Pediatric Psychiatrist vs. Pediatric Psychologist vs. Behavioral Pediatrician -- HELP! - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 22 Old 02-19-2009, 01:11 AM - Thread Starter
 
Katie Bugs Mama's Avatar
 
Join Date: Feb 2004
Posts: 2,160
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Hi--I've finally admitted to myself that dd isn't just an odd duck (a "product of nerd love" as we like to say) but actually has some psychological and behavioral issues that could benefit from professional help. Man, isn't that a nice sanitized way to say that I think that my baby is crazy just like her mother.

Basically, she has a hard time going with the flow and/or compromising if things aren't exactly how she wants them to be or thinks that they should be. She reacts violently, screaming and saying hurtful things. We've tried and tried to teach her to deal with her frustration in acceptable ways that don't hurt and alienate others, but we've run out of ideas.

She also has trouble with other social skills. She has a tendency to talk at people rather than to them. She wants to play with other kids but doesn't seem to know how to approach them. She also has trouble sitting still and staying on task and her hands shake a lot.

Good lord, this makes her sound like a mess. The fact is that she can deal with her frustration some of the time, and she does play well with other kids some of the time. She also has friends, although I worry abut how much longer they will be willing to put up with periodically being screamed at.

Any way, this leads me to my questions: what kind of professional should I be looking for to help her? What's the difference between a psychologist, a psychiatrist, and a behavioral pediatrician? (I know the difference in degrees. I'm confused about the differences in approaches and techniques.) What sorts of questions should I ask when trying to pick someone?

She had some pretty serious anxiety issues that she's made tremendous progress overcoming with the help of a targeted program with a psychologist. I **know** that with the proper intervention she can overcome these other issues too. I just don't know what the "proper intervention" is.
Katie Bugs Mama is offline  
Sponsored Links
Advertisement
 
#2 of 22 Old 02-19-2009, 02:02 AM
 
Roar's Avatar
 
Join Date: May 2006
Posts: 4,419
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I might be missing something...
If she's already been successful working on anxiety with a psychologist, why not start again with that same person and see if you can get help on the other concerns?

From what you described I think a psychologist would be the most appropriate person to work with. I would describe the concerns as emotional immaturity, low ability withstand frustration and need to work on social skills. Those are pretty common concerns. Someone with a cognitive behavioral approach would be a good place to start.
Roar is offline  
#3 of 22 Old 02-19-2009, 03:22 AM
 
storychick's Avatar
 
Join Date: Mar 2006
Location: Pacific NW
Posts: 678
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
My son has a lot of similar issues... we have seen multiple professionals in an effort to fully explore his difficulties. We started with our pediatrician, then an occupational therapist, then visited a developmental delay clinic at the local Children's hospital, then saw a psychologist (she is cognitive-behavioral/play therapy in approach), and we have also taken him to a neuropsychologist for a full academic evaluation and to a neurologist. We are about to see a psychiatrist as well, and he's scheduled for a sleep study. (This is over the last 5 years. He has since been diagnosed with a string of things, including sensory integration problems, ADHD, Tourette's, auditory processing problems, dysgraphia, and anxiety/depression that may be bipolar disorder.)

I'd say since you see a therapist already, start there. They will refer you on as needed. Or else see your pediatrician as a starting place, if you have a good relationship with them. It also depends on what you want out of it -- if you want therapy, then the psychologist is the right place. A psychiatrist will really only do meds, not ongoing therapy. OT will help if the problems stem from sensory problems. Social skills groups may help the social issues. The ped can help you decide if you need to rule out physical causes such as allergies or seizures or a sleep disorder.

Good luck figuring it out and getting her help! I saw your post on the SN board -- that's a good resource to start with, we know how scary and overwhelming all this is. Hang in there.
storychick is offline  
#4 of 22 Old 02-19-2009, 03:25 AM
 
annettemarie's Avatar
 
Join Date: Mar 2002
Location: In the Restricted Section
Posts: 34,451
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
I third the idea of sticking with her current psychologist, if you can. My little guy has some pretty serious anxiety issues, and while he isn't in regular therapy, he still goes in and sees "Dr. John" when he needs to.

