Today, I learned that I am too quick to try to fix things. It’s incredible how much information gathering is needed to properly assess a child. And in this process, we build rapport and empathize with the parent and patient. But right now at this stage in my training, I still find it really hard to resist the temptation to jump into treatment.
And well, as with most things memorable, I learned it the hard way today that if you don’t have the whole picture of a child’s life, you can’t come up with an appropriate plan. Without a good plan, you won’t get the parents on board to implement the plan. The patience required to gather this data is one of the hardest things transitioning from adult to child.
I am also realizing a big distinction that needs to be made in childhood psychiatric disorders; mood disorders versus behavior disorders. This goes beyond just selecting the appropriate treatment plan. The sheer amount of outpatient resources for mood disorders (or ADHD) compared to behavioral issues is staggering. Hospitals are hesitant to take kids with behavior disorders. Schools don’t have support resources for them. And ODD/Conduct disorder kids are labeled “bad kids” and not getting the help they need, even though ADHD is frequently comorbid.
Not to mention systemic racism affecting diagnostic bias in children of color. African American and Latinx kids have disproportionately higher rates of conduct disorder(1). I had a 12 year-old child of color the other day who could barely read, and he was diagnosed with only ODD. Only ODD?! No 12 year-old child who cannot read has only ODD. It just broke my heart.
Another challenge with kids is that therapy is literally first line for everything. Except ADHD. And therapy is so funny. Some days you feel like you have accomplished absolutely nothing and your patient is stuck. Other days, suddenly a switch turns on and they see everything. I have to admit that most of the time, I don’t really have a conscious awareness of what I am doing in therapy. I do have an intuition though, and I think it’s going ok because I sense a mutual understanding and connection. I just have to learn to articulate it better.
In any case, my brain is so full of learning new things that I don’t know how to handle it sometimes. All I know is that I love this job and can’t imagine doing anything else.
- Fadus, M.C., Ginsburg, K.R., Sobowale, K. et al. Unconscious Bias and the Diagnosis of Disruptive Behavior Disorders and ADHD in African American and Hispanic Youth. Acad Psychiatry 44, 95–102 (2020). https://doi.org/10.1007/s40596-019-01127-6
The Good Enough Psychiatrist 