Pediatric psychiatry- Experience? Training?

[Deleted]

I have a friend who is going through issues with her 6 year old. I don't want to give too many details, but could PM if anyone has information, experience or training in this area?

The whole family has issues. The three parents are on antianxiety, etc. drugs. All the kids seem to be on the spectrum, have issues. But the 6 year old, well, I guess things have come to a head over the last year. He was on 2 anti psychotics, a sleeping and an anti anxiety med when I helped her get him into inpatient a few weeks ago. That ended up being a horrible experience. They took him off some drugs but just put him on others. They just added more diagnoses... at this point, I'm not sure what behaviors might be his and which might be med related. She says she has not luck finding a psychiatrist, has seen so many people at this point, all with different opinions and advice, TSS, Mobile therapy, school guidance counselor... meds were given by a FAMILY DOCTOR... it is all so messed up. She spent all day today in the ER, but could not get him seen by psychiatry. They were dumfounded by the meds he is on, but wouldn't touch them... In addition to any insight on the topic, I'm wondering...

Is pediatric psych like this everywhere?

Is it possible to have psychiatric/mental illness munchausen by proxy? .... I have never seen the majority of behaviors mom describes. Other friends have not. I was with them 8 hours before intake into the inpatient, he was energetic but handled it almost better than I did. The friend who was with her in ER today said he was hyper, but again, probably better than most kids in ER 8 hours. I'm not saying there is nothing there. Like I said, they all seem to be on the spectrum somehow, he needs a lot of attention. And lately there have been issues of aggression observed by teachers and TSS, etc.... but those started after antipsychotic meds... I guess I just wonder if its possible to be... well if the environment has complicated the issue. I want to be supportive, but its getting harder, especially when I have these doubts.

Anyway, I've already said too much... i'll probably delete this later, but you all have a wide range of backgrounds and experiences. Thought I'd pick your brains to see if you had any insight into this topic.

Thanks. 

[cronewitch]

I worked in a mental hospital as a cleaning person so saw lots of kids that age with issues. Incorrigible children seem to be created by parents who don't say no until the kid needs to obey to go to school so the kid has no idea others can order him around. Those kids were smart but just refused to obey anyone. I watch staff with them and one little one claimed he wasn't going to school, staff said he was going to school, he said he would throw his books out the school bus window. They tried different punishments on him like no tv, or no allowance until they found one that hurt. That ward was just all children who didn't want to obey. They learned how but I think training the parents could have prevented the problem.
Another children's ward had actual sick children some physical some mental. Out of all the children only one was hyperactive, he was a sweet boy I wanted to take him home. Staff could take children home for the weekend but they said I couldn't because I wasn't trained to take care of a hyperactive child.

[Lizard Queen]

I guess I just wonder if its possible to be... well if the environment has complicated the issue.

I wonder this as well, especially for that age range.  Sorry I don't have anything helpful to add. 

[Artemis Windsong]

I would ask her what testing was done on the child.  A lot of times the schools will not let the parent know what is going on.

The problem with psych medications is every time the provider is changed, they change the medication.  Example:  A rellie had called and said he was having trouble with his med.  The receptionist told him to stop taking it.  It was one of those drugs you don't just stop without a violent outcome.  It was heart breaking and sad because the person was not old enough or experienced enough to question.  Most of those med require a walk down over several weeks.

Also, the process of trying to find the correct med can be brutal.  I went through this looking for an insomnia cure.  I still resent my DH and DD for this.  I forgave them but they are no longer trustworthy in a lot of life areas. 

[mmhmm]

My field of practice was adults, not children. Children with this type of problem I would have referred. Is there a children's hospital within range of where this person lives? That would be my approach. I'd take them to the children's hospital for evaluation there if no child psychiatrists can be found to evaluate.

[JustLurkin]

Mar 21, 2015 21:51:43 GMT -5 mmhmm said:

My field of practice was adults, not children. Children with this type of problem I would have referred. Is there a children's hospital within range of where this person lives? That would be my approach. I'd take them to the children's hospital for evaluation there if no child psychiatrists can be found to evaluate.

We received information on my son's psychiatrist from a local autism group that gathers recommendations from parents.  My son was 16 or so and I wanted a doctor he could stay with when he was no longer eligible for treatment by Children's.  All other specialists have ties to Children's.

