child problem solving skills training

• Trying to Conceive
• Signs & Symptoms
• Pregnancy Tests
• Fertility Testing
• Fertility Treatment
• Weeks & Trimesters
• Staying Healthy
• Preparing for Baby
• Complications & Concerns
• Pregnancy Loss
• Breastfeeding
• School-Aged Kids
• Raising Kids
• Personal Stories
• Everyday Wellness
• Safety & First Aid
• Immunizations
• Food & Nutrition
• Active Play
• Pregnancy Products
• Nursery & Sleep Products
• Nursing & Feeding Products
• Clothing & Accessories
• Toys & Gifts
• Ovulation Calculator
• Pregnancy Due Date Calculator
• How to Talk About Postpartum Depression
• Editorial Process
• Meet Our Review Board

How to Teach Kids Problem-Solving Skills

KidStock / Blend Images / Getty Images

• Steps to Follow
• Allow Consequences

Whether your child can't find their math homework or has forgotten their lunch, good problem-solving skills are the key to helping them manage their life. 

A 2010 study published in Behaviour Research and Therapy found that kids who lack problem-solving skills may be at a higher risk of depression and suicidality.   Additionally, the researchers found that teaching a child problem-solving skills can improve mental health . 

You can begin teaching basic problem-solving skills during preschool and help your child sharpen their skills into high school and beyond.

Why Problem-Solving Skills Matter

Kids face a variety of problems every day, ranging from academic difficulties to problems on the sports field. Yet few of them have a formula for solving those problems.

Kids who lack problem-solving skills may avoid taking action when faced with a problem.

Rather than put their energy into solving the problem, they may invest their time in avoiding the issue.   That's why many kids fall behind in school or struggle to maintain friendships .

Other kids who lack problem-solving skills spring into action without recognizing their choices. A child may hit a peer who cuts in front of them in line because they are not sure what else to do.  

Or, they may walk out of class when they are being teased because they can't think of any other ways to make it stop. Those impulsive choices may create even bigger problems in the long run.

The 5 Steps of Problem-Solving

Kids who feel overwhelmed or hopeless often won't attempt to address a problem. But when you give them a clear formula for solving problems, they'll feel more confident in their ability to try. Here are the steps to problem-solving:  

• Identify the problem . Just stating the problem out loud can make a big difference for kids who are feeling stuck. Help your child state the problem, such as, "You don't have anyone to play with at recess," or "You aren't sure if you should take the advanced math class." 
• Develop at least five possible solutions . Brainstorm possible ways to solve the problem. Emphasize that all the solutions don't necessarily need to be good ideas (at least not at this point). Help your child develop solutions if they are struggling to come up with ideas. Even a silly answer or far-fetched idea is a possible solution. The key is to help them see that with a little creativity, they can find many different potential solutions.
• Identify the pros and cons of each solution . Help your child identify potential positive and negative consequences for each potential solution they identified. 
• Pick a solution. Once your child has evaluated the possible positive and negative outcomes, encourage them to pick a solution.
• Test it out . Tell them to try a solution and see what happens. If it doesn't work out, they can always try another solution from the list that they developed in step two. 

Practice Solving Problems

When problems arise, don’t rush to solve your child’s problems for them. Instead, help them walk through the problem-solving steps. Offer guidance when they need assistance, but encourage them to solve problems on their own. If they are unable to come up with a solution, step in and help them think of some. But don't automatically tell them what to do. 

When you encounter behavioral issues, use a problem-solving approach. Sit down together and say, "You've been having difficulty getting your homework done lately. Let's problem-solve this together." You might still need to offer a consequence for misbehavior, but make it clear that you're invested in looking for a solution so they can do better next time. 

Use a problem-solving approach to help your child become more independent.

If they forgot to pack their soccer cleats for practice, ask, "What can we do to make sure this doesn't happen again?" Let them try to develop some solutions on their own.

Kids often develop creative solutions. So they might say, "I'll write a note and stick it on my door so I'll remember to pack them before I leave," or "I'll pack my bag the night before and I'll keep a checklist to remind me what needs to go in my bag." 

Provide plenty of praise when your child practices their problem-solving skills.  

Allow for Natural Consequences

Natural consequences  may also teach problem-solving skills. So when it's appropriate, allow your child to face the natural consequences of their action. Just make sure it's safe to do so. 

For example, let your teenager spend all of their money during the first 10 minutes you're at an amusement park if that's what they want. Then, let them go for the rest of the day without any spending money.

This can lead to a discussion about problem-solving to help them make a better choice next time. Consider these natural consequences as a teachable moment to help work together on problem-solving.

Becker-Weidman EG, Jacobs RH, Reinecke MA, Silva SG, March JS. Social problem-solving among adolescents treated for depression . Behav Res Ther . 2010;48(1):11-18. doi:10.1016/j.brat.2009.08.006

Pakarinen E, Kiuru N, Lerkkanen M-K, Poikkeus A-M, Ahonen T, Nurmi J-E. Instructional support predicts childrens task avoidance in kindergarten .  Early Child Res Q . 2011;26(3):376-386. doi:10.1016/j.ecresq.2010.11.003

Schell A, Albers L, von Kries R, Hillenbrand C, Hennemann T. Preventing behavioral disorders via supporting social and emotional competence at preschool age .  Dtsch Arztebl Int . 2015;112(39):647–654. doi:10.3238/arztebl.2015.0647

Cheng SC, She HC, Huang LY. The impact of problem-solving instruction on middle school students’ physical science learning: Interplays of knowledge, reasoning, and problem solving . EJMSTE . 2018;14(3):731-743.

Vlachou A, Stavroussi P. Promoting social inclusion: A structured intervention for enhancing interpersonal problem‐solving skills in children with mild intellectual disabilities . Support Learn . 2016;31(1):27-45. doi:10.1111/1467-9604.12112

Öğülmüş S, Kargı E. The interpersonal cognitive problem solving approach for preschoolers .  Turkish J Educ . 2015;4(17347):19-28. doi:10.19128/turje.181093

American Academy of Pediatrics. What's the best way to discipline my child? .

Kashani-Vahid L, Afrooz G, Shokoohi-Yekta M, Kharrazi K, Ghobari B. Can a creative interpersonal problem solving program improve creative thinking in gifted elementary students? .  Think Skills Creat . 2017;24:175-185. doi:10.1016/j.tsc.2017.02.011

Shokoohi-Yekta M, Malayeri SA. Effects of advanced parenting training on children's behavioral problems and family problem solving .  Procedia Soc Behav Sci . 2015;205:676-680. doi:10.1016/j.sbspro.2015.09.106

By Amy Morin, LCSW Amy Morin, LCSW, is the Editor-in-Chief of Verywell Mind. She's also a psychotherapist, an international bestselling author of books on mental strength and host of The Verywell Mind Podcast. She delivered one of the most popular TEDx talks of all time.

Developing Problem-Solving Skills for Kids | Strategies & Tips

We've made teaching problem-solving skills for kids a whole lot easier! Keep reading and comment below with any other tips you have for your classroom!

Problem-Solving Skills for Kids: The Real Deal

Picture this: You've carefully created an assignment for your class. The step-by-step instructions are crystal clear. During class time, you walk through all the directions, and the response is awesome. Your students are ready! It's finally time for them to start working individually and then... 8 hands shoot up with questions. You hear one student mumble in the distance, "Wait, I don't get this" followed by the dreaded, "What are we supposed to be doing again?"

When I was a new computer science teacher, I would have this exact situation happen. As a result, I would end up scrambling to help each individual student with their problems until half the class period was eaten up. I assumed that in order for my students to learn best, I needed to be there to help answer questions immediately so they could move forward and complete the assignment.

Here's what I wish I had known when I started teaching coding to elementary students - the process of grappling with an assignment's content can be more important than completing the assignment's product. That said, not every student knows how to grapple, or struggle, in order to get to the "aha!" moment and solve a problem independently. The good news is, the ability to creatively solve problems is not a fixed skill. It can be learned by students, nurtured by teachers, and practiced by everyone!

Your students are absolutely capable of navigating and solving problems on their own. Here are some strategies, tips, and resources that can help:

Problem-Solving Skills for Kids: Student Strategies

These are strategies your students can use during independent work time to become creative problem solvers.

1. Go Step-By-Step Through The Problem-Solving Sequence 

Post problem-solving anchor charts and references on your classroom wall or pin them to your Google Classroom - anything to make them accessible to students. When they ask for help, invite them to reference the charts first.

2. Revisit Past Problems

If a student gets stuck, they should ask themself, "Have I ever seen a problem like this before? If so, how did I solve it?" Chances are, your students have tackled something similar already and can recycle the same strategies they used before to solve the problem this time around.

3. Document What Doesn’t Work

Sometimes finding the answer to a problem requires the process of elimination. Have your students attempt to solve a problem at least two different ways before reaching out to you for help. Even better, encourage them write down their "Not-The-Answers" so you can see their thought process when you do step in to support. Cool thing is, you likely won't need to! By attempting to solve a problem in multiple different ways, students will often come across the answer on their own.

4. "3 Before Me"

Let's say your students have gone through the Problem Solving Process, revisited past problems, and documented what doesn't work. Now, they know it's time to ask someone for help. Great! But before you jump into save the day, practice "3 Before Me". This means students need to ask 3 other classmates their question before asking the teacher. By doing this, students practice helpful 21st century skills like collaboration and communication, and can usually find the info they're looking for on the way.

Problem-Solving Skills for Kids: Teacher Tips

These are tips that you, the teacher, can use to support students in developing creative problem-solving skills for kids.

1. Ask Open Ended Questions

When a student asks for help, it can be tempting to give them the answer they're looking for so you can both move on. But what this actually does is prevent the student from developing the skills needed to solve the problem on their own. Instead of giving answers, try using open-ended questions and prompts. Here are some examples:

2. Encourage Grappling

Grappling  is everything a student might do when faced with a problem that does not have a clear solution. As explained in this article from Edutopia , this doesn't just mean perseverance! Grappling is more than that - it includes critical thinking, asking questions, observing evidence, asking more questions, forming hypotheses, and constructing a deep understanding of an issue.

There are lots of ways to provide opportunities for grappling. Anything that includes the Engineering Design Process is a good one! Examples include:

• Engineering or Art Projects
• Design-thinking challenges
• Computer science projects
• Science experiments

3. Emphasize Process Over Product

For elementary students, reflecting on the process of solving a problem helps them develop a growth mindset . Getting an answer "wrong" doesn't need to be a bad thing! What matters most are the steps they took to get there and how they might change their approach next time. As a teacher, you can support students in learning this reflection process.

4. Model The Strategies Yourself! 

As creative problem-solving skills for kids are being learned, there will likely be moments where they are frustrated or unsure. Here are some easy ways you can model what creative problem-solving looks and sounds like.

• Ask clarifying questions if you don't understand something
• Admit when don't know the correct answer
• Talk through multiple possible outcomes for different situations 
• Verbalize how you’re feeling when you find a problem

Practicing these strategies with your students will help create a learning environment where grappling, failing, and growing is celebrated!

Problem-Solving Skill for Kids

Did we miss any of your favorites? Comment and share them below!

Looking to add creative problem solving to your class?

Learn more about Kodable's free educator plan or create your free account today to get your students coding!

Kodable has everything you need to teach kids to code!

In just a few minutes a day, kids can learn all about the fundamentals of Computer Science - and so much more! With lessons ranging from zero to JavaScript, Kodable equips children for a digital future.

• DEIJ at CFI
• Mental & Behavioral Health Overview
• Conditions We Treat
• Clinical Services
• Equity Research
• Training Programs
• Mental Health Blog
• WCF Overview
• Support WCF
• Sponsors and Partners
• COVID Mental Health Relief Initiative
• Crisis Counseling Initiative
• Westchester Wellness Initiative
• Faith-Based MH Initiative
• IMPACT Initiative
• WCF Leadership
• Connect to Care Overview
• Media Inquiries

Cognitive Problem-Solving Skills Training

A cognitive therapy approach.

CPSST aims to decrease a young person’s inappropriate or disruptive behaviors by teaching new, constructive ways to manage thoughts and feelings and interact appropriately with others. CPSST therapy focuses on the child or adolescent (rather than on the parents or family), teaching them skills to develop new perspectives and problem-solve new solutions. 

According to CPSST’s underlying principles, children have problematic behaviors because their ways of interpreting reality and responding to the world are limited and involve negative responses . In this way, CPSST expands the “behavioral repertoire”—the range of ways of behaving that an individual possesses—through cognitive processing. CPSST is effective in treating young people with:

• Conduct disorder (CD)
• Intermittent explosive disorder (IED)
• Oppositional-defiant disorder (ODD)
• Attention-deficit/hyperactivity disorder (ADHD) with disruptive behavior 
• Antisocial behaviors or aggressive acting-out

Research on CPSST

In outcome studies, CPSST has been found to be effective in reducing or eliminating problematic behaviors in many children and adolescents. Its success is even greater when combined with  parent management training . Although CPSST originally focused on children with problem behaviors or poor relationships with others, it has generalized to a variety of different disorders in children, adolescents and adults.

CPSST therapy includes weekly individual sessions with the child or adolescent, for a duration of 3-12 months. Through modeling, role-playing, games, real-life experiments and positive reinforcement, treatment helps them: 

• Think differently, challenge unhelpful assumptions, confront irrational interpretations of others’ actions and change inaccurate or narrow views of situations
• Internalize and apply problem-solving skills to generate alternative, positive solutions and avoid physical aggression, resolve conflict and keep out of trouble 

For example:

• A child, suspended from school for becoming physically aggressive with a teacher, is asked by the clinician to describe his thoughts and feelings about the experience. The child says, “My teacher hates me. She always yells at me.” 
• The clinician helps the child explore supporting evidence to confirm or disconfirm that assumption, so the child can see his part in the problem and ways he can influence better interactions in the future. 

Homework component : The young person is given between-session homework, including keeping a log of negative thoughts, conducting a real-life experiment or trying a new option and comparing results to prior activity. In this way, they learn to apply problem-solving skills when faced with problematic situations in school, with peers or at home. Beginning with the easiest ways of thinking, the young person gradually progresses to more complex or challenging circumstances. 

Parental support : Parents or other family members may be brought in to observe and to learn how to assist in reinforcing new skills . Parents learn how to remind their child to use CPSST problem-solving techniques in daily living, as well as how to provide age-appropriate positive reinforcement for trying new techniques and options through praise, affection or other desirable rewards.  

The aim of therapy is to help a young person change perceptions and develop different options for how to respond in difficult situations. Gradually, they shift from making global, negative attributions—“It’s someone else’s fault,” perhaps—to identifying ways to improve a specific outcome. Ultimately, the child or teen gains a sense of efficacy in achieving reliably more positive outcomes in future situations.

Learn more about Cognitive Therapies offered at CFI…

CONNECT TO CARE

The California Evidence-Based Clearinghouse for Child Welfare

• Contact the CEBC
• Sign up for The CEBC Connection
• Topic Areas
• Rating Scales
• Implementation-Specific Tools & Resources
• Implementation Guide
• Implementation Examples

I Can Problem Solve (ICPS)

About this program.

Target Population: Low- and middle-income 4-12 year old students, including African-Americans, Caucasians, Hispanic, and Asian populations

For children/adolescents ages: 4 – 12

Program Overview

I Can Problem Solve (ICPS) is a preventive and rehabilitative program designed to lessen disruptive behaviors. It is a cognitive approach that teaches children ages 4 to 12 how to think, not what to think, in ways that help them learn to resolve interpersonal problems that arise with peers and adults. They learn that behavior has causes, that people have feelings, and that there is more than one way to solve a problem. The curriculum is divided into two parts:

• Pre-problem solving skills -- learning a problem solving vocabulary, identifying one's own and others' feelings, and considering another's point of view
• Problem solving skills -- thinking of more than one solution, considering consequences, and age-appropriate sequencing and planning skills.

Adults learn a problem solving approach to handling conflicts and other problem situations that helps children associate their newly acquired problem solving skills with what they do and how they behave in real life.

Program Goals

The goals of I Can Problem Solve (ICPS) are:

• Improve Interpersonal Cognitive Problem Solving (ICPS) skills:
• Alternative solution thinking
• Consequential thinking
• Sequenced planning (means-ends thinking) skills, if 8-12 years old
• Prevent or reduce early high-risk behaviors:
• Physical, verbal, and relational aggression
• Inability to wait and cope with frustration
• Social withdrawal
• Foster genuine empathy and concern for others
• Foster positive peer relations
• Increase cooperation and fairness that promote healthy relationships with peers and adults
• Improve academic achievement as an outgrowth of less stress fostered by ICPS skills that allow children to concentrate on the task-oriented demands of the classroom

Logic Model

The program representative did not provide information about a Logic Model for I Can Problem Solve (ICPS) .

Essential Components

The essential components of I Can Problem Solve (ICPS) include:

• ICPS is implemented by teachers with groups of children directly in the classroom, teaching them skills to solve interpersonal problems and that help guide their behavior, including disruptive behaviors. Groups of 8 or 10 children are ideal in preschool, and groups of 15 in kindergarten through grade 6. However, teachers have conducted the lessons with whole classes of 30 children.
• School psychologists and guidance counselors are also trained to work directly with high-risk children to reinforce the problem solving concepts the children are learning in the classroom.
• Formal Lessons in the Classroom
• Children learn pre-problem solving and problem solving skills through games, stories, puppets, illustrations, and role-plays
• An ICPS vocabulary sets the stage for problem solving thinking. For example, children play with the words "not", "same", and "different" in fun ways (e.g., "Johnny is painting. Is Peter painting or not painting?" "Are they doing the same thing or something different?") When a problem comes up, the child can be asked, "Do you and Peter see what happened the same way or a different way?" "Is that a good idea or not a good idea?" If the idea is not a good one, the child or children are asked, "Can you think of a different way to tell him what you want?"
• Lessons are sequenced and build toward using vocabulary words to identify age-appropriate feelings, such as "Is Johnny happy or sad?" "Is Johnny feeling the same way or a different way from Robert?"
• Using vocabulary words and feeling concepts, children practice the final problem solving skills to be learned: alternative solution, consequential, and age-appropriate sequenced planning skills.
• Children learn to think of their own ideas to solve a problem in light of how they and others feel, what might happen next (consequences), and, if needed, to think of a different way to solve the same problem.
• Interaction in the Classroom
• Children learn to use ICPS concepts during everyday classroom interactions.
• The program implementer learns a whole new way of communicating with students -- using special ICPS dialoguing techniques (problem-solving talk) when situations arise in real life with peers, siblings, parents, teachers, etc.
• Four styles of communication are depicted on the rungs of a ladder, and adults enjoy "climbing up the ICPS ladder".
• Rung 1: Power, including yelling, commanding, demanding
• Rung 2: Suggestions, including statements such as "You should share your toys."
• Rung 3: Explanations, such as, "You might hurt him if you hit him."
• Rung 4: Problem Solving, turning statements into questions, such as, "How do you think Amy feels now?" "What happened when you (hit) her?" "How do you feel about that?" "Can you think of something different to do so you both won't feel that way, and that won't happen?"
• Rungs 2 and 3 are positive, but the adult is doing the thinking and feeling for the child. On Rung 4, problem solving is a two-way dialogue, involves the child, and empowers the child by giving him/her skills to think for himself/herself. This way of communicating is called ICPS Dialoguing.
• Integration into the Curriculum
• In schools or settings where children are doing homework, they learn to use ICPS concepts as they work on math, reading, science, social studies, and other subjects. For example, children can use age-appropriate memory cards, where a match may be 5X5 for the card with the number 25, or Harrisburg, for the card with the word Pennsylvania. While practicing paying attention, they are also working with numbers, capitols, science concepts, or any topic relevant to the child or children in the group.
• A companion program for parents, Raising a Thinking Child , is available, but is not part of the school-based ICPS program as highlighted here. The program helps parents teach their children interpersonal cognitive problem solving and social emotional skills. Raising a Thinking Child is available in English and Spanish.

Program Delivery

Child/adolescent services.

I Can Problem Solve (ICPS) directly provides services to children/adolescents and addresses the following:

• Physical, verbal, and relational aggression; inability to wait and cope with frustration; social withdrawal; lack of empathy and good peer relations; ADHD; Asperger's Syndrome

Recommended Intensity:

For preschool children, ideal is daily for 20 minutes. If conducted in schools, kindergarten through grade 6 is usually 3 days per week, for one 40-minute period.

Recommended Duration:

The formal lessons last about three months in preschool, four months 3 times a week in grade school. The use of the program's problem solving approach, when real problems come up, continues throughout the year.

Delivery Setting

This program is typically conducted in a(n):

• School Setting (Including: Day Care, Day Treatment Programs, etc.)

I Can Problem Solve (ICPS) includes a homework component:

The program does not include component called "homework," but activities are sent home with children from the Intermediate Elementary Manual.

Resources Needed to Run Program

The typical resources for implementing the program are:

In preschool and kindergarten, a corner large enough for 8 to 15 children in an area free of distractions (e.g., books, toys, bulletin boards). In preschool and kindergarten, where a teacher-aide may be present, it is ideal for the aide to learn the program so as to keep ICPS Dialoguing -- use of the problem solving approach -- consistent when handling problems that come up in real life.

Manuals and Training

Prerequisite/minimum provider qualifications.

None, as long as they are able to relate in positive ways with children.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:

• Stephanie Colvin-Roy www.icanproblemsolve.info [email protected] phone: (717) 763-1661 x209

Training Type/Location:

Onsite for facilitators; train-the-trainer workshops onsite, nationwide

Number of days/hours:

Facilitator Workshops: 1 or 2 days; preferably 2 days Train-the-Trainer Workshops: 3 days

Implementation Information

Pre-implementation materials.

