Friday, April 29, 2011

The Answers to your Questions

The following are the answers to some of your questions:

"Do all children with ADHD have social skills problems?”

In my experience, arguably, most children with ADHD have one sort of social skills problem or another. Children with ADHD do not learn social skills as easily as do typical children. Two children, one typical and one with ADHD, can live in the same house. The typical child will learn positive social skills and the child with ADHD will not. Why don’t children with ADHD learn social skills as easily as typical children?

Children with ADHD do not learn positive social skills because they become distracted during the time they are exposed to them, among other reasons. In other words, their attention to these positive social skills is interrupted; something interferes with their learning of socially appropriate behavior. For example, they may become distracted and have their attention interrupted due to temper tantrums; they may be paying attention to something other than their parent who is teaching them a social skill; or they may be anxious, among other reasons.

Children with ADHD who are easily distractible can learn positive social skills, but it is difficult for them to do so. I do not mean to paint a gloomy picture and say that these children will not learn positive social skills. They can and will learn positive skills if they have some help along the way. These children need help from teachers and parents who understand that they are not purposely trying to behave in a socially inappropriate way. Therefore, as teachers who work on social skills with children who have ADHD, you must have some expertise in both ADHD and social skills training.

"My child takes Concerta and his behavior is perfect when it is working. When it starts to wear off, quite honestly, he is very annoying. What can I do when it wears off?”

A good thing to do is to have your child get some exercise, whether it is riding on a stationary bike or taking a short walk, exercise has been shown to diminish distractibility and hyperactivity. After they exercise, they should be able to sit down and do their homework, for example, in a more focused way.

More answers in tomorrow’s entry…

Thursday, April 28, 2011

Parents' and Teachers' Questions from my Presentation Last Night

I would like to thank all of the wonderful parents and teachers who came to hear my presentation last night on ADHD and social skills at the Furnace Woods Elementary School in Cortland Manor. Everyone was very engaged and asked complex and thoughtful questions.

These were some of the interesting questions that were asked. I will answer these questions in my next entry:

"Do all children with ADHD have social skills problems?

"My child takes Concerta and his behavior is perfect when it is working. When it starts to wear off, quite honestly, he is very annoying. What can I do when it wears off?”

“My child is five years old. When he has to complete tasks, he is very sluggish and oftentimes does not complete them. Does he have ADHD?”

“My child is on the computer for an hour a day. Is that too much?”

“When my child has to do school work when it is not interesting to him, he is very unfocused and does not complete it. How can I help him to complete his work when it is not interesting to him?”

“My child has one week to do a project. How can I help him to complete it on time? He feels that it is overwhelming for him.”

“My child is very distractible at home but his teacher tells me that he is not that way in school. Does that mean that he does not have ADHD?”

Tuesday, April 26, 2011

Please Read the Flyer for my Presentation on Wednesday night, April 27, 7:00 P.M.

The Furnace Woods Elementary School PTA Parent Education Committee


Dr. Esta Rapoport

ADHD Author and Expert

When: Wed, April 27

7:15 p.m. - 8:30 p.m.

Where: The Furnace Woods Auditeria

8-8:30 Q & A Session

Ask an ADHD expert your most pressing questions on this challenging subject

Refreshments will be served

Free babysitting by FWS aides will be provided

Dr. Esta M. Rapoport is an adjunct professor at Fordham University and is experienced in working with children with ADHD and other similar special needs. She has a B.A. from N.Y.U., an M.A. from Teachers College, Columbia University, and an Ed.D from Boston University. Her book, ADHD and Social Skills: A Step-by-Step-Guide for Teachers and Parents, has been endorsed by elite professionals in the field. Dr. Russell A.Barkley stated, “This is a lavishly detailed book providing numerous recommendations for ways to address the social interaction problems and social skills impairments associated with ADHD in children." Autographed copies of Dr. Rapoport’s book will be available for sale after the presentation.

Please join us this Wednesday for this informative presentation!

