and sort of put it up on the shelf. It, it's not tucked away somewhere where we can't access it. It's right there where we can grab it and use it if we need to while we think about other stuff at the same time. Now the reality is that holding a bunch of pieces of information in your head at one time, which is a good definition of what working memory involves, is absolutely crucial to good problem-solving, which is, of course, one of the primary ways that we manage our behavior. Why is it crucial to good problem-solving?

Because good problem-solving involves holding a bunch of pieces of information in your head at one time and manipulating those pieces of information, working with them, without losing them, without forgetting them. You can think of it almost like keeping multiple files or folders or programs open on your computer at one time. Because when problem-solving, you've got to at least keep the file that says, "what's the problem?" open at the same time that you keep open a hindsight file so that you can say to yourself, "okay, how have I handled a problem like this in the past?" Then you want to open up a forethought folder as well by saying, "okay, how do I think I might handle this problem now? And how do I think that's going to work out before I do it again?" So, in other words, all good problem-solving requires toggling back and forth between a bunch of information in your brain at one time.

What's the problem? How have I handled that in the past, and how's it worked out? Or have I seen anybody else handle a problem like this in the past? How have they handled it? How has that worked out? How do I think I might handle it now? And how do I think that's going to work out? And if you can't hold all that information in your head at one time, you're gonna be in trouble because, for instance, one of those files will close on you, like hindsight, and then you won't benefit from hindsight. You'll repeat the same solution to a problem that didn't work before, or forethought will close on you, and you won't be able to sort of test out, will that be a good idea or not? Or I see this a lot with kids that I work with who have some real limitations with their working memory.

The problem, what's the problem? File closes. And all of a sudden, they look at you and be like, "what are we talking about?" And, of course, most adults respond by saying something like, "you know very well what we're talking about." But actually, they've forgotten what we're talking about because their working memory has, become overwhelmed. Now, attention and working memory skills like this, they serve as the basis for all organization and planning skills as well. When it comes to doing things in a logical sequence or an order or things like that, these are all interrelated. They are examples of what we often call executive functioning skills. And the reality is that if somebody struggles with a particular executive functioning skill, like attentional skills or working memory skills, they often struggle with many executive functioning skills. In fact, one of my early mentors used to say that when it comes to executive functioning skills, you need to apply the cockroach principle. I remember asking for the first time what the cockroach principal was, and he said to me, where there is one, there are many.

Now, a quick story to bring this to life. My youngest when she was in preschool, which is quite a while ago now. I had the great pleasure of spending a day in her preschool, and I loved what the preschool did because they'd invite parents to join. But not all at once for sort of an orchestrated parent day, but in fact, one parent at a time. And you just tagged along for the day. I had a blast. It was amazing.

I remember at the end of the day, they have a ritual that they do, And they all sit around. And, of course, I was sitting around, too, on little rug squares in a circle. And this is part of their get-ready-to-leave and goodbye ritual. And it's really a ritual that is intended to help build skills like working memory, planning, organization, et cetera. So the teacher is strumming away in front of these two-year-olds, almost three-year-olds, and me, sitting on our rug squares. And he says to the group of kids, he says, okay, let's remind our guest what we do. Now. I'm going to play the Willaby Wallaby song, and let's remind our guest what we do when we hear our name in the Willaby Wallaby song. So when you hear your name, you stand up, you bring your rug square over to the corner, you go to your cubby, pack your backpack, put on your winter clothes, and then go line up at the door to be excused for the day.

Now, as we're listening to these, I'm beginning to get very nervous because I've already forgotten most of them. I look over at my daughter, and she says, don't worry, dad, I gotcha. Thank goodness. But let me tell you, this was hysterical because even at two and three years of age, you could see the natural diversity in terms of executive functioning skills that we're developing or not developing. So, what happens? Well, a couple of girls, when they hear their name in the Willoughby Wallaby song, what do they do? They immediately get up, they march to the corner, they put their rug squares down, they head off to their cubby to pack up, get their clothes on, line up nicely at the door, standing ready to go. Now one particular young boy, when he hears his name called, what does he do? He stands up, he takes his rug square, rug square, he throws it like a Frisbee, aimed at the corner of the room, and bolts for the door to try to get in line next. Then there was this one poor kid who I remember who he actually got through the Rug square piece and got to his cubby, but I didn't see until I got called. What happened next? And the poor kid was lying in a heap of clothes outside of his cubby, crying. So, you know, this is a point in time in development where attention to working memory skills are rapidly developing. You see a fair amount of diversity. I will tell you, as an adult, though, these skills are every bit as important, and we can struggle with them too. I, I know the older I get, the harder it is to remember things. I find myself, walking around my house, walking upstairs to get something, for instance, and getting up there and saying to myself, what am I doing up here? I've forgotten what I came up here for in the first place. Now the good news is there's usually always something to do up there, so they can do something else. But of course, it's not until you get back downstairs that you invariably remember what it is that you were intending to do when you went upstairs in the first place.

So, in summary, attention and working memory skills are absolutely crucial when it comes to managing frustration, problem-solving, responding adaptively to expectations, demands, and requests that people have for us or just things we are trying to accomplish ourselves.

Language and Communication skills include sending a message to another person and receiving and understanding a message back. These abilities help us understand what someone is saying and to be able to follow a conversation. Language and Communication Thinking Skills help us find the words to share our thoughts, feelings, needs, and ideas. They are necessary when having a back-and-forth conversation to solve problems with others.

Dr. J. Stuart Ablon, founder and director of Think:Kids, explains Language and Communication Thinking Skills, and shares examples of how when kids struggle with these skills it can lead to challenging behavior.

Contrary to conventional wisdom, our behavior is determined by skill, not will. And one of the most important categories of skills that help us to manage our behavior is Language and Communication skills. I remember when I was fresh out of college and in my first job as a research assistant here at Massachusetts General Hospital in the Department of Psychiatry. And, I was involved in this large study looking at kids with attention deficit disorder, who were also diagnosed with oppositional defiant disorder. So they displayed frequent oppositional defiant behavior in response to requests, demands, from adults in their lives. And one of the shocking findings was when we looked at what we call comorbid conditions or coexisting conditions. We found concerningly high rates of language and communication difficulties in these kids who are struggling to manage their behavior. And, you know, it's actually not a big surprise in retrospect because language and communication skills are absolutely crucial to solving problems, handling demands, tolerating frustration, and, more globally, just problem-solving.

In fact, when you look through a developmental lens, and you think about when kids are very young, say two years of age, they don't manage their behavior particularly well. And that, in fact, that's why we refer to that time in life as the terrible twos. One of the reasons, anyway. And the reason we don't call it the terrible threes or fours or fives or sixes is if development is going according to plan by the time kids are three, four, five, or six, one of the things that they start to acquire are better language and communication skills, which are absolutely crucial, both expressive and receptive language skills. If you think about expressive language, it is absolutely crucial that we have the skill, whether it's as a child or as an adult, to let somebody know what's bothering us, to be able to articulate our concern, our perspective, our point of view, if we are going to engage in any problem-solving.

And what's really interesting is before we can let somebody else know what's bothering us, we have to put our finger on what's bothering us in the first place. In other words, we have to tell ourselves—we have to figure it out. And for most of us, the way we figure out what's bothering us is by talking to ourselves. In other words, we use words. We use language to talk ourselves through things and understand what our experiences are. Now, if you actually can put your finger on what's bothering you and have the linguistic skills to be able to communicate that to someone else, you're, of course, not out of the woods because then that person is going to respond to you. And now, you must use your receptive language skills to follow what they're saying. Keep up in the conversation. And then, if you're going to do good problem-solving, it involves a pretty rapid fire back and forth exchange of thoughts and ideas that are largely delivered through language or at least other forms of communication.

Now, if somebody struggles with language and communication skills, this can look like all kinds of different things. This can look like somebody who just says, "I don't know" a lot. This can look like somebody who has long pauses before responding. I've seen many times with adolescents that I work with; this can look like a lot of four-letter words. And you really want to try to embrace the notion of being curious, not furious, when you're struggling to understand somebody else's behavior. Because if this is about skill, not will, what we want to be thinking is, what is this person having a hard time doing that if they were able to do more effectively, they'd be able to manage their behavior better? Because the reality is, kids, adults, all of us, of course, we'd prefer to be managing our behavior better in the first place.

Nobody likes to be behaving badly, which is why, as we always say, kids do well if they can, or adults do well if they can as well. So try to embrace this mindset of be curious, not furious. And one of the things with curiosity you want to be thinking about is how are this person's language and communication skills? Is this an area where they might struggle? And be careful not to act too quickly, because you know, I see many of us adults, we issue demands, requests, commands to kids, and if they don't immediately respond, we reissue the command often with a threat of a potential consequence or something like that. And having worked with a lot of kids with language and communication difficulties, maybe as simple as a slower processing speed, you realize that these kids just oftentimes need a bit more time.

So, for instance, we say something to them like, "turn off the TV and come to dinner." And if they don't turn off the TV and come to dinner in a few seconds, we then re-up the demand. "Did you hear what I said? I asked you to turn off the TV and come to dinner." Maybe with a little bit more aggravation. And the reality is that what might be going on in that kid's head is as simple as this. You say, turn off the TV and come to dinner. And they, this is what's going on in their head. They say to themselves, "okay, turn off the TV and come to dinner. Um, okay, so you want me to turn off the TV and come to dinner now? Uh, the thing is that I'm sort of in the middle of my show, and I kind of want to see how it works out." And as they're still thinking this through, using language in their head, but not particularly rapidly, we jump right in and interrupt the process.

I find it's really helpful when being curious, not furious, to inquire what's going on in a kid's head. I once worked with an adolescent who had developed a particular compensatory strategy for some delays in language processing, which is to say, as soon as somebody inquired about something that required some complex thinking and linguistic skill to express what was going on for him, he would sort of head it off at the pass immediately by saying something like, "I don't care," or worse, "I don't give a," you know what. And I remember I was working with him one time, and I was asking him about something that happened for him in his day. And before I even can finish my sentence, he says, I don't care. And I finally said to him. I said, "you know what? I just noticed that you say, 'I don't care' even before I finished. You can't possibly have had enough time to think about it. Now, if you think about it and really decide you don't care and want to let me know, you don't care, that's cool. But, I can't even tell if you really don't care or that's just something you're saying. So just let's be quiet for a little bit. I just want to ask you a question and just think about it and tell me afterward what your response is." And I bit my tongue and waited for 45 seconds to give him time to think, which may not seem that long, but trust me, in practice, it's like an eternity. And after 45 seconds, I asked him what his thoughts were, and he actually had some thoughts. So it wasn't just that he didn't care. And when I asked him then why he says, "I don't care," he said to me, "well, because most people aren't going to gimme time to think about this. So you know what, I might as well get the whole thing over to begin with."

