Volume_6_Issue_2_Digest

6 TPC Digest The Process and Implications of Diagnosing Oppositional Defiant Disorder in African American Males Marc A. Grimmett, Adria S. Dunbar, Teshanee Williams, Cory Clark, Brittany Prioleau, Jen S. Miller 6 with ODD that may apply to others working with similar populations and contexts. These findings suggest that a diagnosis of ODD can result from more factors than client symptoms fitting the diagnostic criteria. Four domains emerged related to diagnosing ODD: (a) insurance influence —the role of insurance companies and managed care in the diagnostic process; (b) ODD diagnostic criteria —the relative malleability of the ODD criteria listed in the DSM-5; (c) assessment, diagnosis, and treatment —not accounting for family, community and other contextual problems affecting client mood and behavior; and (d) ODD stigmatization —negative stigmatization associated with an ODD diagnosis. African American males are particularly vulnerable to diagnostic stigmatization due to multiple marginalizations that can occur when intersecting with other forms of oppression (e.g., racial bias, stereotypes, prejudice). Thinking through the diagnostic process and beyond the diagnosis requires mental health counselors to consider and balance the needs of the client, provision of ethical and effective mental health services, expectations and requirements of employers, and earning a living. Contextual explanations, including historical and systemic contexts, must be considered before a diagnosis is given. Attending to the role of counselor bias to prevent over-diagnosis is an ethical responsibility for which counselor educators and practicing counselors must hold themselves accountable. Marc A. Grimmett is an Associate Professor at North Carolina State University. Adria S. Dunbar is an Assistant Professor at North Carolina State University. Teshanee Williams and Cory Clark are doctoral students at North Carolina State University. Brittany Prioleau and Jen S. Miller are licensed professional counselors. Correspondence can be addressed to Marc. A. Grimmett, Campus Box 7801, Raleigh, NC 27695-7801, marc_grimmett@ncsu.edu . R esearch studies indicate that the number of African Americans diagnosed with Oppositional Defiant Disorder (ODD) is disproportionately higher than other demographic groups. One potential contributing factor for this discrepancy is racial diagnostic bias, when counselors who hold stereotypical beliefs about clients selectively attend to client information, which influences the assessment process. White American clients, for example, presenting with the same disruptive behavioral symptoms as African American clients, tend to be diagnosed with adjustment disorder. African American masculinity stereotypes of criminal mindedness, violent behavior, aggression and hostility contribute to implicit biases. Clinical assessment may be influenced by personal and societal biases, resulting in misdiagnosing client symptoms. Counselors with limited multicultural and social justice counseling competence can easily over-diagnose African American males with ODD. Counselors working with African American families need to consider the African American family’s unique stressors, worldviews and burdens; possible inclusion of the extended family; possible therapist biases that conflict with client worldview; and strength-based factors that foster competency, resilience, self-reliance and health in African American populations. An appropriate ODD diagnosis in African American males, then, requires culturally competent assessment and treatment planning, including the consideration of contextual factors beyond clinical symptoms reported. The purpose of this qualitative research study was to: (a) understand and explain some of the contextual factors, diagnostic processes and counseling outcomes associated with the diagnosis of ODD in African American males; and (b) identify, describe and make meaning of patterns and trends in mental health care systems that may be associated with the apparent over-diagnosis of African American boys with ODD. Study findings represent an in-depth analysis of the perspectives of six licensed mental health professionals with experience diagnosing and working with clients who are diagnosed