Won’t or Can’t? Nico and the Power of How
By: Matt Cohen
Before I came to Harvard, I worked with a young boy who I'll call Nico. Nico was always brimming with enthusiasm and loved exploring the world with his hands. His excitement was delightfully chaotic and his curiosity was endearingly sincere, but not everyone else saw him the same way I did. Nico was a lot of work and I admittedly found myself frustrated at times, especially when he rearranged my desk onto the floor while playing with my paperclips. Nevertheless, I had a soft spot for misunderstood kids having grown up with Tourette’s myself, and so my heart went out to him. His first year in school started off great, but things unfortunately began to sour as time went by.
Nico was hyperactivity and distractibility incarnate. When excitedly reaching for other children’s toys, his impulsive grabbing was misunderstood as aggression, especially when this pattern continued after several weeks and countless reminders. He would often become so immersed in play during recess that he wouldn't hear his teachers' reminders to come back inside. Although Nico's teachers were very patient at first, they usually had to cross the playground and raise their voice for Nico to hear them. Nico was usually grumpy when he felt he was being yelled at, which got him into trouble by his exhausted teachers for "having an attitude." Nico's high energy and ability to become enraptured with "distractions" chafed with his environment and he needed continuous redirection. Teachers became quicker to raise their voices and Nico became equally as quick to respond defensively. Nico began to feel as though he was unfairly targeted and so his response of righteous indignation was contextually appropriate, but it was usually misconstrued as insubordination. It was a feedback loop of conflict that started with a small misunderstanding that got out of hand.
After coming to Harvard, I worked with many teens through my clinical placements who echoed Nico's experiences. I learned of differences in auditory processing associated with ADHD which explained some of their unresponsiveness to redirection. In many cases, it wasn't that they wouldn't comply, but instead that they literally couldn't hear! Simple changes like confirming that these students heard and understood directions made all the difference, and I wondered if Nico's first experiences in school could have been different if the same was done for him. I wondered about the thousands of kids just like Nico who might have been caught off guard getting in trouble for what began as an innocent misconception on both sides of the conflict. I empathized with the burnt out teachers who must have felt exasperated by their own classes full of Nicos who required so much energy for every single redirection. Most of all, this experience illustrated the shocking power of the subtle difference between assuming won't versus can't. What could I do to make an impact for kids like Nico?
After graduate school, I worked as an in-home clinician supporting kids whose interactions with their parents echoed those of Nico at school. I was able to support many families in implementing the subtle, yet powerful adjustments to redirection that made a difference during my clinical placements. With so much of my job involving parent consultation, I reached out to a former classmate with expertise in this area and she brought the Simple Interactions Toolkit to my attention. I immediately found practical applications.
When a child had high energy, I found the most success when leading with excitement. Trying to directly lower their energy never found success, so I tried to channel that energy instead. “If you have too much energy to walk, let’s do push-ups on the grass instead of running into the street,” I’d say. I ruined some nice clothes and quickly learned to wear sweatpants instead, but this reciprocity let me redirect without creating a power struggle. Moreover, I created a more accessible opportunity to grow by meeting each child where they were at. The combination of these two factors allowed me to foster a stronger connection with the child, creating a positive feedback loop that reinforced the first two principles.
Some parents struggled to do this, however. When a parent held a developmentally inappropriate expectation instead of an opportunity to grow, the child had no pathway to succeed. Without reciprocity, parents didn't realize that their child was struggling rather than refusing, and would understandably become frustrated when things didn't go their way. The implicit assumption of won't versus can't perniciously fostered assumptions of deliberate defiance, which slowly eroded connection.
Some of the kids referred for my services had previously received a diagnosis of oppositional defiant disorder, a label I increasingly began to question as I gained more experience. This diagnosis seemed to misattribute solely to the child what was instead a miscommunication that metastasized to the entire relationship. As I read more studies on its history, I learned it had been disputed for over 30 years and criticized for sometimes pathologizing contextually appropriate behavior. I considered the developmental pipeline through which a child might receive this diagnosis, wondering about the extent to which a parent's interpretation of their child's behavior not only shaped the behavior itself, but also shaped the way the behavior was diagnosed. Everything starts to look like a nail when you’re holding a hammer, so what if a parent’s interpretation fostered confirmation bias in an assessor? In tandem to hoping to answer this developmental question, I hoped to gain the skills to actionably apply these insights so as to steer families toward a trajectory less defined by conflict and misunderstanding.
