I've often said that parents of kids with behavioral challenges go through two developmental stages (it seems teachers may pass through these stages as well). Phase One: believing that a psychiatric diagnosis is going to give you the information you need to understand and help your child or student. Phase Two: coming to the recognition that a diagnosis didn't give you the information you needed to understand and help your child or student. Neither oppositional defiant disorder nor the vast majority of other psychiatric diagnoses that are commonly hung on children tell you what you really need to know. Most diagnoses just tell you what deviant behaviors a kid is exhibiting.

The circular thinking inherent in this process isn't always so obvious, so here goes:

Parent or Teacher: Doctor, why is he throwing tantrums, defying adult rules and requests, and refusing to do what he's told?
Doctor: Because he has oppositional defiant disorder.
Parent or Teacher: How do you know he has oppositional defiant disorder?
Doctor: Because he's throwing tantrums, defying adult rules and requests, and refusing to do as he's told.

Yet, these days, in the real world, the instant it becomes clear that a child has social, emotional, or behavioral challenges, the quest for the diagnostic holy grail commences. In many school systems, a diagnosis is what a kid needs to access services it's already clear he needs. In many places, diagnoses influence funding decisions. A diagnosis is what a kid needs for his mental health provider to be reimbursed by an insurance carrier. A diagnosis is what a kid needs for his parent(s) to know that there is a support group comprised of parents whose children exhibit similar behaviors.

But the down-side of diagnoses outweighs the up. Diagnoses pathologize kids. Diagnoses make it explicit that "the problem" resides within the kid. Diagnoses make it clear that it's the kid who needs fixing, thereby providing justification for many ineffective interventions directed solely at the kid. Diagnoses scare off potential helpers ("He has bipolar disorder! I don't know anything about bipolar disorder! That's for someone else to deal with!"). Diagnoses deprive kids of the help they clearly need ("I'm sorry, Mr. and Mrs. Taylor, but your daughter doesn't meet full diagnostic criteria for Asperger's disorder, so she doesn't qualify for our program.") And, worst of all, diagnoses are distracting. They cause potential helpers to focus more on what a child is doing rather than on why and when he's doing it...and on what the potential helpers can be doing to help.

Why is a child exhibiting challenging behavior? The Collaborative Problem Solving approach provides the following answer: Because he or she is lacking the skills not to exhibit challenging behavior.

When does the child exhibit challenging behavior? The CPS model has an answer to that, too: He exhibits challenging behavior when the demands being placed upon him exceed the skills he has to respond adaptively. Would the child prefer to respond adaptively? Of course! Is the child choosing to respond maladaptively? Now why would he choose to do that? If he had the skills to respond adaptively, he would.

And what do challenging kids do when they're having difficulty responding adaptively to the demands being placed upon them? They exhibit the behaviors that are the basis for the diagnosis they will receive.

Now imagine this. Imagine that we all came to our senses and decided that categories weren't so important or meaningful after all. Imagine that we all realized that challenging behaviors occur on a spectrum, something I refer to as the Spectrum of Looking Bad. At the "easy" end of the spectrum we'd include behaviors like whining, sulking, pouting, and crying. Moving in the "less easy" direction we'd find behaviors like screaming, threatening, growling, swearing, spitting, biting, kicking, hitting, head-banging, lying, and stealing. Moving still further in the "less easy" direction would be behaviors that are harmful (sometimes fatal) to oneself or others. But we'd recognize that all of those behaviors - irrespective of which ones a kid may be exhibiting - occur when the demands being placed on a kid exceed that kid's capacity to respond adaptively. (Just to normalize this, we all look bad when the demands being placed upon us exceed our capacity to respond adaptively. Why do most of us look bad less often than challenging kids? Because we have skills they're lacking.)

Imagine further: instead of putting massive amounts of time and energy into trying to determine the "right" diagnosis, we'd instead focus our efforts on identifying the lagging skills of each challenging child and the specific conditions (unsolved problems) in which those lagging skills were being demanded...in other words, the conditions in which the child was "looking bad." We'd use the Assessment of Lagging Skills and Unsolved Problems (visit The Paperwork section of the website of my non-profit, Lives in the Balance [www.livesinthebalance.org], to download a copy) to make sure we have the right lenses on, to organize our efforts to help, and to determine what problems need to be solved. We'd rely a lot less on punishment and a lot more on problem-solving. And we'd solve those problems collaboratively (rather than unilaterally). Over time, we'd have a lot of solved problems - and a lot less challenging behavior -- to show for our efforts.

In many places - families, schools, inpatient psychiatry units, therapeutic group homes, and residential and juvenile detention facilities - this is no pipe dream. It's the reality. Just not enough places...yet.

                                                 * * * * * * *

I've received numerous emails from people asking me to weigh in on the tragedy that occurred in Tucson, Arizona. I've been closely following Gabby Giffords' amazing day-to-day progress and have dared to imagine her leading a happy, productive life when she leaves the hospital. I've been watching how our leaders have responded to the tragedy, some admirably, some less so, and wondering if their newfound civility will last beyond the end of January.

And, yes, I've been following what there is to read about Jared Lee Loughner. Though hard information has been lacking - we really don't know what he was thinking -- it certainly seems reasonably clear that he wasn't in his right mind when he began shooting. He joins others who have committed similar horrific acts in recent memory: John Hinckley, Mark David Chapman, and those (their names are usually less familiar) who've walked into their workplaces or university campuses or schools and killed co-workers or fellow students and faculty.