"Size of the Problem" Can Be a Problem

“Size of the problem” is a strategy many therapists use to help children gain perspective about how big their problems really are. Often using a scale from 1 to 5, children are taught that some problems aren’t a big deal and others are. For example a problem rated as a “1” may be a minor inconvenience, like losing a pencil or getting a papercut, and a “5” is something like a hospitalization or natural disaster.

Problems that are “1” require very little time, resources, and people to solve. A problem that is a five is something that requires a lot of time, resources, and people to solve. It is very serious. For example:

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Unfortunately, for many children every problem can feel like a “5.” This strategy can be helpful for some children, and ineffective for others for several reasons. Here are some things to consider if you plan to use this strategy.

When Size of the Problem Can Be a Helpful Strategy

When children are upset with themselves

Two weeks after my stepdaughter got her drivers license she got in a car accident that was her fault. Thankfully, it was just a fender bender so it wasn’t that big of a deal. But she was in tears and so upset at herself as though she actually harmed someone or did something really bad. This strategy was really helpful for her to put the situation in perspective. On a scale of 1 to 5 this was a 3 or so. It required some time and people to fix, but no one was hurt and the damage to both cars really wasn’t that bad.

When children have a some impulse control

Having the ability to manage impulses after an upsetting event, even for a moment, helps make this a more effective strategy.

When children have good language skills and cognition

This can be a language-heavy strategy to truly help children understand some of the nuances

When Size of the Problem isn’t Very Helpful

When there are no self regulation strategies at all

If you don’t know what to do other than rate the problem a different way that isn’t very helpful if there aren’t other strategies in place. It’s really hard to believe that when a problem feels like it’s a 5 that it’s actually a 3 unless you know at least some ways to calm yourself.

When children have black and white thinking

When children have black and white thinking they may see everything as being either all good or all bad. Introducing the idea that there are shades of gray can be really helpful to understanding the nuances of this strategy.

It May Dismiss Their Valid Feelings

Unfortunately, the "Size of the Problem" strategy can result in adults telling children how to feel and contribute to a child's masking or feeling invalidated in general. It can affect trust and therapeutic rapport.

I recently evaluated a child who was reported to have big emotional reactions and be easily frustrated. The Sensory Processing Measure (SPM-2) did not show any significant issues.

In this case I can typically use the Clue Cards and find that the child may be masking their sensory stressors and/or learn about the non-sensory things that are causing them to feel stress.

Unfortunately, this child responded to this activity as I would expect if they had been told how to feel with the Size of the Problem strategy. Everything was rated as “not a problem” or a “little problem.” Why do I think she had learned this strategy in the past? Because when I asked what she would rate as a big problem or something she can’t handle she said, “breaking my wrist.” This is a really unusual response for a child to say spontaneously.

Her stress and self-regulation weren’t any better after learning it, and it kept me from fully understanding what she perceived as problems.

I admit that I am guilty of using this strategy with children when they weren’t ready. Now that I see the problems with it I’m addressing it differently.

Consider Addressing These First

Before introducing Size of the Problem, teach some underlying skills, like impulse control, flexibility, and that not everything is black and white.

Teach some internal self-regulation strategies that can always be available, such as deep breathing or positive self-talk.
Present it as Size of the Solution, rather than Size of the Problem. When you have no ability to self regulate little problems do feel big. In fact, most people feel in the initial moments of a sudden problem that it is a big deal until they take a moment to pause and realize they have a way to solve it.
Teach parents to use Size of the Problem language for their own experiences to model it. For example, if a parent had a flat tire that day they can talk about the problem and their experience, but also reflect that it felt like a 5 at first, but it was actually only a two or three because they knew how to solve the problem.
Teach the more concrete components first. For example, ask,”will this take a lot of people to solve, a few, or just one or two?” “Will this take a long time to solve?”

Even a Small Problem is Still a Problem

The thing about problems is that no matter their size they are still that - problems. Acknowledging that it's still a problem even when it's a “1” does not mean it's something that should be dismissed or isn’t important. Many problems adults would rate as a “1” are only rated that way because we have learned how to problem solve or deal with uncomfortable feelings. For example, losing a boardgame doesn’t have a black and white solution. Some of us may have learned to say to ourselves, “we’ll win another time” or “it’s fun just to play,” etc. and that is why we are okay with losing.

Use the Clue Cards as a Problem Solving Tool

Looking for another way to use your Clue Cards? When a child rates a card as a big problem, work with them to rate the time and effort required to solve the problem. Once they have a clear solution to something rated as a big problem use that as an educational tool. For example, if “loud noises” was rated as a big problem and they now have noise cancelling headphones, how do they rate it with their strategy in place? This helps them learn that problems have solutions and can make the Size of the Problem strategy easier to introduce.