My son was recently diagnosed with ADHD. His pedi seems to not be very knowledgable on the subject. There has obviously been an issue since infancy. He spent the first year trying to give me warmed over parenting advice, then spent the next 2 convinced it was autism, even after early intervention and a private neurologist said no. For the next couple of years after that he speculated that my son was bi-polar but would not give me a referral. I get the sense he might not even know of a good child psychologist or psychiatrist! I had to strike out on my own to find help with this, which was difficult without the "golden referral slip." I've been looking around for a new pediatrician, but also wondering if I'm expecting too much and will be equally disappointed elsewhere. Any words of wisdom?
No, my insurance does not require it, but some places were still concerned that the insurance would not pay out without a referral slip. In some cases there was no receptionist and I was unable to ever get a return call.
Does a developmental Pediatrician only deal with behavior issues, or do they take routine sick visits too?
A pediatrician should know enough to refer you to someone who specializes in whatever developmental or behavioral concerns there may be. They should not be "diagnosing" anything like you describe. I'd find a new Dr.
My daughter was given a diagnosis of "mild inattentive ADD" based on two questionnaires. To me, that is not enough to give a diagnosis of anything and from everything I've read, her behaviors are similar to some ADD behaviors, but are more likely a learning style issue and not ADD. I don't feel like the ped. knew much about it, but she did refer me to a good doctor who does and who agreed that the label is not really appropriate for her (and about 80% of ADD cases are not truly ADD). I think most general practitioners know very little about it. I don't expect the doctor to know everything, but I do expect her to admit when she doesn't and find someone who does.
A pediatrician only needs to know enough about those disorders to recognize when he needs to make a referral. He may not know of specific individuals with whom to refer you, tho he should have access to a directory.
Do you have to have a referral to a specific doctor for your insurance to pay for it? I'm not familiar with that process. My insurance has never required that.
Since you're considering a different pediatrician find a developmental pediatrician. They are trained specifically to deal with developmental issues. They case manage for referrals and follow up. They will know of specific people and specific services.
A developmental pediatrician only deals with developmental issues. Behavior is just one. Think developmental milestones. They do not deal with sickness. My grandson has 2 pediatricians; one for development and one for sickness.
We struggled with similar issues until we discovered the developmental pediatrician. She's been of really good help. She referred him to specific clinics for a whole battery of tests. Those clinics recommended certain treatments which insurance then paid for. She sees him quarterly to evaluate how he's doing.
You are right on.
A GOOD pediatrician will know his/her limitations and will refer to a specialized professional.
I am in a similar situation, only my child's pediatrician will refer out with some pressure. When she refers me to someone/some facility that has a mediocre reputation, I'll do my research and then call back with a specific request for a referral that would be more useful.
I'd switch if she BOTH lacked knowledge and thwarted my attempts in gaining professional opinions. So far, she's just a decent pediatrician with little bedside manner, but she isn't hesitant when handing out referrals. So we stay with her.
Best of luck in finding the right team for you child. I applaud your efforts - misdiagnosis (and mismanagement of medications/treatment plans) can be extraordinarily dangerous.
As an aside, have you read, "You Mean I'm Not Lazy, Stupid, or Crazy?"
It's written for adults with ADD, but as a mama (with ADHD-c) and as a parent of a (possibly) ADD kiddo, I've found it to be an essential resource.
I have never asked my pediatrician about psychiatrists because he wouldn't know my insurance. You can see which ones are covered and ask him about them but when it comes to mental health the system is a mess.
Generally a pediatrician shouldn't know a lot about ADHD or Autism. Just like they know little about brain surgery, ya know?
my sons ped knew that he was out of her level of expertise so she referred him to a psychiatrist. since he never sees her for anything except well child/sick visits ALL his psychiatric health is done only through his psych dr. it was my understanding that pediatricians shouldn't diagnose adhd and related issues in children. but like you i didn't need a referral just verification of mental health benefits to get my son into a psychiatrist. so if you can contact your insurance they will tell you ones that are in your area that deal with children. good luck
Get a new pediatrician! He's telling you he sees there's a major problem, but isn't willing to refer you to get help? My pediatrician for my oldest didn't agree with me when I suspected sensory processing disorder (she'd only heard of defensive behaviors, not sensory seeking), but she still gave me a referral. Have you asked for a referral and the Dr. said no? Or are you just waiting for him to offer a referral? If you haven't asked, and your insurance doesn't require it, he may assume you don't need a referral. Either way, get away from this pediatrician as fast as you can!
