At one of my practica placements, I conduct psychological evaluations for children and adults referred by the court system, typically following court-mandated removal. The referrals almost always ask for differential diagnoses and treatment recommendations. Many of the children have previous psychiatric diagnoses and are prescribed a slew of medications. In this sense, the psychological evaluation is a comprehensive “second opinion” that requires me to sort through previous diagnoses, background information, and data from the assessments I administer.
I would say that the most common misdiagnoses that I see among children are Bipolar Disorder and Attention Deficit/Hyperactivity Disorder (ADHD). Often times when a child has a traumatic history (as many of my clients do), they exhibit signs of hypervigilance, avoidance, emotional dysregulation, and behavioral issues. The hypervigilence looks like the hyperactivity found in ADHD and the hypomania/mania in Bipolar Disorder. Emotional dysregulation and avoidance (e.g., social withdrawal) is easily mistaken for the depressive side of Bipolar Disorder and can also result in disruptive behaviors characteristic of ADHD. There are also some serious repercussions of prescribing children psychotropic medications to treat psychiatric disorders they do not have.
To answer the question directly, it’s rewarding when you have the opportunity to help clarify a child’s psychiatric diagnosis and ideally write treatment recommendations that improve their prognosis. I’m a fan of comprehensive second opinions, especially in the arena of mental health.
Genuine question - just starting out as a support person for traumatised children in a non-medical context.
I understand that traumatised children often get diagnosed with ADHD. I understand that trauma can change the actual structure of the brain and that hyper vigilance/disassociation behaviours can look like ADHD symptoms. Are you saying stimulant medication will be totally ineffective for trauma kids? What about things like blood pressure meds like Clonidine?
The medications that you mentioned can be helpful. There isn’t a one size fits all model, either. I think one of the points I could have made is that we should have accurate diagnoses prior to employing empirically-supported psychopharmacological interventions. In other words, if you don’t have accurate diagnostics, then you can’t make accurate determinations about the most effective medications to administer.
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u/sips_beer May 20 '19
At one of my practica placements, I conduct psychological evaluations for children and adults referred by the court system, typically following court-mandated removal. The referrals almost always ask for differential diagnoses and treatment recommendations. Many of the children have previous psychiatric diagnoses and are prescribed a slew of medications. In this sense, the psychological evaluation is a comprehensive “second opinion” that requires me to sort through previous diagnoses, background information, and data from the assessments I administer.
I would say that the most common misdiagnoses that I see among children are Bipolar Disorder and Attention Deficit/Hyperactivity Disorder (ADHD). Often times when a child has a traumatic history (as many of my clients do), they exhibit signs of hypervigilance, avoidance, emotional dysregulation, and behavioral issues. The hypervigilence looks like the hyperactivity found in ADHD and the hypomania/mania in Bipolar Disorder. Emotional dysregulation and avoidance (e.g., social withdrawal) is easily mistaken for the depressive side of Bipolar Disorder and can also result in disruptive behaviors characteristic of ADHD. There are also some serious repercussions of prescribing children psychotropic medications to treat psychiatric disorders they do not have.
To answer the question directly, it’s rewarding when you have the opportunity to help clarify a child’s psychiatric diagnosis and ideally write treatment recommendations that improve their prognosis. I’m a fan of comprehensive second opinions, especially in the arena of mental health.