Closing the accessibility gap to mental health treatment with a personalized self-referral chatbot.

Inequality in treatment access is a pressing issue in most healthcare systems across many medical disciplines. In mental healthcare, reduced treatment access for minorities is ubiquitous but remedies are sparse. Here we demonstrate that digital tools can reduce the accessibility gap by addressing several key barriers. In a multisite observational study of 129,400 patients within England's NHS services, we evaluated the impact of a personalized artificial intelligence-enabled self-referral chatbot on patient referral volume and diversity in ethnicity, gender and sexual orientation. We found that services that used this digital solution identified substantially increased referrals (15% increase versus 6% increase in control services). Critically, this increase was particularly pronounced in minorities, such as nonbinary (179% increase) and ethnic minority individuals (29% increase). Using natural language processing to analyze qualitative feedback from 42,332 individuals, we found that the chatbot's human-free nature and the patients' self-realization of their need for treatment were potential drivers for the observed improvement in the diversity of access. This provides strong evidence that digital tools may help overcome the pervasive inequality in mental healthcare.

Probing apathy in children and adolescents with the Apathy Motivation Index-Child version.

Apathy is linked to mental health and altered neurocognitive functions such as learning and decision-making in healthy adults. Mental health problems typically begin to emerge during adolescence, yet little is known about how apathy develops due to an absence of quantitative measurements specific to young people. Here, we present and evaluate the Apathy Motivation Index-Child Version (AMI-CV) for children and adolescents. We show across two samples of young people (aged 8 to 17 years, total N = 191) tested in schools in the UK and on a smartphone app, that the AMI-CV is a short, psychometrically sound measure to assess levels of apathy and motivation in young people. Similar to adult versions, the AMI-CV captures three distinct apathy domains: Behavioural Activation, Social Motivation and Emotional Sensitivity. The AMI-CV showed excellent construct validity with an alternative measure of apathy and external validity replicating specific links with related mental health traits shown in adults. Our results provide a short measure of self-reported apathy in young people that enables research into apathy development. The AMI-CV can be used in conjunction with the adult version to investigate the impact of levels of apathy across the lifespan.

Exploration heuristics decrease during youth.

Deciding between exploring new avenues and exploiting known choices is central to learning, and this exploration-exploitation trade-off changes during development. Exploration is not a unitary concept, and humans deploy multiple distinct mechanisms, but little is known about their specific emergence during development. Using a previously validated task in adults, changes in exploration mechanisms were investigated between childhood (8-9 y/o, N = 26; 16 females), early (12-13 y/o, N = 38; 21 females), and late adolescence (16-17 y/o, N = 33; 19 females) in ethnically and socially diverse schools from disadvantaged areas. We find an increased usage of a computationally light exploration heuristic in younger groups, effectively accommodating their limited neurocognitive resources. Moreover, this heuristic was associated with self-reported, attention-deficit/hyperactivity disorder symptoms in this population-based sample. This study enriches our mechanistic understanding about how exploration strategies mature during development.

Children are full of optimism, but those rose-tinted glasses are fading-Reduced learning from negative outcomes drives hyperoptimism in children.

Believing that good things will happen in life is essential to maintain motivation and achieve highly ambitious goals. This optimism bias, the overestimation of positive outcomes, may be particularly important during childhood when motivation must be maintained in the face of negative outcomes. In a learning task, we have thus studied the mechanisms underlying the development of optimism bias. Investigating children (8 to 9 year-olds), early (12 to 13 year-olds), and late adolescents (16 to 17 year-olds), we find a consistent optimism bias across age groups. However, children were particularly hyperoptimistic, with the optimism bias decreasing with age. Using computational modeling, we show that this was driven by a reduced learning from worse-than-expected outcomes, and this reduced learning explains why children are hyperoptimistic. Our findings thus show that insensitivity to bad outcomes in childhood helps to prevent taking on an overly realistic perspective and maintain motivation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

I know better! Emerging metacognition allows adolescents to ignore false advice.

Adolescents aspire for independence. Successful independence means knowing when to rely on one's own knowledge and when to listen to others. A critical prerequisite thus is a well-developed metacognitive ability to accurately assess the quality of one's own knowledge. Little is known about whether the strive to become an independent decision maker in adolescence is underpinned by the necessary metacognitive skills. Here, we demonstrate that metacognition matures from childhood to adolescence (N = 107) and that this process coincides with greater independent decision-making. We show that adolescents, in contrast to children, take on others' advice less often, but only when the advice is misleading. Finally, we demonstrate that adolescents' reduced reliance on others' advice is explained by their increased metacognitive skills, suggesting that a developing ability to introspect may support independent decision-making in adolescence.

Human complex exploration strategies are enriched by noradrenaline-modulated heuristics.

An exploration-exploitation trade-off, the arbitration between sampling a lesser-known against a known rich option, is thought to be solved using computationally demanding exploration algorithms. Given known limitations in human cognitive resources, we hypothesised the presence of additional cheaper strategies. We examined for such heuristics in choice behaviour where we show this involves a value-free random exploration, that ignores all prior knowledge, and a novelty exploration that targets novel options alone. In a double-blind, placebo-controlled drug study, assessing contributions of dopamine (400 mg amisulpride) and noradrenaline (40 mg propranolol), we show that value-free random exploration is attenuated under the influence of propranolol, but not under amisulpride. Our findings demonstrate that humans deploy distinct computationally cheap exploration strategies and that value-free random exploration is under noradrenergic control.

Children perform extensive information gathering when it is not costly.

Humans often face decisions where little is known about the choice options. Gathering information prior to making a choice is an important strategy to improve decision making under uncertainty. This is of particular importance during childhood and adolescence, when knowledge about the world is still limited. To examine how much information youths gather, we asked 107 children (8-9 years, N = 30), early (12-13 years, N = 41) and late adolescents (16-17 years, N = 36) to perform an information sampling task. We find that children gather significantly more information before making a decision compared to adolescents, but only if it does not come with explicit costs. Using computational modelling, we find that this is because children have reduced subjective costs for gathering information. Our findings thus demonstrate how children overcome their limited knowledge and neurocognitive constraints by deploying excessive information gathering, a developmental feature that could inform aberrant information gathering in psychiatric disorders.