We also worked with a neuropsychologist in the same practice, which was really helpful. I liked that they were all in the same building and could share info (with our permission, of course).

Best of luck to you. It's so hard to watch them when their hearts are hurting and their emotions are so strong.

Flowers, fairies, gardens, and rainbows-- Seasons of Joy: 10 weeks of crafts, handwork, painting, coloring, circle time, fairy tales, and more!
Check out the blog for family fun, homeschooling, books, simple living, and 6 fabulous children, including twin toddlers

annettemarie is offline  
#5 of 22 Old 02-19-2009, 04:22 AM
 
SleepyMamaBear's Avatar
 
Join Date: Jun 2005
Location: Vancouver, Wa
Posts: 8,849
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
our DD's sound almost identical, only mine is way more often than just sometimes. read "the out of synch child" and "the explosive child" they might help you a bit in knowing what you are wanting to look for in someone to help you.
so far Addy is in OT for the sensory stuff, and we jsut started seeing the behavioral ped. he is really great, and i have high hopes.

treehugger.gif )O( unschooling, witchy mum to Addy(7) and Niamh(4)
Living with an invisible chronic illness.
Fat and hairy. And happy with both *( o Y o )*
SleepyMamaBear is offline  
#6 of 22 Old 02-19-2009, 10:08 AM - Thread Starter
 
Katie Bugs Mama's Avatar
 
Join Date: Feb 2004
Posts: 2,160
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Thanks for the replies. I really appreciate the advice and reassurance.

Sorry that I wasn't clear about the current therapist. DD was part of a study about preventing full-blown anxiety issues in children who have at least one parent with anxiety and who show signs that they might be developing anxiety themselves. DD almost didn't make the "cut off" for the program because she clearly already had anxiety issues and wasn't just beginning to develop them. The professor of psychology who runs the program agreed to let DD participate in the hope that it would help her and with the understanding that she might need more/different therapy afterwards. (I had forgotten that until just now. Typing this out is helping to clarify my thoughts.)

The program consisted of 8 weekly sessions with the whole family, followed by monthly family sessions for three months. The approach was definitely cognitive-behavioral and basically involved teaching DD how to calm herself down by recognizing the signs that she was starting to get upset and then using specific techniques to calm herself down (mostly deep breathing and deliberately replacing negative thoughts with positive ones.)

The approach was very, very structured. It really did help DD a lot, but it didn't really foster much of a connection between us and the particular therapist that we were assigned. I'm not sure that any of us, Kate included, would want to continue with her, even if we could. I feel bad saying it, but she was inexperienced -- a fairly newly minted Ph.D., I believe. I think that she will be great some day, but I want someone who is great today.

I talked to DD's pediatrician a couple of years ago and he recommended a couple of psychologists and a behavioral pediatrician. We wound up going one of the psychologists, mostly because he had an opening immediately. I wasn't overly impressed and months of seeing him didn't help Kate, but I shouldn't write off all psychologists because of that, right? Anyway, I'm going to talk to dd's pediatrician again today and call the therapist that we worked with for the anxiety. I might even call my own psychiatrist to see what she says.

I have serious trust issues when in comes to doctors, so I have a hard time just taking their word for it about what is best. I much prefer to do my own research first so that I have some way to evaluate what they're recommending. That's what I'm trying to do now.

If you've read this epic novel, I appreciate it. Just typing it out has really helped to focus my thoughts. I think that, as someone suggested, a psychologist is the best place to start, especially since I am really, really, really opposed to drugging my 8yo, unless absolutely everything else fails.