[mmhmm]

Mar 21, 2015 22:55:15 GMT -5 JustLurkin said:

Mar 21, 2015 21:51:43 GMT -5 mmhmm said:

My field of practice was adults, not children. Children with this type of problem I would have referred. Is there a children's hospital within range of where this person lives? That would be my approach. I'd take them to the children's hospital for evaluation there if no child psychiatrists can be found to evaluate.

We received information on my son's psychiatrist from a local autism group that gathers recommendations from parents.  My son was 16 or so and I wanted a doctor he could stay with when he was no longer eligible for treatment by Children's.  All other specialists have ties to Children's.

Checking with an autism support group, or one for ADD/ADDH is an excellent idea. Either might have some good recommendations.

[weaselfer]

I can tell you that it is difficult and honestly, most family physicians don't know enough to prescribe the right meds.  My DH has Asperger's and anxiety issues and wasn't diagnosed correctly until he finally saw a psychiatrist that also specializes in children.  It took years.  We travel 1 1/2 hours for visits because it can be hard to find a good psychiatrist.  I wish your friend luck.  The drugs can be a godsend, but all have side effects which can be worse than the disease.

[kittensaver]

Contact your local or regional NAMI (National Alliance for the Mentally Ill) chapter OR the National Mental Health Association (Google their website). Both should be able to give you information and referrals.

[Angel!]

I would ask if she has an EAP, they could likely recommend someone & the first few appointments might be covered.  That or I would search my insurance company's website.  There is likely a way to search for doctors & you could search for a psychiatrist that specializes in children.

I'm getting help for my son & daughter through my daughter's daycare program, although we aren't dealing with nearly the same problem. I would think the school counselor would have recommendations on where to seek help.

I think getting any psych meds from the family doctor would be a mistake. It might easily cause more problems that it helps.  I don't think a family doctor would have nearly the training to be giving psych meds to such a young kid.

[Deleted]

I am writing all of this down. I thank you all for new ideas I was running out if them myself. Now I see new avenues i will recommend the next times we talk. 

[973beachbum]

I'm just guessing but from what I think is your area I would try getting to CHoP or Dupont.   And see if they can get an appointment with a specialist there.

Both are highly rated children's hospital's with lots of Dr's that specialize in children's medicine both physical and mental.  Most medicine is really adult medicine that is "scaled" down for kids but IME children aren't just small people.  Sometimes they don't react to meds like a short adult.  And the Dr prescribing it really needs to know what meds do what for kids vs adults.

[973beachbum]

One other thing is from rereading the OP the issues the child has sound like they could actually be side effects of the drugs.  That is probably another reason to get this kid to a "big city" type place so they can try and sort out what problems he has now that are real vs drug side effects vs the family issues causing people to see things in him that maybe aren't actual problems.


And of course everyone's favorite answer all of the above.

[Deleted]

Is it common to give anti-psychotics to a 6 year old?  

All I can think about is my ex-MIL that used to have all her kids medicated when they were little.  I'm sorry, but it's not extreme to say MIL is not well herself.  Extreme anxiety issues...and according to DH constantly thinking her kids had issues as well.  Well, now as adults 3 of the 7 DO have issues and I tend to wonder how much of that was hereditary and how much was getting pumped full of meds as a child. 

edited to remove what I really thought of MIL. 

[happyhoix]

DH worked as a kid's counselor for several years but quickly burned out because parents brought their kids in to see him and wanted him to 'fix' them kids - when the problem wasn't the kids, necessarily, but the parents.

Lots of verbal abuse, neglect, etc, and then the parent is pissed because the kid is defiant and aggressive at home.

Based on your interactions with the kid and your description of his parents, I suspect this is less a problem the kid has more an issue of screwed up parents, and yes, DH saw plenty of parents that wanted to get their kids diagnosed with problems when there really wasn't a problem. He suspected it made the parents feel better for failing at parenting if they could claim their kid had mental health issues.

Sounds like mom is looking for a magic pill to fix her kid, and sounds like her family doctor went along with it.

I would also recommend they try to get into a really good pediatric program for a true evaluation, hopefully they will get the kid off all the extra drugs and get the parents pointed in the right direction.

[giramomma]

Mar 24, 2015 8:43:52 GMT -5 happyhoix said:

DH worked as a kid's counselor for several years but quickly burned out because parents brought their kids in to see him and wanted him to 'fix' them kids - when the problem wasn't the kids, necessarily, but the parents.