Furnace Woods Elementary School
239 Watch Hill Road Cortlandt Manor, NY

Accepting People who are Different

Why teach the child to accept a child who is different from him rather than to just tolerate him? First, let’s get rid of the word tolerate that seems to be in everyone’s vocabulary lately. In my mind, if a child is taught to tolerate a child who is different, he is “putting up with” that child, knowing that he does not like him for whatever reason. When someone teaches a child to accept another child, it means that he likes him. Even though there may be an emphasis today on teaching children to respect (there is that word again) and accept people’s differences, it is an especially important social skill for children with ADHD to learn. Why?

The reason for teaching the skill of accepting people who are different to children with ADHD is because they are different themselves. I may have given similar examples before, but these examples of things that children with ADHD do that make them appear to be different are relevant here as well:

✱ Children with ADHD have difficulty staying in their seats in class.

✱ In situations that are more unstructured, such as gym class, children with ADHD lose their self-control and, among other behaviors, run around in an excitable fashion.

✱ Children with ADHD often are not as patient as typical children when they have to wait for a turn at play.

✱ Children with ADHD are not always willing to cooperate or compromise with other children.

✱ Children with ADHD find change difficult.

✱ Children with ADHD have difficulty making transitions from one activity to another.

✱ Children with ADHD ask questions often using inappropriate language.

✱ Children with ADHD ask questions at inappropriate times.

✱ Children with ADHD talk excessively.

✱ Children with ADHD do not listen well.

✱ Children with ADHD run into rooms.

✱ Children with ADHD barge into others’ conversations and, therefore, interrupt them.

✱ Children with ADHD act out (i.e., hitting and kicking) when they become frustrated.

Teachers would most likely characterize the previous behaviors as socially inappropriate, which might make them appear different from the other children in the class. If you disagree with me and think that some of those behaviors are not socially inappropriate, then try this exercise: Close your eyes and imagine how a child who exhibits these behaviors could fit into a typical classroom without appearing different. If you still disagree, then please tell me how that would be so. So, you can see why children with ADHD need to learn about understanding and accepting people who are different.

Teaching this social skill requires in-depth discussions with these children. They need to understand that each person is unique, so if they appear not to be the same as the others, that is okay. Children with ADHD, due to inattentiveness, however, may not notice the differences among people. In fact, they may say whatever “pops into their head,” and sometimes make inappropriate comments about other children and do not even realize it.

It is important to teach children with ADHD how people may be different on the outside, (i.e., skin color, hair color, different eyes, different dress, etc.), but may be similar in terms of beliefs, values, and behavior. A good book that may help eachers to instruct children with ADHD to learn that each person is unique is Accept and Value Each Person by Cheryl J. Meiners (2004). It is particularly important to teach this social skill to children with ADHD who are brought up in restricted, narrow settings, such as Orthodox Jews, children who live in inner cities, people of Amish descent, and Mormons. Why?

These children may never see a child who is different from them within their school and extracurricular activities because they only interact with children within their religious or ethnic group. Some children with ADHD may learn this important skill through reading about it, while others will require role playing as well as more in-depth explanations.


Teaching the method of reciprocal conversation is challenging due to the distractibility of the child with ADHD, but if done correctly, the child will come away with a real understanding of accepting people who are different. You will, of course, have to make sure that the child is maintaining eye contact before trying this method of social skills training. Try a question and answer session first.

✱ “What color is your skin?”

✱ “Is the skin of your classmates the same color?” If not, “What color is their skin?” (Researchers state that children are aware of skin color at a young age [Derman-Sparks, 1989, p. 2].) Make sure that the child has paid attention to his classmates’ skin color. If not, you need to stop here and talk to the child about how to recognize his classmates’ skin color. The teacher or the parent must show the child with ADHD pictures of children of various “colors” and make sure that he can discriminate among them. Why is that important? You must make sure that the child understands the concept of difference and being able to discriminate between people’s skin color is a good way to begin. Okay, back to the conversation:

✱ “Do the children’s skin colors in your class make the children different from you?”

✱ “If so, how does their skin color make them different?”

✱ “Do the children in your class play with the same things or with different things than you?”

✱ “What do you like to play?”

✱ “Does everyone in your class wear similar clothing?”

