«The Social Control of Childhood Behavior via Criminalization or Medicalization: Why Race Matters DISSERTATION Presented in Partial Fulfillment of the ...»
Similar to criminalized social control, racialized experiences of school punishment or therapy and medication help to contribute to racial disparities in medicalization over the life-course. For the most part, young men who did not receive therapy and medication for behavior problems during childhood are most likely going to follow a low-risk trajectory of medicalized social control. On the other hand, racial disparities in early therapy or medication for behavior problems appears to set the stage for disparities in medicalized social control for extended periods of the life-course. Both AfricanAmerican and White males who received therapy or medication during childhood had similarly high probabilities of following an adolescent-limited trajectory. However, the probability of following a life-course persistent trajectory of medicalization for AfricanAmerican males was relatively low compared to that of White males receiving similar early labels.
Discussion By using a group-based modeling strategy to conceptualize the processes of criminalization and medicalization as trajectories of social control that individuals follow, this paper helps to initiate a conversation between criminology and medical sociology on the long-term implications of labeling in childhood. Employing panel data from the National Longitudinal Survey of Youth 1979 – Child and Young Adult Survey, this paper tests three sets of hypotheses regarding racial disparities in criminalized and medicalized trajectories of social control. In doing so, this project demonstrates that labeling during childhood via school punishment or the use of therapy and medication for behavior problems has significant implications for long-term trajectories of criminalized and medicalized social control. Moreover, racial disparities in labeling in childhood contribute to racial divergent trajectories of social control across the life-course. These patterns place African-American males at an increased risk of involvement with the criminal justice system and White males at a greater risk of involvement with mental health services and/or psychotropic drugs to control behavior over the life-course.
Results provide partial support for hypotheses 1a and 1b. Specifically, AfricanAmerican males are more likely than White boys to follow life-course persistent criminalized social control trajectories than low-risk trajectories, but are no more likely than Whites to follow an adolescent-limited trajectory of criminalized social control relative to a low-risk trajectory. Similarly, White males are more likely than AfricanAmericans to follow life-course persistent medicalized social control trajectories than low-risk trajectories, but are no more likely than African-Americans to follow an adolescent-limited trajectory of medicalized social control relative to a low-risk trajectory. These contradictory findings suggest that, not only do racial disparities in the social control of problem behavior begin in early childhood, but they continue well into adulthood. Importantly, while White males avoid long-term problems associated with the criminal justice system, their behavior problems are not unsupervised during adulthood.
Instead, they are more likely to rely on therapy and psychotropic drugs to control behavior problems throughout young adulthood.
Results supported hypotheses 2a and 2b, demonstrating that young men who were suspended or expelled from school before they were fifteen were at an increased risk of following a trajectory associated with criminalized social control during adolescence and young adulthood, including routine or repeated contact with the legal system through conviction, probation, or incarceration. Additionally, these young men were unlikely to follow trajectories of medicalized social control, which involved seeking out mental health services such as therapy for violent or disruptive behavior or using psychotropic drugs to control behavior in adolescence and young adulthood. On the other hand, young men who experienced only therapy medication but were not punished in school were no more likely than those who received no label to follow a criminalized life-course trajectory. Instead, these young men became medicalized in early childhood and were likely to remain under medical or psychological supervision for extended periods of the life-course.
The overwhelming majority of the sample was at a relatively low risk of involvement in either criminalized or medicalized social control trajectories. Indeed, most men in the United States will never come into contact with either the criminal justice system or the mental health system. However, for those that do require formal social control during young adulthood, there appears to be two fundamentally different trajectories. For both criminalization and medicalization, there appears to be both an adolescent-limited group and a life-course persistent group. For the adolescent-limited groups, involvement with formal institutions of social control is at its peak during late adolescence and early adulthood and declines steadily in the early twenties. On other hand, for the life-course persistent risk groups, involvement with institutions of social control begins late in adolescence and remains relatively stables through young adulthood. Moreover, not only did young men who had different labeling experiences during childhood experience fundamentally different life-course trajectories, but these relationships remained significant after controlling for time-varying measures associated with stigma and behavior that should have a more immediate effect on contact with institutions of social control for young men following different social control trajectories.
Finally, in support of the third set of hypotheses, racial disparities in labeling during childhood may contribute to later racial disparities in both criminalized and medicalized trajectories of social control. Specifically, because White boys with behavior problems are more likely to receive therapy or medication during childhood and have greater access to resources that accompany early mental health treatment, including better school counseling services and better mental health care, they are better positioned to take advantage of therapy and medication than African-American boys. As a result, they are able to avoid involvement with criminalized forms of social control, including school punishment during childhood and the legal system during young adulthood. On the other hand, once young White males use the mental health system as social control during childhood, they are at a greater risk of medicalized social control continuing during young adulthood. Consequently, White boys appear to be able to use medicalization to escape criminalization and avoid the negative implications of a criminal record during young adulthood.