There are pre-implementation materials to measure organizational or provider readiness for I Can Problem Solve (ICPS) as listed below:

Pre-implementation ICPS Readiness Checklists are available to measure and determine organizational or provider readiness for the I Can Problem Solve program.

Formal Support for Implementation

There is formal support available for implementation of I Can Problem Solve (ICPS) as listed below:

Dr. Myrna Shure, in partnership with ICPS Programs at the Center for Schools and Communities in Camp Hill, PA, a group of international trainers provides train-the-trainer workshops, personal coaching in individual classrooms, training of onsite coaches, consultation, and technical assistance as needed. Contact Stephanie Colvin-Roy at [email protected] or (717) 763-1661 ext. 209.

Fidelity Measures

There are fidelity measures for I Can Problem Solve (ICPS) as listed below:

A fidelity checklist, ICPS Program Planner, (Pre/Post) Implementer Self Questionnaire and (Pre/Post) Childhood Behavior Rating Scale are all available to those attending a train-the-trainer workshop. The checklist consists of evaluating the extent to which a teacher, or adult implementer, teaches the concepts as intended and uses a problem-solving approach when handling problems that come up in real life.

Implementation Guides or Manuals

There are implementation guides or manuals for I Can Problem Solve (ICPS) as listed below:

I Can Problem Solve (ICPS) training manuals are available for three age groups from Research Press at http://www.researchpress.com :

• Preschool, Kindergarten and the Primary Grades, and Intermediate Elementary Grades. The training manuals can be ordered from the website, or by email at [email protected] or by calling 1-800-519-2707. Access to ordering can also be found at http://www.thinkingchild.com (home page) under the photos of the covers of the manuals.
• A Facilitator's Guide is available for educators who participate in the Train-the-Trainer workshops. This includes activities, power points, handouts, a mini-guide for administrators, counselors, school psychologists, nurses and other support personnel.
• There is also an administrator's guide that describes the role of the principal in the implementation of ICPS in his/her school. It also describes roles for the other administrators and a school leadership team consisting of the school psychologist, counselor, nurse, social worker, or any other student-support personnel.

Research on How to Implement the Program

Research has not been conducted on how to implement I Can Problem Solve (ICPS) .

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Shure, M. B., & Spivack, G. (1979). Interpersonal cognitive problem solving and primary prevention: Programming for preschool and kindergarten children. Journal of Clinical Child Psychology, 8 (2), 89–94. https://doi.org/10.1080/15374417909532894

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental) Number of Participants: 131

Population:

• Age — 4–5 years
• Race/Ethnicity — 100% African American
• Gender — 59% Female
• Status — Participants were nursery school and kindergarten students.

Location/Institution: Philadelphia, PA

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of this study was to examine whether enhancing interpersonal cognitive problem-solving skills of four- and five-year-olds could improve inhibited and impulsive behaviors when they already exist and prevent them from emerging when they do not exist. Participants were students at nursery schools, which were assigned to deliver the I Can Problem Solve (ICPS) intervention, or to serve as a control group; these same children were assigned to ICPS or control groups in kindergarten as well. Measures utilized include the Preschool Interpersonal Problem Solving (PIPS) Test, the What Happens Next Game (WHNG), and the Hahnemann Preschool Behavior (HPSB) Rating Scale . Results indicate that ICPS training does reduce and prevent inhibited and impulsive behaviors and that the ICPS and the behavioral impact of such programming lasts at least one full year following intervention. Results also show that for youngsters not trained during nursery school, kindergarten is not too late for training. Limitations include the lack of randomization , concerns about the generalizability of results to other racial/ethnic groups, and the small sample sizes.

Length of controlled postintervention follow-up: 1 year.

Shure, M. B., & Spivack, G. (1980). Interpersonal problem solving as a mediator of behavioral adjustment in preschool and kindergarten children. Journal of Applied Developmental Psychology, 1 (1), 29–44. https://doi.org/10.1016/0193-3973(80)90060-X

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental) Number of Participants: 219

• Gender — Not specified

Summary: (To include basic study design, measures, results, and notable limitations) The study used the same sample as Shure & Spivack (1979). The purpose of the study was to examine the mediating function of interpersonal cognitive problem-solving skills on behavioral adjustment in preschool and kindergarten children. Participants were students at schools which were assigned to deliver the I Can Problem Solve (ICPS) intervention, or to serve as a control group. Measures utilized include the Preschool Interpersonal Problem Solving (PIPS) Test, the What Happens Next Game (WHNG), and the Hahnemann Preschool Behavior (HPSB) Rating Scale . Results indicate that, relative to controls, nursery-trained youngsters improved in three interpersonal cognitive problem-solving skills, while kindergarten-trained improved in two. In both the nursery- and kindergarten-trained groups, increased ability to conceptualize alternative solutions to interpersonal problems significantly related to improved social adjustment. Consequential thinking also emerged as a clear behavioral mediator, especially among kindergarten-aged youngsters. Improvement in behavior could not, however, be attributed to change in causal thinking skills. Limitations include the lack of randomization , concerns about the generalizability of results to other racial/ethnic groups, and the small sample sizes.

Length of controlled postintervention follow-up: None.

Mannarino, A. P., Christy, M., Durlak, J. A., & Magnussen, M. G. (1982). Evaluation of social competence training in the schools. Journal of School Psychology, 20 (1), 11–19. https://doi.org/10.1016/0022-4405(82)90036-X

Type of Study: Randomized controlled trial Number of Participants: 64

• Age — 6.5–8.8 years
• Race/Ethnicity — Not specified
• Gender — 42 Male and 22 Female
• Status — Participants were children with elevated levels of school maladjustment in grades one through three.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to describe and evaluate a social competence program for high-risk children. Participants were randomly assigned to I Can Problem Solve (ICPS) or a control group. Measures utilized include– the Acting Out/Mood/Learning scale (AML) and the Classroom Adjustment Rating Scale (CARS) . Results indicate that the ICPS participants made significant gains in classroom adjustment as rated by teachers compared to the participants in the control group. Limitations include the lack of direct measurement of interpersonal problem-solving skills, the lack of an attention control, and possible teacher bias in ratings.

Shure, M. B., & Spivack, G. (1982). Interpersonal problem solving in young children: A cognitive approach to prevention. American Journal of Community Psychology, 10 (3), 341–356. https://doi.org/10.1007/BF00896500

• Age — 3 years 11 months to 4 years 10 months at study start
• Gender — 56% Female

Summary: (To include basic study design, measures, results, and notable limitations) The study used the same sample as Shure & Spivack (1979). The purpose of the study was to examine whether utilizing an interpersonal cognitive problem-solving intervention [ I Can Problem Solve (ICPS) ] reduced and prevented impulsive and inhibited behaviors skills of four- and five-year-olds. Participants were examined in 4 groups: Twice training (nursery and kindergarten), Once trained Nursery, Once trained Kindergarten, and Never trained (control group). Measures utilized include the Preschool Interpersonal Problem Solving (PIPS) Test, the What Happens Next Game (WHNG), and the Hahnemann Preschool Behavior (HPSB) Rating Scale . Results indicate that the   impact on behavior from ICPS lasted at least 1 full year, training was as effective in kindergarten as in nursery, and for this sample, 1 year of intervention had the same immediate behavior impact as 2. Further, well-adjusted children trained in nursery were less likely to begin showing behavioral difficulties over the 2-year period than were comparable controls. Limitations include the lack of randomization , concerns about the generalizability of results to other racial/ethnic groups, concerns about teacher rater bias, and the small sample sizes.

Dincer, C., & Guneysu, S. E. (1997). Examining the effects of problem- solving training on the acquisition of interpersonal problem-solving skills by 5-year-old children in Turkey. International Journal of Early Years Education, 5 (1), 37–46. https://doi.org/10.1080/0966976970050104

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental) Number of Participants: 74

• Age — 5 years
• Gender — 54% Male
• Status — Participants were kindergarten students.

Location/Institution: Ankara, Turkey

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to examine the effectiveness of the I Can Problem Solve (ICPS) training on the acquisition of interpersonal problem-solving skills by 5-year-old children. Classrooms were selected for the ICPS or control groups. Measures utilized include the Preschool Interpersonal Problem-Solving test (PIPS) . Results indicate that children in the ICPS classrooms made significantly greater improvements on the PIPS , as compared to children in the control group. Limitations include the lack of randomization and the small sample size.

Kumpfer, K. L., Alvarado, R., Tait, C., & Turner, C. (2002). Effectiveness of school-based family and children's skills training for substance abuse prevention among 6-8-year-old rural children. Psychology of Addictive Behaviors, 16 (4, Suppl), S65–S71. https://doi.org/10.1037/0893-164X.16.4S.S65

Type of Study: Randomized controlled trial Number of Participants: 655

• Race/Ethnicity — 87% Caucasian and 8% Hispanic
• Gender — 47% Male and 53% Female
• Status — Participants were children in 1st grade from 12 schools in two school districts.

Location/Institution: Rocky Mountain region of the United States

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of this study was to examine the effectiveness of a multicomponent prevention program with 1st graders in rural schools. Classrooms were randomly assigned to one of four groups: I Can Problem Solve (ICPS) program alone, ICPS combined with the full Strengthening Families (SF) program, ICPS combined with a partial version of SF consisting of only the parent training course, or a no treatment control group. Measures utilized include the Behavioral Assessment for Children (BASC), the Parent Report on School Climate (PRSC), the Parent and Teacher Involvement Questionnaire (PTIQ), the Parenting Practices Scale (PPS), the Alabama Parenting Questionnaire, the Family Relations Scale, the Parent Observation of Classroom Adaptation —Revised (POCA–R), and the Teacher Observation of Classroom Adaptation —Revised (TOCA–R) . Results indicate that the combined ICPS and SF program showed significantly larger improvements and effect sizes on school bonding, parenting skills, family relationships, social competency, and behavioral self-regulation, compared with ICPS -alone or no-treatment controls. Adding parenting-only improved social competency and self-regulations more but negatively impacted family relationships, whereas adding SF improved family relationships, parenting, and school bonding more. An improvement in self-regulation was observed in all three intervention groups in comparison with the control group. Improvement in school bonding from the preintervention to the postintervention was significantly larger in the ICPS -alone group in comparison with the control group. Limitations include that less than a quarter of families assigned to the intervention groups actually enrolled and the large sample size differences between the three intervention groups.

dos Santos Elias, L. C., Marturano, E. M., de Almeida Motta, A. M., & Giurlani, A. G. (2003). Treating boys with low achievement and behavior problems: Comparison of two kinds of intervention. Psychological Reports, 92 (1), 105–116. https://doi.org/10.2466/pr0.2003.92.1.105

Type of Study: Randomized controlled trial Number of Participants: 39

• Age — 8–11 years
• Gender — 100% Male
• Status — Participants were males with behavior and academic problems in Southern Brazil referred by health professionals.

Location/Institution: Southern Brazil

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to examine the effectiveness of the interpersonal problem-solving skills program [now called I Can Problem Solve (ICPS) ] to improve behavior and academic achievement in a sample of elementary school males presenting with behavior problems and poor school performance. Participants were randomly assigned the ICPS group or a control language workshop group; mothers of all subjects received training on handling child behavior programs. Measures utilized include the Rutter Child Scale A, the Brazilian School Achievement Test, and the Child’s Interpersonal Problem-solving Test . Results indicate that participants in the ICPS group improved significantly more than the control group on most measures, including school achievement and behavior problems. Limitations include the small sample size, concerns about generalizability to other populations, and the possible impacts of the mothers’ training.

Boyle, D. & Hassett-Walker, C. (2008). Reducing overt and relational aggression among young children: The results from a two-year outcome evaluation. Journal of School Violence, 7 (1), 27–42. https://doi.org/10.1300/J202v07n01_03

Type of Study: Randomized controlled trial Number of Participants: 226

• Age — Not specified. Participants were in kindergarten at the start of the study.
• Race/Ethnicity — 85% Hispanic, 6% African American, 5% White, and 4% Asian
• Gender — 54% Female
• Status — Participants were students in kindergarten classes in an urban school district.

Summary: (To include basic study design, measures, results, and notable limitations) The purpose of the study was to evaluate the use of the I Can Problem Solve (ICPS) universal prevention program training on kindergarten and first grade children in a racially and ethnically diverse urban school district. Matched pairs of schools were randomly assigned to  ICPS or a control group. Measures utilized include the Preschool Interpersonal Problem Solving (PIPS) Test and the Hahnemann Preschool Behavior (HPSB) Rating Scale . Results indicate that ICPS training reduced aggressive behaviors and increased prosocial behaviors. The mean change scores of both scales showed a significant additive effect, with children receiving two years of ICPS instruction showing greater improvement than both children receiving one year of ICPS instruction as well as the two-year control students. Limitations include attrition , especially among the control group where two of the schools dropped out of the study; and possible teacher/rater bias on the teacher report measures.

Additional References

Shure, M. B. (1999). Preventing violence the problem solving way. Juvenile Justice Bulletin, Office of Juvenile Justice and Delinquency Prevention. Washington, DC.

Shure, M. B. (1992). Children who behave differently, think differently: Handling conflicts the problem solving way. New Jersey Education Association Review, pp. 10-13.

Shure, M. B. (2007). Bullies and their victims: A problem solving approach to treatment and prevention. 2nd Edition. In S. Goldstein & Brooks, R. B. (Eds.). Understanding and managing children's classroom behavior (pp. 408-431). Hoboken, NJ: Wiley.

Contact Information

Date Research Evidence Last Reviewed by CEBC: August 2023

Date Program Content Last Reviewed by Program Staff: April 2020

Date Program Originally Loaded onto CEBC: October 2012

Glossary | Sitemap | Limitations & Disclosures

The CEBC is funded by the California Department of Social Services’ (CDSS’) Office of Child Abuse Prevention and is one of their targeted efforts to improve the lives of children and families served within child welfare system.

© copyright 2006-2024 The California Evidence-Based Clearinghouse for Child Welfare www.cebc4cw.org

A password reset email has been sent to the email address on file for your account, but may take several minutes to show up in your inbox. Please wait at least 10 minutes before attempting another reset.

Email address *

Lost your password?

Lost your password? Please enter your email address. You will receive a link to create a new password via email.

Email address

Registering for this site allows you to access your order status and history. Just fill in the fields below, and we’ll get a new account set up for you in no time. We will only ask you for information necessary to make the purchase process faster and easier.

• Tweens & Teens

Shopping cart

• No products in the cart.

items in the cart: 0

How to Teach Problem-Solving Skills to Children and Preteens

• By Ashley Cullins

Whether it’s a toy-related conflict, a tough math equation, or negative peer pressure, kids of ALL ages face problems and challenges on a daily basis.

As parents or teachers, we can’t always be there to solve every problem for our children. In fact, this isn’t our job. Our job is to TEACH our children how to solve problems by themselves . This way, they can become confident , independent, and successful individuals.

Instead of giving up or getting frustrated when they encounter a challenge, kids with problem-solving skills manage their emotions, think creatively, and persist until they find a solution. Naturally, these abilities go hand-in-hand with a  growth mindset .

Before you continue, we thought you might like to download our FREE Your Words Matter Volume 2 Kit . With these 10 one-page parenting guides, you will know exactly how to speak to your child to help them stand up for themselves, be more confident, and develop a growth mindset.

So HOW do you teach problem-solving skills to kids?

Well, it depends on their age . As cognitive abilities and the size of the child’s challenges grow/evolve over time, so should your approach to teaching problem-solving skills.

Read on to learn key strategies for teaching problem-solving to kids, as well as some age-by-age ideas and activities.

3 General Strategies to Teach Problem-Solving at Any Age

1. model effective problem-solving .

When YOU encounter a challenge, do a “think-aloud” for the benefit of your child. MODEL how to apply the same problem-solving skills you’ve been working on together, giving the real-world examples that she can implement in her own life.

At the same time, show your child a willingness to make mistakes . Everyone encounters problems, and that’s okay. Sometimes the first solution you try won’t work, and that’s okay too!  

When you model problem-solving, explain that there are some things that are out of our control. As we're solving a problem at hand we should focus on the things we CAN actually control.

You and your child can listen to Episode 35  of the Big Life Kids Podcast to learn about focusing on what you can control.

2. Ask for Advice

Ask your kids for advice when you have a problem. This teaches them that it’s common to make mistakes and face challenges. It also gives them the opportunity to practice problem-solving skills.

Plus, when you indicate that their ideas are valued ,  they’ll gain the confidence to attempt solving problems on their own.

3. Don’t Provide “The Answer”

As difficult as it may be, allow your child to struggle, sometimes fail , and ultimately LEARN  from experiencing consequences.

Now, let’s take a look at some age-specific strategies and activities. The ages listed below are general guidelines, feel free to choose any strategies or activities that you feel will work for YOUR child.

Use Emotion Coaching

To step into a problem-solving mindset, young children need to first learn to  manage their emotions . After all, it’s difficult for a small child to logically consider solutions to a problem if he’s mid-tantrum.

One way to accomplish this is by using the  emotion coaching process  outlined by John Gottman.

First,  teach your kids that ALL emotions are acceptable. There are NO “bad” emotions. Even seemingly negative emotions like anger, sadness, and frustration can teach us valuable lessons. What matters is how we  respond  to these emotions.

Second,   follow this process:

• Step One: Naming and validating emotions.  When your child is upset, help her process the way she’s feeling. Say something like,  “I understand that you’re upset because Jessica is playing with the toy you wanted.”
• Step Two:   Processing  emotions.  Guide your child to her  calming space. If she doesn't have one, it's a good idea to create one.  Let her calm her body and process her emotions so she can problem-solve, learn, and grow. 
• Step Three: Problem Solving.  Brainstorm solutions with your child, doing more   LISTENING   than talking during the conversation. This allows your child to practice her problem-solving skills, and she’s more likely to actually implement the solutions she came up with herself.

Say, “Show Me the Hard Part”

When your child struggles or feels frustrated, try a technique suggested by mom and parenting blogger Lauren Tamm . Simply say, “Show me the hard part.”

This helps your child identify the ROOT   of the problem, making it less intimidating and easier to solve.

Repeat back what your child says,  “So you’re saying…”

Once you both understand the real problem, prompt your child to come up with solutions . “There must be some way you can fix that…” or  “There must be something you can do…”

Now that your child has identified “the hard part,” she’ll likely be able to come up with a solution. If not, help her brainstorm some ideas. You may try asking the question, “If you DID  know, what would you think?” and see what she comes up with.

Problem-Solve with Creative Play

Allow your child to choose activities and games based on her  interests . Free play provides plenty of opportunities to navigate and creatively solve problems.

Children often learn best through play. Playing with items like blocks, simple puzzles, and dress-up clothes can teach your child the process of problem-solving.

Even while playing, your child thinks critically:  Where does this puzzle piece fit? What does this do? I want to dress up as a queen. What should I wear?   Where did I put my tiara? Is it under the couch?

Problem-Solve with Storybooks

Read age-appropriate stories featuring characters who experience problems, such as:

• Ladybug Girl and Bumblebee Boy by Jacky Davis: The story of two friends who want to play together but can’t find a game to agree on. After taking turns making suggestions, they arrive at a game they both want to play: Ladybug Girl and Bumblebee Boy.
• The Curious George Series by Margaret and H.E. Rey: A curious little monkey gets into and out of dilemmas, teaching kids to find solutions to problems of their own.
• Ira Sleeps Over by Bernard Waber: Ira’s thrilled to have a sleepover at his friend Reggie’s house. But there’s one problem: Should he or should he not bring his teddy bear? It may seem small, but this is the type of early social problem your child might relate to.

Connect these experiences to similar events in your child’s own life, and ASK your child HOW the characters in these stories could solve their problems. Encourage a variety of solutions, and discuss the possible outcomes of each.

This is a form of dialogue reading , or actively ENGAGING   your child in the reading experience. Interacting with the text instead of passively listening can “turbocharge” the development of literacy skills such as comprehension in preschool-aged children.

By asking questions about the characters’ challenges, you can also give your child’s problem-solving abilities a boost.

You can even have your child role-play the problem and potential solutions to reinforce the lesson.  

For book suggestions, refer to our Top 85 Growth Mindset Books for Children & Adults list.

Teach the Problem-Solving Steps

Come up with a simple problem-solving process for your child, one that you can consistently implement. For example, you might try the following five steps:

• Step 1: What am I feeling?  Help your child understand what she’s feeling in the moment (frustration, anger, curiosity, disappointment, excitement, etc.)  Noticing and naming emotions will diffuse  their charge and give your child a chance to take a step back.
• Step 2: What’s the problem?  Guide your child to identify the specific problem. In most cases, help her take responsibility for what happened rather than pointing fingers. For instance, instead of, “Joey got me in trouble at recess,” your child might say, “I got in trouble at recess for arguing with Joey.”
• Step 3:   What are the solutions?  Encourage your child to come up with as many solutions as possible. At this point, they don’t even need to be “good” solutions. They’re just brainstorming here, not yet evaluating the ideas they’ve generated.
• Step 4: What would happen if…? What would happen if your child attempted each of these solutions? Is the solution safe and fair? How will it make others feel? You can also try role-playing at this step. It’s important for your child to consider BOTH  positive and negative consequences of her actions.
• Step 5: Which one will I try?  Ask your child to pick one or more solutions to try. If the solution didn't work, discuss WHY and move on to another one. Encourage your child to keep trying until the problem is solved. 

Consistently practice these steps so that they become second nature, and model solving problems of your own the same way.  It's a good idea to   reflect :   What worked? What didn’t? What can you do differently next time?

Problem-Solve with Craft Materials

Crafting is another form of play that can teach kids to solve problems creatively.

Provide your child with markers, modeling clay, cardboard boxes, tape, paper, etc. They’ll come up with all sorts of interesting creations and inventive games with these simple materials.

