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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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In his book Visions of Social Control, Stanley Cohen (1985) defines social control as “the organized ways in which society responds to behavior and people it regards as deviant, problematic, worrying, threatening, troublesome, or undesirable in some way or another (pg.1). In the United States, decisions regarding social control have increasingly been left up to two dominant institutions: the criminal justice and medical/healthcare systems (Conrad 1992a, 1992b; Medina and McCranie 2011; Zola 1972). Indeed, over the past half-century, these two systems have come to shape and define an increasingly wide scope of American behavior, both public and private (Conrad 2007; Simon 2007).

Criminologists and medical sociologists have referred to these respective processes as the criminalization and medicalization of social control.

Nowhere have these models of social control become more apparent than among America’s school-aged children. Public schools have adopted the surveillance (metal detectors and random searches), supervision (school resource officers and police officers in school), and punishment and deterrence (zero tolerance policies) measures of the criminal justice system as part of the routine educational setting (Hirschfield 2008a; Kupchik 2010; Lyons and Drew 2006; Simon 2007). Consequently, the number of children experiencing punitive or exclusionary discipline such as school suspension or expulsion has increased significantly. More than a quarter of all American boys have been suspended or expelled from school at least once during their elementary or secondary school careers (Bertrand and Pan 2013). As the use of suspensions and expulsions becomes more common, the number of American children being diagnosed and treated for behavior disorders has also increased at unprecedented rates. For example, the number of diagnosed cases of ADHD increased by almost 400% and prescriptions for stimulant drugs, often marketed as treatment for the growing number of behavioral and conduct disorders, have increased tenfold (Centers for Disease Control [CDC] 2012; Setlik, Bond, and Ho 2009).

As these trends unfold, mounting evidence suggests that increases in both the use of harsh school discipline and medical diagnoses and treatments for behavior disorders are racially patterned. Over the past thirty years, the suspension rate for African-American boys increased from 6% to 15%, while remaining relatively stable for White boys (Losen and Martinez 2013). On the other hand, as a growing number of behavior problems in children are falling under medical control and supervision, African-American boys remain less likely to seek out and receive therapy or treatment for behavior disorders than White boys (Miller, Nigg, and Miller 2009; Morgan et al.

2013). Further, when African-American boys are finally provided with therapy or medication, it tends to be only when behavior problems are extremely severe and frequent (Miller, Nigg, and Miller 2009).

These changes in the social construction of child behavior have important implications for the life-chances of American children. For example, scholars argue that exclusionary school punishment may set the stage for life-course trajectories characterized by routine and repeated contact with the criminal justice system (Hirschfield 2008; Kupchik 2010). On the other hand, the medicalization of childhood misbehavior has changed the ways in which schools, parents, and even the court systems have had to manage unruly and disruptive children (Conrad 2007; Medina and McCranie 2011). For many children, early childhood therapy and medication establishes the medical or mental health systems as the primary social control institutions throughout the life-course (Conrad 2007).

This dissertation furthers our understanding of social control and the social construction of child behavior in several ways. Importantly, I push the criminological and medical sociological literatures regarding social control and the social construction of behavior problems to “speak” to one another about the ways in which different institutions of social control define and manage similar behavior problems. Despite earlier calls for such a conversation (e.g. Bernburg 2009; Timmermans and Gabe 2002), there has been limited research that considers both criminalized and medicalized approaches to social control. By incorporating features of criminology and medical sociology, this dissertation examines racial inequalities in criminalized school discipline versus the use of therapy and medication over the life-course and across multiple units of analysis, including individuals, schools, and school districts. I use this introduction to lay out my approach for bringing together criminology and medical sociology to provide a more comprehensive approach to how we envision social control in the United States (Cohen 1985).

Racial Disparities in the Social Construction of Child Behavior Problems In Chapter 2, I argue that the recent processes of criminalization and medicalization of child problem behavior reflect racial inequalities in the criminal justice and health care systems. For example, in the criminal justice system, perceptions of blameworthiness and dangerousness influence the sentencing decisions of judges and juries (Steffensmeier, Ulmer, and Kramer1998). Because African-Americans are more likely to be considered culpable for their actions than White males and therefore more threatening to society, they are more likely than Whites to get harsh sentences for similar offenses (Steffensmeier, Ulmer, and Kramer1998). On the other hand, because White families are more familiar and trusting of the mental health system, and thus have increased access to new information and technology, they are more likely to use therapy and medication when it is seen as potentially helpful (Bailey et al. 2010; Bussing et al.

2012; Davison and Ford 2000).

When it comes to the problem behavior of young males, many of these same factors influence the decision to punish or use therapy or medication to control behavior problems. For example, perceptions of African-American males as crime-prone and less trustworthy extends well into childhood, as young African-American boys are often denied the same benefit of doubt that young White boys have when they misbehave (Rios 2011; Soung 2011). These preconceived notions of blame and threat influence the decisions of teachers and administrators to punish or not to punish (Ferguson 2000;

Skiba et al. 2013). Similar decisions regarding the use of therapy or medication are influenced by both perceptions of culpability and threat, as well as perceptions of available mental health services. For example, African-American parents are less willing to blame biological or psychological causes for their child’s misbehavior (Bussing et al.

