and her name is Leslie E Packer, PhD. so here are a couple of links to her articles. If you google her name you will get lots of links to great stuff she writes and some of it really good to use in IEP meetings and for assessment. Also to work with admin about inappropriate discipline. There are tons from her and they apply to any difficult child, she writes on different disability sites but her stuff crosses disabilities. Very into Ross greene now but she is her own woman and adds to the discussion not just explaining his stuff. she is a psychologist who ended up a parent of difficult child's. tried the behavior charts and everything. Now has a totally different view of the world. REALLY good stuff. Her article which I can't locate on the internet right now, that talks about how she determined that there had to be a different way is called Confessions of a former Rat-Runner. It is so good so if you can find it and open it please share, It is on my old computer so gone for good. I know it is out there in cyber space. Here is what reminded me of her... Is Behavior Modification Even Appropriate? : Tourette Syndrome "Plus" " Leslie E. Packer, PhD This article just happened to talk about tics, how convenient for me, smile. this one below is called Is Behavior Modification Even Appropriate?? http://www.tourettesyndrome.net/disorders/rage-attacks-or-storms/treatment-of-rage-attacks/ Changing the responses of others is a crucial piece in any intervention plan, as it is often others' responses that either push the patient past their limits or otherwise escalate a situation. Because many people misunderstand the individual's behavior and erroneously attribute it to voluntary misbehavior or 'oppositionalism,' they may speak to the individual in ways that are counterproductive. In my dealings with parents and educators, I often hear, 'All he needs is a firm hand and more discipline,' or 'Well, I understand that he has a neurological problem, but I still can't let him just get away with that.' I generally start by nodding my head to show them that I do understand their thinking, but then say, 'OK, but let's get real. Is your strategy working? Is he learning not to do that?' At that point, they'll usually acknowledge that their approach hasn't worked at all, and that's my opportunity to start showing them another way to think about or understand the child's behavior and another way to approach the problem — an approach that begins not with trying to change the child, but with creating a more supportive environment that reduces frustration, learning to read the ‘warning signs' that the child is about to 'lose it,' and being able to immediately shift gears to restore the child to some equilibrium so that they can problem-solve with you. Educators are often reluctant to embrace this kind of alternative approach. Having been exposed to some semblance of behavior modification in their training, and often feeling vulnerable because of how their administrator may be critical if they do not appear to be in total control of their classroom, they may say something like, 'But there have to be SOME consequences, don't there? if I let Dennis get away with just running out of the room when he's upset, then all the other children will be learning that they can get away with it too. How do I help Dennis without turning the whole classroom into chaos?' Now I may be a bit naive, but I am personally and professionally hard-pressed to envision 20 other middle school students suddenly developing panic attacks and learning to run out of the room. Yes, fairness is an issue to children and they need some kind of explanation for why one student may have accommodations that they don't have, but students are pretty sharp and can generally detect when a peer has a serious problem. They can also be brought into the whole game plan to provide support for their classmate so that things don't get to that point. Applying 'consequences' under the often-misguided notion that such 'consequences' will boost the child's motivation so that they will learn to behave differently often tends to lead to punitive strategies that worsen the situation. They also lead to the parent or educator becoming as inflexible as the child/teen is at that moment. Locked in a power struggle with the child, the teacher or parent will invariably lose. Hence, in my experience, one of my key functions is to provide support to the parent, educator, or colleagues so that they can remain calm and provide support to the child or adult. If the child is not cooperating with you at the moment, instead of assuming that the child doesn't want to cooperate with you, assume that they DO want to cooperate with you but are unavailable to do so, through no fault of their own. Most children really want to keep the good opinion of their parents and teachers. If they are saying 'no' and getting explosive, assume that they have a problem that is preventing them from shifting from what they were doing or thinking about and what you want them to think about or do, and that the problem is not one of motivation. Many children with neurological conditions need more time to make shifts (transitions), and they often need a good amount of support to make shifts. If you simply demand or even politely ask them to make a shift that they cannot make, they will be frustrated. And frustration can lead to explosiveness. As intelligent as many of these children are, they simply cannot see their way out of what appears as an overwhelming conflict or dilemma (e.g., 'I really need to finish this game and Mom is saying I have to do my homework.'). Because they cannot 'see' anything other than those two options, they are likely to either ignore the mother's request or say, 'no.' The mother, if she interprets the ‘no' as 'No, I'm not going to do my homework now because [I'd rather play, or I don't care about my homework]' is likely to become frustrated and insist more strongly, 'Come, it's time to do your homework NOW.' Under conditions of increasing stress, the child will respond, 'NO!' more forcefully or 'In a minute…..' And so it goes. One of the first things I teach parents in my clinical practice is to change their understanding of what 'no' means when their child