View Full Version : Psychologist vs psychiatrist


ADHDWife&Mom
04-16-16, 09:13 PM
We are trying to get our son evaluated for ADHD. Ive been looking in our area and with our insurance company and it seems like almost all of those that "specialize" in ADHD around here are psychologists. At the same time, most people say they used medication to treat it. So.... dont you need to see a psychiatrist if you want them to be able to prescribe medication?

Do you just go to the psychologist to get the evaluation and then have your pediatrician prescribe meds? What about the other treatments for ADHD that you can do either instead of or in addition to medication? Is it something that is on going with a psychologist?

I just dont want to take him to a psychologist and then later find out that he needs to go to a psychiatrist if we want to do meds.
Thank you

sarahsweets
04-18-16, 04:39 AM
IMO a psychiatrist is your best bet. They are qualified to make a diagnosis and prescribe meds. I know some people swear by psychologists but I dont believe they are trained to make diagnosis's of brain disorders or stuff like that. They can highly suspect them, and they may very well be right, but I dont believe they can diagnose them. You may have to travel a wee bit out of your area to find a good one too. Finding one that is suitable to kids and your family might take a little while. You want someone who is capable and open to meds but not pushy about it because meds are not THE solution, but they are part of it. My psyche that has treated myself and my family for 17 years is about 30 min away.
In some cases where financial issues or insurance issues make it so you cant find anyone for your child, a psychologist can make recommendations and talk to your peds doctpor and the doc can handle the meds but I advise that that should be a last resort.

dvdnvwls
04-18-16, 12:05 PM
I have read too many times of a person going to a psychologist and just having to switch to a psychiatrist later anyway.

Not every psychiatrist is familiar with ADHD; in fact, some of them stubbornly refuse to believe (in spite of overwhelming long-term evidence) that ADHD even exists. So it's important to find not just any psychiatrist but one who regularly treats children with ADHD.

ADHDWife&Mom
04-18-16, 04:31 PM
I have read too many times of a person going to a psychologist and just having to switch to a psychiatrist later anyway.

Not every psychiatrist is familiar with ADHD; in fact, some of them stubbornly refuse to believe (in spite of overwhelming long-term evidence) that ADHD even exists. So it's important to find not just any psychiatrist but one who regularly treats children with ADHD.

This is the problem that I am having. There are lots of psychologists in our area that "specialize" in ADHD but I havent found any psychiatrists that even mention it on their website except one that only deals with adults. Only one psychiatrist in our entire state is covered by our insurance too and he doesnt seem to have any interest in ADHD. It seems like very few take any sort of insurance in our area, you have to pay outright and then file your own claim with the insurance company. I wouldnt mind that so much except when its in network its just a copay and when its out of network I have to pay a percentage which is much much more expensive.

There seems to be a really great psychologist that specializes in ADHD very close to us. She works with lots of schools in the area and gives ADHD lectures. She has great office hours, takes our insurance and even responds to emails from patients when you dont have an appointment and you just need to ask a quick question. It really seems like just what Id like but, she cant prescribe meds. Right now we are not set on meds anyway BUT we are also not opposed to meds if they are needed. I dont want to get stuck without that option if we want it and I dont want to be stuck with a doctor that doesnt offer all of the options to us because they arent able to prescribe the meds.

Hiddencreations
04-18-16, 06:26 PM
Both a psychologist and psychiatrist are trained to diagnosis ADHD, some in each field are better at evaluating ADHD than others. They use the same criteria for diagnosis and if either is trained in neurodevelopmental disorders they are both capable and skilled at giving an official diagnosis.

If you think there are other issues like processing issues or learning disabilities, in addition to ADHD, you may want to go to a psychologist first for an evaluation (intelligence test, processing test, interviews, observations, collection of history, and rating scales). If you suspect that your child needs special education services, this evaluation can be completed by the school.

If you already are pretty confident that it is ADHD, then going to a psychiatrist may save you a trip (depending on the psychiatrist as some still want an evaluation).

In summary: each professional is capable of making a diagnosis by their training alone. It all depends on the end goal or what you think is going on, or not going on, with your child.

dvdnvwls
04-19-16, 04:16 PM
One thing I would consider trying is asking around in your area about who is the local go-to person for kids with ADHD. The most important thing of all is having someone who's good at what they're doing and will steer you in the right direction and put you in contact with the right people. You could ask pediatricians, other parents, etc.

