Oppositional Defiant Disorder (ODD), a common diagnosis in child psychiatry, describes children who exhibit frequent anger, irritability, defiance, and vindictiveness. But a new paper by child psychiatrist and founder of the Antiracism in Mental Health Fellowship Rupinder K. Legha, argues that for racially minoritized children, this label can act as a “bad kid” stamp rather than a meaningful clinical tool.
Published in Pediatrics, the flagship journal of the American Academy of Pediatrics, Dr. Leghaâs article unveils how ODDâs diagnostic framework perpetuates systemic racism, fueling school discipline disparities and the school-to-prison pipeline.
âODD describes the presence of unwanted behaviors and suggests they are features of the child, rather than manifestations of underlying neurodevelopmental differences, prior trauma, or co-occurring mental health challenges,â Legha writes.
She highlights research finding that ODD diagnoses are 35% more prevalent in Black children than in white children. She argues that this disparity stems not from inherent behavioral differences but racialized perceptions of defiance. The diagnosis, she explains, often mistakes adaptive responses to systemic racism for dysfunction, reinforcing harmful stereotypes.
The paper calls on pediatric providers to document systemic inequities and advocate for humane, trauma-informed care. By rejecting punitive narratives and reframing behaviors as responses to adversity, clinicians can help rehumanize children and provide the support they deserve.
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See how circumscribed, conceptual lines of enquiry like race or inequality, although crucial factors in themselves, distort and pervert the complete picture which needs to be seen, grasped and understood as a whole, not through narrow and divisive concepts related to social identities which are historically designed and shaped by the very dominant racist culture you are using them to criticise, to expose. Please do see first of all that the main argument in the above piece rests on pure speculation. You put the overdiagnosis of defiant disorder (and the other mental disorders presumably) down to racist perceptions of the care provider, but it is not clear the extent to which over-diagnosis rests on these racist perceptions of prescribers which obviously exists, or else the more serious traumatic social, psychological and emotional injuries owing to the experience of being a black person in a racist society, of which racism experienced at the hands of a mental health care providers are merely one, narrow example.
In addiction, the picture is further confounded, to an excrutiating degree as it happens, by all the other innumerable issues that bare on outcomes which correlate to racial categories but which iNDEPENDENTLY undermine what you call mental health in anyone effected, for example poverty, quality of healthcare available, whether or not there is divorce, addiction or familial trauma, whether children have been fostered or brought up in care, the quality of accessible food and education and healthcare and transport in the neighbourhood, and the degree of alienation and casual racism in the experience of day to day living. So all these additional factors would need to be disentangled and controlled for in order to even hope to extract the contribution of any one single factor to the overdiagnosis in non-white people that you describe, and which again is just one narrow example of ubiquitous racial and social inequality across society – in healthcare at large, in terms of economic inequality, in terms of criminal and environmental justice, and so on and on and on. So all you do with these narrow critical case studies is destroy your own capacity to see the problem as a whole, for it is always a whole, not one neatly divided into the conceptual categories which the dominant culture makes you have and makes you see the whole of your reality through.
After all, it is widely known that the experience of black, Hispanic and white people on all of these measures are on average measurably quite different, so one cannot easily measure the contribution of racial perceptions of the prescriber against all these other various factors which unarguably correlate. To argue for the primacy of one factor over all others is rash, speculative, deceptive, and adds to all the speculative noise covering over really good quality, fact based investigations, descriptions, exposes, and first hand accounts. Such noise drowns out the real – the real facts and the experiences, and the real efforts of the very few serious people committed to the truth and the facts and not the advancement of their own little reputations and careers by adding to the noise of worthless intellectual guff which again and again undermines the cause that this website is devoted to. If MIA can’t sort this out on their own website there is vanishing hope that it can make a difference in wider circles, let alone psychiatry or society as a whole.
