TPC-Journal-V6-Issue2

147 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. Marc A. Grimmett, Adria S. Dunbar, Teshanee Williams, Cory Clark, Brittany Prioleau, Jen S. Miller The Process and Implications of Diagnosing Oppositional Defiant Disorder in African American Males Research studies indicate that the number of African Americans diagnosed with oppositional defiant disorder (ODD) is disproportionately higher than other demographic groups. A consensual qualitative research (CQR) design was used to understand the contextual factors, diagnostic processes and implications associated with ODD in African American males. Six mental health professionals were interviewed and four domains identified: insurance influence, ODD diagnostic criteria, ODD stigmatization, and assessment, diagnosis, and treatment. Findings indicated that factors beyond the health needs of the client, including counselor bias, might play a critical role in diagnostic assessment. Implications are provided for counselors and counselor educators. Recommendations for further research are suggested on the diagnosis– billing model and the long-term implications of ODD diagnoses for African American males. Keywords: oppositional defiant disorder (ODD), diagnosis, African American males, consensual qualitative re- search (CQR), insurance Research studies indicate that the number of African Americans diagnosed with oppositional defiant disorder (ODD) is disproportionately higher than other demographic groups (Feisthamel & Schwartz, 2009; Schwartz & Feisthamel, 2009). One contributing factor for this disproportionality is that White American clients presenting with the same disruptive behavioral symptoms as African American clients tend to be diagnosed with adjustment disorder. Feisthamel and Schwartz (2009) concluded, “counselors perceive attention deficit, oppositional, and conduct-related problems as sig- nificantly more common among clients of color” (p. 51), and racial diagnostic bias may influence the assessment process. Racial biases in clinical decision making are explained in a conceptual pathway developed by Feisthamel and Schwartz (2007). In the pathway, counselors who hold stereotypical beliefs about clients selectively attend to client information. The counselor’s judgment is influenced by personal bias, resulting in misdiagnosing the client. African American masculinity stereotypes of criminal mindedness, violent behavior, aggres- sion and hostility (Spencer, 2013) held by counselors with low multicultural social justice counseling competence (Ratts, Singh, Nassar-McMillan, Butler, & McCullough, 2015; Sue, Arredondo, & McDa- vis, 1992) potentially foster misdiagnosis and overdiagnosis of African American males with ODD. Studies on how African American males are diagnosed with ODD and specific implications for African American males are relatively nonexistent. McNeil, Capage, and Bennett (2002) indicated the majority of information on children diagnosed with ODD has been obtained from primarily White children and families. They recommended that counselors working with African American families consider the African American family’s unique stressors, worldviews and burdens; possible inclusion The Professional Counselor Volume 6, Issue 2, Pages 147–160 http://tpcjournal.nbcc.org © 2016 NBCC, Inc. and Affiliates doi:10.15241/mg.6.2.147