Parents Guide to Getting Good Care
Who Can Assist With Treatment?
Once you have a diagnosis for your child, it’s time to think about treatment options. In some cases the clinician who did the diagnosis will be a good choice for treatment; in other cases you will need to find a different kind of practitioner. Either way, your primary care practitioner or the diagnosing clinician can be a good place to start the search.
A licensed clinical social worker at your child’s school or a mental health facility may play a key role in coordinating care for your child and linking you with other professionals on the treatment team. Through ongoing monitoring, the LCSW helps you evaluate your child’s progress, access necessary services, and address issues as they develop.
Before you decide who to work with, get informed. You’ll want to find out what the first-line treatment recommendations are for your child’s disorder, and make sure that the clinician you choose has both training and experience in that treatment.
For instance, for many anxiety and mood disorders, there are very specific kinds of behavioral therapies tailored to specific disorders. (For a list of such evidence-based therapies and what they are used for, see our Guide to Behavioral Treatments.) The techniques are not interchangeable: The right clinician for you will be one who has experience in the particular therapy your child needs.
If your child would benefit from medication, it’s crucial that you ask if your primary care doctor or psychiatrist who prescribes it actually has experience with that type of medication. Success with psychotropic medications depends on the right dosage, which can take considerable effort to establish, as well as expert monitoring as a child changes and grows. This process takes time and patience; if your doctor is too busy to work with you until the medication is successful, and to monitor your child to see that it stays successful, you should look for another practitioner.
Please know that, in many cases, treating psychiatric disorders may begin with behavioral or environmental interventions, before medications. However, only a skilled clinician can properly explain the order in which treatments should be started and continued.
Above all, you want to work with professionals who communicate effectively with you, explain clearly what they are offering, listen to your concerns, answer your questions, and pay close attention to your child’s particular needs and behaviors.
Here are some specific examples of the kinds of professionals who may help in treatment for your child:
Learning disorders like dyslexia:
If you’ve had a neuropsychological evaluation of your child, and his learning challenges have been identified, you will want to find professionals who can help him build on his strengths and compensate for his weaknesses. He may qualify for an IEP (Individualized Education Plan), which spells out the support the school district is obligated to provide.
In addition to whatever help is provided by school-based professionals, you may want to enlist a learning specialist (or educational therapist), who works with a child to build skills and devise strategies for learning in whatever way works best for him. If he needs help with reading or math-related skills, there are specialists who work on those areas. If he is weak in executive functions, the specialist works with him to structure his time and keep track of the schoolwork he needs to do. Sometimes a tutor is useful for a student weak in a particular subject area, and a homework helper can help an unfocused or disorganized student stay on top of his work.
If he qualifies for an IEP, it will outline the support the school district is obligated to give him. Though navigating the world of IEP negotiations can be difficult, the Individuals with Disabilities Education Act (IDEA) is firm on the provision of accommodations to children who qualify. If these cannot be provided at your child’s school, it is within your rights to find them elsewhere.
Mood disorders like anxiety or depression:
For children with anxiety disorders, such as social anxiety disorder or separation anxiety, the first-line treatment is usually behavior therapy. A psychologist works with both the child and the parents using a treatment protocol that is evidence-tested for his specific disorder. OCD and disorders related to it may be managed in a similar fashion.
If a child is anxious or depressed enough to need medication, usually in addition to the behavior therapy, a psychiatrist or pediatrician prescribes medication and works with the child’s psychologist to monitor his progress. It’s important to make sure that whoever is doing the prescribing has experience with the medication and children similar to yours, and enough time to work with you to manage it successfully.
Since behavior therapy uses very specific techniques that are not necessarily intuitive, it’s important that your psychologist be trained and experienced in the particular therapy that’s appropriate for your child. More often than not, evidence-based behavior or cognitive behavior therapies are manualized and time-limited—that is, procedures are spelled out very specifically—so a therapist should be able to explain clearly what will be expected of both you and your child, and the duration of treatment.
Developmental disorders like autism:
For children diagnosed with autism spectrum disorder, treatment usually begins as early as possible with applied behavior therapy, to help kids build social and communication skills that they’re not developing naturally. Psychologists with training in behavior therapy (including ABA ) will usually work with children and teach parents how to continue the therapy in between sessions. Children with autism or developmental delays often work with occupational therapists or physical therapists to build motor skills that are lacking.
Children with developmental disorders, including autism, often have sensory processing challenges, which cause them to be unusually sensitive to sounds, lights, and other stimuli, or be under-stimulated by their senses. Sensory problems can be severe, when kids are so overwhelmed or disoriented that they can’t function, try to flee, or have alarming meltdowns. They may benefit from behavioral therapy and some children also work with an occupational therapist on these issues.
ADHD and behavior disorders:
If your child has been diagnosed with moderate to severe ADHD, the first-line treatment is usually stimulant medication. A psychiatrist or pediatrician can prescribe and monitor the medication. It’s crucial that your doctor has expertise and experience with these medications; getting the right dosage and medication schedule, adjusting the dosage and reevaluating the medication as the child grows and changes are critical to its success. Stimulant medication is fast acting, but there are many kinds, each with different durations and delivery systems, and it may take time to find the medication plan that’s most effective for your child. It’s not unusual for children to change dosage and medications over time, so a close alliance with your clinician is crucial for success.
For children with ADHD, behavior therapy generally does not affect the inattention, impulsivity, and hyperactivity symptoms, but it can be very helpful in teaching parents and children how to manage them more successfully. Behavioral treatments with a trained psychologist like Parent-Child Interaction Therapy (PCIT), Parent Management Training (PMT) and Positive Parenting Program (Triple P) help families of kids with ADHD. Parents learn to exercise authority and set limits in a calm, positive way; kids learn to rein in their own behavior more effectively.
For children with disruptive behavior disorders, these behavior therapies, with an appropriately trained psychologist, can be very helpful. Sometimes behavior therapy is combined with medication, prescribed by a psychiatrist or pediatrician.