These “open-ended toys” don’t have a “right way to play,” allowing your child to get creative and generate ideas independently .

Ask Open-Ended Questions

Asking open-ended questions improves a child’s ability to think critically and creatively, ultimately making them better problem-solvers. Examples of open-ended questions include:

• How could we work together to solve this?
• How did you work it out? or How do you know that?
• Tell me about what you built, made, or created.
• What do you think will happen next?
• What do you think would happen if…?
• What did you learn?
• What was easy? What was hard?
• What would you do differently next time?

Open-ended questions have no right answer and can’t be answered with a simple “Yes” or “No.”

You can ask open-ended questions even when your child isn’t currently solving a problem to help her practice her thinking skills, which will come in handy when she does have a problem to solve.

If you need some tips on how to encourage a growth mindset in your child, don't forget to download our FREE Your Words Matter Volume 2 Kit .

Break Down Problems into Chunks

This strategy is a more advanced version of “Show me the hard part.”

The bigger your child gets, the bigger her problems get too. When your child is facing a challenge that seems overwhelming or insurmountable, encourage her to break it into smaller, more manageable chunks.

For instance, let’s say your child has a poor grade in history class. Why is the grade so low? What are the causes of this problem?

As usual, LISTEN as your child brainstorms, asking open-ended questions to help if she gets stuck.

If the low grade is the result of missing assignments, perhaps your child can make a list of these assignments and tackle them one at a time. Or if tests are the issue, what’s causing your child to struggle on exams?

Perhaps she’s distracted by friends in the class, has trouble asking for help, and doesn’t spend enough time studying at home. Once you’ve identified these “chunks,” help your child tackle them one at a time until the problem is solved.

Show “ The Broken Escalator Video ”

Discuss the importance of embracing challenges and solving problems independently with the “broken escalator video.”

In the video, an escalator unexpectedly breaks. The people on the escalator are “stuck” and yelling for help. At this age, it’s likely that your child will find the video funny and immediately offer a solution: “Just walk! Get off the escalator!”

Tell your child that this is a simple example of how people sometimes act in difficult situations. Ask, “Why do you think they didn’t get off the escalator?” (they didn’t know how, they were waiting for help, etc.)

Sometimes, your child might feel “stuck” when facing problems. They may stop and ask for help before even attempting to find a solution. Encourage your child to embrace challenges and work through problems instead.

Problem-Solve with Prompts

Provide your child or a group of children with materials such as straws, cotton balls, yarn, clothespins, tape, paper clips, sticky notes, Popsicle sticks, etc.

With just these materials, challenge your kids to solve unusual problems like:

• Make a leprechaun trap
• Create a jump ramp for cars
• Design your own game with rules
• Make a device for two people to communicate with one another

This is a fun way to practice critical thinking and creative problem-solving. Most likely, it will take multiple attempts to find a solution that works, which can apply to just about any aspect of life.

Make Them Work for It

When your child asks for a new toy, technology, or clothes, have her make a plan to obtain the desired item herself. Not only will your child have to brainstorm and evaluate solutions, but she’ll also gain confidence .

Ask your child HOW she can earn the money for the item that she wants, and encourage her as she works toward her goal .

Put It on Paper

Have your child write out their problems on paper and brainstorm some potential solutions.

But now, she takes this process a step further: After attempting each solution, which succeeded? Which were unsuccessful? Why ?

This helps your child reflect on various outcomes, learning what works and what doesn’t. The lessons she learns here will be useful when she encounters similar problems in the future.

Play Chess Together

Learning to play chess is a great way for kids to learn problem-solving AND build their brains at the same time. It requires players to use critical thinking, creativity, analysis of the board, recognize patterns, and more. There are online versions of the game, books on how to play, videos, and other resources. Don’t know how to play? Learn with your teen to connect and problem solve together!

Have Them Learn To Code

Our teens and tweens are already tech-savvy and can use their skills to solve problems by learning to code. Coding promotes creativity, logic, planning, and persistence . There are many great tools and online or in-person programs that can boost your child’s coding skills.

Encourage to Start a Meaningful Project

This project has to be meaningful to your teen, for example starting a YouTube channel. Your teen will practice problem-solving skills as they’re figuring out how to grow their audience, how to have their videos discovered, and much more. 

In the Big Life Journal - Teen Edition , there’s a section that guides them through planning their YouTube channel and beginning the problem-solving process.

Apply the SODAS Method

Looking for a game plan that your teen can employ when faced with a problem? The SODAS method can be used for big or small problems. Just remember this simple acronym and follow these ideas:

• D isadvantages
• A dvantages

Encourage to Join Problem-Solving Groups

Does your teen enjoy solving problems in a team? Have them join a group or club that helps them hone their skills in a variety of settings--from science and robotics to debating and international affairs. Some examples of groups include: 

• Odyssey of the Mind
• Debate team
• Science Olympiad

Looking for additional resources?  The Bestseller’s Bundle includes our three most popular printable kits packed with science-based activities, guides, and crafts for children. Our Growth Mindset Kit, Resilience Kit, and Challenges Kit work together as a comprehensive system designed specifically for children ages 5-11.

• Share this post:

25 thoughts on “ How to Teach Problem-Solving Skills to Children and Preteens ”

I love, love, love the point about emotional coaching. It’s so important to identify how children are feeling about a problem and then approach the solutions accordingly.

Thank you for putting this together. I wrote an article on problem-solving specifically from the point of view of developing a STEM aptitude in kids, if you like to check it out – https://kidpillar.com/how-to-teach-problem-solving-to-your-kids-5-8-years/

I feel that these techniques will work for my kid.. Worthy.. Thank you

I love you guys

Leave a Reply

Your email address will not be published. Required fields are marked *

• New Printable
• Guide Printable

FOLLOW US ON INSTAGRAM

• Introduction
• Conclusions
• Article Information

GRADE indicates Grading of Recommendations, Assessment, Development, and Evaluations; SMD, standardized mean difference.

a For meta-analysis of parental problem-solving skills, quality of life, pediatric quality of life, and social functioning, the problem-solving skills training (PSST) group was preferable when the effect size was greater than 0, while the value of effect size for other outcomes less than 0 indicated a favor of PSST.

b For meta-analysis of parental posttraumatic stress, quality of life, pediatric mental problems, and parent-child conflict, the values of I 2 were less than 50%, and the inverse variance method was therefore used.

c Downgraded 1 level for serious inconsistency due to statistical heterogeneity.

d Downgraded 1 level for serious risk of bias of included studies.

e Downgraded 1 level for serious inconsistency due to statistical heterogeneity, and downgraded 1 level for serious imprecision due to limited sample size.

f Downgraded 1 level for serious inconsistency due to statistical heterogeneity, and downgraded 2 levels for very serious imprecision due to limited sample size and wide CIs.

g Downgraded 2 levels for very serious imprecision due to limited sample size and data from only 2 studies.

h Downgraded 1 level for serious inconsistency due to statistical heterogeneity and downgraded 1 level for serious imprecision due to wide CIs.

i Downgraded 1 level for serious imprecision due to limited sample size.

j Downgraded 1 level for serious risk of bias of included studies and downgraded 1 level for serious imprecision due to limited sample size.

eTable 1. Study Search Strategies

eTable 2. Intervention Characteristics of Included Studies

eTable 3. Author Judgments of Risk of Bias Across All Included Studies

eTable 4. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence Profile

eFigure 1. Forest Plot Meta-Analyses for Different Psychosocial Outcomes

eFigure 2. Subgroup Analyses of Each Outcome According to Children- and Intervention-Level Factors

eFigure 3. Funnel Plot Analyses

eFigure 4. Leave-One-Out Sensitivity Analyses

Data Sharing Statement

• Enhancing the Interpretation of Continuous Outcomes and Subgroup Analyses in Systematic Reviews JAMA Pediatrics Comment & Response April 22, 2024 Jing Wu, PhD; Qi Wang, PhD; Xiaoning He, PhD

See More About

Select your interests.

Customize your JAMA Network experience by selecting one or more topics from the list below.

• Academic Medicine
• Acid Base, Electrolytes, Fluids
• Allergy and Clinical Immunology
• American Indian or Alaska Natives
• Anesthesiology
• Anticoagulation
• Art and Images in Psychiatry
• Artificial Intelligence
• Assisted Reproduction
• Bleeding and Transfusion
• Caring for the Critically Ill Patient
• Challenges in Clinical Electrocardiography
• Climate and Health
• Climate Change
• Clinical Challenge
• Clinical Decision Support
• Clinical Implications of Basic Neuroscience
• Clinical Pharmacy and Pharmacology
• Complementary and Alternative Medicine
• Consensus Statements
• Coronavirus (COVID-19)
• Critical Care Medicine
• Cultural Competency
• Dental Medicine
• Dermatology
• Diabetes and Endocrinology
• Diagnostic Test Interpretation
• Drug Development
• Electronic Health Records
• Emergency Medicine
• End of Life, Hospice, Palliative Care
• Environmental Health
• Equity, Diversity, and Inclusion
• Facial Plastic Surgery
• Gastroenterology and Hepatology
• Genetics and Genomics
• Genomics and Precision Health
• Global Health
• Guide to Statistics and Methods
• Hair Disorders
• Health Care Delivery Models
• Health Care Economics, Insurance, Payment
• Health Care Quality
• Health Care Reform
• Health Care Safety
• Health Care Workforce
• Health Disparities
• Health Inequities
• Health Policy
• Health Systems Science
• History of Medicine
• Hypertension
• Images in Neurology
• Implementation Science
• Infectious Diseases
• Innovations in Health Care Delivery
• JAMA Infographic
• Law and Medicine
• Leading Change
• Less is More
• LGBTQIA Medicine
• Lifestyle Behaviors
• Medical Coding
• Medical Devices and Equipment
• Medical Education
• Medical Education and Training
• Medical Journals and Publishing
• Mobile Health and Telemedicine
• Narrative Medicine
• Neuroscience and Psychiatry
• Notable Notes
• Nutrition, Obesity, Exercise
• Obstetrics and Gynecology
• Occupational Health
• Ophthalmology
• Orthopedics
• Otolaryngology
• Pain Medicine
• Palliative Care
• Pathology and Laboratory Medicine
• Patient Care
• Patient Information
• Performance Improvement
• Performance Measures
• Perioperative Care and Consultation
• Pharmacoeconomics
• Pharmacoepidemiology
• Pharmacogenetics
• Pharmacy and Clinical Pharmacology
• Physical Medicine and Rehabilitation
• Physical Therapy
• Physician Leadership
• Population Health
• Primary Care
• Professional Well-being
• Professionalism
• Psychiatry and Behavioral Health
• Public Health
• Pulmonary Medicine
• Regulatory Agencies
• Reproductive Health
• Research, Methods, Statistics
• Resuscitation
• Rheumatology
• Risk Management
• Scientific Discovery and the Future of Medicine
• Shared Decision Making and Communication
• Sleep Medicine
• Sports Medicine
• Stem Cell Transplantation
• Substance Use and Addiction Medicine
• Surgical Innovation
• Surgical Pearls
• Teachable Moment
• Technology and Finance
• The Art of JAMA
• The Arts and Medicine
• The Rational Clinical Examination
• Tobacco and e-Cigarettes
• Translational Medicine
• Trauma and Injury
• Treatment Adherence
• Ultrasonography
• Users' Guide to the Medical Literature
• Vaccination
• Venous Thromboembolism
• Veterans Health
• Women's Health
• Workflow and Process
• Wound Care, Infection, Healing

Others Also Liked

• Download PDF
• X Facebook More LinkedIn

Zhou T , Luo Y , Xiong W , Meng Z , Zhang H , Zhang J. Problem-Solving Skills Training for Parents of Children With Chronic Health Conditions : A Systematic Review and Meta-Analysis . JAMA Pediatr. 2024;178(3):226–236. doi:10.1001/jamapediatrics.2023.5753

Manage citations:

© 2024

• Permissions

Problem-Solving Skills Training for Parents of Children With Chronic Health Conditions : A Systematic Review and Meta-Analysis

• 1 Xiangya School of Nursing, Central South University, Changsha, Hunan, China
• 2 Xiangya Hospital, Central South University, Changsha, Hunan, China
• Comment & Response Enhancing the Interpretation of Continuous Outcomes and Subgroup Analyses in Systematic Reviews Jing Wu, PhD; Qi Wang, PhD; Xiaoning He, PhD JAMA Pediatrics

Question   What is the association between problem-solving skills training (PSST) for parents of children with chronic health conditions and psychosocial outcomes of the parents, their children, and their families?

Findings   In this systematic review and meta-analysis of 23 randomized clinical trials including 3141 parents, PSST was associated with improvements in parental problem-solving skills; decreased parental depression, distress, posttraumatic stress, and parenting stress; better quality of life for both parents and children; fewer pediatric mental problems; and less parent-child conflict.

Meaning   These findings suggest that PSST should be an active component of and serve as an emerging perspective for psychosocial interventions for parents of children with chronic health conditions.

Importance   Problem-solving skills training (PSST) has a demonstrated potential to improve psychosocial well-being for parents of children with chronic health conditions (CHCs), but such evidence has not been fully systematically synthesized.

Objective   To evaluate the associations of PSST with parental, pediatric, and family psychosocial outcomes.

Data Sources   Six English-language databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library), 3 Chinese-language databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang), gray literature, and references were searched from inception to April 30, 2023.

Study Selection   Randomized clinical trials (RCTs) that performed PSST for parents of children with CHCs and reported at least 1 parental, pediatric, or family psychosocial outcome were included.

Data Extraction and Synthesis   Study selection, data extraction, and quality assessment were conducted independently by 2 reviewers. Data were pooled for meta-analysis using the standardized mean difference (SMD) by the inverse variance method or a random-effects model. Subgroup analyses of children- and intervention-level characteristics were conducted.

Main Outcomes and Measures   The psychosocial outcomes of the parents, their children, and their families, such as problem-solving skills, negative affectivity, quality of life (QOL), and family adaptation.

Results   The systematic review included 23 RCTs involving 3141 parents, and 21 of these trials were eligible for meta-analysis. There was a significant association between PSST and improvements in parental outcomes, including problem-solving skills (SMD, 0.43; 95% CI, 0.27-0.58), depression (SMD, −0.45; 95% CI, −0.66 to −0.23), distress (SMD, −0.61; 95% CI, −0.81 to −0.40), posttraumatic stress (SMD −0.39; 95% CI, −0.48 to −0.31), parenting stress (SMD, −0.62; 95% CI, −1.05 to −0.19), and QOL (SMD, 0.45; 95% CI, 0.15-0.74). For children, PSST was associated with better QOL (SMD, 0.76; 95% CI, 0.04-1.47) and fewer mental problems (SMD, −0.51; 95% CI, −0.68 to −0.34), as well as with less parent-child conflict (SMD, −0.38; 95% CI, −0.60 to −0.16). Subgroup analysis showed that PSST was more efficient for parents of children aged 10 years or younger or who were newly diagnosed with a CHC. Significant improvements in most outcomes were associated with PSST delivered online.

Conclusions and Relevance   These findings suggest that PSST for parents of children with CHCs may improve the psychosocial well-being of the parents, their children, and their families. Further high-quality RCTs with longer follow-up times and that explore physical and clinical outcomes are encouraged to generate adequate evidence.

Childhood chronic health conditions (CHCs) include physical, developmental, behavioral, or emotional conditions with an expected duration of more than 3 months or the impossibility of cure. 1 Approximately 37% of children have at least 1 current or lifelong health condition. 2 The diagnosis of a childhood CHC and its prolonged treatments are profoundly unsettling experiences for children and their families, especially their parents. 3 - 5 Compared with parents of healthy children, parents of children with CHCs have reported worse mental health (more depression, anxiety, and posttraumatic stress), 6 - 8 significant stress and burden, 9 , 10 and a poorer quality of life (QOL). 6 , 11 Considering that parental psychosocial outcomes are strongly associated with children’s health and family adaptation, 12 - 14 interventions to improve parents’ well-being may have synergistic benefits for the whole family. Parental problem-solving skills, which are associated with parents’ well-being, are general coping skills applicable to a variety of difficult situations commonly encountered during the treatment of childhood CHCs. 15 With better problem-solving skills, parents could become more self-assured to address children’s health concerns, fully use resources to cope with stress, and collaborate to address challenges presented by daily care, thereby improving family adaptation and children’s health outcomes. 16 However, nearly one-half of parents lack problem-solving skills, especially the ability to solve daily problems related to their children’s complex treatment processes, 3 which may eventually perpetuate negative outcomes for parental and child well-being. 17 , 18

Problem-solving skills training (PSST) is an effective intervention to improve problem-solving skills and decrease negative affectivity. 19 , 20 Based on the problem-solving therapy approaches of D’Zurilla and colleagues, 20 , 21 PSST includes 2 essential components: establishing a positive problem orientation and mastering the systematic steps to solve problems. The training has long been established as being effective in adults with chronic illness and their caregivers, 22 , 23 which theoretically could have broad outcomes for parents of children with CHCs due to the long-term nature and equally multiple, intensive, and ongoing stressors across childhood CHCs. Problem-solving skills training is a cognitive-behavioral process by which parents can identify and create problem-focused strategies to buffer the outcomes of stressful events and improve coping, thus preventing episodes of negative affectivity by effectively solving various children’s disease-related problems. 15 , 21 These problem-solving strategies, while possibly differing in specifics, are beneficial in helping parents to cope with significant stressors inherent to each CHC. Preliminary studies have shown the efficacy of PSST in enhancing problem-solving skills and alleviating depression symptoms for parents, although the majority of such studies have had small sample sizes. Moreover, these studies only considered improved parental well-being, and most did not show significant changes in pediatric or family adaptation outcomes. 15 , 24 In addition, although previous reviews of PSST have explored the effectiveness of psychosocial interventions for parents of children with CHCs, they had limited specificity. 19 , 25 - 28 To address these gaps, we evaluated the associations between PSST for parents of children with CHCs and parental, pediatric, and family psychosocial outcomes.

The study protocol for this systematic review and meta-analysis has been registered with PROSPERO ( CRD42023424077 ). The revised Preferred Reporting Items for Systematic Reviews and Meta-Analyses ( PRISMA ) guideline 29 was followed to report the findings.

A systematic search was performed across 6 English-language databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, and Cochrane Library) and 3 Chinese-language databases (China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang) from inception to April 30, 2023. The search strategies applied a combination of Medical Subject Heading terms and keywords, and the following constructs were used: child AND chronic health conditions AND parents AND PSST. The full search string for each database is provided in eTable 1 in Supplement 1 . Gray literature was searched using OpenGrey, Mednar, and the World Health Organization’s search portal. We also screened reference lists of included studies to identify potentially eligible articles.

The population, intervention, comparator, outcomes, and study design framework was used to define the inclusion and exclusion criteria ( Table 1 ). Eligible studies were RCTs that performed PSST for parents of children with CHCs and reported at least 1 psychosocial outcome of parents, children, or their families.

All identified articles were imported into EndNote, version 20.0 (Clarivate Analytics) to eliminate duplications. Title and abstract screening and full-text review were performed independently using the web-based software Rayyan 30 by 2 reviewers (T.Z. and W.X.). Data extraction was conducted in duplicate by the 2 reviewers and checked by another reviewer (Y.L.). Information was extracted using a predesigned worksheet, including publication details, population demographics (pediatric [age, medical condition, and illness duration] and parental [age, sex, race and ethnicity]), intervention and control group details (approach, mode, number of sessions, and duration), and psychosocial outcomes and measures.

We included only the postintervention data in the meta-analysis, as follow-up data were not reported consistently enough to achieve proper homogeneity. When both parents and children reported a psychosocial outcome of children, we prioritized extracting the parent-reported data, as they were more reliable. If multiple records were available for the same trial, we collected all relevant data and analyzed them as a single study. Corresponding authors were contacted via email to retrieve missing data.

The risk of bias for the included studies was assessed independently by 2 reviewers (T.Z. and W.X.) according to the revised Cochrane risk-of-bias tool, version 2.0, 31 which includes 5 domains: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. We judged the studies to be low risk, of some concern, or high risk. Additionally, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) 32 framework was applied to assess the certainty of the evidence for all outcomes. The certainty was categorized as high, moderate, low, or very low based on the risk of bias, inconsistency, imprecision, indirectness, and publication bias. 33 , 34 Any disagreements in the study selection, data extraction, and quality assessment processes were resolved through discussion to reach a consensus, and if conflicts persisted, they were arbitrated by a third reviewer (Y.L.).

Statistical analyses were performed using Stata, version 16 software (StataCorp LLC). We conducted a meta-analysis only when 2 or more intervention studies were available with similar participants and outcomes. The psychosocial outcomes included in this review were measured by different scales; therefore, the effect size is presented as the standardized mean difference (SMD) with 95% CI. 35 Statistical heterogeneity was assessed using both the χ 2 test and I 2 statistic. 36 The inverse variance method ( P  ≥ .10 and I 2 <50%) or a random-effects model ( P  < .10 or I 2 ≥50%) was applied based on the P and I 2 values. Subgroup analyses were performed for children’s and intervention characteristics. In addition, we conducted leave-one-out sensitivity analyses to examine the consistent associations between PSST and all identified outcomes. We also used funnel plots and Egger test to evaluate the publication bias for analyses with at least 10 studies. 37 The threshold for statistical significance was set at a 2-sided P  < .05. The most recent analysis update was performed between October 10 and 20, 2023.