Thanks again. Knowing that I'm not alone helps a lot.
Katie Bugs Mama is offline  
#7 of 22 Old 02-19-2009, 11:24 AM
 
DaughterOfKali's Avatar
 
Join Date: Jul 2007
Location: New England
Posts: 12,203
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
You're definitely not alone. I'm going to be calling my local Children's Hospital to get my son seen (and re evaluated) by a neuro psych.

Independent Consultant- Thirty One Gifts www.mythirtyone.com/ShopLiz

Origami Owl http://lizcioci.origamiowl.com

DaughterOfKali is offline  
#8 of 22 Old 02-19-2009, 01:01 PM
 
annettemarie's Avatar
 
Join Date: Mar 2002
Location: In the Restricted Section
Posts: 34,451
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
I hear you on the fears. FWIW, no one has ever even mentioned drugging my 9-year-old. His therapy has been all about developing coping skills.

Flowers, fairies, gardens, and rainbows-- Seasons of Joy: 10 weeks of crafts, handwork, painting, coloring, circle time, fairy tales, and more!
Check out the blog for family fun, homeschooling, books, simple living, and 6 fabulous children, including twin toddlers

annettemarie is offline  
#9 of 22 Old 02-19-2009, 01:43 PM - Thread Starter
 
Katie Bugs Mama's Avatar
 
Join Date: Feb 2004
Posts: 2,160
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by annettemarie View Post
I hear you on the fears. FWIW, no one has ever even mentioned drugging my 9-year-old. His therapy has been all about developing coping skills.
That's exactly what I needed to hear. I worry that they (whoever "they" are ) will take one look at her shaking hands and inability/unwillingness to sit still and decide that she needs ADD drugs. I would really like to avoid that if at all possible.
Katie Bugs Mama is offline  
#10 of 22 Old 02-19-2009, 07:29 PM
 
storychick's Avatar
 
Join Date: Mar 2006
Location: Pacific NW
Posts: 678
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Drugs were a last resort for us as well, though we have now chosen to use them. My son is on guanfacine, which is a blood pressure drug originally used in children 30+ years ago for epilepsy. Its been a good thing for him, has very much controlled his tics as well as helped his focus and hyperactivity. It wasn't an easy choice, and we've had to deal with side effects, but the plusses have outweighed the minuses for us so far. I wouldn't use it if we weren't also doing therapy, or if the therapy/alternatives was enough, but we came to a place where we knew it was the right choice. Just so you know, that its not the end of the world, and that you will know if it becomes the right choice at some point.

I bet the people you did the study with can refer you to someone, as well, if you ped's suggestions don't pan out. And it is hard to find the right therapist -- post on the Tribal Area, or find another local community of SN kids, and see if you can get suggestions? See if you can meet with them as a trial first to avoid paying an arm and leg trying people out?

Good luck!
storychick is offline  
#11 of 22 Old 02-19-2009, 08:20 PM
 
LynnS6's Avatar
 
Join Date: Mar 2005
Location: Pacific NW longing for the Midwest
Posts: 12,446
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
Given her 'multiple' issues, I'd want an evaluation by a developmental pediatrician or a TEAM, with the understanding that treatment will probably be by someone else, once the 'issues' are pinpointed - right now it sounds like she's got anxiety, inflexibility, and trouble with social skills, among other things. that could be anything from anxiety to autism to who knows?

Lynnteapot2.GIF, academicreading.gif,geek.gif wife, WOHM  to T jog.gif(4/01) and M whistling.gif (5/04)
LynnS6 is offline  
#12 of 22 Old 02-19-2009, 09:59 PM
 
thisiswhatwedo's Avatar
 
Join Date: Mar 2008
Location: transient universe
Posts: 365
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I've been posting about my young one and his behaviors, social behaviors and some are similar to ours. I am thinking if I will hold off until next school year and see if his social behavior improves but wouldn't medicate him unless things got a lot worse.
thisiswhatwedo is offline  
#13 of 22 Old 02-19-2009, 11:32 PM - Thread Starter
 