The caution with doing this is: if you get in contact with people who dismiss or doubt or don't believe in ADHD, or who follow quack remedies, then you are in worse trouble than when you started.

sarahsweets
04-20-16, 04:41 AM
Both a psychologist and psychiatrist are trained to diagnosis ADHD, some in each field are better at evaluating ADHD than others. They use the same criteria for diagnosis and if either is trained in neurodevelopmental disorders they are both capable and skilled at giving an official diagnosis.

If you think there are other issues like processing issues or learning disabilities, in addition to ADHD, you may want to go to a psychologist first for an evaluation (intelligence test, processing test, interviews, observations, collection of history, and rating scales). If you suspect that your child needs special education services, this evaluation can be completed by the school.

If you already are pretty confident that it is ADHD, then going to a psychiatrist may save you a trip (depending on the psychiatrist as some still want an evaluation).

In summary: each professional is capable of making a diagnosis by their training alone. It all depends on the end goal or what you think is going on, or not going on, with your child.

Are you sure about this?I was always under the impression that because adhd was not necessarily a mental health disorder that a doctor of some sort had to be the one to make the official diagnosis. I agree that a good psychologist can go a long way with suggesting a diagnosis and very often they are spot on but I thought that a doctor had to give the seal of approval?
Obviously a psychologist cant prescribe meds so you would have to see a doctor for that but...I dont know something isnt sitting right with me on this for some reason. I know that in my experience, when I was inpatient at age 16, I was overseen by a zillion psychologists and psychologist students. At that time I was obviously untreated bipolar but because I was well spoken, smart and a people pleaser, I wasnt diagnosed then. They chalked it up to teen angst and family problems. This, after a suicide attempt.

Laserbeak
04-20-16, 01:35 PM
A psychiatrist is a medical doctor who went to medical school, right alongside brain surgeons, pediatricians, general practitioners etc. They can prescribe medication. They have definitely had to take State examinations and are licensed and must maintain their license on a regular basis by ongoing education just like any other doctor.

Psychologists are generally just college graduates who never went to any special training beyond their regular psychology classes in school. Depending on the state, there may be little or no licensing requirements, testing, or any other requirements other hanging a sign on their door.

I'm sure there are good ones out there, but I would never waste my money on one, go to a psychiatrist.

My 2

TygerSan
04-20-16, 05:05 PM
In some insurance plans, psychiatrists mainly do med-management, and psychologists do evaluation and therapy, so you may not have much of a choice who your kid sees for the assessment.

And while therapists come with a variety of licenses and credentials (licensed counselors of various stripes, licensed social workers, etc.), most, if not all requiring some form of additional cousework or advanced degree, it is my understanding that in order to be a licensed psychologist (at least in my state), you need to have an advanced degree. Either a PhD in clinical psychology or counselling, or a PsyD, which is a professional degree.

namazu
04-20-16, 08:26 PM
There is an overall shortage of psychiatrists in many areas of the U.S. In addition, as you've noticed, there's been a trend of doctors "opting out" of taking insurance for various reasons, so your experience -- and relative lack of in-network options -- is unfortunately pretty common.

Personally, I'd take a well-informed and accessible psychologist over a less-well-informed psychiatrist, assuming I had another doctor of some kind who was willing and able to oversee medication for me.

Clinical psychologists must have at least a master's, and more commonly, a doctorate, to apply for licensure in U.S. states. Here's a table of minimum degree requirements by state and province, for those who are curious. (http://www.asppb.org/HandbookPublic/Reports/default.aspx?ReportType=DegreeLevelLiscensure) In addition to formal degree requirements, psychologists must generally complete many hours of supervised training in clinical settings before they are licensed.

A clinical psychologist who works with kids (and many who work with adults, especially if they started practicing in the past 15-20 years) should have at least the basic training to diagnose and (help) treat ADHD, though as others have noted, experience/interests vary widely among clinicians.

Psychologists can often help with the family, social, and educational issues that often accompany ADHD. They can help demystify ADHD, help a kid work through feelings, teach and reinforce strategies for managing ADHD symptoms in conjunction with medications, and give you feedback on parenting strategies for dealing with certain types of behavior.

Psychologists cannot prescribe medications, and they are not trained to read bloodwork or diagnose or rule out other medical conditions. For these reasons, it's usually a good idea to involve a medical doctor during diagnosis and treatment. However, that doesn't necessarily have to be a psychiatrist.

