View Full Version : Which doctor do I see first??

07-24-09, 09:43 AM
I have some questions about therapists and doctors and what order they need to be seen in ... here is my background first:

I'd say my son has a severe case of ADHD- combo type. He was diagnosed about three years ago and we are on the third medication = 70 mg of Vyvanse. The medication is not working as well as it should in that it controls the hyperactivity, but not the impulsiveness or the attention issues.

His pediatrician has been giving us the medicine, but with the last discusion about how it's not working to optimum results, he said that he is out of his expertise and that I need to work with a Child Psychologist for the medication if I want to try anything other than the newly perscribed 70mg of Vyvanse.

The pediatrician suggested Tyler see a behaivoral therapist to help with some of his issues. I contacted the recomended therapist and saw him a total of 3 times. Once with Tyler and I, and twice just Tyler. He told me Tyler was great and since he was on medication, he would only have to see Tyler a couple times. (and he never really did anything to help Tyler with his behaivor, I think he just talked about things with him but the therapist never touched base with me regarding what was talked about or things I could at home to help Tyler with his behaivor)

Then I got pregnant and was put on bedrest so I couldnt make the trip to the therapist. We always had trouble with scheduling too because I work full time, far away from home, in the opposite direction of the therapist office. .. so I had the baby and called back to make an appointment and the therapist never called me back. I took that as a sign that he wasnt the right therapist for us.

Tyler continued to have extreem difficulty at school. He can't get along with most children because he is very bossy and yells. He is like a mean police man. If he sees anything that is not right or he feels is against the rules, he flips out!! He acts like this to adults too.. no respect!

So, I get another therapist recomendation from the pediatrician. The first visit is the whole family - me, my husband, Tyler and baby Jason. He gives us evaluations and one for me to send to the teacher. It takes about 3 weeks for our next appointment which was to go over the evaluations and make a "plan for action" for Tyler. It comes out that since the ADHD meds aren't working as good as they should, he probably has other issues and it turns out he has Social Anxiety Disorder and possibly Sensory Integration Processing disorder. His father has Social Anxiety Disorder and ADHD also - ADHD is undiagnosed. He's on anxiety meds and is feeling much better now. I assumed Tyler would add anxiety meds too, but no one seems to want to do that at this point.

In Sept, his school is going to test him for Sensory Processing. He has an IEP at school already.

So, this therapist wants to see me and my husband for a 3rd time and at this appointment gives us a sort of action plan for Tyler .. set him up on a daily schedule for the summer. Put him in as many group activities as I can so he ca "practice" his social skills. Keep him busy, in other words. And, if things arnt going as we'd like he suggests we get him in for Neurological testing. He also suggested a med change. That is when I called the pediciatrician and he said he's beyond his comfort zone and I need to see a child psychologist.

So, a good 2 months have gone by and this therapist has yet to actually see Tyler!! Then, I call him after some very tough weeks with his behaivor that have caused me a complete breakdown. This guy tells me that he doesnt treat children this young and starts giving me a list of all different doctors and therapists to call! Why didnt he tell us this from the beging? Why did we waste all this time and $$ on him??!!

So, now I have a few people for each of the following catagories"
Neurological testing, phsyciatrist, child psycologist.

Which do I go to first?? Do I have to get the neurological testing done first, so we know exactly what he has, before we can get his meds straightend out, and then once that is done we start therapy?

My husband wants to skip all of it and order Total Transformation and just work with Tyler ourselves at home. But, I dont think I'm up for it.. I mean as it is, he causes me to tears at least once a week. He's soo bad. I think I'd like at least SOME sort of professional help! I'm thinking the neurological testing and medication but instead of therapy, seeing if the Total Transformation works... if not, then start therapy. (He also gets behaivoral therapy while at school so that would continue)

I'm just in so much over my head that I dont know what to do. I just know that I'm about days away from calling my doctor and asking for anti-depressants because this is taking such a toll on me I havent been happy for months.

HELP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !!!!

