Do Racial Stereotypes Contribute to Medical Misdiagnosis of Child Abuse?

Abstract

Despite growing recognition that misdiagnoses of child abuse can lead to wrongful convictions, little empirical work has examined how the medical community may contribute to these errors. Previous research has documented the existence and content of stereotypes that associate race with child abuse. The current study examines whether emergency medical professionals rely on this stereotype to fill in gaps in ambiguous cases involving Black children, thereby increasing the potential for misdiagnoses of child abuse. Specifically, we tested whether the race-abuse stereotype led participants to attend to more abuse-related details than infection-related details when an infant patient was Black versus White. We also tested whether this heuristic decision-making would be affected by contextual case facts; specifically, we examined whether race bias would be exacerbated or mitigated by a family’s involvement with child protective services (CPS). Results showed that participants did exhibit some biased information processing in response to the experimental manipulations. Even so, the race-abuse stereotype and heuristic decision-making did not cause participants to diagnose a Black infant patient with abuse more often than a White infant patient, regardless of his family’s involvement with CPS. These findings help illuminate how race may lead to different outcomes in cases of potential child abuse, while also demonstrating potential pathways through which racial disparities in misdiagnosis of abuse and subsequent wrongful convictions can be prevented.

How the “Black criminal” stereotype shapes Black people’s psychological experience of policing: Evidence of stereotype threat and remaining questions.

“…However, my colleagues and I also may have failed to detect crime-related threat in Black women due to imprecise measurement, as we asked about concerns related to being stereotyped as a criminal without specifying what type of offense the individual might be suspected of having committed. People’s prototypes of crime tend to skew toward extraordinary and violent circumstances (Finkel & Groscup, 1997), whereas the areas of life in which control over Black women was a primary concern during the era of slavery and the types of activities for which Black women have since been disproportionately scrutinized and criminalized are less sensational and more likely to constitute crimes against property or society—for example, theft, drugs, prostitution, or bad parenting (Najdowski et al, 2020; see McMurtry-Chubb, 2016). When we asked about criminality in the abstract, Black women may have reported on concerns related to prototypical crimes without considering the distinct contexts in which they are vulnerable to stereotyping.…”

A call to dismantle systemic racism in criminal legal systems.

“…Similarly, disclosures of child sexual abuse made during a child forensic interview are less likely to result in substantiation outcomes when the victims are children of color compared with White (Stevenson & Rivers, 2022), an effect that might stem from their disclosures of abuse being perceived as less credible (Alley et al, 2019; Bottoms et al, 2004). Moreover, whereas abuse victims of color might not be taken as seriously, other research suggests that Black parents might face heightened scrutiny as suspects because of negative stereotypes associating people of color with child abuse perpetration (Najdowski & Bernstein, 2018; Najdowski et al, 2020). Indeed, children of color are overrepresented within dependency court, the reasons for which are complex (Pelton, 2010) but stem from a historical legacy of initial exclusion of Black and indigenous children from the child welfare system, followed by present-day policies, procedures, and practices that contribute to their overinclusion (see Cleveland & Quas, 2020).…”

Cognitive Bias in Medicolegal Judgments

“…More recent studies have attempted to illuminate the psychological mechanism(s) that underlie this phenomenon. For instance, Najdowski et al [60] found that emergency medical professionals who read a clinical vignette about an unresponsive infant remembered more abuse-relevant details-both true and false-if led to believe that the family was Black and had prior involvement with CPS. This finding suggests that doctors may be more likely to notice, remember, and/or confabulate information that corroborates their pre-existing stereotypes about abusers.…”