Pediatric Mental Disorders Part 2

The appointment and diagnosis.

In last month’s article Pediatric Mental Disorders Part 1, we covered what mental disorders are and how to know when medical attention is needed. This month, let’s dig deeper. You know your child needs to be seen regularly. But, how do you tell him he needs to go to a psychiatrist?

I usually instruct parents to tell their child that they have been concerned about some issue, to name it, and then say they have spoken to a doctor who talks to children about such matters and that an appointment has been made. A good rule of thumb is to give the child enough notice in days for each year of age. So for a 6 year old, I would advise offering him a little reminder of the appointment with the talking doctor each day for six days.

For most children, that will suffice. For more anxious children, it might be necessary to describe the doctor and the office. Further, emphasize that there are no physical interventions, such as needles, and that you will be in the room with the child, if necessary. For the most part, it is better to downplay the appointment so fears won’t build in anticipation. For example: “Joey, we made an appointment with Dr. Paul who talks to kids about school behavior. You can talk to him about what some of the teachers have been saying to you.” At no time should the visit to a doctor be presented as punishment, as a last ditch effort because you “can’t take it anymore,” or for any reason other than to make your child feel better.

When you come to the office, you’re usually greeted by the doctor. In most cases, the child is invited to come in on his own. If this proves impossible, I usually invite parents in, at least for the beginning of the session. Sometimes the parent(s) have to stay the whole time if there is high anxiety. Usually the parent is able to stay nearby in the waiting room after a short period of time.

The interview with the child is preferably conducted by simply speaking to him. Believe it or not, most children liked being talked to as adults instead of being pulled into a playroom and bombarded with toys that could serve as distractions. Some children who have difficulty conversing for whatever reason, be it age, anxiety, a language disorder, etc., may need the introduction of very limited aids, such as drawing tools, writing implements, puppets, balls, dolls, and so on.

After exhausting the presented problem, the physician may do an inventory interview discussing other areas. For example, if the problem was behavior in school, other topics to address could include friendships, family life, hobbies, etc. It may be necessary to have an additional interview with the child to learn about all the important areas of his life.

In such an interview, information is gathered, and the psychiatrist also evaluates physical health, coordination, hearing, language and speech skills, eye contact, frustration tolerance, motor activity, relatedness, neurological issues, evidence of mood disturbances, psychotic symptoms like false beliefs, temperament, degree of alertness, intelligence, academic skills, coping abilities, and overall adjustment.

After seeing the child, I might ask to see the whole family together, especially if family issues are the focus of the problem. It can be enormously helpful to see how people communicate with each other.

Following the questions and interviews, the psychiatrist determines the problem. This process goes further than assigning the child a diagnosis from a manual. It offers a broader appreciation of the child’s development, the family integrity, and the school and friend environment, as well as a view of where things might be going wrong and a plan to get things back on track. All in all, a child psychiatric evaluation can take up to four or five separate interviews. By the time you leave the last interview, you should have a pretty good idea of what the psychiatrist thinks the problem is and if further diagnostic testing is needed.

Lastly, a tentative treatment plan is made that should include the type of therapy the child needs, including some form of talk/verbal therapy and possible medications. You’ll likely have many questions, and there should be time allowed for this and further contact by telephone for questions which might enter your mind later. After all, the goal is to help the child get on track in his environment. From the beginning, the psychiatrist should be picturing the end of treatment and working toward that goal. Not only will you be involved in the treatment, but you might also be given the option to get your own counseling or treatment; any help and support you get and any progress you make in your life will reflect on your child, as well.