Problems in Living

These days, if you’re a challenging kid, you’re probably in one of two stages of development: the pre-diagnostic stage or the post-diagnostic stage. If you’re in the pre-diagnostic stage, then adults are still trying to figure out why you’re challenging and still have faith that a psychiatric diagnosis will provide useful information. If you’re in the post-diagnostic stage, then adults have probably come to the recognition that a diagnosis isn’t the holy grail and didn’t really help people understand your difficulties at all.

That’s because diagnoses don’t pinpoint the unsolved problems or lagging cognitive skills that are setting the stage for a kid’s challenging behavior. Still, it’s easy to become attached to a diagnosis, and the attachment is understandable. Having a mental health professional confer a diagnosis on your child can be very validating…at last, verification that there is, indeed, something different about your child. Diagnoses can help parents feel less alone; there is comfort in knowing you’re not the only one who has a kid with a particular profile. Diagnoses can point people to resources and support. Diagnoses can convince your insurance company to ante up. Diagnoses can get schools to provide services. Of course, diagnoses can be confusing, too. As I’ve often said, if you bring your child to five different mental health professionals, there’s an excellent chance you’ll wind up with five different diagnoses. And many very challenging kids don’t meet diagnostic criteria for anything…does that mean they’re not really challenging? But, of perhaps greatest concern, diagnoses can be misleading in that they suggest that your child “has” something, that the problem resides within your child, a “mental illness” perhaps. Diagnoses pathologize children, even though, in the case of challenging behavior, it almost always takes two to tango. Diagnoses don’t provide any information about the unsolved problems and lagging skills setting the stage for your child’s challenging behavior. Worst of all, a diagnosis doesn’t help adults know what to do to help. A long time ago, a prominent psychiatrist named Thomas Szasz was as unenthusiastic about the term “mental illness” as I am now. He preferred a different term: problems in living. Now there’s a concept with some real application to challenging kids. If a kid is having problems in living, then the adults in his life know exactly what to do: figure out what problems are making it hard for him to live adaptively and then help him solve them…collaboratively. So I’d like to propose a different stage of development: the non-diagnostic phase. In this phase, adults understand that challenging behavior is an issue of development, not diagnosis. They do a good job of assessing lagging skills so they understand why the child is exhibiting challenging behavior. They’re willing to look at their own role in challenging episodes, not pathologize their child. They’re busy identifying the unsolved problems they need to work on with the child, not studying diagnostic criteria. And then they start solving problems and teaching skills rather than looking for a cure. Much better. Thanks for reading.

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