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<p>This is NOT necessarily true. An HMO psychiatrist actually may be in a much better position to prescribe meds, since they have so much experience doing so. Picking the right meds, adjusting them, etc. is an art that people develop with a lot of experience, and a psychiatrist who is mostly involved in therapy may not have that much experience.</p>
<p>“a psychiatrist who is mostly involved in therapy may not have that much experience.”</p>
<p>I think it goes without saying that experience is good. But if it’s my child we’re talking about, I want the doctor doing the prescribing to see him every week (at least). I want the prescriber keeping a close eye on side effects and their control as the dosage is ramped up. I want the doctor to see the child in person and notice if his color is funny or his affect is off. I do NOT want a prescription and a goodbye, no matter how experienced the doctor may be at this “art,” and no matter who else is also seeing the child.</p>
<p>^^This is perfectly reasonable, of course. I am just suggesting that there are some potential downsides to this as well. The main one being that the best therapist isn’t necessarily a psychiatrist. But obviously, you can’t have everything, you almost always have to compromise in one way or another.</p>
<p>You might need to be picking out doctors twice in the near future. Keep in mind that it will be more convenient to have a doctor near your son’s college prescribe the Concerta, as they can’t give out a year’s supply at one time.</p>
<p>NSM said it best many posts ago. Use referral surce for a psyciatrist that is knowledgeable in area of Asperger’s. Has he/she given a talk in that area? Perhaps a psychologist has lectured on this topic. Either way, one would provide a referral source for the other.</p>
<p>I attend psychopharm meetings 3-5 times a month, so I know which psychiatrists have experience with meds in this area. I also know the local PhDs who have 25 or more years of experience with Aspergers. Don’t hesitate to ask the professional if he/she is knowledgeable in this field, or can they refer you to people who are.</p>
<p>In addition, if you do go to first consult, ask what books they would recommend. The professional should be able to pull books off their bookcase to show you.</p>
<p>By the way, there are no psychiatrists in my location who provide drug therapy as well as counseling. I wouldn’t want a psychiatrist who rushed my son thru a session, but the training is different.</p>
<p>I agree that the director of the college counseling ctr would be a good source for referrals to both an MD and a therapist.</p>
<p>Bookworm gives good advice. If your son will be away at college, location is somewhat critical. Dealing with getting scripts written on summer breaks could be problematic as well. Perhaps your primary care could handle this if meds are stable.</p>
<p>College counseling center would also be a good source. If you can get a list of providers who have experience with Aspergers and run it against the college counselor’s list, you will likely find a good fit.</p>
<p>In our experience, our managed psych benefit (through one of the bigger national providers of this service) generally uses MDs only for pharma management and leaves the counseling to PhDs. Fortunately for us, the 2 providers work at the same clinic and can exchange notes freely, which in some ways is the best of both worlds. The PhD spends more time on behavior management with this population, while our MD has been quite involved in medication studies.</p>
<p>If you can find (and get the insurance to pay for) an MD who does it all, that is great too.</p>
<p>Keep in mind that you may need, if you can afford it, two professionals - one for the meds, one for therapy. Sometimes it’s possible to find someone who is good at both, but not always.</p>
<p>Re #20: I haven’t know anyone who saw a psychiatrist for therapy in the last 10 or 15 years. The arrangement that Northstarmom describes has been the norm.</p>
<p>Sadly, much of the shift in treatment approaches (ie MD does 15’ med checks, psychologist or MA level therapist does the therapy) has been driven by insurance reimbursement. There are still psychiatrists who do both therapy and med management, but it is likely that they do not accept insurance.</p>
<p>I totally agree that you should have Drs. close to his school, but that said, I do not think you should stall and wait 'til he starts school to start treatment. Transitioning to college is stressful enough for any student, not to mention one with Aspergers and/or comorbid depression. If he is stable pharmacologically before he goes to school, and has had a good therapeutic alliance with the Dr. providing therapy, these can be transitioned when he gets to school. Does the college he will be attending have special services for Aspie kids? What is available through their disability services and/or mental health services?</p>
<p>Lastly-
I totally agree that you should find someone who knows and understands Aspergers. If you find a psychologist first (you can call your state psychological association) you can ask them which psychiatrists they recommend. If you must stay with providers in your healthcare network, you might print out a list of providers in your area and ask your pediatrician and/or the psychologist if he/she is familiar with any or can recommend any. Good luck.</p>
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<p>The doctor not continuing care past 18 might be a general rule in the practice.</p>
<p>My daughter’s pediatrician cut her off at age 18 as she headed off to college. I got the distinct impression the doctor wasn’t interested in dealing with young adult medical issues any more than she had to and the end of high school seemed a good time to tell her patients that it was time to move on. She was wonderful and I had hoped that my daughter could stay with her ped. through college - it would have been much more convenient than trying to find someone new for a four year period when she would be away for a great deal of the time.</p>
<p>Anyone remember that episode of Friends where Ross was stll seeing his pediatrician?</p>
<p>Somewhere I have a list of questions we made up when we were looking for a Dr in a new location. I will do some searching this afternoon.
