P3A053: The Impact of Adultification Bias on the Mental Healthcare Provided to Black Girls in U.S. Schools: A Novel Qualitative Analysis

Background: Adultification Bias, or the racialized and gendered social phenomenon of viewing youth as more mature, adult-like, and thus as less innocent than their peers, disproportionately affects Black girls in the United States (U.S.). Previous literature indicates that Adultification Bias may worsen health outcomes and exacerbate racial health disparities, as Black girls have been found to receive less patient education from healthcare providers and to have their pain minimized, resulting in fewer diagnostic tests and specialty referrals. Still, no study to date has investigated the effects of Adultification from the purview of psychiatric health. To rectify this dearth in the literature, the present study examines how Adultification Bias shapes school stakeholders’ perceptions of Black girls and the consequences for mental health outcomes.

Methods: Semi-structured qualitative interviews were conducted with 22 primary and secondary school mental health professionals (psychologists, psychiatrists, and counselors) from May to June 2022. The interviewees geographically spanned all U.S. census regions and were recruited by purposive sampling. The study employed a qualitative thematic analysis methodology to analyze interview data and identify patterns and motifs across all interviews.

Results: Analysis of interviews elucidated two novel themes, which I term: (1) the “Punitive-Support Dichotomy” and (2) the “Tantrum-to-Threat” pipeline. In the “Tantrum-to-Threat” pipeline, interviews revealed that externalizing behaviors (e.g., shouting, kicking, fighting)—although often a coping mechanism for psychological distress—are frequently misapprehended as “attitude” or “threats” when enacted by Black girls within the school setting. Subsequently, young Black girls become estranged from the mental healthcare domain within school professionals’ minds, begetting the Punitive-Support Dichotomy, or the funneling of these Black girls into disciplinary (expulsion, suspension, arrests), rather than supportive arenas (mental health services).

Interviewees also noted that Black girls who exhibit internalizing mental health symptoms – anxiety, loneliness, sadness – are often deemed as “dramatic” when expressing their pain due to Adultified expectations for Black girls to be mentally impervious to stressors. Early internalizing mental health symptoms amongst these students, then, often go undetected, resulting in diagnostic delays. Dismissed as “dramatic,” internalizing Black girls are under-referred to school mental health services, spurring deleterious mental health outcomes such as suicidality, depression, and self-harm.

The mechanism by which Adultification Bias operates for externalizing and internalizing Black girls is summarized in a multi-phase pathway (Figures 1 and 2).

Conclusion: This study expands the current literature by conceptualizing Adultification Bias as a phenomenon that engenders deleterious mental health sequelae for Black girls in U.S. public school settings. The study further presents a novel theoretical model to delineate how Adultification Bias precipitates adverse outcomes for Black girls who exhibit internalizing and externalizing symptoms. Future research should aim to identify strategies to ameliorate the negative mental health outcomes generated by Adultification Bias.