Providers' Perspectives on Decision-Making About Care for Transgender Youth.

Background: Transgender and gender-diverse (TGD) youth face health care decisions that are complicated by both social and medical aspects of gender care. Little is known about how providers support decision-making in this context or the gaps they perceive in decision support. Objective: To explore health care providers' perspectives on the decision-making processes in youth gender care. Methods: We interviewed health care providers (n=17) caring for TGD youth and asked about the nature of families' decision-making, providers' role in this process, and potential improvements to existing support systems. Two independent coders coded all responses which were analyzed using thematic analysis. Results: From providers' perspectives, they serve as "guides" to families through a challenging decision-making process. Youth arrive educated and eager to begin treatment, but caregivers are more hesitant. Providers lack data to address parents' concerns, and struggle to support families through interpersonal conflict. All providers recognized a need to improve decision support for families. Conclusions: Providers described decision-making in this context as a multistep process where interpersonal conflict and limited data slow progress. Practice Implications: There is ample opportunity to leverage insights from adult and pediatric medical decision-making research to improve decision support for providers, TGD youth, and families.

Intuitive Sociology: Children Recognize Decision-Making Structures and Prefer Groups With Less-Concentrated Power.

From an early age, children recognize that people belong to social groups. However, not all groups are structured in the same way. The current study asked whether children recognize and distinguish among different decision-making structures. If so, do they prefer some decision-making structures over others? In these studies, children were told stories about two groups that went camping. In the hierarchical group, one character made all the decisions; in the egalitarian group, each group member made one decision. Without being given explicit information about the group's structures, 6- to 8-year-old children, but not 4- and 5-year-old children, recognized that the two groups had different decision-making structures and preferred to interact with the group where decision-making was shared. Children also inferred that a new member of the egalitarian group would be more generous than a new member of the hierarchical group. Thus, from an early age, children's social reasoning includes the ability to compare social structures, which may be foundational for later complex political and moral reasoning.

Beyond avatars and arrows: Testing the mentalising and submentalising hypotheses with a novel entity paradigm.

In recent years, there has been a heated debate about how to interpret findings that seem to show that humans rapidly and automatically calculate the visual perspectives of others. In this study, we investigated the question of whether automatic interference effects found in the dot-perspective task are the product of domain-specific perspective-taking processes or of domain-general "submentalising" processes. Previous attempts to address this question have done so by implementing inanimate controls, such as arrows, as stimuli. The rationale for this is that submentalising processes that respond to directionality should be engaged by such stimuli, whereas domain-specific perspective-taking mechanisms, if they exist, should not. These previous attempts have been limited, however, by the implied intentionality of the stimuli they have used (e.g., arrows), which may have invited participants to imbue them with perspectival agency. Drawing inspiration from "novel entity" paradigms from infant gaze-following research, we designed a version of the dot-perspective task that allowed us to precisely control whether a central stimulus was viewed as animate or inanimate. Across four experiments, we found no evidence that automatic "perspective-taking" effects in the dot-perspective task are modulated by beliefs about the animacy of the central stimulus. Our results also suggest that these effects may be due to the task-switching elements of the dot-perspective paradigm, rather than automatic directional orienting. Together, these results indicate that neither the perspective-taking nor the standard submentalising interpretations of the dot-perspective task are fully correct.

Young children and adults associate social power with indifference to others' needs.

In hierarchical societies, what do we expect from people at the top? Early in life, children use horizontal relationships (e.g., affiliation) to predict selectivity in others' prosocial behavior. But it is unknown whether children also view asymmetries in prosocial behavior as characteristic of vertical relationships (e.g., differences in social power). In two experiments, we investigated 4- to 7-year-old children's and adults' (N = 192) intuitions about links among relative authority status, helpful action, and unhelpful inaction. In Experiment 1, participants at all ages viewed a character who chose not to help another person as holding a position of authority over them; participants also viewed this unhelpful character as being less nice than the person in need. However, no age group made consistent inferences about the relative authority of a helper and a helpee. In Experiment 2, children had mixed intuitions when separately predicting whether high- and low-authority characters would be helpful in the future. However, older children and adults consistently indicated that a subordinate would be more likely than an authority to help a third party. These findings establish that children's social theories include expectations for links between power and prosociality by at least the preschool years. Whereas some judgments in this domain are stable from 4 years of age onward, others emerge gradually. Whether consistent responses occurred early or only later in development, however, all measures converged on a single intuition: People more easily associate authority with indifference to others' needs.

Associations Between Early Low-Level Tobacco Smoke Exposure and Executive Function at Age 8 Years.

OBJECTIVE: To investigate whether exposure to tobacco smoke during early brain development is linked with later problems in behavior and executive function. STUDY DESIGN: We studied 239 children in a prospective birth cohort. We measured tobacco exposures by caregiver report and serum cotinine 3 times during pregnancy and 4 times during childhood. We used linear regression to examine the association between prenatal and childhood serum cotinine concentrations and behavior (the Behavior Assessment System for Children-2) and executive function (the Behavior Rating Inventory of Executive Function) at age 8 years while adjusting for important covariates. RESULTS: Neither prenatal nor child serum cotinine were associated with behavior problems measured by the Behavior Assessment System for Children-2. On the Behavior Rating Inventory of Executive Function, prenatal and childhood exposure was associated with poorer task initiation scores (B = 0.44; 95% CI, 0.03-0.85 and B = 0.69, 95% CI, 0.06-1.32 respectively). Additionally, in a subset of 208 children with nonsmoking mothers, prenatal exposure was associated with task initiation scores (B = 1.17; 95% CI, 0.47-1.87) and additional components of the metacognition index (eg, working memory, B = 1.20; 95% CI, 0.34-2.06), but not components of the behavioral regulation index. CONCLUSIONS: Tobacco exposures during pregnancy (including low-level second-hand smoke) and childhood were associated with deficits in some domains of children's executive function, especially task initiation and metacognition. These results highlight that decreasing early exposure to tobacco smoke, even second-hand exposure, may support ideal brain functioning.

Children's developing judgments about the physical manifestations of power.

When navigating unfamiliar social environments, it is important to identify who is powerful. Determining who has power can be challenging because observers may have limited social information, and because people achieve influence for many reasons. In experiments with 3- to 5-year-old children (n = 192) and adults (n = 32), we investigated the developmental origins and conceptual structure of power judgments based on physical appearance. At 3 years of age, children already associated physical strength with expansive posture; soon after, expansive postures also supported judgments of normative authority and were joined by similar judgments about masculine facial structure. By the age of 4, children also matched high- and low-power versions of faces and postures together, indicating that they draw connections between different aspects of more or less powerful appearance. The complexity and timing of these changes highlights limitations in current accounts of the origins of adults' intuitions about powerful appearances. This study documents several novel developmental patterns that generate new hypotheses about the mechanisms that support the emergence of children's intuitions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Shyness and Social Conflict Reduce Young Children's Social Helpfulness.

This study examined social influences on 3-year-old children's decisions to help an experimenter gain another person's attention (N = 32). Children were slower to help the experimenter when the target had previously expressed disinterest in attending to her. Shy children were less likely to support the experimenter's attempts to communicate with the target; however, this association was not influenced by children's knowledge of the target's disinterest, and there was no relation between shyness and children's support for a separate physical goal. Therefore, young children's decisions to act helpfully incorporate consideration for others beyond a focal person with an unmet need, and they are further constrained by children's own comfort with the actions required to help.