Katie Bugs Mama's Avatar
 
Join Date: Feb 2004
Posts: 2,160
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by storychick View Post
Drugs were a last resort for us as well, though we have now chosen to use them. My son is on guanfacine, which is a blood pressure drug originally used in children 30+ years ago for epilepsy. Its been a good thing for him, has very much controlled his tics as well as helped his focus and hyperactivity. It wasn't an easy choice, and we've had to deal with side effects, but the plusses have outweighed the minuses for us so far. I wouldn't use it if we weren't also doing therapy, or if the therapy/alternatives was enough, but we came to a place where we knew it was the right choice. Just so you know, that its not the end of the world, and that you will know if it becomes the right choice at some point.
Thanks for the encouragement. I really appreciate it. I completely agree with your take on drugs. I don't want them to be the first (or even second or third) thing that we try, but I'm open to using them if it becomes apparent that they will really help her more than any other option alone.

I think of psych drugs much the way that I think of antibiotics: they can both cause more problems than they solve if they are used inappropriately, but under the right circumstances they are both god-sends.
Katie Bugs Mama is offline  
#14 of 22 Old 02-19-2009, 11:41 PM - Thread Starter
 
Katie Bugs Mama's Avatar
 
Join Date: Feb 2004
Posts: 2,160
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by LynnS6 View Post
Given her 'multiple' issues, I'd want an evaluation by a developmental pediatrician or a TEAM, with the understanding that treatment will probably be by someone else, once the 'issues' are pinpointed - right now it sounds like she's got anxiety, inflexibility, and trouble with social skills, among other things. that could be anything from anxiety to autism to who knows?
Starting with a developmental pediatrician is a good idea. We had her evaluated a couple of years ago by our regular ped, who's a great guy but not a developmental specialist. He basically talked to us a little bit, gave her what amounted to an IQ test, and then gave me three names. His only advice was that they were all "good." Sigh.

Do you know if a "behavioral" pediatrician is the same as a "developmental" pediatrician? Our regular ped recommended a "behavioral pediatrician" who trained with Dr. Brazelton (the Touchpoints guy.) I couldn't get an appointment with her a couple of years ago, but maybe I'll try again.
Katie Bugs Mama is offline  
#15 of 22 Old 02-21-2009, 01:05 AM
 
Freud's Avatar
 
Join Date: Jan 2008
Location: Crazytown
Posts: 1,180
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Personally, I would take my child to see a child psychologist before a psychiatrist(but I am biased, because I will be a child psychologist in a year!). Really, though, I think a child psychologist would be able to evaluate your child and make recommendations without necessarily making an immediate recommendation to get on meds (which shouldn't be the first step for kids anyway). I am just way too weary of psychiatrists, as they push medicine way too much and they are not trained in therapy. Personally, I think play therapy is a good place to start with any young child, as play is that language of children. (www.a4pt.org) If necessary, a psychologist could make a recommendation for a child psychiatrist and/or neuropsychologist if he/she believes that the behavior has an organic cause.

I wouldn't go to a behavioral-developmental pediatrician. Still too closely tied to the medical model for me and not trained up to my standards, personally.

I'm with another poster who recommended the book, The Explosive Child. Excellent.
Freud is offline  
#16 of 22 Old 02-21-2009, 01:11 AM
 
Freud's Avatar
 
Join Date: Jan 2008
Location: Crazytown
Posts: 1,180
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by Katie Bugs Mama View Post
Starting with a developmental pediatrician is a good idea. We had her evaluated a couple of years ago by our regular ped, who's a great guy but not a developmental specialist. He basically talked to us a little bit, gave her what amounted to an IQ test, and then gave me three names. His only advice was that they were all "good." Sigh.

