Case Studies - Page 2

Putting Kids First

Twelve-year-old Carla came to therapy with several problems. Diagnosed with AD/HD because of her short attention span and severe impulsivity, she was overweight and so sensitive to perceived criticism that she constantly squabbled with her peers, and then withdrew from them into lonely isolation and hurt feelings. At home, she was often bad-tempered and frequently had hit her handicapped little brother. She'd been referred to play therapy by the school psychologist; but after a while, she refused to continue, saying "I don't want go there any more; I'm not a baby."

A child psychiatrist at the family services who'd evaluated Carla came to the conclusion that her concentration problems and impulsivity made her behavior so disruptive in class that medication was absolutely necessary to enable her to stay in a normal class. Nevertheless, her parents refused to medicate her, with the result that she was removed to a special school for children with behavioral problems. There, her problems continued. The parents, still searching for a nonchemical alternative, scheduled an appointment with Christine, a Kids' Skills therapist, who explained the idea that problems can be converted to skills that children can be helped to learn. Carla's parents thought the approach worth trying.

The following week, when Carla arrived with her parents, Christine found out that some preliminary work had already been done at home. The mother had told Carla about Kids' Skills, and together they'd worked out a list of new abilities she might need to develop to overcome her problems. The list included "to learn to let adults complete their sentences without interrupting them," "to learn to raise her hand at school to ask for permission to speak," "to learn to be kind toward her little brother," "to learn to sit still for gradually longer periods of time," and "to learn to focus better on her school assignments."

The first step in Kids' Skills is to get an agreement with the child about a skill to learn that would help him or her overcome a specific problem. Kids' Skills works best when children themselves think up the skills they want to learn. Obviously, parents, teachers, and other adults always have their own ideas of what the child really should learn first, but it's preeminently the child who must agree to learn the skill to take ownership of it. So Carla took full part in the discussion with Christine and her parents as they agreed that the first skill she should learn was to control her tendency to act impulsively in social situations and, more specifically, to learn to wait until it was her turn before bursting into conversations or taking action. "I'm simply too impatient," she admitted.

The basis for Kids' Skills has been laid when the skill to learn has been identified and agreed upon with the child, but for that to happen, important steps need to be taken to ensure the child's ownership of the skill and to build her motivation to learn it. These steps include engaging the child in a discussion of the benefits of the skill, asking the child to give a cool name to the skill, letting the child pick an animal (or any other character) to function as a magic supporter, and last but not least (at least if you ask kids!), planning how to celebrate when the child has learned the skill.

"Okay, so now we have a skill for you to learn. What do you think will be the benefits for you of learning that skill?" Christine asked.

Carla earnestly listed a number of benefits. "My friends would respect me more, and they'd like to play with me more. Maybe I'd even get some new friends," she said. "Also, my teachers wouldn't scold me and make me stand against the wall so often. I'd be able to listen better to what the teachers are saying. And in dance class, I wouldn't disturb other people so much."

"Sounds good, and if you were to give a name to this skill, what would you like to call it?" Christine asked. Interestingly, adults often struggle if asked to think up a name for a skill, but children usually do it easily and naturally.

"It should be called 'Waiting Tone,'" Carla said gleefully, explaining that when you call a number and are put on hold, often relaxing music is played to make you feel calmer while you're waiting for someone to take your call.

When asked to pick her power creature or magical helper to remind her of her skill, Carla immediately chose her horse, Cindy, well-known for her ability to wait patiently.

Carla positively lit up when the idea of celebrating her new skill was mentioned. She wanted to have a garden party, inviting her dance group, teacher, parents, and both grandmothers. The event was to be exactly like the parties her parents had for their friends, held in the evening, with a barbecue and drinks. Carla's parents promised to help her organize such a party once she'd learned her skill.

 

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