Finding a psychiatrist for medication management

[egoldber]

We are wanting to do a trial of meds with DD. What do you look for in a psychiatrist?

Part of our problem is that she does not technically "qualify" for any particular disorder. She has aspects of anxiety and ADHD, as well as some social deficits and physical/verbal tics. So we also need someone to tease out what meds would really help her the most. But it is becoming pretty clear that therapy alone is not the answer for her.

Thanks!

[DietCokeLover]

Make sure you look for someone who is a CHILD psychiatrist, rather than one who mostly works with adults. They are much more tuned into the meds that will benefit your child and are much more aware of the potential dangers that using some of the meds can have on children (as they are often times not really intended for children). I am also generally not a fan of seeking psychiatric meds from pediatricians/ GPs. I like seeking out meds/ treatment from the type of doctor that specializes in that area.

[egoldber]

Yes, I agree! I have a list of psychiatrists from DD's therapist. But it's a list of 10 people and I am wondering how to compare one to another.

[lowrioh]

It's these kind of issues that make me happy to live in a big metropolitan area. I have a friend whose DD has Aspergers and there are no Child Psychs in here area so she has to drive nearly an hour and a half each way to get her treatment.
Good Luck!

ETA- have you looked on DC Urban Moms? They can be snarky but there is good information on there.

[hillview]

From personal experience I'd look for some other recommendations from parents, I'd look for someone who has experience with your child's type of situation and who believes in medications AND therapy and is open to either/both being a short or long term solution (IME some folks think that therapy alone or meds alone or meds for a short period only or meds forever are the ONLY answer and IME there is wide variation).

A pediatric psychiatrist is really difficult to find so it could take some time (there is a national shortage). I would at least work initially with one to get the right meds etc going -- maybe for an "eval" :)

/hillary

[hillview]

OK just read your last post. I am sure you are doing this but I'd google them or look them up in pub med -- if they are published you can get a sense of what they are focused on. You can also likely scare up some resumes or background on them. I'd look for someone who has >10 years of experience. I am biased to someone who was trained in a more well known institute (but am from Boston so have been brain washed). The reality is that even since you have a list not all of them might accept patients so I might call around all of them and see what you have to chose from before getting excited about someone only to find out they do not take new patients.
/hillary

[egoldber]

It's these kind of issues that make me happy to live in a big metropolitan area. I have a friend whose DD has Aspergers and there are no Child Psychs in here area so she has to drive nearly an hour and a half each way to get her treatment.

Sadly, there are not even that many in our area. Many are also not accepting new patients.

[lowrioh]

Sadly, there are not even that many in our area. Many are also not accepting new patients.

If they tell you they aren't taking new patients see if your current doctor/therapist can get you in. I am seeing a great neurologist at Hopkins that I only got an appointment with when another neuro called his office.

[StantonHyde]

Does your therapist have any recommendations? Is there a clinic/practice associated with a medical school? You don't want to see a resident, but here, its a pretty sure bet that docs associated with the U are going to be good.

[vludmilla]

Yes, I agree! I have a list of psychiatrists from DD's therapist. But it's a list of 10 people and I am wondering how to compare one to another.

Ask your psychologist for recommendations. In my experience, any psychologist who works with children has experience with child psychiatrists. If your psych doesn't know anyone, ask her to consult with her colleagues. Professional opinion, or word-of-mouth, may be your best lead. Apart from doing that, I would look for someone who intends to spend more than 15 minutes talking to you and your DD as there are a fair number who do that sort of thing. I would also at least consider psychiatrists who may be out of network as many of the best psychiatrists no longer accept insurance, at least in the NYC metro area. Another possibility may be to use a child psychiatrist affiliated with a university training program who teaches. They are often the most current with the cutting edge of knowledge and research. Good luck.

[elektra]

Yes, I agree! I have a list of psychiatrists from DD's therapist. But it's a list of 10 people and I am wondering how to compare one to another.

After you are able to narrow down the 10 a bit based on what others have suggested, I might also just call them to see if they would be open to a quick chat. I would ask what they thought of certain medications and their willingness to try them with your DD. I'm sure you have done research already and know what you think might work best.