So moral of the story when somebody is struggling to manage their behavior, it's about skill, not will. We have 50 years of research in the neurosciences that have shown us that those skills tend to fall into several different domains of what we call neurocognitive or thinking skills. And one major domain is language and communication skills. And I'm not just talking about kids, I'm talking about us adults as well. So when somebody is struggling to manage their behavior, be curious, not furious. This may be a struggle with language and communication skills.

Dr. J. Stuart Ablon

We are in the midst of a youth mental health crisis, the likes of which we have not seen in the last half-century or more, and the ripple effects may be felt for generations. The lasting impact of the chronic stress and trauma of the pandemic has exacerbated what were already dangerously high levels of mental health challenges in kids.

As we know, necessity often breeds innovation. During the pandemic, our reliance on videoconference technology to connect with each other facilitated easier access to remote treatment. This helped lower the barriers to accessing mental health care for many youth and families. However, sadly, no matter how many more psychologists, psychiatrists, and social workers we train and how easy we make it to see them, it is clear that there is no way that we can possibly meet the overwhelming needs of our youth using traditional models of mental health care delivery. We have to think outside the box.
It is clear there is no way that we can possibly meet the overwhelming needs of our youth using traditional models of #MentalHealth care delivery. We have to think outside the box.… Click To Tweet

Is there good news? Yes. As neuroscientists help the mental health community continue learning more about the brain, we realize that the traditional way mental health care was delivered left a lot to be desired anyway. Primarily because it often violated some basic principles of how we change the brain, a.k.a. “neuroplasticity.” First, we know that new connections in the brain are made by repeating many small doses of what neuro-biologists call “good stress.” To change someone’s brain successfully, those small doses of stress would ideally occur many times throughout the day rather than, for example, once a week from 4:00 – 4:50 pm in the therapist’s office! For example, whether you are trying to learn to play tennis or the violin, your skills would advance more by practicing for 20 minutes a day rather than one hour once a week.

Secondly, skills learned in one situation, like a therapist’s office, often don’t transfer or generalize to other situations. These skills often don’t transfer because of the “specificity principle” of neuroplasticity. The specificity principle suggests that to create a new connection in the brain, you need to activate that specific connection or pathway. Artificially created situations do not trigger the same connections or pathways. This is the reason so many of us look great practicing things when no one is watching but then struggle to have that same success when the pressure is on. If you want to get better at hitting a golf ball under pressure, you can’t just practice hitting golf balls. You have to practice hitting golf balls under pressure!

Now that the mental health community has recognized the extensive demands on and limitations of traditional mental health care delivery, many attempts are being made to think outside the box with innovative uses of digital tools to reach youth struggling with their mental health. While digital tools can be helpful for milder symptoms and in short-term ways, many of these digital tools still fly in the face of perhaps the most important principle of neuroplasticity: our brains develop best in rich relationship-based situations, which is hard to recreate in the digital world.

So, what does this all mean? Youth mental health care needs to be delivered by people who already spend lots of time with them in their everyday lives. We need caring people who can provide enough small doses of “good stress” through existing relationships in the real-life situations facing our youth. Who are these people who can help address this youth mental health crisis? Parents and teachers!

Our work at Think:Kids is focused on helping youth with social, emotional, and behavioral challenges by teaching the adults in their lives an evidence-based approach called Collaborative Problem Solving. Behavior challenges rarely occur in isolation. Instead, problematic behaviors like defiance and aggression often happen alongside other issues. They are often the first sign that something is wrong. Behavioral challenges reflect underlying skills deficits across various diagnoses, including mood, anxiety, and autism spectrum disorders, not just disruptive behavior disorders like ADHD.

Through our work, we have shown that parents, teachers, and other adult caretakers can learn and practice an evidence-based approach to mental health care that can be used in everyday life. Our research has proven that when adults practice Collaborative Problem Solving with kids across a wide range of diagnoses, their specific symptoms lessen. In fact, how they are doing overall improves—not just behavioral difficulties. How does it work? The Collaborative Problem Solving approach builds and strengthens relationships, decreases conflict and stress, and builds neurocognitive skills, which improves mental health functioning broadly.

There is no one or simple solution to the current youth mental health crisis. But the answer cannot be simply training more clinicians or solely relying on digital tools. We must rethink the very methods by which we deliver mental health care. Teaching evidence-based approaches to parents and teachers is a powerful way to help address our kids’ mental health needs.

Pollastri, AR, Wang L Eddy, CJ, Ablon, JS. An Open trial of Collaborative Problem Solving in a naturalistic outpatient setting. Clinical Child Psychology & Psychiatry, 00, 2022, 1-13.

A version of this article originally appeared on Psychology Today.

Here at Think Kids, we realize that kids, or anybody else, for that matter, who struggles to manage their behavior on a regular basis is really struggling with the SKILL, not the WILL to behave better. And we follow the research, in the last half a century, which really has made it very clear the types of skills that folks struggle with when managing behavior is a challenge. And those skills include things like language and communication skills, attention and working memory skills, emotion and self-regulation skills, and flexible thinking skills. They also include a whole area of what we refer to as social thinking skills, which is what I want to focus on today.

Social thinking skills are the skills that are required to behave adaptively in social situations, but specifically, they're the skills that have to do with our thinking about social interactions. And here I'm talking about everything from the basics that aren't so basic for some people. Like how to start a conversation. How to go up to a group that's doing something you want to do and let the group know you want to join them without disrupting the group, what we call "right of entry skills." To skills like reciprocity in an interaction, being able to gauge somebody else's interest in something you're doing together, something you're talking about, et cetera. To much more complicated skills like knowing how you're coming across or impacting other people. I refer to those kinds of skills as utilizing our feedback loop.

You know, we all hopefully have some kind of a feedback loop where when we do things and say things, we sort of scan the environment for feedback to see how what we were doing, what we're saying is being received. And ideally, we interpret that feedback accurately, and we then use that to guide how we want to respond. Whether that feedback tells you—keep it going, it's appreciated; better dial it back some; you think you might have just offended somebody. Whatever the feedback might be.

Now, unfortunately, there are a lot of kids who have what I refer to as a sort of broken feedback loop or no feedback loop at all. These are often the kinds of kids who people say “they never know when enough is enough.” They just don't know when to stop because, of course, how would you know when enough is enough? Well, because you are taking feedback in scanning the environment, seeing that people are sending you messages that say, "whoa, that's too much." And then you dial it back. The problem is, if you're not getting any feedback at all, you won't know to stop. Or if you're getting feedback but misinterpreting that feedback, you might not know to stop, either.

This reminds me of a young man I worked with who you would see this issue cropping up at school, both in the classroom and on the playground. In the classroom, this is a kid who's very impulsive, verbally, and really witty too. So he would blurt out really funny stuff during class. And the teacher admitted, you know, it's so funny that she would laugh momentarily, and so would the rest of the class. And he would get that feedback. He would look around and say, people are laughing, and they must love me. And he'd get out of his seat and start delivering a monologue. And very quickly, people would start sending him a lot of signals that they weren't so interested anymore, the teacher and his peers. But if you talked to him about it, he would say, "Oh man, they love me. I mean, even a teacher thinks it's funny. You know, I'm great comic relief. Everybody loves it." Which is true; they loved it for about three to five seconds. His problem was he kept his feedback loop open for three to five seconds and accurately interpreted the information. But then, he stopped gathering feedback. So, he never knew when enough was enough.

Interestingly, this was the same kid who would go onto the basketball court at recess, and they would play that game called Knockout. And when he missed a shot, and he'd go to get the rebound, somebody else would have a rebound. He would get a kid in a headlock trying to get the ball from him. And when you asked him about that, he would say, "Oh, we're just messing around. You know, guys, being guys, just having a good time." And when you ask the other kids on the playground, they would say that the kid was turning blue. And you asked the kid who was in the headlock, and he was like, “I thought I was gonna die.” Now how could there be this disconnect? Because he didn't know when enough was enough because, again, he only kept his feedback loop open for about two seconds, not long enough to see that this kid was turning blue, for instance.

And that's just one example of a lagging social thinking skill that is leading to challenging behavior. And in fact, you know, one of the saddest things I see is that many of the kids that I work with are described as cold and unempathetic because they appear not to care about a kid's feelings in this kind of situation. When actually, you can only have the opportunity to care about somebody's feelings if you're able to gather the information about how they're feeling and then make a decision about whether you care about that. This is a kid who only gathered information for a split second and then closed his feedback loop.

Now, the nice thing about identifying the specific social thinking skills that a kid struggles with that lead to their challenging behavior is that then tells you what you need to work on. Because no end of rewards and punishments, or things like that, are going to help a kid to keep their feedback loop open a little longer and gather more information.

Dr. J. Stuart Ablon

Transcription:

The basis of pretty much all of our work here at Think:Kids is recognizing that kids who struggle to manage their behavior, they don't lack the will to behave well. What they lack are the skills to behave well. And we've done a lot of research, but many other people around the world have done a lot of research over decades now, basically a half a century, to help identify the types of skills that kids who struggle with their behavior have a hard time with. And in essence, it comes down to five core domains of skill. And today, I want to talk a little bit more about one of those. And I have to say that it might be one of my favorite areas, and that is cognitive flexibility. And there are a whole bunch of kids out there who struggle with cognitive flexibility. That is with being flexible in their thinking.

They are what we often refer to as the black and white thinkers of the world, stuck in what is, unfortunately for them, a pretty gray world. You know, as you navigate your way throughout the course of the day, things rarely go exactly according to plan. We are asked to be flexible a lot during the day. Kids who struggle with flexibility, well, if everything goes magically according to plan, according to the routine, the template they had in their head, well, life is good. But if there's any change in the routine, if things don't go quite according to plan, if something crops up that requires a change, a shift, they really struggle. These kids also struggle with any new or ambiguous situation where they aren't able to create a template in their head ahead of time.

Now, the flip side of this is that these are kids who, you know, create templates in their heads, so if they do something one way, one time, it's often burned into their brain that way. They have incredible memories like that. The problem is just flexing with that information if it needs to be shifted at any time in the future.

