Collaborative Problem Solving with ASD and PDA

In a previous post, I highlighted the paradigm shifts and approaches that have been helpful for me in navigating the day-to-day with a child with ASD/PDA who, at points, has existed in a near-constant state of fight-or-flight(-or-...). Most of what I wrote there was with an eye to getting through escalations and dysregulation.

Before proceeding, I'd like to emphasize that, for us, regulation is 99% of the battle. As I talked about in that previous post, that encompasses ideas of relationship, safety, co-regulation, parental self-regulation, validation, emotional processing and the like. Virtually all of my efforts as a parent need to focus on these things. If we can navigate all of that successfully, most problems either evaporate or become simple to solve. Or even to leave unsolved, with a nod of acceptance to the things we cannot change.

Yet eventually, there comes a time when the crisis has passed and co-regulation has seen us through the latest meltdown, and yet problems that do need some sort of solution remain. What then? A frequent answer is Collaborative Problem Solving (CPS).

Now CPS is often bandied about in a very dismissive manner; a "just go use CPS, and everything will be fine so why on earth are you still struggling" sort of direction. I've found collaborative problem solving to be less than straightforward with ASD, let alone with PDA, and I'd like to discuss some of those complications here.

But first...

What is Collaborative Problem Solving?

I think it is necessary to differentiate between the general concept of collaborative problem solving, which I'll label lower case cps, and the professionalized version of Collaborative Problem Solving, which I'll label upper case CPS.

Collaborative problem solving (lower case) is an important philosophy for me, and fits well with my values. I don't generally believe in imposing my will unilaterally on anyone, either my children or others. I do believe in advocating for my own needs (in theory anyway; I admittedly struggle here in practice), and feel that others should do the same. I believe in the process of consensus building, which, to watch the state of politics in the world, appears to be a very lost art. I don't think there is anything particularly special or revolutionary about the idea of cps, though others with a different parenting style than mine might find it a bigger paradigm shift. I'm sure generations of unsung parents -- or anyone else through the eons who has not lived out their days in a vacuum -- have figured out their own versions of cps through a combination of ancient wisdom and sheer necessity.

The modern, professionalized incarnation of Collaborative Problem Solving (upper case) is associated with two names, Ross W. Greene, PhD, and J. Stuart Ablon, PhD. CPS uses a framework that lays out three different approaches: Plan A, Plan B, and Plan C. In the context of parenting, Plan A encompasses the non-negotiable demands, where parental authority reigns. Plan C are the things we, as parents, let go and drop all expectations around, allowing the child to do (or not) as they will. Plan B is where the CPS process comes into play, and a negotiated solution that is satisfactory to both the child and parents is arrived at.

For a bit of background with an added dash of ridiculousness: there is quite the tale behind these two names that leaves me rolling my eyes at the utter absurdity of a legal battle between two Collaborative Problem Solving experts. You, dear reader, can search up the story if you care to. I shall move on without further comment.

Books

There are two books commonly associated with CPS:

The Explosive Child by Ross W. Greene, PhD

and

Changeable by J. Stuart Ablon, PhD

Changeable sits on my bookshelf, and it is the book which I will refer to in this post. I have read The Explosive Child, and other than its similarity in broad terms to Changeable, I have to confess I don't remember too may details, so I won't otherwise refer to it in this post.

Changeable by J. Stuart Ablon, PhD

I have conflicted feelings about this book. I initially read it early in my journey, before being immersed in ND-affirming approaches and before surrounding myself with other neurodiverse voices, and many of the ideas were validating, hopeful, and a relief. However, while writing this post, I re-read sections of Changeable, and became deeply uncomfortable with certain aspects of it. There is a reason this book is not decorated with an array of Post-It flags in the manner of some of my other books, and is rarely lifted off my bookshelf. I will, however, strive to be fair.

Helpful Aspects

The main premise of this book, and CPS in general, is the idea that challenging behaviour is an issue of "skill not will", and that children (and adults) do well when they can.

This is indeed a welcome departure from the voices that told Oranguette (and us) that she was uncooperative, and other useless and demeaning adjectives. So far, so good. The author also lays out an excellent case for the failings of conventional rewards-and-punishments approaches. At this point in my journey, these ideas seem obvious to me, and I tend to forget at least some of the time how sorely needed this paradigm shift in society as a whole still is.

