This book by Ross Greene and his colleague, Stuart Ablon, is an excellent manual for clinicians dealing with a very common problem in child psychiatry; namely, children with significant oppositional defiant behaviour and explosive outbursts of temper and rage. It is a follow up to Ross Greene’s very successful and popular book written in the late nineties called “The Explosive Child.” The current diagnosis for these children in DSM IV is that of oppositional defiant disorder. However, as the authors note these children at different times have been called defiant, aggressive, angry, raging, intransigent, resistant, willful, non-compliant, challenging, stubborn and so on. In the first chapter of the book titled “The Need for a Different Paradigm” Ross Greene outlines his philosophy of children and dealing with these challenging children. It is the premise of his book that explosive kids have lagging skills in the global domains of flexibility or adaptability, frustration tolerance and problem solving. He presents a deficit model for understanding and dealing with these challenging children. He sees these children as having deficits in a variety of skills, including executive skills, language processing skills, emotional regulation, cognitive flexibility, social skills and recommends a skills teaching intervention for these children and their families.
This is very much a hands on “how to do it” book. The parents are asked to describe an explosive episode and the motto, which accompanies this request, is that “a story is just a story unless it is used to identify a pathway or a trigger.” In other words contained within each story is information about cognitive skills that the child or the adult caregivers lack or precipitants that heighten the child’s frustration. Ross Greene summarizes his initial advice to parents and caregivers dealing with explosive children as follows:
Plan A, Plan B and Plan C. In Ross Greene’s model Plan A is what many parents or care-givers do when a child does not meet expectations; namely, to insist more intensively. In ordinary children this imposition of adult will does not typically have major adverse ramifications and the child ultimately meets the parents’ expectations. However in the case of explosive children, imposition of adult will (Plan A) greatly increases the probability of an explosive episode and therefore does have major adverse ramifications.
Plan C is the opposite of Plan A. This involves reducing or removing a given expectation. For example, if a child is not brushing their teeth (as opposed to Plan A where the parent would more strenuously insist that the child brush their teeth properly), using Plan C the parent would say nothing or simply convey that they do not object to the child bulking at brushing their teeth. The goal is to reduce the likelihood of an explosive outburst. The authors describe Plan C as a viable and often the only option once explosive outbursts get out of control. They recognize that this is “giving in” to the child, but they see this as the beginning of a new parenting strategy. The ultimate goal is to use Plan B, which is to teach the child cognitive skills that are lacking, but to do this teaching at a different time of the day, not when the child and parent are emotionally charged and drained. This is very much a collaborative problem solving approach, hence, the subtitle of this book “The Collaborative Problem Solving Approach.” The book describes Plan B in detail and then, using multiple case vignettes, describes the way this strategy works in the consulting room. The approach then is described in other settings including schools, child psychiatry inpatient units, as well as in youth detention centers.
In my opinion, the book is well worth reading. It is well written and easy to read. The ideas make sense and are consistent with an increasing interest in child psychiatry in developing nonconfrontational supportive means of managing explosive children. The book is highly recommended. The main criticisms are as follows:
The authors are anti diagnosis and view the use of DSM IV diagnoses as completely irrelevant to the understanding and management of such kids. Nevertheless, this method can easily be incorporated into a standard biopsychosocial approval.
The book is good at identifying the cognitive deficits, but less explicit in providing solid advice as to what exactly to do to remedy these deficits.
Traditional parent management training is labeled coercive. Practitioners of this well validated behavioural method may disagree with that description of it.