Jacqueline M. Amato, MD
Child Psychiatrist
Springfield, Oregon, USA
Email: [email protected]
Date First Published: August 15, 2007
The course of treatment for children with autism is a complicated path. Often, the most comprehensive and effective treatment for any person with autism requires a team of providers. Parents (and guardians) play a crucial role in navigating this complicated maze and advocating for their child. They are tasked with assembling an appropriate team, making decisions about when to call upon a particular provider, making judgments about the appropriateness of individual providers, finding the money and time to see the various providers, and making changes to the team depending on the issues that the child is facing at different points.
A child and adolescent psychiatrist can play a key role in the lives of some children with autism. But, what is the role of a child and adolescent psychiatrist and when should parents engage one? The decision to see a psychiatrist involves knowing when you are in over your head, trusting your gut, and listening to others both inside the family and out. This decision is difficult, but must be made when raising a child with autism.
Child and adolescent psychiatrists diagnose and treat any psychiatric problems that the child with autism may exhibit. The child psychiatrist also continues to provide supportive care and medication management after the initial diagnosis.
The start of the treatment of psychiatric disorders generally begins with your pediatrician — the person who examines your child on a routine basis. If your child’s behavior begins to change, if he/she experiences episodes of rage and/or out of control behavior, or if he/she exhibits self-injurious behavior, you should contact your pediatrician. You and your pediatrician can then decide if further referral is warranted or if other tests need to be done.
When should parents seek out a child and adolescent psychiatrist?
First and foremost among the red flags is safety! Other red flags include:
- An increase in the child’s episodes of loss of control
- Appearance of physical aggression toward self or others
- Verbal escalation that evolves into uncontrollable screaming
- Prolonged verbal and physical rages
- Fear is another primary motivating factor. Are you fearful of the child and his or her behavior with siblings? Is the hair on the back of your neck standing on end when the child’s behavior escalates? Do you ever wonder how long you can go on living like this?
When should pediatricians and other care providers refer their patients to a child and adolescent psychiatrist?
- When the number of calls to the provider from a parent in distress about the child increases.
- When there is an observed or reported negative change in the child’s behavior.
- When the child with autism can be heard screaming in the background when parent makes a phone call for help.
- When multiple messages of concern from other sources such as teachers, day care providers, and grandparents, further help may be necessary.
- The treatment of autism is best served using a multidisciplinary approach. The components of the team may consist of learning specialists, developmental pediatricians, child neurologists, speech pathologists, occupational therapists, and child and adolescent psychiatrists. Again, the child and adolescent psychiatrist will diagnose and treat any psychiatric issues that the child with autism exhibits and continue to provide supportive care and medication management.
Psychiatric diagnoses may be complicated by the child’s inability to communicate verbally or unusual symptom presentation. Many of the issues that children with autism experience do not fit into neat diagnostic boxes or fit the ‘formal criteria’ for one specific psychiatric disorder. In these cases, parents should identify the most incapacitating symptoms first and present these to your child psychiatrist for initial treatment recommendations.
One of the most important factors when working with a child and adolescent psychiatrist is trust. This psychiatrist may be in your lives for many years and one needs to feel quite comfortable when entrusting one’s children to their care. The child with autism may need medication and or other treatments that the psychiatrist prescribes. Open communication between you, your child and the child and adolescent psychiatrist is paramount to the success of any treatment plan.
Additional Resources:
When a Psychiatric Crisis Hits: Children with Autism in the Emergency Room
What is a psychiatrist?
Psychiatrists are medical doctors who have undertaken further study in mental health, and specialise in diagnosing and treating people with mental health conditions, such as schizophrenia, depression, bipolar disorder, eating disorders and addiction.
The same way as a cardiologist is a specialist in cardio-vascular health and a gynaecologist is a specialist in women’s health and reproduction, psychiatrists are medical specialists that specialise in mental health conditions.
What is the difference between a psychiatrist and a psychologist?
