Challenging Children: Getting Professional Help

Evaluation components

How to Find the Right Professional

• Consult your pediatrician.
• Call support group(s). Locate support groups on the Internet; then look for a local chapter in the telephone book. Or call the national organization for recommendations in your area.
• Call local mental health agencies. Start with your city or county health service. Ask them for names of private agencies as well.
• Do research--read books; seek information on the Internet.
• Survey professionals. Look for overlapping referrals:
  • From your pediatrician
  • From school
  • From friends and knowledgeable acquaintances
• Interview professionals you might want to use.
• Trust your gut instincts. The professional (or professionals) you choose has to "feel right" or you may not have confidence that the diagnosis is correct, especially if you don't like it. If it doesn't feel right, you will be far less likely to follow the specialist's recommendations for treatment.

Sharon: Any diagnosis should be the result of a thorough evaluation, not a judgment or pronouncement at the end of a single appointment. It's a process, based on a great deal of information supplied by the child and parent, and gathered by the specialist(s). The evaluation process results in a differential diagnosis, that is, a determination not only of what your child's diagnosis is, but, just as importantly, what it is not. Through an extensive review of information, combined with parent and child interviews and observations, an experienced professional makes an assessment, or diagnosis. It is this thorough process that drives decisions regarding treatment. If one professional doesn't handle all aspects of a complete evaluation, seek referrals for those who can augment what has been done. It can be lengthy and inconvenient but it is invaluable.

 

Assessment or Evaluation Components
Component	Reason
Family Evaluation (with a social worker or other specialist)	To determine what family dynamics, if any, may be contributing to the child's problem; suggest having a family behavioral modification
Psychosocial and school assessment (teacher or guidance counselor contact)	To assess child's peer functioning; determine academic and behavioral performance at school
Psychological testing (with a psychologist)	A broad group of tests that assess the child's emotional and cognitive (thinking) functioning
Neuropsychological testing (with a psychologist)	Extensive and specific tests to evaluate a child's thinking or information-processing abilities
Structured parent interviews	Detailed questions about your child's history
Medical assessment (pediatrician)	Physical examination and laboratory studies as indicated; suggested prior to using medications and when there are concerns about a medical contribution to the child's problem
Medication evaluation	Thorough history of the child and his or her current and past emotional and behavioral problems; review of above

This table represents potential assessments for children with behavioral and emotional disorders. The evaluation process varies greatly dependent on the region of the country, the type of practice, and the circumstances of the child.

Adapted from "Table 2. Elements of the Psychopharmacology Evaluation Process," in Straight Talk about Psychiatric Medications for Kids by Timothy E. Wilens, M.D. (New York: Guilford Press, 1999), p. 56.