A good psychologist and a well-informed MD or DO (e.g. pediatrician, general practitioner, or family medicine doctor) can often work together to treat ADHD, including managing medications.

Often you (as a parent) can sign release forms allowing the psychologist and the MD to share information with each other about your son's treatment -- so, for example, the psychologist could document the ADHD evaluation/diagnosis for the MD, and the MD could provide results of bloodwork. There will undoubtedly be some coordination required on your part, especially if the two aren't part of the same health care system or group.

If your son's ADHD isn't complicated by additional medical issues, that may be a workable option for you, especially if psychiatrists who take insurance are in short supply locally. If your son has other significant medical concerns, or if medication doesn't work well or causes troublesome side effects, then involving a psychiatrist may be necessary. But you can cross that bridge if you come to it.

Best wishes!

Hiddencreations
04-20-16, 10:48 PM
Are you sure about this?I was always under the impression that because adhd was not necessarily a mental health disorder that a doctor of some sort had to be the one to make the official diagnosis. I agree that a good psychologist can go a long way with suggesting a diagnosis and very often they are spot on but I thought that a doctor had to give the seal of approval?
Obviously a psychologist cant prescribe meds so you would have to see a doctor for that but...I dont know something isnt sitting right with me on this for some reason. I know that in my experience, when I was inpatient at age 16, I was overseen by a zillion psychologists and psychologist students. At that time I was obviously untreated bipolar but because I was well spoken, smart and a people pleaser, I wasnt diagnosed then. They chalked it up to teen angst and family problems. This, after a suicide attempt.

Yep! 100% sure. Majored in psychology, currently in graduate school for psychology, and I know a lot of clinical psychologists.

Clinical psychologist can give an official diagnoses, they don't need a seal of approval from psychiatrist. For example, you don't generally follow up a diagnosis of autism from a psychologist with an assurance from a psychiatrist.

The big differences between a clinical psychologist and a psychiatrist, other than medication are:

1. School -- Psychologist have PhDs or PsyDs, Psychiatrist have MDs. Clinical Psychs go to graduate school for 5+ years for there degree. Psychiatrist go for 4 years of medical school and then 1 year of residency.

2. Focus -- Psychiatrist focus more on exclusion when it comes to diagnosis (what can they rule out), it tends to be more focuses on neurochemicals. Clinical psychologist tend to focus on the behavior, feelings, or thoughts on functioning.

3. Therapy -- most Psychiatrist do not provide therapy (in the 70s and 80s it was common), not it is not. Clinical psychs can and many do.

4. Testing -- Clinical Psychs know more about cognitive, behavioral, and emotional measures and they are trained to administer them in-depth. Psychiatrist aren't really focused on providing these types of administration.

With IP and partial hospitalization, most of the time even though a psychologist is involved, the psychiatrist is the one who has the final say on the diagnosis. This is different from Outpatient where a psychologist can give a diagnosis.

(From my experience IP when I was 16 too, I don't recall ever meeting a psychologist--only a psychiatrist)

Laserbeak
04-21-16, 02:50 AM
@namazu -- That might be the way it works in some places, but I KNOW it wouldn't work where I live. There would be no way in HELL that any of the general practitioners I've ever had would write a prescription for a controlled substance on the recommendation of a non-doctor.

While there's no shortages of psychiatrists in New York City, I've been to hell and back over pain medication for my chronic pain from a radial head fracture. There is a HUGE shortage of pain management doctors here and it takes months to get in to see one. FINALLY I got a paper from them saying I should be taking Oxyodone 4x/day for the foreseeable future (along with several non-controlled drugs), then only did my doctor become relaxed in continuing the prescription.

They are all scared to death of the DEA or the State of New York swooping down on them, taking their license and throwing them in jail. They all want to CYA themselves with a letter from a specialist M.D., a psychologist, even if he had a Ph.D. and she personally knew him would fly.

namazu
04-21-16, 03:54 AM
It's true that some primary care docs are uncomfortable prescribing controlled substances, and that opioids have their own stigma. My guess would be that pediatricians prescribing ordinary doses of stimulants to children diagnosed with ADHD are not subject to as much DEA scrutiny as doctors prescribing opioids to adults with chronic pain.

The American Academy of Pediatrics has clinical practice guidelines for treating ADHD (http://pediatrics.aappublications.org/content/128/5/1007.full) that explicitly endorse judicious use of stimulants (along with therapy) for treatment of ADHD in elementary school-aged kids.