The initial comprehensive search yielded 2665 publications: 2641 from 9 databases and an additional 24 from gray literature and reference list review. After removing 1195 duplicates and screening 1470 titles and abstracts, 227 full-text articles were assessed for eligibility. Ultimately, 23 eligible RCTs 38 - 60 were included in the review, and 21 studies 38 - 42 , 44 - 48 , 50 - 60 were included in the meta-analysis ( Figure 1 ). Almost perfect agreement on the study selection was achieved (97%; κ = 0.89). 61

Table 2 summarizes the characteristics of the included 23 RCTs published between 2002 and 2021. Most were conducted in the US (21 studies 38 , 40 - 44 , 46 - 60 ), with 1 study each in Australia 45 and Jamaica. 39 Twenty-one studies 38 - 48 , 50 - 59 used a 2-arm RCT design. In addition, most studies (12 [52%]) 39 , 42 , 45 - 48 , 50 , 53 - 57 reported that a control group received usual care.

A total of 3141 parents were included in this review. Twenty-one studies 38 - 47 , 49 - 58 , 60 reported on parent sex, which totaled 2799 mothers (94%) and 185 fathers (6%), and 6 studies 38 , 39 , 42 , 53 - 55 only recruited mothers. The age of the parents ranged from 20 to 67 years, with an estimated mean (SD) age of 38.3 (9.0) years. Of 2914 parents who reported race and ethnicity, 38 , 41 - 44 , 46 - 60 569 (19%) were Hispanic, 316 (11%) were non-Hispanic Black, 1708 (59%) were non-Hispanic White, and 321 (11%) were of other race or ethnicity. The CHC diagnoses were traumatic brain injury (6 studies), 49 , 51 , 57 - 60 cancer (5 studies), 38 , 52 - 55 sickle cell disease (2 studies), 39 , 40 autism spectrum disorder (2 studies), 41 , 42 epilepsy (2 studies), 46 , 47 mental health problems (1 study), 43 inflammatory bowel disease (1 study), 44 first-episode psychosis (1 study), 45 diabetes (1 study), 48 chronic pain (1 study), 50 and asthma (1 study). 56 The mean (SD) age of the children was 10.0 (5.5) years, with the illness duration ranging from 2 weeks to 8 years.

Problem-solving skills training was confirmed as the primary focus of the intervention across the 23 RCTs, all of which were developed based on problem-solving therapy that emphasized positive problem orientation and covered the 5 core problem-solving steps (eTable 2 in Supplement 1 ). The number of PSST sessions included ranged from 2 to 21, with the duration of PSST varying from 5 weeks to 12 months. Most studies (18 [78%]) 38 - 43 , 45 - 48 , 50 , 52 - 57 , 60 involved interventions that required parents to attend face-to-face sessions, 6 of which integrated telephone-based online support. 40 , 43 , 45 - 48 In the remaining studies, 38 , 44 , 49 , 51 , 52 , 58 - 60 PSST was delivered entirely online, including via telephone sessions, web-based didactic modules, and videoconferences. Three interventions 39 - 41 were group-based, 9 interventions 38 , 42 , 43 , 45 , 50 , 52 - 55 were delivered to individuals 1 on 1, and 11 interventions 44 , 46 - 49 , 51 , 56 - 60 included both parents and children.

The methodological quality assessment resulted in 96% mutual agreement (κ = 0.93). 61 Seven studies (30%) 39 , 42 , 45 , 47 , 50 , 51 , 56 were classified as low risk, 8 studies (35%) 40 , 44 , 46 , 52 , 55 , 57 , 58 , 60 raised some concerns, and 8 studies (35%) 38 , 41 , 43 , 48 , 49 , 53 , 54 , 59 were identified as having a high risk ( Figure 2 ). Two studies 41 , 48 reported neither random sequence generation nor allocation concealment and hence were considered high risk for the randomization process. For 5 trials (22%), 38 , 49 , 53 , 54 , 59 there was a high risk of reporting bias, as the prespecified outcomes were not fully reported (eTable 3 in Supplement 1 ).

Figure 3 illustrates the meta-analysis summary for all outcomes. Forest plots and GRADE ratings are presented in eFigure 1 and eTable 4 in Supplement 1 , respectively.

Overall, PSST had a significant positive effect on problem-solving skills (12 studies including 1887 parents 38 - 42 , 46 , 50 , 52 - 55 , 58 ; SMD, 0.43; 95% CI, 0.27-0.58; I 2  = 64.28%), depression (12 studies including 2036 parents 38 , 39 , 41 , 42 , 50 - 52 , 54 , 55 , 57 , 58 , 60 ; SMD, −0.45; 95% CI, −0.66 to −0.23; I 2  = 85.29%), and distress (12 studies including 2038 parents 38 , 45 , 50 - 55 , 57 - 60 ; SMD, −0.61; 95% CI, −0.81 to −0.40; I 2  = 83.88%), all of which indicated a medium effect size and moderate certainty evidence. The studies also showed that PSST significantly alleviated posttraumatic stress (5 studies including 1469 parents 38 , 50 , 52 , 54 , 55 ; SMD, −0.39; 95% CI, −0.48 to −0.31; I 2  = 44.93%) and parenting stress (5 studies including 391 parents 39 , 41 , 42 , 45 , 50 ; SMD, −0.62; 95% CI, −1.05 to −0.19; I 2  = 76.24%). The levels of evidence for the associations of PSST with lower posttraumatic stress and parenting stress were moderate and low, respectively. The meta-analysis of parental anxiety showed a positive but nonsignificant effect. In addition, 2 studies 45 , 50 including 175 parents indicated a significant improvement in QOL among parents in the PSST group (SMD, 0.45; 95% CI, 0.15-0.74; I 2  = 0.00%), with low-certainty evidence and no heterogeneity ( Figure 3 ).

There was an association between PSST and better pediatric QOL compared with control groups (6 studies including 590 parents 40 , 44 , 47 , 48 , 56 , 60 ; SMD, 0.76; 95% CI, 0.04-1.47; I 2  = 94.90%). Data for 436 parents showed a significant association between PSST and fewer children’s mental problems (6 studies 50 , 51 , 57 - 60 ; SMD −0.51; 95% CI, −0.68 to −0.34; I 2  = 34.54%) ( Figure 3 ). We found that PSST had both medium effect sizes for improving pediatric QOL and mental health, with low- and moderate-certainty evidence, respectively, whereas no association was found for social functioning. Four RCTs 41 , 48 , 51 , 57 including 314 parents provided low-certainty evidence that PSST may reduce parent-child conflict (SMD, −0.38; 95% CI, −0.60 to −0.16), with moderate heterogeneity ( I 2  = 36.98%).

Subgroup analyses were conducted according to child- and intervention-level characteristics (eFigure 2 in Supplement 1 ). Subgroup analysis by child age indicated that PSST was associated with significant changes in parental depression (SMD, −0.39; 95% CI, −0.52 to −0.26), problem-solving skills (SMD, 0.36; 95% CI, 0.24-0.48), posttraumatic stress (SMD, −0.40; 95% CI, −0.49 to −0.31), and parenting stress (SMD, −0.43; 95% CI, −0.72 to −0.13) for the parents of children who were 10 years or younger compared with the parents of older children (>10 years). Regarding changes in parental depression and posttraumatic stress, PSST had no association for parents of children who had not been newly diagnosed with a CHC but was associated with significant changes (reductions) for parents of children with newly diagnosed CHCs (depression: SMD, −0.40 [95% CI, −0.52 to −0.28]; posttraumatic stress: SMD, −0.40 [95% CI, −0.49 to −0.31]). Furthermore, compared with other medical conditions, PSST was associated with significant improvement in all psychosocial outcomes in parents of children diagnosed with cancer.

Overall, PSST delivered online yielded larger effects on all outcomes except for parent-child conflict than only face-to-face PSST. There was a significant improvement in depression (SMD, −0.39; 95% CI, −0.52 to −0.27) and problem-solving skills (SMD, 0.37; 95% CI, 0.24-0.50) among parents who received individual-based PSST. However, the parent-child interventions showed significant changes in pediatric and family psychosocial outcomes. As for intervention duration, PSST for 5 to 8 weeks had stronger effects on reducing parental depression and parenting stress and improving problem-solving skills than PSST with durations exceeding 8 weeks. The number of sessions followed a similar pattern, with significant improvements in depression (SMD, −0.48; 95% CI, −0.67 to −0.28) and problem-solving skills (SMD, 0.50; 95% CI, 0.29-0.70) among parents who underwent 8 to 12 sessions.

We assessed the publication bias for outcomes that included more than 10 trials (problem-solving skills, parental depression, and distress). Overall, the funnel plots were mostly symmetrical (eFigure 3 in Supplement 1 ); Egger tests were not significant for problem-solving skills ( z  = 1.64, P  = .10), depression ( z  = −1.21, P  = .23), and distress ( z  = −0.46, P  = .65), thus indicating no publication bias. The leave-one-out sensitivity analyses yielded similar results to those of the primary analyses, indicating the robustness of key outcomes (eFigure 4 in Supplement 1 ).

This systematic review and meta-analysis of 23 RCTs is the first to our knowledge to adequately examine the positive association of PSST with improved parental, pediatric, and family psychosocial outcomes. The findings show that PSST was associated with improved problem-solving skills, less negative affectivity, and better QOL for parents. Positivity and problem-solving throughout PSST is achieved by refining problems and effectively troubleshooting obstacles commonly encountered during the treatment of childhood CHCs, thus contributing to parental well-being. 15 , 41 Additionally, PSST was associated with improvements in pediatric QOL, mental health, and parent-child conflict, in accordance with previous review results that psychological interventions for parents may facilitate their ability to scaffold behavioral and emotional changes in their children and thus reduce conflicts between parents and children. 19 , 27 , 62 Our findings extend this evidence by suggesting that PSST is also associated with better psychosocial outcomes for children and families, showing promise for the use of PSST to increase the well-being of all family members and promote family adaptation.

Problem-solving skills training is an emerging and promising area of research, with 17 (74%) included studies published in 2010 or later. 39 - 47 , 49 - 52 , 55 , 56 , 59 , 60 A total of 3141 patients were included in this review, and there were sufficient sample sizes for most outcomes. Although the included RCTs were conducted in only 3 countries, which may decrease the representativeness of the results in terms of dissemination capability, the ethnic and linguistic diversity of parents across included studies showed equally positive responses to PSST when presented in various contexts. Across all psychosocial outcomes, the certainty of the evidence varied from moderate to very low. Despite the suggested effectiveness of PSST in this review, some heterogeneity remains. On one hand, the included studies used diverse definitions and instruments to measure psychosocial outcomes; on the other hand, the studies included parents of children with 11 different CHCs, all of which may have introduced clinical heterogeneity. However, the diversity may also suggest a better clinical fitness of the evidence in this review. Additionally, the current evidence on the long-term effects of PSST is limited by the small number of follow-up studies. Overall, although our review provides relatively high certainty of evidence, further research on higher-level evidence with sustained follow-up is warranted. Furthermore, it is necessary to expand the range of outcomes (eg, physical and clinical) to fully reflect the effectiveness of PSST, as most relevant studies have only reported psychosocial outcomes.

Our subgroup analysis revealed a significant decrease in negative affectivity among the parents of children aged 10 years or younger and who had been newly diagnosed with CHCs, as younger children are more reliant on their parents for daily life and disease management. 63 These findings are compatible with broader evidence supporting early PSST’s improvement of parental well-being when children are newly diagnosed. 64 A significant decrease in negative emotions was also found among parents of children with cancer compared with the parents of children with other medical conditions, possibly because cancer is a leading cause of death in children 65 and their parents may experience a substantial care burden. 8 , 66 The subgroup analysis according to intervention characteristics indicated that online intervention yielded larger effects on most outcomes than the in-person approach, which may be due to the flexibility and wider dissemination of an online approach. 52 , 67 With the rapid development of internet and mobile technologies in pediatric nursing, 68 future research could combine in-person PSST with enhanced online materials. Additionally, individual-based PSST was preferable for parental well-being, whereas the parent-child intervention favored pediatric and family psychosocial outcomes. The participants had more opportunities to receive personalized feedback in the individual-based interventions that included 1-on-1 activities 69 and to enhance family communication and cohesion in the parent-child intervention. 26 Hence, it may be worthwhile to integrate parent-child interaction when tailoring PSST according to families’ needs. Finally, PSST delivered for 5 to 8 weeks and consisting of 8 to 12 sessions had stronger associations in terms of parental psychosocial outcomes. This finding highlights the importance of shorter periods and less complexity to higher engagement in PSST, as parents’ busy schedules may interfere with long-term interventions. 70

This review had several limitations. First, we limited our search to articles in English and Chinese, which might have led to selection bias and affected the reliability of the results. Second, some of the findings must be interpreted with caution, as they were based on only 2 or 3 studies. Third, the assessment could differ across people due to the methodological subjectivity of the risk-of-bias tool and GRADE. Fourth, the psychosocial outcomes identified in this review were measured using multiple scales, and despite using SMD as recommended, the heterogeneity of most outcomes was high. Hence, the interpretability and application of the results were diminished. Finally, only the postintervention data were analyzed, as follow-up data were not reported consistently and sufficiently, and the long-term outcomes remain unclear.

The findings of this systematic review and meta-analysis suggest that PSST is associated with improvements in parental psychosocial outcomes (problem-solving skills, depression, distress, posttraumatic stress, parenting stress, and QOL) as well as pediatric (QOL and mental problems) and family psychosocial outcomes (parent-child conflict). Moreover, our findings on children- and intervention-level characteristics may guide the design and delivery of future PSST by presenting information on factors associated with effectiveness. Further high-quality RCTs with longer follow-up times and that explore physical and clinical outcomes are encouraged to generate adequate evidence for PSST. In conclusion, PSST should be an active component of psychosocial interventions for parents of children with CHCs.

Accepted for Publication: October 25, 2023.

Published Online: January 2, 2024. doi:10.1001/jamapediatrics.2023.5753

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Zhou T et al. JAMA Pediatrics .

Corresponding Author: Yuanhui Luo, PhD, Xiangya School of Nursing, Central South University, No. 172, Tongzipo Rd, Changsha City 410013, Hunan Province, China ( [email protected] ).

Author Contributions: Drs Zhou and Luo had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Zhou, Luo, J. Zhang.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Zhou, Luo, H. Zhang.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Zhou, Xiong, Meng, H. Zhang.

Obtained funding: Luo.

Administrative, technical, or material support: Luo, J. Zhang.

Supervision: Luo, J. Zhang.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grant CMB-OC-22-462 from the China Medical Board (Dr Luo).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

• Register for email alerts with links to free full-text articles
• Access PDFs of free articles
• Manage your interests
• Save searches and receive search alerts

• Collaborative Problem Solving for Parents »

Collaborative Problem Solving for Parents

Our evidence-based approach, developed at Massachusetts General Hospital, is a big mind-shift when it comes to understanding your child’s behavior and what to do about it. Collaborative Problem Solving ® (CPS) is an evidence-based, trauma-informed practice that helps kids meet expectations, reduces concerning behavior, builds children’ skills, and improve family relationships.

You’ll learn how to partner with the children in your life to identify the triggers for their challenging behavior, and work together to produce a game plan for how to handle problems before they happen. Collaborative Problem Solving avoids using power, control, and motivational procedures. Instead, it focuses on collaborating with children to solve the problems leading to them not meeting expectations and displaying problematic behavior.

Collaborative Problem Solving is designed to meet the needs of all children at all ages, including those with social, emotional, and behavioral challenges. It promotes the understanding that kids who have trouble meeting expectations or managing their behavior lack the skill—not the will—to do so . These children struggle with skills related to problem-solving, flexibility, and frustration tolerance and Collaborative Problem Solving builds these skills.

Transform Discipline at Home

Are you tired of the meltdowns, nagging, yelling, and constant power struggles between you and your child? If behavior charts, rewards, and punishments aren't working, we know why!  Research shows kids with challenging behavior lack the skill, not the will, to behave.

Traditional discipline is broken, it doesn’t result in improved behavior or improved relationships between adults and children. The Collaborative Problem Solving approach is an effective form of relational discipline that reduces concerning behavior and parent stress while building skills and relationships between adults and children.

A Mother’s Story

Ways you can learn more.

Join one of our courses to learn more about Collaborative Problem Solving.

Have you wondered why a child or an adult you know struggles to meet certain expectations or manage their behavior?

This 1-hour, self-paced,  free  course teaches the five Thinking Skills we all use to manage our behavior and meet expectations.

Parents & Caregivers, learn how you can help your kids meet expectations and improve your relationship!

This 1.5-hour, self-paced course introduces the principles of Collaborative Problem Solving ® while outlining how the approach can meet your family's needs. Tuition: $39 Enroll Now

Parents, guardians, families, and caregivers are invited to register for our supportive 8-week, online course to learn Collaborative Problem Solving ® (CPS), the evidence-based and trauma-informed approach for helping children develop the skills they need to manage their behavior.

The Results

Our research has shown that the Collaborative Problem Solving approach helps kids and adults build crucial social-emotional skills and leads to dramatic decreases in behavior problems across various settings including schools, residential, in and outpatient treatment, and homes. Results reported by parents, pediatricians, and outpatient therapists include improved behavior and reductions in caregiver stress.

Collaborative Problem Solving in Action

Watch these examples of Collaborative Problem Solving conversations to get an idea of what it is all about.

What Our Families Say

Parent & caregiver insights, how to talk to your kids about social media, kids lack skill, not will, behaviors charts: helpful or harmful, seeing red 4 steps to try before responding, changing behavior takes time, a mother’s collaborative problem solving story, the power of brief relational interactions in changing our brains and behavior, is social media ruining kids’ mental health let’s ask them, thinking skills assessment, attention and working memory thinking skills, language and communication thinking skills, rethinking our approach to youth mental health care, child having trouble transitioning between activities here’s how to help, how lagging social thinking skills can influence behavior, managing challenging behavior in youth sports, privacy overview.

• Learn Bright Ideas
• News You Can Use

About Bright IDEAS

Welcome to the bright ideas problem-solving skills training program., for more than 20 years, our* work with mothers of childhood cancer patients has shown that learning how to successfully solve the many kinds of problems faced by families of a child with cancer helps to decrease stress and anxiety. our results have been so positive that we’re now providing this training in several ways: through in-person visits with a trainer and on line. we are also inviting fathers, grandparents, other caregivers, and patients themselves to learn this skill..

Actually, learning how to be a good problem solver is a skill that you can use throughout life not only to cope with cancer but also to cope with ANY problem --- how to do your job better, how to run your household better, how to work with people in your family and community better. Many day-to-day life situations lend themselves to this careful, thoughtful problem solving strategy.

Good problem solving comes naturally to some people, but for most of us, it takes understanding the system and practice. Our program is designed to help your feel optimistic that you can solve the problems you face---this is the Bright in Bright IDEAS --- and the first step toward success. Then we help you learn the basic steps of problem solving itself, which spell the word IDEAS. I for Identify the problem, D for Define your options, E for Evaluate your options and pick the best option or solution for you, A for Act, that is try out the solution you picked, and S for See if it worked. If the outcome was as good as you hoped, then it’s time to move on to another problem. But, if the solution really wasn’t good enough, the program helps you try another solution from your list or think up a new solution entirely. Sometimes you have to try out two, three, or more plans until you’re satisfied that your problem has been solved.

Parents of children with cancer cannot avoid facing some challenging problems. However, effective problem-solving skills can help you feel that the problems are manageable and that you can find positive outcomes. These skills can also help give you a sense of being in control: a very important feeling to have when you are overwhelmed by your child’s cancer.

Again, welcome to the Bright IDEAS Problem-Solving Skills Training program.

*Bright IDEAS was developed by a group of childhood cancer specialists from some of the top childhood cancer centers:

• Martha A. Askins, PhD, UT/MD Anderson Cancer Center
• Robert W. Butler, PhD, Oregon Health Sciences University
• Donna R. Copeland, PhD, UT/MD Anderson Cancer Center
• Michael J. Dolgin, PhD, Ariel University, Israel
• Diane L. Fairclough, DrPH, University of Colorado Denver
• Ernest R. Katz, PhD, Children’s Hospital Los Angeles
• Raymond K. Mulhern, PhD, St. Jude Children’s Research Hospital
• Robert B. Noll, PhD, University of Pittsburgh Medical Center
• Sean Phipps, PhD, St. Jude Children’s Research Hospital
• Olle Jane Z. Sahler, MD, University of Rochester Medical Center
• James W. Varni, PhD, Texas A&M University

• U.S. Department of Health & Human Services
• Administration for Children & Families
• Upcoming Events

Teacher Time

• Open an Email-sharing interface
• Open to Share on Facebook
• Open to Share on Twitter
• Open to Share on Pinterest
• Open to Share on LinkedIn

Prefill your email content below, and then select your email client to send the message.

Recipient e-mail address:

Send your message using:

Problem-solving and Relationship Skills with Infants and Toddlers

Woman: Places, everyone. Are the lights ready? Three, two, one.

Mike Browne: Ooh-whee! Estoy aqui, estoy listo. I am here. I am ready and let's rock and roll!

Becky Sughrim: I'm ready, too!

All: [Singing] "Teacher Time.” "Teacher Time.” "Teacher Time.” "Teacher Time.” "Teacher Time.” "Teacher Time.”

Mike: Hello, everyone. You know that never gets old. I'm like sitting here jogging along. Welcome, everyone, to our third infant and toddler episode of "Teacher Time" this program year. I'm Mike Browne. My pronouns are he/him. And I'm joined by...

Becky: Becky Sughrim, and my pronouns are she/her.

Mike: And we are from the National Center on Early Childhood Development Teaching and Learning. And as always, we are super excited to be here with you all today. Thank you for joining us. We have been focusing all of our episodes this past season of "Teacher Time" on positive behavior support. So far, we talked about many different things. We talked about the importance of relationships. We talked about how to support emotional literacy. Today is going to be another fun one on problem-solving and friendship skills and building friendship skills with infants and toddlers.

