Misdiagnosed and Overmedicated: How U.S. Schools Pathologize Black Boys Without Providing Comprehensive Mental Health Care

Abstract

Attention-deficit/hyperactivity disorder (ADHD) and conduct-related disorders, including oppositional defiant disorder (ODD) and conduct disorder (CD), are commonly used to classify children’s behavior in school settings. When applied appropriately, these diagnoses can support academic and social functioning. However, national disparities in behavioral referral and classification raise concerns about how diagnostic pathways operate for Black boys. This paper examines patterns of ADHD and conduct-related diagnoses among Black boys ages 6 to 14, focusing on how similar behaviors are interpreted and classified differently across racial groups. It argues that Black boys are disproportionately labeled as disruptive or defiant and are more likely to be diagnosed with conduct-related disorders rather than ADHD, even when presenting comparable symptoms as their white peers, reflecting patterns of racialized misclassification. This increases their use of psychiatric medication, while they are less likely to receive counseling, trauma-informed care, or comprehensive mental health support. Drawing on research on adultification bias and structural racism, this paper demonstrates how disparities in diagnosis and treatment are shaped by institutional processes, including referral systems, behavioral documentation, and resource inequities in under resourced schools. It further examines how surveillance practices and diagnostic decision-making influence long-term developmental outcomes. This analysis calls for structural reform grounded in trauma-informed screening, culturally responsive assessment, strengthened Multi-Tiered Systems of Support (MTSS), and social work–informed practice to promote more equitable school-based mental health evaluation.