Change Management and a Whole Family Approach
Dr. Moncino’s approach at GCADP is grounded in the idea that “kids do well if they can.” He acknowledges that he borrowed this idea from psychologist Ross Greene, who delivered the tenet at a medical conference. “At the time, this was one of the most enlightening statements I’d ever heard about pediatrics,” says Dr. Moncino. “Every single child wants to do well. They want to please their parents and teachers; they want to work as hard as possible. Treating LDs is not about a child’s motivation, but rather it’s about giving them the tools to succeed. If a child is not doing well, it is up to us, the parents, teachers and the pediatricians, the adults in the room to figure out what tools, tricks or accommodations are necessary.”
Dr. Moncino does offer the caveat that children, especially adolescents, who have experienced significant shame, blame or trauma around their developmental difference may lack motivation. “Eventually, children with unrecognized and thus unaccommodated LDs can feel squelched and turn in on themselves, and no longer care about academic success. They can become socially isolated, and frankly sad, depressed, and disinterested in school,” he explains. “But this reaction isn’t intrinsic; it’s coming from overwhelming academic demands, and blaming the child for poor academic performance or labeling them as ‘not trying,’ when indeed, they are trying, they just need accommodations to succeed. If The LD is not recognized, those accommodations can’t be provided.”
Dr. Moncino continues, “This kind of closing off doesn’t typically happen in early childhood. The implication is that if a child isn’t doing well academically or socially, it is our job, the job of the adults taking care of the child, to help figure out what is getting in the way of that child’s success.” These roadblocks can be discovered, says Dr. Moncino, through the process of change management, a model borrowed from the business world. Change management encourages pediatricians to meet children at their current developmental level, guiding them to adapt to changes in small increments. “Incremental changes over time lead to success,” says Dr. Moncino.
“Change management occurs with both kids and families,” he continues. “Often, parents come in because they are upset with their child. For example, a parent may bring in a kid with anger management issues, but the kids may not care or want to change. I try to help parents recognize that their child won’t change overnight, and that’s okay. We ask the question: how can we break this issue into small incremental steps where kids complete a task, are rewarded, and then build confidence?” To support these small changes, Dr. Moncino takes a holistic approach. He sees his role as the “head of a child’s developmental home,” meaning he synthesizes information from pediatricians, contracted therapists, and educators to support families in meeting their goals.
He offers the example of anger, or misbehavior. “If a kid is acting out, we can take a step back and consider the challenges that this kid is facing,” says Dr. Moncino. His approach involves looking beyond the pediatric office and the home and unpacking the child’s experience at school. “Are the tasks at school outside of that child’s skill set or current ability? If they keep getting tasked with something they can’t do, they will of course get frustrated and angry. We have to identify what problems we can work on with kids to help them succeed.”
Dr. Moncino also finds it helpful to frame childhood behavioral change in the context of potential adult behavioral change. “If behavioral change was easy, none of us would smoke. None of us would drink to excess!” he explains. “All of us would be exercising daily. But we all understand how difficult behavioral changes are.” Dr. Moncino encourages family members to build empathy with their child by considering the challenges they’ve faced in their own attempts at behavior change. “If they can build empathy, they can build patience,” he says.