# Paediatrician v Child Psychiatrist



## Wyxie (Apr 10, 2013)

I've cross posted this from AUK, as I know some people here have professional involvement with children's services, and wondered if anyone had any thoughts.

We are trying to get some help for our daughter Wyxling.  We have private health insurance which we have found out will fund two consultations with an appropriate expert, they said it would likely be a paediatrician or a child psychiatrist, in order for them to reach a diagnosis and suggest a course of treatment.  They would then tell us if the treatment was something they would fund.  Although there are some exclusions regarding development issues, actually they would cover a lot of the things we're concerned about including attachment disorders.

I went to the GP today in the hope of getting some sort of referral for her to mental health services.  The GP, not particularly helpful in general it has to be said, was very reluctant and would only really discuss a possible referral to a Community Paediatrician.  I mentioned us having private health cover through my husband's work and she was quite hostile and questioned why I would want to use that.  I resisted the urge to suggest that 2 1/2 years of banging my head against a brick wall trying to get help for my daughter might be why we would seize any possibility of help as I guess this isn't the best person to aggravate at the moment.  She was clearly quite dismissive of the extent of Wyxling's problems, as she generally is, and as I need to take Wyxling back to see her before any referral can be discussed further I don't imagine that will help.  Wyxling presents very, very well to strangers.  

Anyway, I guess I want to go back to the GP next week armed with the right information.  I don't feel the Community Paediatrician (or a Consultant Paediatrician if we went down the route of using our health insurance) is the right way to go.  In fact I am very concerned it's going to lead to an incorrect diagnosis of ADHD or Autism.  Even in the many and varied forms I've looked up which have been helpfully suggested by several people, it just doesn't seem to ring anything close to true for Wyxling.  She has no development delay at all, no special educational needs, in fact quite the opposite.  She has massive control issues, some self-regulation issues although she is improving in that area, and I'm sure a lot of her disturbing and difficult behaviours and difficulties come as a result of early trauma.  

But we are also increasingly worried she has underlying mental health problems and more than anything we really strongly feel that, whatever the diagnosis, the only help to Wyxling (who is 4) would be play therapy with someone who is an expert in children's mental health and who can start to unpick the very complicated mess that is going on in her extremely bright little head.  This sounds like it is something that our private health insurance would actually cover, but only if we can get an appropriate referral from a GP to a professional who "gets" the complicated situation and makes the appropriate referral onward.  I'm not sure a Paediatrician is the right person to do that.

So I guess what I really want to know is what people's experience of Paediatrician are set against experience of mental health services.

Thanks,

Wyxie xx


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## GERTIE179 (Apr 20, 2005)

Hey

Again big hugs to you guys as I think you're doing an amazing job in tough circumstances.

I rate my Consultant Community Paed. They are clued up on our issues and whilst they lean towards ADHD/autism, they've been a great catalyst for us in accessing services and signposting things.

In my area, I rate our LA's educational phychologist and they come along to our post adoption support teams. This is where I would turn to if in your shoes currently (need to go through post adopt support to get it). I'm waiting in my next appt with Paeds to support our request just to beef up (our post adopt support has been ok).

In your shoes and from what you've said re PAS etc, I'd be inclined to see if the GP would refer to PAC/Chrysalis/Family Futures about a Mental Health Assessment or Family therapy or even look at an initial consult (some of these can be free). 

If I'm honest I really don't know if a phychologist would be able to do much in isolation and certainly in my area you can't go to CAMHS without going through Community Paed at this young age (older ones get referred to educational phychologist here first).

Really hope you get somewhere with it all as it really is a minefield. Could AUK support helpline help with guidance?
X


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## Wyxie (Apr 10, 2013)

Thanks for the information.

Just to clarify that if the GP made the referral using the NHS it would be either Community Paediatrician or CAMHS for mental health.  They're the only ways they'd refer.  However if they were willing to do either we could ask them instead to do an open referral either to a Paediatrician in stead of Community Paediatrician, or to a Child Psychiatrist instead of CAMHS, in order to get the consultation done through my husband's health insurance, and once they had given their opinion on treatment, depending on diagnosis, that would then be referred on to an appropriate person (e.g. play therapist). 

I'm not familiar with PAC, but we can't get a referral to Chrysalis or Family Futures in our area - no funding.  :/  

PAS in our area is pants.  We do have a meeting with a new SW next week but I'm trying not to get my hopes up.


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## GERTIE179 (Apr 20, 2005)

I'd be inclined to try getting the referral for the child psychologist (private) or CAHMs then as based on what you've stated I think that's where your gut instinct is telling you.

The Comm Paed and indeed a private Paed is likely to focus on behavioural traits and health issues whereas being referred for a Pysch is leading to the fact you feel it's trauma/history related. Whilst there's every chance some of it may be genetic (especially as you're seeing different difficulties with Bladelet), this may not bring about the help you feel you need now.

