Child Psychiatry For Children & Youth

By Kristi Panik, MD, © Copyright 2008.

Child Psychiatry Has Helped Kids With

• Sadness
• Irritability
• Anxiety
• Fears
• Nightmares
• Defiance
• Aggression
• Difficulty making and keeping friends
• Problems in school/refusing to go to school
• Divorce of parents
• Family problems
• Any other issue that’s holding a child or teen back from progressing and growing emotionally or socially

Child Psychiatry Can Help In The Following Areas

Spirit: Because Child Psychiatry can positively affect physical, emotional and social aspects of a child or teen’s life, it can greatly enhance a person’s overall essence or spirit. It can also help kids work through spiritual or religious questions or issues.

Body: Because emotions and the body work together in concert, help with emotional disorders affects the body in positive ways; such as improved immune function or decreased pain, to name just two. The Child Psychiatrist can help children and teens deal with chronic medical disorders like diabetes or cerebral palsy.

Mind: Child Psychiatry can help young people with problems in thinking that may be related to emotional or learning disorders. Some kids have scary experiences of seeing or hearing things not perceived by other people. Child Psychiatry can help to get those kids back on track. Help from a Child Psychiatrist can also restore motivation or will. Creativity and/or imagination can come alive!

Emotions: Child Psychiatry can help young people with sadness, anxiety, mood swings, out-of-control anger or any emotion that is troubling. The goal of Child Psychiatry is essentially to enhance positive emotional states like good self-esteem, tolerance, empathy, fortitude and joy!

Social: Child Psychiatry can help kids feel better so they feel more like being with friends. It can help some kids learn how to make or keep friends. It can help families get along better.

Brief Description of Child Psychiatry

• Child Psychiatry in the United States is a way of helping children with a variety of disorders and difficulties. It begins with a thorough assessment of the difficulties the child or adolescent is having.
• A Child Psychiatrist carefully investigates the current and past circumstances of the young person’s and family’s lives and how the young person and family members interact with one another and within their environment. The Child Psychiatrist explores the strategies that have already been put in place (or attempted) by the young person and family to deal with difficulties.
• Drawing upon years of training and experience, the Child Psychiatrist attempts to determine factors that may be contributing to the young person’s difficulties. The Child Psychiatrist then suggests things that can be helpful. These may include ideas about how to approach the issues in a different way: talk or play therapy; extra help at school; further evaluations or tests; close attention to diet, exercise and sleep; and sometimes, prescription medication or over-the-counter treatments.
• In American Child Psychiatry the child or teen may be involved with psychologists, social workers and family therapists who do the talk or play therapy sessions. Psychologists may also administer psychological tests for further information when needed.
• Child Psychiatrists consult with schools or any organizations such as a medical clinic or child protective agency that are also working for the young person’s welfare.