I reached out directly to my former Professor, Junlei Li, for his advice. At Harvard, he taught us to analyze the active ingredients behind each intervention. In toothpaste, fluoride is the active ingredient that cleans teeth. In the same way, relationships were the active ingredient behind the SI principles. But what if that active ingredient wasn't quite working as intended yet? What if toothpaste needed the help of a toothbrush to actually achieve its function? Even if I answered my developmental ponderings, I still needed the tools to apply them. Telling families what to do would be comparatively easy, but helping them in the process of how to get there was a challenge I needed help to solve.
A Discussion between Matt and Junlei
Matt: I wanted to reach out to get a sense of practical strategies I might use to help struggling families change course. What are some patterns you've identified in how to help adults implement SI principles? Although relationships are the "active ingredient" for an adult implementing SI principles directly into their own life, what are the active ingredients that go into the effectiveness of a capacity-builder (e.g., me) helping to facilitate the development of those skills?
Junlei: You asked a really good question about the active ingredient that helps adults in their interactions. We used to say, "do for the adult what you would imagine the best adult would do for the child." We want to help adults avoid holding rigid assumptions about the child and instead focus on understanding the child's needs – to do that, we need to expand our own understanding and empathy for the adults. In your essay earlier, you demonstrate just that for burnt-out teachers and parents. You wanted adults to see the child's strengths and positive engagements, and not just "defiance". You could do the same for the adults: help them "remember" times and moments when they were able to engage, help them understand "why" those moments might have worked, and help affirm the interactions that the adults most likely got right.
Often, when we think of "change", we think only of correcting mistakes and deficits. We don't think enough about affirmation (of what is already working). What we have learned from SI work about how adults change is two-fold: 1) If they know why something they already do is working, they can do more of it and do it with more intention; 2) If they get to experience 1), they are more likely to notice and change the things that aren't working.
To recognize what is already working, the adults have to learn to "see" their interactions. Sometimes this can mean literally seeing and watching their own interactions. The intervention Family Check-Up supports parents who struggle with their young children or teens. One key component of this 3-session intervention is a procedure called "video feedback" in which a clinician carefully guides the parent through observing their own interactions with children on video recording. The clinician helps the parent focus on what is working before moving on to missed opportunities. The intervention, Filming Interactions to Nurture Development (FIND), has parents watch annotated videos of their own interactions to identify moments that support and enhance language development. The annotation points out what is working well and why. SI work takes a similar approach, bringing video recordings of everyday practice back to the community of that practice.
What happens when it is not feasible to film and see these interactions? I think there might be two alternative approaches. One is to guide the adult to remember their interactions and relationships with young people. In the “empathic mindset” intervention conducted by Dr. Jason Okonofua and colleagues, teachers completed a simple (but not simplistic) online exercise. First, teachers were presented with a realistic description of a student's challenging behavior. They were asked to imagine non-pejorative reasons for that behavior (e.g., “the child is struggling with math” vs. “the child just wants to disrupt others”). This might help break the cycle of conflict you spoke of by poking holes in people’s automatic assumptions about children’s behaviors. Second, teachers were asked to describe how they built strong relationships with students in the past. Translating these into SI terms, we need to help adults first think creatively and openly about what a child is trying to tell us through their behavior and how we can understand them, and then help them affirm their own relational practices. This may be the strategy generally considered "thinking your way into a new way of acting".
The complementary approach can also be promising – "acting your way into a new way of thinking." Encouraging an adult to engage in a different kind of interaction once or twice a week may reshape the trajectory of the relationship. In the Banking Time intervention, teachers who struggled with young children with persistent challenging behaviors (like the burnt-out teachers you worked with) were asked to set aside 15 minutes, 2 or 3 times a week, to interact with that child in ways that are different from what's typically experienced by the child (and the teacher). These interactions embody semi-structured Connection Y/Z, Reciprocity Y (but with the child leading), and Opportunities to Grow Y. Even though SI does not prescribe that Y or Z is better than X, if a child is often stuck in X with adults, it would make sense to enrich interactions to include more Y and Z.
Across these interventions, changes in how adults thought about and interacted with children had a real impact. For youth, it halved their in-school suspensions. For young children, it significantly and meaningfully reduced their stress levels while in school.
--
Matt: I am hearing a couple of core themes in what you shared:
Identify and build on what is already working
Follow the family's needs rather than prescribing a course of action (universality without uniformity)
Prompting metacognition to facilitate 1 and 2
I think point 3 is especially an area of growth for me. As I reflect on my own practice, I think I might be too quick to provide parents with a developmental explanation for a child's behavior. In so doing, I am robbing my families of the opportunity to discover the answer for themselves and thereby build the skills to implement the principles with more independence.
