Racial/Ethnic Disproportionality in Psychiatric Diagnoses and Treatment in a Sample of Serious Juvenile Offenders

Abstract

Psychiatric disorder prevalence has been shown demonstrably higher among justice-involved adolescents than youth in the general population. Yet, among arrested juveniles, little is known regarding racial/ethnic differences in disorder prevalence, the role of trauma exposure in the diagnosis of behavioral disorders, or subsequent psychiatric treatment provided to adolescents with such diagnoses. The current study examines racial/ethnic disparity in psychiatric diagnoses and treatment of behavioral disorders associated with delinquency, controlling for traumatic experiences, behavioral indicators, and prior offending among serious juvenile offenders. Logistic regression is employed to explore the racial/ethnic disproportionality in behavioral disorder diagnoses and psychiatric treatment provision among 8763 males (57.7 % Black, 11.8 % Hispanic) and 1,347 females (53.7 % Black, 7.6 % Hispanic) admitted to long-term juvenile justice residential placements in Florida. The results indicate Black males are 40 % more likely, and Black females 54 % more likely to be diagnosed with conduct disorder than Whites, even upon considerations of trauma, behavioral indicators, and criminal offending. Black and Hispanic males are approximately 40 % less likely to be diagnosed with ADHD than White males, with no racial/ethnic differences for females. Importantly, Black males are 32 % less likely to receive psychiatric treatment than White males, with no differences between White and Hispanic males, or any female subgroups. Traumatic exposures increased the odds of oppositional defiant disorder and ADHD, but not conduct disorder for males, though adverse childhood experiences were unrelated to behavioral disorder diagnoses among females.

Neurodisability among Children at the Nexus of the Child Welfare and Youth Justice System

“…Third, given the Australian context, somewhat limited sample size, and missing data it was not possible to examine how other demographic differences played out, including but not limited to Indigenous status, and to a lesser extent race/ethnicity. The latter comparison is especially important in light of research findings from Florida in the US showing that while blacks are more likely than whites to be diagnosed with conduct disorder, they are much less likely to receive necessary treatment (Baglivio et al 2017). Yet, treatment is critical for helping them overcome their trauma and help to increase the chances of improved adult outcomes.…”

Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth

“…For example, clinicians often over-pathologize behaviors of ethnic and racial minorities as more dangerous and disobedient, and can hold personal and inadvertent biases of criminal behavior, aggression, violence, and hostility toward certain minority groups [9,37,38]. These biases can lead to diagnostic disparities, explaining why non-Hispanic white children who demonstrate comparable behaviors (that are often diagnosed as CD and ODD in ethnic and racial minority youth) tend to be diagnosed with conditions such as mood, anxiety, development, or adjustment disorders [1,6,9,22].…”

“…ADHD is less frequently diagnosed in ethnic and racial minorities, even when controlling for confounding variables such as adverse childhood experiences, prior juvenile offenses, and sociodemographics [3][4][5][6][7][8]. African Americans are two and a half times more likely to receive a diagnosis of CD than they are ADHD and five times more likely than non-Hispanic white children to receive a diagnosis of adjustment disorder than ADHD [5].…”

“…This can be particularly true for the provision of a diagnosis of oppositional defiant disorder (ODD), conduct disorder (CD), and attentiondeficit/hyperactivity disorder (ADHD), as diagnosing these complex conditions can be nuanced. There is a growing body of evidence indicating that when compared to non-Hispanic white youth, some ethnic and racial minority youth are more likely to receive a diagnosis of a disruptive behavior disorder and are less likely to receive a diagnosis of ADHD [1][2][3][4][5][6][7][8]. When controlling for confounding variables such as adverse childhood experiences, prior juvenile offenses, genetics, and sociodemographics, these diagnostic and treatment disparities remain [6][7][8].…”

Therapie mit „bösen“ Jugendlichen

“…Diagnose Zur Diagnosestellung müssen laut DSM-5 in den vergangenen 12 Monaten mindestens 3 von 12 Kriterien erfüllt sein, die folgenden Bereichen zugeordnet werden können: ▪ aggressives Verhalten gegenüber Menschen und Tieren ▪ Zerstörung von Eigentum ▪ Betrug oder Diebstahl ▪ schwere Regelverstöße Epidemiologie Epidemiologischen Studien zufolge liegt die Prävalenzrate der SSV zwischen 2 % und 10 % [1], bei jugendlichen Straftätern sogar zwischen 53 % und 66 % [2,3]. Eine aktuelle Studie konnte zeigen, dass Jungen eine 6-fach höhere Wahrscheinlichkeit haben, an einer SSV zu erkranken, wobei sich Jungen und Mädchen in ihrer Symptomatik nur geringfügig voneinander unterscheiden [4].…”