Where to turn when you have a challenging child

 What happens when you have a child that seems to perplex everyone with their behavior?  What happens when despite your giving your child all the advantages of early childhood, such as access to books and complex language, educational toys, preschool, social opportunities and a loving family the child is not morphing into the angel you hoped for but instead reminds you of some possessed demon?  Where do you go?  What to do you do?

In the past it was not uncommon for children like this to be written off with comments like, "He is just a mean kid.  He is just not motivated.  He is just being a boy.  She is just selfish.  She is spacey.  She is shy.  She is clumsy and slow."

Thankfully we know a lot more these days about development and learning and how to help children who are perhaps struggling to fit in and mature along side their peers.  But getting access to that knowledge as a parent and navigating the maze of special education, psychology and psychiatry is not always easy.  More often than not a parent must put on their "Sherlock Holmes Detective Hat" and prepare to become a team leader of a slew of professionals.  And for many parents starting this process is daunting.

The first question most parents ask is "What professionals should I see?"  Well it helps to know what the various professions are and what their training is and what they can do to help you.  Your job as a parent is going to be to create a team of professionals that can help you attact your child's problem.  Creating that team can be challenging.  Don't just settle for the first professional you happen upon.  Do some research.  Talk to other parents.  Listen to your gut when you meet that professional.  Do they give you their full attention?  Are they critical thinkers?  Are they current in their field?  Are they willing to help you advocate for your child?  Are they quick to make judgements about you and your family?  Are they detailed oriented and not immediately rushing to a specific treatment?  Can you work with them and relate to them?  Are they following proper protocols?  Are they willing to refer you to other professionals? Have they worked with children in your child's school district?  

 Pediatrician:  Your pediatrician is probably the first person you have talked to about your concerns having to do with your child.  But although there are some pediatricians with knowledge about learning disabilities, neurology and psychology, most pediatricians are trained as generalists and simply don't have the knowledge to assist you.  I would be very wary of any pediatrician, unless they had specific training in addition to their pediatric training, that feels comfortable prescribing medication for ADHD or Mood issues. There are some pediatricians who specialize in developmental problems and they are called, Developmental Pediatricians.  In general they have more knowledge about behavior then a regular pediatrician.

Pyschologists can be anything from somebody who just received a 1 year master's degree in psychology to somebody who has a PhD in psychology and has completed a residency program in psychology at a major hospital.   Different states even have different laws about who can call themselves a psychologist and what is required to get a license.  Also different psychologists will have different approaches.  There are too many to list here but some of the most common and effective methods these days are, DBT, Cognitive behavioral therapy and interpersonal therapy.  Psychologists can not prescribe medications and are not MDs.

Neuropsychologists are psychologists who specialize in studying how the brain is working.  They have been trained to test and evaluate the brain under controlled circumstances and can detect whether there are learning disabilities or other problems interfering with learning.  They often have a doctorate or PhD in the field.  Neuropsychologists are the professionals one would see to get an evaluation.  Some school districts have trained neuropsychologists on their staff do to evaluations of students who are referred to special education.  But other school districts have regular psychologists who just have a master's degree administer the tests.  

Psychiatrists have been to medical school and are MDs.  They have specialized in the field of psychiatry and are therefore knowledgeable about biologically based brain conditions such as schizophrenia, bipolar, depression and ADHD.  They are qualified to prescribe medicines but they are also qualified to give therapy and evaluate other conditions that may be contributing to the mental health of a patient.  There is a subset of psychiatrists whose specialty is medication and they are called psychopharmacologists.  Within psychiatry there are specialists in Child and Adolescent psychiatry.  You can read about child-adolescent psychiatry at www.acpa.com

Neurologists are also MDs but they have specialized in the specific domain of the nervous system and the brain.  Many will treat patients with  the same range of drugs that the psychologists use for people with mood and behavioral disorders (a class of drugs called anti-convulsants for their known ability to work on those having seizures).  Neuropsychologists also might be the doctor to administer physical tests to the brain such as EEGs-which measure electrical signals and look for seizure type activity, MRIs and CAT scans which are imaging technologies used to evaluate the brain.  Some neurologists are well schooled in the interface between neurology and psychiatry, others are not.  Just as some psychiatrists are more comfortable with a neurological approach to behavior and others are more comfortable with a more therapeutic approach.

Gastroenterologists are another type of doctor who study the digestive system.  You might ask what this type of doctor has to do with challenging children.  Well many challenging  children have digestive problems.  It is not uncommon for  a parent of a challenging child to talk about how their child is constantly constipated or has other minor bowel issues.  Also increasingly we are learning that there is a very strong brain-gut connection and that if digestion is not working properly or the body is not getting the appropriate balance of nutrients, the brain will not function properly.

Geneticists are doctors that understand diseases that have genetic origins (such as Downs syndrome)..  There are a few genetic diseases that are often misdiagnosed as ADHD or Autism or other generic labels.  One such disease Fragile X can be tested for.

DAN doctors are doctors who have committed to the DEFEAT AUTISM NOW movement.  Because there is a strong belief in the Autism community about the relationship between nutrition and brain function many  DAN doctors are willing to work with patients to address their problem with nutritional interventions.  And because many of these doctors believe that Autism is a spectrum disorder they are willing to look closely at kids with ADHD as well as kids with severe PPD type behaviors.

Educational Advocates  are people who are willing to go work with you to advocate for your child within the public school system.  Their training varies.  Some are ex-teachers and administrators themselves who have decided to go help parents navigate the system.  Others are parents who had special education children themselves and want to share what they learned  with others.  There are no regulations regarding training for advocates but some lay advocates are trained by federal financed parent training centers that exist in ever state.  Check out www.taalliance.org/Centers/index.htm.  Learning what your child's rights are under IDEA can be daunting and it is highly recommended that you find somebody to initially help you learn the ropes.  Otherwise you may not realize your rights.  I personally did not know that my own son could of gotten several months of home tutoring until I took a parent training course at our state center for parent training.  

What if money and your insurance situation makes assembling a killer team for your child impossible.  Well it is important to know that many states have a Department of Mental Health.  Many parents may be afraid to approach this organization, as I was for years, for fear of creating a paper trail that might later affect your child or of having the state interfere with your family.  But DMH in most cases is set up to keep kids OUT of the justice system and OUT of hospitals.  They don't generally have a ton of money and so they focus on prevention.  I know that in my state DMH can offer family stabilization services, respite care, and one on one mentoring.  DMH is entirely confidential and your chlid's records will not be accessible to future employees.

Many teaching hospitals will have research programs and entering into a research project is one way to get a top doctor involved with your child's case.  Sometimes the doctors will keep your child as a patient well after the clinical trial or research project is done.

Good Luck in your search and remember many of us have been down this path before and can assist you if you feel stuck.  Don't be afraid to reach out to your fellow parents.

-Jisper