Now, to make this come to life a little bit, I thought I would share a story of a girl who came into the office with her mom for a consultation. And the reason I like this story is it demonstrates that when you're looking through the lens of skill, not will, and paying attention; it's pretty easy to spot the skills that a given kid struggles with. You know, for instance, a full neuropsychological evaluation is very, very helpful if you can get it. But if you can't get it, looking in the right places will tell you a lot. And as I mentioned at the outset here, one of the five areas you want to pay attention to is flexibility in thinking. Now, what are the others that will cover some other times? They are things like language and communication skills, attention and working memory skills, emotion and self-regulation skills, and social thinking skills.

So back to the story. I go out to meet this young girl and her mother for consultation. And the first thing I, of course, like to do is to make some connection with the child who is probably wondering what they're doing here and why their parent dragged them here. And I go out into the waiting room. I see this girl who's in this amazing getup. She's got this big straw hat, is one thing, with dozens and dozens of beaded necklaces that are wrapped all around the hat and draping down from the hat, that she's clearly made. And she's also carrying, clutching close to her chest, what looks to me like a diary. And I was pretty sure it was a diary because my daughter used to have one just like it. So, in any case, I walk up, and I get down to my knee to meet her, eye to eye.

And I say, "I love your hat." And I said, "it's really cool. Did you make those necklaces yourself?" And she says, "yep." And I said, "and is that a diary?" And she looks at me, and she says, "no." I said," oh, it is not a diary. Okay. Well, what is it?" And she says, "it's a book." So, of course, I said, "oh, what kind of a book?" And she said, "a book, you write stuff in." And I was like, "oh, cool, okay." Following along, "what kind of stuff do you write in the book?" And she looks at me, and she says, "private stuff." And I'm thinking to myself, sounds like a diary. And so I say to her, "oh, it sort of sounds like a diary." And she says, "it's not a diary. It doesn't have a lock." I was thinking to myself, ah, okay.

To be a diary, it must have a lock or else. It is not a diary. So I'm taking a mental note. And I say to her, um, so do you mind me asking the kinds of private stuff you like to write in there? And she says, well, I can't tell you much, or it wouldn't be private. I said, good point. And she says, but I'll tell you that I do like to write songs. Oh, okay. She says, I just wrote a new one. Want to know what it's called? I said, of course. And she says, "Mad."

So I said, "oh, okay." And she says, "do you want to hear it? I said, "of course." And she says, "okay, it's eight minutes long. And don't interrupt me!" At this point, I decide, you know what? I should probably take this from the waiting room back into my office here, especially if it was going to be eight minutes long. And she willingly goes back into the office with me and then proceeds to recite, by heart, an eight-minute song with the theme being "mad." Now I share this little anecdote with you just to say again; you don't have to be a neuropsychologist to figure out in the first minute of an interaction with a girl like this the types of skills that she likely struggles with that lead to her behavioral challenges. In other words, the reason that her mother was bringing her in to see me and into our clinic in the first place. And which area should be screaming loud and clear at you, cognitive flexibility skills.

Now, of course, if you're paying close attention, you're wondering yourself, okay, her song she's writing all about is "Mad." Maybe there are some emotion-regulation challenges there, and yes, you might have guessed from our little interaction that social thinking skills may not be her strong suit. Which is a good reminder, folks, that it is extraordinarily rare that a kid will struggle in just one of those five areas that I mentioned because they're interrelated. They are not mutually exclusive. And for instance, I've never met a kid who has been very rigid, concrete, literal in their thinking like her, who struggled with flexibility, who doesn't also struggle to regulate their emotions, and have some difficulties in social interactions. Because the reality is when you're a very black and white thinker, you're sort of always operating in this state of hyper-vigilance—wondering when the world is going to throw the next gray thing at your black and white thinking brain, which has you in sort of a state of heightened anxiety.

And, of course, social interactions are all about taking another person's perspective or point of view into account, even if it doesn't align perfectly with yours, which makes for a lot of social subtleties, being hard for a child who struggles with cognitive flexibility skills. I hope this little anecdote is helpful to bring it to life. Again, the big take-home point here is that if a kid is struggling with their behavior, it's about skill, not will. And we know the types of skills that you need to be on the lookout for. And if you're looking for those skills, even in the slightest of little interactions, you'll get confirmation about whether your hypotheses are right or not. And once you figure out which skills the kid struggles with, well now, you know what you need to on, because if it's about skill, not will rewards and punishments and things like that. They're going to be barking up the wrong therapeutic tree. Instead, after identifying the skills that a child like this struggles with, our job, as adults, as helpers in this child's life, is to help them build those skills.

Dr. J. Stuart Ablon

You may have heard the phrase “executive functioning skills.” It is becoming more and more common language for parents and educators alike and even in the workplace. So what exactly are executive functioning (EF) skills? They are a family of interrelated skills in areas like managing our emotions, controlling our behavior, focusing and shifting our attention, holding multiple pieces of information in our mind at one time, and thinking flexibly. Specific examples include controlling our impulses, staying calm in the midst of frustration, handling changes, initiating and sticking with an activity or task, shifting from one task to another, filtering out distractions, multi-tasking, and even perspective-taking (Wang et al, 2018).

Neuropsychologists have long recognized that EF skills are critical to reasoning, planning, problem-solving, and managing life’s demands in general. Given how crucial these life skills are, it is not surprising that good EF skills are associated with things like better achievement, health, economic stability, and relationship success in addition to preventing substance use and incarceration, and with general quality of life (Diamond & Ling, 2016).

Let’s discuss the good news first: EF skills can be improved. Like any other skill, EF skills improve with practice, and the research shows the more practice, the better. Also, like many other skills, if you don’t keep practicing, you likely will lose the skills you may have gained. In other words, when it comes to EF skills, it is “use it or lose it.” Research has also shown that it is important to make sure the practice is challenging to keep skills sharp (Diamond & Ling, 2016). The complexity and novelty of training help. And relying on external rewards to motivate someone to practice actually decreases EF performance.

So what’s the bad news? EF skills don’t transfer or generalize that easily from the situations in which they are practiced to other situations. In other words, if you practice EF skills in artificial circumstances, don’t expect them to look better in the real world.

But back to some good news: If you take what we know about how best to build EF skills into account, approaches like Collaborative Problem Solving (CPS) are tailor-made for the job (Ablon, 2019). CPS improves EF by helping people practice EF skills through natural attempts at problem-solving in their own lives (Pollastri et al, 2013). Parents, teachers, mentors, managers, and supervisors can use the three ingredients of the CPS process to tackle any problem that comes up during the day. Baked into the CPS problem-solving process is the opportunity to practice dozens of EF skills. Each situation provides a new opportunity to practice those skills without needing to translate them into the “real world” because they are already being practiced in the real world using real problems.

Like it or not, real life also throws us plenty of opportunities to try our hand at solving complex problems, so the practice never gets old or stops and doesn’t require taking extra time out of the day to practice. We also know dosing is important for any form of skill-building, since skill-building is code for changing the brain, and changing the brain requires repetition without hammering away too much, or neural networks become “refractory” and stop responding (Perry & Ablon, 2019). Using naturally occurring problems as the practice field for building skills supplies new opportunities spaced out throughout the day/week.

Finally, when using CPS, we teach people to resist using motivators to solve problems. On the contrary, we help people see that when someone is struggling to handle a situation well, it is most likely an issue of skill, not will. And incentives don’t teach skills. But problem-solving practice does—especially EF skills.

Previous research has shown that CPS builds neurocognitive or thinking skills, especially EF skills, but we again put this idea to the empirical test in a study with our partner, Youth Villages, led by Dr. Lu Wang and Dr. Alisha Pollastri of our research team.

We studied whether delivering in-home CPS improved EF skills over time by looking at youth, caregiver, and staff reports and administering objective, tablet-based neuropsychological tests. CPS was associated with building youth’s overall EF skills, specifically flexible thinking, attention, and working memory skills. We also wanted to explore what factors might predict these changes and learned that the more caretakers embraced the philosophy of CPS (remember it’s about skill, not will), the more skill growth happened, resulting in better behavior. These findings provide empirical validation of the theory of change behind the CPS approach: behavior is determined by skill, not will. When we shift our thinking to realize this and focus on practicing problem-solving instead of relying on incentives, EF skills improve, resulting in behavior changes.

References:

Diamond, A., & Ling, D. S. (2016). Conclusions about interventions, programs, and approaches for improving executive functions that appear justified and those that, despite much hype, do not. Developmental Cognitive Neuroscience, 18, 34–48.

Wang L, Pollastri AR, Vuijk PJ, Hill EN, Lee BA, Samkavitz A, Braaten EB, Ablon JS, Doyle, AE. (2018) Reliability and validity of the Thinking Skills Inventory, a screening tool for cross-diagnostic skill deficits underlying youth behavioral challenges. Journal of Psychopathology and Behavioral Assessment, 41:1, 144-159.

Ablon JS. (2019) What Is Collaborative Problem Solving and Why Use the Approach?. In: Pollastri A., Ablon J., Hone M. (eds) Collaborative Problem Solving. Current Clinical Psychiatry. Springer, Cham

Pollastri, AR, Epstein, LD, Heath, GH, & Ablon, JS. The Collaborative Problem Solving approach: Outcomes across settings. Harvard Review of Psychiatry, 2013, 21(4), 188-199.

Perry BD, Ablon JS. (2019) CPS as a Neurodevelopmentally Sensitive and Trauma-Informed Approach. In: Pollastri A., Ablon J., Hone M. (eds) Collaborative Problem Solving. Current Clinical Psychiatry. Springer, Cham

This article originally appeared on PsychologyToday.com.

Dr. J. Stuart Ablon and Dr. Alisha Pollastri

We are often asked how challenging behaviors relate to mental health disorders. Historically, psychiatry has understood mental health problems through the lens of categorical diagnoses listed in the always controversial Diagnostic and Statistical Manual of Mental Disorder which is in its 5^th edition (the DSM-V). One of the reasons that the DSM is controversial is that categorical diagnoses imply that a person who has depression is different from a person who has anxiety, etc. However, the last decade’s advancements in genetic and brain imaging technologies have told a very different story. Genetic research has found that there is a significant cross-heritability of psychiatric disorders. Suppose someone in your family has one mental health disorder. In that case, you are indeed more likely to have that disorder than another randomly selected person, but also more likely to have another psychiatric disorder, even one from an entirely different diagnostic category.

