| Psychiatric Evaluation & Medication |
A comprehensive psychiatric evaluation by a child and adolescent psychiatrist is appropriate for
any child or adolescent with emotional and/or behavioral problems. Children and adolescents with
serious emotional and behavioral problems should have an evaluation.
Evaluations usually require several hours over one or more office visits for the child and parents. With
the parents' permission, other significant people (e.g., family physician, school personnel, relatives) may
be contacted for additional information.
The evaluation frequently includes the following:
The child and adolescent psychiatrist then develops a bio-psycho-social assessment. The assessment
describes the child's problems and explains them in terms that the parents and child can understand.
The assessment combines biological, psychological and social parts of the problem with developmental
needs, history and strengths of the child, adolescent and family.
Parents often come to such evaluations with many concerns, including:
· What is wrong?
· Is my child normal?
· Does my child need treatment?
· Am I normal?
· Do I need treatment?
· Am I silly to worry?
· Am I to blame?
· Can you help my child?
· Can you help us?
· How can the family help?
· What is the diagnosis?
· What are your recommendations?
· What will treatment cost?
· How long will treatment last?
Parents are often worried about how they will be viewed during the evaluation. Child and adolescent
psychiatrists are there to support families and to be a partner -- not to judge or blame. They listen to
concerns, and help the child or adolescent and his/her family define the goals of both the evaluation and
treatment.
Psychiatric medications may be prescribed. Psychiatric medication should be used as part of a
comprehensive plan of treatment, with ongoing evaluation and, in most cases, medical psychotherapy.
Before deciding whether or not to prescribe a psychiatric medication, psychiatrists either conduct or
order a thorough psychological and medical evaluation, which may include laboratory tests. No child
should fear taking a psychiatric medication if he or she has received a complete medical and physical
examination and is properly monitored for both the medicine's benefit and side effects.
Parents should be informed about known risks and/or FDA warnings before a child starts any
psychiatric medication. All medicines have positive and negative effects. While very effective in
controlling the painful emotional and mental symptoms, psychiatric medicines can produce unwanted
side effects. Parents with children who are suffering from mental illness should work closely with their
psychiatrist to understand what medicines their children are taking, why they are taking them, how
they should take them and what side effects to watch for.
Parents should be provided with complete information when psychiatric medication is recommended as
part of their child's treatment plan. Children and adolescents should be included in the discussion about
medications, using words they understand.
Parents should ask the following questions before their child or adolescent starts taking
psychiatric medications:
1. Are there any activities that my child should avoid while taking the medication?
2. Are there any other medications or foods that my child should avoid while taking the medication?
3. Are there interactions between this medication and other medications (e.g., prescription and/or over-
the-counter) my child is taking?
4. Can this medication be abused?
5. Does my child's school nurse need to be informed about this medication?
6. How long before I see improvement?
7. How long will my child need to take this medication?
8. How often will progress be checked and by whom?
9. How often will the medication be taken?
10. How will the decision be made to stop this medication?
11. How will the medication help my child?
12. Is the medication known by other names?
13. Is this medication addictive?
14. What are the side effects with this medication?
15. What do I do if a problem develops (e.g. if my child becomes ill, doses are missed, or side effects
develop)?
16. What is known about the medications helpfulness with other children who have a similar condition
to my child?
17. What is the cost of the medication (generic vs. brand name)?
18. What is the recommended dosage?
19. When will the medication start to take effect?
20. Will any tests need to be done while my child is taking the medication?
21. Will someone be monitoring my child's response to medication and make dosage changes if
necessary?
After asking these questions, if you still have serious questions or doubts about medical treatment, get a
second opinion from another psychiatrist.
How Medications (Meds) Are Used—
Medication can be an effective part of the treatment for several psychiatric disorders of childhood and
adolescence. A doctor's recommendation to use medication often raises many concerns and questions in
both the moms & dads and the youngster. The physician who recommends medication should be
experienced in treating psychiatric illnesses in kids and teens. He or she should fully explain the reasons
for medication use, what benefits the medication should provide, as well as possible risks and side
effects and other treatment alternatives.