The chapter on "Plan B" is a good start, in that it sets out a series of steps beginning with empathizing before proceeding to a sharing of concerns, and finally, brainstorming solutions. The neurobiology underlying the paradigm of regulate-relate-reason is presented. The author does caution against a rush to solutions, and emphasizes that none of these steps can be skipped or done out of order. Again, so far, so good.

However....

Unhelpful Aspects

As the parent of a child with an ASD/PDA presentation who spends a disproportionate time outside of their widow of tolerance, much of this book and many of the anecdotes come across as unbearably glib and neuronormative.

Using CPS with PDA

Changeable does not touch directly on PDA, which is perhaps one reason why the book as a whole fails to resonate with me. When PDA is involved, the mantra of "skill not will" is, I believe, not entirely correct. "Distress, not will" might perhaps be a better phrase.

I've already repeated myself enough regarding regulation above all else for a PDAer, but at the risk of belabouring the point, the mere idea of an "Emergency Plan B" is somewhat laughable to me. Nothing about Plan B is workable in the moment for us, or at least nothing past Step 1 (empathizing and regulation). If we find ourselves on a train track with a freight train is bearing down, then Plan A of dragging Oranguette off the tracks comes into play. Otherwise, everything goes to Plan C. For us, airing concerns and problem solving do not immediately follow empathizing; those come much later. As in days or weeks later. Or more.

I also heartily disagree with the author's assertion that Plan C does not aid with "building any underlying skills or helping to forge a strong helping relationship". During times of prolonged crisis, I have gone through periods of Plan Cing almost everything. I do not see that as giving up or giving in; I see that as a necessary part of saving a child's life, overcoming trauma, and rebuilding relational safety and trust. During the worst of it, I wish I'd moved even more demands into the Plan C bucket, and done so with far more grace and acceptance. Even now, with crisis in the rear view mirror but with only a fragile stability, I am trying to teach myself a new mantra: when in doubt, plan C it. For me, this is the heart of low-demand parenting of a PDAer.

When it is the time and place for Plan B, this needs to be executed using low arousal techniques. When brainstorming, seeds of ideas need to be planted indirectly. Statements like "what about doing X?" need to be replaced by statements like "I know it might not work for you, but I once heard about someone who did X. Crazy, right?". A few statements like that can be made, then the whole process needs to be suspended for days or more, giving Oranguette time to process and come up with her own alternatives, and find her own path. Options are offered, but without demanding that a choice be made in the moment.

My young PDAer has high intrinsic expectations of herself, as one would expect with someone with a high drive for autonomy. She has a clear and very specific vision of the goals she wants to achieve. For us, using Plan B rarely involves trying to meet parental expectations, but rather, helping her to meet her own. For example, Oranguette is currently determined to attend her particular bricks-and-mortar school, whereas I, in contrast, am much more flexible as to how and when she obtains an education. Problem solving ends up involving validating her conflicting emotions about doing this (it is a very difficult environment for her to navigate as an autistic teen), helping her to balance these conflicts, and helping her to brainstorm workable solutions, together with her support team.

Collaborative Problem Definition versus Collaborative Problem Solving

I have seen a lot of failed attempts at CPS with Oranguette, and most of them failed because the person in power was simply trying to disguise Plan A requests in the language of Plan B. Stuart Ablon does address this pitfall in the book; however, the anecdotes invariably describe how a child or patient eventually complies with the underlying demands of the adults or institutions in power. This is not a dynamic that works well in our reality. In my experience, parenting a PDAer pushes one out well outside of conventional power structures and societal norms.

Instead, for us, far more attention needs to be paid to examining and defining the problem. Credits to Mr. Orangutan for coming up with the phrase "collaborative problem definition" (cpd?).

The tired old narrative, clearly illustrated by one of the anecdotes in the book, is how to get a child to start attending school. The CPS process is illustrated for Susan, who magically goes back to school once concerns about managing her migraines are addressed. What a useless, condescending story for those of us with deeply complex children and less than ideal schools that cannot meet our children's legitimate needs.

Instead, we need to follow Mr. Orangutan's other guiding principle of asking "why", deeply and repeatedly. The problem to be solved is not getting Oranguette back into a school that cannot support her; instead, it is working with her to find radically different ways of meeting her educational and social needs. Those are very different problems, and it is important to choose the correct problems to solve.