✱ “Does everyone in your class have the same customs?”

✱ “What are some of your beliefs? For example, are you nice to people who are nice to you? Do you do things for people who are nice to you? Do the children in your class have similar values?”

By incorporating the answers to the posed questions, the teacher should then be able to teach the child about accepting people who are different. This lesson may have to be repeated in several ways. One way to reinforce this social skill, for example, is to have the teacher and the child with ADHD write a social story together based on the lessons learned from the conversation.



Social Story: Accepting People Who Are Different

✱ You may be different from your classmates in terms of the color of their skin, dress, and culture.

✱ It is important to treat each and every one in your class with respect, no matter what their differences.

✱ The differences of each person in your class should be looked at positively and appreciated.

✱ No matter how different people seem in your class, everyone can work and play together successfully.

Being Different Is a Positive Attribute

Sometimes reading a story that articulates the positive side of being different can be a big help to the child with ADHD. An example of such a story is Tacky the Penguin by Helen Lester (1998). Tacky the Penguin is the story of Tacky, a penguin who did not behave in the same way as the other penguins.

For instance:

✱ The other penguins greeted others quietly, while Tacky greeted others by slapping them on their backs.

✱ The other penguins marched in order, while Tacky marched out of order.

✱ The other penguins dove into the water gracefully, while Tacky made a huge splash.

✱ The other penguins sang lovely songs, while Tacky sang odd songs.

Tacky used his difference in a positive way when hunters came to their home one day. He slapped them on the backs, marched out of order, and sang songs that irritated the hunters so much that Tacky made them leave the penguins alone and go away from their home! The other penguins appreciated him for what his difference helped him accomplish. Tacky used his difference to get the hunters to go away without harming the penguins. This is a great book to read to a child with ADHD because oftentimes, these children think that they are different in a weird, strange way. Children with ADHD think that others think of them as different as well, but unlike Tacky, in a negative way.

Children with ADHD often think that other children do not like them as well. Some of their thinking may unfortunately be correct. However, they can be taught that some of the characteristics that make them different can be used in a positive

way, just as Tacky did. For example, especially in consideration of the fact that children with ADHD often feel different from other children, it would be good for them to work on accepting peer suggestions for activities.

Monday, April 25, 2011

My Presentation is this Week! Come One, Come All!

I am presenting my book, ADHD and Social Skills: A Step-by-Step Guide for Teachers and Parents, this Wednesday, 7:00 P.M. at Furnace Woods School, 239 Watch Hill Road Cortlandt Manor, NY.

The presentation is open to the public, so please come. Any questions? Write me here or at my gmail address.

Tuesday, April 19, 2011

Punishment does not Motivate Children with ADHD to Complete their Homework Independently

It can be very frustrating to parents when their child with ADHD does not behave in a way that they consider optimal. Let us talk about a child with ADHD who is of middle school age. Some children with ADHD have great difficulty writing by hand. Additionally, even though they can complete most of their homework on a computer, they may not be ready to do so or may refuse to do so. Instead, they dictate their homework to a parent, who in turn, writes their homework out for them.  What is the problem here?

First of all, if a parent works all day, they may have things to do themselves at night, or at the very least, might want to relax for a short time. Second of all, this is a very manipulative pattern that simply is not good for either the child or the parent. Routinely, when the parent returns from work and begins to make dinner, she asks the child whether or not he has done his homework. The child invariably answers “No.” What does the parent then say to the child? “From now on, if you do not at least start your homework and complete a few subjects before I get home, I will ground you.” What is the problem with the parent making that statement? First of all, if that statement is made, the parent has to be ready to carry it out. Second of all, punishing a child with ADHD for not doing his homework himself when writing is a real issue, is not going to get the child to do his homework independently.

Children with ADHD arguably have self-esteem issues. Why? People are annoyed with them, criticize them, rebuff them and reject them, which does not generalize to their building positive self-esteem. Trust me that these children would love to do their homework by themselves, but sometimes they need some support in order to do so. I would rather see a reward system set up based on one of the child’s interests that will encourage him to begin his homework by himself, than seeing him punished because he does not do so. 