Do you know if a "behavioral" pediatrician is the same as a "developmental" pediatrician? Our regular ped recommended a "behavioral pediatrician" who trained with Dr. Brazelton (the Touchpoints guy.) I couldn't get an appointment with her a couple of years ago, but maybe I'll try again.
Really? Pediatricians are not trained in administering, scoring or interpreting IQ tests or any other psychological test. It is illegal and unethical for them to administer them. At least in my state, the only people legally allowed to administer and interpret psychometric tests are Clinical Psychologists (this does not apply to things like Depression Inventories or self-report measures, which take not skill or special training to administer or interpret).

A behavioral pediatrician is the same things a developmental pediatrician, at least in my state.
Freud is offline  
#17 of 22 Old 02-21-2009, 01:12 AM
 
Surfacing's Avatar
 
Join Date: Jul 2005
Location: stuck between a rock and a hard place
Posts: 6,633
Mentioned: 2 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
: Reading with interest as there is heavy anxiety in our family tree all over the place (dh and I both included) and I see some signs in dd1.... : I hope you find someone who is the right fit soon!

wash.gif  Me  + bikenew.gif Dh =  broc1.gif  Dd1(9 yrs) + hearts.gif  Dd2(6 yrs) and blowkiss.gif Ds(3.5 yrs)
Surfacing is offline  
#18 of 22 Old 02-21-2009, 01:57 AM
 
Theoretica's Avatar
 
Join Date: Feb 2008
Location: Inside my head (it's quiet here!)
Posts: 3,663
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
You've gotten a ton of great advice, pretty much what I would have said too, so just wanted to give you this...





Good luck mama...this is so hard!

GOOD moms let their kids lick the beaters. GREAT moms turn off the mixer first!
Humanist Woman Wife , & Friend Plus Mama to 6 (3 mos, 2, 9, 13, 17, 20)
Theoretica is offline  
#19 of 22 Old 03-01-2009, 12:22 PM - Thread Starter
 
Katie Bugs Mama's Avatar
 
Join Date: Feb 2004
Posts: 2,160
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Thanks for all of the advice and support. I really appreciate it. We have an appointment to take her to the behavioral clinic at Johns Hopkins Hospital for a complete evaluation. We're extraordinarily lucky that we live nearby and that our insurance will cover almost all of it. (Good thing, since the fee just for the evaluation is close to $500.)

I've talked to other parents who have used this program, and they speak very highly of it. Evidently, DD's "team" will work closely with us and with her school to give her the support that she needs. I'm hopeful and excited and think that she will be too.

I'll let you know how it goes.
Katie Bugs Mama is offline  
#20 of 22 Old 03-01-2009, 02:12 PM
 
annettemarie's Avatar
 
Join Date: Mar 2002
Location: In the Restricted Section
Posts: 34,451
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
I'm wishing you and your daughter all the best.

Flowers, fairies, gardens, and rainbows-- Seasons of Joy: 10 weeks of crafts, handwork, painting, coloring, circle time, fairy tales, and more!
Check out the blog for family fun, homeschooling, books, simple living, and 6 fabulous children, including twin toddlers

annettemarie is offline  
#21 of 22 Old 05-13-2009, 01:33 PM - Thread Starter
 
Katie Bugs Mama's Avatar
 
Join Date: Feb 2004
Posts: 2,160
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Hi, I just wanted to thank you all for your support and let you know that dd is doing a lot better. She still has issues -- don't we all?? -- and some days are better than others. However, she's seeing a psychologist the Behavior Clinic at the local teaching hospital and is doing really well.
Katie Bugs Mama is offline  
#22 of 22 Old 05-14-2009, 01:11 AM
 
Surfacing's Avatar
 
Join Date: Jul 2005
Location: stuck between a rock and a hard place
Posts: 6,633
Mentioned: 2 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)
Oh that's good news!

wash.gif  Me  + bikenew.gif Dh =  broc1.gif  Dd1(9 yrs) + hearts.gif  Dd2(6 yrs) and blowkiss.gif Ds(3.5 yrs)
Surfacing is offline  
Reply

User Tag List

Thread Tools
Show Printable Version Show Printable Version
Email this Page Email this Page


Forum Jump: 

Posting Rules  
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off