Using CPS with ASD

Moving along, what about the autism component?

The author briefly acknowledges the extreme inflexibility he has encountered during his work with "countless patients on the autism spectrum", and the necessity of "scaffold[ing] the process to help build the skill", ending with a statement that "Almost always, we see progress eventually." You will perhaps forgive me for finding that paragraph meaningless and smug. He proceeds to outline a scenario in which he "gently push[es]" an inflexible child to consider some shades of grey. I can say after many, many hours of similar conversations with Oranguette, such an approach only causes her to either escalate uncontrollably, or shut down entirely. These sort of CBT-inspired approaches have been equally ineffectual for us when attempted by conventional therapists. Instead, statements like Oranguette hating "everyone" (or more frequently, "everyone" hating her) require endless amounts of validation and support with identifying and processing emotions. Not just a few sentences, over and done with in a few minutes, but over the course of days, or weeks, or even years.

The other factor that gets ignored in this section is that, for Oranguette at least, cognitive inflexibility waxes and wanes with her distress level. This relates to the idea that much of what neurotypical professionals in particular perceive as inherent characteristics of autism are actually distress behaviours of autistic individuals. If Oranguette's dysregulation (typically quiet and internalized) are recognized, and the focus remains on co-regulation, then the cognitive inflexibility tends to dissipate on its own. Of course therapy still has a role, but therapy then shifts from a long, tedious, often fruitless process to try to break that inflexibility, to a much more productive and pleasant process of providing information and alternative explanations to consider. Think of a curious, relaxed, young neurodiverse anthropologist studying the puzzling neurotypical beings she is surrounded by, with the guidance of a like-minded psychologist.

The Relevance of ASD to CPS

Perhaps my biggest philosophical issue with Changeable is its dismissiveness of diagnoses such as autism. Refer, for example, to the author's discussion of inflexible thinking in the second chapter where he notes that many people struggle with inflexible thinking do not have a particular diagnosis, nor is one necessary.

This to me leads in some very problematic directions. If we say, for example, that an autism diagnosis is irrelevant, then first of all we lose a great deal of very important and helpful information. An autism diagnosis indicates that the individual will have social difficulties, as that is a fundamental part of the diagnostic criteria. It will also suggest that sensory issues are at play, and so on. Why would anyone want to throw out all of that useful information? Does any psychologist or psychiatrist have the time and energy to figure out a patient's lagging skills and differences from scratch?

Secondly, and more importantly, if we neglect underlying diagnoses such as ASD and focus on simply building lagging skills, where does that lead? In my opinion, we arrive straight back at things like ABA therapy, where the focus is on training (by whatever means) the autistic individual to behave in a neurotypical manner. The understanding that someone with an autism diagnosis has a disability that requires accommodations is completely lost. Skills cannot always be learned, at least not in the way the author seems to suggest. We neurodiverse folks can learn the skills of self-advocacy and the skills of working with our own unique brain wiring, but that is a very different thing.

This is, from my perspective, a huge shortcoming of the "skill not will" paradigm. It is also deeply personal, as this was the perspective demonstrated by Institution 1 when Oranguette was told that she was using her autism as "an excuse" and bombarded with traditional therapies that only made things worse. Beware.

Final Thoughts

The idea, implicit in the title of Stuart Ablon's book, of changing someone (as opposed to empowering, educating, and supporting them, say) does not sit right with me. The book still falls into the paradigm of neurotypical professionals preaching on how to "manage" the neurodiverse and mentally ill. Although it may go about it in a different way, compliance is still the end goal, and it feels coercive. Despite a section near the end on "Solving Problems when the Relationship is Power Neutral", the vast majority of the book deals with CPS in the context of hierarchical relationships where one party -- a psychiatrist, teacher, or parent -- wields power over a child, student, or patient.

Perhaps this focus is necessary when speaking of institutional settings (psychiatric hospitals and mainstream schools) which this book is in part aimed at, but it does not reflect the more equitable and countercultural footings of my own little neurodiverse orangutan buffoonery. So, we will stick to our own ever-evolving bespoke versions of cps and cpd, and leave the esteemed doctors to their CPS.