Meanwhile, brain imaging research finds significant overlap between the parts of the brain that are affected in people diagnosed with disorders that were previously thought to be separate. As a result, the National Institute of Mental Health (NIMH) now emphasizes a framework for understanding and studying the common elements that contribute to all mental health disorders. These common elements underlie all the different mental health disorders in the same way that flour, sugar, and eggs can make cookies on one day and cake on another, depending on how they are mixed and with what. The “ingredients” of all of these mental health disorders include components of our cognitive, social, regulatory, and sensorimotor systems. These components represent the skills we need to navigate the complicated environments in which we live. These systems mix in a certain way with our environment to produce our psychology, including mental and behavioral health.

Challenging behaviors are simply the downstream effect of neurocognitive skill deficits, which underlie many mental disorders cutting across diagnostic categories, including mood disorders, anxiety disorders, disruptive behaviors disorders like ADHD, autism spectrum disorders, and psychosis, to name several. “So what?” you might ask. Well, then focusing on these skills instead of the diagnostic categories they reflect has important ramifications for early identification, prevention, and treatment:

Challenging behavior is the canary in the coal mine, informing us of early trouble in neurocognitive development before the typical age of onset for many psychiatric disorders.
Building neurocognitive skills associated with managing our behavior can prevent brain-based disorders (i.e., mental health disorders) or lessen their impact.

What we have learned from recent genetic and brain imaging research also helps explain why categorical diagnoses leave a lot to be desired for so many children and adolescents (and adults) with challenging behavior. Most kids don’t fit neatly into a particular diagnostic box but rather meet the criteria for a literal alphabet soup of diagnoses which is more overwhelming than helpful. And then some kids don’t seem to meet any criteria for any specific diagnosis but clearly experience plenty of problems managing their behavior. We like to say that you don’t need a diagnosis to have a problem; you just need a problem to have a problem!

For all of these reasons, we advocate for a focus less on categorical diagnosis and more on the underlying skills that someone struggles with that lead to their challenges in living which, if unaddressed can result in a mental health diagnosis. Focusing on skills also helps remind us of the good news that skills can be built through practice.

Emotion Regulation skills help us control or manage our feelings, whether that be excitement, anxiety, sadness, anger, frustration, or any other form of emotion. Self-regulation skills are things we do to help control ourselves. This includes things like delaying our impulses, so we can stop and think before we act, waiting for something, or managing our energy level to match the situation around us.

Dr. J. Stuart Ablon, founder and director of Think:Kids, explains emotion and self-regulation skills and how when these skills are hard for someone, it can often lead to challenging behavior.

Transcript

Today, I want to talk to you all about a set of skills that, in professional jargon, we refer to as emotion regulation skills. And try not to get tripped up by the jargon because if you think about it, the word regulation or to regulate simply means to manage or control. So when we're talking about emotion regulation skills, we're talking about our skills at being able to manage or control our emotions. And this is an area that if somebody struggles in their ability to manage their emotions, it often leads to challenging behavior. In other words, challenging behavior, whether that's oppositionality defiance, aggression, or refusal, you name it, those things are often the downstream effect of difficulty managing our emotional response to things like frustration.

I want to share a quick anecdote from early on in my career. One of the first times that I was working in a juvenile detention facility, we were doing some training there; I had a chance to talk one-on-one and do an interview with a particular young man who'd been accused of a pretty heinous crime. And I want to admit I was fairly new to this and fairly naïve. And so as I sat across from this young man at this little table, so our heads were pretty close together, I started off by asking him a pretty silly question. I'm very interested in how our thinking or our difficulty thinking or our thinking skills that we struggle with, how they lead to challenging behavior. So I'm really interested in what's going on in people's heads before they exhibit challenging behavior. So I made the mistake of asking this young man if he could tell me when he did what he did, what was going through his head. I actually asked him directly. So, can you tell me what you were thinking when you, and I'll never forget it, I still get goosebumps thinking about it because this kid leaned in even closer to me, so our noses were a couple of inches apart, and he looked right at me, and he said to me, "That is the stupidest f-ing question anybody's ever asked me." And I have got to admit, I thought to myself, may very well be the case. And I was naïve but not defensive. So I decided to carry on, and I asked him, okay, that may be the stupidest question anybody's ever asked you, but do you mind explaining why it's such a stupid question? And there was this long pause, and then he leaned back in even more. And he said to me, this I'll never forget, he said, "do you think I would have done this if I was thinking when I did it? You moron." And I remember thinking to myself right there, well, of course.

But it's interactions like that with kids where I often thought to myself, I perhaps could have skipped a couple of years of grad school as well, because what you learn in these interactions is things you can read in a textbook, but man, did they sink in when you learn it firsthand from a youth who's struggling with skills like this. Because I learned in graduate school that, for instance, proactive aggression, planned proactive, pure, proactive aggression, it's actually really rare in the animal world, including us human animals. Most aggression is what we refer to as reactive aggression. It's driven by, for instance, a poor response to frustration, which is an emotion regulation skill. It's difficulty managing our emotional response to frustration. And unfortunately, this young man was in prison at that point, so he would remember not to do something like that in the future. And of course, what he articulated to me very clearly is when he's calm and when he's got his cortex accessible to him, he knows he shouldn't do those things. That's not the problem with him. The problem is this skill that, to use jargon again, we clinicians call our ability to separate affect. Why do we call it separate affect, affect meaning emotion? Because what we're trying to do is we try to separate the emotions that we feel from the thinking that's going to be required to respond to a feeling like that. And the reality is with us humans, feeling comes flying in whether we like it or not, but we've got to go to the door, as my grandfather used to say, and whistle and call thinking into the mix.

And some of us are better at that than others. Some of us are able to stay calm in the midst of frustration and not be flooded by emotion. Because, in essence, there's a negative correlation or an inverse relationship between how much we humans feel and how clearly we can think. And I want to be very clear that this is not an advertisement for not feeling. No, feeling tells us there's a problem, but feeling doesn't tend to solve problems. What you need to do is you need to tamp down the feeling enough. So thinking can rise to the fore also. So you can decide using the smart part of your brain, "How am I going to handle a situation that is making me feel like this?" And unfortunately, in this situation, this young man was so flooded by emotion that there was no thinking going on whatsoever. Now, what does this kid need? He doesn't need time to think about his actions and what he's done; what he needs is help developing his skills at managing his emotional response to frustration. So he can think straight. And again, if you realize that challenging behavior is the result of skill, a lack of skill, not a lack of will. It sends you in a completely different direction. So you'll stay away from a punitive or a correctional mentality. And instead, embrace the mentality that the goal here is building skills.

Dr. J. Stuart Ablon

September 3, 2018

Wish your teenager would do his homework or his chores just because it was important to him instead of because you bribed him to do it? Wish people on your sales team would strive for higher numbers not just when an incentive trip is dangled in front of their noses but just because they want to be good at their job?

Parents, teachers, managers, and CEOs alike all search for the Holy Grail of performance: internal motivation. How do you internally motivate someone, and is asking that very question antithetical to the goal itself? Can you actually help someone to be more internally driven?

Many people opine about the keys to intrinsic (as opposed to extrinsic or external) motivation, but let’s use empirical research here to set the record straight. There is, in fact, an entire field of research in this area. What do the data say? No, you can’t make someone internally motivated. However, it turns out that it is quite possible to help foster sustained intrinsic drive in others. The key lies in three very basic psychological needs that we humans must have satisfied if we are going to be internally driven to pursue a goal. These three basic and essential needs are:

Mastery
Autonomy
Connection

Self-determination theory flows from research in this area and has shown that we must feel (1) reasonably good at something (i.e., competent), (2) that we have some independence, and (3) connected to those around us if we are going to internally motivated to pursue any particular goal in a sustained way. Think about your own job. If you like your job and feel internally motivated to go to work, it is probably because you feel good at your job, feel like you have some autonomy, and feel connected to your colleagues and others with whom you work. However, if you don’t particularly like your job and often feel unmotivated, it is likely because you don’t feel particularly good at it, you feel told what to do or controlled, and you feel and disconnected from those around you.

In my previous blog, I described the dangers of focusing on extrinsic motivators like rewards. One of those dangers is a marked decrease in intrinsic (internal) drive. There is a negative correlation between the two. This makes sense when you realize that using a carrot and stick approach doesn’t build skills, autonomy, or connection. In fact, when you try to incentivize people to perform, you are taking away their autonomy by attempting to control or manipulate their behavior. So instead of bribing someone, if we want to foster sustained, internal drive we need to think about how to help people feel more independent, more connected and better at the task or job at hand. But how exactly do we do that? Easier said than done for sure.

However, we’ve made some basic observations while teaching people our Collaborative Problem Solving approach for over 20 years now. When an individual is having a hard time meeting expectations, it’s important to not turn, as many of us do, to offering incentives or threatening consequences. Those only work for the short term because the only focus on increasing external motivation. If you really want long term change, you’ll need to invite your child, student, employee (or yes, even friend, partner or relative) to solve problems together with you, to foster connection and autonomy while also helping them practice and build their skills – skills that lead to them becoming and feeling more competent in the future. In fact, we actually see the ingredients of our Collaborative Problem Solving process as a sort of a roadmap for meeting these three basic psychological needs that lead to sustained intrinsic drive. Start by understanding and valuing their perspective on a problem before sharing yours. Then invite them to brainstorm solutions together with you, giving them first chance to suggest an idea.

So, if you want your child to get her homework done, don’t reward her with more Fortnite time whenever she actually completes it. That will just make her more motivated to play Fortnite! Instead, ask her what gets in the way of getting the homework done. Get her perspective on it. Maybe it’s a focus issue, a fatigue issue after school, maybe she often doesn’t know where to start without the teacher’s help. Whatever it is, assume she’s got a good concern and find out why before you share why the homework is important in your mind. Finish by inviting her to try to come up with solutions to the homework problem. If she’s co-author of some ideas to try, she will be much more invested in the solutions. She will also feel much more competent, independent, and connected to you while doing so.

Same deal with your colleagues at work. Start by finding out why, directly from them, that they aren’t jazzed about selling your new product. Express the obvious concern you have about sales numbers and invite them to the problem-solving table. All of a sudden, they are a part of the solution, not a part of the problem. And your team members will feel … you guessed it, more competent, independent, and connected – the recipe for fostering internal drive. If you use this process repeatedly, you are bound to see increases in internal drive—and long-term change. The data don’t lie.

