On Sept. 21, 2008, Adrian Thomas, a 26-year-old African American man, awoke to find his four-month-old son Matthew limp and unresponsive. At the hospital, the case garnered the interest of police investigators. While still treating Matthew, the pediatric critical care doctor told detectives, “Somebody murdered this child.” The detectives took Thomas in for 10 grueling hours of interrogation, leading Thomas to falsely confess to repeatedly slamming Matthew down on a bed. Meanwhile, Matthew passed away. Thomas was charged with the murder of his son, and after a trial jury watched his videotaped confession, he was convicted. However, the New York Court of Appeals determined Thomas’s confession was involuntary and overturned his conviction. Without the incriminating false confession, Thomas was acquitted at his retrial.
At both the original trial and the retrial, Thomas’s defense included expert witnesses who presented evidence that his son’s death was a result of an overwhelming bacterial infection and sepsis—not abuse. Why, then, did the doctor conclude that the infant had been murdered? We don’t know, but cases like this one are not unprecedented. The National Registry of Exonerations reports that 17 individuals have been wrongfully convicted of crimes involving shaken baby syndrome based on misleading or false forensic evidence supporting a mistaken diagnosis. And these cases likely reflect only a fraction of wrongful convictions related to misdiagnoses of abuse.
It is important to consider whether stereotyping and bias might contribute to such misdiagnoses. Research has shown that a child’s injuries are as much as nine times more likely to be reported as resulting from abuse when the child is black rather than white (Lane, W.G., et al., JAMA, Vol. 288, No. 13, 2002). Moreover, though there is no racial or ethnic difference in the frequency with which children are confirmed as abuse victims, children from minority backgrounds are more likely to be reported and evaluated but ultimately determined not to have experienced abuse (Hymel, K.P., et al., The Journal of Pediatrics, Vol. 198, 2018).
Najdowski and Bernstein documented the existence, content and strength of stereotypes that could contribute to these patterns (Child Abuse & Neglect, Vol. 86, 2018). In particular, the stereotype linking race to child abuse leads medical professionals to think of black parents as poor, uneducated, stressed and drug-involved, and to view battering and neglect as part of an intergenerational cycle in black families. Medical decision-making frequently occurs in situations characterized by complexity, extreme time constraints and stress. These are the very conditions that increase the likelihood that practitioners will rely on these stereotypes—knowingly or unknowingly—to disambiguate situations and increase their certainty in a diagnosis. Such reliance may be especially problematic when they are considering diagnoses for which medical experts lack consensus regarding symptomatology, like shaken baby syndrome.
Disparities in misdiagnosis of abuse may lead not only to unnecessary involvement of minority families in the child welfare and criminal justice systems but also to physicians missing actual cases of abuse experienced by white children. Psychologists must devote more attention to identifying factors that contribute to injustice and developing interventions to improve medical decision-making in ambiguous cases.