Psychiatric medication should not be used alone. The use of medication should be based on a
comprehensive psychiatric evaluation and be one part of a comprehensive treatment plan.
Before recommending any medication, the psychiatrist interviews the youngster and makes a thorough
diagnostic evaluation. In some cases, the evaluation may include a physical exam, psychological testing,
laboratory tests, other medical tests such as an electrocardiogram (EKG) or electroencephalogram
(EEG), and consultation with other medical specialists.
Meds which have beneficial effects may also have side effects, ranging from just annoying to very
serious. As each youngster is different and may have individual reactions to medication, close contact
with the treating physician is recommended. Do not stop or change a medication without speaking to
the doctor. Psychiatric medication should be used as part of a comprehensive plan of treatment, with
ongoing medical assessment and, in most cases, individual and/or family psychotherapy. When
prescribed appropriately by a psychiatrist (preferably a psychiatrist), and taken as prescribed,
medication may reduce or eliminate troubling symptoms and improve the daily functioning of kids
and teens with psychiatric disorders.
Medication may be prescribed for psychiatric symptoms and disorders, including, but not limited to:
1. Anxiety (school refusal, phobias, separation or social fears, generalized anxiety, or posttraumatic
stress disorders)-if it keeps the youngster from normal daily activities.
2. Attention deficit hyperactivity disorder (ADHD)-marked by a short attention span, trouble
concentrating and restlessness. The youngster is easily upset and frustrated, often has problems getting
along with family and friends, and usually has trouble in school.
3. Autism-(or other pervasive developmental disorder such as Asperger's Syndrome)-characterized by
severe deficits in social interactions, language, and/or thinking or ability to learn, and usually diagnosed
in early childhood.
4. Bedwetting-if it persists regularly after age 5 and causes serious problems in low self-esteem and
social interaction.
5. Bipolar (manic-depressive) disorder-periods of depression alternating with manic periods, which may
include irritability, "high" or happy mood, excessive energy, behavior problems, staying up late at night,
and grand plans.
6. Depression-lasting feelings of sadness, helplessness, hopelessness, unworthiness and guilt, inability to
feel pleasure, a decline in school work and changes in sleeping and eating habits.
7. Eating disorder-either self-starvation (anorexia nervosa) or binge eating and vomiting (bulimia), or a
combination of the two.
8. Obsessive-compulsive disorder (OCD)-recurring obsessions (troublesome and intrusive thoughts)
and/or compulsions (repetitive behaviors or rituals such as handwashing, counting, checking to see if
doors are locked) which are often seen as senseless but which interfere with a youngster's daily
functioning.
9. Psychosis-symptoms include irrational beliefs, paranoia, hallucinations (seeing things or hearing
sounds that don't exist) social withdrawal, clinging, strange behavior, extreme stubbornness, persistent
rituals, and deterioration of personal habits. May be seen in developmental disorders, severe
depression, schizoaffective disorder, schizophrenia, and some forms of substance abuse.
10. Severe aggression-which may include assaultiveness, excessive property damage, or prolonged self-
abuse, such as head-banging or cutting.
11. Sleep problems-symptoms can include insomnia, night terrors, sleep walking, fear of separation,
anxiety.
Types Of Meds—
Psychiatric meds can be an effective part of the treatment for psychiatric
disorders of childhood and adolescence. In recent years there have been
an increasing number of new and different psychiatric meds used with kids
and teens. Research studies are underway to establish more clearly which
meds are most helpful for specific disorders and presenting problems.
Clinical practice and experience, as well as research studies, help physicians
determine which meds are most effective for a particular youngster. Before
recommending any medication, the psychiatrist (preferably a psychiatrist) should conduct a
comprehensive diagnostic evaluation of the youngster or teen. Moms & dads should be informed about
known risks and/or FDA warnings before a youngster starts any psychiatric medication. When
prescribed appropriately by an experienced psychiatrist (preferably a psychiatrist) and taken as
directed, medication may reduce or eliminate troubling symptoms and improve daily functioning of
kids and teens with psychiatric disorders.
