Confused about next steps for child - anxiety, ADHD

[Anonymous]

I initially posted on the General Parenting forum but based on suggestions - posting here.

https://www.dcurbanmom.com/jforum/posts/list/0/1073090.page#23107915

I feel like we want to try behavioral help professionally before we go the meds route but then I am reading conflicting info online that we need to make an appt with a Psychiatrist MD first and then they will guide us to next steps for clinical psychologist?

Any insight appreciated.

[Anonymous]

Surely you know any psychiatrist will jump into drugs. So no, you go to them only as a LAST resort. The drugs are very high risk.

[Anonymous]

Anonymous wrote:Surely you know any psychiatrist will jump into drugs. So no, you go to them only as a LAST resort. The drugs are very high risk.

What? No. Obvious troll is obvious. Move along.

[Anonymous]

You need meds and behavioral therapy. full stop

[Anonymous]

Anonymous wrote:Surely you know any psychiatrist will jump into drugs. So no, you go to them only as a LAST resort. The drugs are very high risk.

Total and complete bullsh*t.

[Anonymous]

Anonymous wrote:Surely you know any psychiatrist will jump into drugs. So no, you go to them only as a LAST resort. The drugs are very high risk.

My DD’s psychiatrist believes in as few meds as possible and requires that sue also see a therapist. He is actively encouraging her to wean off the meds soon, but she is going into senior year of high school and we want to make sure the timing is right.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Surely you know any psychiatrist will jump into drugs. So no, you go to them only as a LAST resort. The drugs are very high risk.

My DD’s psychiatrist believes in as few meds as possible and requires that sue also see a therapist. He is actively encouraging her to wean off the meds soon, but she is going into senior year of high school and we want to make sure the timing is right.

OP. Would you be willing to share name?

Also what is the order is my question - psychiatrist first? Since there seem to be differing opinions.

[Anonymous]

Anonymous wrote:Surely you know any psychiatrist will jump into drugs. So no, you go to them only as a LAST resort. The drugs are very high risk.

OP. Can you please explain high risk? Research articles? I am a new to all this.

[Anonymous]

I’m sorry this thread has gone off the rails. I was the poster that mentioned it was great he was being successful at school. Based on what you detailed in the other thread, I would seek an executive functioning coach first to see what supports could be put in place at home for getting through task. I would also seek some sort of cognitive behavior therapy for the anxiety he exhibits. I do somewhat agree with above poster about waiting on medications and psychiatrist until you have tried some lower level supports first.

[Anonymous]

Everything I have read here and online is that executive function coaches are useful if parents are clueless or don’t have the time and energy to dedicate. Insurance doesn’t cover and it’s expensive. Looks like OP and her DH are very involved and educated about options. I would recommend more books perhaps? All I’ve heard anecdotally too about executive function coaches is not worth the money - you can do this yourself. Not like needing a psychiatrist since you don’t prescribe and manage medication.

[Anonymous]

My dd with increasing anxiety and mood disorder saw a developmental ped first (Dx was that she didn’t have any concerns except mild social cognition issues), then a therapist (who helped a lot but didn’t diagnose or make the mood/anxiety really go away). Finally DD asked to see a psychiatrist, which I resisted because I felt Dd was looking at meds as a silver bullet.
To my surprise, the psychiatrist has been great so far—the first steps were to have some deeper tests done which revealed that DD, a staunch vegetarian (nearly a vegan) has some critical deficiencies that impact her health. (This despite Dd eating an incredibly healthy diet—a spectrum of fruit snd veggies, unprocessed foods, even vitamin D and iron supplements. But the psychiatrist, being an MD, drilled down on what is missing in DD’s biomarkers and recommending both supplements (like omega 3) and meds for the short term as a “scaffold”. Of course, omega 3 (as one example) seems like a no-brainer but to see the actual levels DD has vs what’s needed for optimal brain health was extremely convincing and really provided a clear road map. It’s early days for DD on medication but it’s been helpful to think about all these different factors and solutions.

[Anonymous]

Anonymous wrote:My dd with increasing anxiety and mood disorder saw a developmental ped first (Dx was that she didn’t have any concerns except mild social cognition issues), then a therapist (who helped a lot but didn’t diagnose or make the mood/anxiety really go away). Finally DD asked to see a psychiatrist, which I resisted because I felt Dd was looking at meds as a silver bullet.
To my surprise, the psychiatrist has been great so far—the first steps were to have some deeper tests done which revealed that DD, a staunch vegetarian (nearly a vegan) has some critical deficiencies that impact her health. (This despite Dd eating an incredibly healthy diet—a spectrum of fruit snd veggies, unprocessed foods, even vitamin D and iron supplements. But the psychiatrist, being an MD, drilled down on what is missing in DD’s biomarkers and recommending both supplements (like omega 3) and meds for the short term as a “scaffold”. Of course, omega 3 (as one example) seems like a no-brainer but to see the actual levels DD has vs what’s needed for optimal brain health was extremely convincing and really provided a clear road map. It’s early days for DD on medication but it’s been helpful to think about all these different factors and solutions.

