What is a Psychiatric Evaluation?
What is a Psychiatric Evaluation?
If you have concerns about your child’s emotional health, you will have lots of questions. Where do I start? What will an appointment look like? Who will talk with the doctor? Will they listen to my concerns? These are all very normal questions to be asking. Today, we will talk about what is involved in a typical psychiatric evaluation so you have some ideas about what to expect.
What is involved in a Psychiatric Evaluation?
The initial appointment with a psychiatrist is a comprehensive evaluation of the various factors that contribute to the current problem. My initial psychiatric interviews are 90 minutes because there is a lot of information to cover. It is important to understand the current problem and how it developed. We cannot fully understand it without putting it in the context of your (or your child’s) history and current environment. Illnesses do not occur in a vacuum. Psychiatric illness is biological, psychological and social. We must understand each of these areas, how they contributed to development of the illness and how they will influence (and be influenced by) recovery from the illness.
For the evaluation of a pediatric patient, the appointment has three parts: First, we will start with both the child and the parent(s) together. Then the parents will leave the room and I will meet with the child alone. At the end, the parent(s) will be invited back into the room to discuss diagnostic impressions and discuss options for treatment plans. Together we will come up with a treatment plan that everyone feels comfortable with. A lot of information is covered in each of these 3 sections:
1.) During the first part of the appointment, when both child and parent(s) are together, the first task is to understand your main concerns: what is the problem that prompted you to come in for help? Getting a good idea of when you first had concerns and how they have developed over time sets the stage for the rest of the appointment. Some symptom screening questions will be asked of the parents. For example, screening for signs of depression that the parents may have seen. Next, we will take some time to review the child’s history: medical history, developmental history, family history, psychiatric history, educational history and social history. Once this information is collected and discussed, the parents are excused to the waiting room and the child will meet with the doctor alone.
2.) When meeting alone with the child, I spend time getting to know the child, their likes and dislikes, their strengths and struggles. During this time, we will complete screening for symptoms of all the major psychiatric illnesses. These include mood disorders, anxiety disorders, psychotic disorders, eating disorders, substance use disorders, ADHD and others as indicated by the initial concerns expressed by the parent(s). Next all the other areas of a child’s life that contribute the current symptoms will be explored. We will discuss the child’s home and family life, their school environment, friendships, hobbies, lifestyle habits (such as diet and exercise) among other topics. Questions are asked different ways depending on age and personality of the child. I once had a very anxious child finally participate in the interview while hiding behind the couch and speaking to me through a puppet. It was enough to get things started and by the second appointment she was able to sit on the couch and talk to me about how she was feeling.
The amount of time spent with the child alone will depend on the age of the child and the main complaint. For younger patients, more time is spent with the parent(s) and child together and less time with the child alone. As teenagers get closer to adulthood, they are better able to articulate their inner feelings. Some symptoms are most easily observed by others and some symptoms are internal experiences and are best reported by the patient themselves. With younger children, often they show their emotions in their behavior and parents are more objective reporters of these symptoms.
In some cases, there may be time when parents meet alone with the doctor. I try to reserve this for times when there are specific concerns that cannot be discussed in front of the child. Some parents want to do much of the interview without the child present, but I try to avoid this for several reasons. First, I want the child to feel that I am “on their side,” I want to communicate to them that I am their doctor and my job is to help them to feel better. This helps them to feel confident in the relationship so it can be a place where they feel safe to share their biggest fears and toughest feelings.
Additionally, sometimes children fear that I spend that time telling their parents what they have told me. As we discuss at the start of every appointment, what the child tells me is confidential. There are a few exceptions to this rule when there are serious concerns about safety: child harming themselves, harming others or someone harming them. Parents do make the final decisions on treatments, so they need to know in general what is going on and what we are targeting with treatment, but the child needs to know the details are private in order for them to feel comfortable sharing.
3.) After meeting alone with the child, the parents are invited back into the office. Sometimes further information may be collected from the parent(s). The end of the appointment is for discussions of diagnosis and treatment planning. Various options for treatment will be discussed. Risks and benefits of each option will be reviewed. We will spend some time letting both parent(s) and child ask questions. Once a treatment plan is chosen by the child and parents, the details for initiation of treatment and follow-up are discussed.
In many ways the psychiatric evaluation is similar to any medical evaluation. We collect information about current symptoms, the previous symptoms, the person’s medical history and screen for other related illnesses. The difference with a psychiatric evaluation is that instead of collecting labs, we observe, and we ask questions. The answers to those questions and the observations of behavior help us to understand the cause of your concerns and the best ways to treat them. Remember, the psychiatric evaluation is never a commitment to any treatment. It is a chance for the family and the doctor to get to know one another and determine if it is a good treatment fit. Many people feel nervous at their psychiatric evaluation. But it can be the beginning of a supportive and therapeutic relationship which helps their child heal and move on to live a happy and productive life.