I would love to call to your attention to the Viewer's Guide, where you can find it in the Resource Widget. This season our Viewer's Guide is a Viewer Guide from birth to five. It includes age-specific information for infants, for toddlers, for preschool children. It's packed full of so many different things — resources, helpful quick tips, reminders that you can take right into your learning space. And there's also a note-taking space in which you can use to jot down some notes for today. You can download the guide and use it throughout our time together for taking notes, reflecting, planning, and please, as always share the Viewer Guide with your colleagues.

Becky: During our time together, we're going to be focusing on a number of things. We're going to first talk about some positive behavior support teaching practices. Then we're going to take some time to promote your wellness and our wellness and connect our affective practices to brain development in our new segment this season called "Neuroscience Nook.”

Then we're going to take a look at the "Teacher Time" basics. In "Small Change, Big Impact" and in our "Focus on Equity" segments, we're going to talk about individualized strategies that build a sense of belonging and promote social and emotional skill with all children, including children who have a variety of learning characteristics.

Of course, we will wrap up our time together as we always do with the "BookCASE," where Mike got to meet with our "Teacher Time" librarian, and we connect our topic to books that you can share with children and families.

Mike: As we begin, let's check in using our famous, world famous, "Teacher Time" Tree. Enter to the Q&A, which is that purple widget, what number are you feeling today? What number creature that you're showing up and you want to relate to us. And, of course, you can jot down why you're feeling like that.

I will get us started. I am feeling a little like, I don't know, I like the lighter colors, I like the 11, 12 because yesterday I got a chance to visit a classroom and one of the first children I had when they were infants, they saw me, they ran up to me and they were like, "Mike?” And I was like, "I haven't seen you in two-and-a-half years!” And like, just jumped up and gave me a big hug and now I'm feeling all cuddly and cozy. What about you, Becky?

Becky: That's such a great story. Thanks for sharing, Mike. That makes me feel warm and fuzzy thinking about it. I feel like a number 10. I'm excited for today. I'm ready to be with everyone and just open arms ready to learn and be alongside with you and all of our participants.

Mike: We got some tens, we got some fives in the chat, we've got some ones. Keep them coming. Let us know how you're feeling and we're going to rock and roll to our next slide.

Becky: Thank you. I got a little excited. We are very excited, as you can tell, that we're going to be focusing on positive behavior supports this season. We have focused on this on our last two infant/toddler webinars as well. And you probably already know this, that social-emotional development is one of the domains in Head Start Early Learning Outcomes Framework, or the ELOF. And the practical strategies we're going to be talking about today are going to be focusing on the relationships with other children subdomain of the social-emotional development domain as you can see highlighted here.

We have been working our way through the pyramid. And we've been thinking about the pyramid model, and this is a Positive Behavior Support, or PBS framework that is proactively addressing the social-emotional development and challenging behaviors that young children might experience.

And the framework offers a continuum of evidence-based teaching practices that are organized into four levels of support. The first level is nurturing and responsive relationships. The second level is high-quality supportive environments. Then we have the purple, the third level, social and emotional teaching strategies, and the top of the pyramid, intensive intervention.

And today, we're going to be focusing on that third level of the pyramid, or a second-tier support where we're talking about social and emotional teaching strategies. If you want learn more about the pyramid model, we hope that you will check out the recourses in your viewer's guide from the National Center of Pyramid Model Innovations, or NCPMI in the Resource List section.

Mike: We would love to hear — because I'm already like I need a sip of water — we'd love hear using that purple Q&A widget some of the strategies and practices that you have in place in your center, and your learning environment that really supports problem-solving and relationship skills with infants and toddlers. Once again, type that into the chat using your purple Q&A widget.

Once again, I'm going to start it. I think one practice that I did specifically with infants is whenever we're by the door and it's during pickup time, we will have that child, just look up and we're like, "Oh, is someone's parent here? Or someone's caregiver here?” And they'll go "Dada! Dada!" And I say, "Oh, should we go over to such-and-such, Nico, and say, 'Oh Dada's here?'" "Let's come with me.” You're building that relationship with the child and building relationship between the children.

And something that I like to do with toddlers when they're a little bit older, I love doing like a little scavenger hunt. I'll say, "Oh my goodness! I lost my coffee!” "My adult drink.” Well, maybe not adult drink, some coffee. "Let's go find it!” "Hmm, you're getting warmer. You're getting colder" They've been learning about spatial awareness, difference in temperature, things of that nature.

Becky: And also the collaboration of working together as a team if you're in a group care setting, all trying to find coffee that we need in the morning. Let's see what we have in the Q&A talking about having a welcome song with each child's name.

Mike: We're having some redirect. Redirection is always key.

Becky: Having open-ended questions with toddlers. Totally. And one of the things that I like, which I'm sure is going to also come up in the chat is to engage in that narration when a toy struggle is happening or there's a problem where we're talking about what the toddlers are doing, and what we see. And just letting them know what's happening in real-time.

Mike: That sounds like something we should talk about on Parallel Play.

Becky: Yeah. If you haven't checked out our podcast, we hope that you will. Mike and I also host a Parallel Play podcast. Let's think about positive behavior supports. As we know, the pyramid model is one way we can engage in positive behavior supports. And let's think a little bit deeper about what positive behavior supports are and what they mean. This is really a positive approach to prevent and address challenging behavior or behaviors that adults find challenging.

And the number one thing to remember is that PBS is proactive. That we're proactively thinking about ways in which we can prevent challenging behaviors from occurring. It's positive and proactive. And at the heart of PBS is this recognition that challenging behavior is communication. That challenging behavior is used to communicate a message like, "I want to play with that person or that other toddler.” Or "I want to turn right now.” Or "I want to play in the sensory bin too.” Or something like, "I want that green ball.”

There's all behavior is a form of communication and children are sending us a message. Educators can be their best detectives and together with the family uncover what the child is trying to communicate through their behavior and then teach the child a more effective way to communicate and problem solve with support.

Mike: We’re going to turn it back right to you. I hope your fingers are ready. We're going to be doing this all day. Let's turn the attention back to you. We do our best caregiving and teaching when we feel well ourselves. Really engaging in self-care practices can help educators, admin, everyone build greater social and emotional capacity to work through problem-solving together.

And our ability to support children with problem-solving and relationship skills starts with our ability to really center ourselves by noticing and observing all the little things that are happening within our bodies, with as little judgment as possible and really softening to what is. We can help young children work through challenges with peers, for a more grounded, balance, soft, and objective place by naming what we see happening come. Before we support the children in our care with problem-solving and relationship skills, it's super important that we find ways to regulate our own feelings throughout the day.

Just by taking a minute right now, we're going to do a quick little body scan to know what's happening in our bodies, to really softening to that moment, like I said earlier, slowing down and centering ourselves at any point of the day, but specifically right now since I'm going to ask you all to do it with me. This practice supports our well-being first, enabling us to hold a really non-judgmental space and respond intentionally and responsibly to children cues, behaviors, and communication, as we support them in building healthy relationships with each other. Get your wiggles out.

You might want to start in the seated position, or if you're laying down, maybe you're on a standing desk, I don't know, whatever feels comfortable to you and just start to slowly bring your attention to your body. You can close your eyes. I would love to close my eyes, but the blinding lights are in front of me. I won't do that. Only close your eyes if you're feeling comfortable.

And just start to notice your body wherever you are. As you inhale, and as you exhale have that really sense of relaxation. And you can notice your feet, or your body on the floor. You can notice — for me, I notice the seat underneath me or that if I lean back, the back of the chair against me. That was a lot of words I wanted to say.

Bring your attention now to your stomach area. If it feels tight, right, let us soft it. Imagine you're on a beach somewhere. I know one of our participants says they're going on vacation. Notice your hands, and your arms, and your shoulders. Let them be soft. Let your jaw and your face muscle soften up. And notice your whole body just being present. Then take that one last deep breath.

Now, if you're so inclined to, feel free to share how you are feeling during or feel now after the body scan. What shifts do you notice? Me, oh, I was like, I got a lot of things in my shoulders. I was like, I need to go to a massage place.

Becky: I was thinking the same thing. So much tension I hold in my shoulders and my neck. We're on the same page, Mike.

Mike: There you go.

Becky: As these are coming in let's start to think about problem-solving in relationship skills. Social competencies like self-regulation, empathy, perspective-taking, and problem-solving skills are all really key to foundational healthy social-emotional development. This includes positive interactions and friendships, or relationships between peers. Educators can help children learn these skills that are necessary to develop healthy peer relationships and find ways to work though social conflicts with children and providing support with the child.

The first thing that we can do with infants and toddlers is about modeling problem-solving skills. And if we model problem-solving skills early on, this will build a foundation of problem-solving and relationship skills that children can build on and will be able to access with adult support as they develop and start to use these skills more independently. As children become more independent and more mobile, they tend to run into situations in the natural environment that can lead to frustration or challenging behavior like a toy is out of my reach, or I also want to play in the sensory table and someone is already there.

If we teach children problem-solving skills and they become good problem solvers on their own, and with our support, their self-esteem increases in their ability to solve problems. They're more likely to cope with a certain level of frustration and engage in less challenging behavior. There might be some children in your care who don't readily learn these skills through foundational teaching strategies like modeling or co-regulation, and this might include children with disabilities or suspected delays.

It's important to be aware of the process of all children and use more individualized practices to teach these skills to children who need more support. And we will talk more about that in the basics. Let’s look at some key ideas. When we're thinking about working with toddlers there's three key ideas we want to think about when supporting problem-solving and relationship skills. The first one is promoting healthy relationships. Educators can model relationship skills with things like sharing or helping or cooperating like you were talking about.

Mike: Yeah.

Becky: Earlier, Mike, with everyone helping you to find your coffee, and providing comfort, and making suggestions in play, and then celebrating each other. That's a big piece of promoting healthy relationships. And teachers can also create developmentally appropriate opportunities for practicing these skills throughout the day, like setting up a space for two or three toddlers to play together at one time. There might be limited space, and limited materials. This way toddlers can practice turn taking and sharing, like we see in this picture on the left.

And we might also start to notice in the toddler years that children could be showing preferences for a particular playmate. This is also a great time to pause and think about what value do we put, or you put, on peer relationships, and how do you expect peers to act with each other? And our awareness of these questions, and our responses to these questions is really supportive of our equitable teaching practices.

Mike: Can I take the middle one?

Becky: Yeah. Yeah!

Mike: Perfect because I love teaching about problem-solving. Conflict happens all the time in case you never have been in an early childhood classroom, but I don't think this — I think this audience knows. Conflicts happen all the time in early childhood environments where children are really just learning to manage their emotions or behavior through co-regulation. Remember, these are the first times that they might be having these types of emotions. They're like, "Whoa! What is going on?”

Toddlers are beginning to reason, and really beginning to understand simple consequences. Educators can describe the problem. We can offer solutions. Then that's how we can support toddlers in trying a couple different new strategies out. Like, how I imagine as I'm looking at this middle photo, I imagine this educator something — I'm trying to channel my inner educator. "I see you reaching out and you're touching Zoa's leg. I wonder if you're wanting some more space. You can say, 'I need some more space please.'"

Becky: Yeah, totally. Thank you so much, Mike. The next key idea we want to talk about is teach problem-solving in the moment. Problem-solving is hard work as we know, and educators can help toddlers use the problem-solving steps in the moment by first being proactive and anticipating social conflicts before they happen.

This might be being close, as we see in this picture on the right, that the educator is close to the child, supporting her through this interaction. We can also provide support by describing steps for solving the problem and modeling them and supporting the child in going through them. We can also generate solutions together and then we can celebrate success.

And, of course, we want to you remember to individualize the strategies you used to provide support on these skills based on the learning characteristics and needs of the children you support. Some children may need the amount of language used to be modified. Some children may need visual cues or gestures paired with verbal language. Some children may need specific feedback on consequences to help them learn the effect of their behavior on the environment. Again, please stay tuned for the basics and we're going to share some more information about providing specific feedback.

Mike: Let's now take a second to pause and watch a clip on teaching problem-solving in the moment and how that might look like with toppers.

[Video begins]

Teacher: Are you guys taking turns? Would you like to have a turn? OK. Cayden's turn. Now, whose turn is it to put one on top?

Cayden: It's Marcos!

Teacher: It's Marcos' turn. Marcos, did you hear that? He said it's your turn.

Marcos: I make a red one.

Teacher: Your turn. Wow! Your turn! Look at how many blocks — you guys, what could you tell Ryan? Say, "Ryan, that was my tower.”

Marcos: Stop!

Ryan: That was my tower.

Teacher: Stop. That was a good word. Look it, we could get our — oh, I took my cards off. Look it, we could use our cards. We could use our cards, Ryan. Ryan, we could use our cards. Look it, what could we do? You could wait and take a turn to knock it down. Look, you have your own tower to knock down. And you guys did such a good job of ignoring him when he knocked your tower down. Nice job.

[Video ends]

Mike: There was so many wonderful moments here that I just loved. Use our Q&A, purple Q&A widget to type in what did you notice, what did you see, what did you want to express? And we'll kick us off. The first thing that I'm just thinking about is that the educator was the proximity of the educator. What's close by to really support and to anticipate — not jump in right away, but just to anticipate a little bit around problem-solving in the moment.

Becky: Yeah. Like, what we're talking about. Being close. I notice that the educator was narrating the turn-taking and supported turn-taking too.

Mike: And even when the block fell, the educator gave the child words to say and then asked for the toddler for their input.

Becky: Yes, giving the child the words to say because sometimes in the moment they don't know what to say. That's really helpful. I also love this idea of having the solution cards close by. That they were within arm's reach. She didn't have to leave the block area to go and get them.

Mike: As we think about educators and being responsive and thinking about everyone in the learning environment, really, I saw the educator also talking to all the children who were involved. It wasn't just to the child who knocked off the block. Talk to all the children involved about what they can do in order to solve this problem moving forward or next time because it will happen again.

Becky: Yes. And the educator provided positive feedback, which I saw come through the chat giving specific feedback and praise and of utilizing the solutions. We also saw that the educator was very attentive. She was calm, and encouraging, and involving everyone. More comments about being calm and a soft tone of voice which makes a huge difference.

Mike: Exactly. As we move through this presentation, and this, our time together, remember to take time — or let's do it right now. Let's take another moment to pause and reflect on these questions that will support equitable teaching practices. I think the three that you mentioned earlier were how do you expect peers to act with one another with each other? Another one that you said was — you remembered it, you said it.

Becky: Yeah, it was think about how do we feel about conflict or disagreement, or debates?

Mike: That reminds me. The last one that you said was do you listen openly to all children when there is a problem. Just keep these in the back of your mind and because we're probably going to revisit this in a little bit.

Becky: Thank you, Mike, for those reflective questions. Let's think about key ideas for problem-solving and relationship skills with infants since it’s slightly different than toddlers. When we think about promoting healthy relationships with infants, that's what the work is all about. It's all about relationships. This means modeling healthy relationships with the infants in your care so they can feel what it feels like to be in a healthy relationship. It also means modeling healthy relationships with other adults in the learning environment, so infants can see what healthy relationships look like.

Educators can create opportunities for infants to play side-by-side and interact with each other like we see in this picture on the left. The two educators are sitting close together with three infants in their laps. The infants are close enough to notice and reach out for each other, and maybe after they're done reading the book, the infants are placed on the carpet together where they can explore the books on their own and with each other.

Mike: When I just think about the other photo, this where it says, "Practice problem-solving." The one on our right, this is about being aware of infants' cues. Remembering that some infants may not give clear or predictable cues. All infants have different temperaments and varying temperaments, and that creates varying abilities to give cues.

Also, think about infants with disabilities or suspected delays. They may not be using behaviors we're typically accustomed to, such as eye gaze or vocalization, especially if they are the only — and especially if we're working with children who are typically neurotypical. It's important for adults to be very intentional about their observations and what behaviors they recognize as cues. Watch for situations that may trigger stress, or conflict, and provide comfort to those infants while describing what the problem is or was and possible solutions.

Narrate what you are doing in the moment to problem solve as you go along. Like in this picture on the right, you might say something like — I always like pretending to say something, you might say something like, "Oh, I see your holding on to this book. And this looks like it might be a problem. You both look very upset. Hmm. How about we try looking at the book together at the table?”

Becky: Right now, let's watch what promoting healthy relationships with infants might look like. As you're watching this clip, please put in the Q&A what you might say to the two infants that would help promote peer relationships.

Teacher 2: Thank you. Do you want to stand up? Do you need a diaper, Ivy? You need a diaper? She actually [Inaudible] because she was doing something at the table.

Teacher 3: Okay. You going back?

Teacher 2: [Inaudible] Wow! Look at you.

Becky: I love this video so much.

Mike: I'm, like, grinning ear-to-ear.

Becky: What did you notice, Mike, about the video?

Mike: I noticed that these two infants are playing next to each other and they're naturally sharing. They're naturally being in community with one another, which involved naturally taking turns, holding, and lifting up the basket.

Becky: It's such a beautiful moment and I love, like you said, the natural turn taking that's happening. As comments are coming into the chat, one of the things I might say to the two children in this video clip are, "Oh, I see you are both using the basket. Look at how you can take turns.”

Mike: Or I would say something like, "Oh, you two are playing next to each other.” Acknowledging this beautiful interaction, with a lot of excitement and warmth in my tone, a voice.

Becky: And yes, the tone of voice is so important because what we say is just as important as how we say it and how we say it is just as important as what we say.

Mike: And I would even say in just say the joy that's happening, because we often don't look at our Black children, our Black boys, as joyful beings. You can tie that all in together.

Becky: There's so much joy happening in this clip, but I think it gives us a both a lot of joy. Let's see in the chat we're having some comments coming in about, "Oh wow, good job sharing," or let's see here, I'm looking, there's so many things that coming up.

Mike: "It's nice to see you two playing together with the basket.”

Becky: "I see you are sitting together, and you are being kind to each other.”

Mike: "Wow, good job sharing.” And that positive tone, once again.

Becky: Yes, lots of comments about — and stating the child's names and how they are sharing the joy. It's wonderful. Keep bringing those in and our wonderful Q&A team will send them out. Mike, I want to hear more about neuroscience now.

Mike: Of course, you do. Research tells us that the early years are foundational. Most important part, especially when brain development, in adults we play a vital role in supporting a healthy brain development, connection and architecture.

In this segment, Neuroscience Nook, we are so excited to connect this research to everyday teaching practices. An important side note before we continue, and as questions using that purple Q&A widget comes in, remember we absolutely want to hear from you. We just don't want to sit here and talk, we want to hear from y'all. If you got questions, comments, concerns, thoughts, ideas, share them with us, or post them in the "Teacher Time" Community in My Peers.

Executive function. The pre-mental cortex begins to develop early on in life. This area of the brain is responsible for what are known as the executive functioning skills. And it's essential for the development of strong and healthy relationships. As you can see on this graphic, it includes so many different things.

Attention, being able to focus on a task. Working memory, being able to remember rules and procedures. Self-regulation and the ability to control impulses which I didn't have last night when I was eating ice cream. Organization, switching between tasks, flexible thinking, problem-solving, planning behavior, decision-making, motivation.

All of these skills are important to problem-solving and heathy relationships. We can help young children, support young children, to start developing this critical relationship building and problem-solving skills through responsive caregiving and affective teaching practices that are responsive to the individual child's needs. Just like we mentioned in our most recent episode of "Teacher Time," in case you missed it you can go back on…

Becky: DTL Push Play, and you can access our first two infant toddler webinars about building relationships and emotional literacy.

Mike: There you go. I always like to throw it to you because I always forget where exactly it is. But yes, just like she said. We encourage you to look back at the last two years guides, Building Relationship with Children Birth to Five, and Emotional Literacy with Children Birth to Five to see more about the importance of nurturing relationships and the impact on the developing minds. Looks like I also have the next slide. Now let's hear from Dr. Juliet Taylor as she described the development of executive functioning skills.

Juliet Taylor: I'm going to show you a graphic of how executive function develops over time. Here's sort of a graphic representation. And one thing to point out is that we are not born with executive function skills in place. We're born with the potential to develop them, or not, depending on our experiences, our neurophysiology, and the interactions between those things.

This graph shows that on the horizontal axis you can see this is ages birth to 80. And notice that there's not an even distribution between the ages. And that is because there are particular peeks in executive function development. You can see skill proficiency on the vertical axis. And I'm going to highlight a couple of areas where you see tremendous growth and executive function skills. And that is really in the preschool ages between three to five. And then in early adolescents to early adulthood, there's another spike in development.

The foundations of executive function are laid down in the earliest months and years of life. And that really happens through basic, sort of serve and return it's sometimes called, or those basic interactions between child and adult that happen over, and over, and over again. And that spike really does happen in the preschool years after children have verbal language.

Becky: This is such a helpful graphic and such a helpful explanation of executive functioning skills. I'm a visual learner, it meets my learning needs.

Mike: Exactly. We are not born with executive function, but we are born with the potential to develop them. That is why our work, whether it's your direct support, or your indirect support, or you're just hanging out in the back. It's so important that our work is with infants and toddlers to create that lifelong success. We can't say it enough to you. What you are doing is important work. I know we tired sometimes but stick with it. We love you. And thank you for being here with us.

Becky: Yes. I second that. I also, from this video, I think about these peeks in executive functioning that there's a peek between three to five years old right after children have verbal language. And toddlers are just entering into that spike in executive functioning skills which is —I love thinking about that and what does that mean, and what does that mean for toddler behavior, and toddler development.

Mike: And the last two things that are really coming up for me in this one is the foundation of executive function is laid out in the very few first months and years of life. Learning is having in the room and right out as soon as you leave. I was like, I don't know how I'm going to work that. The last thing I was thinking of is the importance of serve and return. If you're like, "What is serve and return?” You know where you can find that? In our last webinar that we did.