These guidelines also mention the importance of working with parents/guardians, educators, and other mental health professionals.

Doctors don't always prescribe medications just because a psychologist says they should. However, a well-informed pediatrician also will not summarily dismiss the results of a competent, thorough evaluation performed by a qualified psychologist with expertise in ADHD -- especially if no alternative medical or environmental cause adequately explains the symptoms, and if the child is struggling and could potentially be helped by medication.

The high prevalence of ADHD and limited mental health resources require primary care pediatricians to play a significant role in the care of their patients with ADHD so that children with this condition receive the appropriate diagnosis and treatment. Treatments available have shown good evidence of efficacy, and lack of treatment results in a risk for impaired outcomes.

It's worth looking into this option (working with a psychologist and pediatrician or family doctor) in a situation like the one ADHDWife&Mom described.

Laserbeak
04-21-16, 08:28 AM
The American Academy of Pediatrics has clinical practice guidelines for treating ADHD (http://pediatrics.aappublications.org/content/128/5/1007.full) that explicitly endorse judicious use of stimulants (along with therapy) for treatment of ADHD in elementary school-aged kids.


I looked through here and I still don't see how this is an adequate substitute for a psychiatrist when it comes down to choosing the actual drug and dose to be used in every case.

Even if I grant you that a psychologist is qualified to make a diagnosis, they certainly are not qualified to choose which drug and dosage to administer to treat the disease. And I don't think this small pamphlet really substitutes for being a medical doctor and training under other doctors to get real life experience.

Another thing is pharmacies. I have had problems with the Walgreen's/Duane Reade here dispensing Schedule II drug prescriptions written by a GP long term. I had to take them the letter from the pain management doctor at one point for them to continue to dispense Oxycodone to me because they said that a specialist should be writing the prescriptions for long-term dispensing of those types of controlled substances. But for some reason these idiots still could never understand that it is the policy of the pain management doctors to not prescribe, just advise the GP.

Now that is obviously some company policy, not a law -- a doctor who can prescribe anything can prescribe everything. But they ended up giving me so much trouble I found a different pharmacy to use, a mom-and--pop place near the hospital. They always have everything plus they don't treat you like a criminal just for getting you prescription filled.

Laserbeak
04-21-16, 08:29 AM
The American Academy of Pediatrics has clinical practice guidelines for treating ADHD (http://pediatrics.aappublications.org/content/128/5/1007.full) that explicitly endorse judicious use of stimulants (along with therapy) for treatment of ADHD in elementary school-aged kids.


I looked through here and I still don't see how this is an adequate substitute for a psychiatrist when it comes down to choosing the actual drug and dose to be used in every case.

Even if I grant you that a psychologist is qualified to make a diagnosis, they certainly are not qualified to choose which drug and dosage to administer to treat the disease. And I don't think this small pamphlet really substitutes for being a medical doctor and training under other doctors to get real life experience.

Another thing is pharmacies. I have had problems with the Walgreen's/Duane Reade here dispensing Schedule II drug prescriptions written by a GP long term. I had to take them the letter from the pain management doctor at one point for them to continue to dispense Oxycodone to me because they said that a specialist should be writing the prescriptions for long-term dispensing of those types of controlled substances. But for some reason these idiots still could never understand that it is the policy of the pain management doctors to not prescribe, just advise the GP.

Now that is obviously some company policy, not a law -- a doctor who can prescribe anything can prescribe everything. But they ended up giving me so much trouble I found a different pharmacy to use, a mom-and-pop place near the hospital. They always have everything plus they don't treat you like a criminal just for getting your prescription filled.

ADHDWife&Mom
04-21-16, 12:03 PM
Thank you all for your input it has been very helpful to read.

I spoke with both a potential Psychologist and our Pediatrician about how to proceed. Our pediatrician says he can evaluate our son in an office visit. I asked how he does the evaluation and they said its a physical exam plus the questioners for parents and teachers and that's it. With just that he will prescribe medication. This actually bothers me a bit since everything Ive read says that is a really bad way of evaluating. We are not looking to ONLY give meds either. We are hoping for other options and the possibly combining with meds.
Then the clinical psychologist is a PhD. She has lots of experience with ADHD. Seems to be highly recommended in the area. She will do an interview evaluation, the parent/teacher questioners and also a TOVA test (test of variables of attention). She will give a full report with recommendations. She also will work with our pediatrician if we want to try meds. She says they have options that they like to try before meds if that is what we choose. I'm planning to ask if they can do an IQ test as well because he is super smart and its been mentioned to me that giftedness can mimic ADHD at times and he is always very bored with school because its so easy for him.

