Challenging behaviors are simply the downstream effect of neurocognitive skill deficits, which underlie many mental disorders cutting across diagnostic categories, including mood disorders, anxiety disorders, disruptive behaviors disorders like ADHD, autism spectrum disorders, and psychosis, to name several. “So what?” you might ask. Well, then focusing on these skills instead of the diagnostic categories they reflect has important ramifications for early identification, prevention, and treatment:
- Challenging behavior is the canary in the coal mine, informing us of early trouble in neurocognitive development before the typical age of onset for many psychiatric disorders.
- Building neurocognitive skills associated with managing our behavior can prevent brain-based disorders (i.e., mental health disorders) or lessen their impact.
What we have learned from recent genetic and brain imaging research also helps explain why categorical diagnoses leave a lot to be desired for so many children and adolescents (and adults) with challenging behavior. Most kids don’t fit neatly into a particular diagnostic box but rather meet the criteria for a literal alphabet soup of diagnoses which is more overwhelming than helpful. And then some kids don’t seem to meet any criteria for any specific diagnosis but clearly experience plenty of problems managing their behavior. We like to say that you don’t need a diagnosis to have a problem; you just need a problem to have a problem!
For all of these reasons, we advocate for a focus less on categorical diagnosis and more on the underlying skills that someone struggles with that lead to their challenges in living which, if unaddressed can result in a mental health diagnosis. Focusing on skills also helps remind us of the good news that skills can be built through practice.