«The Social Control of Childhood Behavior via Criminalization or Medicalization: Why Race Matters DISSERTATION Presented in Partial Fulfillment of the ...»
These preconceived notions of criminality and blameworthiness shape how students are treated by school employees and inevitably lead teachers and administrators to seek out harsher punishments for African-American boys observed breaking the rules (Ferguson 2001; Skiba et al. 2013). In some school settings, racial and ethnic minorities are more often singled out even before they exhibit any behavior problems, leaving them with a very narrow line to cross before facing punishments (Ferguson 2001; Rios 2006, 2011). For example, in her in-depth study of school discipline and its role in shaping African-American masculinity, Ferguson (2001) reveals how school staff joke about young boys “having a prison cell” written all over them. To these teachers, boys who misbehave are simply preparing themselves for their future lives as criminals, and time spent in the school’s isolation room is just preparation for jail or prison (Ferguson 2001).
In another example, Victor Rios (2006) reports that many young African-American males felt that their teachers, schools, and even families treated them like criminals from very young ages and that these institutions were collaborating to channel them into a life of incarceration and involvement with the criminal justice system.
Cumulative Disadvantage/Advantage Social and structural conditions in the US are heavily influenced by race, which further contributes to a racialized process of criminalization. According to a cumulative disadvantage/advantage perspective, racial discrimination and structural inequality place young African-American boys at a greater risk of harsh punishments even after behavioral risk factors are considered. African-American boys are routinely subjected to criminalized forms of social control at all stages of development (Rios 2006). For example, African-Americans are more likely to go to schools with on-campus police officers, metal detectors, and zero tolerance disciplinary policies, all of which increase the risk of suspension and expulsion for even minor offenses (Kupchik 2010). In addition, these schools are more likely to experience overcrowding and lack the resources to handle individual student problems in ways other than forced removal (Ferguson 2001;
Kupchik 2010). As a result, school punishment serves as another disadvantage, compounding the ways in which poverty and discrimination influence the long-term wellbeing of young Black boys.
Race and Medicalization Labeling Theory The decision to seek therapy and/or medication for child misbehavior is extremely complicated. For many families, being diagnosed with mental or behavioral health disorder can be a stigmatizing experience for both young boys and their parents (Bailey et al. 2010; Brinkman et al. 2012). Therapy and medication can be controversial, as many parents are hesitant about giving their kids pharmaceutical medication, particularly stimulants at such a young age (Brinkman et al. 2009; Mueller et al. 2012). On the other hand, the stigma of mental illness has declined over time, as people are more willing to accept biological or psychological explanations for deviant behavior than they were in the past (Perry 2011; Pescosolido 2013). Moreover, many teachers and medical professionals claim that therapy and medication can provide the best chance of rehabilitation for child with behavioral or mental health disorders (Barkley 1997; Conrad 2007; Millichamp 2010). These concerns are reflected in the different ways that AfricanAmerican and White boys’ behavior is social constructed.
Fearing the stigma associated with poor mental health, African-American mothers are less likely than White mothers to consider their child’s behavior as a result of a medical or psychological cause (Bailey et al. 2010; Bussing et al. 2012; Miller, Nigg, and Miller 2009). A history of discrimination in American schools has left African-American families distrustful of recommendations made by teachers and administrators regarding their children’s behavior (Davison and Ford 2002). Similar to the education system, there is a legacy of discrimination in the U.S. healthcare and mental health systems. The legacy of the Tuskegee experiments has left many African-American families skeptical of medical research, particularly contested and controversial issues (Bailey et al. 2010;
Shavers, Lynch, and Burmeister 2000). As a result, African-American mothers are skeptical of how behavior disorders such as ADHD are constructed by professionals (Davison and Ford 2002; Fitzgerald 2008; Miller, Nigg, and Miller 2009). Instead, they blame misbehavior on other factors such as too much sugar (Bussing, Schoenberg, and Perwien 1998; Bussing et al. 2012).
On the other hand, social structural factors in the United States often leave White parents in a better position to consider the potential biological or genetic causes behind misbehavior (Bussing, Schoenberg, and Perwien 1998). Nearly all White parents are at least somewhat familiar with common behavior disorders such as ADHD (Bailey et al.
2010; Bussing et al. 2007). As a result, they are more familiar with the etiology of these disorders and are more likely to attribute their children’s behavior to biological or genetic causes (Bussing, Schoenberg, and Perwien 1998; Bussing et al. 2007). Furthermore, White parents are more likely to have cordial and cooperative relationships with their sons’ teachers and school administrators and are more willing to accept their recommendations when it comes to therapy or treatment (Bussing et al. 2012; Kupchik 2010).
Despite differences in the willingness to blame mental health problems for their sons’ misbehavior, African-American and White parents are similar in their belief in the effectiveness of treatment at controlling behavior (Anglin et al. 2008; Miller, Nigg, and Miller 2009). However, African-American parents’ often believe that behavior problems will subside on their own (Anglin et al. 2008; Bussing et al. 2012; Miller, Nigg, and Miller 2009). Moreover, when they do seek treatment, mental health providers often characterize African-American boys as incompetent and uncontrollable and therefore unable to benefit from therapy or treatment (Alegria et al. 2011; van Ryn and Fu 2003).
As a result, not only are young African-American boys less likely to have their misbehavior blamed on a mental or behavioral health issue, they are less likely to be considered suitable targets for treatment. On the other hand, White boys are viewed as more capable of adhering to a treatment regimen and more likely to be more responsive to therapy and medication (Bussing et al. 2012; Cuffe et al. 2005). These different perceptions of threat and the capacity for rehabilitation contribute to racial differences in the likelihood to seek out treatment or therapy.