Children with ADHD arguably need to be motivated in order to do their homework by themselves especially when they have difficulty writing by hand.  Punishment is anything but motivating. In fact, punishment generally shuts down children who have poor self-esteem. Children with ADHD do not behave as they do out of their own choice, but instead, because they just cannot behave in any other way. They certainly would rather not behave in such a way that causes adults to be angry at them and punish them. 

They need to learn alternative behavior that instead of resulting in them becoming rebuffed, instead, helps them to become accepted. The process of learning more acceptable behavior, however, takes time and the adults who are responsible for taking care of these children need to have patience with them. Children with ADHD can learn to behave in more acceptable ways by being taught positive behaviors that will replace the inappropriate behaviors that they often exhibit. We all could learn to become a little more patient, don’t you think?

Monday, April 18, 2011

Another Answer (Tailored for all of you!) to a Reader's Question: What is the Best School Environment for Children with ADHD?

I know that it may seem hard to believe, but children with ADHD need stimulation so that they can achieve hyperfocus. In fact, oftentimes, if a child with ADHD does not find stimulation, he stimulates himself, for example, by tapping a pencil on his desk, by spinning his chair, etc. Therefore, some children with ADHD might respond to the school environment that you describe as distracting to your son, as one that instead, is stimulating.
However, if your child finds his current school environment too distracting, he may need a more structured environment, where every component of that context is consistent and constant. Due to the tenuous economic situation in which our schools find themselves, it may be difficult to find a public school with smaller classes, unfortunately. If cost is not an issue, then I would suggest a private school, which will most typically have smaller classes. I would suggest one with a person who is an expert in academic support, however.
 If private school is not an option, then perhaps find a town which would be characterized by a smaller population than the one in which your child’s school is currently located. If the population is not as large, then it is likely that the classes would be smaller.
Even more important, however than the number of students in a class, is the organization, structure, consistency, and predictability of the teaching, the classroom subjects, the classroom materials as well as the activities in which the children are involved.
An example of that consistency, are rules for the children’s behavior that have been written in a positive tone and are based on a collaborative effort of the teacher and the students. These rules must be followed by everyone consistently.
In addition to classroom rules, the teacher’s lessons should be designed according to the developmentally appropriate needs of each child, as well as to each child’s individual learning styles, learning strengths and needs.
 In order to help the child with ADHD to focus optimally, the teacher should have the child’s desk as close to her desk as possible, without stigmatizing the child. Additionally, the child with ADHD should not be seated next to a child who has similar behavioral issues.
So what am I really saying? The appearance of the school as well as the number of the students in each class, is not nearly as important as whether or not the child’s needs are being met by a teacher who is extremely organized, consistent and patient in terms of the symptoms that a child with ADHD exhibits. Therefore, when you look for a new school for your child, I would look to see if the teachers who are working with your child are warm, organized, consistent, patient, and knowledgeable of how important it is to teach children with ADHD inclusive of emotional intelligence. Our children need to talk about how they feel and desperately need someone to listen to them.

Be Careful Concerning the Social Skills that you Model for your Children!

The other day, I was driving in New York City. There was some traffic and I was trying to turn into a street from an avenue. I had to wait for the cars ahead of me to drive, so I was inching forward one foot at a time. Additionally, as I was trying to turn into the street, I had to stop and wait for the pedestrians to cross before I completed my turn. I had waited seemingly a long time before completing my turn, when I saw a mother crossing the street with her son.

I sat at that intersection and was not planning to move until they finished crossing the street. As I sat there waiting, the mother shouted out “Patience, grandma!” I was stunned. First of all, I do not look like the stereotype of a grandma. I have long red hair and I do not look anything like a grandma (not that there is anything wrong with that!) in any way. Second, I was sitting there patiently for an interminable time, with no intention of driving until they had finished crossing the street. Third and perhaps the most important point, is that the mother made a very inappropriate and disrespectful comment in front of her child!

How are children supposed to treat other people with respect if their parent is disrespectful? So…please be careful what social skills you model as a parent when you are trying to teach positive social skills to your children!

