What Are Adverse Childhood Experiences?

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Behavior labeled “defiance” is often a signal of distress, trauma, or unmet needs—not disorder.

ODD diagnoses disproportionately affect Black, Latine, and Indigenous children.

When systems fail children, people often diagnose the child instead of questioning the system.

When a child is labeled "oppositional," adults often assume the problem is the child. In my experience as a child psychiatrist, the truth is often much more complicated.

This is a tale of two children.

One is affluent and privileged, attending an elite prep high school where they were subjected to relentless transphobic bullying. When they expressed a desire to self-harm after cruel treatment from classmates, the school counselor sent them home and said they could not return until a child psychiatrist cleared them. I was that child psychiatrist. With their parents' consent, I wrote a firmly worded letter stating that the school's measures were exclusionary, harsh, and damaging to the child's well-being.

The other child, from a racially minoritized and poor background, was terrorized by an authoritarian school principal during grade school. Upon evaluation, I learned about a history of profound trauma related to the death of a parent. Yet their predominantly white school repeatedly suspended and expelled them, compounding their suffering. None of their paperwork acknowledged the parent's death. I wrote a letter condemning the school's actions and highlighting how their approach perpetuated harm rather than providing support.

Both families sought out these schools, believing they were giving their children the best education possible. Instead, the schools failed their children, labeling them "oppositional" and "defiant" rather than addressing the root causes of their behavior.

As a child psychiatrist, I've seen how the diagnosis of oppositional defiant disorder (ODD) is frequently misunderstood and misused. While it is intended to describe persistent patterns of defiant, angry, or vindictive behavior, in practice, the diagnosis often functions less as a path to support and more as a form of condemnation. For children like these two, the label can become a fast track to punishment and exclusion rather than the educational and emotional support they need.

We are in the midst of a pediatric mental health crisis. Suicide rates among Black youth are rising faster than for any other racial group in the United States, and the school-to-prison pipeline continues to push out children of color, criminalizing behaviors that should be understood as cries for help. ODD diagnoses disproportionately target Black, Latine, and Indigenous children, exacerbating inequities in school........

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