Dealing with Angry and Explosive Children

There are a number of children who parents, siblings, schools and friends have a difficult time dealing with because of their apparent mood swings, what appears to be angry attitude towards others and often explosive, angry and sometimes aggressive response to requests or instructions.
Sometimes these children are diagnosed with a mood disorder (paediatric bipolar disorder, mood disorder NOS), sometimes with ODD (oppositional defiant disorder) and often with related neurological disorders which might be referred to as NVLD (non-verbal language disorder), high functioning autism, Asperger’s disorder or even a sensory disorder.
Treatment interventions range from simple behavioural programs using reinforcement schedules to the use of visual cues and prompts and medication. While one of the main interventions I teach in my office is a simple 8 part behaviour management program based upon the book Your Defiant Child by Dr. Russell Barkley. However, with certain children there is more to the problem than can be fixed with behavioural interventions in the home. This is especially true because for behavioural interventions to work they must be done in an environment we can control, and finally, besides changing an inappropriate behaviour and replacing it with a new appropriate one, there is often a much more complex task we need to teach- problem solving.
With these children we often use the work of Dr. Ross Green and his “Collaborative Problem Solving” approach. To teach this technique we strongly recommend parents read the book The Explosive Child (available on my web site, go to the home page and click “books recommended by Dr. Roche). We also suggest parents watch the video Parenting the Explosive Child and then practice the skills taught for several weeks under the support and supervision of a trained clinician.
What is the Collaborative Problem Solving approach?
Dr. Green thinks that challenging children have often been poorly understood. All to often their challenging and difficult behaviour is seen as willful and goal oriented. (In spite of the fact it rarely gets them to their goal.) In other words the explosive and angry behaviour is seen as a means to getting attention and coercing people to give in to their demands. In fact, based upon research by Dr. Green and others, the basis of their difficult and explosive behaviour can best be seen as a learning disability or developmental delay in the executive functions of the brain that support flexibility in thinking and frustration tolerance. When the situation calls for the cognitive skills that are part of mental flexivbility (seeing things from the perspective of others) or handling frustration, they have difficulty. They may appear to be choosing to be non-compliant and explosive, but they are making that choice no more than the child who acts out in reading class when the work becomes too hard due to a reading disability.  Dr. Green compares the typical view of these acting out children: “Children do well if they want to,” with the collaborative problem solving approach’s philosophy of, “Children do well if they can.”
How do these children get this way? Is it poor parenting?
There are a number of different factors that leads to this lack of appropriate developmental skills. For some it is a developmental issue. For others it might be a combination of neurological (hard wiring) and neurobiological (chemical) issues. Dr. Green has identified five major areas of deficit that may be at the heart of the problems:1. Executive Function Skills; 2. Language Skills; 3. Emotional Regulation Skills; 4. Social Skills; 5. Cognitive Flexibility Skills. Luckily we have simple and effective ways to evaluate and determine where the child’s weaknesses as well as strength are. This can help us make intervention choices on a day to day basis that begin to address skill deficits rather than just make life more quiet and peaceful temporarily.
That’s a nice philosophy, but how do you make changes in my families day?
The approach Dr. Green and others have developed (actually this is a rather old idea, you can find it in the treatment interventions of the Teaching Family Model at Boy’s Town) is called the Collaborative Problem Solving Approach (CPS). There are three major goals to this approach: 1. Allow adults to pursue expectations; 2. Teach lacking thinking / cognitive skills, and; 3. Reduce meltdowns and angry outbursts.
We do this by first understanding what are called the pathways (skills deficits) that underly the explosive behaviour; decide which plan will be used to handle any specific problem or situation (There are three plans, A,B,C); and then executing some form of plan B to teach the lacking skills. Plan be is the teaching of collaborative problem solving. Teaching your child how to work out a conflict with another person, whether it is another child, adult, teacher or you. Using this plan B is a way to support your child’s lack of executive control. Making up for and supporting your child with a structured interaction that naturally leads to solving problems. What’s in your mind and mouth are the phrases, “Let’s work it out,” and “We worked it out.”
How does this interaction style help control anger and meltdowns?
The plan consists of three steps. First: Empathy and reassurance, then we define the problem, and next there is what is called the invitation. (This process is similar to other interventions taught for working with aggressive individuals such as CPI, the Boy’s Town Teaching Family Interaction, most mediation training, the approach to parenting found in Dr. John Gottman’s book Bringing up Emotionally Intelligent Children and many others. Green, however, has made it simple and emphasized the philosophy behind this positive support approach.) 
Empathy is communicated through reflective listening and letting the child know that “you heard them.” This may sound simple, but we need practice, practice and more practice. This helps the child calm down, and ensures them that their issues are “on the table” and being heard. In a very specific order we ask what is going on with the child, let them know they have been heard, get them to tell us more (this is where language deficits might come in) and give them reassurance (Green says, “I’m not saying no....”)
We then clearly define the problem and invite the child to use problem solving skills to solve our mutual problem. All through the process you are teaching and modelling skills that address the child’s deficits as defined in the pathways assessment. This is a process that takes practice, can often use feedback, and honestly doesn’t guarantee there will be no more blowouts. But it does reduce the risk of them, it increases the chances you will have a pleasant and successful interaction with a usually angrey and easily frustrated child, and it will, over time, teach you child the executive problem solving skills they need to be not just compliant with your commands and requests, but able to negotiate and collaboratively problem solve with others out in the real world.
How long does this process take? And who comes to therapy?
It’s my kid who needs therapy, not me.

Honestly, while in my practice I see your child for an initial evaluation, and then may see them a few more times throughout the process, the most effective and successful way to treat children with anger problems of this magnitude is through education those who they interact with during the majority of their day. This usually means parent meetings and sometimes training and consultation with schools. It’s hard to give a length of time or number of sessions that you can expect. What I can say is that I have divided the process into eight parts, and each week we review some of Green’s work, usually watch and discuss Dr. Gottman’s video or book on emotionally intelligent children and review the basics of parenting skills found in Dr. Barkley’s program. Eight weeks is the usual length of family treatment. We then often meet a month later for a check up and then as needed. (Even Super Nanny comes back to visit!) I’m afraid that many people expect children can see a therapist in their office and play therapy or other interventions will make a dramatic change. There isn’t really any scientifically based proof that this kind of therapy is effective. Your best changes for significant positive change involves everyone, and we need to remember it’s about your relationship with your child.
Final Word
Finally, I want to remind you that there are other techniques and interventions that are effective and may be used in conjunction with collaborative problem solving, and sometimes are more appropriate. These include using visual supports, teaching anxiety reduction skills, using cognitive behaviour therapy through a structured child focused program like “The Incredible Five Point Scale” and positive behavioural supports. Often school is a critical area where we need to intervene. This might include an assessment aimed at “coding” to obtain school based support, conducting a functional behaviour analysis (FBA)  and developing a positive behaviour support plan and the possibility of medical interventions. Whenever there are serious behavioural concerns you should start by visiting your medical doctor for a full check up.
For more information on child  therapy you can visit my website at www.relatedminds.com or www.socialcognitivetherapy.com I have offices in Burnaby (serving New Westminster, Coquitlam, Port Moody and Maple Ridge) and Vancouver, BC.
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