Hope this helps but I will admit I've no knowledge over the differences or anyone accessing help still at preschool years.
X x


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## crazyspaniel (Sep 12, 2012)

Wyxie,
Sorry things are so difficult at the moment...
I don't know what the answers are but our experience was an initial referral to cahms was unsuccessful, they refused to see dd and pointed us back to pas for parenting advice.
Next dds sw asked a specialist play therapist to see us, initially she was reluctant to take us on due to geographical constraints so she offered over the phone advice... she suggested a basic parenting course and tried to tell me that when children bite themselves they don't bite very hard   ....
We are now being seen by a small therapeutic service that specializes in working with children in care and who have been adopted. Dd and I go to therapy weekly and there are extra evening sessions for Dh and I to discuss parenting strategies and generally process what's going on. Although progress is extremely slow as dd is so resistant there has been progress.
So I guess what I'm saying is psychologist is working for us at the moment although clearly there may be more to her difficulties than early trauma..!
Cs x


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## Mummy DIY Diva (Feb 18, 2012)

In response to your gps stupid question I would say when work will cover private treatment it seems irresponsible to take up an nhs spot when the nhs is so over burdened.  Obviously the nhs is a wonderful resource but it seems cruel to waiting children and parents to take a place out of principle and prevent another child getting treatment asap when work are paying for this. What an absolute tool you poor thing.  

I would ask what experience they have with children in Wyxlings position.  Obviously seeing a throat specialist for a broken leg won't help.  I think people including gps are very ignorant.  Mu friend who is a gp said at no point in the last ten years of her medical training has adopted patients ever been discussed as a unique patient group.  

My gut would say psychological team personally.  I'd perhaps ask / try and find out what both teams are able to diagnose. I'm not a health expert but is there some kind of funding body you can call and chat to informally so you know your rights.  If you push and complain can they ultimately say no? Will pre school write a report to support your request I did this a lot as a teacher.  I know they don't see all you do but I think you said her behaviour is getting more challenging there. Hugs xx


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## Handstitchedmum (Mar 24, 2013)

I still maintain, you need to see a consultant child psychotherapist. They are the ones most likely to 'get' Wyxling and know how to treat her. The earlier she accesses therapy, the better.


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## NancyS (Oct 16, 2013)

It probably won't make a huge difference as there is a big crossover between community paediatrics and CAMHS/child psychiatry.  However, if there are no developmental delays and no speech or language difficulties - mental health services might the best place to start.  

Seeing a child psychiatrist will likely be a different experience than just being referred to CAMHS.  If referred to CAMHS, you are frequently bounced back to other services and it is unlikely that you would be seen by a psychiatrist at first appointment.  Many of the child psychiatrists I know, have also got fairly extensive paediatric experience and have often done some paediatric training prior to training as a psychiatrist - and they can all diagnose/rule out ASD/ADHD, as well as considering trauma.  

I would have a look at what your local private services offer and take it from there.  Your GP also sounds very unhelpful, is there a different GP that you can see?


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## Lorella (Jan 10, 2013)

Hi Wyxie
It might also be worth googling 'family support workers'. I don't know what area you are in but in our area they have been lottery funded and they are a free service. Its basically someone who can come into your home and give you support and advice. They can also make referrals to child therapy services. 
I don't know if this is just in our area though but thought it might be worth mentioning so you could have a look just in case. 
Xx


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## Flash123 (Jan 29, 2006)

We have just had a young LAC diagnosed by CAMHS as having Attachment disorder caused by trauma and neglect. I have been SENCo for over 15 years and this is the first time I have seen this diagnosis first hand.  Paed pushed for an Autism diagnosis. thankfully CAMHs seem to be  finally opening their eyes to the  world of trauma and neglect. 
Stepping Stones Cardiff gave excellent advice as to which channels to proceed with.


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## Mummy DIY Diva (Feb 18, 2012)

That's interesting flash thank you for sharing xx


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## Wyxie (Apr 10, 2013)

Thank you everyone for taking the time to reply.  

I think I need to get the names of the pediatricians / psychiatrists that the insurance would fund and investigate what their areas of speciality are, but in general I do think that mental health would be the way to go.  Community Pediatrician would be great for Bladelet though who is a completely different fishy!

We did used to have FSWs in our area, I think we still do, but I think we're really past that stage now.  Wyxling's problems have been ongoing for some time.  The way they're showing themselves is evolving as she gets older, but the underlying issues are probably the same.  I'm being pretty firm that I'm not being palmed off with supposed "support" or "advice" for me.  Support and advice for us would be great, but only if it comes as part of a "package" which includes properly qualified medical/therapeutic support for Wyxling.

I think it's unlikely I'll get a mental health services referral tbh from the GPs attitude, but I will make a case for it.  I'm hoping she will at least make a Pediatrician referral, although it would not surprise me if she decided not to after meeting with Wyxling.

All the best,

Wyxie xx


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## bulmer (Sep 5, 2010)

Hi
I know this is unusual and not popular with GPs at all but have you tried to bypass them and contact CAMHS unit direct.  They will turn you down at first and you will have to make a bit of a nuisance of yourself but it can be effective - even if they see you briefly to get rid of you at least you can find out who the staff are and what specialisms they have. I have dealings with our local unit through work and to be honest the support staff there are fabulous at giving advice on how to get the referral you need - a good receptionist or secretary can provide you with so much information as they know all the local contacts.
Good luck


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## Mummy DIY Diva (Feb 18, 2012)

http://www.theadoptioncounselor.com/pdf/Attachment%20pamphlet.pdf

This may or may not be helpful (I've not read it yet fully just a skim while googling). It may or may not be American too which might not help. However page 5 it says that an attachment disorder can only be diagnosed by a Child Psychiatrist. Counsellors, therapists and other doctors don't have the ability to diagnose. xxx

/links


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## Wyxie (Apr 10, 2013)

I would guess from the spelling and wording it is American, but it's a really interesting article.  Thanks.  xx


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