Meeting a new provider can be scary and by the time I am seeing your child, you have likely struggled for a long time trying to figure things out. I am here to make the process go smoothly so you feel comfortable with me and confident about the direction of treatment.
I use an informal interview style. I ask lots of questions. Psychiatry (unlike Psychology) does not typically do any type of “testing” for information. The first appointment will be an hour and cover current concerns- the reason you are seeing me, your child’s past, and general information about your child and family. I may ask you to complete questionnaires, but they are not always necessary. I may give handouts for teachers to complete, but they are not always necessary. I provide as much education as we go along and encourage questions and discussion.
Unlike general medicine where a diagnosis usually clarifies, psychiatry has a reputation for not being clear, and often, even confusing. Parents frequently tell me they have been told of different diagnoses for the same behavior. How do you know who to believe?
Diagnoses in psychiatry are based on very specific criteria that are determined by the Diagnostic Statistical Manual (you have probably heard the term DSM). It is in the 5th edition meaning it has been updated 4 times since the original, based on research and statistics. The last update was in 2015. If there is a manual with specific criteria, why then is there so much confusion?
Well, frankly, I think psychiatry has gotten away with being vague and dismissive of the importance of a clear and working diagnosis. People often are not even told their diagnosis or, if they are, it is vague and includes more than one. I often hear something along these lines: “I have depression, anxiety, bipolar and anger issues.” None of those are actual diagnoses and they are not meaningful in determining treatment
Why is Diagnosis Important?
Glad you asked. It determines treatment. A clear diagnosis is as important in psychiatry as in general medicine. For example, your child may have a fever but if we just diagnosis the fever, we are not going to treat the real problem. It’s the same in psychiatry. Your child may be restless but we must determine the cause- ADHD, anxiety or a stereotypic behavior. If we don’t know the cause (aka diagnosis), we will not be able to find the right treatment.
How do You Diagnosis?
It’s the questions, lots and lots of detailed questions to help me understand how your child’s brain is functioning and what may be leading to problem behavior. Along with my questions, I have extensive experience. I have interviewed hundreds of people in my career- likely over 1,000 in the 20+ years. This has created a data base in my mind of symptoms as they relate to a diagnosis. I can draw from this data base in real time. It is a solid foundation to understand behavior on a broad spectrum from normal to abnormal with the variations in between. This experience gives me confidence in my ability to diagnosis accurately. I specialize in clarifying differential diagnoses understanding that the main barrier to progress in treatment is a misdiagnosis.
After I complete the initial evaluation, you will be told the diagnosis. It is possible the diagnosis is a rule out- meaning I need more time and input to figure this out. But, you will have a clear idea of what I think the diagnosis is and a strategy for treatment. Not all kids referred to psychiatry have a psychiatric diagnosis which will be determined with the evaluation.
Wait, What, I Didn’t Expect That Diagnosis?
There are a lot of depictions of mental illness in movies, TV and in the media. Not to mention the things we hear from friends, family and co-workers who often feel they have expertise. Unfortunately, these are often not clinically accurate which can lead to an unexpected diagnosis. My role is to bridge the gap between psychiatry and the ideas you came in with. Your child may have been diagnosed in the past, but we will still start with a complete evaluation which may shed new light, or even dispute, a previous diagnosis. It is possible your child was diagnosed in error which can also be difficult to accept.
In all cases, I will provide the specific criteria that lead to the diagnosis of your child. I will answer any questions, clarify any confusion and discuss as long as we need, but, I will not change a diagnosis based on parental resistance. If you do not agree with my diagnosis, I encourage you to get a second opinion, but we must operate under the same understanding of what is causing the behavior which is the diagnosis.
I have had many distressed parents tell me that they think a diagnosis is a label that will follow their child forever. I want to respond to this idea. A diagnosis tells us what is not functioning properly. In psychiatry it tells us what is not functioning properly in the brain. This is not a reflection of you, your child or your family. It is a medical condition. And like all medical information, it is protected by federal law. We do not give medical information to anybody without your consent. We are HIPPA compliant and will provide paperwork to explain this so you can put your mind at ease. We do not share any information without your written consent. And even then, we only share the minimum needed to complete the task.
Treatment may be medication or therapy or some combination of both. I am judicious with medication, but I recognize that some symptoms are not going to be responsive to therapy alone. Our relationship is collaborative which means I will provide as much information to help you make an informed decision. I will never tell you that my way is the only way and ultimately treatment is only going to work if you believe it is the best option for your child.
And, we are in luck! Treatment is evidence based which means it relies on research and data- just like the DSM-V which provided the diagnosis. This means I can clearly outline for you the course of treatment for your child after the diagnosis is made and we can both feel confident things are going to get better.
What Does Evidence Based Mean?
Coming soon, in the meantime, feel free to ask me about it.