Having had experience with a few different psychiatrists I will offer some things I would think about.
Firstly how much can you afford to spend? Look into your insurance policy and see what they cover for mental health benefits. Look carefully because this might change when he turns 18. For some strange reason that we have never gotten a firm explanation for my son’s psychiatrist bills were covered prior to age 18 at one rate which was reasonable. After he turned 18 the insurance began using their clearly stated mental health allowance which limited the cost they would cover and the number of visits based on the diagnosis. (this increased our out of pocket expense per visit almost 300 dollars. Our insurance company clearly expects their clients to get their mental health needs met by MFT’s since they only will pay around 60 per visit. I don’t know anywhere you can get care for that price. The going rate for a psychiatrist in the 3 cities I have looked is now $275-$350 for 50 minutes. Be prepared for the first visit to be close to $500 since it is usually longer. This cost puts it our of reach for most people, especially for weekly therapy. Of the last 7 I have either used or made inquires about only 1 of them took insurance. And of the 3 we used he was the one we were the least pleased with. His visits were usually less then 15 minutes and he cycled people in and out quickly. I found for my child it did not give him the time to really talk with her to get a good feel for how the meds were working.
How much feedback to you as a parent want from the Dr. Especially with your child turning 18 you will no longer have any rights to talk with the Dr unless your son gives permission.
How easy is it to reach the Dr. Does he have a receptionist? Or do you leave a voicemail. Does he or she communicate via email. In 2 of our cases the Dr’s use of email was great. We could voice our concerns. And any quick med questions were answered promptly.
Also what is the Dr’s policy regarding what you say to them getting back to the child. 1 of the Dr’s we worked with was quite clear that any concerns we shared with him would be shared with the child. The other Dr we used was willing to take what we shared into account but not always share it with our child. Neither were willing to share any confidential info the child had shared and we were fine with that.
What is the focus of their practice? Is it mainly children and young adults or majority adults.
Are they willing to run prescription information with the parent? Do they consult the parent before making any med changes? We had one experience with one Dr who handled all the med changes with just my son without consulting us. How would you feel about that?
What is their approach to therapy?
In the 2 dr’s we have the most experience with the approaches were drastically different. One Dr was very traditional. His practice ran like clockwork. It worked for that child.
The other Dr was not in the least bit what you would think of as a traditional psychiatric visit. They talked, he did do med management but they also did alot of other exploration. They sometimes met in his office, sometimes outside on a patio, other times they would take a walk. He also pushed my son to find out more about himself. He helped him discover his passion and then found ways for my son to explore those passions. If my son had not gone to this Dr he would be studying Math or engineering instead of Art. He also worked on getting him to face his fears. It was not traditional and was not the least bit structured. But it worked great for that child. This Dr would have been an absolute mistake for my other child.
The point of that long story is what works for one child might not work for another. Also what works for the child might not work for the parent.
Unless you are in a large city I think it is going to take work to find the Dr that works for you. You might get lucky with the first one. It might take quite a number of tries. It might also take quite sometime to even get an appt.
Also as someone else pointed out you will probably need two people. One for meds and one for therapy. I also have found in that arena that what the license is doesn’t always make the best therapist. For my oldest child who has been through quite a few Dr’s and therapists the most effective for her was a Clinical Social Worker. Not the degree but the person made the difference.
As for meds in college. I think you are smart at this point (he is a junior?) to explore different meds. If he can have some stable time on the correct med before going to college the easiest way to get him meds is for you to get the prescription filled at home and then mail the filled prescription. For my son we found the health center did not carry controlled substances and the nearest pharmacy was 3 miles away. He did not have a car. It was easiest for me to just mail it.</p>
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<p>Ditto here. For 3 years, I hand-carrried a prescription monthly for a controlled substance from dr’s office to pharmacy to post office. It had to be monthly and hand-carried (no faxing to pharmacy) because of state laws. It had to occur on a specific date, not too early or too late, because of insurance.</p>
<p>Talk about having one’s life ruled by a drug! And I wasn’t even taking it. Still,
this was easier than finding someone in another state through a college health clinic. All that would have been would be an initial visit to a psychiatrist in her state, who visited her campus every two months; a faceless relationship to a prescription. I felt things were in better control from here. When the kid came home on holiday, we’d make a check-up visit for face-to-face. </p>
<p>It felt very strange, especially that part about mailing controlled substances across state lines.</p>
<p>Whoa! So many things to think about. Glad he’s just a junior!</p>
<p>Just an update in case anyone cares. Son had his (last) pediatrician appointment yesterday. My husband took him and asked for a recommendation for a psychiatrist. He came home with two pages photocopied from some directory and most of the psychiatrists listed provided “in patient” services. So much for the pediatrician’s recommendation!</p>
<p>The question to ask is “If it were your child, who would you take him to?”</p>