Wednesday, April 13, 2011

The Answer to a Question that was Posed in my Question Forum: What is the Best/Most Successful Environment for Children with ADHD?

Even though I answered one of my reader's questions in the comments section, I felt that the topic was such an important one, that I would write my answer here, as well.

 Here is my comment:

The best/most successful environment for children with ADHD is one that is structured in terms of being consistent, but not restrictive. Every component of the child with ADHD’s environment should be organized in a structured and constant way, so that the child with ADHD knows what to expect at all times.

For example, his room should be organized with a specific place for each toy or book, which is color coded. You will need to work with him until he knows the relationship of a specific color to the place where it may be found. You can color code the books separately according to their titles. Even if your child is too young to read as of yet, you are bringing literacy into his life in the natural setting of his room.

The importance of organizing his room is so that he will become accountable for his personal items. By becoming responsible, he will feel ownership of his personal items and therefore, build positive self-esteem.

Why use color-coding? Children with ADHD need stimulation. By incorporating a colorful cue as to where the material should be placed when they are finished with it, will help him to remember where it goes. By doing so, he will precisely know where to return the material to its place after accessing it.

The child with ADHD's activities within his environment should be structured and consistent as well. For example, he should do his homework the same time every day. In terms of not being restrictive, this is what I mean: The place where he chooses to do his homework, as well as where he will do his homework, may be varied and determined by him within his activity level. He may choose to do his homework at the kitchen table, walking around or lying down on his stomach.

Children with ADHD work best within their activity level as chosen by them. I would encourage him to do his homework by himself. That being said, you can scaffold or support him by asking him questions about his homework from time to time, which will give you an idea as whether or not he is doing it.

Caveat: I would NOT ask him if he has finished his homework, which might cause him to become angry and noncompliant. I would, however, ask him something about the subject that he is studying. For example, if he is studying certain Constitutional amendments, you might say, “I can never remember what the 14th Amendment says. Could you remind me?”

I would also color code his homework folders, and then teach him which color represents a specific subject. By doing so, the likelihood of him remembering to put each subject’s homework in his schoolbag is higher. He should place the completed subject in the prescribed folder immediately upon finishing it. The more organized the child with ADHD’s environment, the higher likelihood that he will feel comfortable in knowing what to expect in terms of his responsibilities. In that way, he will become more accountable in terms of his personal items.

Tuesday, April 12, 2011

The Importance of Play as a Vehicle to Teach Social Skills to Young Children with ADHD

When I was teaching my graduate students last night, one of my students who is a student teacher in a kindergarten class asked me “How can I teach social skills in our kindergarten class when there is no playtime?” It appears, arguably, that kindergarten is the new college, where only academics are taught with no time for play included into the schedule. Those kindergarten children do not even have recess!

Play is a powerful learning context that helps a child to become engaged in social interaction with their peers with no predetermined outcome. Additionally, play helps to build a child’s creativity because those outcomes are due to trial and error.

Kindergarten and preschool is a time that is typically rich in terms of opportunities to teach social skills to children with ADHD. However, if young children with ADHD do not have the opportunity to play with their peers in school, how will they learn the positive social skills that they need to experience positive social experiences? The answer is that if those children do not have the opportunity to play during school, it will very difficult for them to learn those positive social skills.

Children with ADHD arguably need assistance and support from their teachers in order to learn social skills. Therefore, if the opportunities for social interaction are not part of their school day, the child with ADHD’s teachers will not be able to teach them the necessary social skills.

I often suggest to teachers that even though they are teaching academics, there are ALWAYS opportunities to embed the teaching of social skills into their academic subjects. I know that in active preschool and kindergarten classrooms where the children are involved in collaborative projects, there have to be ample opportunities for teaching positive social skills. Additionally, lunchtime is a perfect time to teach positive social skills, in terms of learning good manners, listening to others without interrupting, being respectful, among other social skills.

If you are an early childhood teacher who has children in your classroom who either have a diagnosis of ADHD or those whom you suspect have ADHD, please teach social skills intentionally through any opportunities that you can design. Remember: Children with ADHD with social skills problems become adults with ADHD who have social skills problems.