Success With Child Psychiatry

• Steven is an 8 year old boy who lives with his mom and sisters, except for every other weekend when he and his sisters live with his dad and dad’s girlfriend.
• His mom brought him in because he was having anxiety so badly he was having trouble sleeping at night, his grades were dropping in school and he had lost his appetite.
• A careful interview revealed that Steven was most nervous just before going to his dad’s house. Initially, Steven stated that his reluctance to go to his dad’s was because he thought his mom would be lonely with all the kids gone. Mom tried to reassure him and wondered if medication may help.
• Over several more sessions trust was gained and Steven revealed that, as the male, his father saw Steven in a dominant role. Steven was pulled aside regularly, given details about his father’s relationship difficulties and told he needed to be responsible for the welfare of his sisters. Scared of his father’s disapproval, Steven just sat and listened. He felt an enormous responsibility that he did not want.
• Through talk therapy Steven became empowered to eventually tell his father that he was expecting too much of an eight year old boy. Steven chose this solution instead of having adults talk to his father for him. And he did all of this without the help of medication! Sleep and appetite improved right away and grades improved over time.
• Rachel is a 14 year old girl who wanted help for feeling sad or angry most of the time. For the past few months she has been having trouble getting up in the morning and has been taking long naps during the day. She’s been hanging out with her friends less and less. Most interactions with her parents or sister turn into arguments. Usually a B student, she is now getting Cs, Ds and Fs.
• She began seeing the counselor at school on a weekly basis and after two months Rachel’s mother found a letter in Rachel’s trash can detailing her continuing despair and wish to “end it all.”
• They were referred to a Child Psychiatrist. After finding out that Rachel had no specific plans to kill herself, her family agreed to monitor Rachel’s safety at home. It was confirmed that illicit drugs and alcohol were not involved. Medical conditions like anemia or thyroid disease, which can play a role in depression, were also ruled out by laboratory testing. Close attention to a healthy diet and good sleep habits were discussed, again employing help from Rachel’s family.
• Anti-depressant medication was discussed and agreed upon by Rachel and the family after the third meeting, as things seemed to be getting worse. Rachel continued her counseling at school. After about 2 weeks it was noted that Rachel was less irritable and was talking to her friends a bit more often. The school counselor felt Rachel was able to identify issues more readily in sessions. Rachel “felt like herself again” after about three months!

Child Psychiatry Is Appropriate For Ages

• It is appropriate for ages birth to 18, or older if someone has a developmental delay or disorder such as autism.

Children & Youth’s Reactions To Child Psychiatry

• On average most people are a bit nervous coming to a Psychiatrist for the first time. However, children and teens can begin to feel comfortable as early as the first session - just in taking that step in dealing with the difficulties.
• Many children and teens have ambivalence about coming, noticing positive changes but wanting to avoid reminders of their difficulties.
• It is important that parents encourage the young person to come if she or he is reluctant. It’s like getting a child or teen to do their chores or homework: kids often resist, but it is good to insist in order to promote learning and overall growth.

Extra Care Is Needed

• When the young person’s parents live apart, the Child Psychiatrist should consider talking to everybody - parents and step-parents alike. Legal custody issues must be talked about and decisions made based on these factors.
• Opposing custody lawyers may subpoena the child’s psychiatric records in court. Whenever the courts request anything from a Psychiatrist, a lawyer should be consulted.
• Care must always be taken in considering issues of privacy and confidentiality.

Contraindications: When Child Psychiatry Should Be Avoided

• Parents need to feel comfortable with the Child Psychiatrist and should ensure that a thorough evaluation has been conducted before any treatment is begun, especially medication.

Basic Concepts And Components Of Child Psychiatry

• The young person needs to be viewed in the context of his whole being and surroundings. The environment plays a big role in a child’s difficulties. The word environment here refers to the family, school, and any other aspect of the child’s or teen’s life outside of them: friends, the neighborhood, grandma’s house, and so on. Consideration is paid to after-school activities, weekend activities, weekend residence (if different), spiritual beliefs or practices, abuses of any kind and parenting styles, to name a few important environmental factors.
• Possible biologic causes of difficulties must be explored as well. Some disorders are passed on within families. Biologic causes of difficulties could also be from medical illnesses, reactions to medications, or nutritional problems. Substance abuse in the mother can contribute to or cause difficulties that appear later in the child’s life and substance abuse by the young person can lead to a variety of symptoms.

