A 56-day wilderness expedition in Arizona costs $21,000. Residential Treatment Programs and Therapeutic Boarding Schools often charge between $50,000 upwards to $80,000 for a 9-12 month length of stay.

The fees charged by these private-pay behavior modification programs are not much different than those charged by the top-quality private programs that cater to the juvenile justice system. But when courts or state agencies send youths to private programs, the cost is spread among hundreds of thousands, or even millions, of taxpayers. When parents send their own children, it's usually at their own expense.

The fact that more than 20,000 families a year are paying these enormous sums speaks volumes about their levels of despair over their children's behavior. But how can ordinary people afford to spend so much?

For starters, most of the families that send children to these programs are upper middle-class or wealthy.  But there are families that have had to use up their kid's college savings. What good is saving for college if you're not going to have a kid who can go?"

Many of the programs employ financial counselors to help families figure out how to pay. Some advise parents to take out home equity loans, because the interest is tax-deductible. Others steer parents towards traditional school loan providers. (Starting this tax year, some of that interest will be deductible, too.)

Some families are lucky enough to have health insurance policies that will pay part of the costs. Twenty-two of the 70 programs featured in the 2008 edition of "Places for Struggling Teens" report that one-third or more of their clients have some costs paid by third-party payers, including insurers, school districts and juvenile courts. In general, insurers are most likely to pay for programs that are licensed and accredited, and offer a significant therapeutic component.

Some families manage to persuade their local school districts to pay if their children require special education services and the districts can't meet their needs.

Most private-pay programs and schools are organized for profit, so few provide scholarships. However, in this economy, programs and schools are offering creative solutions for parents to help off-set the cost of private programs which means scholarships are up for discussion.

Despite the high cost, the National Association of Therapeutic Schools and Programs (NATSAP), states that the private-pay market has yet to be fully tapped. At the group's organizational meeting in January, literature was posted that there were "at least 200,000 adolescents in America right now who need our programs and can afford them."

A diagnosis is an important piece of the puzzle we are trying to solve when we try to help kids with disabilities learn how to function. Many parents are relieved when they get a diagnosis for their acting-out, "problem child" because they see it as a guideline for the future. They think, "Now we'll know what to do; this is it? we'll finally get our child the help he needs." The truth is that I've seen families go through the drudgery of doctors and diagnoses many times. I've worked with kids who had Attention Deficit Hyperactive Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder, Obsessive Compulsive Disorder (OCD), and many others. I've also seen individual kids with five different diagnoses: every time they were hospitalized or went to a new therapist, they would get a new one. But sadly, in the end their parents were left with the fact that simply having a diagnosis didn't necessarily mean they could get help improving their child's behavior, or get them the skills they needed to learn how to function successfully.

A diagnosis doesn't mean that you are assured treatment for your child from which you will see change. A diagnosis doesn't mean you're going to get funding to help give your child the success he needs. And a diagnosis does not mean he's going to get the services he really needs. Sadly, there are no guarantees. I've worked with many parents whose kids had been given multiple diagnoses, but their children were still punching holes in the wall, cursing them out and having meltdowns at home and in school.

I believe these kids can change, and that the process of change works best when it starts at home. I've worked with acting-out children for thirty years, and I've found that if there's a culture of accountability at home or in school, it enhances these kids' potential to respond. Real change does occur, but it takes a lot of work and sacrifice on the parts of all the adults involved. I'll tell you what I've told many parents in my office: "It doesn't end with the diagnosis, it just starts there."