It Doesn't Matter What I Think

As a psychologist, people often ask me what I think.

“What do you think about ADHD?”

“Why do you think there’s a rise in autism?”

“What do you think I should do about my son… my daughter…?”

You might want my professional opinion as a neuropsychologist, and I’ll do my best to steer you in the right direction, but, here’s the thing – it doesn’t matter what I think.

Science Trumps Clinical Judgment

Science and statistics, not individuals with fancy degrees behind their names, have the answers. The questions typically asked of me are empirical ones – they can and should be tested (using the scientific method and ideally in a randomized controlled trial) to draw accurate conclusions. When people ask me about psychology or when parents ask me about their children, I refer to the research.

In 1954, Paul E. Meehl, PhD published Clinical vs. Statistical Prediction, one of the most referenced books in the field of psychology. In his book, Dr. Meehl put the judgment of clinicians up against the predictive power of statistics. The gist of his argument? Statistical models based upon scientific research usually beat clinical judgment. His argument has stood the test of time. No psychologist, regardless of their experience, will consistently predict what will happen to you or your child better than well-constructed research.

Becoming a Better Consumer of Healthcare

Why am I telling you this?

It’s important for you to be an informed consumer of healthcare. When you are equipped with the right information, you can access high-quality services from your child’s providers and choose treatments wisely. When you go to a doctor’s office or when your child receives an evaluation, rather than ask your doctor what they think, instead, ask:

  • “What does the research say about this condition?”
  • “What is the evidence to support the intervention you are recommending?”
  • “What randomized control trials have been conducted to test this program? This medication? This course of action?”

Asking the hard questions will hopefully result in more accurate answers and better care for your child. But be prepared for the response, “I don’t know.” A good clinician does not have all of the research committed to memory, but rather, they are willing to admit what is not known, take time to review the literature, and come back to you at a later time with an evidence-based conclusion.

When Clinical Judgment Matters

Unfortunately, the research does not have all the answers yet. There are still gaps in scientific evidence: Not every question has been asked and answered, conducting a well-designed research study can take many years, and studies are not without their limitations.

Limitations may include small sample sizes, reliance on self-report measures, and attrition (participants dropping out), among other things. Treatment trials also often have “exclusionary criteria,” which help answer one question but restrict other inquiries. For example, testing a treatment for depression might mean needing to exclude individuals with co-occurring conditions, such as ADHD.

Perhaps the biggest limitation is that science typically works with averages; it does not tell us how your specific child will perform.

Thus, clinicians must rely on their judgment to varying degrees. Clinical judgment is helpful when someone needs to synthesize conflicting research, filter out research with significant limitations, or customize findings to your child’s specific situation. Nevertheless, science should always be the starting point.