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Differences in the diagnosis and treatment decisions for children in care compared to their peers: An experimental
Rosie McGuire1, Sarah L Halligan1,2, Richard Meiser-Stedman3
1Department of Psychology, University of Bath, Bath, UK.
Insights
Mental health professionals were less likely to diagnose post-traumatic stress disorder (PTSD) and recommend evidence-based treatments for children in care. This study highlights potential biases in diagnosing and treating PTSD in vulnerable youth.
Area of Science:
- Child and Adolescent Psychiatry
- Mental Health Services Research
- Trauma Studies
Background:
- Children in care exhibit high rates of mental health difficulties, yet debates persist regarding traditional diagnoses and treatments.
- Post-traumatic stress disorder (PTSD) is a trauma-specific disorder with significantly higher prevalence in children in care compared to their peers.
Purpose of the Study:
- To quantitatively investigate if mental health diagnosis and treatment decisions differ for young people identified as being in care.
- To specifically examine these differences in the context of post-traumatic stress disorder (PTSD).
Main Methods:
- 270 UK mental health professionals completed an online survey.
- Participants were randomized to receive one of two vignettes describing a teenager with PTSD symptoms: one in foster care, the other living with their mother.
- Professionals were asked to select a primary diagnosis, treatment approach, and potential secondary diagnosis.
Main Results:
- Clinicians were twice as likely to diagnose PTSD and recommend NICE-recommended treatments when the vignette described a child living with their mother versus in foster care.
- Diagnosing PTSD as primary increased the likelihood of selecting a NICE-recommended treatment by threefold.
- Developmental trauma was a common diagnosis for both groups, but resulted in divergent treatment decisions.
Conclusions:
- Children in care face diagnosis and treatment decision-making biases concerning PTSD.
- These findings have significant implications for clinical practice and the equitable treatment of children in the care system.
Objectives:
Despite evidence of high rates of diagnosable mental health difficulties in children in care, there remains ongoing debate around the appropriateness of traditional diagnoses and treatments. The aim of this study was to quantitatively explore whether mental health diagnosis and treatment decision-making differed when a young person was identified as being in care, specifically focused on post-traumatic stress disorder (PTSD). PTSD is a trauma-specific mental health disorder with rates substantially higher in children in care versus their peers.
Methods:
Participants were 270 UK mental health professionals who completed an online survey. Participants were randomized to receive one of two vignettes, which were identical in their description of a teenage boy experiencing PTSD symptoms, except in one he was in foster care and in the other he lived with his mother. Participants were asked to select a primary diagnosis, treatment approach, and potential secondary diagnosis.
Results:
Professionals were twice as likely to choose a primary diagnosis of PTSD and a National Institute for Clinical Excellence (NICE)-recommended PTSD treatment when randomized to the mother vignette versus the foster carer vignette. Selecting PTSD as the primary diagnosis made clinicians three times more likely to select a NICE-recommended treatment for PTSD. Developmental trauma was the most common 'diagnosis' for both groups, although this led to different treatment decisions.
Conclusions:
In the context of PTSD, we found children in care face diagnosis and treatment decision-making biases. Practice implications are discussed.
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