Pediatrician or psychiatrist for guidance on ADHD meds?

[Anonymous]

We are exploring ADHD meds for DD15 (inattentive type) and very underwhelmed with our ped's knowledge of ADHD medication. Their advice is basically to just pick a stimulant and see if it works. Is that typical advice? I feel so disappointed in their lack of knowledge and desire to understand our daughter's struggles (she performs well at school but struggles with social/emotional issues and sound sensitivity).

I am expecting this will involve adjusting and switching meds as we go - I just don't feel confident the ped is in the best place to guide us in this journey. What type of provider did you work with? Any recommendations (we are in Nova) or other advice starting the process of ADHD meds? DD is wanting to try meds to see if it will help her. Thank you in advance.

[Anonymous]

Yes, it’s kind of typical to have trial and error, but a psychiatrist might be more helpful. I have heard there is a genetic test that can be done to see which med is most likely to be effective.

[Anonymous]

Pretty much the norm for both a psychiatrist or a pediatrician. Sometimes you get the right one in the first try. Sometimes there is a lot of adjustment and changes. It’s really not magic - just trial and error.

Here’s the thing. It’s easier to get in with a Ped and if you want faster attention, a Ped can be a better option. If there are comorbitities, then you probably need a psychiatrist. You could find a really responsive, call you back right away, fit you in for out of cycle appointments to make adjustments, but I haven’t run into that yet.

[Anonymous]

That is the typical way to start drugs. There is no good science. In other words, if you say to a psychiatrist “she only has inattention in the afternoons, plus gets shy in parties and loud music bother her” the doctor will not be able to say “oh she should try xyz because it is particularly good for those symptoms.”

Nope, there is Ritalin class and the other class. And they have different pill forms and other differences around the extras but you just need to try them to see what works for your daughter. One person with her symptoms may do well with Ritalin, and someone else with the same symptoms may prefer quialivant. No way to predict. So with that said, with extremely run of the mill, non crisis adhd as you have described, just go to a ped and start trying them out. It won’t be any different than a psych.

If your child had more complicated symptoms, like rage or anxiety or Tourette’s or bipolar, then you go to a psychiatrist because treatment will likely end up with multiple drugs and side effects will be far more important to watch.

[Anonymous]

My pediatrician would not due the evaluation for ADHD. She was happy to manage meds after DC was diagnosed, though. So we got a dx from a child psychologist and our pediatrician managed the meds.

[Anonymous]

Agree with the above. I would start with the pediatrician. Gather feedback from teachers as well along the way. Work your way to a psy. Our ped told us flat out she would not prescribe past certain dosages. But it took us a while to get in with a psy.

[Anonymous]

Personally my pediatrician refers to specialists - developmental pediatricians, neurologists, neuropsychs - to diagnose adhd and other developmental disorders and manage medication. In my opinion, a psychiatrist would be better for medication management post diagnosis.

Would be much easier to get appointments with my pediatrician though!

[Anonymous]

I go to Niku Singh at Tysons Psychiatric and I was really hesitant to go back on meds. He talked to me in great detail about each of the stimulants and the differences between each. I have been able to talk through med changes with him.

[Anonymous]

A psychiatrist is much more qualified to prescribe ADHD meds. It’s fine to use your ped once the situation is stable but these meds involve a lot of trial, error and tweaking and that’s best done by an expert.

[Anonymous]

Get with a good psychiatrist. They are the one you want for this.

[Anonymous]

A good psychiatrist will explain the drugs a bit, but it will basically boil down to “pick a stimulant, try it, see what happens.”

[Anonymous]

There is trial and error, but a psychiatrist will have better understanding of the differences among meds and so can better guide the trial and error. And will likely know of more choices -- my kids are on two different stimulants and our pediatrician hadn't heard of either of them.