Re: re unrelated males in household--AND THE IMPOSSIBILITY OF CREATING A VALID MEASURE OF IMMINENT DANGER

[Eric Mart <emart@xxxxxxxxx>]

Ron Kokish wrote:

> >>Very important to keep this issue alive.<<
>
> Thanks for your response.  I agree it's important to keep this issue alive.
> A post earlier this morning worried me.  Earlier today someone suggested
> that we have to treat countless children with fevers to prevent a few cases
> of meningitis. This is so, but treating a fever rarely involves police
> officers forcibly moving children from their families to unfamiliar, often
> institutional surroundings.
>
> So, HOW can we keep this issue alive in ways that are likely to make a
> difference in the real (political) world?  I think this is a crucial
> question for researchers and one that will take a lot of courage to address
> meaningfully.
>
> ***************************************************************************
>  Ron Kokish at Delson-Kokish Associates, P.O. Box 476, Trinidad, CA 95570
>         Clinical and Forensic Evaluations, Consultation & Training
>                  (707) 677-3181 voice        677-0187 fax
>                  ron@delko.net email         www.delko.net
> ***************************************************************************

Ron,

Just to chime in here- It seems to me that ignorance or neglect of the base
rates problem is a major child health issue insofar as it has contributed to the
disruption and in some cases destruction of families. Over the past 10 years or
so i have been very active in the area of MSBP, and this issue comes up all the
time. I think what as happened in MSBP is an excellent exemplar of this problem
in child protection generally. You start with a syndrome (we'll leave aside the
issue of syndromatic validity for the moment) that has a frequency of 6
pediatric cases out of each million children. You then use highly questionable
and certainly non-empirical data to develop a behavioral profile of unknown
reliability and discriminative validity to target possible abusers. Even when
only medical data is utilized, such as rapid resolution of the condition on
separation, the low base rate of MSBP guarantees that there will be a high rate
of false positives. If you grabbed the first 3rd year medical student you came
across and asked "If a disease is rare, and the methods of assessment have high
sensitivity and low specificity, what will happen?" they would tell you that
there would be a high rate of false positives. Despite this, in the May issue of
Child Maltreatment, which was devoted entirely to MSBP,  there was not a single
reference to the base rate problem and false positive diagnosis. Interestingly,
no article or book that questioned the syndromatic validity of MSBP was even
cited in any of the bibliographies of any of the articles in the issue, let
alone discussed. Nor, I might add, was a single expert with doubts about the
syndrome even consulted. So, obviously we do have a long way to go with this
issue in a number of areas of child protection.


Eric Mart