Who is treating my child?

With the ever-increasing trend towards specialization in medical education, all patients with chronic conditions have felt the frustration of never-ending doctor’s appointments. While, as a patient, you most likely understand the value of receiving highly specialized care from individuals with unique skill-sets and refined knowledge, it is difficult to keep tabs on what each member of your healthcare team is in charge of and what they are able to offer. For the parents of children with developmental delays or a developmental disorder such as Autism Spectrum Disorder (ASD), there are many types of physicians, healthcare professionals, and services that will be recommended or suggested for their children, making this a particularly confusing time. To help clarify, here is a brief breakdown of who these people are and the services they can provide, starting at the beginning:

Your general pediatrician: This is often your first point of contact with the healthcare system as this individual serves as your child’s primary care physician. For some, this will be one person who your child has seen regularly throughout his or her life and who is familiar with your child’s medical history. For others, this may be a nearby pediatric office that you drop in to when needed or a pediatric practice where you see whichever pediatrician is available on the day of your appointment. Either way, this is most likely your first call when you have concerns about your child’s development. Your child’s pediatrician should be assessing developmental milestones at your regular doctor’s visits. If a general pediatrician believes there are signs or behaviors indicative of ASD, they may choose to do some initial screens, such as a Social Communication Questionnaire (SCQ), in order to gather more data. Depending on the physician, their previous experience and training, he or she may or may not feel comfortable giving your child a preliminary diagnosis of ASD, and that’s okay. Regardless, you will need to be referred to a specialist to receive a comprehensive evaluation; access appropriate intervention services and receive an official diagnosis. The person you will most commonly be referred to is a licensed clinical psychologist or psychiatrist. However, in some circumstances, it is another pediatrician. Whoever this person may be, he or she should be comfortable with diagnosing ASD and should be able to put you in touch with the right resources.

Psych: “Psych” is a frequently used, catch-all term to describe the many professions relating to mental health. For the purposes of this discussion, the most significant domains within the psych umbrella are psychiatry and psychology. These two fields are quite similar and, thus, are often confused. However, psychiatrists and psychologists have different backgrounds and are thus able to provide different services.

Psychiatry – Psychiatrists are graduates of medical school who choose to pursue a residency in psychiatry. If someone tells you they are a child psychiatrist, it means they have done additional training beyond the standard psychiatry residency, and have completed a fellowship that better enables them to diagnose and treat children with psychiatric disorders. They are also the best resource for the prescription and management of any psychiatric medication that your child may require.

Psychology – A licensed clinical psychologist is someone who attended graduate school specific for psychology and graduated with a PhD or PsyD. They work in a variety of settings including hospitals, specialized treatment centers such as Sunfield Center, private practice and schools. Psychologists have been trained to provide treatment and various sorts of therapy based on the specific needs of their patients. Psychologist may be an integral part of your treatment team as they can offer a plethora of services including a comprehensive evaluation, parent education and support, school consultation and advocacy, as well as individual treatment and group interventions to increase independence and improve social skills. In the majority of circumstances, psychologists are not licensed to prescribe medication.

The pediatric specialties: A licensed pediatrician is a physician who elects to complete a pediatric residency after medical school and who passes all of the proper licensing exams, including the pediatric boards. These individuals are able to practice medicine as a primary care physician or complete a fellowship in order to specialize. Below are some of the pediatric specialties that are commonly utilized by the families of children with ASD.

Developmental-behavioral pediatrics – Developmental-behavioral pediatricians, sometimes referred to as “DBPs,” complete a three year fellowship after their pediatric residency. Their fellowship is a combination of research and clinical work that allows them to spend more time learning about the development of children and the management of their behavior. Since children with ASD often have co-occurring behavioral disruptions, such as difficulty sleeping, bed-wetting, and/or attention deficit hyperactivity disorder (ADHD), a DBP can serve as a wonderful resource to help you address these issues in the setting of an underlying ASD diagnosis. DBPs can be hard to find, depending on where you live and your access to the healthcare system.

Neurology – Children with ASD are predisposed to seizure disorders, particularly in adolescence. If there is concern for an underlying seizure disorder, pediatric neurologists are the doctors w­­­ho are best able to evaluate, diagnose, and treat it.

Genetics – Several genetic mutations have been identified that are known to increase a child’s susceptibility to ASD. At this point, knowing whether or not a child with ASD carries a specific mutation that might explain their underlying diagnosis doesn’t tell us too much – meaning that it doesn’t really change our management or indicate a prognosis. Hopefully one day it may. Until then though, the utility in pursuing a genetics evaluation for a newly diagnosed child with ASD is mostly in family planning so that parents can better understand their chances of having another affected child. Therefore, the referral to genetics is not automatic and is made by physicians on a case-by-case basis depending on the goals of the family being treated.

So there you have it – a brief explanation of what some of the major players on your child’s healthcare team may be able to offer. This list is hardly comprehensive, and there are likely other specialties or services to which you will be referred. Also it is important to note, as in most professions, there can be great differences in expertise between doctors, regardless of the field in which they practice. The information provided above is meant to be generalized and does not apply to every individual practicing within a given discipline. However, this is a good start to understanding the dynamics of the fields that represent a substantial portion of the care your child is likely to receive.

Sunfield Center psychologists are available to work with children, adolescents, adults and families. To schedule an appointment, please call us at (734) 222-9277.