What does a Child Psychiatrist do? By: Israel Sokeye, MD

Dec 09, 2013 by Israel Sokeye, MD

It is a fact that in the field of Psychiatry there is a lack of child and adolescent specialists. At PrairieCare we are fortunate to work with 10 of the Twin Cities Board Certified Child and Adolescent Psychiatrists.  Read on to learn more about what it is that set them apart in the field of Psychiatry.

What are some common reasons parents decide that a child needs to see a psychiatrist?

One common reason involves behavioral issues at home or in school, such as a youth that becomes increasing irritable, easily angered, socially withdrawn, avoidant, and has declining academic functioning.

Can you share some examples of how children benefit from psychiatric counseling?

Counseling can help children manage anxiety and depression and build social skills. Children who’ve experienced trauma benefit from trauma-focused cognitive behavioral therapy that helps them process the trauma. Other therapies help children problem-solve stressful situations. Studies demonstrate that incorporating counseling into treatment hastens improvement of symptoms.

How does child psychiatry differ from adult psychiatry?

Children are treated with a developmental framework in mind: certain symptoms may not be pathological at certain developmental ages. For example a hyperactive, impulsive, inattentive, aggressive five year old with developmental delays may not necessarily be diagnosed with ADHD despite having several symptoms of the disorder, due to the fact that developmentally, the child is at age two. Also, children metabolize drugs differently than adults and thus may require higher doses of drugs or more frequent dosing than adults. Lastly, information from school and other care providers is crucial for appropriate diagnosis and treatment because one of the most common responses from a teenager, when asked ‘why you are here’ is, “I don’t know!”

Please tell us about medication’s role in child psychiatry.

Counseling plus medication is more successful than medication alone or therapy alone.  Medications have been known to help children with significant self-harm and aggressive behaviors stay calm, as in the case of children with autism, thereby allowing them to learn skills. Historically, the advent of antidepressants coincided with fewer suicides.

How does a child psychiatrist interact with counseling professionals available through school channels?

We consult with school staff to help them problem-solve. We may observe youths in the classroom and provide recommendations to staff. Sometimes schools refer youths for counseling. The most comprehensive interaction is through a school mental health clinic. This allows the psychiatrist to evaluate the child in the school setting with collaboration from the school’s psychologist, social workers, and nurses, and to treat the child and family. We typically connect with a patient’s school to obtain information about the child’s functioning and academic struggles. After treating a child for a while, we ask the school for an update on his/her school progress.

Please tell us how a youth’s family is integrated into therapy.

Family involvement is crucial to the child’s participation and likelihood of success. It’s essential to build rapport with youth and family. Understanding family dynamics is integral to building rapport. If, for example, if the patient is the family’s scapegoat, chances for therapeutic success are limited without integrating the family. We touch base with families regularly, especially for teen patients. Educating youth age 15 and older and their families about confidentiality is critical to successful therapy.

Some estimates place the number of children receiving psychiatric care as low as 20 percent of those who need it. What can you tell us about this?

The Centers for Disease Control and Prevention (CDC) reported in May 2013 that annually, up to one in every five U.S. children experiences a mental disorder. Sadly, too few receive psychiatric care. Reasons range from poverty and lack of affordable health care to the shortage of children’s mental health providers. The Affordable Care Act made it easier for people going into this field to repay school loans. The number of advanced practice nurses in psychiatry has grown. However, there are approximately 7,000 child and adolescent psychiatrists in the United States, and to adequately treat the target population we need about 30,000.  Child psychiatric services in this country are severely maldistributed. Rural children have significantly reduced access. The ratio of child and adolescent psychiatrists per 100,000 youth ranges from 3.1 in Alaska to 21.3 in Massachusetts, with an average of 8.7.

Please offer our readers advice to help them recognize if their children may need mental health care. 

Identifying mental illness early enhances successful outcomes. Children can become at risk for this disorder during periods of change, including divorce, school transitions, moving, a loved one’s death/bereavement, and after trauma.  External symptoms can include irritability, anger, aggression, quickly changing moods, and hyperactivity. Other symptoms can be harder to identify:  withdrawal, isolation, crying, guilt, and suicidal ideas. Be proactive by keeping communication channels open, especially with teenagers. It is important to try and understand the child, rather than seeking to be understood by the child. This means refraining from being overly reactive or quick to label the child. Be aware of the child’s change in functioning, monitor for safety concerns, and seek immediate help if you feel it’s needed. Call your primary care provider and request an evaluation whenever you’re concerned.

Dr. Sokeye was featured in the November issue of MN Healthcare News – click here to read more.

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