ADHD Meds: Stimulant and non-stimulant meds may be helpful as part of the treatment for attention
deficit hyperactive disorder (ADHD). Examples of stimulants include: Dextroamphetamine (Dexedrine,
Adderal) and Methylphenidate (Ritalin, Metadate, Concerta). Non-stimulant meds include Atomoxetine
(Strattera).
Antidepressant Meds: Antidepressant meds may be helpful in the treatment of depression, school
phobias, panic attacks, and other anxiety disorders, bedwetting, eating disorders, obsessive-compulsive
disorder, personality disorders, posttraumatic stress disorder, and attention deficit hyperactive
disorder. There are several types of antidepressant meds. Examples of serotonin reuptake inhibitors
(SRI's) include: Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine (Luvox),
Venlafaxine (Effexor), Citalopram (Celexa) and Escitalopram (Lexapro). Examples of atypical
antidepressants include: Bupropion (Wellbutrin), Nefazodone (Serzone), Trazodone (Desyrel), and
Mirtazapine (Remeron). Examples of tricyclic antidepressants (TCA's) include: Amitriptyline (Elavil),
Clomipramine (Anafranil), Imipramine (Tofranil), and Nortriptyline (Pamelor). Examples of monoamine
oxidase inhibitors (MAOI's) include: Phenelzine (Nardil), and Tranylcypromine (Parnate).
Antipsychotic Meds: These meds can be helpful in controlling psychotic symptoms (delusions,
hallucinations) or disorganized thinking. These meds may also help muscle twitches ("tics") or verbal
outbursts as seen in Tourette's Syndrome. They are occasionally used to treat severe anxiety and may
help in reducing very aggressive behavior. Examples of first generation antipsychotic meds include:
Chlorpromazine (Thorazine), Thioridazine (Mellaril), Fluphenazine (Prolixin), Trifluoperazine
(Stelazine), Thiothixene (Navane), and Haloperidol (Haldol). Second generation antipsychotic meds
(also known as atypical or novel) include: Clozapine (Clozaril), Risperidone (Risperdal), Quetiapine
(Seroquel), Olanzapine (Zyprexa), Ziprasidone (Geodon) and Aripiprazole (Abilify).
Mood Stabilizers and Anticonvulsant Meds: These meds may be helpful in treating bipolar disorder,
severe mood symptoms and mood swings (manic and depressive), aggressive behavior and impulse
control disorders. Examples include: Lithium (lithium carbonate, Eskalith), Valproic Acid (Depakote,
Depakene), Carbamazepine (Tegretol), Gabapentin (Neurontin), Lamotrigine (Lamictil), Topiramate
(Topamax), and Oxcarbazepine (Trileptal).
Anti-anxiety Meds: These meds may be helpful in the treatment of severe anxiety. There are several
types of anti-anxiety meds: benzodiazepines; antihistamines; and atypicals. Examples of benzo-
diazepines include: Alprazolam (Xanax), lorazepam (Ativan), Diazepam (Valium),and Clonazepam
(Klonopin). Examples of antihistamines include: Diphenhydramine (Benadryl), and Hydroxizine
(Vistaril). Examples of atypical anti-anxiety meds include: Buspirone (BuSpar), and Zolpidem (Ambien).
Sleep Meds: A variety of meds may be used for a short period to help with sleep problems. Examples
include: Trazodone (Desyrel), Zolpidem (Ambien), Zaleplon (Sonata) and Diphenhydramine (Benadryl).
Miscellaneous Meds: Other meds are also being used to treat a variety of symptoms. For example:
clonidine (Catapres) may be used to treat the severe impulsiveness in some kids with ADHD and
guanfacine (Tenex) for "flashbacks" in kids with PTSD.
Long-Acting Meds: Many newer meds are taken once a day. These meds have the designation SR
(sustained release), ER or XR (extended release), CR (controlled release) or LA (long-acting)
any child or adolescent with emotional and/or behavioral problems. Children and adolescents with
serious emotional and behavioral problems should have an evaluation.