Description Of A Typical Session

• Each session is as different as is each child.
• During the first session, it is helpful if the assessment process is explained: what to expect in terms of length and structure. The concept of confidentiality is discussed: this concerns what is kept private and what is not. It’s important for parents to know that the young person may talk about things with the Child Psychiatrist that are kept private. This is to promote trust so that the child or teen will feel comfortable talking about difficult issues. If the young person tells the Child Psychiatrist something that indicates that the child or teen may endanger themself or another person, the Child Psychiatrist will then make sure the parents are informed.
• Often two or three sessions are needed for a full assessment. The first session typically involves the parents with the child or sometimes the parents alone. The child is generally seen alone for a session. If another session is needed, it can be structured as seems best.
• During the assessment, questions are asked detailing the difficulty the child or teen is having: What is happening now? What has led up to the difficulties? There may be discussion about what has already been utilized to deal with the difficulties. Information about any kind of treatment by medical doctors or mental health professionals is obtained. Details about life at home and school are very important. The Child Psychiatrist asks about the young person’s early life - from the time of pregnancy forward. The Child Psychiatrist will probably ask permission to talk with teachers or other doctors.
• During the assessment session with a child on their own, the Child Psychiatrist and child may “play.” During this “play” the Child Psychiatrist is getting a view into what the parents may experience at home. It can help the child to act more spontaneously than sitting talking face to face. The Child Psychiatrist is looking for certain themes or issues to be expressed through play. An older child or teen may prefer to talk rather than play. A teen may feel more comfortable going for a walk.
• When the assessment is complete the Child Psychiatrist will meet with parents and the young person to discuss their thoughts and impressions and to work out a treatment plan together.

Major Differences Of Opinion Between Practitioners

• Length of evaluation – one brief visit or an extended period for evaluation
• How much to include the family in the evaluation and within the treatment
• Prescribing medication alone as treatment, or using Play or Talk Therapy in conjunction
• Some disagree on which medications to use and which dosage. It is not an exact science but more of an art.

Fees/Costs In 2007 (Averages In Northern California)

• First session – intake: $200 to $400 or sometimes more; ongoing sessions may be $150 to $300 for an hour, or less for half an hour.
• Most health insurance covers part of the visit.

Average Time Per Session

• Sessions are usually 45 to 60 minutes long.
• The first session is often longer.
• Sometimes sessions discussing primarily medication can be completed in 30 minutes.

Recommended Length Of Time Between Sessions

• If the Child Psychiatrist, child and family are working together in therapy, meetings are often weekly.
• If the Child Psychiatrist is only prescribing medications while the therapy is being done elsewhere, visits to the Child Psychiatrist can be monthly or even every couple of months.

Estimated Length Of Time Before Improvements Can Be Expected

• Sometimes the decision to get help facilitates some change, or change can happen after the first meeting.
• With medication, while relief can sometimes begin in a few days or weeks, play or talk therapy is important in helping to ensure that changes stick.
• In some cases, it may take months or even years of therapy before significant change is achieved.

Suggestions To Make Child Psychiatry More Effective

• Children and teens like seeing a Child Psychiatrist when parents feel hopeful that the Psychiatrist is going to help and that improvement in the child’s life is going to happen. Young people seem to be able to know when their parents don’t feel good about Psychiatry.
• Consistency and commitment from the young person and the family are good predictors of a positive outcome.

Other Methods/Practices That Are Similar To Child Psychiatry

• Child Psychiatry combines aspects of psychology and medicine – linking mind and emotions with body and physical health.

Other Methods/Practices That Complement Child Psychiatry

• Psychological testing
• Occupational therapy
• Speech and language therapy
• Sensory integration therapy

Nature And Length Of Training To Be A Practitioner

• After high school, one completes four years of college.
• This is followed by four years of general medical school and three to four years of Psychiatry Residency Training working with adults.
• Finally, two years of additional Psychiatry Residency Training working with children and adolescents is completed.

Certification/Licenses Held By Practitioners

• First, a Bachelor’s degree is acquired.
• Then a Medical Doctor (MD) or Doctor of Osteopathy (DO) degree is acquired.
• Then each state grants licenses to individuals to practice medicine after many tests have been passed.
• An optional certification is Board Certification by the American Board of Psychiatry and Neurology in Adult and/or Child and Adolescent Psychiatry through the taking of further examinations.

