Clinicians should be aware of the cultural paranoia that blacks tend to have as a result of their relationships with whites and with white-dominated institutions. Thus, blacks often express reluctance to be evaluated or treated and can be only minimally revealing with professionals. Forensic clinicians should also be aware that incarcerated juveniles are under tremendous stress. The natural paranoia, together with differences in language and appearance, may combine to make black juveniles appear abnormal, leading to labeling as retarded or of borderline intellectual functioning. In addition, larger societal and racial factors may determine whether black juveniles are found in the court system or the hospital. However, serious mental illness, depression, and thought disorders are not more prevalent among whites than blacks, controlling for socioeconomic status. Thus, clinicians must make thorough and thoughtful evaluations, recognizing that they may provide the only informed and fair examination the youth will ever receive. Clinicians must also educate patients, caretakers, and society about the psychiatric difficulties to which black juveniles are exposed. Tables and 45 references.