Lady Lark
07-24-09, 11:45 AM
I personally don't really think you need to see anyone for neurological testing, but that's my "not a dr" opinion. I would recommend finding a developmental pediatrician, and a play therapist. The DP is a medical dr, so medication can be prescribed (with psychologists can't), that specializes in early childhood development delays, and the issues that cause them. You'll get a full eval that will look at everything, not just ADHD, and they know the other kid dr specialists in the area, so can give you recommendations. (just a warning, they almost always have a waiting list, but I think it's worth it)

The play therapist I always recommend for ids, because your traditional "talk" therapy just doesn't work for small kids. A good play therapist will help him work on whatever issues he having, in a fun way so it doesn't seem like therapy.

That's my advice.

07-24-09, 01:48 PM
Remember one important thing. I psychologist can diagnose, but the cant prescribe medications. They also are not really trained to work with Psychiatrists, and tend not to tell their patients to see psychiatrists because of the risk of loosing them as clients. Although that is just a personal opinion of mine.

Your pediatrition is right in saying your sons problems are out of his league. You need to find a psychiatrist that specializes in children or even a doctor that specializes in childrens medications.

The anger that you talk about is not generally considered part of ADHD. In children, irritability can be a sign of depression. A good MD with experience in childrens psychiatry can help you find the right meds. I have one daughter that that was an incredibly angry bossy child. She now takes one small dose of Lexipro and she is a model child. (still a bit bossy and controlling, but more in a good way) Her anger used to affect all aspects of her life, and it was not going away. Forget about the therapists for a while, you need to find a good MD.

07-24-09, 02:04 PM
Forget about the therapists for a while, you need to find a good MD.

I agree that this is what's best right now.

07-24-09, 04:08 PM
Thank you sooo much .. so if I do a search for Developemental Peditricians, near Whitman, Massachusetts... I should find a list of them?! Then, call to make sure they take my insurance and try and make an appointment?

This is such a relief and sooo helpful. I really thought I had a good grasp of things a year ago, but things are spiraling out of control and I feel like I'm in over my head and I just dont know what to do. Now I have a good starting point! It's funny how the "professionals" can make you feel more confused and not know which direction to go to. It's great to talk to others that are in the same type of situation! Thank you sooo much!!!!!!!!!

Lady Lark
07-24-09, 09:36 PM,+near+Whitman,+Massa chusetts&fb=1&split=1&gl=us&view=text&ei=3WBqSqCdJIGuswOe7KSWBQ&sa=X&oi=local_group&ct=more-results&resnum=1
A quick google search and I found half a dozen, easy. Also, you can check with local children's hospitals, since many are associated with them.

One thing to keep in mind, for any doctor in any situation. You should always feel like they are there for you, and are willing to answer questions. It's even more important in cases like this. When we first saw the DP, it was a 2 hour visit, and it's at least 1/2 an hour now, even if things are going well, and it's just a med check. Having been the first DP I've dealt with, I can't say if this is a "trade" thing, or if we just lucked out.

07-24-09, 11:11 PM
With all due respect, in my now 32 + years of clinical practice, there has been only a 6

month time period in which I haven't worked with at least one psychiatrist;either directly

or as a consultant.

That simply isn't true;as applied to my professional experiences in TX.,NC.,GA.,or MN.

Even before starting my program,working in a residential treatment center in Texas, or

during my internship at a state hospital in NC,where there were obviously psychiatrists, I

have always worked closely with them.

That would also include working with my late father,who was a psychiatrist.

At the rural,non-profit, community mental health center in the midwest USA where I've

been for 25 1/2 yrs now, we have 3 psychiatrists and 3 Clinical Nurse Specialist's

(Master's level RN's who can prescribe under a psychiatrist's supervision).

I also refer out to the 7 or 8 other psychiatrists and the one pediatric neurologist within

about an hour away.

They have been equally kind as well.

While I am speaking about my own experiences,I can also say that the state of the

profession of the clinical practice of psychology today,especially as pertains to a child

specialty practice,demands a positive working relationship with the local medical


I again respect and appreciate the feedback herein, as well as the source(s).




07-29-09, 03:32 PM
I know I should not generalize. Also, in the scope of things my experience is very limited. There are probably a lot of factors involved. Like you mentioned, the training of therapists/psychologists varies by state.