«The Social Control of Childhood Behavior via Criminalization or Medicalization: Why Race Matters DISSERTATION Presented in Partial Fulfillment of the ...»
Table A.3 presents the results from the second multinomial logit model introducing a race dummy variable indicating whether the respondent was nonHispanic Black or nonHispanic White. Results from Table A.3 provide support for the second hypothesis. Specifically, during the period of time under study, African-American boys were 173 percent [100*(e1.006)-1] more likely to be suspended or expelled than White boys and 30 percent [100*(e-1.198)-1] less likely to receive therapy or medication for behavior problems than White boys. This can be observed in Figure B.2, which presents predicted probabilities of school punishment and therapy/medication for all years of 1988 and 2010.
Figure B.2 reveals clear racial disparities in the social construction of child behavior. For White boys, the chance of receiving therapy or medication for a behavior problem is a little over 7 percent, compared to just 4 percent for African-American boys.
On the other hand, while White boys have less than a 4 percent chance of being suspended or expelled from school, African-Americans boys’ chances are more than 15 percent. Thus, over the past 25 years, school punishments were predominately experienced by African-American, while White boys were more likely to experience therapy or medication during the same period. Since both possible responses to child behavior are being examined simultaneously, this evidence suggests the behavior of African-American and White boys is socially constructed in fundamentally different ways.
Table A.4 presents results from multinomial logit models examining the odds of punishment or receiving therapy or medication over time (in years), net of an individual’s propensity to engage/demonstrate externalizing behaviors. Results from Table A.4 provide support for my third hypothesis. Higher externalizing behavior scores are associated with greater odds of school punishment, the use of therapy or medication for behavior problems, or both. A one-unit increase in CBCL externalizing behavior scale is associated with 26 percent [100*(e0.231)-1] increase in the odds of receiving therapy or medication, a 20 percent [100*(e0.182)-1] increase in the odds of school punishment, and 53 percent [100*(e0.424)-1] increase in the odds of both punishment and therapy/medication. While frequent displays of externalizing behaviors increases the likelihood of a formal social response, the likelihood of whether than response was a therapy/medication or school punishment is still determined by the respondent’s race.
Compared to White boys with similar behavior problems, African-American boys are 225 percent [100*(e1.182)-1] more likely to be suspended or expelled without receiving therapy or medication compared than they are to receive no label at all. Moreover, they are more than 62 percent [100*(e-0.967)-1] less likely to receive therapy or medication for a behavior disorder without punishment than White boys.
Results thus far have indicated that rates of school punishment and the therapy or medication of behavior disorders increased between 1988 and 2010. Further, AfricanAmerican boys were significantly more likely to be punished and less likely to receive therapy or medication for behavior problems than White boys, even after differences in the frequency of externalizing behavior problems is considered. Next, I examine whether there are racial disparities in the increased use of both school punishment and medicalization. Specifically, did the use of school punishment increase faster for African-American boys than for White boys? Conversely, did the use of therapy or medication increase faster for White boys than for African-American boys?
Table A.5 presents results from multinomial logit models examining the odds of punishment and therapy/medication over time (in years) after including interactions between my African-American dummy variable and both year and year-squared to assess the relative differences in the rates of criminalization and medicalization across AfricanAmerican and White boys. Overall, results from Table A.5 reveal clear racialized patterns in the social construction of childhood behavior over time. Specifically, AfricanAmerican boys are not only more likely to be punished without therapy/medication than White boys, even after controlling for behavior, but their rate of increase in school punishments over time is far more pronounced. Furthermore, while White boys are more likely to receive therapy or medication versus no label than African-American boys, there is no evidence to suggest that racial disparities in medicalization are increasing or decreasing over time. To facilitate a discussion of these trends, I turn to a series of figures displaying predicted probabilities of school punishment and therapy or medication over time for African-American and White boys.
Figure B.3 presents changes in the predicted probability of only therapy or medication (versus no response) for African-American and White boys between 1988 and
2010. Overall, White boys are more likely to receive therapy or medication than AfricanAmerican boys. However, there are no significant differences between White boys and African-American boys in the increase in the use of therapy or medication. While African-American boys begin the period much less likely to receive therapy or medication for behavior disorders that White boys, the rates converge somewhat after the turn of the century. Meanwhile, White boys experience two noteworthy spikes in the likelihood of therapy or medication at the beginning and end of the 1990s.
Unlike therapy or medication alone, there are clear racial disparities in the overall likelihood of school punishment and the rates of increase in school punishment over time.
As Figure B.4 demonstrates, increases in the use of suspensions and expulsions were predominately experienced by African-American boys. Indeed, as the chances of school punishment for African-Americans changed rapidly over time, increasing from 5 percent in 1988 to over 20 percent in 2000 and down to 10 percent in 2010, they remained relatively stable for young White boys. At no time in the study did the chances of school punishment for White boys reach that of African-American boys at their lowest (in 1988).
Indeed, White boys were left relatively unaffected by changes in school punishment over the past 20 years.
