When the Labels Don't Fit: A New Approach to Raising a Challenging Child By Barbara Probst
A book review by Mika Gustavson
Have you ever thought that we have become too quick to pathologize children whose behavior is disruptive, unexpected or otherwise “outside the box”? Are there so many diagnosed cases of ADHD because we are creating more of this pathology by the changes in our society, or are we seeing everything as a nail because what we have to use is a hammer? An alternative understanding is presented in a new book called When the Labels Don’t Fit: A New Approach to Raising a Challenging Child, by psychotherapist and teacher Barbara Probst. Probst’s thesis is that diagnoses, while sometimes useful in formulating helpful responses to challenging children, can also fail to capture the “full story” on a particular child and may not be an effective lens through which to view them.
Psychological diagnosis is done by comparing a set of behaviors to the specific diagnostic criteria as laid out in a book. A clinician has multiple incentives (including the ability to obtain payment from insurance companies) to fit their client’s behaviors into one of the slots created by the DSM (Diagnostic and Statistical Manual of Mental Disorders). Confining a description of any human to such a narrow range is difficult, and especially so for those who are gifted or twice-exceptional (2e) -- that is, being both gifted and having learning differences. Once a diagnosis is applied, there is a big risk of it being used to label the child, and to direct choices about interventions and treatments to the exclusion of other salient factors. The diagnosis is treated, rather than the whole child.
Using clinical diagnosis as a label rather than a description implies that a child fits into a particular category with defined treatments and desired outcomes which may not actually be appropriate for that individual child. It also sets us (the adults in his or her life) up to see the child's behaviors as “wrong” and in need of correction. The message to the child can easily become “You are wrong” or "You are bad", leaving the door wide open for poor self-esteem, depression and anxiety on the part of the child. What if there were a way to conceive of the difficulties in raising a challenging child that did not make the child wrong, merely different from some of those around him? What if “behavior problems” were understood to be an issue of environmental fit, or a form of communication when linguistic expression is insufficient? What if what was missing was not compliance on the part of the child, but a different understanding on the part of the adult? That would lead to a very different self-concept for the child, and would allow for greater insight as well as improved relationships for all involved.
Rather than look through the eyes of symptomology, Probst encourages her readers to consider viewing their children as having a combination of traits. As she puts it,
“It’s not just a matter of semantics: describing your child’s traits as organizing principles helps you understand and know what to do; describing your child’s symptoms leads to pejorative labels and implies that he has to be changed or cured."
Probst offers a thorough consideration of temperament, beginning with a testing instrument to loosely assess behavior patterns and traits for the purpose of identifying areas of concern. The goal is to understand how your child experiences life and where there may be mismatches of perception at the root of conflict. She then moves the reader through an explanation of each of 11 traits, and discusses each one in a variety of contexts. Finally, she sums up the material from the previous chapters in (my favorite) chapter titled “Putting it All Together: Ten Principles for Raising a Challenging Child.” You might be tempted to skip to this chapter, and you could certainly benefit just from this chapter alone, but don’t miss out everything that leads up to it --- the potential “aha” moments as you recognize your child’s (or your own) behavior are well worth the wait.
One thing I particularly liked was the emphasis on understanding the interrelationship between a child’s traits and those of the parents. When “misbehavior” is reframed as a disconnect between traits in a parent and a child, the way is paved for proactive problem solving, rather than judging each other. This can be a very empowering perspective for a parent who has been feeling helpless to create change in their child. Understanding their own traits, a parent can see a child’s behavior through a lens which takes into account their entire environment, including the parent’s behavior and expectations. While a parent may have little direct control over their child’s behavior, they have a great deal of control over their own behavior and expectations. For the devoted yet perplexed parent with an unusual child, this can be a vital piece in developing a way to live together happily.
Another aspect of the book I found very helpful was the great number and variety of vignettes, coupled with clear examples of suggested behaviors and solutions for parents. Probst also has a keen appreciation of the complexity of human behavior, and demonstrates an understanding of the interactions of traits within an individual that is remarkable. I did, at times, find the long lists of examples for all 11 traits (which can be expressed as either high or low levels, meaning 22 states altogether) a little overwhelming. However, you can easily focus on only the elements that apply in your situation, which I believe may have been the author’s intent in any case.
Usefulness for parents:
This, in my opinion, is a great addition to the bookshelf of any parent with “outside the box” kids, especially those who have been made uneasy by a clinical assessment which might or might not fit. The book also offers ways of conceiving of a child’s difficult behaviors which make it much easier to communicate about them with the other adults in the child’s life. Grandparents, babysitters and teachers can all appreciate the concrete suggestions a parent will be able to offer them. I think that after reading this book, parents will be much better prepared to advocate for the particular needs of their children in all areas of life.
Usefulness to teachers:
I would recommend that teachers keep a copy of this book around as a manual for dealing with sticky situations in the classroom, especially in areas relating to sensory sensitivities. The book is set up in an easily-referenced manner, allowing quick access to the solutions that the teacher might want to consider.
Usefulness to clinicians:
As a practicing therapist, I really appreciate Probst’s willingness to challenge our standard clinical, symptom-based training, and invite us to a new way of looking at our clients. In addition to being an interesting and helpful book for clinicians to read, it is a useful resource for clients. I am often met with questions from concerned parents along the lines of “Yes, well, so what do we DO about it?” This book is a tool I can suggest to parents to help them feel that there IS some way they can help their children.
I think an often-overlooked issue in parenting challenging children is the problem of caregiver burnout. Even when you have a set of tools that you can implement, these children demand ongoing effort that wears down even the most dedicated and energetic parent or teacher. This wear-down in turn can color the relationship, making it even harder for the caregiver to find the necessary vigor and focus to provide what their child needs. If this book can help turn the tide and rescue a relationship between a child and a caring adult in their lives, it is absolutely worth the read. I strongly believe that Probst’s ideas can help readers go beyond mere rescue, and point the direction to genuinely enjoying life with a challenging child.
Barbara Probst has a web site where you can learn more about her: When the Labels Don't Fit
Mika Gustavson, MFT, has been helping children and families for nearly 20 years. Currently, she is in private practice, specializing in gifted and twice-exceptional children and families, transitions into parenthood, childhood trauma and domestic violence. Another “pet project” of hers is raising the awareness of other mental-health professionals about the impact of sensory processing disorders on children, their families and their educational experiences. She lives in the SF Bay Area and can be reached at mikag@pacbell.net
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