This article originally appeared on Psychology Today.

References

Pink, D.H. (2009) Drive: The Surprising Truth About What Motivates Us. New York: Riverbed Books.

Ablon, J.S. (2018) Changeable: How Collaborative Problem Solving Changes Lives at Home, at School, and at Work. New York: Penguin Random House.

Ryan, R.M. & Deci, E.L. (2000) Intrinsic and Extrinsic Motivations: Classic Definitions and New Directions, Contemporary Educational Psychology 25.

Why is it so hard to change problem behavior—in our kids, our colleagues, and even ourselves?

Dr. J. Stuart Ablon

May 27, 2018

The answer is actually quite simple. Our understanding of how to change problem behavior comes from our understanding of why the problem behavior exists in the first place. And our explanation for why people behave poorly is typically wrong! When someone doesn’t behave or perform as we would like them to, our default assumption is that they must not be trying very hard; they just don’t want it badly enough. This is true whether we are talking about a child in our home or school, our friend, relative, or partner, an employee whom we manage, or even a professional athlete on our favorite team. As a result, when people fail to meet our expectations, we typically respond with incentives intended to make them try harder in the future. Unfortunately, these conventional methods often backfire, creating a downward spiral of resentment and frustration, and a missed opportunity for growth.

But what if people don’t misbehave because of a lack of desire to do better, but because they lack the skills to do better? What if changing problem behavior is a matter of skill, not will?

Interestingly, neuroscience research has shown for decades now that people who struggle to meet others’ expectations (and even their own!) have challenges with specific thinking skills. It is time to listen to this research and accept the fact challenging behavior is the result of a lack of skill, not will—skills in areas like flexibility, frustration tolerance, and problem-solving.

For the last 20-plus years, I have been teaching an approach called Collaborative Problem Solving to parents, teachers, clinicians, managers, and entire organizations interested in behavior change. The approach is predicated on the simple philosophy that skill, not will, determines behavior. I have had the opportunity to work with some of the toughest settings to try to change some of the most challenging behavior, and I have seen firsthand how powerful and effective this shift in mindset is. The simple but powerful skill, not will philosophy puts us in a far more compassionate and helpful place as a parent, teacher, friend, partner or manager. And the good news is that skills can be taught! We’ve shown that by practicing problem-solving skills, as opposed to resorting to incentives and punishments, you can improve just about anyone’s behavior. So the next time someone’s behavior frustrates you, remind yourself that we are all doing the best we can to handle what life is throwing at us. And if we aren’t handling it well, it’s probably more about skill than will. In fact, people who struggle with these skills are likely trying harder than anyone else to behave themselves—because it doesn’t come naturally to them.

I’m excited to announce the arrival of my new book, Changeable, which starts shipping June 5, 2018! In the book, I review the research behind this way of understanding challenging behavior and describe the simple and remarkably effective framework that Collaborative Problem Solving provides for helping anyone in your life (even yourself!) build skills related to flexibility, frustration tolerance, and problem-solving. I describe my experience applying the approach in some very tough settings, including state psychiatric hospitals for chronically mentally ill adults, prisons, residential treatment centers working with traumatized youth, and with police officers working in schools in the poorest congressional district in the United States. Regardless of setting, the basic tenets of the approach are the same. I then detail the implications for anywhere there is conflict between us humans, whether or not there is a power differential present—parent-child interactions, teacher-student interactions, relationships with friends, partners, and family members, as well as with employees and supervisees. Perhaps the furthest-reaching implications apply to problems on the world stage. In the book, I make the case that we all might benefit from a more compassionate and empathic stance towards others and legitimate attempts to solve problems in mutually satisfactory ways.

I hope you will join me here in the future as I go into more detail on different aspects of the model and tackle all kinds of related topics with some guest experts as well. For now, remember these 3 key take-aways:

We are all doing the best we can with the skills we have
The key to behavior change is thinking skill not will
Skills can be built so we are all changeable!

This article originally appeared on Psychology Today.

References

Ablon, JS. Changeable: How Collaborative Problem Solving Changes Lives at Home, at School, and at Work. New York: Penguin Random House; 2018.

Greene, RW, Ablon JS, Monuteaux, MC, Goring, JC, Henin, A, Raezer-Blakely, L, Edwards, G. Markey, J & Biederman, J. Effectiveness of Collaborative Problem Solving in affectively dysregulated children with oppositional defiant disorder: Initial findings. JCCP, 2004; 72(6): 1157-1164.

Pollastri, AR, Epstein, LD, Heath, GH, & Ablon, JS. The Collaborative Problem Solving approach: Outcomes across settings. Harvard Review of Psychiatry, 2013, 21(4), 188-199.

Pollastri, AR, Lieberman, RE, Boldt, SL & Ablon, JS (2016) Minimizing Seclusion and Restraint in Youth Residential and Day Treatment Through Site-Wide Implementation of Collaborative Problem Solving, Residential Treatment for Children & Youth, 33:3-4, 186-205

The Double Jeopardy of Behavior Bias

Dr. J. Stuart Ablon

September 29, 2020

Our understanding of the causes of challenging behavior often do not flow from science. They flow from bias.

We assume that kids who behave in challenging ways do so on purpose, in order to get or avoid things. Stop anyone on the street and ask them why kids misbehave, and you will likely hear some version of this conventional wisdom. These assumptions are what we might call an explicit or conscious bias. They are explicit because we are fully aware of, endorse and knowingly pass these ideas onto others. And they are a bias because the ideas have been completely disproven by science.

More than half a century of research at this point confirms that people who struggle to control their behavior do not do so purposefully, but rather because they struggle with the skills required to behave better. Skills like flexibility, frustration tolerance, and problem-solving. As I’ve written many times, it’s about skill not will. Countless kids have suffered as a result of this explicit bias about their behavior that leads to carrot and stick approaches which typically don’t work and often make matters worse because they are poorly matched to the actual problem.

Tragically, kids of color who struggle to manage their behavior suffer from double jeopardy when it comes to biases about their behavior. They suffer from both explicit bias that has their behavior misunderstood in the first place and implicit bias borne of racism that has them receive far more punitive responses.

Implicit or unconscious bias is what lurks beneath the surface, often outside of our awareness but causes people of color to be subject to far more frequent and severe discipline for lesser infractions. So kids of color with behavioral challenges are both explicitly and implicitly misunderstood and mistreated.

When we focus on the actual problem—skills struggles, rather than a lack of motivation—we can interrupt these two behavior biases and instead set the stage for relational approaches that help kids build the skills they need to succeed.

It’s high time we begin to listen to science—not bias—to spare kids of color from the double jeopardy of behavior bias.

This article originally appeared in Psychology Today.

How to help kids process big issues and events in the world.

May 26, 2021

J. Stuart Ablon & Michelle Millben, Esq., Founder of Explanation Kids.

Over the last year, adults have been faced with talking to kids about a pandemic that changed how we live and go to school, a presidential election and the insurrection that followed, and the series of cruel reminders of the deadly presence of racism in our world. Fortunately, many organizations have stepped in, providing guidance about how to talk to kids about such challenging topics. What seems to be missing from this dialog is how to listen to kids during deeply scary, troubling, and traumatic times.

As adults, when we are scared, confused, or angry, we strive for some sense of control. We feel more in control when we have words packaged nicely to pass along to our kids. But this often leads to our conversations with kids devolving into lecturing without allowing space to listen. Every parent has been there—talking away and knowing that kids are tuning out.

Indeed, getting our kids to listen to us is a big hurdle. The challenge is even greater in the digital age as kids are doing more listening and thinking about what is happening around them in the world. Kids are gaining more access to information and misinformation from news cycles and in our communities. Kids, even as young as Pre-K age, internalize much of this information, yet often have a hard time expressing and processing what all of these big issues mean to them. Instead of making assumptions about what kids have heard, seen, and what they think and feel about these events, it is in these times that they need the listening ear of adults perhaps more than any wise words.

Parents and educators have shared with us some of the questions that their kids are asking. What is evident from their conversations is this: The hard work of listening is tough, confusing, and at times heartbreaking. However, kids are leaning on adults to take an interest in what is worrying them.

For example, one parent shared that her 6-year-old son thinks that the police are now the bad guys and he cannot tell the difference when playing “cops and robbers.” Another parent shared that after seeing a picture of George Floyd, his 8-year-old son could not tell whether George Floyd was white or Black. His son said, “He is brown, Dad. Not peach like me. So is he white or Black?”

A mother shared that her 7-year-old daughter raised an obvious but stumping question: “If Mr. Floyd was telling the officer that he could not breathe, why didn’t he get up and let him breathe?” And another 9-year-old kid saw news coverage of the protests from last summer and asked her mother “Why are you not doing anything like protesting or making signs?” Others questions ranged from “Why wasn’t George Floyd treated fairly?” or “Why were those people looting?” or “I don’t understand why everyone is upset.”

When kids are encouraged to share their feelings, they may express anger, upset, and disappointment, and they may even say what seems like the wrong thing. We may feel shocked or uncomfortable by such questions. However, we must challenge ourselves to listen.

How can we equip ourselves to handle these kinds of observations and comments? How can we listen effectively when we are upset and often taken off guard in conversations? How can we develop a healthy practice of allowing kids to lead the conversation from time to time? Thankfully, active listening can actually be reduced to using four “tools” that are relatively easy to learn, remember, and practice:

Ask open-ended questions. (What have they heard, what do they think, how do they feel?)
Take educated guesses if needed to get the ball rolling, but try not to make too many assumptions.
Reflect what you hear in your own words so they know you hear them.
When needed, provide reassurance that you really want to hear what they are thinking and feeling.

Listening to our kids is a powerful tool for their development. Not only is being heard reassuring and calming, but from a neurobiological perspective it literally puts kids in a position to hear adults and what we have to share. This is not some touchy-feely theory; it is a truth reflected in how our brains process information: When we are upset, worried, or scared, the smartest part of our brain is less accessible. If, however, we can regulate our emotions, we have more access to the higher-level thinking skills involved in listening, processing, and understanding. Empathic listening is regulating. When we do that first, our kids will hear a lot more of what we have to say. Stated differently: If we want our kids to listen to us, we need to start by listening to them.

A special thank you to Michelle Millben for co-authoring this article.

Michelle Millben, Esq. is a former White House, Justice Department, and Capitol Hill official and Founder of Explanation Kids.

