Understanding Challenging Behaviors: A Positive Systems Approach

by Dr. Bob Carey

The recent New York Times investigation into the booming autism therapy industry raised deeply concerning questions about the commercialization of childhood behavioral and developmental challenges. (5 Takeaways From a Times Investigation on Autism Therapy Clinics, by Sarah Kliff and Margot Sanger-Katz, May 23, 2026) (5 Takeaways From a Times Investigation on Autism Therapy Clinics). According to the investigation, some autism clinics and therapy providers in the U.S. recommended extraordinarily intensive treatment schedules—sometimes amounting to the equivalent of a full-time workweek for very young children with Autism Spectrum Disorders. These providers often benefited financially from systems that rewarded high billing and high service volumes. The report also highlighted how rapidly expanding private clinics, some backed by investors and private equity, operated within systems where oversight often lagged behind growth.

The Bigger Picture

What makes this story especially important is not simply the issue of fraud, overbilling, or overtreatment. Those are symptoms of a larger societal pattern: our increasing tendency to isolate children’s behavior from the systems surrounding them. In many ways, the investigation reflects a cultural mindset that continues to ask, “What is wrong with this child?” rather than “What is happening around this child?” That distinction is critical.

In my latest book, What if it’s Not Just the Behaviour?, I discuss the Positive Systems Approach (PSA). This approach encourages parents, educators, and professionals to widen the lens through which behavior is understood. The core principle behind PSA is that behavior does not exist in a vacuum. Behavior is communication. Children’s actions often reflect broader systems—family stress, school environments, peer dynamics, emotional regulation difficulties, community resources, socioeconomic pressures, and cultural expectations.

The Risks of Over-Medicalization

The New York Times investigation exposes what can happen when systems lose sight of this broader perspective. When behavior becomes overly medicalized or commodified, there is a risk that children become defined by diagnoses rather than understood as human beings navigating complex environments. Families who are overwhelmed, exhausted, and desperate for answers are often drawn toward programs promising intensive intervention and measurable outcomes. In a culture increasingly driven by performance, productivity, and optimization, it can feel reassuring to believe that more therapy automatically equals better outcomes. But children are not machines to be recalibrated. They are developing human beings embedded within emotional, relational, and social systems.

Understanding Behavior in Context

One of the most important ideas in PSA is that disruptive or concerning behavior often makes sense when viewed in context. A child who is melting down may not simply be oppositional; they may be overwhelmed, anxious, dysregulated, sleep-deprived, socially isolated, or reacting to chronic stress within the family system. Similarly, a child who struggles socially may not need forty hours a week of intensive behavioral conditioning as much as they need emotionally attuned relationships, safe environments, supportive schools, and caregivers who themselves are not operating in survival mode.

The Impact of Societal Stressors

The investigation also indirectly reveals how broader societal stressors shape parenting decisions. Many families today are functioning under extraordinary pressure. Parents are stretched thin financially and emotionally. Communities are less connected than they once were. Extended family supports are often absent, and schools are overwhelmed. On top of this, mental health resources remain difficult to access. In these environments, parents naturally search for solutions that appear concrete, structured, and authoritative. Intensive behavioral programs can seem to offer certainty in a world filled with uncertainty. Yet PSA reminds us that if we focus exclusively on changing the child without examining the systems surrounding the child, we risk missing the true drivers of distress.

Sometimes the behavior we are trying hardest to eliminate is actually a signal that the larger environment needs attention. A child’s dysregulation may reflect chronic overstimulation, unrealistic expectations, family stress, social disconnection, academic pressure, or cultural mismatches between home and school environments.

Rethinking Autism and Neurodiversity

This is particularly relevant in conversations surrounding autism and neurodiversity. Increasingly, autistic adults and advocates have raised concerns about therapeutic models that focus excessively on compliance, masking, or making children appear “normal” at the expense of emotional well-being and authenticity. While behavioral interventions can absolutely be valuable and helpful when implemented ethically and compassionately, the larger question remains: Are we supporting children in ways that honor who they are, or are we simply trying to reduce behaviors that make adults uncomfortable?

The Positive Systems Approach encourages a different path. Rather than asking how to control behavior, PSA asks how to create systems where children can thrive. That includes strengthening family relationships, reducing environmental stressors, teaching emotional regulation skills, building community supports, and recognizing the role that culture, socioeconomic realities, and relational health play in development. It also means supporting parents themselves, because dysregulated systems often produce dysregulated behavior. A stressed parent, an overwhelmed school, or an unsupported community inevitably shapes the emotional climate in which children develop.

The Importance of Family and Community

The broader lesson from the New York Times investigation is not that therapy is inherently harmful or that families should avoid intervention. Rather, it is a reminder that when systems prioritize profit, compliance, or symptom reduction without adequately considering context, humanity can get lost. Children are more than billable hours, treatment plans, or behavioral targets. They are deeply influenced by the emotional ecosystems surrounding them.

As parents and professionals, we need to resist the temptation to search only for quick fixes located within the child. Sometimes the most meaningful interventions happen outside the therapy room: restoring family connection, reducing stress within the home, strengthening community supports, improving emotional attunement, and creating environments where children feel safe, understood, and valued for who they are.

Creating a Supportive Environment

When we widen the lens in this way, we stop asking only, “How do we change this child’s behavior?” and begin asking the far more important question: “What kind of world are we creating around this child?”

In conclusion, the Positive Systems Approach offers a framework for understanding and addressing challenging behaviors in children. By focusing on the systems surrounding them, we can foster more connected and supportive environments. This shift in perspective not only benefits the children we aim to support but also enriches the lives of families and communities as a whole. Let's embrace this approach and work together to create a nurturing world for our children.