March 27, 2025 Story by: Editor
A California psychiatrist has raised concerns about the disproportionate diagnosis of oppositional defiant disorder (ODD) among Black children, arguing that it unfairly labels them as “bad kids” and perpetuates systemic racism.
“I often say ODD greases the school-to-prison pipeline,” Dr. Rupi Legha, a Los Angeles-based child and adolescent psychiatrist, told MindSite News. “It becomes a way to shove kids quicker. They’re going to slip and fall a lot more and it’s going to go a lot faster.”
A 2024 study published in Scientific Reports revealed that Black individuals are diagnosed with ODD 35% more frequently than their white counterparts. Additionally, conduct disorders—which encompass ODD—are diagnosed more than twice as often in Black children and 73% more often in Black adolescents compared to white youth. Legha’s report, which examines the overdiagnosis of the disorder and suggests ways psychiatrists can help mitigate its impact, was published in the journal of the American Academy of Pediatrics.
Identifying as an “antiracist MD,” Legha has developed an “antiracist solution” that encourages healthcare providers to contextualize ODD within a historical framework of racism, highlight systemic disparities, and adopt trauma-informed care approaches to humanize affected children.
MindSite News interviewed Legha about her methodology. The discussion has been condensed for clarity and brevity.
Josh McGhee: What does it mean to adopt an antiracist approach to mental health disorders?
Legha: An antiracist approach requires acknowledging the inequities that shape healthcare and understanding their historical origins. It involves developing specific strategies for clinical practice while also considering broader policies that extend beyond immediate patient interactions.
What led you to focus on Oppositional Defiant Disorder?
As a child psychiatrist working in emergency rooms and outpatient clinics, I quickly noticed a pattern: Black and brown children were disproportionately diagnosed with ODD. The research confirms this overdiagnosis. It became apparent early in my career that I needed to address this issue.
My duty is to protect and care for these children. Initially, I followed standard care protocols, but I soon realized they were insufficient. There were no new guidelines to guide me, no directives from supervisors. Instead, I had to navigate the issue independently, using both my heart and mind to ensure these children received appropriate care.
Why is adopting an antiracist approach crucial?
The diagnosis of ODD unfairly stigmatizes marginalized children, particularly Black youth. The history of diagnostic labels being used to justify racial discrimination is well documented.
I often compare ODD to drapetomania, a pseudo-medical condition coined in the 19th century by psychiatrist Samuel Cartwright to explain why enslaved people attempted to escape captivity. The prescribed “treatment” for drapetomania was whipping. This historical context highlights how psychiatric diagnoses have been weaponized against Black individuals.
Why does this classification lead to punitive actions rather than support?
Diagnostic labels serve as tools of judgment. When a child is labeled with ODD, it often results in coercion and force rather than support. Punitive measures become the default response instead of a last resort.
In emergency room settings, ODD can justify seclusion and restraint. In outpatient clinics, it leads to increased disciplinary action and parent training. In schools, it correlates with higher suspension and expulsion rates. In the juvenile justice system, the diagnosis can determine whether a child is placed on probation or sent to a residential facility.
Are these punitive measures also applied to white children?
There are stark racial disparities in school discipline. Black children, particularly Black girls, face significantly higher risks of suspension and expulsion. The ODD diagnosis exacerbates these inequalities.
While white children also face disciplinary actions, research suggests they are more likely to be referred for mental health treatment, with their behavior perceived as a symptom of distress. In contrast, Black children are more often subjected to punitive measures, including suspension, expulsion, and juvenile justice involvement.
What changes should mental health professionals implement?
The key takeaway from my research is that providers cannot rely solely on existing guidelines. Instead, they must actively consider the broader inequities at play and recognize how an ODD diagnosis can perpetuate harm in educational, healthcare, and juvenile justice systems.
As mental health professionals, we must be committed to challenging these systemic issues and advocating for policies that protect vulnerable children.
Source: Mind Site News