On the other hand, discrimination and disadvantage associated with racial minority status and the negative consequences of exclusive school punishment during childhood combine to increase the risk of entering criminalized social control trajectories for young African-American males. Indeed, for many African-Americans, school punishment may be the first stage in a life-course process in which removal from school has negative implications for long-term well-being of African-American boys beyond educational and economic success. For example, suspended and expelled AfricanAmerican boys are more likely to be viewed as dangerous or criminal and less likely to be seen as capable of rehabilitation (Kim, Losen, and Hewitt 2010; Soung 2011). As a result, school punishment initiates a life-course process in which the misbehavior of young African-American males is viewed as criminal, thus criminalizing the child himself. Moreover, because African-American males are less likely to receive any form of therapy or medication, they do not following medicalized social control trajectories and instead becoming increasingly criminalized across the life-course.
While these findings provide support that labeling in childhood has long-term consequences, some unanswered questions remain. First, because of data availability, I am unable to include measures of school racial and disciplinary context. This is an important omission, since African-American boys are more likely to attend predominately African-American school with harsh disciplinary policies and fewer educational and counseling resources. Second, relying on maternal report of behavior may bias these results. Nevertheless, tests of the Behavior Problems Index suggest that this issue does not bias studies using the NLSY-C (Guttmannova, Szanyi, and Cali 2007).
Furthermore, prior research using the NLSY-CYA suggests that maternal reports of behavior provide the most accurate measure of problem behavior in childhood and attitudinal measures provide the best measure during adolescence and young adulthood (Hay and Forrest 2008; Piquero and Turner 2002). Finally, my measures of criminal activity and criminal justice contact are severally limited and do not include serious offenses. However, many of the proposed mechanisms of labeling, including stigma and the benefits of medicalization, are more likely to help minor behavior problems and less likely to prevent serious crime. Moreover, given that the NLSY-CYA is a national sample and not a sample of offenders, the levels of serious offending in the sample are low and reflect levels in the population.
Finally, the use of group-based models has some drawbacks. In particular, estimated trajectories are not “real” and actual entities. Instead, they are approximations of trajectories that different groups in the population experience (Nagin 2005; Nagin and Tremblay 2005). They are intended to serve as heuristic devices to facilitate discussion and not represent reflections of what occurs in society (Nagin 2005; Nagin and Tremblay 2005). However, these trajectories provide an excellent tool for describing how early life events impact later involvement in manner that captures longitudinal processes over time.
By viewing the criminalization and medicalization as trajectories rather than discrete events that occur at single points in time, this project provides a useful starting point for discussing how school suspension and the use of therapy or medication during early childhood affect the risk of long-term offending patterns while not necessarily influences criminal justice contact in a given year. Furthermore, a three-group model better approximates reality, in which most young men carry a relatively low risk of criminal justice contact throughout life, some experience criminal justice contact during young adulthood, and only a few experience life-course persistent offending behavior (Moffitt 1993; Sampson and Laub 2005).
The United States has experienced unprecedented growth in the use of school punishment and medically diagnosed behavior problems. Furthermore, as these different forms of social constructing child behavior take hold, clear racial disparities have emerged. However, we know little about how or whether these different ways to label child problem behavior influence extend across the life-course. In particular, scholars are unclear as to how school punishment and the use of therapy or medication influence longterm social control outcomes, including criminalization or medicalization, processes in which behavior problems during childhood increase the likelihood that individuals will spend their adolescence and young adulthood involved with different social control institutions.
This project brings us closer to understanding just how labels can influence later life events. Specifically, the use of therapy or medication for behavior problems can be stigmatizing, but it may provide some benefits that can protect against long-term negative consequences associated with this stigma. Specifically, while young men who received therapy or medication during childhood were likely to rely on medicalized social control during young adulthood, they avoided involvement with the criminal justice system.
While medicalization is not without its difficulties, including increased risk of depression (Currie, Stabile, and Jones 2014), medical sociologists argue that it is a qualitatively more beneficial social control experience than probation or incarceration (Conrad 1992b, 2007;
Medina and McCranie 2011; Zola 1974). On the other hand, school punishment is a stigmatizing experience that marks a young man as a troublemaker, a label that has troubling long-term implications for social and economic well-being. Consequently, because African-American males are more likely than Whites to receive these criminalized labels during childhood, they receive criminal identities at early ages that can follow them well into adulthood.
Chapter 4: The Influence of School- and District-Level Racial Composition on the Criminalization or Medicalization of Child Behavior through School Discipline Policies Scholars argue that increasingly punitive school discipline for a childhood problem behaviors in school mirrors societal responses to criminal activity among adults, such as mandatory sentencing and three-strike laws (Hirschfield 2008a; Simon 2007). At the same time, there is a growing focus in American schools on identifying and attempting to control deviant behavior of children and adolescents through the use of methods modeled on medical treatment, most notably through the identification and therapeutic treatment of conditions such as ADHD, conduct disorders, and oppositional defiant disorder (Conrad 2007; Frick and Nigg 2012; Rafalovich 2013). Thus, as we enter the second decade of the twenty-first century, more American schoolchildren are either suspended or expelled from school or diagnosed and treated for behavior disorders in the United States than at any time in history (Conrad and Slodden 2013; Losen and Martinez 2013).
As important socializing institutions, how schools define and manage deviant behavior reflects the ideas and emotions of the community regarding child behavior (Cohen 1985). The use of punitive school discipline and medical or psychological
diagnoses as social control provide examples of two dominant models of social control: