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:

  • 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).