Private diagnosis for schizophrenia?

[YouAreMyRain]

It's me again.
I have posted a similar thread in children's MH on here but there's not much traffic.
I thought some people on this area may (unfortunately) be able to help.

I have two adopted DD. DD1 is 8yo, under Camhs, lots of MH issues. We have had a horrendous few days with her trying to drown her sister (6yo) in the bath and saying that she wasn't angry, she just had a "feeling" that she "had to hold her head under the water until she stopped breathing".
I have spoken to Camhs and PAS, who were considering removing her as a risk to the other children (I have a one yr old DS who she has previously threatened) but have changed their mind.

Anyway, the main reason for this thread is that I am concerned that she is showing early signs of schizophrenia or a personality disorder.

Camhs in our area have said that they would not diagnose either of these until late teens or early twenties as the personality is still fluid until then.

I would be happy to pay privately as she may need meds and specialist treatment etc but I don't know how to find a private child psychiatrist who would do so. Any thoughts?

I'm In The U.S. and have watched documentaries about a girl named January who has schizophrenia. They had a younger son, and for his safety they live in two apartments in the same complex. I think they took turns living with the daughter in the apt that was set up for her. I think it is called Raising January. If you Google it it should be easily found. January is a beautiful child with red hair, but scary.

Handsie - I've not seen that documentary but lots of pp have discussed it earlier in the thread. I think there is some disagreement over whether the diagnosis is accurate or not.

I also think she should see a psychiatrist.

I am biased because I am one (not a CAMH one though)

My reasoning is that there will be a psychiatrist in the team and they will be the most highly paid and most qualified person in the team. This is a complex, risky case surely she needs their best person on it.

A psychiatrist specialises in diagnosis and having a medical background can integrate physical, neurodevelopmental and psychological/ psychiatric aspects. It's not just cases that need medication (which I agree doesn't seem a likely solution here) who need a psychiatrist or CAMH psychiatrists would it have much to do.

A psychologist is a highly trained professional too but they are specialised in delivering therapy and assessing for therapy.

I think that surely she needs a senior person to give an opinion to stop all the going round in circles getting nowhere.

Where there are a number of agencies involved in health and social care then a professionals meeting can be helpful to make sure conflicting advice is not given.

Your GP might be key in helping you to navigate all this. Are they sympathetic? Can you ask them to write to the CAMH psychiatrist

I think we are heading for some sort of big meeting. Wether that is a CAF (common assessment framework) or TAF (team around the family) or just a professionals meeting I don't know yet.

Can anyone please help me to make sense of this email I have just received from PAS. (AE = Adoption Expert)

"I discussed your present situation with AE last week because they had been successfully involved with you and recommended CAMHS involvement. AE is very happy to visit you as a follow up from the work they did with you but also their recommendation for CAMHS involvement.
AE will be able to help us understand why the CAMHS involvement is not proving successful and why they are not able to make a diagnosis."

They seem to be bringing in the AE who recommended Camhs to tell me why Camhs isn't working.

I'm sorry I can't...
Why would the AE know why Cahms can't make a diagnosis ? Surely only they know that ?

I suspect that AE may see everything through attachment tinted spectacles, which is presumably their explanation for Camhs not making a diagnosis. Ie it's because it's all down to attachment issues.

The problem is that DD is complex, so it's not a simple case of either "attachment disorder" or "healthy attachment" she has almost definitely got other issues.

If we switch to AE then anything other than attachment issues will be overlooked. I doubt that AE is able to complete psych-diagnostic testing etc

Have you voiced these concerns to them ? Forcefully ?

At next I think ea has spoken to sw who has gotten muddled to be fair. He's said I'll come and discuss treatment and why diagnosis is so tricky and she has conveyed it badly.

This is why you need multi agency meeting. Camhs maybe don't agree their intervention package is a write off. They also maybe are best placed to explain why diagnosis has not felt appropriate.

I

I have emailed them my concerns, but have not responded to the latest "explanation" as I've not had chance to put my thoughts together yet.

This is the same LA that offered me "relate" sessions a few months ago (no idea why but presumably because they are cheaper than anything helpful) and the same LA that accidentally disclosed my address to the birth family.

Hi YouAre, I googled January and now there is thought that her younger brother might have schizophrenia too! I see the reluctance in the U.K. To diagnose schizophrenia, so a real difference of opinion in two leading countries. The documentary about January was riveting to watch.

I'm also interested in FAS and autism. FAS is such a tragedy and completely avoidable. My hat is off to you for your care and dedication to your girls.

I wouldn't switch from a team with (theoretically) access to psychiatry, psychology, psychotherapy for a one man band. The ae is supposed to be a condultAnt so can also work alongside/in consultation with camhs.

I really would push for a meeting. Establish there the rational and plan for psychiatry involvement (or lack of), establish how or when you will know if current intervention working with psychotherapist.

Can anyone please help me to make sense of this email I have just received from PAS. (AE = Adoption Expert)

Do you think it's possible they want to keep things 'in house' and are nervous of exposing the neglect while in foster care? It seems like one of those emails that's trying to sound like it means one thing but is really about something else that nobody can verbalise. Or perhaps I'm just jaded and paranoid.

Rain nothing to add at all except to say I agree with munch and I ... wouldn't switch from a team with (theoretically) access to psychiatry, psychology, psychotherapy for a one man band.

And just massive hugs my dear.

Keep strong. Something good is going to come out of all this, I really really hope.

