Mystery combined with stigma about mental illnesses often discourages families from seeking treatment. Psychiatric treatment should feel no different than going to see an allergist or any other specialist.
By James Waxmonsky, MD
As a child psychiatrist—a medically trained physician who specializes in assessing and treating children with mental health disorders–– I realize that first-time visitors to the office might have very little information about what to expect. Most children come to a psychiatrist fearing a vaccination shot. Their parents think their child is going to be psychoanalyzed on my couch. They will enter an office filled not with busts of Freud and sofas, but basketball nets and images of Homer Simpson.
Parents’ perceptions come from their own mental health experiences, the Internet, TV and movies. Unfortunately, mystery combined with stigma about mental illnesses often discourages families from seeking treatment. Child psychiatrists must strive to make people more comfortable with the process and help integrate psychiatric treatment into mainstream medical care. Visiting us should feel no different than going to see an allergist or any other specialist.
What to expect
Before a visit, it’s helpful to know the following:
The goal of any good psychiatric evaluation is to assess how your child is functioning at school, at home and with friends.
Troubles in any of these areas means looking closer to see if a child’s identified problem behaviors are reasonable reactions to events in his or her life. For example, we expect children to be distressed and a bit withdrawn if the family has other critical issues, such as a seriously ill close relative.
Information is collected simply by talking —usually with the family, then with parents alone and then with the child alone. The younger the child, the less time is spent talking with them apart from their parents.
There are no blood tests or imaging exams to help here, unlike most other fields in medicine.
If the problems do not appear to be predictable reactions to stressful events, then the questions are whether the symptoms are excessive for the age, and do they cause problems. If yes to both, there may be a mental health disorder.
Mental health disorders are well-defined illnesses, some of which have been studied for over 100 years.
A diagnosis generally is not made until after the first two visits, sometimes longer.
Looking for a diagnosis
Once parents decide to see a psychiatrist, they usually want a quick diagnosis. While the psychiatrist wants to provide answers, he or she does not wish to make a premature diagnosis of a complex mental illness when simpler explanations may exist. To come up with a diagnosis for your child the psychiatrist must be a thorough and compassionate investigator. The psychiatrist is trained to know what to ask and how to ask it.
Many parents come into my office fearing that they are the source of their child’s problems and will be blamed by the doctor. While parents play a huge role in their child’s development, it is extremelyrare that they are the cause of the problem.
Indeed, their decision to seek expert advice shows their concern. Families are always viewed as a critical part of the solution. Parents––not the doctor––are the true experts about their child.
Treating the child
If it is determined that there is a mental health disorder, then the next step is to decide what kinds of treatment would help. Diagnoses might include depression, anxiety, ADHD or bipolar disorder
The good news is that almost all mental illness is treatable, and many disorders are easier to manage when diagnosed early. The goal of any treatment is to increase the chances that the child will find his or her fullest potential at home, school and with friends. Treatment almost always includes meeting with a professional therapist who can teach the child and parents skills to relieve stress and control symptoms. Often the therapist will be a psychologist or a social worker; occasionally it’s the psychiatrist.
If medication is a consideration, then the family will meet with the psychiatrist. Medication can be effective, and sometimes necessary. A decision to use medication is always made after consulting the parents and child, and not determined solely by the doctor. If medication is warranted, I try to use the lowest dosage possible. Remember, whether to use medications will likely be a collaborative decision—more than what you’re familiar with from your child’s pediatrician.
For most disorders, including bipolar disorder, medication is often considered part of the wellness program. For medication to be fully effective, it should be used in combination with counseling, and this counseling needs to focus both on the patient and the entire family.
While the format of a psychiatrist visit may be different from a pediatric exam, the goals are the same: Making sure your child is healthy and develops as expected. The more everyone works together to decrease the mystery, anxiety, and stigma surrounding the psychiatric process, the better the chances more children will receive the appropriate care when they need it most.
Printed as “Our Kids: Getting comfortable with therapy”, Spring 2008
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