Patients' Contexts and Their Effects on Clinicians' Impressions of Conduct Disorder Symptoms

Abstract

The purpose of this study was to examine whether contextual information about patients' clinical presentations affected clinicians' judgments of conduct disorder symptoms. Forty-five clinicians read vignettes describing hypothetical patients who displayed one conduct disorder symptom alongside information about the patients' home, school, and peer contexts. Clinicians judged the likelihood of patients meeting conduct disorder criteria. Contextual information highly affected judgments and these effects varied across the 15 conduct disorder symptoms. It is important to note that clinical judgments were not in agreement on the symptoms affected by context.

Do Clinical Psychologists Extend the Bereavement Exclusion for Major Depression to Other Stressful Life Events?

“…In conjunction with previous work examining the influence of explanatory life event context on assessments of conduct disorder and artificial disorders, [35][36][37][38]40,41 clinical psychologists are consistently influenced by explanatory context across disorders in assessment, even when the DSM is inconsistent in its treatment of explanatory context between disorders (e.g., between MDD and PTSD, in which a traumatic life event is one of the formal criteria for diagnosis 43 ). As argued in previous work, 57 although the DSM is often predominantly descriptive, clinical psychologists seem to push beyond the surface and incorporate causal factors into their assessments.…”

Principles Underlying the Use of Multiple Informants' Reports

“…These findings from De Los Reyes and Marsh (2011) indicated that trained judges of patients’ behavior attend to the contexts surrounding patients’ clinical presentations when providing reports about patients’ behavior. Thus, the findings raise the question as to whether discrepancies between untrained informants’ reports might be explained, in part, by differences between informants in the contexts within which they observe behaviors about which they provide reports.…”

“…For instance, De Los Reyes and Marsh (2011) presented clinicians with vignettes of children described as living in contexts that either posed risk for a conduct disorder diagnosis (e.g., exposure to parental psychopathology and poor peer relations) or contexts posing no such risk. Clinicians provided ratings of the likelihood that a comprehensive clinical evaluation of the child would suggest that the child meets criteria for a conduct disorder diagnosis.…”

Discrepancies Between Parent and Adolescent Beliefs About Daily Life Topics and Performance on an Emotion Recognition Task

“…In support of this theoretical work, studies of participants ranging from preschool to adulthood have demonstrated that greater informant discrepancies relate to increased variation in the contexts within which participants express the behaviors being assessed (De Los Reyes, Bunnell, & Beidel, 2013; De Los Reyes, Henry, Tolan, & Wakschlag, 2009; Hartley, Zakriski, & Wright, 2011). Further, experimental work indicates that trained judges of children’s behavior (i.e., clinicians) attend to contextual information (e.g., environmental risk factors of childhood psychopathology) when providing reports about such behavior (De Los Reyes & Marsh, 2011). Additional experimental work indicates that parents and adolescents can be trained to incorporate information about the contexts within which specific behaviors occur when providing reports about these behaviors (De Los Reyes, Ehrlich et al, 2013).…”