Tag Archives: fuzzy trace theory

Fuzzy trace theory and adolescent medical decisions

fttimagesThis post is based on the paper, “Fuzzy Trace Theory and Medical Decisions by Minors:  Differences in Reasoning between Adolescents and Adults,” by Evan Wilhelms and Valerie Reyna that appeared in the June 2013, Journal of Medical Philosophy. This is an application of Fuzzy Trace Theory to the medical decision setting. The concept is more generally addressed in the first of three posts: FTT Meaning, Memory, and Development.

The mature minor exception allows adolescents under the age of 18 to make medical decisions and consent to procedures with equivalent authority of an adult. Although this was originally conceived to be applied in emergency situations in which parents are not available, it now according to Wilhelms and Reyna represents a blanket exception for those over the age of 14, so long as the benefits outweigh the risks and the adolescent is not otherwise deemed intellectually incapable. This expansion of rights has been used for easier access to abortion and contraceptives without parental consent, as well as the access to treatment for sexually transmitted infections, addictions, mental health problems and prenatal care. On occasion, this expanded legal standing of minors has been used to justify treatment refusal.

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Development Stages of Intuition and Analysis

Valerie Reyna has inserted development as humans transform from young children to adulthood and on to advanced age as a means to study decision making.  In fuzzy trace theory, there is gist-based intuition and verbatim based intuition. They do not develop in the same way.  In fact, there are development reversals in which biases increase with age.  During childhood, verbatim based calculation skill increases continuously, but gist based bottom line meaning in many situations increases more quickly. Verbatim and gist representations are encoded and processed in parallel.  Which controls task performance depends on which is more accessible and on the constraints of the task.  In general, gist is more accessible and more useful, especially when informed by age and experience.

Reyna finds that the argument that adolescence is a time of increased irrationality is flawed.  Preference for risk exhibits a fairly stable downward trend across age. She concludes that precise calculation of risks and rewards promotes risk taking among adolescents, whereas simple all-or-none gist based intuition protects adults against unhealthy risk taking. Reyna also sees inhibition as a third factor which increases with age during adolescence and young adulthood.

Reyna concludes that mature adults differ from adolescents in more than the ability to rein in responses to tempting rewards.  If offered a million dollars to play Russian roulette, an adult quickly refuses.  An adolescent probably does a quick cost-benefit analysis.  Determining if the reward is worth the risk sounds smart and it fits a traditional definition of rationality. To an adult, it is categorically crazy, a gist based, all-or-none intuition.

Peters et al discuss the age related impacts of cancer decision making. In familiar situations, older adults are benefited by their reliance on gist-based intuition. However, when complex or changing rules must be learned, older adults may make poorer decisions.  Understanding of numeric information is likely to be poorer, also.  Thus, clinicians should emphasize affective meaning with verbal labels such as excellent and fair to interpret numeric risk information.

Betsch and  Glockner point to the need to do research on how children intuitively integrate information.  The limited research shows promise.  Ebersbach demonstrated that kindergarten children are capable of spontaneously integrating three orthogonally varying stimulus dimensions in their judgments of volume.

Betsch, T & Glockner A (2010) Intuition in Judgment and Decision Making: Extensive Thinking without Effort. Psychological Inquiry, 21: 279-294.

Peters, E; Diefenbach, M; Hess, T; Vastfjaii, D;(2008) Age Differences in Dual Information-Processing Modes: Implications for Cancer Decision Making. Cancer December 15: 113(12 Suppl):3556-3567.

Reyna, V(2012) A new Intuitionism: Meaning, memory, and development in Fuzzy-Trace Theory. Judgment and Decision Making, Vol 7, No. 3, May 2012, pp. 332-359.