Evaluations usually require several hours over one or more office visits for the child and parents. With
the parents' permission, other significant people (e.g., family physician, school personnel, relatives) may
be contacted for additional information.
The evaluation frequently includes the following:
- Description of present problems and symptoms
- If needed, laboratory studies such as blood tests, x-rays, or special assessments (e.g.,
psychological, educational, speech and language evaluation)
- Information about family relationships
- Information about health, illness and treatment (physical and psychiatric), including current
medications
- Information about school and friends
- Information about the child's development
- Interview of parents/guardians
- Interview of the child or adolescent
- Parent and family health and psychiatric histories
The child and adolescent psychiatrist then develops a bio-psycho-social assessment. The assessment
describes the child's problems and explains them in terms that the parents and child can understand.
The assessment combines biological, psychological and social parts of the problem with developmental
needs, history and strengths of the child, adolescent and family.
Parents often come to such evaluations with many concerns, including:
· What is wrong?
· Is my child normal?
· Does my child need treatment?
· Am I normal?
· Do I need treatment?
· Am I silly to worry?
· Am I to blame?
· Can you help my child?
· Can you help us?
· How can the family help?
· What is the diagnosis?
· What are your recommendations?
· What will treatment cost?
· How long will treatment last?
Parents are often worried about how they will be viewed during the evaluation. Child and adolescent
psychiatrists are there to support families and to be a partner -- not to judge or blame. They listen to
concerns, and help the child or adolescent and his/her family define the goals of both the evaluation and
treatment.
Psychiatric medications may be prescribed. Psychiatric medication should be used as part of a
comprehensive plan of treatment, with ongoing evaluation and, in most cases, medical psychotherapy.
Before deciding whether or not to prescribe a psychiatric medication, psychiatrists either conduct or
order a thorough psychological and medical evaluation, which may include laboratory tests. No child
should fear taking a psychiatric medication if he or she has received a complete medical and physical
examination and is properly monitored for both the medicine's benefit and side effects.
Parents should be informed about known risks and/or FDA warnings before a child starts any
psychiatric medication. All medicines have positive and negative effects. While very effective in
controlling the painful emotional and mental symptoms, psychiatric medicines can produce unwanted
side effects. Parents with children who are suffering from mental illness should work closely with their
psychiatrist to understand what medicines their children are taking, why they are taking them, how
they should take them and what side effects to watch for.
Parents should be provided with complete information when psychiatric medication is recommended as
part of their child's treatment plan. Children and adolescents should be included in the discussion about
medications, using words they understand.
Parents should ask the following questions before their child or adolescent starts taking
psychiatric medications:
1. Are there any activities that my child should avoid while taking the medication?
2. Are there any other medications or foods that my child should avoid while taking the medication?
3. Are there interactions between this medication and other medications (e.g., prescription and/or over-
the-counter) my child is taking?
4. Can this medication be abused?
5. Does my child's school nurse need to be informed about this medication?
6. How long before I see improvement?
7. How long will my child need to take this medication?
8. How often will progress be checked and by whom?
9. How often will the medication be taken?
10. How will the decision be made to stop this medication?
11. How will the medication help my child?
12. Is the medication known by other names?
13. Is this medication addictive?
14. What are the side effects with this medication?
15. What do I do if a problem develops (e.g. if my child becomes ill, doses are missed, or side effects
develop)?
16. What is known about the medications helpfulness with other children who have a similar condition
to my child?
17. What is the cost of the medication (generic vs. brand name)?
18. What is the recommended dosage?
19. When will the medication start to take effect?
20. Will any tests need to be done while my child is taking the medication?
21. Will someone be monitoring my child's response to medication and make dosage changes if
necessary?
After asking these questions, if you still have serious questions or doubts about medical treatment, get a
second opinion from another psychiatrist.
How Medications (Meds) Are Used—
Medication can be an effective part of the treatment for several psychiatric disorders of childhood and
adolescence. A doctor's recommendation to use medication often raises many concerns and questions in
both the moms & dads and the youngster. The physician who recommends medication should be
experienced in treating psychiatric illnesses in kids and teens. He or she should fully explain the reasons
for medication use, what benefits the medication should provide, as well as possible risks and side
effects and other treatment alternatives.
