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Red Flags: When to take your child with autism to a psychiatrist

Jacqueline M. Amato, MD
Child Psychiatrist
Springfield, Oregon, USA

Email: JAmato@peacehealth.org

Date First Published: August 15, 2007

A photo of a boy with a fireman's helmetThe 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.

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Additional Resources: 

When a Psychiatric Crisis Hits: Children with Autism in the Emergency Room