Once my Ped noticed that DS was having trouble with school and after talking with me about other issues she referred my out. It's what I would expect her to do.
Wow, time for a new pediatrician. I'd have no faith in him if he'd suggested such varied conditions, but refused to give you a referral. Sounds like he isn't even confident in his OWN judgment.
You are NOT expecting too much.
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I would definately switch doctors. Pediatricians should at leasy have a working knowledge of ADHD, autism, bi-polar and all the different disorders. This Dr. doesn't seem to have the knowledge and it is making you jump through hoops to get the correct diagnosis, and you don't seem to have trust in his diagnosis being correct. We switched peds when my daughter was 5 and I loved her, but she made some questionable calls and I realized I needed a doc that I trusted.
Good luck getting the proper diagnosis.
A pediatrician is not who should be prescribing meds or evaluating your child for ADHD. A licensed psychologist who does testing as their profession will be able to do a deep accurate eval and make the proper diagnosis.
They are "the" professional that this is what their degree is all about. A pediatrician is for a lot of kids things, like a family doc is. They just treat short younger people.
I purposely chose our pediatrician because his profile on Kaiser's site mentioned ADHD as a special interest of his (at the time, our son was showing extreme behavior, so I thought he'd at least have ideas that could help us). He didn't diagnose or treat our son's ADHD, but when it came time to get real help for our son's issues, he knew right away there was a problem and sent us to a specialist.
Pediatricians in general won't be very knowledgeable about specialized conditions, but should be able to recognize warning signs and point you to experts who are in a position to diagnose and treat. It sounds like your pediatrician was awful and it's definitely time to move on. Not all pediatricians are that bad.
When my son had issues his dr. told me i should quit my job and home school him so that he wouldn't have problems at school. He also walked up to my son and told him that he would help him because he knew how no one else was doing it. he didn't want to refer me either. i finally got the school to help me do a referral that's how bad it was. the SCHOOL wanted him to have a referral. I haven't been back to that dr. since, he was horrible. he kept telling me it was all my fault. it was horrible. My son really is Bi-Polar. Find a new pedi. or go through the school or call your county. anything.
There are many pediatricians who are more informed than your's is on ADHD. Many evaluate and treat it successfully. For those who decide not to treat it should have a list of referrals for you. You would need a child psychiatrist or neurologist to prescribe medication; a psychologist or MD could diagnose.
A little about me: I'm a child, adolescent, and adult psychiatrist, in practice 17 years, currently in Menlo Park. I have a 21yo son and 15yo daughter (and a husband!) with ADHD. I treat a lot of it. It would be in your son's best interest to get him evaluated and treated early in his school career.
Our pediatrician did the diagnoses and seems to be extremely knowledgable. She is also very young. I would be willing to be that the younger docs are going to have more experience doing the testing and diagnoses themselves. I am also willing to bet some of the "more mature" docs out there still think only a trained psych dr. can diagnose and treat it. I would look for a new dr.
ALL decently trained pediatricians should be able to suspect and/or diagnose ADHD. If they keep up to date, there are even special questionnaires that they can have in the office that the parents and teachers are supposed to fill out, are easy to score, and aid greatly in being able to diagnose ADHD, or ADD. From there, it depends on how comfortable they feel with treating it themselves, which a lot of people do, or referring to a specialist, be it a pediatric neurologist, psychiatrist, or most likely a Developmental pediatrician. Things have changed and you no longer even need a referral to see a psychologist, you just look up who is available in your health plan and call them directly, if you want to get help in terms of how to deal with some situations/counseling/coping. To me it seems you just need to look for another pediatrician, period. Ask your family and friends and neighbors if they have someone they like and recommend and try it out. You might need to shop around for a while, but you'll eventually find someone that fits. As mentioned before, the developmental peds deals only with the behaviorla issues, for physicals and sick visits you need to go to a regular pediatrician. As for the person who recommended going to a family practice doctor, that I would not necessarily recommend; it would depend on how old your child is. Many of them don't see little kids, many start seeing kids at 10 or 14 years old, because kids are not mini adults, and they don't feel very comfortable dealing with them. Besides, they never have the same trianing than a pediatrician, after all, out of their 3 years of residency, they see about a fifth or so of peds than what a pediatrician does, since most of their rotations are internal medicine, as well as some OB/Gyn. Good luck.
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