Conclusion and Discussion This article draws from focal concerns perspective in criminology and theories of labeling and cumulative disadvantage/advantage from medical sociology to examine racial disparities in the social construction of childhood misbehavior. Employing twelve waves and twenty-two years of panel data from the National Longitudinal Survey of Youth 1979 – Child Survey, I use multinomial regression models to demonstrate that there are clear racial disparities in the social construction of child behavior that translate into different social control experiences in childhood. Specifically, as rates of school punishment and medically diagnosed behavior disorders increase between 1988 and 2010, African-American boys have been more likely to be punished, while White boys have been more likely to receive therapy or medication to control their behavior. Finally, as the rates of school punishment for African-American boys increase over time, White boys are generally able to avoid trends in criminalized school discipline through medicalization.
While frequent behavior problems are associated with a greater likelihood of punishment or the use of therapy and medication, they cannot explain racial disparities in the two forms of social control. Instead, when African-American and White boys are displaying similar levels of externalizing symptoms, parents and teachers are more likely to attribute the behavior of White boys to medical or psychological disorders and view them as capable of treatment (Bussing et al. 2012). Additionally, increased access to mental health professionals and information about disorders among White families may help White boys to receive treatment and avoid punishment. On the other hand, AfricanAmericans may be considered more blameworthy for their actions and viewed as threatening to the school environment when they misbehave. Insufficient access to mental health care and disproportionate exposure to zero-tolerance disciplinary policies may increase the likelihood that African-American boys will be punished and less likely to be treated without punishment.
These findings have important implications for how we understand the social construction of child behavior problems. First, as rates of school punishment increase over time, they too are reflected in increasing disparities in incarceration in adulthood (Western 2002). Meanwhile, while White boys only display slightly fewer externalizing symptoms, they are much less likely to be punished when they do act out. Consequently, while the use of therapy or medication may come with stigma, it may still provide Whites boys with the chance to escape serious consequences of stigma through rehabilitation and treatment (Kim, Losen, and Hewitt 2010).
While there is no statistically significant difference in the rates of increase for therapy or medication for African-American boys and Whites boys, two striking patterns in Figure 4 bear mentioning. For African-American boys, the rates of medicalization remain relatively stable until about 1996. However, for White boys, they increase rapidly between 1990 and 1996, immediately after passage of the Individuals with Disabilities Education Act (IDEA) of 1990 and an increased policy push to cover children diagnosed with ADHD under Section 504 of the Rehabilitation Act of 1973. These laws extended many protections and programs to children diagnosed with certain behavior and learning disorders that interfere with their free access to a public education (Kim, Losen, and Hewitt 2010).
In late 1997, the U.S. Food and Drug Administration (FDA) issued new guidelines that allowed pharmaceutical companies to air direct to consumer advertisements on television (Conrad and Barker 2010; Payton and Thoits 2011). In the following years, the pharmaceutical industry targeted predominately White and middleclass consumers, including parents of children with behavior problems (Conrad and Potter 2004). As a result, the rates of medicalization again increased for White boys relative to White boys (Conrad 2007; 2013; Conrad and Potter 2004). Future scholarship should consider how policy at the federal and state levels influences these trends, as well as examine how White families can use their privileged role in the market place to avoid school punishment and ensure therapy and treatment.
Finally, the behavior of African-American boys is increasingly being constructed using the language of social control. While African-Americans are being punished at skyrocketing rates, they are also more likely to be diagnosed with behavior disorders than they were two decades ago. By layering the social control of African-American boys in both criminal justice and medical terms, the state, through schools, are able to maintain the racial status quo and prepare White and African-American boys for their racialized roles in a post-industrial society (Kupchik and Monahan 2006). Specifically, harsh punishment and nearly consistent formal social control perpetuate racial inequalities and reinforce stereotypes of African-American males as deviant and threatening (Wacquant 2001).
In order to prevent racial disparities in punishment and treatment, school disciplinary policies should focus on prevention strategies and alternatives to suspension and expulsion, particularly for high-risk populations. Further, school and community resources should be shifted from discipline or identifying behavior problems to addressing structural conditions that lead to problem behavior in the first place. Finally, policymakers need to consider racial/ethnic disparities in the social construction of childhood behavior when considering special education and testing policies so that African-American children are not subjected to over-control and pushed out of the education system too fast.
While these findings present clear evidence of racialization in the processes of criminalization and medicalization, there are some unanswered questions. 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.
Nevertheless, Chapter 4 of this dissertation addresses these important questions in a large sample of U.S. schools and districts. Second, there is evidence that White and AfricanAmerican mothers view their children’s behavior differently. Consequently, 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). Finally, this analysis is limited to comparisons between White and African-American males. Evidence suggests that Latino males may experience similar disparities in criminalization and medicalization (Alegria et al. 2008;
Rios 2009). Furthermore, recent research suggests that African-American females may be experiencing increases in both school punishment (Losen and Martinez 2013) and medicalization (Miller, Nigg, and Miller 2009). These trends notwithstanding, the findings of this paper speak to important historical trends in both criminal justice and mental health and further our understanding of how social control is socially constructed at very early ages.
The United States has experienced unprecedented growth in exclusionary school punishments and the use therapy or medication to control child problem behavior.