Youth Trauma Histories are Associated with Under-diagnosis and Under-treatment of Co-occurring Youth Psychiatric Symptoms. Issue 2 (4th March 2023)

• Record Type: Journal Article
• Authors: Becker-Haimes, Emily M.; Wislocki, Katherine; DiDonato, Stephen; Beidas, Rinad S.; Jensen-Doss, Amanda
• Is Part Of: Journal of clinical child and adolescent psychology. Volume 52:Issue 2(2023)
• Page Start: 184
• Page End: 195
• Publication Date: 2023-03-04
• Subjects: Child psychology -- Periodicals; Child psychiatry -- Periodicals; Adolescent psychology -- Periodicals; Adolescent psychiatry -- Periodicals; Adolescent Psychology -- Periodicals; Child Psychology -- Periodicals; Psychology, Clinical -- Periodicals; Adolescent psychiatry; Adolescent psychology; Child psychiatry; Child psychology; Periodicals; 155.4
• DOI: 10.1080/15374416.2021.1923020
• Languages: English
• ISSNs: 1537-4416

Abstract

ABSTRACT: Objective: We examined whether in the presence of trauma exposure, non-traumatic stress-related symptoms are interpreted by mental health clinicians as less salient than the trauma exposure and are de-emphasized as a treatment target, consistent with a diagnostic overshadowing bias. Methods: Using an adapted version of a diagnostic overshadowing bias experimental paradigm, mental health clinicians ( N = 266, M age = 34.4 years, 82% female) were randomly assigned to receive two of six clinical vignette variations. Vignette 1 described an adolescent with obsessive-compulsive disorder (OCD). Vignette 2 described a pre-adolescent with oppositional defiant disorder (ODD). Vignettes were identical except for whether the youth reported exposure to a potentially traumatic event (PTE; no PTE, sexual PTE, or physical PTE). Clinicians received one vignette with a PTE and one without, counterbalancing order. Clinicians rated the likelihood the youth met criteria for various diagnoses and the appropriateness of various treatments on 7-point scales. Results: Across both vignettes, clinicians rated the target diagnosis (OCD in Vignette 1, ODD in Vignette 2) as less likely for vignettes with a PTE than for the same vignettes without a PTE. Clinicians also rated evidence-based treatment modalities for target diagnoses as less appropriate in the presence of a PTE than when a PTE was present. Conclusions: Consistent with possible bias, clinicians may under-recognize and under-treat non-traumatic stress-related mental health symptoms in youth with a co-occurring trauma history. Future work to validate this bias in real-world practice is indicated.