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Calming the Explosive Child

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Collaborative problem solving

Not everyone is enthusiastic about the collaborative problem-solving model, however. Some critics, even those who agree with its underlying principles, complain that CPS has yet to be proven more effective than traditional parent training. Child psychologist and psychology department chair Stephen Hinshaw of the University of California, Berkeley, notes that only one rigorous study on children with only one type of disorder, ODD, has been published, whereas at least two good trials by two different research teams are typically required before the American Psychological Association considers a treatment “empirically supported.” “The proof is going to be in repeated demonstrations in trials with three groups: children with bipolar disorder, with conduct disorder and with other forms of aggressive or explosive behavior,” says Hinshaw. “And CPS needs to work when other scientists investigate it too. What we have so far are interesting, even fascinating, first-round studies.”

And while some people worry that CPS is too new, others point out that its basic tenets are not new at all. For example, a book published in 1970 and revised in 2000, Parent Effectiveness Training, by Thomas Gordon, advocated parent-child communication, problem-solving and empathy. The idea that some parents and children don’t “fit” well isn’t novel either; it originated more than 30 years ago and suggests that explosive behavior may be one outcome of incompatibility between the personalities of parent and child. “At a conference last year, CPS was discussed, and one comment from the floor was, thank you for reminding us of stuff we should have been doing all along,” says Jacob Venter, a child and adolescent psychiatrist at the MGH.

CPS can also be difficult to implement, primarily because it requires parents and workers to adapt to a new way of looking at behavior problems. In the Italian Home, Maine’s correctional facilities and the Massachusetts DSS, it took months to convince staff members to change—and some never did. “Our staff initially thought CPS was just a way to give in to the kids, and a lot of people outside the juvenile system feel they should be punished—that’ll fix them,” says Maine’s Bouffard.

Inevitably, even people sold on the model start worrying that children are being indulged. But Greene discounts that concern: “Nothing about CPS says you let a child do whatever he wants.” And while he admits that the model builds on previous research, he says that’s how science works. What’s more, studies by other investigators are planned in inpatient, outpatient and institutional settings, and also in schools, Greene says. Meanwhile, he and Ablon each spend at least one day a week speaking about CPS at schools, hospitals and residential facilities around the country, as well as some 12 hours a week supervising institutions that are implementing the model. They have also established a nonprofit organization, the CPS Institute, and as part of a public-awareness campaign called Think:Kids, have launched a Website for parents, pediatricians, teachers and mental health clinicians.

“What Ross and Stuart have come up with is not exactly brand new under the sun, but it’s a really creative synthesis of ideas that may change the way parents view their child’s difficult behavior,” says Hinshaw. “Not as willful, defiant or the product of poor parenting, but as the result of a deficit in some basic skills.”

For Jonathan Diamond, now 20 and newly admitted to the theater department of a Boston college, gaining those skills through CPS has enabled him to live a life that seemed inconceivable back in the days of his daily eruptions. Though still fighting anxiety and other difficulties, he hasn’t had an explosion in about six years, and he says he even uses the method to help other students. “CPS takes a lot of adapting to, and you don’t see instantaneous results, but it produces permanent changes,” he says. “Real solutions just take more work.”

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The Plan in Action

Here, an example of a cornerstone in collaborative problem-solving: a parent-child conversation about a problem that regularly causes explosions.

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hed-dossier

1. Treating Explosive Kids, by Ross W. Greene and J. Stuart Ablon (The Guilford Press, 2006). An explanation of the research behind CPS and how psychologists, teachers, social workers and counselors can apply the method in their practices, schools and institutions.

2. “Book Review: Treating Explosive Kids,” by Nicholas Carson, Journal of the American Academy of Child Adolescent Psychiatry, September 2006. Carson takes a critical look at the CPS approach, detailing its psychological roots and assessing whether it is truly the paradigm shift that Greene and Ablon claim. 

3. Opening Our Arms: Helping Troubled Kids, by Kathy Regan (Bull Publishing Company, 2006). Through a series of personal narratives, nurse manager Kathy Regan describes how she applied CPS (among other methods) with surprising results in an inpatient child psychiatry unit at Cambridge Hospital in Massachusetts.

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