Along with adult psychiatry, I also specialize in adolescent & child psychiatry in Menlo Park, CA. Schedule an appointment with me for a diagnostic evaluation.
Child and Adolescent Patients
For children under 14, I meet first with the parents to understand their goals for the evaluation and concerns about treatment. I take a complete history of the presenting problem – previous treatment, current stressors, symptoms and behaviors and their duration, the effects of the symptoms and behaviors on family and peers and on academic functioning.
I also take histories for a) the child’s health, b) the family psychiatric profile, c) birth and developmental history, d) social development, and e) school achievement. If the child has already seen a therapist, I get consent to talk with him/her to gather further history and understand any other issues facing the family and child. Sometimes I speak with teachers and school counselors if the family approves.
I then meet with the child to understand the problem from their point of view, their hopes and fears of treatment, and their understanding of why their parents have brought them to me. I begin to build a trusting therapeutic relationship where the child feels understood and safe to say whatever they want. I do a full mental status examination to assess the child’s ability to relate appropriately, their mood and level of anxiety, safety issues (including suicide risk), any disordered thinking, and a brief cognitive screening.
I then see the parents again, (together with the child if appropriate), to discuss a preliminary diagnosis and develop a treatment plan. If necessary, I discuss possible medication treatment. I refer for psychological or educational testing as needed. I also give referrals for therapists, since research shows therapy and medication together are most effective in treating mental health disorders. Finally, I make sure to address all their questions.
I meet with an adolescent first, before the parents, since they should be developing autonomy from the family. This sequence underscores it is their treatment first and the family’s second. I explain confidentiality; that I will not reveal our private talk to the parents. (I only break confidentiality, as the law requires, if I see a risk of imminent self- harm.) These agreements help build trust and offer a safe environment for the adolescent to talk about themselves and their concerns. I take the same history as with a child, adding any facts of substance use/abuse and sexual activity.
I then add the parents for a conference to understand their goals and concerns, and to gather family and developmental history. I then discuss the provisional diagnosis and develop a treatment plan, which may include therapy, medication, and/or psychological or educational testing.
When meeting with adults, I ask why they are consulting me, and about their goals for the evaluation and subsequent treatment. I gather the current history of symptoms and how these symptoms are impacting their social, educational, and work lives; past psychiatric history, – which treatments worked and which did not; family psychiatric history, educational, work, and social history, and history of substance use/abuse.
I conduct a detailed mental status exam to gauge the level of depression or anxiety that may be present, if there are any manic symptoms present; whether their have normal, linear thought or if they are psychotic, the quality of their judgment, and whether they are cognitively intact.
If the person is willing, I will gather collateral information from family members and their therapists. I will give my diagnostic impressions, and we will develop a treatment plan. If they are not in therapy, and are willing to go, I will provide referrals.