Your Child Isn't the Problem. Their School Report Might Be.

ODD is overdiagnosed in Black and brown children. It doesn't explain their behavior. It blames them for it.

School reports are shaped by racism. Anger and adultification bias lead to misdiagnosis of Black children.

Parents have the right to ask providers how they use school reports. If they can't answer, that matters.

The first time I met Micah, a Black elementary school student, I was struck by his cherubic face, bright eyes, and nonstop knock-knock jokes that had me laughing out loud. He was warm and polite. His grandmother sat close by, gently encouraging his respectful tone. She described him as responsible and kind, and everything I saw affirmed that.

So I was puzzled—then troubled—by his school's mental health referral. Teachers had described him as a "behavior challenge" and asked for help managing his "defiance." His school records even falsely claimed his mother was a cocaine addict. None of it matched the child in front of me.

As I got to know him, the real story came out: Micah had watched his father collapse and die, and had tried to resuscitate him before help arrived. His grief had been misread as misconduct.

This is not an unusual story. And it raises a question every parent deserves to ask: What is your child's mental health provider actually doing with the information they receive from their school?

Schools are not neutral sources of information

Working with schools is a hallmark of child mental health. What is not standard is questioning whether that information is accurate, fair, or free from bias.

For Black children and other children of color, bias shows up in the following ways:

Anger bias leads teachers and other adults to misperceive Black children as angry, even when they're not—and their behavior is labeled accordingly.

Adultification bias leads Black children to be seen as less innocent and more adult when compared to their white peers.

Overpunishment and the school-to-prison pipeline mean schools overpunish, expel, and literally push children of color out of school settings.

Diagnostic condemnation means that certain diagnoses, like oppositional defiant disorder (ODD), are given to racially minoritized children for behaviors rooted in trauma, racism, or structural inequity rather than addressing the hardships they face. An ODD diagnosis, or any disruptive behavior diagnosis, can result in educational needs—in the form of 504 plans or individualized educational plans—not being met.

When "school avoidance" is the wrong diagnosis entirely

I recently worked with a delightful middle schooler who was newly diagnosed as autistic and having difficulty attending school. Their school quickly framed this as “school avoidance” and recommended exposure therapy—essentially, pushing them to attend more.

Their therapist and I saw something entirely different.

In the letter we wrote to the school together, we explained that this child's difficulty attending wasn't avoidance at all. It was capacity-based exhaustion—their nervous system was being overwhelmed by the demands of the in-person environment. After school days, they experienced medical symptoms and sleep disruption consistent with nervous system dysregulation.

For autistic children, difficulty attending school is not always school avoidance. It may mean the school is not a good fit or is not meeting their needs. Crucially, this child wanted to attend school. That fact alone should have challenged the avoidance framing from the start.

What this child needed wasn't more exposure. They needed more flexibility—the ability to take breaks, to contact a parent when overwhelmed, to leave when they'd reached their limit, to attend on a partial or non-consecutive schedule. They needed their sense of control and safety restored, not overridden in the name of attendance.

The school's framework treated a symptom. Our clinical letter named the root cause.

Schools label, so providers must look deeper—and protect more

In the case of Micah and my autistic patient, their schools made the same move: When a child struggled, the problem was located entirely within the child. A label was applied. A standardized intervention followed. And the adults in the room—teachers, administrators, and in too many cases, mental health providers—never had to reckon with the role the institution itself was playing.

However, providers can engage in protective practices. Here's what that means–and what families have a right to ask for:

Ask about context, not just behavior. Before accepting a label, they ask: Is this child facing trauma, loss, or discrimination? Are they reacting to a hostile environment? A child who struggles at school but thrives at home is telling you something important about the school—not just about themselves.

Notice what's missing. Trauma, loss, racist incidents, sensory overwhelm, the racial makeup of a classroom—these are clinically relevant. If they're absent from a school report, that absence is itself meaningful.

Protect your child's record. Language like "aggressive," "oppositional," "avoidant," or "behavioral challenges" can cause lasting harm when put into a child's chart. A protective provider chooses their words deliberately and refuses to let a school's framing become a child's diagnosis.

Write letters of support when needed. Bold, specific letters that name what a child has been through, challenge inaccurate characterizations, and advocate for a safer, more flexible school environment are a legitimate—and underused—clinical tool.

When commencing a child's mental healthcare journey—or if you are questioning a diagnosis your child has already received based on school input—ask your provider:

"Can you please tell me about how you communicate and collaborate with my child's school?"

"How do you determine whether they are nurturing or hindering my child's wellbeing?"

"How do you determine how to use their reports and assessments about my child?"

"Do you write letters to schools?"

You are allowed to ask these questions. You are allowed to expect answers. And if a provider cannot engage with them thoughtfully, that is important information too.

If your child struggles at school, they may not be the problem

For Micah, the solution wasn't medication or behavior interventions. It was removing the harmful label and validating what his grandmother already knew: that the school was failing him, not the other way around.

The same was true for my autistic patient. They didn't need to be pushed harder into an environment that was overwhelming their nervous system. They needed a provider and a therapist willing to push back on their behalf — and a school willing to listen.

There are no bad kids. There are only systems–including school systems–that fail them. Every family deserves a provider who knows the difference — and acts on it.

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Your Child Isn't the Problem. Their School Report Might Be.

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