says it. I teach them to mentally respond by thinking, 'When he says ‘no,' he really means, 'Mommy, I'd really love to cooperate with you right now because I think you're the most wonderful mother in the world, but as much as I want to, I'm not available to cooperate with you.' Now of course, there are times when the child really means 'No, I don't really care what you want because I have to have what I want when I want it, and I want to play this game,' but if we are going to err, it is probably safer to err on the side of giving the child the benefit of the doubt for the moment. With that revised interpretation in mind, what can the mother do or say? Well, there are actually many things she could say or do, but what she won't do is keep insisting or start arguing. If she simply acknowledges her child's experience and respects it by saying, 'OK, but I'm concerned about your work getting done, so can you just put that on ‘pause' a moment to tell me when you're going to be able to do your work?' or if she says, 'OK, I understand that you need to keep playing that right now. Please come tell me as soon as you are available,' there will be much less chance of an explosive outburst. And reducing the explosive outbursts is a priority. HELPING THE CHILD CHANGE While the parents and teachers are learning alternative ways to talk to the child so as not to provoke or escalate a situation, the child is also learning to think flexibly when they are thwarted or encounter frustration. These skills can generally not be learned when the child is in a state of heightened arousal if they are over-aroused, but if the child has some level of increased arousal, they also may be more motivated to work with you (if they think that it will lead to them getting more of what they want at that moment). The learning and rehearsal also take place in the home and office with therapist and parents, so that the child develops skills that they will be able to access when they really need them — when they are in a situation where they may be in a state of heightened arousal or starting to get dysregulated due to thwarting from teachers or the environment. As the child masters simpler exercises in problem-solving and begins to identify solutions to their problems, the challenges or tasks are progressively increased. When your child (or patient) comes to you with a problem, that is a wonderful opportunity to help them learn some strategies, because if the strategies are successful, then the next time they have a problem, they will be more likely to try the strategy. The following example from my clinical practice may illustrate this point: .....(go to link to read whole article if interested)...... The elements of a comprehensive prevention and treatment program might include: Increasing your own awareness and understanding of how neurobehavioral conditions affect your child (student, or family member). That may mean getting a neuropsychological evaluation, a speech and language evaluation, a sensory integration evaluation, as well as other more obvious evaluations and assessment procedures. Identifying situations or stimuli that are more likely to provoke or trigger such attacks and eliminating as many of these sources as you can. At the beginning, preventing rage attacks has to be your top priority. Later on, as coping skills improve, you may be able to reintroduce certain environmental conditions on a gradually increasing basis so that the skills can generalize to more situations. Learning to pick and choose your battles. Helping the individual stay calm when they're started to get agitated or too aroused. During calm periods, help them develop any deficient cognitive skills and/or social skills, including a vocabulary to communicate their emotions and needs. Parents are often surprised to discover that it may take their child an incredibly long time to think of any options — and indeed, the child may not see what appear to be 'obvious' solutions. You may need to wait quite a while for your child to see even one option or solution, but be patient. If they really can't come up with any options, ask them if they'd like you to tell them some options that you can think of. If they say 'yes,' give them one option and ask them if they can think of any others. If they say 'no' when you ask them if they'd like to hear your ideas, just drop it. If you keep doing that, sooner or later they will probably ask you what your thoughts are, but they may not be ready for that at the beginning. Keep rehearsing the cognitive problem-solving skills — particularly the skill of seeing compromises or alternatives when things aren't going the way they feel they 'have to' go. Work with the child to develop some key phrases that they can use to communicate, and share those with your child's teachers. For example, in my practice, I often teach children or teens to not only recognize when they're mentally ‘stuck' on something or unable to shift gears, but to tell their parents and teachers, 'I'm stuck.' In the presence of that communication, the parents and teachers can generally shift into a different mode to help the child get un-stuck. (Note: my use of ‘stuck' is comparable to what Dr. Ross Greene refers to as 'vapor lock' — the state in which the child or teen is starting to lose their ability to think coherently and solve their problem). If the child has a rage attack, give them space. They will know when the attack is over, and they may need to sleep or just withdraw for a while afterward. Allow them to sleep or to engage in a highly motivating task — the latter will help focus them and bring them 'back.' Do not rush to have a discussion with them about what happened, and if they say they don't really remember, don't push. For many families, family therapy is an important component as old patterns of interacting will need to be significantly altered. If you can't get your spouse to go with you, though, all is not necessarily lost. I have seen reluctant family members decide to start coming when they started noticing changes in the home that were improving things. Nothing succeeds like success. Medication may be also be an integral piece of the plan, depending on what the comprehensive assessment indicates.