This article originally appeared in Psychology Today.

Trying times require trying proven strategies.

Dr. J. Stuart Ablon

Everyone is struggling now. Parents, teachers, kids—we are all feeling incredibly isolated and stressed. Mass dysregulation is perhaps the best way to describe it. The COVID-19 pandemic is leading to escalating conflict in our homes and disturbing rates of abuse across the globe. And the traumatic effects are just beginning.

Responding to the pandemic is demanding extraordinary flexibility, frustration tolerance, and problem-solving skills from us all—much more than we have been accustomed to in our daily lives. Ironically, however, those very skills we need the most right now start to disappear on us under chronically stressful situations like this.

At our program at Massachusetts General Hospital, we specialize in working with people who struggle with flexibility, frustration tolerance, and problem-solving skills. And the good news is that there are a lot of lessons to be learned from that work that can be applied directly to today’s challenges. We can handle this together, but we need to do things differently.

First, we need to think differently. We need to realize that we are all doing the best we can right now under these trying conditions. We need to have extra empathy for each other and ourselves. Remembering our simple mantra can help: “People do well if they can.”

Next, we need to establish new routines and expectations. Many of those involve our kids. Rather than imposing new routines on them, we need to work together with our children to set those new routines, expectations and schedules. By making kids co-authors of their new reality, they will feel control, which is something we all need in the midst of a situation that is very much outside of our control. They will also be much more invested in the plans and routines working out well. When some of these new structures inevitably do not work well, it won’t be our fault as parents and teachers. Rather, we will be in it together with our kids and students.

Finally, when our best-laid plans don’t work out well, we need to avoid the impulse to attempt to restore our sense of control by resorting to power and control. Specifically, we need to avoid doling out rewards and punishments to try to make our kids adhere to those new routines. Instead, we need to engage kids in the problem-solving. Fortunately, we have a proven formula for effective problem solving with stressed individuals where flexibility and frustration tolerance are key:

1. Start by listening first to kids’ perspectives of why something isn’t working. Whether it is online classes, physical distancing, bedtime, the need for exercise, you name it—ask what’s getting in the way. What’s hard for them? If they are struggling to explain, try educated guessing. And if they don’t seem to want to talk at all, reassure them that you value their perspective and really want to understand it.

2. Only once we have a sense of their perspective on the issue, should we can share our perspective on the problem we are trying to solve.

3. Finally, once we understand each other’s stances, invite them to come to the table to brainstorm solutions that will work for all of us. Give them the first chance to craft solutions.

This is a process we call collaborative problem solving for obvious reasons. It is widely considered a way to manage conflict that is sensitive to the issues raised by traumatic events. It has been proven effective in the most chronically stressful situations even with kids with significant struggles with flexibility, frustration tolerance, and problem-solving skills. We know it can be helpful right now.

Problem-solving like this reduces conflict peacefully, improves relationships, and maximizes skills. Listen first and then invite collaboration, all while trying to maintain empathy for ourselves and others.

These are trying times. Trying times require trying a different way. But let’s try one that we know works.

References

Ablon, JS.Changeable: How Collaborative Problem Solving Changes Lives at Home, at School, and at Work. New York: Penguin Random House; 2018.

Ablon, JS, Pollastri, AR. The School Discipline Fix: Changing Behavior using Collaborative Problem Solving. New York: Norton; 2018

Pollastri, AR, Epstein, LD, Heath, GH, & Ablon, JS. The Collaborative Problem Solving Approach: Outcomes Across Settings. Harvard Review of Psychiatry, 2013, 21(4), 188-199.

As originally posted in Psychology Today.

A recent New York Times Magazine article asks the question, “Can You Call a 9-Year-Old a Psychopath?” Although, technically speaking, you can call anyone anything, we know that broad labels such as this do not provide specific enough information to intervene in an effective way. However, the article goes on to describe certain children as “callous-unemotional,” which does lead us closer to identifying some specific skill-deficits, which can in turn lead to more effective interventions.

Although there is a fair amount of conventional wisdom (the word “manipulative” pops up quite a bit), the article actually makes a great case for the need to do Plan B. The author discusses the difficulties involved in teaching empathy, something that is definitely lacking in “callous-unemotional” children. We know, of course, that empathy is a skill that can be taught. However, the distinction between emotional empathy and cognitive empathy is key. Many of the strategies used to directly teach empathy tend to get at the more cognitive/intellectual aspects of empathy. The risk, as is mentioned in the article, is that the “callous-unemotional” child uses this information in a hurtful manner. In order to truly build empathy in kids who lack empathic skills, the child must experience empathy. This is what happens during the first step of Plan B. True empathy/understanding. And then, in the second step, the cognitive aspect of empathy/perspective taking is taught. These and other skills are taught indirectly through the problem solving process (as opposed to the more common direct instruction method). One benefit of teaching these skills indirectly is that the child does not have to “agree” that they lack empathy nor do they have to “agree” to let someone teach empathy to them.

The challenge, of course, is that it is quite difficult to empathize with someone who is perceived to be “callous-unemotional” and who engage in the serious maladaptive behavior described in the article. As a result, instead of empathy, these children often receive harsh punishments, which can lead them to be even more disconnected from others. And thus, the label becomes destiny.

There is a brief mention of “one early study” which indicated that “warm, affectionate parenting seems to reduce callousness in C.U. kids over time, even in children who initially resist such closeness.” Plan B is a great way to provide what these children desperately need. And remember, empathy does not equal agreement. So, take specific problems, work with the child to solve them, and take your time in step 1. Through it all, you can build empathy and a stronger relationship with a child who desperately needs it.

The Impact of Trauma on Brain Development and What to Do About it

There is renewed interest in the effects of chronic, overwhelming stress and trauma on children’s development. Trauma-informed care is emphasized more than ever. Yet, parents, educators, clinicians, mental health workers and law enforcement alike still struggle to understand the impacts of trauma on brain development in a concrete and tangible way. Perhaps even more so, adults trying to help these children and adolescents long for user friendly and accessible strategies that operationalize what brain science tells us will be helpful to facilitate development arrested as a result of complex developmental trauma.

Collaborative Problem Solving (CPS) is a practical, evidence-based process that all adults can follow in any setting to ensure trauma-informed intervention. CPS has been used effectively across systems to provide concrete strategies that operationalize fundamental principles of neurodevelopment.

Specifically, CPS first helps adults understand how children exposed to chronic overwhelming stress and trauma do not lack the will to behave well, they lack the skills to behave well. CPS helps adults understand how toxic stress and trauma arrests brain development by identifying the specific skills they children lack in areas like flexibility, frustration tolerance and problem solving. Then CPS provides clear guideposts for adults to use in order to engage children in problem solving discussions which build helping relationships with the children while fostering a relational process that develops flexibility, problem solving, and emotion regulation skills. All the while, CPS avoids the use of power an control which is re-traumatizing and instead aims to help reduce the power differential which traumatized children find so dysregulating.

The latest neuroscience research has shown that facilitating brain change is not about erasing old associations in the brain resulting from trauma, but about creating new associations in the brain – in other words, new neural pathways. Exposing children repeatedly to small, digestible doses of novel experiences with a different, more positive emotional quality to them creates these pathways. The challenge is that the brain processes information from the bottom up. So with traumatized children, one must help regulate them at the level of the brainstem before you can engage their limbic system to relate to them and finally then teach them the kind of higher order problem-solving skills that are located at the level of the prefrontal cortex or top of the brain. The CPS process respects this awareness of the sequence of engagement at the level of the brain by recruiting the brainstem first, then the mid-brain and finally the cortex. It begins by teaching adults how to help children stay regulated through the use of empathic listening and curiosity. Once a child is regulated, CPS then helps the adult relate to the child by sharing their adult concerns. Finally, the child is then asked to reason with the adult to collaborate and brainstorm solutions. The entire process is built to help adults expose children to these small, digestible doses of “good stress” needed to foster brain change.

Why is it so hard to change problem behavior—in our kids, our colleagues, and even ourselves?

But what if people don’t misbehave because of a lack of desire to do better, but because they lack the skills to do better? What if changing problem behavior is a matter of skill, not will?

I’m excited to announce the arrival of my new book, Changeable,which starts shipping June 5th! In the book, I review the research behind this way of understanding challenging behavior and describe the simple and remarkably effective framework that Collaborative Problem Solving provides for helping anyone in your life (even yourself!) build skills related to flexibility, frustration tolerance, and problem-solving. I describe my experience applying the approach in some very tough settings, including state psychiatric hospitals for chronically mentally ill adults, prisons, residential treatment centers working with traumatized youth, and with police officers working in schools in the poorest congressional district in the United States. Regardless of setting, the basic tenets of the approach are the same. I then detail the implications for anywhere there is conflict between us humans, whether or not there is a power differential present—parent-child interactions, teacher-student interactions, relationships with friends, partners, and family members, as well as with employees and supervisees. Perhaps the furthest-reaching implications apply to problems on the world stage. In the book, I make the case that we all might benefit from a more compassionate and empathic stance towards others and legitimate attempts to solve problems in mutually satisfactory ways.

We are all doing the best we can with the skills we have
The key to behavior change is thinking skill not will
Skills can be built so we are all changeable!

References

Ablon, JS. Changeable: How Collaborative Problem Solving Changes Lives at Home, at School, and at Work. New York: Penguin Random House; 2018.

Pollastri, AR, Epstein, LD, Heath, GH, & Ablon, JS. The Collaborative Problem Solving approach: Outcomes across settings. Harvard Review of Psychiatry, 2013, 21(4), 188-199.

This article originally appeared on Psychology Today – “Help Anyone Change Their Behavior—Even Yourself!”

If you give a dog name… the dirty little secret of motivational procedures

J. Stuart Ablon Ph.D.

In my first blog for Changeable, I described some of the foundational thinking behind the Collaborative Problem Solving approach that my colleagues and I teach. I pointed out that when someone exhibits challenging behavior, we typically resort to conventional methods aimed at motivating better behavior from them, safe in the assumption that what is getting in their way is a lack of motivation. Motivational procedures can make the possible more possible, but they do not make the impossible possible. If challenging behavior is the result of a lack of skill, not will, then relying on rewards and consequences might be barking up the wrong therapeutic tree! However, I sometimes find myself less concerned about the fact that motivational procedures don’t work with the most challenging behavior and more concerned about their side-effects. Not only may motivational procedures not work if challenging behavior is caused by skills deficits, but I often see them make matters worse.