Exactly munchkinmaster! Especially when that one man band recommended Camhs increase their involvement and pushed for psychotherapy.

The trouble is that my LA only seem to have one answer for all PAS issues and that is this AE. This AE has a certain way of working that is quite specific, more of a one man band with only one instrument!

Regarding your daughter's complex-ness, the best people to speak to will probably be other parents of FAS children who have been through similar. Most children with disabilities needs are complex, as their disability is often not diagnosed until some behaviours are habitual and these then have to be teased out of the equation so there will be similar real life examples to compare with. There are probably very few studies on attachment and Tourette's or attachment and ADHD, but probably there are plenty of children with both issues. These women will have a wealth of information and experience that no doctor, psychiatrist, social worker or otherwise will have.

PAS are pushing for a meeting between me and the AE. I don't know if it's of any benefit, I suspect that it will be a bit like a personal sales pitch for their services. I might prefer for them to just attend a multi agency meeting. Let the professionals argue it out in the open.

It's probably fine to bring the AE into the equation, no harm done? I don't think psychotherapy/psychiatric input will be as helpful as a good neuro assessment and MRI scan.

Perhaps that's one of their concerns - once drugs are administered you can't do those other tests accurately.

I would interpret the email as social services having a bit of a dig at health!

Everyone can see that things are really hard. Social services have not covered themselves in glory (eg the unauthorised disclosure) and they were hoping that CAMH had the magic bullet and are disappointed that they do not.

Perhaps it's not the right therapy or not the right therapist?
Or perhaps it will just take longer to see any result

That's why it will be best if everyone sits down in a room and thrashes out what is the best way forward to help DD1. It should stop everyone trying to dump on everyone else.

With respect I am sure that there will be no one easy answer and no one key intervention. I don't think she will have an MRI and someone will be able to point to a bit of brain and say 'look it's that bit there'.

often there is not really one unifying diagnosis which everything can be put down to and a formulation encompassing all the different factors makes more sense.

Very simply you can think in terms of biological (effects of maternal drug and ? Alcohol use, possible neurodevelopmental disorder eg autism or FASD), psychological (attachment disorder) and social (parents divorce, new partners and a new sibling- that is in no way meant to be blaming it's just that it is likely to be relevant).
Also factors that are predisposing, precipitating and maintaining.

If I were you I would decline the 1:1 meeting as it's just another opportunity for splitting and push instead for the AE to come to a meeting with CAMH and PAS with an aim to get an MDT plan agreed

With respect if the child has an undiagnosed neurodevelopmental disorder it will be impossible to give her any treatment that will work. The basic health stuff has to come first. Of course it will be complex and it may not give all the answers but it's probably the most important part of this process. Every day goes by and this girl thinks this is her own doing - a diagnosis will liberate her to blame her syndrome/disorder not to mention open up the possibility of therapies and strategies that will actually work and avoid the whole drugs rollercoaster.

I have to disagree about a brain scan. The only tines this would be appropriate would be to rule out a growth with a sudden and unexplained change in behaviour. This is not the case here.

Any differences due to fas etc will be subtle and not the gross structural issues which an MRI could capture. An MRI would not be diagnostic and would require a general anaesthetic for this child to stay still (so not risk free).

Neurodevelopmental will be done via observations and a detailed developmental history . I think op has said two psychologists are doing this. It's hard in this case as the early history is unknown and trauma /neglect potentially started at birth.

All treatment will need to take in both neuro dev and emotional/attachment factors. Therapy needs to be mindful and tailored but is not wasted on kids with asd etc . Neither will a Neuro dev diagnosis indicate a magic bullet.

I have just sent this email -

"Dear PAS

Thanks for your email, yesterday. I am still a bit confused about what the AE can offer that is above and beyond what Camhs are doing.

You seem to be proposing that AE, (one person) may be more successful with DD than a whole team of psychiatrists, psychologists and psychotherapists. My confusion is compounded by the fact that it was AE themselves who recommended that Camhs increase their involvement and start psychotherapy.

I think it's best if we have a multi agency meeting (maybe a CAF?) where AE will be able to speak directly to other professionals and things like this can be clarified and everyone can share their experience and expertise in order to help DD.

I would also like to suggest that a single organisation, with an in-house multidisciplinary team of professionals, such as Family Futures or PAC may be the best way forward for DD and the whole family.

Thanks

YouAreMyRain"

Have attended CAF meeting's with many professionals and children with FAS , can say most have ended with putting in place Strategy's for the child with appropriate professional's working in partnership with them , home and school, Problem being too much support can be departmental, such children only capable of taking so much on board, too much support can result in meltdown at home. Teachers and others often say they are wonderful at school, of course they are, they want too succeed impress their teacher's and people around them. Working in partnership's understanding the children , keeping support for a child with complexed needs simple and manageable, appropriate strategy's are the way forward
there are usual no solutions for such children just interventions and strategy's, which can lesson or do away with future secondary problems.

Rain re I have just sent this email...

great, good email.

Can't comment on all the ins and outs as no idea but the more professionals the better, IMHO.

Other parents are great at offering support and ideas for coping but are not a replacement for professionals who hold the key to potential diagnosis and purse strings to potential therapies.

If a child who has attempted to kill herself and threatened (attempted?) to do harm to her sister, is not eligible for family futures then who is?

If the worse happens who will be responsible? I wonder who has the capacity to help and is failing you, Rain?

I know you are doing all you can so I feel just so angry on your behalf that you are being let down.

Love and blessing Italian.