Child and adolescent psychiatrists are specialised doctors who work with young people up to the age of 18, their families, and all those around them (e.g. schools, children services).
They treat a wide range of mental health problems and conditions including ADHD, autism spectrum disorders, depression, anxiety, tic disorders, substance misuse and eating disorders, amongst others. They also try to promote mental health wellbeing for the young person. Dr Maite Ferrin is here to describe what you and your child can expect during sessions.
What can I do and say to prepare my child for their first appointment with a psychiatrist?
The young person needs to know that the psychiatrist will sit down with them and their parents for a length of time and will explore several difficulties in their lives. For that purpose, the doctor will ask easy and open-ended questions to the young person and the parents, which they will be free to answer.
The doctor will listen to the answers and will never be critical or judgmental, as their role is to better understand the whole situation. Child psychiatrists are very used to hearing all types of things about children, so they will never be surprised by what the young person is saying. Also, child psychiatrists are usually very empathetic, not only towards the child but also towards the whole family environment, so they usually make everyone feel understood and very conformable.
Are parents usually involved during their child’s appointments with a psychiatrist?
Parents are always invited to participate in the meeting. They are usually the principal source of information concerning the child, especially when the child is too young. For older children, they are also invited to participate, unless the young person specifically declines or there are legal reasons why the parents cannot be invited.
Most of the first assessments start with the family as a whole (e.g. the young person and their family with the psychiatrist) so that the young person is not meeting the psychiatrist on their own. The psychiatrist will explore the interaction with the child and how the child responds to the parents.
As the interview progresses, and only if the young person and the parents feel comfortable, the psychiatrist will ask the parents to leave the room and will stay with the young person to have a more intimate but relaxed conversation with them.
What happens during appointments with a child psychiatrist?
During the visit, the psychiatrist will ask about the child’s main difficulties at home, school or in their social life. They will try to ascertain what factors are contributing to these difficulties or maintaining them, and how symptoms started and evolved. The psychiatrist will ask about the child’s functioning at home.
They will also explore how the child relates to other members of the family, and the problems that parents encounter at home. The social and academic functioning are very important elements too. It is important to reflect on how the young person is coping with the academic demands and how they respond to stress, how is their relationship with their peers and if there is any bullying. Also, the psychiatrist will consider what their hobbies and after school activities are.
The psychiatrist will ask about general physical health, such as how the child eats and sleeps, and about other medical conditions, such as allergies and previous operations. Finally, the doctor will complete detailed information about pregnancy, birth and early development of the child to investigate how the child reached developmental milestones. They will also explore the strengths of the child and their family and how those around the young person have tried to support them with their difficulties throughout.
What other things are parents asked to do for the initial assessment?
Most of the assessments will also involve parents and those children above the age of 8 years to complete some forms or questionnaires too. Only with the child’s and their parents’ permission, the psychiatrist will try to contact the school to gather some information about the child’s academic and social functioning there.
Whilst some parents may be reluctant to school being informed or involved, this is very useful information as children’s functioning and behaviour can be very different at home and at school. It also helps in establishing future liaison work with the school.
While the psychiatrist asks questions, and during the meeting with the child on their own, they will be observing the child’s behaviours and interactions, with both their parents and the examiner too. This is what we call a mental health assessment. It provides the psychiatrist with a list of symptoms that may be suggesting a mental health problem in that particular child.
The psychiatrist will also be assessing the risks of the particular child towards themselves and from and towards others (e.g. risk of self-harm, risk of suicide, risk of aggression, risk of neglect, safeguarding issues, etc).
Finally, some assessments may include additional tests to be done by the child. For instance, we can ask the young person who is going to be assessed for ADHD to perform a computerised test called the QbCheck to test their ability to focus and stay still. With children who are going to be assessed for autism, we will require a separate, standardised observation procedure, such as the ADOS (Autism Diagnostic Observation Schedule) and a more specific interview that will take much longer. Parents will be informed about whether or not additional tests may be required beforehand.
Can a psychiatrist legally tell me what my child says during their appointments?
The psychiatrist is legally obliged to keep confidentiality when the young person requests it. Under these circumstances, the young person is informed that the parents will not be informed about the things that they want to keep confidential. Confidentiality is well reflected on the Royal College of Psychiatrists guidelines “ Good Psychiatric Practice, Confidentiality and information sharing ”.
However, as these guidelines clearly state there are “situations where there is an immediate risk of serious harm to a person who may be identifiable or to people who may form a group or community who may or may not be identifiable. The risk may be heightened because the patient is distressed and agitated and may be refusing to consent to discussion of their case with others.
There may also be concerns that alerting the patient may actually increase the risk to others; or that attempts to contact the patient or their representative may result in delay in warning others who may be at risk of serious harm ”. In circumstances such as these, the psychiatrist will need to outweigh whether it is in the child’s or in the public interest to disclose the information, and since this is in breach of the duty of confidentiality, the psychiatrist has to have a good justification for this decision.
Therefore, the young person will be informed that in the scenario of the psychiatrist considering an immediate risk towards the child or someone else (e.g. a life threatening situation, risk of child abuse or neglect, assault, a traffic accident, or the spread of an infectious disease), the psychiatrist will need to share the information provided with those parties that are directly relevant to the case (e.g. children services, police).
As a parent, will the psychiatrist offer me techniques to use in my child’s home and personal life?
Child psychiatrists in the UK usually take a conservative approach and will not immediately prescribe medication, unless clearly recommended by guidelines and good practice. With independence of whether or not a particular child requires any medication, child and adolescent psychiatrists usually provide some techniques and advice so that the parents are more able to cope with the young person’s needs.
Usually, parents would expect everything from the very first appointment, however, as the psychiatrist needs to get to know the patient well, most of the time the first appointment can only generate basic and generic recommendations for the young person. It is later on, during subsequent follow-up assessments and meetings with the child, parents and/or school, that the child psychiatrist will better understand the specific characteristic and nuances of the case and will be able to provide more tailored specific recommendations and interventions for the child.