Of course race is a fundamental factor in determining one’s quality of life but race is not something I am. Race is something society has construed me as – I am my skin colour according to this society, or my sexual behaviour. Being treated thus by society is responsible, evidently, for grave traumas not just to non-white people but to the whole of society and to the health of our hearts and minds. But the problem has to be approached and grasped as a whole, not through narrow and divisive categories the obsession of which creates conflict and division, creates noise and distraction, and entirely obscures the clear perception of what is as it is. And this is a recurring problem on MIA. Your attempt to explain everything according to the implicit judgements of the mental health sector is yet more non-factual speculation, more conceptual hypostatization, and a far cry from uncovering the actual life experiences, testimonies, and injuries of real people of every colour who come in for and/or are destroyed by mental health treatment, which is at once an uncovering of the actual psychological and social terrain as it is, the understanding of which is the understanding of reality itself. If you are too conditioned to understand what I am saying don’t shoot the messenger because you’ll end up proving your own idiocy. I may have expressed this poorly but it is just the plain truth people. How do I know? Because understanding your suffering, or that of any other human being, cannot be done through defining them as the white society defines them – normatively according to invented categorical differences from themselves, for example in skin colour. A liberated human being is a human being, not their skin colour or who they want to f*ck. See the appalling indignity of these superficial social identities to which we cling, although nationalism and patriotism is in many ways the most toxic of all and indissociable from racism and general domestic social and cultural repression of us all.
What you call critique is an objective thing, but it is not really critique. It’s the clear description using words of that which has been perceived and understood, and only sounds like criticism to the intellect which has not learned the importance of seeing things as a whole. All your brains are blighted by the stupiefying intellect. You invest everything in it but it turns a whole, total, unitary reality into nothing but utter disorder and a fragmented, confused, groping, lost mind.
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Good to see. It reminds me of the old psychiatric dx given to slaves who tried to run away.
Fritz Redl on of the many WWII refugees who came to the United States and had the need to help out ran a house in Detroit, Michigan for youths in trouble as well as writing a book When We Deal with Children which discussed his concept of a time/ life/ space interview as well as a total milieu therapy approach. I think he did not have a great understanding of the deep and complex history of the United Syayes but he tried and cared and knew trauma himself as a child. He was a survivor.
One of the techniques he used which was brilliant and so child appropriate was this. He walked into Pioneer House one day and the residential counselor was trying to cope with a bunch of boys being wild and almost out of control. He walks up and says anybody want ice cream? Problem solved. One has to know children well to be able to pull of such an intervention that changes everything in a second. Doesnât always work but fits in the historical context of this article.
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I had, apparently incorrectly, thought the ODD diagnosis was created in about 2013, as an alternative diagnosis for all the children who had the common adverse effects of the ADHD drugs and antidepressants misdiagnosed as “bipolar,” as Whitaker pointed out in his 2010 “Anatomy of an Epidemic?”
There should be a call for an end to the “invalid” DSM stigmatization of all children, and humans. Your DSM “bible” was debunked over a decade ago, “mental health” industries, please wake up to reality … and flush your billing code “bible” of scientifically “invalid” (albeit iatrogenically created) stigmatizations.
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I think it’s criminal to diagnose children, especially small children with mental disorders and put on medications. I’ve heard of a five year old girl being diagnosed with Borderline Personality Disorder!! I was shocked. My husband said that eventually they will start diagnosing fetuses in the womb. “Oh, your baby is kicking your stomach? Let’s give the baby some medications. Here, mom, take these pill for your fetus to calm down.”
Don’t just blame psychiatrists. They can’t get paid for anything unless they record a diagnosis in order for insurance companies to reimburse them. It’s the same in every branch of medicine. They need to record a diagnosis in order to get paid from insurance companies.
Also, families seem to be quick to bring their children in for a diagnoses and medication so they don’t have to deal with anything for whatever reason. Denial of problems that exist in the family or too busy or too tired, etc. We are brainwashed into thinking that we need to go to a doctor for anything that ails us but then many people are looking for an easy way out too.
And I think society, overall, works against the emotional well-being of practically everyone, including children.
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Kids get irritated, fed up, and lose their cool just like anyone else. And God knows they have every reason to do so, especially in a world increasingly overrun by psychiatry’s thoroughly quacked disease model.
Too bad so many adults aren’t able to see that they’re the ones who are misbehaving, not the kids.
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