I have not worked with a child psychiatrist before but I did this with my neurologist. I went in with a spreadsheet of several medications, and had columns for side effects, pregnancy rating, etc. and I told her which one I thought was the best to try for me. My old neurologist would not have responded to that well. But I have always felt completely respected by my new (7 or so years with her) neurologist and she has been willing to work with me on dosage and different medications based on my own research. It has also allowed me to trust her more when she suggests something different because I know she is willing to try things too.
I imagine that child psychiatrists may be more used to this kind of patient involvement by way of the parents, but I would want to make sure the new doctor was VERY open to suggestions about medications, as it sounds like that is exactly what you are looking for.

[Elilly]

I would call the practices that have been recommended to you and ask what the provider specializes in. Many may say ADD but the other diagnoses they list could give you a great deal of insight about their interests.

[pinkmomagain]

Since it was your dc's therapist who gave you the list of psychiatrists, you could ask him/her to help with narrowing down, you could ask other parents...ie. I think you've mentioned your dd is in a social skills group -- maybe they've heard about or use some of the professionals on the list, you could ask the ped about the drs on the list, you could ask the school psychologist about the list. Any way to narrow it down based on recommendations of others would be great. I would also look on the internet and see if they've written any articles, books, or give lectures -- particularly on issues similar to your dd's. Although, the therapist for my dds is known for a particular area of anxiety which my girls don't have, they are doing well her.

Once the list is narrowed down (I myself would want it to be like 3 or so) I would then call and ask to speak with them. Maybe briefly talk about your daughter and ask if they've treated any children with a similar profile? Have they found success with medication? What classes of meds might they consider? See if they are patient with you and open. Find out how maintenance goes....they should be wanting to see your dd on a regular basis to follow up and monitor (we go every 6-8 weeks). Proximity and convenience of appointments plays a role too since you will be there often enough.

Ultimately, the first consult is usually pretty pricey...so I would try my best to feel fairly confident with a choice prior to the consult if possible. HTH a little.

[DrSally]

Does your therapist have anyone he/she works with? My first thought would be to make sure it's a child psychiatrist. Those can be harder to find, but you're in a major metro area, right? Maybe contact the University hospital psychiatry dept. and see if they have any recommendations. You want someone who's going to take the time to understand your DD.

[DrSally]

Good suggestions from others on narrowing down the list. I'm surprised DD's therapist gave a list of 10 with no specific preferences. Perhaps she did that b/c it may be hard to get appts., so she wanted you to have options, but I would go back and ask her to basically giver you her top 3 and why. She, more than anyone, would know who would be a good fit for DD.

[HIU8]

The special needs forum is much less snarky than pretty much any of the other forums. I would ask there. You will get some decent information.

[egoldber]

Perhaps she did that b/c it may be hard to get appts., so she wanted you to have options,

Yes, that is what she said. She was not even optomistic I would get into any of those and has another "reserve list" to give me. It was a crazy weekend and we were out of town. I will call tomorrow.

Thanks all!

Heather, I got two suggestions on DCUM, neither of whom was on the list, but one was close by.

[cuca_]

I am late to this thread but I figured I would answer just in case. DD1 is on meds for ADHD. When we were looking for a doctor, it was recommended that we use a pediatric psychiatrist that specializes in psychopharmacology. We love DDs doctor, and one of the things I appreciate most is that we can easily get in touch with him via email and he keeps in close touch whenever we are closely monitoring dosage or medication.

[egoldber]

Thanks for reminding me to update. :)

We were actually able to get in relatively quickly. I had a group that was recommended to me through 2 or 3 different local sources and so I just went with them. They are a group of pediatric psychiatrists, all with specialties in anxiety and/or ADHD and medication management. The only downside is they don't accept ANY insurance, so we will just go out of network.

We have a series of 3 appointments (one with us, one for DD and then another one for us and her to go over options.) Our first appointment is mid March.

Thanks!

[cuca_]

Glad you found someone quickly. The doctor we use does not take insurance either, but it is well worth it to go out of network.