Psychiatrists are medical doctors and are permitted to prescribe medications. Psychologists are health professionals who also study the human mind but use psychotherapy – sometimes called cognitive therapy or ‘talk’ therapy – to help people find solutions to relationships, learning, performance in a range of areas, and life’s challenges.
How can psychiatrists help people with autism?
Some Psychiatrists have an interest and expertise in autism, gained through additional study and clinical experience.
A General Practitioner (GP) or other health professional may refer the person to a Psychiatrist if they suspect they may have autism, or have concerns about their mental health. Self-referrals can also be made to a Psychiatrist.
Psychiatrists may also be referred by your GP or other health professional to support areas including mental health conditions.
Specifically, psychiatrists can assist people with autism, or who are suspected of having autism, with the following professional services:
Assessment
Psychiatrists can assist in the assessment and diagnosis of autism. A psychiatrist will usually work in a diagnostic team, with a paediatrician, psychologist and/or speech pathologist to diagnose Autism Spectrum Disorder (ASD). Diagnosis is based on observing a specific combination of behaviours. Psychiatrists can also assist with managing the mental health of a person with autism, or who have suspected autism.
Assessments can occur at any point in a person’s life to ensure their behaviours are understood and that they are being supported appropriately. Assessments can involve input from other health professionals.
Intervention
Develop treatment and support interventions plans, which may include medication, and therapeutical supports and services.
Medication
Prescribe medication if required.
Referral
Refer the person to other medical specialists such as neurologists and paediatricians and/or allied health professionals such as occupational therapists, psychologists and speech pathologist.
Connections
Psychiatrists have a deep understanding of the medical and health system and can provide connections with a range of health and community services.
Reports
Prepare formal reports and professional opinions for schools, employers and other doctors and specialists.
How do psychiatrists provide their services?
Most people will meet a psychiatrist for the first time after a referral from their GP.
They will often participate in an in-clinic individualised assessment which can be followed by counselling and therapy sessions. This first assessment may lead to a long-term relationship where the psychiatrist can monitor progress and adjust treatment programs and medications.
Where do psychiatrists practice?
Psychiatrists work in private practices or in clinics, hospitals and community mental health services. You can find out more about psychiatrists who may have specific experience with autism from your GP.
What training do psychiatrists undertake?
Psychiatry is a regulated health profession. It is a medical specialisation that can take more than 11 years to complete. This includes a university medical degree, followed by general medical training in a hospital, and then at least five years of psychiatry specialty training, supervised by the Royal Australian and New Zealand College of Psychiatrists (RANZCP).
To make autism diagnostic assessments, they may also need to complete additional professional development requirements.
What does a psychiatrist cost?
Psychiatrists are medical specialists who set their own fees. It is best to enquire directly with the Psychiatrist to find out more about what you can expect to pay.
For more information about the funding options that may be available to you please visit our financial services page.
Further information
For more information about psychiatry and where to find psychiatrist visit the official website of the Royal Australian and New Zealand College of Psychiatrists.
People of all genders, races, ethnicities, and economic backgrounds can be diagnosed with ASD. Although ASD can be a lifelong disorder, treatments and services can improve a person’s symptoms and daily functioning. The American Academy of Pediatrics recommends that all children receive screening for autism. Caregivers should talk to their child’s health care provider about ASD screening or evaluation.
Autism is known as a “spectrum” disorder because there is wide variation in the type and severity of symptoms people experience.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a guide created by the American Psychiatric Association that health care providers use to diagnose mental disorders, people with ASD often have:
Autism spectrum disorder (ASD) is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a “developmental disorder” because symptoms generally appear in the first two years of life.
People on the autism spectrum also may have many strengths, including:
People with ASD have difficulty with social communication and interaction, restricted interests, and repetitive behaviors. The list below gives some examples of common types of behaviors in people diagnosed with ASD. Not all people with ASD will have all behaviors, but most will have several of the behaviors listed below.
