TPC-Journal-V6-Issue2

The Professional Counselor /Volume 6, Issue 2 153 Oppositional Defiant Disorder Is Stigmatized An ODD diagnosis carries negative social weight and judgment within and beyond the mental health fields. African American males are particularly vulnerable to diagnostic stigmatization due to multiple marginalizations that can occur when intersecting with other forms of oppression, such as racism (Arrendondo, 1999; Ratts et al., 2015). Most participants referenced long-term negative impli- cations for these clients, including, “I think it leaves a permanent scar, with elementary kids all the way up.” One participant expressed further that: I have had kids that have been diagnosed with [ODD] and they drop out. I have had young African American boys in my office and they say ‘You know this has been going on with me since I was a kid?’ And you know that they are telling the truth. They ask themselves, ‘Why am I still in school?’ So they drop out. Another mental health counselor added: I see it when we go to court even [with] an African American judge. African American boys would typically get a harsher sentence. It’s a systemic issue. We just start viewing through a lens and we automatically have an assumption to what the problem is. We have a negative interpretation of one kid’s actions versus another. Assessment, Diagnosis and Treatment Assessment, diagnosis and treatment do not account for family, community and other contextual problems affecting the client’s mood and behavior. One mental health counselor explained, “if the parent has been incarcerated, they are going to act out. If they are dealing with a domestic violence situation in their home, this is a way of relieving stress for them.” Another participant added: We leave the whole family out of this process . . . That may be where the problems exist. It is person centered to a fault. To the neglect of it being family centered versus person centered or being both, because you would dare not want to intervene with a child and not involve family. Despite [that] the parents will come and say, 95% of the time, ‘I am okay—you need to fix my son or daughter.’ When treatment plans get tailored based on that premise, then everybody is in trouble. Trauma also was identified as a contextual issue that warrants consideration in the diagnostic process. Past trauma, living in very difficult situations, near or below poverty are not taken into ac- count. What might be very adaptive behaviors for a kid, or might be situational dependent, are then just translated into the diagnosis. Participants acknowledged mental health counselor bias plays a role in diagnosis as well. A mental health counselor may have a tendency to diagnose certain clients with ODD because it is a familiar and commonly used diagnosis. One mental health counselor stated, “a lot of times, particularly with new clinicians, [ODD] is a buzz word . . . like ADD was a buzz word years ago.” A different partici- pant shared the diagnostic rationale, “it helps them, too, because it’s a relatively non-offensive diag- nosis. It’s not as personal a diagnosis, so they don’t feel as bad being diagnosed oppositional defiant disorder as they would something else.” The relative cultural competency of practitioners also was referenced by participants as potentially compromising the diagnostic process, with one indicating that: