people, whether healthy or dysfunctional, even if there is a small chance that this may occur, some families are reluctant to allow their children to participate in screening efforts.
Males with a genotype resulting in low MAOA activity who are maltreated in childhood have a strong chance (85 percent) of developing antisocial behavior (Caspi, McClay, et al., 2002). Screening early in life with genetic testing would appear to be advantageous in that preventive interventions are available that focus on cultivating strong family systems. However, screening could be stigmatizing for black males, who are frequently stereotyped and more likely to be harshly punished compared with their counterparts (U.S. Public Health Service, 2001a). There has been public and organized opposition to screening programs, such as Teen Screen,1 a national mental health and suicide risk screening program (Lenzer, 2004). This dilemma represents a barrier for screening programs for MEB disorders.
Stigma has been recognized as a barrier to screening and mental health services in many settings, including schools. The President’s New Freedom Commission called for a national campaign to reduce the stigma of seeking mental health care and the delivery of universal preventive interventions, especially in schools (Mills, Stephan, et al., 2006). Stigma has been characterized as public, self, and label avoidance. General approaches to changing stigma include protest, education, and exposure (public) as well as fostering group identity, cognitive rehabilitation, and disclosure for self-stigma and label avoidance (Corrigan and Wassel, 2008). Positive Attitudes Toward Learning in Schools (PALS) is one organized effort to reduce stigma that emphasizes families as partners with schools and the use of community consultants (Atkins, Graczyk, et al., 2003; Atkins, Frazier, et al., 2006). Other approaches have embraced the term “mental health” as a positive concept in their communication with the public in an attempt to avoid stigma.
Several states have adopted antistigma programs, including advertisements (New Mexico) and a Youth Speakers Bureau (Ohio). The magnitude of the impact of stigma and antistigma efforts on prevention programs for MEB disorders remains to be determined. A survey of adult attitudes of children’s mental health problems found that among adults able to differentiate depression and attention deficit hyperactivity disorder (ADHD) from “daily troubles,” a significant percentage rejected the label of mental illness (13 and 19 percent for depression and ADHD, respectively) (Pescosolido, Jensen, et al., 2008). Existing stigma reduction efforts have not been widely supported, probably contributing to the persistence of this barrier. Routine screening for mental, emotional, and behavioral problems may help alleviate concerns about stigma and labeling.