Cumulative Disadvantage/Advantage According to the cumulative disadvantage/advantage perspective, increases in medicalization reflect the ability of White parents to use their social status and position to ensure their children can get the best care possible for their children’s behavior problems.
Like other health disparities, racial gaps in the medical treatment of behavior problems are partially due to the ways in which social and economic resources are distributed along racial lines in the U.S. (Williams et al. 1997; Williams and Sternthal 2010). For example, compared to African-American families, White families, on average, have higher family incomes and are more likely to be covered under private insurance plans. These resources can facilitate the medical treatment of childhood problem behaviors by reducing barriers to care, providing payment for effective treatment, and improved health literacy (i.e.
being able to understand this often complicated knowledge and put it into practice) (Morgan et al. 2013; Williams et al. 1997; Williams and Sternthal 2010). However, racial disparities in mental health and mental health treatment extend far beyond racial gaps in socioeconomic status.
In the United States, a racialized social structure can influence racial gaps in the medicalization of child behavior in several ways. First, since African-Americans are much less familiar with many common behavioral disorders, they are less exposed to information about symptoms and treatments (Bussing et al. 2012). Second, racial residential segregation interferes with the ability of African-American families to obtain effective medical and mental health care locally (Williams et al. 1997; Williams and Sternthal 2010). Finally, even if they are able to seek care, racial prejudices and biases on behalf of providers influences the type of care that African-American boys receive.
For example, pediatricians are less likely to solicit information about behavior problems from the parents of African-American boys (Guerrero, Rodriguez, and Flores 2011). In addition, young African-American boys often do not receive the appropriate therapy or medication because the doctor was either too busy to assess him properly or did not view the child as capable of adhering to treatment (Bailey et al. 2010; Bussing et al. 2012).
While African-American families are underserved by the mental health system, White families are far more familiar navigating the medical and healthcare systems to meet the needs of their children. As the most frequent consumers of medical technology, White families are often the target of direct to consumer advertisements (Conrad and Potter 2004; Conrad 2007). As a result, White parents are able to influence mental health professionals with respect to treating their children’s behavior problems (Conrad and Leiter 2004; Goldman and Lakdawalla 2005). Indeed, doctors and psychologists often claim that they are simply confirming parents’ diagnoses of behavior disorders, rather than examining and identifying symptoms themselves (Conrad 1992b; Rafalovich 2005).
As a result, White families and children are better able to direct care and persuade their providers as to which diagnoses meet their children’s symptoms (Conrad and Leiter 2004; Bussing et al. 2012; Goldman and Lakdawalla 2005). Once they are able to secure the desired therapy or medication, they have more options and are better able to find a provider that can offer effective treatment (Bussing et al. 2012). Moreover, they are able to use their child’s diagnosis to ensure that their son receives extra consideration and assistance at school, particularly in the case of misbehavior (Conrad 2007; Kim, Losen, and Hewitt 2010).
Summary and Hypotheses The research discussed above describes how racial and ethnic disparities in the social construction of youth behavior emerged over time. Specifically, as school punishment and medical treatment became common responses to the misbehavior of young boys in the United States, there are clear racial disparities in the way these approaches are applied. Stereotypes of young African-American men as criminal extend to boys at very young ages, including notions of blameworthiness and perceptions of risk.
Moreover, African-American boys are more likely to attend schools in hypercriminalized environments and have limited family involvement with mental health services. On the other hand, the parents and teachers of young White boys are more likely to consider biological or psychological causes of misbehavior and be more accepting of medical therapy or medication. In addition, White families are more likely to be involved in school disciplinary decisions and have greater access to information about behavioral disorders that may afflict their sons. Drawing from the research discussed above, I develop and test four specific research hypotheses regarding the ways in which racial stratification influences how child problem behavior is socially constructed, either
through a process of medicalization or criminalization. These are delineated below:
H1: The probability of African-American and White boys being punished or receiving therapy/medication has significantly increased over time.
H2a: African-American boys are significantly more likely to be suspended or expelled from school than White boys.
H2b: White boys are significantly more likely to receive therapy or medication for behavior problems than African-American boys.
H3a: Higher levels of externalizing behavior problems will be significantly associated with a greater likelihood of a punishment and therapy/medication.
H3b: Racial differences in the frequency of externalizing behavior symptoms do not fully account for racial disparities in school punishment and therapy/medication.
H4a: The probability of school punishment for African-American boys’ behavior will increase at a significantly greater rate than the probability of school punishment for White boys.
H4b: The probability of therapy/medication for White boys’ behavior will increase at a significantly greater rate than the probability of therapy/medication for African-American boys.
Data and Methods The data for this chapter were taken from the National Longitudinal Study of Youth, 1979 Cohort – Child and Young Adult Sample (NLSY79-CYA). The NLSY79 is a prospective longitudinal study originally designed to capture the labor market experiences of Americans who were between the ages of 14 and 22 in 1979. A total of 12,686 male and female respondents were interviewed annually from 1979 through 1994 and biannually from 1996 until 2010. Since its inception, the mission of the NLSY has expanded to include important health and family conditions. In 1986, a separate biennial survey of all children born to original NLSY79 female respondents was initiated. By 2010, the NLSY-Child Survey included information on 11,504 children from 4,932 mothers, ranging from 0 to 14 years of age 1. The NLSY-Child Survey is beneficial for two key purposes. First, it contains prospective and repeated information on important developmental and socioeconomic characteristics throughout childhood. Second, the study period of the project overlaps with an unprecedented increase in both school punishment and medically diagnosed behavior problems in American boys (Losen and Martinez 2013; CDC 2012).