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«The Social Control of Childhood Behavior via Criminalization or Medicalization: Why Race Matters DISSERTATION Presented in Partial Fulfillment of the ...»

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Medicalization in schools can take place through the implementation of services for children that meet the criteria for specific behavior disorders mandated by two federal laws, the Individuals with Disabilities Education Act (IDEA) of 1990 and Section 504 of the Rehabilitation Act of 1973 (Gius 2007; Holler and Zirkel 2008; Kim, Losen, and Hewitt 2010). Under the guidelines put forward by these two pieces of legislation, schools are required to ensure that children with disabilities, including behavior disorders such as ADHD, oppositional defiant disorder, and conduct disorder, are guaranteed free access to a public education (Kim, Losen, and Hewitt 2010; Holler and Zirkel 2008). To meet this guarantee, schools provide, among other things, individualized education plans (IEPs) including modified curriculum, enhanced learning environments, and extra school personnel to assist with behavioral and educational needs (Guis 2007; Holler and Zirkel 2008; Kim, Losen, and Martinez 2010). Most importantly, because misbehavior in school may be the result of a child’s disorder, schools must determine whether an infraction was the result of a behavior disorder before making any disciplinary decisions (Kim, Losen, and Hewitt 2010; Holler and Zirkel 2008). By considering potential medical or psychological causes for school misbehavior, implementation of services under IDEA and Section 504 reflects the medicalization of social control through a diagnostic and therapeutic approach to school discipline.

While both IDEA and Section 504 establish guidelines for schools to consider and make accommodations for students’ behavior disorders, there are several key differences between the two pieces of legislation that have significant implications for the current study. First, the two statutes differ with respect to how they define disorders (Zirkel 2011). To qualify for IDEA, students must meet the diagnostic criteria for one of thirteen disability categories (Holler and Zirkel 2008). For example, children with oppositional defiant disorder are classified as having an emotional disturbance, and provided specialized services based on their abilities to get along in a normal classroom (Kim, Losen, and Martinez 2010). Similarly, students clinically diagnosed with ADHD are often covered under “other health impairments” and given assistance with note and test taking, as well as other necessary services (Holler and Zirkel 2008). On the other hand, children whose primary disorder falls outside of these behavior categories, for example Autism or deafness, are provided services that best meet the needs associated with those impairments (e.g. interpreter services for children who use sign language) that they would not provide to children with behavior disorders 1.

Instead of a formal diagnosis from a medical or mental health professional, eligibility for coverage under Section 504 requires that students have a “physical or mental impairment that substantially limits one or more major life activities” (Holler and Zirkel 2008, pg.

20). Unlike IDEA, these major life activities extend to areas outside of learning, including behavior and attention problems that do not always interfere with classroom performance (Gius 2007; Holler and Zirkel 2008). Thus, if a child is not diagnosed with a behavior disorder as defined under IDEA, schools are able to formally provide similar services and coverage (Gius 2007; Holler and Zirkel 2008; Kim, Losen, and Martinez 2010).

The second important difference between the two laws involves eligibility requirements. While, IDEA requires that students be formally diagnosed by a medical or psychological professional for such disorders, teachers and administrators are allowed to initiate a Section 504 plan without an official diagnoses from a health professional (Holler and Zirkel 2008; Kim, Losen, and Martinez 2010). Thus, not only are schools legally bound to offer services to children with behavior disorders, Section 504 offers For children with multiple disorders, the “most disabling” condition, or the condition that best describes the child’s impairment, is considered the primary disability and is official impairment listed with the school (Holler and Zirkel 2008).

school officials the discretion to decide whether certain students may require services and which services are most appropriate, without the need of a doctor or psychologist (Fitzgerald 2008; Guis 2007; Holler and Zirkel 2008; Kim, Losen, and Martinez 2010).

Finally, the two statutes differ in the ways in which are services provide are funded. Specifically, while IDEA explicitly sets aside funds for special education services, Section 504 is an unfunded mandate require schools and districts use their own resources to ensure compliance (Holler and Zirkel 2008; Kim, Losen, and Hewitt 2010).

Because Section 504 does not require an official diagnosis and services rely on resources provided by the school or the district, enrolling children in a Section 504 plan can be a costly and sometimes controversial decision (Gius 2007; Fitzgerald 2008; Kim, Losen, and Hewitt 2010). Thus, the choice to offer Section 504 services to a child relies on much more than just actual behavior, including teachers’ perceptions of behavior, the ability of educators in the school and district to properly diagnose problems with a doctor, and schools’ and districts’ available social and economic resources. As a result, Section 504 plans involve a greater deal of discretion by teachers and school administrators than the seemingly straightforward guidelines proposed under IDEA (Gius 2007; Kim, Losen, and Hewitt 2010).





Some schools may lack the human and economic resources to provide adequate services under IDEA or Section 504. Instead, schools rely on exclusionary discipline and suspend or expel higher rates of students. Consequently, if schools are not implementing these policies and programs evenly across the United States, children with similar behavior problems may experience significantly different responses from their teachers and administrators. For example, many scholars have pointed out significant racial and ethnic disparities in the use of both the use of more criminalized forms of school discipline and the medicalization of childhood problem behavior (Kim, Losen, and Hewitt 2010; Kupchik and Ward 2013; Irwin, Davidson, and Hall-Sanchez 2013; Morgan et al. 2013). These scholars point to stratification in other social institutions, suggesting that school disciplinary policies reflect and perpetuate longstanding inequalities in social control in the United States (Kupchik and Ward 2013; Irwin, Davidson, and Hall-Sanchez 2013; Wacquant 2001).

