can we predict the interpretation of ambiguous symptoms from clinicians’ theories for disorders?...
Post on 18-Jan-2016
213 Views
Preview:
TRANSCRIPT
Can we predict the interpretation of ambiguous symptoms from clinicians’
theories for disorders?
Leontien de Kwaadsteniet & Nancy S. Kim
Research Question
When clinicians have initial hypotheses about disorders/diseases, interpretation of information may get distorted (e.g. Ben Shakar, et al., 1999; Kostolopou, 2009)
Clinicians may arrive at different initial hypotheses, based on the same client information
→ Can we predict clinicians’ initial hypotheses?
This study: Can we predict initial hypotheses from clinicians’ theories for disorders?
More specifically:
Can we predict what diagnoses clinicians rate as most likely, when presented with ambiguous symptoms,
from the causal status of these symptoms in clinicians’ theories for disorders?
This presentation:- Ambiguous symptoms
- Causal status effect
- This study
- Discussion, new study?
Ambiguous symptomsIn clinical practice clients’ problems and symptoms may have
different causes
In DSM-IV different disorders have some symptoms in common
E.g. Depression – Generalized Anxiety Disorder:- sleeping problems- fatigue- difficulty concentrating
E.g. ADHD-Autism- attention problems in ADHD may show in difficulty following social rules – similar to problems in social interaction in Autism (APA, 2000)
Causal status effect
Kim & Ahn (2002): Clinicians weight symptoms differentially which are equally weighted in the DSM-IV, depending on the position of the symptoms in their theories:
Client with symptoms more causally central in theory for disorder → judged more likely to have disorder
More causally central symptoms have more other symptoms depending on them
Theory drawing task
• Different disorders: symptom lists of DSM-IV: criteria and associated symptoms
• Causal relations between symptoms/groups of symptoms • Weak, moderate, strong
Composite drawing anorexia nervosa
Ahn & Kim, 2008
Example
In one clinician’s theory for Anorexia Nervosa (Kim & Ahn, 2002):• “Refuses to maintain weight” causes other symptoms of
Anorexia Nervosa (e.g. excessive exercise, dieting, preoccupied with food)
• “Absence of the period for more than 3 months” does not cause any other symptoms
• Client who “Refuses to maintain weight” rated more likely to have Anorexia Nervosa than client with “Absence of the period for more than 3 months”
• See also Cobos et al., later today? ☺
This study
Can we predict clinicians’ initial hypotheses from their theories for disorders?
Hypothesis:
Clinicians’ interpretations of ambiguous symptoms depend on the causal status of these symptoms in their theories:
Clinicians will interpret ambiguous symptoms as stronger evidence for disorder in which ambiguous symptom is most causally central.
To clarify:• Ambiguous symptom X occurs in disorders A and B• In theory for disorder A symptom X is causally central• In theory for disorder B symptom X is causally peripheral
• Client presents with symptom X• What disorder is most likely: A or B?• Predicted response: Disorder A
A Sx Sy
B Sv Sw Sx
Sz
Method
Participants• 18 experienced clinicians
Procedure
1. Theory drawing:
Participants drew causal relations between symptoms of ADHD, Autism, Depression and General Anxiety Disorder
(symptoms described in criteria & associated symptoms)
(cf. Kim & Ahn, 2002, experiment 1)
Example model GAD
Example model Depression
Questionnaires
2. Questionnaires based on individual models: hypothetical clients presenting with one or two ambiguous symptom(s) Which diagnosis do you think is most likely (0-100), disorder A or B?
• Different causal status in disorders • Rank orders causal centrality calculated from causal models
(cf. Kim & Ahn, 2002)• Control for: criterion or associated • Goal: four hypothetical clients per participant:
– One ADHD – Autism: ADHD most causally central– One ADHD – Autism: Autism most causally central– One Depression – GAD: Depression most causally central– One Depression – GAD: GAD most causally central
Example model GAD
Example model Depression
Problems
It appeared difficult:
- To find ambiguous symptoms that differed (sufficient??) in causal centrality between disorders
- To control for criterium – associated
- To arrive at good formulations
Preliminary results
• 12 Experienced clinicians (Mean experience = 10.2 years; SD = 7.4; 1 man and 11 women)
• On average 2.6 hypothetical clients
• Proportion choices for disorder in which ambiguous symptom is most causally central:– Experienced clinicans: 63% (t(11)=1.3; p=.11 (one-tailed))
Discussion
• Waiting for more data
Problems:• Differences in causal centrality in different disorders often
small (cf. Kim & Ahn, 2002)?• Symptom descriptions deviate from symptoms drawn in
models• Possible confound base rates (ADHD-Autism?)
To do:
• To control for base rates:– Ask participants for base rate ratings? – Use artificial disorders in new study?
Thank you!
top related