There are two primary dangers to focusing on external reinforcers like incentives or rewards and consequences:

Decreasing internal drive
Damage to trust and self-esteem

A very clear finding from thousands of studies in this area is that the more you rely on extrinsic rewards to motivate behavior, the more you eat away at a person’s intrinsic drive to achieve those very goals. I have seen this time and time again in my work with some pretty tough children and adolescents, and Daniel Pink and others have described what this looks like in the workplace for us adults. The more we rely on a carrot and stick approach, the more dependent we get on constantly producing shiny new objects for people to be motivated by. In the worst-case scenario, over-reliance on extrinsic rewards actually encourages unethical behavior when people we are trying to motivate become focused solely on how to get the rewards as opposed to the goals we are trying to get them to achieve with those rewards in the first place. Much research has confirmed the negative correlation between extrinsic reinforcement and intrinsic motivation. The more we try to incentivize someone to do something, the less internal drive they will feel.

A related side-effect of over-using external motivators, is something my 101-year-old grandfather describes best. He often says: If you give a dog name, eventually they will answer to it. This is his way of describing how when we treat someone as though they are lazy, unmotivated or just not trying hard enough, that we should not be surprised when over time they start to look like, and talk like, and act like someone who is lazy, unmotivated and not trying hard enough. I like to think that none of us would want to consciously try to make someone else feel as if there are lazy, unmotivated and simply not trying hard, but the cold reality is that whenever we use reinforcers to try to motivate better behavior we are indeed sending the not so subtle message that we think things would go better if they just tried harder. This is a dangerous message to send, and I have seen its impact firsthand in homes, schools, treatment facilities, and workplaces all around the world. When someone is constantly subjected to external reinforcers, they really have no choice but to come to one of two conclusions: (1) either the people trying to motivate me are right – I must not really be trying very hard; or (2) the people trying to motivate me are missing the boat and don’t understand me at all. I am not sure which conclusion is more damaging – to one’s self-esteem or trust in others.

As a parent, teacher, clinician, manager or leader, I hope this blog gives you pause before you design your next sticker-chart, demerit system or employee incentive program. In my next blog, I have some good news. There is a whole field devoted to how to foster that elusive thing called internal drive. So if you want to foster internal drive and steer clear of the side-effects of external reinforcers I described above, I will walk through what to focus on instead. Together, we will dive into the fascinating field of what is called self-determination theory to highlight what actually does foster sustained intrinsic drive. Stay tuned!

As published in Psychology Today

Ablon and Perry to the Helpers: “You are more important than you think.”

RVTS South in Oslo, Norway interviewed Dr. Bruce Perry and Dr. Stuart Ablon as part of their 2018 Children’s Conference in October 2018. This interview is translated and excerpted from: RVTS Organization; Interview by Siri L. Thorkildsen

Dr. Bruce Perry of The Child Trauma Academy has worked for years with children who have experienced long-term, complex trauma and gross neglect. Dr. Perry has developed a neuro-sequential model that is based on the stresses the child has experienced. His model helps those impacted by trauma by understanding what brain functions have had been interrupted in development, and seeing their challenges in the context of when in life the trauma occurred.

Dr. J. Stuart Ablon in Think:Kids at Massachusetts General Hospital has researched how the Collaborative Problem Solving approach helps children – and adults – build good relationships, create security, and develop the brain. With this model the child and you problem-solve, together, through empathetic listening and cooperation. Dr. Perry and Dr. Ablon want to inspire helpers meeting with children who face challenges, and help provide tools and information that are developmentally beneficial for these children.

You Make a Big Difference

What is the most important message to those who are meeting with or are parenting children who are facing challenges?
Dr. Perry: “My main message is that you make a big difference. You play a big part, and it is so incredibly important that you are with these children. The most important thing to keep in mind is that, while it is difficult, these meetings will have a meaning and this will make a difference for these children. These meetings provide opportunities for neural pathways to be repaired and new pathways can be created.”

Dr. Stuart Ablon: “Sometimes a meeting is much stronger than you might even understand, even when the meeting lasts only a few seconds. These meetings can have a huge impact on development. Those who are in the main position to help these children are the ones who are most with them. At the same time, these adults are often times the ones who have the least resources, lowest pay, and hardest jobs. When they, in fact, have the most important job.”

Love Is the Key

Dr. Perry, you have said that love is the most important and strongest change agent. What is the meaning of this when working with children who are having trouble?

“When I talk about “love,” it’s because I want to recognize the emotionally-minded element that is about being able to stand the pressure at its worst. When you can recognize the child for who he or she is although he or she may be very challenging. It is the love that allows you to be present, attentive, thoughtful, and responsive in these healing moments.

One of the things we know is that being associated with someone is one of the most important things to be healed. Ideally, this means that someone shows you love. “Love” means so many things, and it has different meanings in different relationships. But, what I think is important in a healing relationship is that you look at the person in a positive way, no matter what happens. And that you want to be there for them, even if you may not understand them or know what to do. You show that you are there and that you do what you can to help. It’s love that has a real therapeutic effect,” says Perry.

“And it’s really hard to love a child when they behave at their worst. And that’s the biggest challenge, because it’s these kids who need it most. Unfortunately, their behavior makes it difficult because it’s typically viewed as reprehensible. Dr. Perry has helped us understand how this behavior is a result of trauma and this has given people an opportunity to look at these children and the behavior in a whole new light. This also helps change the attitude of the children they meet and meet them on a much more humane and kind level, which makes it possible to actually treat these children with respect – something they rarely experience, but is exactly what they need,” adds Ablon.

Children Do the Best They Can

When you, Dr. Ablon, say, “Skill, not will,” that “children do as well if they can”: How do we combine that with Dr. Perry’s view of love?

“They are incredibly complementary,” says Ablon.

“Dr. Perry’s research shows that these children do not behave badly because they want to, they actually are doing as well as they can. If they could do well, they would do well. And if they’re struggling, then there is something in the way that makes them unable to do well. What Dr. Perry gives us is an understanding of why it is so, developmentally, while Collaborative Problem Solving provides some practical tools to do something about this,” explains Ablon.

“Yes, they fit like hand in glove because what we try to understand about the child is: Where are they in terms of development?” says Perry.

“Too often we have an expectation for the child based on age. But because of neglect, trauma, or other things that have stood in their way, they are often emotionally, socially and cognitively behind. It is a persistent mismatch that creates conflict, so the moment you can understand where your child is, in terms of development, you can actually meet the child at the right level. And if you use Collaborative Problem Solving, then we can meet the child where he or she is. Then we can create small, glorious doses with challenges that can help them succeed and get them into a good developmental path again. It’s really beautiful when you think of it!” explains Perry.

Why does the world need Collaborative Problem Solving?

“Many parts of the world still misunderstand why children do not behave well or why they do not do what we want them to do. As a result, we are not particularly pleased when it comes to children and youth who challenge us.

What our research shows is that challenging behavior is the result of lagging skills; not because they do not want to behave well. We see this reflected in flexibility, frustration tolerance and problem solving in the child. But this can be learned. And if we build the ability to cope with this, in a loving, understanding environment, we can facilitate development and reduce challenging behavior without having to resort to power and control – something we usually consider as a solution, when we face challenging behavior,” Dr. Ablon answers.

Is it always really so, that children are doing the best they can? Anyone who has experienced bedtime with young children may have other thoughts.

Dr. Ablon laughs, and answers that sometimes the will is not always in place. “But I do not always trust that adults understand the difference between will and skill, especially in the toughest moments when it is most important to understand the difference. Because in those moments we are angry, frustrated, stressed. You are tired yourself, have plenty to do. You may not be in the best mindset to decide if the child does not do what you say because it does not work, or because they simply don’t want to. So then it’s better to take the safest solution, namely to assume that the child is unable to do what you ask for. You do not lose anything by treating a child empathically with the understanding something they are we are asking them to do may be difficult for them. But treating the child as if it does not want to do as you ask, that sends you down a dangerous road. So it is always safest to assume “skill, not will.”

Revolution Takes Time

You work has revolutionized the subject and contributed to a paradigm shift, where we fundamentally change how we look at and relate to children who are having a hard time. What do you think of this?

“I think people realize that this change in how we look at behaviorally challenging children makes sense. But change is really difficult. How do we help a child’s brain heal and change? You also have to change the brain of the adult so we can think and behave differently around these children. All these adults are often stuck in a structure, in systems where we have done things in a special way for a long time. It requires a lot of restraint, work – and honestly, discomfort – to change this for us adults too,” Ablon answers.

“We have talked about these concepts for thirty years, but it’s only now that these are ideas are making their way into the professional life without too much resistance and negative reactions. So it takes time,” Perry adds.

“The more I do this work, the more I see that what we must help adults keep calm in difficult situations. Being regulated when the pressure is really on. It’s about the adults, and their ability to stay regulated. If we adults can stay regulated; half the job is done. Most of the time, it’s our own unregulated behavior that creates escalating behavior – and that is when we do not use “common sense” and we do not have access to our own thinking brain.

This is also where an understanding of the brain’s structure is useful. It helps us understand that our feelings and unregulated behavior “infect” others. Learning Collaborative Problem Solving provides concrete strategies that help us to retreat, self-regulate and re-enter the situation in a quieter way,” explains Perry.

Dr. Ablon agrees and emphasizes Dr. Perry’s work in connection to this principle. “Something I’ve always thought you’re doing in a wonderful way, Dr. Perry, is to emphasize that: If it is “contagious” to be unregulated, then the good news is that it is also “contagious” to be regulated. So if adults manage to keep regulated, we will help children regulate themselves too.”

Dr. J. Stuart Ablon

Everyone has had that person at work whose behavior frustrates you. It might be your colleague, your boss, a report of yours, or even your CEO. Difficult behavior in the workplace strains team dynamics, damages workplace morale and culture, and leads to enormous losses in productivity. If the behavior doesn’t cross the line into something that can be reported to HR, is there anything besides grin and bear it?

Thanks to the latest in neuropsychological research, the answer is yes! But the key is understanding why some colleagues behave in a challenging way in the first place. Contrary to conventional wisdom, they aren’t behaving that way because they are simply not trying hard enough to get along with their team members or because they like the attention their behavior brings them. They aren’t difficult because they want to be. They lack the skill, not the will to behave better. What skills? Skills like flexibility, frustration tolerance, and problem-solving. Some of these employees can be incredibly talented in other ways, contributing unique gifts to their work, but their behavior can also threaten team dynamics so it must be addressed.

