Term of Award

Summer 2024

Degree Name

Doctor of Psychology in Clinical Psychology (Psy.D.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


Department of Psychology

Committee Chair

C. Thresa Yancey

Committee Member 1

Dorthie Cross

Committee Member 2

Nicolette Rickert


Approximately 20% of children ages nine to 17 in the United States struggle with mental health concerns each year (Gamm et al., 2010). Early identification of child and adolescent mental health concerns is crucial for initiating treatment to prevent recurrence or persistence of pathology into adulthood (Logan & King, 2001). Children are primarily dependent upon adults in their lives (e.g., parents/caregivers, education professionals, healthcare providers) to recognize mental health concerns and seek services (Sayal et al., 2010). Providing these adults with guidance on how to appropriately identify and recognize these mental health needs in children is critical (Crouch et al., 2019). Despite this well-documented mental health crisis in children/adolescents, there is a marked delay in or underutilization of services (Reinke et al., 2011), suggesting a barrier to service attainment. The current study aimed to investigate this barrier by examining adults’ recognition and response to at-risk or “pink flag” behaviors/symptoms of externalizing or internalizing concerns in a fictitious child. The study used vignettes depicting a child with various psychological concerns (i.e., externalizing, internalizing, or none-control) and then assessed the adult’s ability to recognize presented concerns and their likelihood to refer for services. Participants who received either experimental vignette (externalizing or internalizing) reported higher likelihood to refer for services and those who were healthcare providers were the highest reporters (compared to parents and education professional). This study has strong clinical implications for those who have or work with children and/or in the field of teaching/education or developmental psychopathology.

Research Data and Supplementary Material