Breaking Down Barriers in Pediatric Mental Health Consultations: Understanding Patients' Use of I DON'T KNOW.

Barriers to effective provider-patient communication take many forms that can be difficult to recognize and appropriately address. This paper offers probabilistic indicators for one such form, patient-produced "I don't know" (IDK), distinguishing its use as a cognitive claim and its use as a strategy for resisting discussion of sensitive topics. A total of 95 audio-recorded psychiatrist-child interactions are drawn from a US-wide corpus of physician-patient consultations. From these, 376 patient-produced IDKs are extracted and coded for linguistic/social factors, including form, function, prosody, age, gender, and primary diagnosis. Two multiple logistic regressions are performed to determine the predictors of cognitive and resistive IDK functions respectively. Cognitive IDK uses are associated with the full form (p < 0.01) and unstressed prosody (p < 0.01). Use of resistive IDK is correlated with decreasing patient age (p < 0.01) and emotionally labile mental health diagnoses (p < 0.01). Cognitive and resistive IDK uses have distinctive linguistic and social distributions in psychiatrist-child interactions, where cognitive uses have two objectively identifiable linguistic characteristics and resistive uses are associated with certain patient types. Providers may learn to recognize cognitive and resistive IDK uses, thus acquiring the ability to correctly interpret interactional cues relevant to the diagnosis and treatment of pediatric mental health conditions.

Interpreting "I don't know" use by persons living with dementia in Mini-Mental State Examinations.

OBJECTIVE: We investigate dementia patients' use of "I don't know" (IDK) in Mini-Mental State Exams (MMSEs) using objective linguistic indicators to differentiate IDK signalling lack of knowledge (LOK) from IDK used to hedge responses, affect exam progression etc. We hypothesize that increased proportional use of LOK-IDK correlates with worsening dementia severity. METHODS: 189 IDK tokens were extracted from 72 MMSE interactions and coded for linguistic/social characteristics. A data-driven, discourse position/relation-based functional taxonomy for IDK in MMSE was developed and the resulting functional distribution was subjected to multiple logistic regression. RESULTS: Use of LOK-IDK (vs. non-LOK-IDK) is significantly correlated (p=0.01) with clinicians' subjective ratings of patients' dementia as 'severe' vs. 'mild'/'moderate', indicating that objective sociolinguistic criteria approximate physician judgments. 92% of 'severe' patients' IDKs signalled LOK, compared to only 68% of 'mild' patients', suggesting that uncritical interpretation of IDK as signalling LOK would result in 8-32% of IDK responses being mis-scored. CONCLUSION: LOK and non-LOK uses distinguished on the basis of reliable, objective usage patterns are differentially distributed among dementia severity groups. PRACTICE IMPLICATIONS: LOK-IDK serves as a supplemental indicator of dementia severity. Correct interpretation may improve diagnostic accuracy and allow clinicians to respond supportively during cognitive assessment.