Psychiatric medication should not be used alone. The use of medication should be based on a
comprehensive psychiatric evaluation and be one part of a comprehensive treatment plan.
Before recommending any medication, the psychiatrist interviews the youngster and makes a thorough
diagnostic evaluation. In some cases, the evaluation may include a physical exam, psychological testing,
laboratory tests, other medical tests such as an electrocardiogram (EKG) or electroencephalogram
(EEG), and consultation with other medical specialists.
Meds which have beneficial effects may also have side effects, ranging from just annoying to very
serious. As each youngster is different and may have individual reactions to medication, close contact
with the treating physician is recommended. Do not stop or change a medication without speaking to
the doctor. Psychiatric medication should be used as part of a comprehensive plan of treatment, with
ongoing medical assessment and, in most cases, individual and/or family psychotherapy. When
prescribed appropriately by a psychiatrist (preferably a psychiatrist), and taken as prescribed,
medication may reduce or eliminate troubling symptoms and improve the daily functioning of kids
and teens with psychiatric disorders.
Medication may be prescribed for psychiatric symptoms and disorders, including, but not limited to:
1. Anxiety (school refusal, phobias, separation or social fears, generalized anxiety, or posttraumatic
stress disorders)-if it keeps the youngster from normal daily activities.
2. Attention deficit hyperactivity disorder (ADHD)-marked by a short attention span, trouble
concentrating and restlessness. The youngster is easily upset and frustrated, often has problems getting
along with family and friends, and usually has trouble in school.
3. Autism-(or other pervasive developmental disorder such as Asperger's Syndrome)-characterized by
severe deficits in social interactions, language, and/or thinking or ability to learn, and usually diagnosed
in early childhood.
4. Bedwetting-if it persists regularly after age 5 and causes serious problems in low self-esteem and
social interaction.
5. Bipolar (manic-depressive) disorder-periods of depression alternating with manic periods, which may
include irritability, "high" or happy mood, excessive energy, behavior problems, staying up late at night,
and grand plans.
6. Depression-lasting feelings of sadness, helplessness, hopelessness, unworthiness and guilt, inability to
feel pleasure, a decline in school work and changes in sleeping and eating habits.
7. Eating disorder-either self-starvation (anorexia nervosa) or binge eating and vomiting (bulimia), or a
combination of the two.
8. Obsessive-compulsive disorder (OCD)-recurring obsessions (troublesome and intrusive thoughts)
and/or compulsions (repetitive behaviors or rituals such as handwashing, counting, checking to see if
doors are locked) which are often seen as senseless but which interfere with a youngster's daily
functioning.
9. Psychosis-symptoms include irrational beliefs, paranoia, hallucinations (seeing things or hearing
sounds that don't exist) social withdrawal, clinging, strange behavior, extreme stubbornness, persistent
rituals, and deterioration of personal habits. May be seen in developmental disorders, severe
depression, schizoaffective disorder, schizophrenia, and some forms of substance abuse.
10. Severe aggression-which may include assaultiveness, excessive property damage, or prolonged self-
abuse, such as head-banging or cutting.
11. Sleep problems-symptoms can include insomnia, night terrors, sleep walking, fear of separation,
anxiety.
Types Of Meds—
Psychiatric meds can be an effective part of the treatment for psychiatric
disorders of childhood and adolescence. In recent years there have been
an increasing number of new and different psychiatric meds used with kids
and teens. Research studies are underway to establish more clearly which
meds are most helpful for specific disorders and presenting problems.
Clinical practice and experience, as well as research studies, help physicians
determine which meds are most effective for a particular youngster. Before
recommending any medication, the psychiatrist (preferably a psychiatrist) should conduct a
comprehensive diagnostic evaluation of the youngster or teen. Moms & dads should be informed about
known risks and/or FDA warnings before a youngster starts any psychiatric medication. When
prescribed appropriately by an experienced psychiatrist (preferably a psychiatrist) and taken as
directed, medication may reduce or eliminate troubling symptoms and improve daily functioning of
kids and teens with psychiatric disorders.
