Between badness and sickness: Reconsidering medicalization for high risk children and youth

• Children with behavioral disorders experience a process of partial medicalization.
• Interpretations of behaviors shift between attributions of badness and sickness.
• Attributional shifts may follow predictable patterns.
• Youth who are disadvantaged may ultimately have their behaviors framed as badness.

Most of the sociological literature about “troubling” children and youth focuses on how the scientific authority of medical experts, with a discourse of sickness, has come to displace the moral authority of justice enforcement officials and their rhetoric of badness as arbiters of childhood pathology. Yet my experience working with high-risk children and youth during a post-MSW fellowship strongly suggests that discourses of badness have not supplanted discourses of sickness. Indeed, these discourses remain deeply intertwined with implications for the way we conceptualize troubling children and youth, for the treatment we prescribe, and for how children and youth understand themselves. Discussing two composite cases to illustrate how negotiations of badness and sickness unfold, I argue that shifts in attributions of badness and sickness follow predictable patterns generally occurring in response to: (1) changes in the context (whether the child is at home, school, or in a treatment setting); (2) changes in an actor's interests or role (parents may attribute troubling behaviors as badness at home but frame them as sickness with people outside the family); and/or (3) changes in external structures of time (e.g. the end of the school year or the end of a Medicaid authorization). In conclusion, I consider the implications of partial medicalization and these patterns of narrative negotiations for future research and practice.