I especially like the idea of having adults interact with the child in ways they haven't typically done before, especially in how the intervention leaves the specifics open-ended for the family to define for themselves. I think it elegantly captures the idea of "universality without uniformity" by providing a general direction for the family while giving them full agency over the "how." As much as we talk about strengths-based approaches for children, we often forget to implement the same principles for parents.
You've given me a great deal to think about. Especially when it comes to extending deeper empathy toward parents, I'm beginning to wonder what kinds of pathways might lead a parent to reach conclusions of "won't" rather than "can't." Culture and burnout are among the first that come to mind, but I think I can extend the principles above to identify each parent's individual pathway so as to offer individualized support. Moreover, by prompting metacognition in this way, I can probably help them to better understand and identify for themselves what does or does not work in their own case.
--
Junlei: I read through and I agree with the approach! One quick clarification follow-up: Can you give me an example of a "won't" vs. "can't" in the parenting context you had in mind?
___
Matt: I'd be happy to clarify! Let's consider the behavior of a child who does not respond the first time an adult gives an instruction. I use the comparison between "won't" and "can't" to illustrate two distinct lenses through which the same behavior could be interpreted. If the interpretation is that Nico "won't listen," it subtly implies deliberate intent. On the other hand, an interpretation that he "can't hear" has very different implications for how to provide support.
I use the phrases "won't" and "can't" here to refer to the tendency to interpret through one lens rather than the other. In many ways, this idea connects to the concept of the fundamental attribution error, which I understand to be a relatively universal bias toward overattributing others' behavior to personal deficits rather than to contextual factors. That being said, what kinds of factors or experiences help to shape the degree of this bias in this particular context? My guess is that it would probably be mediated, at least in part, by empathy.
Junlei: Thank you, I understand what you mean now!
I think all of us who are once trained as professionals to care for children (you as a counselor, I as a developmental psychologist) need to "extend deeper empathy toward parents" (and other adults). That's a worthy goal, but it will take time. The principle of universality without uniformity applies. Even as we try to understand individual parents or families, we can ground ourselves in a universal understanding of parents' needs. In my work with parents and families, I've found a few universals: parents need to know and want to know that they are doing something right, even if they are struggling with parenting; few parents feel they've done "enough" for their children, and it helps parents to know that they are making a difference in the lives of their children even when they don't feel "enough".
Matt: It's helpful to have the insight into that universal need. It provides a helpful backdrop to further inform why it's effective to build on existing strengths and how the work that builds on it promotes positive change. Knowing what I'm aiming for with more precision can help me to be more deliberate in my support.
Junlei: You asked a really good question about the active ingredient that helps adults in their interactions. We used to say, "do for the adult what you would imagine the best adult would do for the child." We want to help adults avoid holding rigid assumptions about the child and instead focus on understanding the child's needs – to do that, we need to expand our own understanding and empathy for the adults. In your essay earlier, you demonstrate just that for burnt-out teachers and parents. You wanted adults to see the child's strengths and positive engagements, and not just "defiance". You could do the same for the adults: help them "remember" times and moments when they were able to engage, help them understand "why" those moments might have worked, and help affirm the interactions that the adults most likely got right.
Often, when we think of "change", we think only of correcting mistakes and deficits. We don't think enough about affirmation (of what is already working). What we have learned from SI work about how adults change is two-fold: 1) If they know why something they already do is working, they can do more of it and do it with more intention; 2) If they get to experience 1), they are more likely to notice and change the things that aren't working.
To recognize what is already working, the adults have to learn to "see" their interactions. Sometimes this can mean literally seeing and watching their own interactions. The intervention Family Check-Up supports parents who struggle with their young children or teens. One key component of this 3-session intervention is a procedure called "video feedback" in which a clinician carefully guides the parent through observing their own interactions with children on video recording. The clinician helps the parent focus on what is working before moving on to missed opportunities. The intervention, Filming Interactions to Nurture Development (FIND), has parents watch annotated videos of their own interactions to identify moments that support and enhance language development. The annotation points out what is working well and why. SI work takes a similar approach, bringing video recordings of everyday practice back to the community of that practice.
What happens when it is not feasible to film and see these interactions? I think there might be two alternative approaches. One is to guide the adult to remember their interactions and relationships with young people. In the “empathic mindset” intervention conducted by Dr. Jason Okonofua and colleagues, teachers completed a simple (but not simplistic) online exercise. First, teachers were presented with a realistic description of a student's challenging behavior. They were asked to imagine non-pejorative reasons for that behavior (e.g., “the child is struggling with math” vs. “the child just wants to disrupt others”). This might help break the cycle of conflict you spoke of by poking holes in people’s automatic assumptions about children’s behaviors. Second, teachers were asked to describe how they built strong relationships with students in the past. Translating these into SI terms, we need to help adults first think creatively and openly about what a child is trying to tell us through their behavior and how we can understand them, and then help them affirm their own relational practices. This may be the strategy generally considered "thinking your way into a new way of acting".
