Understanding Racial Differences in Diagnosing ODD Versus ADHD Using Critical Race Theory

Although both oppositional defiant disorder (ODD) and attention-deficit and hyperactivity disorder (ADHD) are associated with poor long-term outcomes, ODD may lead to worse outcomes. While epidemiological literature suggests similar prevalence of ODD and ADHD across racial groups, a review of studies assessing “real-world” diagnostic practice suggests Black children may be over-diagnosed with ODD. Critical race theory (CRT) is applied to determine the etiology and sequelae of a racial effect in diagnostic practice to explain this disparity in findings. Social work practice implications include encouraging examination of professional diagnostic training and procedures for racial bias, active questioning of ODD diagnoses, research to build counter-narratives to that of the dangerous Black child, and advocacy for structural changes to disrupt racism.