Thursday, April 7, 2011

Today is a Question Forum

Hi Everyone:

Today is a day that I have dedicated as a question forum day. I will take any questions that you write to me, and will answer them quickly.  Are the following some of the topics about which you would like to ask?
  • ADHD: What is is?
  • A child with ADHD
  • An adult with ADHD (perhaps you?)
  • Social skills problems: What are they?
  • A child who has social skills problems
  • An adult who has social skills problems
  • Other disorders besides ADHD that are accompanied by problems with social skills
Ask away!!!!!

Wednesday, April 6, 2011

Is your Child with ADHD Immature? How does that Immaturity Affect his Daily Existence?

As we are completing yet another year of school, have you asked yourself why your child or a student with ADHD in your class appears immature, as compared to the typical children in your home or classroom? Is there a delay in brain development in children with ADHD that causes them to be developmentally delayed approximately three years? Does knowing and understanding about that developmental delay help teachers and parents to manage children with ADHD in a more positive way?

I have previously discussed the definitive research that was completed by Shaw et al. (2007), concerning whether or not there was a delay in brain development in children with ADHD. Here is a quote from Dr. Shaw:

“The current study, really ever since ADHD was first described, there's been a debate about whether it represents a delay in brain development or whether it's due to a complete deviation away from normal brain development. To address this question we looked at the cortex and we measured the thickness of the cortex across thousands of points in the brain in about 450 kids, some with ADHD some without. And we looked at how the cortex developed. What we found is that in all children the cortex starts off quite thin it then gets thicker. It reaches its peak thickness and then starts thinner throughout adolescence. And the big difference we find in the current study was between the ADHD kids and the kids who didn't have ADHD was in the age at which they reached this milestone of peak cortical thickness throughout the brain. So for healthy kids they sort of peak around age 7 or 8, whereas the ADHD kids there delayed and they reach their peak at about age 10.”

“So while there was delay the sequence or the order in which the different parts of the brain matured was very similar in both the kids with ADHD and those who didn't have it. So if ADHD was a complete deviation away from normal brain development you'd expect the sequence to be completely disrupted and it wasn't. So we think this is pretty strong evidence that ADHD is more of a delay in brain development” (Retrieved April 6, 2011 from

So now that we know, according to the results of Shaw et al.’s (2007) definitive research, that children with ADHD mature approximately three years later than typical children, how does that affect our expectations for the child with ADHD? How does this information affect the parent’s daily interactions with their child? How does it affect the child’s teacher’s expectations for the child with ADHD?

Despite the results of this definitive research, teachers and parents, respectively, (rightfully so) have certain expectations and standards to which the children in their class and at home must adhere. The best that we can hope for is that both you and your child’s teacher have some understanding of the child with ADHD’s immaturity, which will help all of the adults in his life to manage these children in a more positive way.

That being said, we must encourage our children with ADHD to realize those expectations. Oftentimes children with ADHD do not think about others’ expectations for them. If they do not realize those expectations, how can they satisfy those expectations? The answer is if they do not realize the expectations that are set for everyone, they cannot meet them.

It is vital to do the following for our children with ADHD, so that they learn about the expectations that others set for them: (This list is for teachers and parents) (If the child with ADHD does not read, find some pictures that will cue them regarding their responsibilities.)

• Do not assume that if other children understand the expectations that are set for them, that children with ADHD are aware of those expectations

• Explain about expectations in general, as well as how they apply to individuals

• Talk to the child with ADHD either in one long conversation, or depending on his attention span, in a few short conversations about the following:

o grooming standards at home and at school

o housekeeping responsibilities at home, especially concerning his own possessions and his room

o an explanation of classroom responsibilities

o an explanation of behavioral expectations toward the teacher as well as toward his peers

o age-appropriate social skills (I would NOT use the word age-appropriate with the child, but as long as you are aware of what that phrase means, you can explain it to the child in a positive way)

o the change in the expectations for him for the next school year

It will be interesting to hear if by explaining the child’s expectations to him, he will become more flexible and responsive as related to how you and his teacher can help him to become accountable, as well as to begin to meet the daily expectations that others delineate for him.