ADHD Meds: Stimulant and non-stimulant meds may be helpful as part of the treatment for attention
deficit hyperactive disorder (ADHD). Examples of stimulants include: Dextroamphetamine (Dexedrine,
Adderal) and Methylphenidate (Ritalin, Metadate, Concerta). Non-stimulant meds include Atomoxetine
(Strattera).
Antidepressant Meds: Antidepressant meds may be helpful in the treatment of depression, school
phobias, panic attacks, and other anxiety disorders, bedwetting, eating disorders, obsessive-compulsive
disorder, personality disorders, posttraumatic stress disorder, and attention deficit hyperactive
disorder. There are several types of antidepressant meds. Examples of serotonin reuptake inhibitors
(SRI's) include: Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Fluvoxamine (Luvox),
Venlafaxine (Effexor), Citalopram (Celexa) and Escitalopram (Lexapro). Examples of atypical
antidepressants include: Bupropion (Wellbutrin), Nefazodone (Serzone), Trazodone (Desyrel), and
Mirtazapine (Remeron). Examples of tricyclic antidepressants (TCA's) include: Amitriptyline (Elavil),
Clomipramine (Anafranil), Imipramine (Tofranil), and Nortriptyline (Pamelor). Examples of monoamine
oxidase inhibitors (MAOI's) include: Phenelzine (Nardil), and Tranylcypromine (Parnate).
Antipsychotic Meds: These meds can be helpful in controlling psychotic symptoms (delusions,
hallucinations) or disorganized thinking. These meds may also help muscle twitches ("tics") or verbal
outbursts as seen in Tourette's Syndrome. They are occasionally used to treat severe anxiety and may
help in reducing very aggressive behavior. Examples of first generation antipsychotic meds include:
Chlorpromazine (Thorazine), Thioridazine (Mellaril), Fluphenazine (Prolixin), Trifluoperazine
(Stelazine), Thiothixene (Navane), and Haloperidol (Haldol). Second generation antipsychotic meds
(also known as atypical or novel) include: Clozapine (Clozaril), Risperidone (Risperdal), Quetiapine
(Seroquel), Olanzapine (Zyprexa), Ziprasidone (Geodon) and Aripiprazole (Abilify).
Mood Stabilizers and Anticonvulsant Meds: These meds may be helpful in treating bipolar disorder,
severe mood symptoms and mood swings (manic and depressive), aggressive behavior and impulse
control disorders. Examples include: Lithium (lithium carbonate, Eskalith), Valproic Acid (Depakote,
Depakene), Carbamazepine (Tegretol), Gabapentin (Neurontin), Lamotrigine (Lamictil), Topiramate
(Topamax), and Oxcarbazepine (Trileptal).
Anti-anxiety Meds: These meds may be helpful in the treatment of severe anxiety. There are several
types of anti-anxiety meds: benzodiazepines; antihistamines; and atypicals. Examples of benzo-
diazepines include: Alprazolam (Xanax), lorazepam (Ativan), Diazepam (Valium),and Clonazepam
(Klonopin). Examples of antihistamines include: Diphenhydramine (Benadryl), and Hydroxizine
(Vistaril). Examples of atypical anti-anxiety meds include: Buspirone (BuSpar), and Zolpidem (Ambien).
Sleep Meds: A variety of meds may be used for a short period to help with sleep problems. Examples
include: Trazodone (Desyrel), Zolpidem (Ambien), Zaleplon (Sonata) and Diphenhydramine (Benadryl).
Miscellaneous Meds: Other meds are also being used to treat a variety of symptoms. For example:
clonidine (Catapres) may be used to treat the severe impulsiveness in some kids with ADHD and
guanfacine (Tenex) for "flashbacks" in kids with PTSD.
Long-Acting Meds: Many newer meds are taken once a day. These meds have the designation SR
(sustained release), ER or XR (extended release), CR (controlled release) or LA (long-acting)
| Dr. Richard Falzone describes the developmental tasks of adolescence. |
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