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

Kathleen J. Pottick, Xin Tian, Stuart A. Kirk, and Derek K. Hsieh

Journal of Psychopathology and Behavioral Assessment
Using a between-subject 3 × 3 design of an experimentally manipulated realistic case vignette of Black, White, and Hispanic youth in a survey mailed to 1540 experienced psychologists, psychiatrists, and social workers, the authors examined if clinicians alter their judgments about treatment for antisocially behaving youth based on the symptom’s social context (e.g., life circumstances) and the youth’s race or ethnicity, even among youth who are otherwise identical in terms of behavioral symptoms. Vignettes describe behaviors meeting DSM-IV criteria for conduct disorder, but contain contextual information suggesting either internal dysfunction (ID) or a normal response to a difficult environment [i.e., environmental-reaction (ER)]. Comparison was symptom-only (SO). Judgments of effectiveness of 14 treatments for youth exhibiting antisocial behavior were examined. Frequencies and median scores of perceived effectiveness level (1–9, Likert) were compared in bivariate analyses, stratifying context and youth’s race or ethnicity. The context of the behavior was associated significantly with differences in effectiveness judgments in 13 of 14 treatments. Within ID and ER contexts, clinicians judged three different treatments as effective (median = 7 of 9). In the SO condition, clinicians were less selective, judging six as effective. In the ID context, psychiatric medications, systems oriented family therapy, and residential care were judged more effective for White than for Black or Hispanic youth. Evidence-based practice research may be hampered by inattention to the social context of behavioral symptoms. Context may activate implicit racial assumptions about treatment effectiveness. Implications are for clinical training to improve service delivery, and future clinical research.

Kathleen J. Pottick, Xin Tian, Stuart A. Kirk, and Derek K. Hsieh. (2017). "Treating the Child or Syndrome: Does Context Matter for Treatment Decisions for Antisocially Behaving Youth?" Journal of Psychopathology and Behavioral Assessment, online ahead of print, March.