Becky: In our "Building Relationships with Infants and Toddlers," we talk a lot about serve and return. Now it's time for the basics. We've talked a lot about the importance of problem-solving and relationship skills. Let's shift to looking at practical strategies for how to support these skills with infants and toddlers.

We're going to do that by getting back to the basics. The basics are a collection of strategies that could be used in any setting with infants and toddlers. And the "Teacher Time" basics are behavioral expectations in advance, attend to and encourage positive behavior, scaffold with cues and prompts, increase engagement, create or add challenge, and provide specific feedback.

In this season of "Teacher Time," we have been focusing on two letters of the basics every episode. We hope that you will join us for all of the webinars this season. And remember, if you've missed the last two webinars on building relationships and emotional literacy with infants and toddlers, you can access those on DTL Push Play. We invite you to tune in to our future webinars. There's a registration link in the resource list if you want to sign up for that now so that you can get all of the basics of positive behavior of sorts.

Today, we're going to be looking at examples of C, create, or add challenge and S, specific feedback to support problem-solving and relationship skills. Let's take one look at how we can create or add challenge. When we're thinking about supporting problem-solving and relationship skills, we can add challenge by carefully selecting toys and materials for the learning environment that support taking turns, waiting, and learning how to share.

This might look like putting out a ball track, or a car track, or a toy that naturally supports turn taking where the children have to wait before sending a ball or a car down the track, or where one ball or one car will fit on the track at a time. Or maybe you put out stacking rings and encourage children to stack together since only one ring could be stacked at a time like we see in this picture on the left.

You could also create waiting games with the materials and routines that you have in the learning environment, like waiting to go down the slide or waiting to go through the tunnel like we see in this picture on the right. You might also sing a song while you wait to wash your hands, or like one of our participants said in the beginning, you have a greeting song in the morning where the children have to wait to do their special dance, or their special move until they hear their name.

Mike: I think that is a great segue, it's almost like you've seen this before, into us watching a video of what a waiting game might look like in the learning environment with a toddler. As you watch the video, we invite you to share once again in the Q&A how you see the educator supporting waiting, and what would you do to support toddlers with waiting in your program center?

Teacher 4: OK, one, two, three, go!

Connor: Whee!

Teacher 4: Good job, Connor.

Teacher 5: You want to count? OK. One, two, three, four, five, go!

Teacher 5: Yay! One, two — Oh, she couldn't wait, could she? She just couldn't wait. That's fine. She went on two. That's good. You want to count? Ah! Hailey didn't want to wait either. That's fine.

Mike: You can see right away, like you heard the counting, the toddler is down before they can actually go down the slide.

Becky: And I loved that the educator honored when the toddlers did wait and when they just couldn't wait. And she said, "Oh, she couldn't wait. That's fine.”

Mike: And it looks like someone in our chat just beat us to it before we said that. There's so much waiting to happen in this video in taking turns, waiting at the top of the slide, toddlers waiting for their turn.

Becky: There’s so much and it felt like this was a very natural turn taking game for this group of toddlers. It felt like it was familiar to them. And it felt like it was something that they were enjoying.

Mike: And just thinking about like my own culture being Afro-Caribbean, in my culture we love to give children control over the waiting time. They want to wait until they are down the slide, the first child is down the slide to climb up, they have that control. Or we'll say, "Hey, how many seconds do you think we should wait?” We're giving them that power, that control.

Becky: I love that. The real traces and the agency. We have a few comments coming in from the chat. Just the encouragement and patience from the educator. That there was a countdown as a verbal strategy and we also saw that the educator was giving examples of waiting, like naming who waited and who couldn't wait.

Let’s  think about specific feedback and providing specific feedback is another way that educators can support problem-solving an relationship skills. Providing specific feedback is about naming and acknowledging when you see a child engage in building relationships.

It might sound like, "Oh, you're helping me put on Natalie's coat.” Or "I saw you get a tissue for Kai. That was so kind.” And the key to specific feedback is being specific. Thinking about what you see and what you saw that toddlers or infants do. Educators can also provide specific feedback to a child when they see them taking turns or sharing, or trying to solve a problem, or playing next to each other, or even playing with a child. That might sound like, "Oh look, Nora is watching you. I think she wants to play too.”

And providing specific feedback is a helpful tool to teach children what to do. You might provide feedback on how to be a friend, or how to solve a problem like, "Hmm, I see that you two are frustrated and have a problem. Let get our solution kit for some ideas.” Or you might say, "Oh, you knocked into Lucas because you were running, and you didn't see him. Let's see if he's okay.”

It's about offering specific ideas of what the toddler can do next and then supporting the infants and toddlers with those next steps and those skills. Remember that, again we said this earlier, how feedback is given, including what you say and how to you say it is important and should be individualized to meet the learning characteristics and temperament of each child.

Mike: Do you remember those three questions I asked earlier? Or you asked them and then I reiterated them? Here's where it comes up again. Three questions. How do you expect peers to act with one another? How do you feel about conflict? And do you listen openly to all children? This is where we are going to apply them.

In our segment Small Change Big Impact where we share how small and adjustments to the way we set up our learning environments, modify a curriculum, or engage with children can make a huge difference in a child's learning. We know that children vary in their learning characteristics and how they engage with people, and materials, and learning environment.

These small changes, and these curriculum modifications are made so that the individual child -- they're made thinking about the individual needs of a child in order to promote their engagement, their participation, and we know that children are more engaged when they have opportunities to learn.

Some children might need more highly individualized teaching practices to help them learn problem-solving such as imbedded teaching or intensive individualized teaching, making curriculum modifications based off a child's individual learning needs can be a great place to start to support this engagement.

Today we're going to be focusing on environmental supports like making physical adjustments to the learning environment to promote participation, engagement, learning problem-solving, relationship skills, the two things of today's talk. When you think about the strategies of physical adjustments, I would love for us to consider changing the space, the location, and arrangement of materials, of activities, to really support the needs of individual children. Like, setting up the smallest space, for example, for a few toddlers to sit together and read a book, or a small sensory table where a few children can play together at the same time. Do you got any ideas?

Becky: I think about managing materials and supplies. Materials could be used in many ways to support individual children with problem-solving and relationship skills. We can think about adding in materials, taking out materials, varying materials, and strategically using the materials to support a desired behavior. You might take out some materials to encourage sharing and turn-taking between toddlers, or you might bring in materials that support waiting. Like, we talked about in the basics.

Or maybe, you set up larger items like tumbling mats, or a large balance beam like we see in this picture in the middle where one child is walking at a time and one child takes a turn at a time. You could also bring in materials that are more engaging and fun with two children, like a rocking boat, or a toddler-safe seesaw.

Mike: For our last one, you can always add visual cues. You could add simple ones. You could add complex ones. I don't know. Do you. Individual cues can really promote relationship between peers and problem-solving skills like sharing a hug or giving a high-five.

Once again, check out the viewer's guide for more suggestions and resources on ECLKC. We encourage you to observe each child to see how they engage in specific areas with a group, and with each other. This can help us think about what are some of the best ways to support the child in building peer relationships and problem-solving skills by individualizing the support that you provide and how to you modify the environment.

Once again, viewer's guide has all these information and tips and tricks of the trade. Let's take a break. Well, we're going to take a break. Y'all aren't going to take a break. To watch a video of how an educator intentionally changes the setup of the environment to support her interactions. And of course, whatever comes to your mind, type it into your purple Q&A widget.

Teacher 6: There we go. Are you ready to make soup? Come here. Oops. This one is not broken. We can put water in it. We can hold water. Ready? Oh, Joy wants to do it. Joy, do you want to put some water in here?

Boy: I would.

Teacher 6: You want to help, too? Can you wait one minute? Just wait for Joy's turn? Oh, I don't think she liked that. Can you give it back to Joy, please? Oh!

Teacher 6: What happened?

Mike: This educator knows how much the toddlers at the table loves to play with water. To support this toddler were peer interactions and relationships. The education staff set up the water vents near the dramatic play areas. Did you notice that? Where two toddlers were making soup.

Becky: And as we got to see the children interacted with each other and the soup making moved from the dramatic play area to the table. The educator really supported turn taking at the end of this clip when she narrated what was happening, she used sign language, and asked specifically asked one toddler to give the scoop back to another toddler. We saw a lot of individualizing practices in this video where thinking about a child's interest, thinking about some games that other children were playing, and how we can bring those two together.

Mike: If you are in my classroom, we're making caldo, we're making pozole. But that's neither here or there. Throughout this webinar we have been discussing ways to foster social-emotional skills for all children. Becky, what are we going to talk about more in this segment?

Becky: Thanks, Mike. We're going to think about those reflective questions that we've been mentioning throughout the webinar. In our focus on equity segment, we're going to be using our equity lens to take a closer look at implicit bias and how that impacts how we interact with children and support them in building problem-solving skills, and relationship skills. The value we place on peer relationships and the way we go about building and maintaining them are influenced by our family, our culture, our community, and our experiences.

Sometimes our subtle biases can interfere with our ability to approach conflict between children with an open mind and help them solve problems in a way that is respectful and fair to all children involved. Uncovering these biases take time and reflection. Again, some of these helpful questions to reflect on are — what value do you place on peer relationships? How do you expect peers to act with each other? How do you feel about conflict, disagreements, or debates?

Mike: Do you listen openly to all children when there is a problem?

Becky: And is there a child that you are more likely to make negative assumptions about when a problem involves that specific child? We just encourage you to ask a friend, or a colleague, or a coach to video record you during a time of day when there tends to be more conflict between children. Then go back and watch the video and notice how you respond and interact with each child involved in the conflict. And again, ask yourself, "Does every child receive the support and instruction they need?”

Mike: I am just a little bit excited for this because I'm featured on it. "Teacher Time Library," Emily Small, with someone you clearly recognize that you see in this video, me, Mike Browne, I got to sit with our "Teacher Time" librarian, Emily, and I'm so excited about this month's book. Let's watch me, Emily, make the CASE.

Mike: Welcome to "Teacher Time Library.” My name is Mike Browne. My pronouns are he/him and I'm joined by the wonderful...

Emily Small: Emily Small. And my pronouns are she/her.

Mike: I am so excited to be here today with you all because we have a great selection of books that Emily has curated to be able to share with us today. And it is all centered around our theme of relationships with other children, which is within the social-emotional development domain of our ELOF goals.

Today, we are going to make the case. The CASE, what is that? You might be unfamiliar. You might not. But either way I'm going to refresh your memory. CASE is an acronym that we love to use in order to make connections between the books and what we're trying to hope to achieve within our ELOF domain.

C is pretty simple, C for cookie, also means connecting to ELOF, which is our Early Learning Outcome Frameworks. A, which is about advancing vocabularies. Books are an amazing opportunity. It is both a window, a mirror, and a sliding door into worlds that can really build children's emotional language, vocabulary, and concept development.

S, now this one is a bit of a long one, but it's about supporting engagement. And engagement looks different for each and every single child. Books stirs creativity. It stirs or imagination and by listening to the voices of children, we can really find ways to support them in being active participants not just in their learning, but of their learning environment.

And last but not least we have E. E is about extending the learning well beyond the books. Think about the questions in your curriculum, your provocations, and the activities that you do each and every single day. How can you plan that, so it connects to STEM? How can you use STEM to connect to dramatic play. How can you connect dramatic play to mental health? And so on and so forth because we're all about loving and nurturing the entire child. But that's enough about me, we going to throw it over to these books. And this first one is my favorite, not just because we are matching.

Emily: Yes, we do match today. A quick note before we get into them. I actually borrowed these from my local library. But also, I encourage everyone to check out their local library rather than just having to purchase the items.

Emily: Our first one is "Blocks" by Irene Dickson. We have two friends, Ruby and Benji who are in parallel play with one another in the block area. Benji would really, really like one of Ruby's red blocks and he takes it. And we see what happens next. How they problem solve, how their peer relationship grows, and then we actually have a third friend enter the picture at the end named Guy. There's a chance to make a prediction about what will happen next.

Mike: STEM.

Emily: Yes. We have that nice high gloss cover, we've got "Mine, Mine, Mine, Yours" by Kimberly Gee.

Mike: We hear, "Mine, mine, mine" a lot with toddlers.

Emily: Yes.

Mike: Not so much "Yours," but that's okay.

Emily: We have some great examples in this one of some repetitive phrases on every page. For instance, we have "Jump, jump, jump, bump.”

Mike: That happens.

Emily: All the time. And then we have "Sorry, sorry, sorry.” "That's okay.” But in the pictures, we're seeing a chance for the children to check in on one another.

Mike: And I think that's so important. Especially when we're talking about social-emotional development is that it's not just enough to say, "Sorry," but how are we also coaching in educating our children in order to say, "Hey, check in, what do you think might help them feel better?” We can take it to another level.

Emily: Definitely. That's "Mine, Mine, Mine, Yours.” Then we have this tiny little board book called "The Last Marshmallow.” It's part of the Storytelling Mass series. There's a bunch in this series. I highly recommend them. You can, again, see I borrowed it from my library. And it is a very cold day, just like it is today, and some friends would like two cups of hot chocolate but there's three marshmallows.

Mike: I'm already hearing the STEM, the math right there.

Emily: They each get one but there's one left and they have to problem solve to figure out how they're going to make this fair.

Mike: Oh, like you said, it's a very cold day, give it to me.

Emily: That's the "The Last Marshmallow" by Grace Lin. And then the one we're going to make the case for is "You Hold Me Up" by Monique Gray Smith and Danielle Daniel. This one, I love the illustrations in this book so much. For our connection, our C, this book uses the phrase, "You hold me up when," and then it gives us very specific examples of how people feel connected and respected to one another. For our advanced vocabulary, we see words such as kind, learn, respect, comfort. Those are great words to be using as part of your daily routine with children.

For our S for supporting engagement, the words on the page reference the illustrations but they don't say specifically what's happening. As children are showing interest in them, talk about what is going on in the illustration. We're seeing this family it looks like baking together. You can comment on that.

Mike: You can even talk about how the intergenerational family is well in this one.

Emily: Yes. There's multiple images throughout this book that show intergenerational families. And then for E, extending the learning, one of the other examples they give is "You hold me up when you sing with me," and so, we know that singing is a great thing to do with infants, especially for those early verbal skills. I would encourage you to incorporate some singing and then of course some musical instruments as well.

Mike: You can even point out and say, "Oh, what type of instrument do you think this is?” And it's perfect because there's this book that was written and illustrated by First Nation People. You can talk about Indigenous people and how they're still alive and they're thriving. There's multiple ways to tie in so many key concepts.

Emily: Absolutely. That's "You Hold Me Up" by Monique Gray Smith and Danielle Daniel.

Mike: Now, what we don't have is one of my other favorite books and that's "Kindness Makes Us Strong," which you can always pick up at...

Emily: Your local library. It comes in a really nice big board book format which is great for both reading individually with children or in a group setting.

Mike: Well, I don't know about you, Emily, but I am ready to go read some books...

Emily: Awesome.

Mike: ...to color, to do it all. Maybe not first. Right now, we are going to say goodbye. But until next time, take care of yourselves and we can't wait. We are wrapping up today's episode and I can't wait to check out my local library to see all those great books that they have. Remember to check out the viewer's guide for complete book list. And if you work with toddlers, Emily also made the case for another book not shown here, "Kindness Makes Us Strong.” Again, all the info is in your viewer guide.

Becky: We just want to say thank you so much for joining us today. We are so excited that you are here and I also want to invite you to next months "Teacher Time" webinar, "Problem-Solving and Relationship Skills in Preschool.” And you can find the registration link in your Resource List Widget for the next three "Teacher Time" webinars. Sign up now. We hope to see you there.

We are also excited to let you know about our Dual Language Celebration Week coming up. Please make sure to register for that as well. And that widget is going to pop up on your screen right after we say goodbye. Thank you so much and we just can't wait to see you until next time.

Mike: Happy Black History Month, everyone. Happy Dual Language Learner Celebration Week. Until next time.

Children are born ready to solve problems! Infants and toddlers rely on supportive relationships to learn how to recognize problems and find solutions. Problem-solving involves patience, persistence, and creativity from both the child and the adults in their lives. As infants and toddlers explore their world and engage in play with peers, challenges and conflicts provide opportunities to learn and grow. Discuss practical strategies to foster problem-solving and relationship-building skills with infants and toddlers.

Note: The evaluation, certificate, and engagement tools mentioned in the video were for the participants of the live webinar and are no longer available. For information about webinars that will be broadcast live soon, visit the Upcoming Events section.

Video Attachments

• Webinar Slides (579.91 KB)
• Viewer's Guide (1.31 MB)

Resource Type: Video

National Centers: Early Childhood Development, Teaching and Learning

Age Group: Infants and Toddlers

Audience: Teachers and Caregivers

Series: Teacher Time

Last Updated: December 18, 2023

• Privacy Policy
• Freedom of Information Act
• Accessibility
• Disclaimers
• Vulnerability Disclosure Policy
• Viewers & Players

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• PMC10271908

Parent Management Training Combined with Group-CBT Compared to Parent Management Training Only for Oppositional Defiant Disorder Symptoms: 2-Year Follow-Up of a Randomized Controlled Trial

Maria helander.

1 Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 65 Solna, Sweden

2 Stockholm City Council Child- and Adolescent Psychiatry, Stockholm, Sweden

Pia Enebrink

Clara hellner.

3 Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden

Johan Ahlen

4 Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden

5 Department of Global Public Health, Karolinska Institutet, Solna, Sweden

Associated Data

Parent management training (PMT) is recommended treatment for children with oppositional defiant disorder (ODD) and child-directed cognitive behavior therapy (CBT) is also recommended for school-aged children. The current study examined 2-year follow-up effects of parent management training (PMT) combined with the CBT based group intervention Coping Power Program (CPP) compared to PMT only. Results showed long-term effectiveness of both PMT and PMT combined with CPP in reduced disruptive behavior problems and harsh parenting strategies, and increased emotion regulation- and social communication skills. The earlier reported increase in emotion regulation- and social communication skills in the PMT with CPP condition during treatment remained stable while the PMT condition showed continued improvement during the follow-up period. To conclude, PMT with CPP did generally not provide significant benefits at the 2-year follow-up compared to PMT, apart from an improvement earlier in time regarding emotion regulation- and social communication skills.

Trial registration number ISRCTN10834473, date of registration: 23/12/2015.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10578-021-01306-3.

Disruptive behavior disorders such as oppositional defiant disorder (ODD) [ 1 ] and conduct disorder (CD) [ 1 ] have increasingly been recognized as a major public health concern [ 2 ] and are associated with a range of comorbid psychiatric disorders such as mood disorders, anxiety disorders, and substance use disorders [ 3 , 4 ] and with a large financial and societal burden [ 5 , 6 ]. Oppositional defiant disorder (ODD) [ 1 ] is one of the major causes for contact with child- and adolescent psychiatry and has a lifetime prevalence of 10.2% [ 3 ] and children with an ODD diagnosis have an increased risk of developing CD and associated antisocial behaviors [ 7 ]. Prompt and sustained treatment effect for disruptive behavior disorders is essential to reduce risk of future antisocial development, individual suffering, and the immense societal costs associated with an antisocial development [ 6 ].

Parent Management Training (PMT) is recommended treatment for children up to 12 years of age with disruptive behavior disorders [ 8 ], a term summarizing both ODD, CD and Disruptive behavior disorder NOS, and has shown medium effect sizes in numerous meta-analyses on reduced disruptive behavior [ 9 – 14 ], medium effect sizes on improved parental strategies [ 15 – 17 ] and small effect sizes on mental health, including parental stress [ 15 , 17 ]. The long-term effects of PMT on disruptive behavior have been examined in a few meta-analyses showing sustained effects. One meta-analysis, Van Aar et al. [ 18 ], included RCT studies and evaluated long-term effects using within-group effect sizes up to three years after treatment. In the Van Aar meta-analysis, including both intervention trials (clinical level of disruptive behavior problems; n  = 10), pure prevention trials (including children without clinical levels of disruptive behavior; n  = 3) and trials in between (including children with differing levels of disruptive behavior; n  = 27), a sustained effect of PMT was identified, regardless of the initial levels of child disruptive behavior problems. When it comes to long-term effects of PMT on parenting strategies examined in a meta-analysis on clinical and sub-clinical disruptive behavior, no parenting program techniques were associated with stronger long-term effects [ 10 ].

Another meta-analysis, Fossum et al. [ 19 ], included studies on children with clinical levels of disruptive behavior and evaluated the long-term effectiveness of PMT together with other types of treatment modalities (child CBT, PMT with child directed CBT and family focused treatments). Sustained treatment effects were shown on conduct problems in within group comparisons. A limitation with the Fossum study was the inclusion of non-RCT studies and the inclusion of different treatment modalities alongside PMT in the analysis, making the specific long-term effects of PMT harder to distinguish. In conclusion, very few studies on long-term effects of PMT on disruptive behavior disorder symptoms, with intact randomization exists.

Apart from PMT, clinical guidelines recommend child directed treatment, child-CBT, which teaches children anger management and social- and cognitive problem-solving skills [ 8 ]. Lochman and colleagues have stated that emotion regulation, specifically anger control, is a key to the successful decrease of conduct problems [ 20 ]. Training in social problem-solving strategies has been found to increase emotion regulatory skills that in turn lead to reduced irritability [ 21 ]. The ability to monitor and regulate one’s own negative emotions reduces aggressiveness and in fact, the mere awareness of angry emotions and attempts to generate strategies, seems to suffice to decrease aggressive responses [ 22 ]. This is of importance since aggressive behavior is found to be related to peer rejection [ 23 ] and peer rejection is, together with problems with social information processing, reciprocally associated with further increased aggressive behavior [ 24 , 25 ]. One type of problem with social information processing that has been associated with peer rejection is hostile attribution bias, i.e., the tendency to attribute benign or ambiguous social situations and cues of others as more hostile than intended, and with a tendency to generate fewer and more hostile responses to social situations [ 24 ]. In a recent meta-analysis, a robust association was found between childhood aggression and hostile attribution showing that the relationship between aggressive behavior and hostile attribution was stronger in emotionally engaging situations [ 26 ]. In child CBT treatment, the components that target these difficulties include emotion awareness, emotion regulatory skills, social- and cognitive problem-solving skills training and perspective taking.