OP. OMG. My child is almost vegan with that diet. We don't supplement with Vit D (assumption play outside) but do Omega 3. Can you please share your MD's info. Thank you.

[Anonymous]

I’m adult with ADHD and my psychiatrist also said that low ferritin levels, and magnesium and vitamin D deficiencies are related to the severity of some of the ADHD symptoms.

Ugh. I really need to be better about remembering to give my kids supplements.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My dd with increasing anxiety and mood disorder saw a developmental ped first (Dx was that she didn’t have any concerns except mild social cognition issues), then a therapist (who helped a lot but didn’t diagnose or make the mood/anxiety really go away). Finally DD asked to see a psychiatrist, which I resisted because I felt Dd was looking at meds as a silver bullet.
To my surprise, the psychiatrist has been great so far—the first steps were to have some deeper tests done which revealed that DD, a staunch vegetarian (nearly a vegan) has some critical deficiencies that impact her health. (This despite Dd eating an incredibly healthy diet—a spectrum of fruit snd veggies, unprocessed foods, even vitamin D and iron supplements. But the psychiatrist, being an MD, drilled down on what is missing in DD’s biomarkers and recommending both supplements (like omega 3) and meds for the short term as a “scaffold”. Of course, omega 3 (as one example) seems like a no-brainer but to see the actual levels DD has vs what’s needed for optimal brain health was extremely convincing and really provided a clear road map. It’s early days for DD on medication but it’s been helpful to think about all these different factors and solutions.

OP. OMG. My child is almost vegan with that diet. We don't supplement with Vit D (assumption play outside) but do Omega 3. Can you please share your MD's info. Thank you.

Hi, PP. The test that DD's psychiatrist prescribed is the "Nutreval/Metabolomix" test from Genova Diagnostics ('GDx'). (I don't know which name applies--or whether they are 2 components of one text or one's the test and the other is a technology). It's a 'nutritional and functional' assessment that seems really comprehensive. Here is a sample report: https://www.gdx.net/core/sample-reports/Metabolomix+Sample-Report.pdf

2 caveats:
1. The test is not typically covered by insurance, and it's expensive ($hundreds); I'm grateful I could afford it and I felt it was a worthwhile investment (much cheaper than the developmental pediatrician's appointments/assessment, for example--who I'd expected would do this kind of analysis, but didn't), and hopefully reducing family stress in the long run.

2. The depth of the report is more than I could initially explore with DD's psychiatrist; I suspect it will benefit you all the more if you are willing to dive into the detail yourself as well and put it together with your own observations. When DD and I reviewed the report with the psychiatrist (a 1-hr appointment) we also covered the results of 2 additional/different tests (also useful). So although we went into some detail, and got some very clear direction on what to do next, there's still more in the 14-page report that leaves room for exploration. For example, knowing my DD's diet/eating habits much more fully than the psychiatrist does (understandably), I was surprised that DD's microbiome indicators were low, and wonder if it could be complicated by certain other things. This is my first time working with a psychiatrist and I am assuming they would be happy to look into things further, but that it's more efficient if I could narrow down the areas that I want to further discuss...and that they might need time to do it (whereas I'm happy to google away to read various medical studies).

I'd rather be a bit vague about the specific psychiatrist but I will say that they work at Potomac Psychiatry. I think there would be other psychiatrists who use this kind of test/approach, though I'd recommend that before making an actual appointment you explicitly ask if they'd be willing to have this test (or similar) performed.

I hope this helps...does your nearly-vegan DD have mood issues and anxiety? My DD is a high schooler now and she has gotten more anxious/irritable since becoming a vegetarian in 5th grade, which coincided with puberty, so I was always wondering how everything related. Now I have some science to help me navigate. On that front, discussing the report with the psychiatrist finally convinced my stubborn DD to be willing to have omega-3 from fish sources.

[Anonymous]

immediate pp here. I apologize, op, for not realizing it was you that posted this last question--I thought it was a new poster with a vegetarian kid with similar issues! Ignore my question at the end!

I really do think that without a nutritional-type assessment, you may be missing some key issues that you could address (I'm not saying that you shouldn't also consider meds, and I think a psychiatrist can be very useful in helping you tease out meds vs supplementing for deficient vitamins. Ours did not push meds but responded to DD's desire for them as a support.) From what I have read, the nutritional/biological imbalances can affect concentration/adhd etc. But do go for the professional's analysis! Wishing you the very best.