Researchers don’t know the primary causes of ASD, but studies suggest that a person’s genes can act together with aspects of their environment to affect development in ways that lead to ASD. Some factors that are associated with an increased likelihood of developing ASD include:
Diagnosing ASD
Health care providers diagnose ASD by evaluating a person’s behavior and development. ASD can usually be reliably diagnosed by the age of two. It is important to seek an evaluation as soon as possible. The earlier ASD is diagnosed, the sooner treatments and services can begin.
Diagnosis in Young Children
Diagnosis in young children is often a two-stage process.
Stage 1: General Developmental Screening During Well-Child Checkups
Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children receive screening for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits, with specific autism screenings at their 18- and 24-month well-child visits. A child may receive additional screening if they are at high risk for ASD or developmental problems. Children at high risk include those who have a family member with ASD, show some behaviors that are typical of ASD, have older parents, have certain genetic conditions, or who had a very low birth weight.
Considering caregivers’ experiences and concerns is an important part of the screening process for young children. The health care provider may ask questions about the child’s behaviors and evaluate those answers in combination with information from ASD screening tools and clinical observations of the child. Read more about screening instruments on the Centers for Disease Control and Prevention (CDC) website.
If a child shows developmental differences in behavior or functioning during this screening process, the health care provider may refer the child for additional evaluation.
Stage 2: Additional Diagnostic Evaluation
It is important to accurately detect and diagnose children with ASD as early as possible, as this will shed light on their unique strengths and challenges. Early detection also can help caregivers determine which services, educational programs, and behavioral therapies are most likely to be helpful for their child.
A team of health care providers who have experience diagnosing ASD will conduct the diagnostic evaluation. This team may include child neurologists, developmental pediatricians, speech-language pathologists, child psychologists and psychiatrists, educational specialists, and occupational therapists.
The diagnostic evaluation is likely to include:
- Medical and neurological examinations
- Assessment of the child’s cognitive abilities
- Assessment of the child’s language abilities
- Observation of the child’s behavior
- An in-depth conversation with the child’s caregivers about the child’s behavior and development
- Assessment of age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting
Because ASD is a complex disorder that sometimes occurs with other illnesses or learning disorders, the comprehensive evaluation may include:
- Blood tests
- Hearing test
The outcome of the evaluation may result in a formal diagnosis and recommendations for treatment.
Diagnosis in older children and adolescents
Caregivers and teachers are often the first to recognize ASD symptoms in older children and adolescents who attend school. The school’s special education team may perform an initial evaluation and then recommend that a child undergo additional evaluation with their primary health care provider or a health care provider who specialize in ASD.
A child’s caregivers may talk with these health care providers about their child’s social difficulties, including problems with subtle communication. These subtle communication differences may include problems understanding tone of voice, facial expressions, or body language. Older children and adolescents may have trouble understanding figures of speech, humor, or sarcasm. They also may have trouble forming friendships with peers.
Diagnosis in adults
Diagnosing ASD in adults is often more difficult than diagnosing ASD in children. In adults, some ASD symptoms can overlap with symptoms of other mental health disorders, such as anxiety disorder or attention-deficit/hyperactivity disorder (ADHD).
Adults who notice the signs and symptoms of ASD should talk with a health care provider and ask for a referral for an ASD evaluation. Although evaluation for ASD in adults is still being refined, adults can be referred to a neuropsychologist, psychologist, or psychiatrist who has experience with ASD. The expert will ask about:
- Social interaction and communication challenges
- Sensory issues
- Repetitive behaviors
- Restricted interests
The evaluation also may include a conversation with caregivers or other family members to learn about the person’s early developmental history, which can help ensure an accurate diagnosis.
Obtaining a correct diagnosis of ASD as an adult can help a person understand past challenges, identify personal strengths, and find the right kind of help. Studies are underway to determine the types of services and supports that are most helpful for improving the functioning and community integration of autistic transition-age youth and adults.