Tuesday, April 5, 2011

Seeing Behavior Challenges as Lagging Skills: An Update on Collaborative Problem Solving

by Mark Katz, PhD

WHY ARE CHALLENGING CHILDREN SO CHALLENGING? Ross Greene, PhD, says the answer is simple: “They lack the skills not to be challenging.” Experts in the field of child neuropsychology, including some leading ADHD researchers, have been saying much the same thing.

To effectively control our behavior, regulate our emotions, communicate our needs, think flexibly and get along socially, we call upon a number of different skills. Children delayed in these skills often struggle behaviorally, socially, and emotionally. To help them, says Greene, we need to start by seeing challenging behaviors through “a new set of lenses.” His innovative Collaborative Problem Solving (CPS) model does just that.

The CPS approach, first highlighted in this column in October 2006, has helped countless parents, teachers, school administrators, and healthcare professionals learn to see a host of challenging behaviors through a new set of lenses. This is a necessary first step, says Greene, in successfully implementing CPS’s many other unique and innovative components.

Once lagging skills are successfully identified, CPS practitioners turn their sights to how they impact a child’s ability to meet everyday demands. For it is when everyday demands outweigh existing skills that challenging behaviors are set in motion, ranging from benign to extreme. Some children whine, some explode in fits of rage. Greene chooses not to describe behavioral reactions in diagnostic terms. Instead, they’re merely somewhere on what he call the “spectrum of looking bad,” a continuum of behaviors all human beings exhibit when they are not able to look good.

Wherever they lie on the spectrum, challenging behaviors relate directly to unsolved problems, like completing homework, completing assignments at school, or handling disappointment when you lose at a game. For some children, Greene observes, as few as two or three unsolved problems can account for seventy to eighty percent of their challenging episodes. He developed a one-page assessment and intervention guide, known as the ALSUP, or Assessment of Lagging Skills and Unsolved Problems (see sidebar) to help identify lagging skills and unsolved problems.

Three common approaches to handling challenging behaviors

Adults have three options for resolving unsolved problems with children: Plan A, Plan B, and Plan C. Plan A involves solving problems unilaterally, usually through imposition of adult will, often with adult-imposed consequences attached (“You’ll do it my way and that’s it”; “I’ll count to three – 1, 2, 3”). For children with lagging skills, Plan A can actually precipitate challenging behavior by further aggravating problems rather than resolving them. Indeed, it often results in an adult-child power struggle. Plan B involves solving problems collaboratively and is where CPS practitioners spend the bulk of their time with children. Plan C requires dropping an unsolved problem for now, because we’re working on a much higher priority issue at the moment.

Solving problems collaboratively, or Plan B, involves three steps (or ingredients): 1) Empathy, 2) Define the Problem, and 3) Invitation. The goal of the Empathy step is information gathering, but in a very nonjudgmental or neutral way; solutions come later. Adults first have to be very good listeners, so they can understand a child’s concern in the clearest and most accurate way possible. If we’re doing the Empathy step well, a child should feel heard. Next comes the Define the Problem step, when the adult’s concern is entered into consideration. Time is taken to ensure that it’s clarified, heard, and understood. Up to this point there has been no talk of solutions, just two concerns about an unsolved problem yet to be resolved. It’s in the third step, the Invitation, that solutions are discussed in a brainstorming process designed to address the two concerns.

A solution is not reached in CPS until both the adult and the child agree that the solution is acceptable. Among its many other innovative features, CPS not only focuses on a child’s concerns, but on the adults’ concerns as well. Whether it’s a parent, teacher, or staff member in a residential treatment center, the process requires that the adult and the child arrive at a mutually agreed-upon solution to an unsolved problem. “It takes two to tango,” says Greene. Many treatment strategies focus on a child’s problem, separate from the impact it might be having on the important adults in the child’s life. CPS places the focus on a relationship. And when mutually satisfactory solutions are reached, a relationship can grow even stronger than it already is.

