Providers and health organizations alike encourage children and families to pursue mental healthcare as if it were universally healing. Amidst the ongoing pediatric mental health crisis — characterized by increased rates of anxiety, depression, and suicide attempts — “access to quality mental healthcare” remains the prevailing discourse. But what if child psychiatry was not originated or designed to protect and serve your children’s best interests? What if it refused to acknowledge the unique harms facing your child? What if it carried unstated risks of harm that are not accounted for in these general recommendations to pursue it?
The Role and History of the AACAP in Child Mental Health
The American Academy of Child and Adolescent Psychiatrists (AACAP) was founded in 1953. It is now one of the country’s leading child mental health organizations, issuing clinical guidelines for treatment, establishing research agendas, and influencing the training of future child psychiatrists.
However, for most of its existence, AACAP has largely remained silent regarding social issues impacting children of color. Its original constitution made no mention of racism. Furthermore, amidst the Civil Rights Movement and racial reckoning taking place nationwide (1962-1967), AACAP’s official journal made no mention of racism. This silence is remarkable because Black children like Ruby Bridges, Elizabeth Eckford (part of the Little Rock 9), and Walter Gadsden were being brutalized as their public schools were integrated, including by the police. Some were even being killed.
How Early Child Mental Health Pathologized Non-White Children
During its inception in the early 20th century, child mental health set standards for “normal” according to whiteness (or behaviors stemming from white privilege), conceptualizing deviations as pathology. When it did consider children of color, the agenda was treating their aggression and delinquency. Through child guidance clinics, early child mental health forged partnerships with juvenile courts. The majority of children seen there were from poor or immigrant families. As they were considered deficient and deviant, confinement was the logical solution.
Early educational programs from President Johnson’s Great Society campaign, like Head Start (launched in the 1960s) followed a similar logic of deficiency — called “cultural deprivation theory” — conceptualizing Black children as deprived of the stimulating environment white children enjoyed and deficient in capacity and intellect relative to white peers.
Contemporary Interventions and Their Impact on Children of Color
This origin story lives on today. Many contemporary treatment interventions — similarly developed and implemented by white clinicians and researchers, and practiced on families of color — are touted as wholly therapeutic because they fill perceived gaps and deficiencies.
Multisystemic therapy (MST) and functional family therapy (FFT) are two examples widely practiced across the United States. Both disproportionately target Black and Brown children, particularly those involved with the juvenile justice system. MST does not aim to protect children of color from the over-policing traumatizing them. Nor does it strive to end the school-to-prison pipeline, fueled by the overpunishment of Black and Brown children at school. Instead, it locates pathology within these children and focuses on controlling their behavior. Pointing the finger of blame at them takes priority over addressing racist structures.
Progress and Limitations of Antiracism in Child Psychiatry
These days AACAP’s official journal has a clear stance on antiracism, which emerged following the 2020 racial reckoning provoked by the deaths of George Floyd, Breonna Taylor, and Ahmaud Arbery. However, training guidelines and clinical practice parameters for disorders like anxiety and depression still lack any antiracist orientation.
Juvenile justice and child welfare systems’ disproportionate impact on Black and Brown children is well-established. However, organized child mental health considers them spaces to target families for interventions, including parenting and coping skills, rather than sources of harm to be challenged. This distinction is crucial. Juvenile justice, child welfare–and the family separation they cause–are themselves traumatizing and damaging to children’s developmental trajectories. People with lived experience inside these systems are clear: children and families do not need help coping within them. They need to not be subjected to them at all. As a result, there are legislative and grassroots efforts nationwide to diminish their presence or eliminate them altogether.
Why Parents of Color Need to Know This History
Parents of color deserve to know this history before they walk through a provider’s door. Antiracist child mental healthcare requires transparency about the histories of oppression coursing through the field’s contemporary practices. Providers who are doing this work avoid diagnostic condemnation, refuse racist diagnoses like oppositional defiant disorder, and renounce clinical coercion and force as baseline commitments. They explain openly how these racist origin stories permeate contemporary child psychiatry — because this profession was not created for families of color, and many of its practices have never been interrogated, much less reimagined toward something more affirming and nurturing.
When commencing a child’s healthcare journey, parents might consider asking their providers the following questions:
“Can you explain how the legacy of racism and White supremacy lives on in child mental health today?
How do you determine whether the treatments you’re recommending carry more benefit than risk for my child?
How do you ensure you are not over-pathologizing my child?”
This reckoning feels even more urgent now. In 2021, both the American Psychiatric Association and the American Psychological Association offered official apologies for their roles in perpetuating racism. By contrast, AACAP has neglected to engage in such formal self-reflection, instead issuing statements condemning external forms of structural racism. While not without value, these statements suggest that the profession has no legacy of racism of its own to reckon with. As federal protections for children in education and healthcare are actively dismantled, that silence carries even greater consequences. This oversight should leave parents questioning whether child mental health practices do more harm than good and demanding that their providers engage in the same risk-benefit analysis.