The complementary approach can also be promising – "acting your way into a new way of thinking." Encouraging an adult to engage in a different kind of interaction once or twice a week may reshape the trajectory of the relationship. In the Banking Time intervention, teachers who struggled with young children with persistent challenging behaviors (like the burnt-out teachers you worked with) were asked to set aside 15 minutes, 2 or 3 times a week, to interact with that child in ways that are different from what's typically experienced by the child (and the teacher). These interactions embody semi-structured Connection Y/Z, Reciprocity Y (but with the child leading), and Opportunities to Grow Y. Even though SI does not prescribe that Y or Z is better than X, if a child is often stuck in X with adults, it would make sense to enrich interactions to include more Y and Z.
Across these interventions, changes in how adults thought about and interacted with children had a real impact. For youth, it halved their in-school suspensions. For young children, it significantly and meaningfully reduced their stress levels while in school.
--
Matt: I am hearing a couple of core themes in what you shared:
Identify and build on what is already working
Follow the family's needs rather than prescribing a course of action (universality without uniformity)
Prompting metacognition to facilitate 1 and 2
I think point 3 is especially an area of growth for me. As I reflect on my own practice, I think I might be too quick to provide parents with a developmental explanation for a child's behavior. In so doing, I am robbing my families of the opportunity to discover the answer for themselves and thereby build the skills to implement the principles with more independence.
I especially like the idea of having adults interact with the child in ways they haven't typically done before, especially in how the intervention leaves the specifics open-ended for the family to define for themselves. I think it elegantly captures the idea of "universality without uniformity" by providing a general direction for the family while giving them full agency over the "how." As much as we talk about strengths-based approaches for children, we often forget to implement the same principles for parents.
You've given me a great deal to think about. Especially when it comes to extending deeper empathy toward parents, I'm beginning to wonder what kinds of pathways might lead a parent to reach conclusions of "won't" rather than "can't." Culture and burnout are among the first that come to mind, but I think I can extend the principles above to identify each parent's individual pathway so as to offer individualized support. Moreover, by prompting metacognition in this way, I can probably help them to better understand and identify for themselves what does or does not work in their own case.
--
Junlei: I read through and I agree with the approach! One quick clarification follow-up: Can you give me an example of a "won't" vs. "can't" in the parenting context you had in mind?
___
Matt: I'd be happy to clarify! Let's consider the behavior of a child who does not respond the first time an adult gives an instruction. I use the comparison between "won't" and "can't" to illustrate two distinct lenses through which the same behavior could be interpreted. If the interpretation is that Nico "won't listen," it subtly implies deliberate intent. On the other hand, an interpretation that he "can't hear" has very different implications for how to provide support.
I use the phrases "won't" and "can't" here to refer to the tendency to interpret through one lens rather than the other. In many ways, this idea connects to the concept of the fundamental attribution error, which I understand to be a relatively universal bias toward overattributing others' behavior to personal deficits rather than to contextual factors. That being said, what kinds of factors or experiences help to shape the degree of this bias in this particular context? My guess is that it would probably be mediated, at least in part, by empathy.
Junlei: Thank you, I understand what you mean now!
I think all of us who are once trained as professionals to care for children (you as a counselor, I as a developmental psychologist) need to "extend deeper empathy toward parents" (and other adults). That's a worthy goal, but it will take time. The principle of universality without uniformity applies. Even as we try to understand individual parents or families, we can ground ourselves in a universal understanding of parents' needs. In my work with parents and families, I've found a few universals: parents need to know and want to know that they are doing something right, even if they are struggling with parenting; few parents feel they've done "enough" for their children, and it helps parents to know that they are making a difference in the lives of their children even when they don't feel "enough".
Matt: It's helpful to have the insight into that universal need. It provides a helpful backdrop to further inform why it's effective to build on existing strengths and how the work that builds on it promotes positive change. Knowing what I'm aiming for with more precision can help me to be more deliberate in my support.
References:
Beltrán, S., Sit, L., & Ginsburg, K. R. (2021). A call to revise the diagnosis of oppositional defiant disorder—Diagnoses are for helping, not harming. JAMA psychiatry, 78(11), 1181-1182.
Frick, P. J., & Nigg, J. T. (2012). Current issues in the diagnosis of attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. Annual review of clinical psychology, 8(1), 77-107.