Another distinguishing feature of CPS is that it works directly on important and predictable unsolved problems. It makes the process clear, focused, and meaningful, both to the child and to the adult. Another benefit is that children receive a lot of practice in learning how to listen, how to understand the perspective of others, and to see how their behavior impacts those to whom they feel connected. Adults get a lot of practice in these skills as well. And when adults and children continually engage in Plan B resolutions of unsolved problems, children’s lagging skills grow stronger. Rather than focusing directly on improving lagging skills in hopes of resolving unsolved problems, CPS practitioners work on successfully resolving unsolved problems collaboratively, which in turn serves indirectly to improve lagging skills.

“How do we know when CPS is working?” Several ways, according to Greene. A child begins to engage in Plan B openly and starts to talk about meaningful information related to personal concerns. Trust is increasing and the relationship feels like it’s growing stronger. Unsolved problems are being resolved, and their number is decreasing. Slowly but surely, lagging skills are also being trained. And the adult engaged in the CPS process is more optimistic about better days down the road.

Lives in the Balance

Greene founded Lives in the Balance, a nonprofit organization that provides free web-based resources to parents, teachers, clinicians, and others to help them understand children prone to behavioral challenges through this new set of lenses. Visitors to the site can learn about CPS in impressive detail through articles, training handouts, streaming videos of an actual full-day training on CPS conducted by Greene, and streaming videos of CPS in action in real-life vignettes.

They can also access a Listening Library that contains recorded archives from the three weekly web-based radio programs Greene conducts. One focuses primarily on applying CPS at home, a second on its application at school, and a third for implementing the model in restrictive therapeutic facilities. Dates and times of upcoming radio broadcasts are also listed for those wishing to call in live. Among its many other features, the website also provides an advocacy component, where individuals wishing to communicate with adults whom they feel could benefit from learning about CPS can, for a fee, send those adults an anonymous package of materials explaining the CPS process. Visit to learn more about CPS.

CPS and Response to Intervention

Rather than waiting for struggling children to fail before determining whether they qualify for special education services, Response to Intervention (RtI) is designed to identify the earliest signs of an academic or behavioral problem and to provide evidence-based interventions that can strengthen skills and resolve behavioral challenges before they grow more serious. Unique to this paradigm is its ongoing (formative) assessment process known as progress monitoring, which provides a continuous picture of a child’s “response to intervention.”

If interventions are successful they can either be continued or faded out. If unsuccessful, more intensive interventions can be implemented, and again monitored closely to determine their effectiveness. This represents a significant departure from how children have traditionally qualified for additional help for learning, behavior, social, or emotional difficulties. No longer do children have to fail repeatedly before help is forthcoming.

For those addressing challenging behaviors within an RtI paradigm, Greene believes that CPS can be a very helpful tool for children who show early warning signs of more serious problems. In school, challenging behaviors are not often viewed as a function of lagging skills. But by seeing the behaviors through “new lenses” as a function of lagging skills, we incorporate experiences in the struggling child’s life that can help him or her improve lagging skills. “Our explanation guides our intervention,” says Greene. CPS may have an important role to play in preventing and reducing challenging behaviors among school-age children, but successfully implementing it in schools may require that we treat challenging behaviors more like we treat learning disabilities, more as a function of specific skill deficits needing to be strengthened.

In addition to previously conducted studies, several large-scale independent studies of the effectiveness of CPS are currently underway. These include a five-year NIMH-funded study at the Virginia Tech Child Study Center and a large-scale study involving twelve public schools in Maine (funded by the Maine Juvenile Justice Advisory Group).


A clinical and consulting psychologist, Mark Katz is the director of Learning Development Services, an educational, psychological, and neuropsychological center located in San Diego. He is a contributing editor to Attention magazine and a member of its editorial advisory board, a former member of CHADD’s professional advisory board, and a recipient of the CHADD Hall of Fame Award.

This article originally appeared in the April 2011 issue of Attention magazine. Copyright © 2011 by Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD). All rights reserved.

Home Contact Join CHADD E-News Privacy Policy Site Map Donate

© 2010 by Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). All rights reserved.