Lots of verbal abuse, neglect, etc, and then the parent is pissed because the kid is defiant and aggressive at home.

Based on your interactions with the kid and your description of his parents, I suspect this is less a problem the kid has more an issue of screwed up parents, and yes, DH saw plenty of parents that wanted to get their kids diagnosed with problems when there really wasn't a problem. He suspected it made the parents feel better for failing at parenting if they could claim their kid had mental health issues.

Sounds like mom is looking for a magic pill to fix her kid, and sounds like her family doctor went along with it.

I would also recommend they try to get into a really good pediatric program for a true evaluation, hopefully they will get the kid off all the extra drugs and get the parents pointed in the right direction.

about a thousand times.

[happyhoix]

One really sad case DH had was of a girl whose mom was referred to family counseling because a school employee overheard mom screaming at her daughter over the school office phone using the words "You F**** Bitch". (The girl had gotten in trouble for something, and the office had told her to call her mother to tell her what was going on).

When mother came to counseling, in her mind, the problem was the girl was a F**** Bitch, and she wanted DH to 'fix' her. Her main complaints were that the girl 'talked back.'

DH tried to explain that, in a household where the Mom uses that kind of language to her 11 year old, the 11 year old will think that kind of language is normal and acceptable for her to use, as well. Mom not only didn't understand what he meant, she got mad when he said she shouldn't yell foul words at her daughter,  when what he needed to do was straighten out her f**** bitch of a daughter. I guess  maybe mom wanted DH to call her daughter a f***** bitch, too?

Seriously, it should be a lot harder to have kids. There would be a lot less screwed up kids if it was.

[JustLurkin]

Mar 24, 2015 7:58:55 GMT -5 973beachbum said:

One other thing is from rereading the OP the issues the child has sound like they could actually be side effects of the drugs.  That is probably another reason to get this kid to a "big city" type place so they can try and sort out what problems he has now that are real vs drug side effects vs the family issues causing people to see things in him that maybe aren't actual problems.


And of course everyone's favorite answer all of the above.

Oh, yessssss, I failed to mention....my child works with a neurologist for his "problems" (in our case seizures), the psychiatrist works to help counteract the side-effects the seizure medication causes.

[Formerly SK]

There are TONS of side effects to these drugs. It sounds like the child needs a psychiatrist to oversee care and (hopefully) eliminate some meds.

Wanted to say that IMO, medical issues are presented 24/7.  Anger/agitation/ADHD behaviors, if MEDICALLY caused, happen wherever the child is: school/home/daycare/etc.  My child has a medical ADHD/autism dx because wherever he is, he has the same issues.  They don't only emerge when he's happy/sad/angry/anxious/whatever.

Behaviors that only happen at school or at home or at grandma's are SITUATIONAL and require counseling, not drugs.  If a child can control his emotions/behavior in certain situations but not in others IMO it is not a medical condition.  It means that environmentally something is causing these behaviors and therapists need to figure out what situational dynamic is causing the problems. 

Again, JMO.  I work in an elementary school and I can totally tell the difference between "hyper" kids and AHDH kids (whether dx or not).  They are NOT the same thing.

[shanendoah]

How long did the family leave the child in the in-patient care? They may very well have switched meds as part of the process of getting him off meds. When one of my BFF's nephews told his grandma he thought the world would be better if he was dead at the age of 5, he went into in-patient care for almost 2 weeks, the first 3+ days of it with no contact with family members. He wasn't on drugs at the time, and really did (and does) continue to deal with clinical depression, but the first goal of in-patient was to rule out the family factors.
If it was only a couple of weeks ago and the kid is out, even with all of these dx, I have to wonder if the family pulled him out (perhaps because they wouldn't allow visitation).


I agree that getting him to an actual children's hospital or program geared specifically toward children is the best plan.


One of the last things we did for Mini Wheat was to get him an intake appointment for a possible ADHD diagnosis. He had some physical behaviors that were completely unconscious- he honestly did not realize he was doing them. We learned from talking to people that there are other dx that present very similarly. He was no longer with us when the intake appointment happened, so I have no idea what the outcome was, but I, like Formerly SK, really feel that there is a noticeable difference between a hyper/high energy child and one that actually has ADHD.