CABF interviews Ross Greene, author of The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, "Chronically Inflexible" Children

The following interview was conducted by CABF Executive Director Martha Hellander:

CABF: Dr. Greene, The Explosive Child has gained a huge following among parents of children with bipolar disorder. Have many parents in the audiences you've spoken to around the country told you their child has this diagnosis?

RG: Yes, I've found that bipolar disorder is an increasingly common diagnosis in children and adolescents who also fit the description of "explosive."

CABF: You write that most children with what you call inflexible-explosive behavior are not the product of poor parenting, nor have they been abused nor neglected. What does cause this behavior, then?

RG: My own take on things is that these children are lacking in two critical skill areas: flexibility and frustration tolerance. A variety of factors stemming from poor self-regulation and poor emotional modulation may impair the development of these skills. Naturally, how adults respond to these children is also important.

CABF: What can a parent do when a child is becoming frustrated and a meltdown appears likely?

RG: I wish there was a simple answer.

First, it's important to know the precise factors that are underlying the child's inflexibility and chronically poor tolerance for frustration. In other words, the child's difficulties must be well-understood.

Next, because the child is probably becoming frustrated over an adult command, a change in plans, or a disagreement, it's crucial for adults to have a roadmap (a plan) for how to handle certain issues. Ask yourself, is the issue so important that it's worth having the child explode? Or is it so unimportant that it makes more sense to drop it completely. Or is it an issue on which adults wish to train the child in gaining skills of flexibility and frustration tolerance?

All three are important ways of responding to an explosive child, although the last way is far and away the most important. I don't have a great deal of faith in interventions that don't teach a child how to think in the midst of frustration and how to stay calm enough to be able to do it.

CABF: What happens during the period you call vapor lock?

RG: Vapor lock is when the child exhibits the first early warning signs that he or she is stuck or becoming frustrated. My approach focuses on helping adults intervene proactively, or on the front-end, rather than reactively, or on the back end. I have a lot more success helping adults learn to intervene before Humpty Dumpty falls off the wall.

CABF: Tell us what you mean by mental debris.

RG: When they're frustrated, explosive children often say things they don't typically say, including "I hate you," "I wish I were dead," "I wish you were dead," "I'm going to kill you," and so forth. While such statements must be taken seriously, in my opinion they are also an indication that a child has become irrational. The main goal is to restore the child to a rational state.

CABF: What advice do you have for handling a meltdown that occurs in a public place, like a grocery store?

RG: the main goal in the case of any meltdown is to restore the child to a rational state. Thus, the litmus test for any intervention that occurs during a meltdown is the degree to which it restores a child's rationality. As awful as they are, meltdowns are simply an indication that something about a given situation is still presenting the child with significant difficulty. A meltdown tells us we have more work to do. If the child predictably melts down at the grocery store, there are three viable options: avoid taking the child to the grocery store; make alterations or adjustments so that going to the grocery store is more doable for the child; or train the child in the skills he or she is lacking so that he or she is eventually able to go the grocery store.

CABF: Do you think children with bipolar disorder could get well if their parents just followed your recommendations without using any medication?

RG: There are some children diagnosed with bipolar disorder who have benefitted enormously from my approach without aid of medication. But, in most, the mere fact that they have been diagnosed with bipolar disorder signifies that they are exhibiting extreme difficulties that often require a combined medical and non-medical approach.

CABF: What should be parents' top priority when a child is having frequent meltdowns?

RG: Get an answer to the question "What's up with my kid?" In other words, once parents have a clear sense as to why the child is having frequent meltdowns, intervention options become a lot clearer and decisions can be made about whether medication or non-medical interventions are best suited to addressing the child's needs. A comprehensive assessment is typically necessary.

CABF: Please describe your basket method of setting priorities.

RG: The baskets are metaphors for different ways in which parents respond to their children.

Basket A contains those behaviors that are important enough to have meltdowns over.

Basket B contains behaviors that are important but aren't worth meltdowns; it is these behaviors on which adults are training the child how to think in the midst of frustration and how to stay calm enough to be able to do it. This is accomplished by walking the child through problem solving and working things out (sometimes by compromising). The goal is for the child, over time, to acquire the cognitive skills necessary for increased flexibility and frustration tolerance so that he can eventually handle frustrations on his own.

Basket C contains those behaviors that adults are choosing to remove from the child's radar screen to reduce the child's global level of frustration. In many other approaches, Basket A is the most important basket. In this approach, Basket B is the most important, for it's the only basket in which missing cognitive skills are trained. Basket B is also very hard to do, at first. All of this is explained in much greater detail in the book.

CABF: Why is school such a difficult setting for many children with bipolar disorder?

RG: Schools present a variety of hurdles to children whose self-regulation and emotional modulation skills are compromised. While there are exceptions, schools tend to have minimal tolerance for the behaviors exhibited by such children, and often aren't prepared to handle these problems in a way that would be most productive. Some school professionals are very open to new ways of doing things. I've had success helping teachers implement my approach in a way that was both effective and helped students with bipolar disorder remain in regular education classrooms.

CABF: Have you seen children with bipolar disorder helped when families adopted the techniques recommended in your book?

RG: Many. But, thanks to the Stanley Foundation, I now have funding for the next two years to more formally gather data on the effectiveness of my approach as applied to highly oppositional children with bipolar disorder.

CABF: Thank you very much! We look forward to the results of your study for the Stanley Foundation.

RG: My pleasure.

The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, "Chronically Inflexible" Children is available for purchase in the CABF Bookstore. View Ross Greene's website and speaking schedule at http://www.explosivechild.com/.