Parents Guide to Getting Good Care
Where to Go for Diagnosis Help
If you’ve determined that your child’s behaviors, thoughts, or emotions might call for attention, your next move is to consult a professional. But where should you go? A potentially bewildering range of mental health providers are out there, and not all of them are the best people to go to for an evidence-based assessment and sound diagnosis. Where to start depends on the makeup of your child’s current healthcare team and the services available in your area.
Not all of the specialists below will deliver a diagnosis, but many of them (pediatrician, school psychologist) can be valuable in the process of getting an accurate diagnosis that will help your child. (See our Guide to Mental Health Specialists for information about the types of specialists who treat children, their training and the kind of services they provide.)
Where do I start?
For most parents, consulting your family doctor is the first step. While medical doctors are not required to have substantial training in mental health, many do diagnose and treat psychiatric disorders, and others may be able to refer you to a specialist who can.
The advantage to going to the pediatrician is that she already knows your child and your family, and she sees so many children, she can be adept at recognizing when behavior is beyond the typical range. She can also do medical testing to rule out possible non-psychiatric causes of troubling symptoms.
The disadvantage is that your pediatrician may have limited experience in diagnosing psychiatric and developmental disorders and most don’t have time to do the kind of careful assessment that is important for an accurate diagnosis, given that many common problem behaviors in children—i.e. inattention, tantrums, disruptive behavior—can be caused by several different psychiatric or developmental disorders.
Best practices in diagnosing children include using rating scales to get an objective take on symptoms, and collecting information from multiple sources, including the child, the parents, caregivers, teachers, and other adults. (Effective diagnosis of very young children requires extra measures, discussed here.)
You should be upfront with your doctor and ask if she is comfortable and knowledgeable concerning mental illness. Ask for a referral or seek out another clinician if you are not comfortable with what your doctor offers.
- A developmental and behavioral pediatrician is a pediatrician who has completed additional training in evaluating and treating developmental and behavioral problems. Their expertise may make them a good choice for children with complicated medical or developmental problems.
- A child and adolescent psychiatrist is a medical doctor with specialized training both in adult psychiatry and psychiatric diagnosis and treatment in young people. They are equipped to diagnose the full range of psychiatric disorders recognized in the Diagnostic and Statistical Manual (DSM).
- A clinical child psychologist has a PhD or a PsyD as well as supervised clinical experience evaluating and treating kids with mental illness. Psychologists are trained to diagnose the whole range of disorders, and can coordinate other necessary evaluations.
- Neuropsychologists specialize in the functioning of the brain and how it relates to behavior and cognitive ability. Pediatric neuropsychologists do postgraduate training in testing and evaluation. Your child might be referred to a neuropsychologist for an assessment if your concerns include issues of focus, attention, problem-solving, or learning. Neuropsychologists can determine the likely cause of these problems—whether they are psychiatric symptoms, or symptoms of a learning or developmental disorder—in much the same way other specialists can rule out medical causes.
- Neurologists are medical doctors who specialize in the nervous system; a referral for neurological assessment aims to determine whether symptoms are the result of nervous system disorders, such as seizures.
- School psychologists can diagnose mental health disorders, but more frequently a school psychologist will serve as a repository of information from school reports and perhaps as a coordinator for a larger intervention team for your child. A school psychologist, much like a pediatrician, is a great place to start with your concerns, get advice, and, perhaps, a referral.
- A social worker is often one of the first people a child will see if he is having difficulty in school or is referred to a mental health facility. Licensed clinical social workers are extensively trained to assess the needs of a child and his family needs, diagnose psychiatric problems, and develop a treatment plan with the family. LCSW’s are skilled in finding ways to address issues and to explore why they are happening.
What questions should I ask about diagnosis?
When looking for a mental health specialist to provide a diagnostic evaluation for your child, you’ll want to be prepared with questions that will help you decide if a particular clinician is a good match for your needs:
- Can you tell me about your professional training?
- Are you licensed, and, if so, in what discipline?
- Are you board certified, and, if so, in what discipline?
- How much experience do you have diagnosing children whose behaviors are similar to my child’s?
- How do you arrive at a diagnosis? What evidence do you use?
- When do you consult with other professionals?
- Do you provide the treatments you recommend, or do you refer to others?
What if there are no mental health specialists in the area?
It is a frustrating fact for far too many families in this country that adequate mental health services are not readily, or even realistically available. This is one reason that so much of the burden of caring for children with psychiatric and learning disorders has fallen to primary care doctors, even if their training isn’t always adequate for a child’s needs, especially in complex cases. Luckily, many state health services have begun to address this problem through telepsychiatry—giving local family doctors access to consultation with trained psychiatrists via telephone or internet.
If you are having trouble finding someone competent to evaluate and perhaps diagnose your child, ask your pediatrician or any mental health provider you are in contact with if they can research getting a consultation from a remote service. If that is not available, it may be well worth the time and effort to go to an appropriate center some distance away to get an excellent evaluation and treatment plan that can be taken back for implementation by clinicians closer to home.