2012; Miller, Nigg, and Miller 2009). Moreover, African-American families are less trusting than White families of the healthcare system and more apprehensive regarding disorders like ADHD (Bailey et al. 2010; Shavers et al. 2000).

In light of these different visions regarding problem behavior and social control, I consider how race influences the social construction of child misbehavior over an extended period of time, net of the frequency or severity of behavior. Using twenty-two years of panel data on a sample of young African-American and White males, I propose that, as the criminalization and medicalization of children’s behavior increases over time, there are racial disparities in school punishment and the use of therapy or medication for behavior problems. Further, I argue that these disparities are not explained by the frequency of behavior problems evidenced by African-American boys and White boys?

Finally, I argue that the criminalization and/or medicalization of young White and Black boys’ have increased at different rates.

Childhood Labels and Trajectories of Social Control Chapter 3 examines the consequences of school suspension and therapy or medication during childhood on individuals’ long-term experiences with both the criminal justice system and the mental health system. Despite the ways in which school punishment and therapy and medication for behavior problems during childhood may set the stage for racial disparities in the adult criminal justice and mental health systems, scholars have yet to test these connections empirically. Specifically, it remains unclear whether racial differences in experiences of school punishment and the use of therapy or medication contributes to racial disparities in long-term involvement in the criminal justice and mental health systems as adults. Moreover, we are limited in our understanding of whether racial disparities in the social construction of child problem behavior reflect and contribute to racial disparities in the criminal justice system versus the use of mental health services as adults.

In Chapter 3, I conceptualize contact with the criminal justice system and the use of mental health services during adolescence and young adulthood as two separate trajectories of social control during adolescence and young adulthood. I then use groupbased modeling techniques to test how race, punishment, and therapy or medication during childhood influence the likelihood of following different life-course trajectories of social control. The use of group-based models allows me to overcome some of the earlier limitations on the long-term consequences of either school punishment or therapy and treatment by examining long-term patterns of social control, as opposed to shorter term effects on behavior or academic performance. Further, by examining punishment and therapy or medication simultaneously, I can compare and contrast the long-term implications of these dominant forms of social construction in childhood.

In Chapter 3, I argue that African-American and White males with similar behavior problems during childhood follow different trajectories of social control during young adulthood, characterized by repeated and routine contact with the criminal justice and mental health systems respectively. Furthermore, school punishment increases the likelihood of following a life-course trajectory characterized by further criminalization, including conviction, probation, and even incarceration. However, the use of therapy or medication for behavior problems during childhood influences the likelihood of following a different trajectory of social control characterized by visits to mental health professionals and the use of psychotropic drugs to control behavior. Finally, racial disparities in labeling in childhood contribute to racial disparities in trajectories of social control during adolescence and young adulthood such that, unlike African-American males, White males who misbehave during childhood are able to escape long-term involvement with the criminal justice system through medicalization.

The Criminalization and Medicalization of School Discipline Chapter 4 shifts the focus from the individual experiences of African-American and White males to the ways in which schools contribute to the criminalization and medicalization of social control through the implementation of difference disciplinary policies. Specifically, through the use of harsh school discipline measures, schools criminalize social control using a disciplinary philosophy and strategies rooted in the American criminal justice system (Simon 2007). Meanwhile, schools can medicalize their social control strategies by enrolling children in programs established by federal laws that consider medically diagnosed behavior disorders in the disciplinary process (Kim, Losen, and Hewitt 2010).

Schools are important socializing institutions. As such, the ways in which schools define and manage deviant behavior reflects and influences the larger community’s approach when it comes to child problem behavior (Cohen 1985). The use of school suspension and expulsion, which exclude deviant children from the classroom and brands them as troublemakers, reflects society’s negative attitudes toward children they view as criminal and responsible for their behavior, thus in need of strict social control (Hirschfield 2008a). On the other hand, when schools consider underlying behavior disorders in the disciplinary process, it represents a willingness to treat symptoms of disorders and not simply punish the rule-breakers (Conrad 1992b; Kim, Losen, and Martinez 2010; Rafalovich 2013).

A few scholars have recently examined racial and socioeconomic disparities in exclusionary or punitive policies at the school-level and find that policies such as suspension and expulsion are more common in schools with relatively larger AfricanAmerican populations (Irwin, Davidson, and Hall-Sanchez 2013; Kupchik and Ward 2013; Welch and Payne 2010;2012). However, policies such as the use of parent-teacher conferences and oral reprimands are applied equally across schools regardless of racial configurations (Kupchik and Ward 2013; Welch and Payne 2012). While no research has considered how or whether schools, as institutions, implement medicalized forms of social control (Kim, Losen, and Hewitt 2010), results from empirical studies at the individual-level suggest that schools with larger African-American populations will rely less on medicalized school discipline because African-American children are less likely to be diagnosed with behavior disorders than White schoolchildren (Miller, Nigg, and Miller 2009; Morgan et al. 2013).

Chapter 4 considers how perspectives on racial inequality arising from both criminology and medical sociology help to understand the influence of school and district level racial and ethnic composition on the criminalization and medicalization of school discipline across a broad range of school contexts. I propose that racial composition, as measured by the relative size of the African-American population, has independent school- and district-level effects on rates of both criminalized and medicalized school discipline. Furthermore, I argue that district-level racial composition moderates the association between school-level racial composition and school disciplinary policies.

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