Professional Associations To Contact For Names Of Local Practitioners

• American Academy of Child and Adolescent Psychiatry (AACAP); 3615 Wisconsin Ave., NW; Washington, DC 20016-3007; 202-966-7300; Fax: 202-966-2891; Website: www.aacap.org
• American Psychiatric Association (APA); 1000 Wilson Blvd., Suite 1825; Arlington, VA 22209-3901; 703-907-7300; Fax: 703-907-1088; Website: www.psych.org; Email: apa@psych.org
• National Alliance on Mental Illness (NAMI); Colonial Place Three; 2107 Wilson Blvd., Suite 300; Arlington, VA 22201-3042; 888-999-6264; Fax: 703-524-9094; Website: www.nami.org; Email: available on website

Other Methods Of Locating A Good Practitioner

• Look in the phone book or on the world wide web.
• Consult with your family doctor or pediatrician.
• Consult with psychotherapists.
• Ask school psychologists and teachers.

Number Of Certified Practitioners In U.S., Canada, And Mexico

• The AACAP represents over 7,500 Child Psychiatrists, mostly in the U.S. but also internationally.
• Many Child Psychiatrists are not members of this organization.

What To Look For When Choosing The Best Practitioner

• Look for someone who is going to gather a significant amount of information before recommending any plan of treatment.
• Find someone with whom you are comfortable. This is extremely important for success!
• Look for someone who appears knowledgeable and is confident speaking about the child’s or teen’s difficulties.

Bibliography

• Your Child: What Every Parent Needs To Know. American Academy of Child and Adolescent Psychiatry (AACAP) and David B. Pruitt. New York: Collins, 1998.
• Your Adolescent: Emotional, Behavioral and Cognitive Development from Early Adolescence Through the Teen Years. AACAP and David B. Pruitt. New York: Collins, 2000.

Helpful Tips For Parents

• Consistency in parenting is key.
• Modeling effective conflict resolution at home is very important.
• Frequent reminders of love and affection are important. Children need to know that no matter how angry their parents may get, they will love their kids no matter what.
• Attention to nutrition, sleep patterns and exercise can make a world of difference.

Biography Of Kristi Panik, Author

• I grew up in Florida and went to college and medical school at the University of South Florida in Tampa. I then completed my General and Child and Adolescent Psychiatry training at the University of California in Irvine.
• Since I’ve completed my training in 1998, I have worked in public clinics in Southern California, New Zealand, and at Sonoma County Mental Health Services in Santa Rosa, California. Until 2007 I worked for public systems in both outpatient and inpatient child, adolescent, and adult psychiatry.
• I began a private practice serving children, adolescents and adults in January 2007 in Berkeley, California.
• In addition, I work a limited number of hours at the student health center at the University of California, Berkeley and at La Cheim School for seriously emotionally disturbed teens.

Kristi Panik’s Personal Statement

Young people are our future teachers, police officers, doctors, CEOs and entrepreneurs. I love working with this energetic population and their families to help effect positive change and the motivation to always grow emotionally. My hope is that in the future, my work and that of other Psychiatrists will be more about the preventative work of strengthening positive emotions and traits, and less about trying to solve problems.

To Contact Kristi Panik, Who Contributed This Chapter

Kristi Panik, MD; 2428 Dwight Way, Suite 5; Berkeley, CA 94704; Ph: 510-845-5155; Email: drpanik@gmail.com

Dr. Marie Mulligan’s Comment About Child Psychiatry: Many children & youth benefit from psychiatric medications. There is concern that psychiatric medications are being used in the place of human contact and more time intensive therapies.

Rick Geggie’s Comment About Child Psychiatry: I am sad that Child Psychiatry is so misunderstood by the public. I believe that it is one of the most challenging of all medical specialties. I have referred hundreds of children/teens to Child Psychiatrists. Results were most often excellent when the children’s parents really wanted the child’s life to change and were willing to change their own behavior and beliefs. Child Psychiatrists most often gave excellent advice to me and to my fellow educators on how we could help the children grow easier.

One of their biggest contributions to me was teaching me that the child’s behavior is just another language that the child/teen uses when they cannot use words directly.

The other great contribution was in helping me see how body chemistry greatly affects behavior/growth/living – especially in children and adolescents.