Is there a role for Collaborative Problem Solving in Autism?

BC Interior ADHD Clinic - whatwe seeChildren/ Youth with an ASD diagnosis (struggling withresources, treatment, school, home and relationshipfunction/ attentional difficulties part of overall picture)Children Youth referred for an ADHD assessmentwhere ASD has not yet been identified as a potentialdiagnosis

BC Interior ADHD Clinic - whatwe seeFamilies: struggling to secure resources, implementassessment recommendations and navigate acomplex system.Children/ Youth that are struggling with academicsand behaviour at school, conflict and “explosiveness”at home.

Any “behaviourists”in the room?disclaimer!!

ObjectivesReview the Collaborative Problem Solving model with a focus on the“lens,” through which challenging behaviour is viewed.Review the key similarities and differences between the planningprocess for CPS and a traditional behaviour approach/ functionalanalysis.Discuss case examples from community settings where CPS hasbeen implemented with individuals with ASD, their families andcaregivers.

what are your explanations?What the possibleexplanations for theproblem?“He’s just looking for attention”

Dealing with ProblembehaviourPhilosophy - Children do well if they want toAssumption - They don’t want toGoal - Make them want toMethod - Reward/ PunishmentCause - Learned behaviour? Poor parenting? Inconsistency?Labels - Unmotivated, attention-seeking, manipulative, avoiding etc.Intervention - Help Parents be more consistent, contingent

Dealing with ProblembehaviourPhilosophy - Children do well if they canAssumption - Something is in their wayGoal - Find out what is in their wayMethod - Collaborative Problem SolvingCause - Skill deficits in flexibility/ adaptability, frustration tolerance,problem solvingLabels - Skill deficit, learning difficulties, developmental delayIntervention - Assess skill deficits, teach skills

CPS and autism spectrumdisorders?'It’s often assumed that the CPS modelhas no application to autistic kids, andthat well-known applied behaviouranalysis methodology is really the onlyoption. I beg to differ. “Autismspectrum” doesn’t say anything aboutthe kid’s general cognitive functioning,and unless you’re ready to throw in thetowel on teaching the kid lagging skillsor helping him learn to solve problems– and hopefully, you’re not – then CPSmay well have a role to play.Ross Greene

FBA1Describe/ VerifySeriousness of problem3Analyze Information24Refine the definitionCollect information onpossible function5Generate hypothesisregarding probablefunction6Test hypothesisregarding probablefunction7Develop and implementbehaviour plan

FBASome mechanism for performance/ skill deficitconsideration when categorizing behaviourHelps identify situations and triggers for behaviourFocus on purpose or function of behaviourBehaviour serves to “get something” or “avoidsomething”Then teach/ reinforce replacement behaviours thatserve the same function. (ie “Get attention, avoidwork.”

CPS Key differencesSkill deficit + trigger/ situation = maladaptivebehaviour/unsolved problemAssess skill deficit, understand child’s perception/concern, solve problem collaborativelyThe “function” of the maladaptive behaviour is to let usknow: something is in the way of the child doing wellFocus is on skill development/ collaboration

ASD - is cps a fit?(Discussion)CPS requires some degree of communicationWhat if the lagging skills are in the areas ofcommunication/ language?“Back up the bus,” work on acquiring language/communication around the unsolved problemThen . . .Plan B discussionsThe “CPS Lens”

a few words on processWhile solving aproblem using PlanB is an importantgoal, it isn’t the onlygoalIt’s the Plan Bprocess that helpswith understanding,relationship andskill-building

The Process - trainsreflection, flexible thinkingand problem solvingAre Skills Taught with Plan B?Indirect versus DirectteachingIdentifying and expressingconcerns / separating affect(Step One)Taking other’s perspective,impact on others, empathy(Step Two)Generation of solutions,problem solving, anticipatingoutcomes, moving off oforiginal ideas (Step Three)

The CPS Lens - Keeping ourTriggers in CheckRelated to ourbeliefs and valuesRelated to ourexplanationsLinked to our ownself awarenessBiological link

amygdala hi-jack!beware . . .

Can we have “Dead End Explanations?”“He has bipolar disorder“He has FASD”“She’s adopted”“She just wantsattention”“He wants his own way”“He’s manipulating us”“He has an attitudeproblem”“She is making badchoices”“She won’t cooperate”“He wants control”

How do we know if our explanation is aDead End?Explanation Litmus Test: “If my explanationguides my intervention, what would I do next?Have I been left at the “doorstep” ofintervention?”

CPS can be messy

Videos and Case StudyDiscussion

Summary - CPS and ASDMore research needed with ASDConsideration of severity (language/communication)Direct versus Indirect teaching (social skills/language/ communication and cognitive skills)Process component - involving the child

Summary - CPS and ASDThe “Lens” is a key piece with parents andcaregiversChildren do well if they canExplanation guides our interventionCan help with “Amygdala Hijack”

Remember your lens . . . .thank you!Kids Will Do WellIf They Can

References• Greene, R (2009) www.livesinthebalance.orgInternet site and contact information regardingCollaborative Problem Solving Model and Dr. RossGreene.•• Ablon, S (2009) www.thinkkids.org Internet site andcontact information regarding the CollaborativeProblem Solving Model, Massachusetts HospitalThink Kids organization and Dr. Stuart Ablon.

References• Parenting Children with Disruptive Behaviours: Evaluation of a Collaborative ProblemSolving Pilot Program Journal of Clinical Psychology Practice 2010 (1) 27-40• Reduction of Restraint and Seclusion Through Collaborative Problem Solving: A Five-Year Prospective Inpatient Study Psychiatryonline.org, Dec 2008 Vol 59 No. 12• Greene R, Ablon J, Hassuk B, et al: Use of collaborative problem solving to reduceseclusion and restraint in child and adoles- cent inpatient units. Psychiatric Services57:610–612, 2006• Greene RW: The Explosive Child: A New Approach for Understanding and ParentingEasily Frustrated, Chronically Inflexible Children, 2nd ed. New York, Harper Col- lins,2001• Schaubman, Averi et al: Reducing Teacher Stress by Implementing CollaborativeProblem Solving in a School Setting. School Social Work Journal. Vol. 5. No. 2. March2011

References• Kimberly D. Becker • Bruce F. Chorpita • Eric L. Daleiden: Improvement in SymptomsVersus Functioning: How Do Our Best Treatments Measure Up? Adm Policy MentHealth. Published Online 05 Jan 2011• Greene, R., Ablon, J., Monuteaux, M., Goring, J., Henin, A., Raezer, L., et al. (2004).Effectiveness of collaborative problem solving in affectively dysregulated youth withoppositional defiant disorder: Initial findings. Journal of Consulting and ClinicalPsychology, 72, 1157–1164.