ADHD medication provider? Pediatrician or Psychiatrist

[Anonymous]

Psychiatrist. DH was nervous about meds for our kid and asked how often she sees kids like DD. She laughed and said every single day. This is what she does. A pediatrician might be fine if the first med and dose works, but to have someone to help trouble shoot, add meds, stops meds, change dosages etc who sees similar cases every single day is helpful .

[Anonymous]

Started with ped but when the obvious choices (Vynase included) caused major mood disturbances, ped referred us to psych.

Our neurologist demonstrated next to none understanding of mood issues. I would not rely on numerologists opinion alone.

[Anonymous]

DS is 17 now and has been on medication for over 5 years (Concerta).

He was pretty much at max dose on Concerta and having issues with side effects - our pediatrician was managing RX from start with her developmental pediatrician colleague recommending Concerta.

But as we explored next steps, ped was supportive of bringing in a psych consult. Ped was recommending Focalin. Psych agreed and set out a plan for trying Focalin and possible titration.

Now that DS is on a good dose, pediatrician is managing bi-monthly check ins and refills.

Psych is available for a follow up as needed and is a resource if DS needs to change medication later.

[Anonymous]

^^ psych meaning psychiatrist

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:A psychiatrist would be better but might not be possible given the shortage. Our pediatrician is handling DD's Vyvanse prescription right now and we're also paying cash because our insurance only covers the never-available mythical generic version.

OP, how long has your DC been on the 10 mg dose? My DD is the same - ADHD, dyscalculia, dysgraphia. She was 2 grade levels behind in the 2nd grade when diagnosed. She's now in 7th and just about on grade level. This takes a lot of time, and upping the Vyvanse may or may not be a good next step. Another possibility to consider is a booster dose in the afternoon.

Best of luck!

She’s been on medication for about 3 months. Any other advice on how you have her at grade level for 7th?! I’m not sure I can Will her through school! We have a weekly math tutor but I’m not sure it does much, she seems to forget things quickly. Thanks!

What do you mean by benchmark testing? Standardized testing? If so, I wouldn’t be spending money on tutors or be basing medication decisions on that. I’d be most interested in school performance and grades. Standardized testing isn’t indicative of the performance ability of some kids.

+1. My DD is consistently in the top 2-3 kids in math in terms of in-class performance and I can see she gets the concepts easily. But her standardized testing is a solid 1.5-2 years behind grade level. The kid cannot take tests on the computer to save her life, which is alarming for the future, but also doesn’t mean she needs a tutor.

And as an adult with ADHD, definitely a psychiatrist. A ped can handle maintenance, but they are not experts and a child needs expert care at the beginning.

[Anonymous]

We started with our pediatrician. But when we needed to adjust beyond the first two options we switched to a psychiatrist. She was so much more knowledgeable and found us the right dose quickly.

[Anonymous]

Anonymous wrote:Psychiatrist. Absolutely. As a pp mentioned, in the DMV this likely involves getting on a waitlist.

Or not. We expected to wait a long time to get in with someone at a practice that takes insurance, and they had appointments available a few weeks out.

[Anonymous]

Anonymous wrote:Can I hijack and ask whether a pediatric neurologist would be an appropriate medication provider in similar circumstances (suspected ADHD, dysgraphia, dyslexia, diagnosed motor and speech disability)? We have a pediatric neuro appointment coming up at the end of the summer. Would there be reason to also schedule a psychiatrist appointment?

We started with a neurologist (in MoCo) because we couldn't secure an appointment with a psychiatrist. It was fine, but I don't think all the expensive testing they required in the beginning was necessary. We ended up having our DC's pediatrician take over because the neurologist's practice also wanted monthly check-ins and after 6 months it seemed unnecessary.

If that's all you can get right now, PP, I would go for it so you don't have more delay. Just keep in mind later you may want to get on a psychiatrist's waiting list and/or move to pedi managing the meds.

[Anonymous]

Any tips for finding or getting in with a psychiatrist?

[Anonymous]

In theory, a psychiatrist should be better.

In reality . . . our DC has been on meds for 8 years and we’re still using a pediatrician to prescribe. We’ve tried moving to a psychiatrist three times, at different practices, and they’ve all been terrible. None of them would look at the neuropsychologist or developmental ped reports; they all wanted to start from scratch and have many sessions before they would prescribe. Two were out of network so this was thousands just to get to that point. But they were terrible clinicians. They didn’t seem to be able to relate to DC, didn’t have empathy, didn’t seem interested in truly understanding DC, etc. One suggested a non-stimulant to start. I understood the perspective, but knew it wouldn’t give DC the focus needed. In contrast, it was very easy to work with the ped, and have a very practical conversation, use the evidence that we had, and find a stimulant that worked well on the second try.

Not sure what we’ll do when DC ages out of the ped. I don’t trust that adult psychiatrists will be any better.

[Anonymous]

Both parents see a psychiatrist....who said finding a child psychiatrist is hard for the reasons PP said. The challenge too is our kid isn't exactly eager to try out a bunch of meds after the trials with stimulant side effects well outweighed any benefit. Thankfully summer is here with low demands and a lot of movement to tide us over while we search.

[Anonymous]

Pediatrician has been handling DS's meds for 7y. We have titrated up a couple of times without incident.