Hamilton, S. S., & Armando, J. (2008). Oppositional defiant disorder. American family physician, 78(7), 861-866.
Hawes, D. J., Gardner, F., Dadds, M. R., Frick, P. J., Kimonis, E. R., Burke, J. D., & Fairchild, G. (2023). Oppositional defiant disorder. Nature Reviews Disease Primers, 9(1), 31.
Krueger, R. F., Watson, D., & Barlow, D. H. (2005). Introduction to the special section: toward a dimensionally based taxonomy of psychopathology. Journal of abnormal psychology, 114(4), 491–493. https://doi.org/10.1037/0021-843X.114.4.491
Loeber, R., Lahey, B. B., & Thomas, C. (1991). Diagnostic conundrum of oppositional defiant disorder and conduct disorder. Journal of Abnormal Psychology, 100(3), 379.
Marcus, D. K., & Barry, T. D. (2011). Does attention-deficit/hyperactivity disorder have a dimensional latent structure? A taxometric analysis. Journal of abnormal psychology, 120(2), 427–442. https://doi.org/10.1037/a0021405
Moffitt, T. E. (2006). Life-course-persistent versus adolescence-limited antisocial behavior. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology: Risk, disorder, and adaptation (2nd ed., pp. 570–598). John Wiley & Sons, Inc..
Moffitt, T. E., Arseneault, L., Jaffee, S. R., Kim-Cohen, J., Koenen, K. C., Odgers, C. L., Slutske, W. S., & Viding, E. (2008). Research review: DSM-V conduct disorder: research needs for an evidence base. Journal of child psychology and psychiatry, and allied disciplines, 49(1), 3–33. https://doi.org/10.1111/j.1469-7610.2007.01823.x
Regier, D. A., Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2009). The conceptual development of DSM-V. The American journal of psychiatry, 166(6), 645–650. https://doi.org/10.1176/appi.ajp.2009.09020279
Rowe, R., Maughan, B., Costello, E. J., & Angold, A. (2005). Defining oppositional defiant disorder. Journal of Child Psychology and Psychiatry, 46(12), 1309-1316.
Beltrán, S., Sit, L., & Ginsburg, K. R. (2021). A call to revise the diagnosis of oppositional defiant disorder—Diagnoses are for helping, not harming. JAMA psychiatry, 78(11), 1181-1182.
Frick, P. J., & Nigg, J. T. (2012). Current issues in the diagnosis of attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. Annual review of clinical psychology, 8(1), 77-107.
Hamilton, S. S., & Armando, J. (2008). Oppositional defiant disorder. American family physician, 78(7), 861-866.
Hawes, D. J., Gardner, F., Dadds, M. R., Frick, P. J., Kimonis, E. R., Burke, J. D., & Fairchild, G. (2023). Oppositional defiant disorder. Nature Reviews Disease Primers, 9(1), 31.
Krueger, R. F., Watson, D., & Barlow, D. H. (2005). Introduction to the special section: toward a dimensionally based taxonomy of psychopathology. Journal of abnormal psychology, 114(4), 491–493. https://doi.org/10.1037/0021-843X.114.4.491
Loeber, R., Lahey, B. B., & Thomas, C. (1991). Diagnostic conundrum of oppositional defiant disorder and conduct disorder. Journal of Abnormal Psychology, 100(3), 379.
Marcus, D. K., & Barry, T. D. (2011). Does attention-deficit/hyperactivity disorder have a dimensional latent structure? A taxometric analysis. Journal of abnormal psychology, 120(2), 427–442. https://doi.org/10.1037/a0021405
Moffitt, T. E. (2006). Life-course-persistent versus adolescence-limited antisocial behavior. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology: Risk, disorder, and adaptation (2nd ed., pp. 570–598). John Wiley & Sons, Inc..
Moffitt, T. E., Arseneault, L., Jaffee, S. R., Kim-Cohen, J., Koenen, K. C., Odgers, C. L., Slutske, W. S., & Viding, E. (2008). Research review: DSM-V conduct disorder: research needs for an evidence base. Journal of child psychology and psychiatry, and allied disciplines, 49(1), 3–33. https://doi.org/10.1111/j.1469-7610.2007.01823.x
Regier, D. A., Narrow, W. E., Kuhl, E. A., & Kupfer, D. J. (2009). The conceptual development of DSM-V. The American journal of psychiatry, 166(6), 645–650. https://doi.org/10.1176/appi.ajp.2009.09020279
Rowe, R., Maughan, B., Costello, E. J., & Angold, A. (2005). Defining oppositional defiant disorder. Journal of Child Psychology and Psychiatry, 46(12), 1309-1316.