The effectiveness of PMT combined with child CBT compared to PMT only on disruptive behavior problems has been examined in a few intervention studies: in a group setting for younger children 4–8 years [ 27 , 28 ] and in an individual format for children aged 8–12 years [ 29 ]. One-year follow-ups of child CBT and PMT compared to PMT effectiveness have shown mixed results. Two of the studies showed significantly reduced behavior problems in the combined treatment compared to PMT only [ 28 , 29 ] while one of the studies showed no significant differences between the combined versus the single treatment in behavioral outcomes [ 27 ]. In addition, PMT combined with child CBT has also been found to increase social skills [ 28 , 29 ] and to improve parental strategies [ 27 ]. Long-term effects of group-based child CBT combined with PMT have not been examined for children aged 8–12 on clinical levels of disruptive behavior disorders.

For clinical utility, there is a need to differentiate between treatments that generally work for a disruptive child and her/his family, and how treatments work when individual characteristics are considered. In meta-analyses, PMT programs have been found to be equally effective for families with high and low socioeconomic status immediately post treatment [ 30 , 31 ], but treatment gains were harder to sustain for disadvantaged families [ 31 ]. Parental level of education has further not been found to moderate treatment results [ 32 ]. Concerning child characteristics, severity of child behavior problems before PMT is initiated has been associated with larger reductions in behavior problems [ 32 , 33 ]. A high number of ODD symptoms in childhood has been associated with increasingly poor functioning in relationships with peers, partners and parents in adult life [ 34 ]. Child age [ 35 ] and gender differences [ 18 ] have been reported not to moderate treatment effects in meta-analyses examining PMT effectiveness in clinical and subclinical populations. Further, a common comorbid diagnosis with disruptive behaviors is Attention Deficit Hyperactivity Disorder (ADHD) [ 1 , 4 ]. Comorbid ADHD has not been found to moderate treatment effects of PMT in an individual participant data meta-analysis [ 36 ]. To conclude, a firm knowledge base supports short term treatment effectiveness of PMT for treatment of children with disruptive behavior. There is however a need for studies that shed light on the long-term effectiveness of PMT in clinical samples, as well as PMT in combination with group child CBT, and studies that investigate the moderating effect of baseline characteristics of children.

The current study presents data from a 1- and 2-year follow-up of a clinical trial conducted in Swedish child- and adolescent psychiatry [ 37 , 38 ]. In the trial, children aged 8–12 diagnosed with ODD, CD or disruptive behavior NOS, were randomized to (1) the Swedish group-based PMT program KOMET or (2) to KOMET combined with the child group-based CBT program, Coping Power Program (CPP), in this article called KOMET with CPP. Komet is a Swedish group-based PTP program for parents that consists of 11 group sessions of two and a half hours each with 6 families (parents of 6 target children) in each group [ 39 ]. The Komet program includes the treatment components found in most PMT programs aiming to increase positive parent–child interaction and reduce disruptive behavior: Play or positive time together with the child, training in giving clear instructions/commands, praise and rewards to increase reinforcement on positive behavior, reducing the reinforcement of negative behavior by not focusing on minor disruptive behaviors, handling anger outburst calmly, and using non-punitive consequences. The child CBT program used was the child-component of CPP [ 40 ]. The CPP is a manual-based group CBT intervention for children 8–14 years old. In CPP, children are trained in emotion regulation, anger management skills, social problem-solving skills, perspective taking, social skills and handling group pressure.

As previously reported, the effectiveness pre- to post treatment showed no significant differences in behavior problems post treatment, while social skills were significantly increased in the KOMET with CPP group compared to KOMET only [ 38 ]. In moderator analyses, children with high levels of behavior problems, manifested by high number of ODD diagnostic criteria fulfilled according to clinician-rated diagnostic interview, and children with high levels of clinician-rated risk for future antisocial development, benefitted significantly more from the combined treatment group compared to PMT only in reduced behavior problems. In addition, the group of children with a high number of clinician-rated ODD symptoms benefitted more from the combined treatment compared to PMT only in significantly increased social skills.

Aims and Research Hypothesis

The overall aim of the present study was to investigate the treatment effects from treatment termination to the 2-year follow-up of KOMET with CPP compared to KOMET only in reducing child conduct problems and increasing social skills, as well as in improving parenting behaviors. Our first hypothesis was that the combined treatment, KOMET with CPP would be more effective in reducing child disruptive behavior compared to KOMET only in the long-term. Our second hypothesis was that the significantly increased social skills at post assessment for children in the KOMET with CPP-group compared to KOMET, would be sustained during follow-up. Our third hypothesis was that the combined treatment would yield less parental stress and improved parental strategies compared to PMT only during the follow-up period. Our fourth hypothesis was that for children with severe ODD, the significantly reduced behavior problems and increased social skills post treatment would remain during the follow up period. We further hypothesized that there would be no moderator effect of comorbid ADHD, prescribed medication at baseline, or gender.

Trial Design

The study was a 2-year follow-up of a clinical study with a randomized controlled design. In the present study, the data analyzed are parent rated questionnaires collected at baseline (T1), post treatment (T2), one year after treatment termination (T3), and two years after treatment termination (T4). The study was approved by the regional ethics review board in Stockholm and registered on Current Controlled Trials www.isrctn.com (ISRCTN10834473).

Participants

A total of 120 children, 8–12 years old, diagnosed with ODD, ODD combined with CD or disruptive behavioral disorder NOS, were enrolled in the study. Exclusion criteria were (a) autism (b) intellectual disability or (c) severe other psychiatric comorbid disorders that required treatment. See Table ​ Table1 1 for participant characteristics. For the present study, parent-rated baseline data were available for 118 children (KOMET, n = 55 and KOMET with CPP, n = 63), since in two cases, parent-rated data was lost at baseline due to an administrative mistake. In the KOMET condition 29 (52.7%) of the families randomized participated in assessment at T3 and 31 (56.4%) at T4. In the KOMET with CPP condition, 42 (66.7%) of the families randomized participated in assessment at T3 and 52 (82.5%) at T4. In Fig.  1 , the flow of participants from inclusion to the 2-year follow-up is illustrated.

Characteristics and demographics of participants included in the study

ODD = Oppositional Defiant Disorder; DBD NOS = Disruptive behavior disorder not otherwise specified (in this study children who fulfill 3 diagnostic criteria of ODD); 7 or 8 ODD symptoms = children who fulfill 7 or 8 DSM-5 diagnostic criteria for ODD; CD = Conduct disorder; ADHD = Attention Deficit Hyperactivity Disorder; Parents with post graduate education = Proportion of parents with university level of education

* p- value based on Fisher’s Exact Test

Children were recruited from six child- and adolescent psychiatric outpatient clinics in mid-Sweden. For the present study of follow-up effects, parents filled out rating scales through an internet-based secure homepage. The follow-up assessments were part of the trial design, to which the parents had given their consent. The parents were given the option to fill out rating scales in paper format, and if that format was preferred the material was sent via regular mail with a pre-payed return envelope. In the case parents did not fill out the questionnaires, contact was made via phone to see if help was needed with login, other technical support or if there were other reasons for not completing the questionnaires. In the case both parents had filled out the rating scales at all time points, data from one parent was randomly chosen to be included in the dataset. In the case one parent had filled out the rating scales at more time-points than the other, this parent was chosen to be part of the follow-up dataset. Compared to the pre-post study, 18 of the parents were interchanged to include the parent that participated with most data.

The PMT program used in this study was the Swedish PMT program KOMET [ 39 ]. KOMET is a group treatment for parents, led by two group leaders, consisting of 11 group sessions of two and an half hours each with six families (parents of 6 children) in each group. The child CBT program used was a Swedish adaption of the child-component of the Coping Power Program, a manual-based group CBT intervention for children 8–12 years old [ 40 , 41 ].

Primary Outcome Measure

The primary outcome in the present study was the oppositional/defiant subscale of the Disruptive Behavior Disorder rating scale rated by parents (DBD-ODD) [ 42 ]. The ODD subscale consists of eight items that corresponds to the diagnostic criteria of the ODD diagnosis ranging from range from 0–3, from “not at all “ to “very much”. (Chronbach’s alphas at T1-T4 ranged from α  = 0.79 to 0.90 from pre to 2 years follow-up).

Secondary Outcome Measures

Social skills were measured with three different measures. The first, the Social Competence Scale-Parent version (P-COMP) [ 43 ], was a 12-item-scale that assesses child emotion regulation skills such as “controlling temper when there is a disagreement” and prosocial communication skills such as “resolves problems with friends alone”. The measure has a 5-point scale, from “not at all” to “very well” ( α  = from 0.84 to 0.90). The second measure was the SDQ prosocial scale [ 44 ] which captures a child’s capacity to consider other people’s feelings and child helpfulness towards others such as “helpful if someone is being hurt” and “kind to younger children” ( α  = from 0.70 to 0.75). The third measure was a modified version of the Social Skills Rating System (SSRS) [ 45 ], which captures prosocial competence such as helping others, complying with rules, asking others for information, ability to communicate with adults and responding appropriately to teasing. In the present study the total scale was used ( α  = from 0.82 to 0.90).

To assess parental strategies, we used the Parenting Practices Interview (PPI) [ 46 ]. In the present study, two subscales were used: the Harsh and inconsistent disciplines subscale that assesses harsh as well as submissive responses to child misbehavior (15 items, α ranged from 0.76 to 0.83) and the Praise and Incentives subscale (11 items, α ranged from 0.70 to 0.74) that evaluates the extent to which parents responds with hugs, praises, and rewards when a child shows desired or expected behavior.

To assess parental stress, we used the Perceived Stress Scale (PSS) [ 47 ]. This is a 14-item scale targeting the degree to which situations in life are appraised as stressful. In the present study a short version of 10 items was used (range 0–4 from “never” to “very often”, α ranged from 0.84 to 0.89).

Moderators/Predictors of Treatment Effects

The moderators investigated in this study were clinician-rated severity of ODD, ADHD, prescribed medicine at baseline, and gender. The severity of ODD at baseline was evaluated with the Kiddie-SADS, Present and Lifetime Diagnosis (Version P/L), a semi-structured diagnostic interview [ 48 ]. The assessments were made by psychologists with several years of experience from clinical child and adolescent psychiatry. To identify children with the most severe problem level, the number of ODD diagnostic criteria fulfilled was used to divide the sample into two groups: (1) light to moderate problems with three to six diagnostic criteria fulfilled ( n  = 91) and (2) severe problems with seven to eight diagnostic criteria fulfilled ( n  = 27). This dichotomous variable was then entered as a moderator in the regression analyses. In addition to the dichotomization into two groups, we also explored number of criteria as a continuous moderating variable (e.g., values between three and eight). ADHD diagnosis at baseline was evaluated with the Kiddie-SADS. Prescribed medicine was measured using a dichotomous question (yes/no) at baseline, where parents were asked if their child had any prescribed medicine that they took regularly.

Data Analysis

Statistical analyses were performed in SPSS version 25 and in the R software program [ 49 ]. Linear mixed models (LMM) were applied to analyze the long-term effects of the two treatments. LMMs are adequate when analyzing repeated measurement data and also involve the benefit of not deleting participants with an incomplete number of observations [ 50 ]. In the analysis of long-term treatment effects, we performed the LMMs in two ways. First, we examined treatment effects over the whole time period (T1 to T4). Due to the partly large amount of attrition during the follow-up period, we additionally explored attrition and its possible effect on the long-term outcome. Following the procedure described by Hedeker and Gibbons [ 50 ], we entered a dummy-coded variable of attrition (that is, missing or non-missing at the 2-year follow-up) into the LMM evaluating the outcome. Then, we specifically examined the treatment effects over the follow-up period (T2 to T4) in segmented LMMs, that is, partitioning the time variable into a separate treatment-interval, and a follow-up interval. Additional analyses controlling for the attrition effects were not possible to perform on the follow-up period as participants with missing data did not contribute to the follow-up data. Effect sizes (Cohen's d ) were estimated based on the beta-estimates obtained from the LMMs. Thus, within-group effect sizes were calculated by multiplying the beta-coefficient of time with number of months (to estimate the change in scores over the whole time period), and dividing with the pooled standard deviation of the measure at the pre-assessment [ 51 ]. Between-group effect sizes were calculated similarly, however, by using the time by treatment interaction beta-coefficient. To explore possible effects of the heterogeneity of the study sample, we additionally ran sensitivity analyses for all outcome measures excluding participants with a comorbid conduct disorder and participants with a DBD-NOS diagnosis.

Further, we examined the Reliable Change Index (RCI) [ 52 ] to interpret the clinical significance of the effect in parent-rated ODD symptoms. Children whose parents completed the 2-year follow-up assessment were categorized according to four categories: recovered; improved, unchanged, or deteriorated. Children who were reliably changed between T1 and T4 and moved from a clinical population to a non-clinical population were categorized as recovered. A reliable change was defined as the difference in the DBD-ODD scale between T1 and T4, divided by the standard error of the measure. An RCI below -1.96 or above 1.96 was considered a reliable statistical change at p  < 0.05. A clinical population was defined as scores at or above the 95th percentile on the ODD-scale [ 42 ], gender and age-specific, in a Swedish normative sample (unpublished data). Children who showed a reliable decrease but did not move from a clinical to a non-clinical population were categorized as improved. Children with no reliable change were categorized as unchanged, and children with a reliable increase of symptoms were categorized as deteriorated. Differences between groups were not tested using inferential statistic tests due to low power. We described the proportions of children in the different categories for both treatment arms separately, and also by subdividing into high or low clinician-rated baseline ODD.

Attrition Effects

Of the 118 children with complete baseline data, 71 (60.2%) participated in the one-year follow-up and 83 (70.3%) participated in the 2-year follow-up. A Chi-square test showed no significant difference between the two treatment conditions in proportion of participants lost to follow-up at one-year follow-up (KOMET n  = 26 [47.3%], and KOMET with CPP n  = 21 [33.3%]). However, at the 2-year follow-up there was a significantly larger proportion lost to follow-up in the KOMET condition ( n  = 24, [43.6%] compared to KOMET with CPP n  = 11, [17.5%], p  = 0.002). To understand differences in patterns of attrition between the two treatment conditions, we analyzed baseline descriptive statistics by missingness separately for each treatment arm (see Table ​ Table2). 2 ). First, in the KOMET condition only, a Chi-square test showed that a larger proportion of girls than expected was missing at the 2-year follow-up. No such difference was found in the KOMET with CPP condition. Further, in the group missing in the KOMET condition, there were significantly higher levels of baseline disruptive behaviors (DBD-ODD), significantly lower emotion regulation- and prosocial communication skills (P-COMP), and significantly higher skills in the positive parental strategies using praise and incentives (PPI Praise) compared to completers at the 2-year follow-up assessment. In the KOMET with CPP condition, there was significantly lower baseline prosocial competence (SSRS) in the group missing at follow-up, compared to completers. This indicates that families in the KOMET condition who completed the follow-up assessment differed from the original sample, with lower levels of child behavior problems, higher child emotion regulation- and social communication skills as well as more reported use of parental praise and incentives.

Attrition analysis of baseline data for study completers versus families missing at the 2-year follow-up

a Families with data at the 24-month follow-up assessment

b Families with missing data at the 24-month follow-up assessment

c Difference between Completers and Missing. Welch two sample t-tests for continuous variables and Fisher’s Exact Test for categorical variables

* p  < .05, ** p  < .01, Higher Education % = Proportion university level of education compared to elementary + high school level of education. ODD-risk % = Percentage children with severe ODD; DBD ODD = The Parent/Teacher Disruptive Behavior Disorder rating scale – Oppositional Defiant Disorder scale; P-COMP = Social Competence Scale- Parent; SSRS = Social Skills Rating System total scale; SDQ prosocial = Strengths and Difficulties Questionnaires Prosocial scale; PSS = Perceived Parental Stress; PPI Harsh = Parenting Practices Interview, Harsh and inconsistent discipline scale; PPI Praise = Parenting Practices Interview, Praise and incentives scale

Long-Term Effects on Behavior Problems

To examine our first hypothesis, if the combined treatment KOMET with CPP was more effective in reducing disruptive behaviors compared to KOMET over the 1- and 2-year follow-up, we evaluated parent-rated ODD-symptoms in the DBD-ODD scale in a series of LMMs. In the LMMs, the KOMET condition was entered as the reference category. Means and standard deviations of the included outcomes in raw score format are presented in Table ​ Table3 3 .

Means and standard deviations in PMT and PMT with child CBT from pre-treatment to two years follow up, and between-group effect sizes (standardized mean differences, Cohen’s d) at the 2-year follow-up

a A negative effect-size indicate an advantage to the PMT condition

DBD ODD = The Parent/Teacher Disruptive Behavior Disorder rating scale – Oppositional Defiant Disorder scale, P-COMP = Social Competence Scale-Parent, SSRS = Social Skills Rating System total scale, SDQ prosocial = Strengths and Difficulties Questionnaires Prosocial scale; PPI harsh = Parenting Practices Interview harsh and inconsistent discipline; PPI Praise = Parenting Practices Interview praise and incentives scale; PSS = Perceived Parental Stress

In the primary outcome (DBD-ODD), the LMM showed a significant main effect of time over the whole time period, pre to 24 months follow up ( t 274.6  = − 4.51, p  < 0.001, d  = − 0.80), interpreted as a large reduction in ODD-symptoms (i.e., in the reference treatment condition). We found no significant time by treatment interaction effect, meaning no significant difference between treatments was found from pretreatment over the follow-up period. When entering the dichotomized variable of attrition in the LMM, we found similar results (i.e., significant main effect of time and no significant time by treatment interaction effect when controlling for attrition).

When examining the follow-up period from post-assessment to the 2-year follow-up, we found a significant main effect of time in the KOMET condition ( t 257.6  = − 2.07, p  = 0.040, d  = − 0.38), interpreted as a small reduction in ODD symptoms during the follow-up period. Further, we found a significant time by treatment interaction ( t 255.7  = 2.08, p  = 0.039, d  = 0.49), between post and 2 years follow-up. When rerunning the same analysis using the KOMET with CPP as the reference category, we found no significant main effect of time from post to follow-up in the KOMET + CPP condition. Thus, the results showed that the KOMET with CPP condition remained stable from post to follow-up while the KOMET condition improved significantly during the follow-up period reaching a similar result as the combined treatment.

Long-Term Effects on Social Skills

According to the second hypothesis, we examined whether the significantly increased social skills seen during treatment in KOMET with CPP compared to KOMET in the original study would remain at the 2-year follow-up. Regarding child emotion regulation- and social communication skills as measured by P-COMP we found a significant main effect of time over the whole time period ( t 273.2  = 2.78, p  = 0.006, d  = 0.50) but no significant time by treatment effect, indicating that both treatment conditions showed moderately increased emotion regulation and prosocial communication skills between T1 and T4. Similar results were found when running the subsequent LMM controlling for attrition. Looking at the follow-period only, we found no significant main effect of time, nor time by treatment interaction effect.

When it comes to child capacity to consider other people’s feelings and child helpfulness as measured by SDQ prosocial scale, we observed no significant main effect of time, nor time by treatment interaction effect. Consequently, no long-term effect on the SDQ prosocial scores was found between T1 and T4. Similar results were found when controlling for attrition. Further, we found no significant main effect of time over the 2-year follow-up period, however, a significant time by treatment interaction effect ( t 262.8  = − 2.32, p  = 0.020, d  = − 0.51). When rerunning the same analysis using the KOMET with CPP as the reference category, we found a significant main effect of time from post to follow-up in the KOMET + CPP condition ( t 262.8  = − 3.57, p  < 0.001, d  = − 0.59). Thus, the results showed that the significant increase in SDQ prosocial during the treatment period in the KOMET + CPP condition regressed during the follow-up period while the KOMET condition remained unchanged.

Finally, regarding prosocial competence as measured by SSRS, we found a significant main effect of time over the whole time period ( t 273.2  = 2.22, p  = 0.028, d  = 0.39) but no time by treatment interaction effect, indicating that both conditions showed a small increase in prosocial competence between T1 and T4. However, when controlling for attrition, the main effect of time was no longer significant ( t 261.9  = 1.70, p  = 0.090, d  = 0.31). Over the follow-up period we found no significant main effect of time, however, a significant time by treatment interaction effect ( t 256.2  = − 2.02, p  = 0.045, d  = − 0.45), indicating that the KOMET + CPP condition showed a relative decrease in prosocial competence compared to the KOMET condition during the follow-up period.

Long-Term Effects on Parenting Strategies and Stress

According to the third hypothesis, we examined if the KOMET with CPP would yield improved parental strategies and less parental stress compared to KOMET at the 2-year follow-up. Regarding harsh parenting, we found a significant main effect of time over the whole time period ( t 273.8  = − 3.46, p  < 0.001, d  = − 0.53) but no significant time by treatment interaction effect, indicating a moderate decrease in harsh parenting over the whole time period in both treatment conditions. Similar results were found when controlling for attrition. No significant main effect of time, or time by treatment interaction effect was found over the follow-up period, meaning no significant changes in harsh parenting in any of the treatment conditions over the follow-up period.