Race, Social Control, and School Discipline The association between school and district racial composition and the use of school disciplinary policies is complex. Schools and districts serving predominately White student bodies now implement strict disciplinary policies that were once limited to urban schools and those with larger racial and ethnic minority populations (Kupchik 2009). For example, in an in-depth qualitative and quantitative study of four American high schools, Kupchik (2010) found that predominately White and African-American schools all adopted similarly punitive measures, including the use of school suspension and expulsion when student broke the rules. Furthermore, by the end of the first decade of the 21st century, most school districts had adopted zero tolerance disciplinary policies, regardless of racial and ethnic composition (Hirschfield 2008b; Kupchik 2010). As Johnathon Simon (2007) argues, the behavior of all children in the United States is increasingly “governed through crime” as schools adopt a one size fits all approach to school discipline (Kupchik 2009; Kupchik and Ward 2013).

There are similar arguments regarding the relationship between race and the use of medicalization and medicalized social control in schools. As discussed earlier, schools medicalize deviant behavior through services initiated by federal laws such as IDEA or Section 504, which manage students with behavior problems through medical technology and techniques rather than punitive coercion (Fitzgerald 2009; Gius 2007; Holler and Zirkel 2008; Reid and Katsiyannis 1995; Zirkel 2011; Zola 1972). Importantly, these federal laws mandate a one size fits all strategy when it comes to the medicalization of school discipline. Specifically, schools are required to provide equal services to students with any health disorder that interferes with their free access to a public education. While the quality of these services is highly contingent on the resources that schools and districts are able to provide, it is illegal for schools and districts to not provide medicalized students with educational and behavior services (Kim, Losen, and Hewitt 2010). Therefore, regardless of whether local racial composition influences the ability of schools to adequately meet the needs of children with behavior problems, they are required to enroll and provide at least nominal services to diagnosed children (Kim, Losen, and Hewitt 2010).

While schools may adopt similar and supposedly race-blind disciplinary strategies “on the books,” the execution of such practices is heavily influenced by school racial or ethnic composition (Kupchik 2009; Kupchik and Ward 2013). According to racialized crime and punishment theories, including critical race theory and racial threat, social control practices and policies in the United States reflect historical racial tensions which subjugate and criminalize African-Americans (Irwin, Davidson, and Hall-Sanchez 2013;

Wacquant 2001). Many scholars highlight the historical connections between slavery and Jim Crow to recent phenomenon such as the War on Drugs and mass incarceration (Alexander 2010; Irwin, Davidson, and Hall-Sanchez 2013; Wacquant 2001). They argue that a history of racialized social control practices provide a template for modern criminal justice strategies on controlling socially marginalized populations, particularly African-Americans. Recently, a few studies have extended these racialized crime perspectives towards the study of disciplinary practices across school contexts in the United States. In particular, the view of African-Americans as dangerous and in need of constant control extends throughout the life-course, with childhood being no exception (Rios 2009; 2011).

While racialized crime theories suggest that race and school racial composition of local areas is associated with differences in the use of punitive school disciplinary measures, research from population health and medical sociological perspectives suggest that there are clear racial disparities in medicalization. Similar to school punishment, these disparities exist in a manner that benefits White children. Specifically, because medicalization of behavior offers children many benefits, including extra test time, modified curricula, and a requirement that schools consider behavior disorders before discipline a child, it is likely to be the preferred method of controlling advantaged children (Medina and McCranie 2011; Rafalovich 2013). Furthermore, because medicalizing children requires both financial resources and expertise, schools serving disadvantaged populations are less likely to implement such measures (Kim, Losen, and Hewitt 2010). According to the fundamental cause hypothesis (FCH), social conditions are “basic causes” of health disparities in that they affect multiple outcomes through multiple mechanisms (Link and Phelan 1995; Phelan, Link, and Tehranifar 2010).

Applying a FCH framework to racial inequalities in health, scholars suggest that race can serve as a primary organizing factor that determines access to important resources, such as money, information, and social support that help individuals escape health problems (Link and Phelan 1995; Williams 2005; Williams and Sternthal 2010).

Link and Phelan (1995) argue that socially advantaged groups are able to purposefully use their social and economic resources to maintain better physical and mental health. As such, schools serving predominately White student bodies can access resources, including social and human capital, which enable them to implement the medicalized disciplinary regimes such as IDEA and Section 504 (Goldman and Lakdawalla 2005; Phelan, Link, and Tehranifar 2010). On the other hand, with limited social and economic resources, schools and districts serving predominately AfricanAmerican students are unlikely to cover children with behavior problems (Kim, Losen, and Hewitt 2010).

While the fundamental cause hypothesis suggests that access to resources drives racial disparities in the medicalization, critical race scholars suggest that such these disparities reflect the racialized social structure of the United States that consistently disadvantages racial minorities, particularly African-Americans (Williams 2005;

Williams et al. 2010). Historical patterns of racial discrimination have left AfricanAmerican families extremely distrustful of both the education system and mental health systems (Bussing et al. 2012; Davison and Ford 2002). As a result, recommendations made by teachers and administrators regarding their children’s behavior or learning problems are met with skepticism and contempt (Davison and Ford 2002; Fitzgerald 2008; Miller, Nigg, and Miller 2009). Further, even when parents’ support of medicalization is not necessarily required, as is the case with Section 504, teachers and administrators in schools with greater proportion of minority children are less likely to view misbehavior of children as the result of a medical issue (Soung 2011). Instead, they are likely to consider inattention and class disruption to be confrontational behavior akin to criminal activity (Ferguson 2001; Rios 2011; Soung 2011).



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