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:
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 psychiatricdisorders of childhood and adolescence. In recent years there have beenan increasing number of new and different psychiatric meds used with kidsand teens. Research studies are underway to establish more clearly whichmeds are most helpful for specific disorders and presenting problems.Clinical practice and experience, as well as research studies, help physiciansdetermine which meds are most effective for a particular youngster.
Beforerecommending 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 ofkids 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.