When examining parental praise, we found no significant main effect of time, nor time by treatment interaction effect over the whole time period, meaning none of the treatment conditions showed changes in parental praise between T1 and T4. Similar results were found when controlling for attrition. We found a significant small main effect of time over the follow-up period ( t 263.7  = − 2.82, p  = 0.005, d  = − 0.42), indicating a small decrease in parental praise. No time by treatment interaction effect was found, indicating no significant difference between treatment conditions over the follow-up period. When it comes to parental stress, we found no significant main- or interaction effect, neither over the whole time period nor over the follow-up period.

Moderators of Long-Term Effects

Regarding the moderator high vs. low ODD severity, 22.9% of the children were rated high in ODD severity at baseline (21.8% [ n  = 12] in the KOMET condition and 23.8% [ n  = 15] in the KOMET with CPP condition). At the 2-year follow-up, 20.5% of the families had children with a high number of ODD criteria at baseline, 19% [ n  = 6] in the KOMET condition, and 21% [ n  = 11] in the KOMET with CPP condition.

When entering the dichotomous variable high/low to moderate baseline ODD in the LMM evaluating DBD-ODD (over the whole period), we found a significant three-way interaction effect of time × treatment × high/low baseline ODD ( t 268.9  = − 2.46, p  = 0.014). This indicated that the difference between treatments over time was moderated by high ODD-symptoms. Regarding the different measures of social skills (P-COMP, SSRS, SDQ-prosocial), we found a significant three-way interaction effect of time × treatment × high/low ODD on the P-COMP ( t 266.4  = 1.98, p  = 0.049) and the SDQ-prosocial subscale ( t 275.7  = 2.95, p  = 0.003). However, when exploring severity of ODD at baseline as a continuous variable, we found no significant moderation effect (three-way time × treatment × ODD criteria interaction for DBD-ODD, P-COMP, SDQ-prosocial, or SSRS.

A total of 66.1% of the children had ADHD at baseline (63.6% [ n  = 35] in the KOMET condition and 68.3% [ n  = 43] in the KOMET with CPP condition). When entering ADHD in the LMMs evaluating DBD-ODD, P-COMP, SSRS, and SDQ-prosocial over the whole period, we found no evidence that ADHD moderated the effect for any of the outcomes.

In 43.2% of the children, parents reported them having a prescribed medication at baseline (36.4% [ n  = 20] in the KOMET condition and 49.2% [ n  = 31] in the KOMET with CPP condition). We found no evidence that prescribed medication at baseline moderated the effect on DBD-ODD; P-COMP, SSRS, or SDQ-prosocial over the whole period.

Regarding gender, 27.3% were girls in the KOMET condition and 23.8% in the combined condition at baseline, whereas 16.1% ( n  = 5) of the girls that remained in the study were in the KOMET condition and 23.1% ( n  = 12) in the combined condition at the 2-year follow-up. We entered the dichotomous variable gender as moderator in the LMMs evaluating DBD-ODD and the three measures of social skills. We found a significant moderating effect only in one outcome, the SSRS where girls in the KOMET with CPP conditions benefitted significantly more compared to girls in the KOMET condition ( t 276.8  = 2.28, p  = 0.020).

Sensitivity Analyses

When excluding the participants who met criteria for CD and participants with a DBD-NOS diagnosis at baseline, we found no important differences in the results compared to the results of the full sample (Supplementary Tables S1 and S2). The only observed differences were that, although similar effect-sizes, the main and interaction effects on DBD-ODD, and the interaction effect on SSRS did not reach statistical significance.

Clinically Significant Change

To additionally explore our first hypothesis regarding change in disruptive behavior, we analyzed clinically significant change for the primary outcome, DBD-ODD. In the sub-sample of children with complete data ( N  = 83), it appeared that children in the KOMET with CPP condition recovered to a larger degree whereas there was no difference between the conditions for those who improved (see Table ​ Table4). 4 ). A larger proportion in the KOMET condition was unchanged compared to the KOMET with CPP group. Further, a larger proportion had deteriorated in the KOMET with CPP condition compared to the KOMET condition. Furthermore, in an exploratory subgroup analysis of clinically significant change divided by level of clinician-rated ODD symptoms at baseline, it appeared that children with high number of ODD symptoms at pre-assessment improved more in the KOMET with CPP condition, while children with low to moderate ODD were similarly recovered/improved in both treatment condition, but fewer deteriorated in the KOMET condition, see Table ​ Table4 4 .

Clinically significant according to Jacobson and Truax (1991) between baseline and 24-months follow up in participants with complete data at two years follow-up

Measure DBD ODD = The Parent/Teacher Disruptive Behavior Disorder rating scale – Oppositional Defiant Disorder scale

Recovered = Children who were reliably changed between T1 and T4, and moved from a clinical population to a non-clinical population; Improved = children who showed a reliable decrease, but did not move from a clinical to a non-clinical population; Unchanged = children with no reliable change; Deteriorated = children with a reliable increase in symptoms; Low to moderate ODD at baseline = children who fulfill 3 to 6 DSM-5 diagnostic criteria for ODD; Severe ODD at baseline = children who fulfill 7 or more DSM-5 diagnostic criteria for ODD

This study aimed to evaluate the long-term treatment effects of KOMET combined with CPP compared to KOMET only in children, 8–12 years, with disruptive behavior disorders in a clinical child- and adolescent psychiatric context. In this article, the follow-up effects from post-treatment to 2-year follow-up are described. At baseline, there were no significant differences between the groups in any of the outcome variables. At post-treatment, as we have previously reported, a significant time x group interaction benefitting KOMET with CPP compared to KOMET was found in two measures of social skills, PCOMP and SDQ prosocial. This implies that the two groups differed in the social skills outcomes at post-treatment with a larger improvement seen in KOMET with CPP.

Our first hypothesis was that children in KOMET with CPP would benefit more in terms of reduced disruptive behavior over time compared to KOMET. This hypothesis was not confirmed. Over time, there were no significant differences between the two treatment conditions in parent-rated ODD symptoms, the DBD-ODD scale from T1 to T4. When comparing the results of the behavioral outcome in this study to previous studies examining the additive effect of child CBT to PMT for the same age group, this study did not show as clear results as those shown by Kazdin et al. [ 29 ], where parent-rated disruptive behavior in the individual PMT with child CBT condition improved more compared to the individual PMT condition at the 1-year follow-up. Our results are more similar to the Norwegian study by Larsson et al. [ 27 ] where adding group child CBT to PMT showed no additional effect compared to PMT only for younger children.

In an exploratory calculation of proportion with reliable clinical change in DBD-ODD in the subsample with complete data, a larger proportion of children in the KOMET with CPP condition had recovered or improved compared to the children in the KOMET only condition. However, the proportion of children that had deteriorated was also larger in the KOMET with CPP group compared to KOMET. The proportion of deteriorated children in PMT with CPP is in line with rates of deterioration found in other studies on treatment effects of PMT at 18 [ 53 ] and 24 months follow-up [ 54 ]. Some of the variations in reliable clinical change could be explained by the level of difficulties in disruptive behavior before treatment, where children with high levels of clinician-rated ODD symptoms were recovered and improved to a larger extent in the KOMET with CPP condition. The large proportion of children missing at the 2-year follow-up in the KOMET condition in the high ODD group, (50%), compared to the KOMET with CPP condition (27%), restricts our possibilities to draw firm conclusions.

The second hypothesis was that children in KOMET combined with CPP would show increased social skills compared to children in KOMET only and that this effect would remain over time. This hypothesis was not confirmed since there were no significant differences between the two conditions in any measure of social skills, and the only measure of social skills that improved significantly from baseline to 2-year follow-up was the measure of emotion regulation- and social communication skills (PCOMP). The PCOMP results are in proximity to those of Drugli et al. [ 55 ] and Webster Stratton and Hammond [ 28 ], where both PMT and PMT with child CBT showed significant improvements in social skills over time but there were no difference between treatment conditions at the one-year follow-up.

When it comes to time-point of improvement in emotion regulation and social communication, a difference between the treatments conditions was detected where the children in the KOMET with CPP improved during the treatment period while children in the KOMET condition reached the same treatment gains but over a longer period of time. It is not surprising to see an early and sustained effect in emotion regulation and social communication in PMT with CBT since emotion regulation skills explicitly were trained in the Coping Power Program, and sustained effects have been demonstrated in earlier research on child CBT combined with PMT as outlined above. More surprising was the effect, however delayed, in the KOMET condition only. The results might be influenced by the fact that those who were missing at two years follow-up in the KOMET condition had significantly lower PCOMP ratings at baseline compared to those who remained in the study. It might however also be the case that PMT by itself results in improved child emotion regulation- and social communication skills. This is supported by a study by Hagen and Ogden [ 56 ] showing that low pre-treatment social skills predicted larger improvement in social skills following PMT post-treatment.

Contrary to expected, the significant improvement in KOMET with CPP during the treatment period in child helpfulness and capacity to consider others’ feelings as measured by the SDQ prosocial scale regressed during the follow-up period. SDQ prosocial targets more of an emotionally empathic capacity that is not explicitly trained in Coping Power Program, compared to the extensive training in emotion regulation techniques and this might explain the regression. No effect at all was seen in the KOMET group which is not consistent with an earlier PMT study where an effect on SDQ prosocial behavior was seen over time [ 57 ]. Likewise surprising, no treatment effect was found in SSRS over time after controlling for attrition. SSRS is a multidimensional measure of social skills whereas SDQ prosocial and PCOMP each measure different single dimensions of social skills [ 58 ]. Using the total score of SSRS as in this study, might conceal effects in the different dimensions of social skills. The result might however imply that PMT as well as PMT with child CBT produce immediate treatment effects but do not result in long-lasting effects two years after treatment in measures of child helpfulness and capacity to consider others’ feelings and prosocial behavior. Long-term evaluations of PMT effects on social skills are scarce and there is, to our knowledge, no other study with intact randomization of PMT effects in a clinical sample with data on child social skills two years post treatment.

The third hypothesis, that the combined treatment would yield less parental stress and further improve parental strategies compared to PMT only, was not confirmed. At post-treatment, the groups in both treatment arms had improved with regard to reduced harsh parenting, increased parental praise and reduced parental stress. At two years follow-up, the initial reduction of harsh parenting in both treatment groups was stable but parental praise went back to pre-treatment levels, and parental stress showed a small but non-significant decrease over time. This result is not seen in the literature where previous studies comparing child CBT with PMT compared to PMT only on parental skills and parental stress have shown significant effects over the treatment period that have been sustained during one-year follow-ups in both treatment groups [ 27 , 28 ]. In addition, the Kazdin study showed that PMT with child CBT was significantly better than PMT only in the parental outcomes [ 29 ]. The difference in results may however be explained by the longer follow-up period in current study. Furthermore, positive parenting has been suggested a key factor, mediating change in child behavior problem in a study by Gardner et al. [ 59 ], however on a short-term basis. Studies of long-term PMT effects are scarce and when long-term key parenting components were examined in a meta-analysis, no parenting program techniques were associated with stronger long-term effects [ 10 ]. More studies with long-term follow-up of PMT effects on disruptive behavior with regarding type of parental strategies are needed.

The fourth hypothesis, that children with high levels of ODD would benefit more from the KOMET with CPP condition compared to the KOMET condition at the 2-year follow-up was confirmed. However, this result must be considered with caution since it is derived from a smaller group of children with severe ODD at baseline and there was a large proportion of these children missing in the KOMET condition at the 2-year follow-up. Moreover, when number of baseline ODD diagnostic criteria fulfilled was calculated as a continuous moderator, no moderator effect was found, adding further uncertainty to the result. It is not obvious that the numbers of diagnostic criteria can be treated as a continuous variable but, as this result indicates, there was no linear relationship between number of ODD symptoms and treatment effectiveness while there might be a cumulative effect where children with a high number of ODD symptoms might have a larger effect. Further studies on this subgroup with a large number of ODD symptoms are needed to draw firm conclusions.

We found no evidence that children with ADHD, or children that regularly took medication, benefitted more (or less) from the treatments compared to children without ADHD and medication. Also, we found no evidence of differential effects between the two treatments dependent on these two variables (i.e., ADHD and medication). These results are in line with a recent review concluding that there is no evidence that ADHD would reduce the effect of behavioral interventions on conduct problems [ 60 ]. Also, a recent treatment study on children with CD found that medication for ADHD did not moderate treatment efficacy [ 61 ].

Gender was found to moderate social competencies as measured by SSRS showing a larger treatment effect for girls in the KOMET with CPP condition compared to KOMET. This result needs to be taken with caution since there was a significant dropout of girls in the KOMET condition at the 2-year follow-up.

Looking at treatment effects over time, it seems as if the different treatment conditions were equally effective in reducing disruptive behavior and improving emotion regulation- and social communication skills, as well as in reducing harsh parenting. The only difference in effects between the two treatment arms that was detected was an earlier improvement in time in emotion regulation and social communication in KOMET with CPP compared to KOMET. An earlier improvement in emotion regulation and social communication might still be an important factor since it may help disruptive children to handle conflicts more efficiently and become more accepted in social contexts with prosocial peers and thereby reduce the risk of peer rejection. Training in emotion awareness, emotion regulation, and social- and cognitive problem-solving skills are likely to affect the irritability symptoms in ODD such as tantrums more directly, compared to PMT where tantrums are handled with reduced attention as well as with more indirect methods such as improved relationship with parents, attention to prosocial behavior and to give clear and prepared instructions.

The findings in this study are important in the attempt to shed more light on the effects of adding child CBT to PMT. This study is the first to investigate the 2-year follow-up effect of group CBT combined with PMT compared to PMT only for children 8–12 years with disruptive behavior disorders two years after treatment. The effectiveness of PMT combined with child CBT compared to PMT has been investigated previously at one-year post-treatment showing mixed results as shown above. One way of understanding the difference in effects could be the different treatment formats, group vs. individual delivery. However, the question of format has been explored in a study where individual delivery of the Coping Power program was compared to group delivery on parent-rated disruptive behavior, finding no differences between the treatment modalities at one and four years post treatment on parent-rated disruptive behavior while teacher-ratings showed that children with lower initial self-regulation improved more in the individual format [ 62 , 63 ]. Thus, the number of studies examining the additive effect of child CBT to PMT is still small, and there are differences in format, age group addressed, as well as treatment results that still obscures a firm conclusion.

Limitations

There are several limitations to this study. One obvious being the large amount of attrition in the KOMET group at the 2-year follow-up, leaving 56% of the participants in the KOMET group and 83% in the KOMET with CPP group, which poses a threat to internal validity [ 64 ]. This missingness leaves us with some uncertainty regarding the treatment effects. It is not possible to rule out that the large group of children missing at the 2-year follow-up in the KOMET group with significantly larger pretreatment difficulties in the primary outcome, would have impacted the long-term treatment effect in the KOMET group if they were to remain in the study. Another limitation was that the study was underpowered at start with 120 participants of the 130 anticipated, and power was further reduced by the large attrition. Moreover, the results at the 2-year follow-up are likely confounded by the natural maturation of the children and life events not controlled for in this study. Further, when exploring prescribed medication as a moderator, we only had dichotomous data on which children that regularly took medication and no specification on what medication. Finally, a limitation is the lack of follow-up data from the children themselves. It would have been valuable to gain information about the usability of the skills trained in the Coping Power Program over time.

Conclusions

The 2-year follow-up of KOMET compared to KOMET with CPP for children with disruptive behavior disorder, 8–12 years old, showed that the Swedish parent management training program KOMET was effective in reducing disruptive behavior, increasing emotion regulation and prosocial communication, and reducing harsh parenting strategies and that these effects hold over a 2-year follow-up period. In the group where the child CBT program Coping Power Program was added to KOMET, an improvement was seen in emotion regulation and prosocial communication skills in the KOMET with CPP group during the treatment period while children in the KOMET condition improved and reached the same result during the follow-up period. The study has also shed some light on the long-term effects of PMT on parental strategies and stress which is a valuable contribution in the field of PMT research where long-term follow-up studies are scarce. The study points out a need for future studies on the effects of child CBT combined with PMT, long-term effects of differing parental strategies in PMT outcomes, how the social skills trained in child CBT are sustained over time and if PMT by itself produces a sufficient increase in social skills.

For children with oppositional defiant disorder (ODD) up to twelve years of age, Parent management training (PMT) is recommended treatment and for school-aged children, child-directed cognitive behavior therapy (CBT) is also recommended. The current study examined the 2-year follow-up effects of PMT combined with the child CBT intervention Coping Power Program (CPP) compared to PMT only in a randomized controlled trial in Swedish Child- and Adolescent Psychiatric setting. Participants were one hundred and eighteen children, 8–12 years, with ODD, CD, or Disruptive Behavioral Disorder NOS. The results showed long-term effectiveness of both PMT and PMT combined with CPP in reduced disruptive behavior problems and harsh parenting strategies, and increased emotion regulation- and social communication skills. In the group where the child CBT was added to PMT, an improvement was seen in emotion regulation and prosocial communication skills during the treatment period while children in the PMT condition improved and reached the same result during the follow-up period. To conclude, PMT with CPP did not in general provide significant benefits at the 2-year follow-up compared to PMT, apart from an improvement earlier in time regarding emotion regulation- and social communication skills.

Below is the link to the electronic supplementary material.

Acknowledgments

We want to thank the participating children and parents, and all group leaders for their work.

Open access funding provided by Karolinska Institute. This work was supported by Stockholm County Council and by grant from the Söderströmska-Königska Foundation SLS-312941.

Declarations

The authors have no financial or proprietary interests in any material discussed in this article. All procedures involved in the study were in concordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments of comparable ethical standards. Ethical approval number: Dnr 2011/1587-31. Informed consent was obtained from all participants in the study.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

How to Train Your Problem-Solving Skills

From the hiccups that disrupt your morning routines to the hurdles that define your professional paths, there is always a problem to be solved. 

The good news is that every obstacle is an opportunity to develop problem-solving skills and become the best version of yourself. That’s right: It turns out you can get better at problem-solving, which will help you increase success in daily life and long-term goals.  

Read on to learn how to improve your problem-solving abilities through scientific research and practical strategies.

Understanding Problem-Solving Skills

You may be surprised to learn that your problem-solving skills go beyond just trying to find a solution. Problem-solving skills involve cognitive abilities such as analytical thinking, creativity, decision-making, logical reasoning, and memory. 

Strong problem-solving skills boost critical thinking, spark creativity, and hone decision-making abilities. For you or anyone looking to improve their mental fitness , these skills are necessary for career advancement, personal growth, and positive interpersonal relationships. 

Core Components of Problem-Solving Skills Training

To effectively train your problem-solving skills, it’s important to practice all of the steps required to solve the problem. Think of it this way: Before attempting to solve a problem, your brain has already been hard at work evaluating the situation and picking the best action plan. After you’ve worked hard preparing, you’ll need to implement your plan and assess the outcome by following these steps:  

• Identify and define problems: Recognizing and clearly articulating issues is the foundational step in solving them.
• Generate solutions: Employing brainstorming techniques helps you develop multiple potential solutions.
• Evaluate and select solutions: Using specific criteria to assess solutions helps you choose the most effective one.
• Implement solutions: Developing and executing action plans, including preparing for potential obstacles, guides you to positive outcomes.
• Review and learn from outcomes: Assessing the success of solutions and learning from the results for future improvement facilitates future success. 

Strategies for Developing Problem-Solving Skills

There are many practical exercises and activities that can improve problem-solving abilities.

Cultivate a Problem-Solving Mindset

• Adopt a growth mindset: A growth mindset involves transforming phrases like “I can’t” into “I can’t yet.” Believing in the capacity to improve your skills through effort and perseverance can lead to greater success in problem-solving.
• Practice mindfulness: Mindfulness can enhance cognitive flexibility , allowing you to view problems from multiple perspectives and find creative solutions.

Enhance Core Cognitive Skills 

• Strengthen your memory: Engage in activities that challenge your memory since accurately recalling information is crucial in problem-solving. Techniques such as mnemonic devices or memory palaces can be particularly effective.
• Build your critical thinking: Regularly question assumptions, evaluate arguments, and engage in activities that require reasoning, such as strategy games or debates.

Apply Structured Problem-Solving Techniques

• Use the STOP method: This stands for Stop , Think , Observe , and Plan . It's a simple yet effective way to approach any problem methodically, ensuring you consider all aspects before taking action.
• Try reverse engineering: Start with the desired outcome and work backward to understand the steps needed to achieve that result. This approach can be particularly useful for complex problems with unclear starting points.

Incorporate Technology into Your Training

• Engage with online courses and workshops: Many platforms offer courses specifically designed to enhance problem-solving skills, ranging from critical thinking to creative problem-solving techniques.
• Use cognitive training apps: Apps like Elevate provide targeted, research-backed games and workouts to improve cognitive skills including attention, processing speed, and more. 

Practice with Real-World Applications and Learn from Experience

• Tackle daily challenges: Use everyday issues as opportunities to practice problem-solving. Whether figuring out a new recipe or managing a tight budget, applying your skills in real-world situations can reinforce learning.
• Keep a problem-solving journal: Record the challenges you face, the strategies you employ, and the outcomes you achieve. Reflecting on your problem-solving process over time can provide insights into your strengths and areas for improvement.

Embracing Problem-Solving as a Lifelong Journey

Since problems arise daily, it’s important to feel confident in solving them. 

And you can do just that by downloading the Elevate brain training app. Elevate offers 40+ games and activities designed to improve problem-solving, communication, and other cognitive skills in a personalized way that’s backed by science. Pretty cool, right? 

Consider downloading the Elevate app on Android or iOS now—it’ll be the easiest problem you solve all day. 

Related Articles

How Problem-Solving Games Can Boost Your Brain

• Discover why problem-solving games are fun and effective ways to train your brain. 

Improving Your Problem-Solving Skills

• Discover how to improve your problem-solving skills and make logical, informed decisions.  

Best Ways to Boost Your Mental Fitness

• Mental fitness refers to your ability to sustain your overall well-being. Learn tips to improve yours.