The influence of contextual information on lay judgments of childhood mental health concerns.

Abstract

Decisions about whether a person is in need of mental health care are often made by laypeople with no training in the identification of mental health concerns. For example, the parent of a child displaying problematic behavior has to decide whether this behavior is likely related to mental health concerns and necessitates professional care. The process of identifying mental health concerns is made more complicated by the rich background of real-world environmental factors or contexts in which concerns can present-contexts that might or might not relate to the presence of mental health concerns. We investigated whether laypeople use contextual information to make judgments regarding childhood mental health disorder symptoms. In Experiment 1, we demonstrated that laypeople's judgments of the likelihood of a mental disorder are influenced by non-diagnostic contextual information that surrounds symptoms of the disorder. In Experiment 2, we demonstrated that providing a causal origin for such disorder symptoms accentuates the use of context, regardless of the nature of the causal process (i.e., environmental vs. biological). These findings indicate that contextual influences on judgments about mental health concerns may reflect a more general set of mental reasoning processes than indicated by previous work focused on clinicians' judgments. Consequently, these findings have important implications for how we think about the influence of contextual information on decision making more generally as well as for improving our ability to both reliably identify children in need of mental health care and increase children's access to such care.

The validity of the multi-informant approach to assessing child and adolescent mental health.

“…For instance, whereas high-risk contextual information might have influenced one clinician's judgments about a child's truancy, the same high-risk contextual information might have had little influence on another clinician's judgments about the child's truancy. These findings have since been replicated when examining judgments about attention-deficit/hyperactivity concerns, as well as judgments completed by laypeople (Marsh, De Los Reyes, & Wallerstein, 2014). …”

Treating the Child or Syndrome: Does Context Matter for Treatment Decisions for Antisocially Behaving Youth?

“…As family members are normally the gateway to engagement of their children in treatment, future studies might explore the influence of context on their judgments of treatment effectiveness. For judgments of the existence of mental disorder, research has demonstrated that laypersons often make similar distinctions as professionals (Wakefield et al 2006;Garb 1998;Marsh et al 2014), and some scholars think that the similarities may reflect general reasoning processes (Marsh et al 2014). From these findings, we expect that parents may be equally sensitive to the importance of context for making judgments about treatment.…”

The sweet spot of clinical intuitions: Predictors of the effects of context on impressions of conduct disorder symptoms.

“…In this paper we explore this issue by including a sample of laypeople and assessing what beliefs underlie their use of contextual information in making a diagnostic judgment. This is an important issue to address because laypeople comprise key stakeholders in determining whether their own behavior or that of significant others (e.g., children, spouses, or coworkers) warrants mental health care (e.g., they are the point of initial contact between a person needing care and a mental health professional; see Marsh et al, 2014).…”

“…In the following experiment, we tested whether the perceived prevalence, diagnosticity, abnormal-ity, or importance to diagnosis of mental disorder symptoms predicts the extent to which judges are influenced by contextual life information in making clinical ratings of those symptoms. To do this we adopt the methodology of De Los Reyes and Marsh (2011) and Marsh et al (2014) and test symptoms within conduct disorder. We predict the influence of context will follow a curvilinear relationship as a function of our measures of interest, with symptoms that are seen as the most and least possessing of a given construct (i.e., prevalence, diagnosticity, abnormality, or importance) lending the same information to diagnosis regardless of context.…”

“…Often bullies threatens or intimidates others Often initiates physical fights Has used a weapon that can cause serious physical harm to others Has been physically cruel to people Has been physically cruel to animals Has stolen while confronting a victim Has forced someone into sexual activity Has deliberately engaged in fire setting with the intention of causing serious damage Has deliberately destroyed others property (other than fire setting) Has broken into someone else's house building or car Often lies to obtain goods or favors or to avoid obligations Has stolen items of nontrivial value without confronting a victim Often stays out at night against his parents' wishes and has been doing so since elementary school Has run away from home overnight multiple times Is often truant from school and has been doing so since elementary school Note. Taken from Marsh, De Los Reyes, and Wallerstein (2014). This document is copyrighted by the American Psychological Association or one of its allied publishers.…”