Right now, Im feeling like I should just go to both doctors. I can get him evaluated like I want with the psychologist and then have the pediatrician check him over so we have a record of it if we want to try medication.

TygerSan
04-21-16, 12:12 PM
Sounds like you have a plan :)

The funny thing is that when I went back as an adult to try meds, I walked into the psychiatrist's office (and, yes, he was a psychiatrist, not a psychologist or counselor) with my evaluation from when I was 16. He did the initial screening questionnaire, went over it with me question-by-question, and then decided between my results on that (honestly, they were a bit borderline) and the report I brought in, to prescribe me meds. Like literally, 20 minutes after I met the guy I walked out with a prescription for Concerta.

Honestly, I was a little floored with how easily that happened, and I had my reservations about how to proceed.

On the other hand, there really isn't a terribly pressing reason to do a neuropsych evaluation unless you think that there might be something going on in addition to ADHD (like a learning disability, for example). Even the TOVA is not particularly informative, especially in this age of video games (anything that's shiny and new, even something that's shiny, new, and painfully boring, can hold attention for at least a little while). Most good evaluators will base their diagnosis on a combination of self-reports (if the person is old enough), school reports, behavioral observation, and family history.

To be quite honest, I wouldn't really worry so much about the credentials of the person doing the evaluation so much as whether you think the evaluation process was well-done, and the findings correct.

I've gone to a psychiatrist, a psychologist, and a neurologist, all of whom treated me appropriately. If you need to go the meds route, clearly it's easier if the pediatrician is on board (and incidentally, there is such a thing as a developmental pediatrician who may also specialize in the treatment of ADHD and learning disabilities), but the psychologist is more likely to be able to take on the additional behavioral supports more easily than a plain old pediatrician.

sarahsweets
04-21-16, 02:54 PM
Thank you all for your input it has been very helpful to read.

I spoke with both a potential Psychologist and our Pediatrician about how to proceed. Our pediatrician says he can evaluate our son in an office visit. I asked how he does the evaluation and they said its a physical exam plus the questioners for parents and teachers and that's it. With just that he will prescribe medication. This actually bothers me a bit since everything Ive read says that is a really bad way of evaluating. We are not looking to ONLY give meds either. We are hoping for other options and the possibly combining with meds.
Then the clinical psychologist is a PhD. She has lots of experience with ADHD. Seems to be highly recommended in the area. She will do an interview evaluation, the parent/teacher questioners and also a TOVA test (test of variables of attention). She will give a full report with recommendations. She also will work with our pediatrician if we want to try meds. She says they have options that they like to try before meds if that is what we choose. I'm planning to ask if they can do an IQ test as well because he is super smart and its been mentioned to me that giftedness can mimic ADHD at times and he is always very bored with school because its so easy for him.

Right now, Im feeling like I should just go to both doctors. I can get him evaluated like I want with the psychologist and then have the pediatrician check him over so we have a record of it if we want to try medication.

be careful with that part. Remember she wants her part in this too. If meds solve everything she may feel that she needs a reason to keep you on. Just saying, meds are a first line treatment. But they are a first line treatment WHEN combined with things like therapy and behavior mods(imo) which she should be good with. As long as she knows you are open to both and you know you might want both it could work out beautifully.

Hiddencreations
04-21-16, 05:28 PM
That seems like a great plan!

It sounded like you were on the border between wanting to try medication, so it seems like the psychologist's philosophy, or standard plan, fits or works with your course of thinking. You have the option of a lot of different resources and services, which is always a good thing.

The great thing about psychologist who specialize in ADHD, and are working in tandem with a developmental (or any) pediatrician, is that they tend to have a lot of knowledge about medication and different conventional and unconventional combinations just from being in practice a long time. My psychologist knows a lot about ADHD medication because she specializes in development and neurodevelopmental disorders.

Also, depending on how often you see her, it can be a good way of getting an outside perspective of the effectiveness of medication or if there are any areas to work on socially or emotionally.

---

Giftedness can mimic ADHD, but you can also be gifted and have ADHD (schools call it Twice Exceptional). And even if it's not giftedness, she should be able to provide the school recommendations for keeping and maintaining engagement.

Has the school noticed that he is bored or unchallenged academically?