Collaborative Problem Solving is an approach that operationalizes these key findings from brain science to address some of the most challenging behavior in some of the most challenging settings. The method has been battle-tested. It works. The lessons learned from helping people in places like correctional facilities and psychiatric facilities apply just about anywhere we struggle to manage someone’s behavior. You can put them to use right away in your workplace.

The approach starts with a simple mindset which helps us maintain some empathy and patience for our colleagues who can be pretty challenging to work alongside at times. Begin by assuming that underneath their difficult behavior your colleague probably has reasonable concerns, but they lack the skills to express and pursue those concerns more reasonably. Next use the following proven problem-solving roadmap that not only reduces challenging behavior and solves problems but will also help your colleague (and maybe even yourself!) build the skills they may struggle with. The roadmap has three simple steps:

EMPATHIZE: Bring up the issue in as non-threatening and reassuring a way as possible. Then work hard to understand your colleague’s concern or perspective about any specific problem you are trying to solve. You might need to do some detective work. Ask questions and take guesses to try to gather information from them. Remind yourself that while you may not like their behavior, they probably have reasonable concerns leading them to behave that way. And also remember that empathizing does not mean agreeing or disagreeing. It simply means understanding. If they are suspicious, simply explain what you are trying to do. Only once you understand their point of view, do you proceed to the second step.
SHARE YOUR CONCERN: Next, let your colleague know what your concern or perspective is about the specific issue without using blaming language. You can give those some thought before the conversation so you are already prepared when you get to this point. Then, only once you have clarified both sets of concerns, should you move to the third and final step.
BRAINSTORM: Invite your colleague to brainstorm possible solutions to the problem, but make sure they are solutions that address both your colleague’s and your concerns. Try giving them the first chance to generate a solution. This will increase investment and buy-in. You can throw your ideas out also. But whoever suggests an idea make sure you collaborate to test out the potential solutions to ensure that they address both parties’ concerns and are actionable. Once you arrive at what seems like a good solution, make a plan to enact it and check back in with each other to see how it panned out. Keep in mind that most plans require a little tweaking before a durable solution is found.

If this process sounds too simple to really work, the data don’t lie. Not only will you arrive at durable solutions to problems with colleagues, but both you and your colleague will have practiced a host of critical skills in the process. Skills like communication, perspective-taking, staying calm in the midst of frustration, empathy, flexibility, creativity, and collaboration.

One of the keys to dealing effectively with challenging behavior is not contributing to it. When someone behaves poorly, it frustrates us and our responses often tend to make matters worse. That’s because dysregulation, as we psychologists call it, is contagious. When we get dysregulated, we don’t have access to the smart part of our brains. We operate from much lower down in the brain, meaning that we often then have two people without access to good, rational problem-solving skills. So how do we stay calm in the midst of challenging behavior? First, remember skill, not will so you don’t take the behavior personally or retaliate. Then, practice the three steps above. The first step will help calm your colleague and ensure that s/he will be more likely to listen to your point of view in the second step. Finally, collaborating to find a mutually satisfactory solution in the third step gives both parties some measure of control which is also calming.

Just be prepared that if you practice this new mindset and three-step process to address issues with a difficult colleague, you may be asked to do it again. After all, the skills to solve problems collaboratively are in high demand in every workplace.

Ablon, JS. Changeable: How Collaborative Problem Solving Changes Lives at Home, at School, and at Work. New York: Penguin Random House; 2018.

C. M. Pearson and C. L. Porath, The Cost of Bad Behavior: How Incivility Is Damaging Your Business and What to Do About It (New York: Portfolio, 2009).

C. Porath and C. Pearson, “The Price of Incivility,” Harvard Business Review, January–February 2013, accessed April 3, 2017, https://hbr.org/2013/01/the-price-of-incivility.

This article originally appeared in Psychology Today

How Lazy Language Harms Kids

J. Stuart Ablon Ph.D.

I’m a bit of a stickler for language. I often have to resist my urge to irritatingly correct people’s grammar. But one thing I try not to resist correcting is lazy language that harms kids.

When kids behave poorly, we often throw around pat phrases as explanations. Here are some common ones you might recognize:

“He just wants attention”
“She just wants her own way”
“He just wants control”
“He’s an expert manipulator”
“She’s got a bad attitude”
“She’s making bad choices”
“He won’t cooperate”

Unfortunately, when someone utters one of these explanations, the typical response is nodding in agreement. But are we really sure these statements are accurate? Because if they aren’t, they reinforce inaccurate, derogatory views of these kids. And if they are even accurate, are they helpful? Let’s examine them together.

“He just wants attention” implies that’s why he’s behaving badly. But doesn’t everyone want attention of some kind? So, isn’t he like everyone else in the world who likes attention except that he has a hard time seeking it in a more adaptive manner?
“She just wants her own way.” I love this one. Show me the person who prefers other people’s ways! In my experience, what this actually means is that she wants her own way just like everyone else but struggles more than others when things don’t go her way. We call that cognitive flexibility. In other words, her challenge is about skill, not will, but being lazy with our words perpetuates the harmful assumption that she’s just a spoiled brat.
“He just wants control.” Again, don’t we all? Show me the person who prefer a lack of control. Wouldn’t it be more accurate to say that when things are outside his control, he struggles more than others who also prefer control? Skill, not will.
“He’s an expert manipulator.” My first response to this is often to just say, “No, he isn’t.” Why? Because if he was such an excellent manipulator, then you wouldn’t know you are being manipulated! Clearly, he must be a terrible manipulator. I also like to ask people to define what they mean by this phrase. The answer usually goes something like this: “He’s always trying to get what he wants.” Hmmmm. Sounds like us all – which begs the question, why would he go about trying to get what he wants in a way that irritates others if he had the skills to get what he wants without irritating others?
“She’s got a bad attitude” seems to imply that she’s choosing to have a bad attitude. In my experience, these kids have some pretty good reasons for a less than cheery attitude. Being misunderstood, for example, is one.
“She’s making bad choices” is another favorite of mine because it seems to imply that she is weighing her options, determining which are good and which and bad and then deciding to go with a bad one! Kids who make bad choices have been shown to struggle with the skills necessary to make better choices – skills like coming up with multiple solutions to a problem, projecting those solutions into the future, and assessing potential outcomes. Once again, being lazy with how we describe these kids reinforces and perpetuates incorrect and harmful assumptions.
“He won’t cooperate.” Now this is an interesting one. When we adults say that, we of course typically mean that he won’t do what we say – now. So why is that interesting?

Because the definition of the word “cooperate” means to collaborate or come together. It does not mean do what I say now! See how we adults have literally changed the definition of the word to fit our assumptions? Imagine if instead we said that he had a time responding quickly to requests? Then perhaps we would be curious about whether he just needs more time to process things or whether has difficulty shifting gears in general. That is to say, we would be more likely to be curious, not furious with him. And that’s a big difference because it opens the door to more compassionate and helpful responses.

So, let’s work harder to use more accurate and helpful language when we describe kids with challenging behavior. Wait! I am guilty myself. Maybe we aren’t being lazy with our language. Maybe we just lack some awareness. I’m hoping this blog will help all of us rethink the words we choose. Our kids deserve better from us.

As originally featured on the Changeable blog in Psychology Today

Social science research tells us what to focus on.

Dr. J Stuart Ablon

For a long time now, we have known that therapy works. In fact, all kinds of different therapies work for different reasons, and they often tend to be equally effective with not a lot of differences in outcomes. This finding has been termed the “Dodo bird effect” – alluding to the line from Alice in Wonderland, “Everybody has won and all must have prizes.”

In graduate school and the years after, I was fascinated by the question of what makes different types of therapy successful. When I analyzed video recordings of individual therapies intensively using across 100 different variables, I often did find interesting dynamics specific to that particular patient-therapist dyad that predicted the outcome of the therapy (Ablon et al, 2002, 2006, 2011).

But when I analyzed dozens or hundreds of different therapies together, I repeatedly found that what has been termed “common factors” predicted outcomes. The most powerful of those common factors have been referred to as the “therapeutic alliance,” referring to the bond between client and therapist. Study after study has shown that the quality of the relationship between client and therapist is the only reliable and the most powerful predictor of a positive outcome. This construct has also been referred to as the helping alliance, the working alliance or the collaborative alliance. Whatever name you use to describe it, it refers to the bond between helper and helpee as they work together towards a common goal, a bond marked by non-judgmental acceptance and empathy.

During the 20-plus years since I left graduate school, I’ve focused on helping kids and adolescents with challenging behaviors, and things have come full circle for me. The helping relationship is the key to change. This is true wherever I’ve worked, whether it is a therapist-client, parent-child, or teacher-student relationship. The quality of the helping relationship determines success. And just to be clear: a helping relationship does not simply mean a nice or friendly relationship. A helping alliance is characterized by digging in and working on hard things together, but always punctuated by empathy, acceptance and a lack of blame.

The real struggle when it comes to helping kids with behavioral challenges is that it is very hard to build and maintain an empathic, non-judgmental stance when their behavior is so frustrating and disruptive. The more we feel triggered and disrespected by their behavior, the harder it is to maintain that helping alliance. This is why helping adults to have compassion for kids with behavioral challenges is more than half the battle. The approach we teach tries to instill an empathic and hopeful mindset while giving adults concrete tools to partner with kids to work on the challenges together (Ablon, 2018). In other words, the approach helps adult foster a therapeutic alliance with kids despite their challenging behavior. Our research has shown that the better the adults are at using the approach, the higher their alliance is with the kids, which given all we know about therapeutic alliance undoubtedly translates into better outcomes for kids.

So, what’s the bottom line here? The most powerful vehicle of change we have is relationships. Not surprisingly, our success in helping kids is entirely dependent on the relationships we build with them.

References

Ablon JS, Jones EE, Katzenstein T. Psychotherapy and controlled clinical trials: A square peg and a round hole. Psychoanalyst Psychologist, 2002.

Ablon JS, Jones EE. Validity of controlled clinical trials of psychotherapy. AJP, 2002;159:775-783.

Ablon JS, Levy, RA, Katzenstein, T. Brand names of psychotherapy: Identifying empirically supported change processes. Psychotherapy: Theory, Research, Practice, Training, 2006; 43(2), 216-23

This article was originally featured in Psychology Today.

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