Child psychiatrist only taking zoom consultations

[itsacat]

Please advise, my DD needs to see a psychiatrist for ADHD related issues and what we think could be the beginnings of an eating disorder.

The psychiatrist we have been recommended only takes zoom consultations due to covid (sigh).

What are your thoughts on this? Have you had at experience with zoom consultations for this type of issues, and how did it work? I’m just not feeling sure about this, intuitively it feels like DD needs to see someone face to face but of course it’s important to see the right person, and if a remote assessment works just as well we wild be open to it.

Should I try and find someone who takes face to face consultations, or will zoom do just as well?

Perhaps I should add that we have a referral from a psychologist already. I asked their advice, if they think a zoom consultation will work, and they seemed to think so.

Would be interested in hearing from anyone whose DC have had a remote consultation for something like this, and if it worked well

My son has, and I think it works fine. The consultant can still see your child's body language etc. Try it and see how it goes would be my advice

My DD (13) has had both zoom consultations and face to face for CBT and she got SO much more out of the face to face ones (same counsellor). I would try to get face to face if you can.

My teen “sees” her psychiatrist via Teams. It’s been really good having the flexibility and they have a great therapeutic relationship. She also has a CBT therapist who is really flexible in offering online sessions if she struggles to get into the clinic.

I’m doing cbt via teams at the moment and actually it is working even better than I thought and the not being face to face, or having to sit in waiting rooms before or anything has worked well for me.

Worth asking for a trial session and then see how she feels?

Have you asked your daughter her preferences? I’m a clinical psychologist and some people prefer therapy online. The outcome data shows that it is as effective as f2f. I can honestly say I have some fantastic therapeutic relationships with clients I have never met with brilliant outcomes. Of course some people do prefer and get on better with f2f. The pandemic has been a huge learning curve and a lot of us have developed new therapy skills. I think online therapy will always be something that is offered because it is really effective for some people. I would ask your daughter what she thinks but also don’t necessarily be put off in thinking it’s a poor alternative to f2f.

My DD had psychologist sessions over Zoom and it was absolutely fine (and meant we didn't have to take loads of time off work ferrying her back and forward in the middle of the school/work day).

Thank you everyone, very helpful.

Dd says she would prefer page to face but did not have a very strong opinion one way or the other.

@PomegranateSeed as you are a psychiatrist, can I ask a further question? Dd was referred by her educational psychologist following an assessment, because they felt that it would be helpful to look into medication to help with her adhd symptoms. Would such a decision be possible via zoom? We are so new to this. I was thinking perhaps you need to meet in person to be able to prescribe medication?

Worked well for us.

I think online therapy / psychiatrist appointments can be very valuable - I was very resistant at the beginning of lockdown but now I find them much better than face to face - but the only thing to flag is that it can be a bit tricky with eating disorders. My psychiatrist would normally weigh me (or at least be able to look at me and gauge any weight gain / loss) but he can't really do that via Zoom so has to rely on me to be honest with him about my weight. Other than that, I think that it can be great especially if you're the kind of person who gets nervous.

@itsacat I’m not a psychiatrist but a Clinical Psychologist so don’t prescribe meds. The team I work with (psychiatrists, nurse prescribers and pharmacists) do prescribe meds via our online platform though. They might get someone else to complete physical health checks (weight, bloods etc) and then for GP to continue prescribing via the shared care agreement.

Private psychiatry appointments are expensive(unless you have insurance) and of course you want the right person. Why don’t you raise your queries before you make a decision?

My daughter is not a fan of online calls. So when we had to have an online call for her assessment I was worried - but it actually went ok. We made sure she had the privacy she needed and could be open in her conversations.
Her ongoing therapy has been a mix of online/f2f and she does prefer the f2f. It has meant that her going to Uni means she still can have her ongoing sessions online with her therapist that she trusts.

@PomegranateSeed ah ok! I thought it said psychiatrist! Thank you for your input, I will definitely speak with them before we make the appointment. I think we will be paying out of pocket, I haven’t raised this with the insurance yet but I’d be surprised if they agree to cover any of this

My DS was diagnosed ADHD and dyspraxia with a psychiatrist over zoom. He did various assessments f2f with different specialists, but the psychiatrist who pulled it all together for a diagnosis is video only (for her health).

Advantages = no travelling, no hanging around, no childcare to find for DS2 etc.

Disadvantages = well, I have to be in the meeting with him but Im not sure if I would be f2f. Its too easy for him to slide off his seat/fiddle with something/hide from the camera... i spend a lot of time getting him back into position.

He also is reluctant to speak but that's because I'm there and he always prefers for me to speak for him.

To get meds we had to see a pediatric psychiatrist in person to be weighed etc and monitored for the first 6 months.

I actually don't mind the video cos we have soooo many appointments all over the place this is nice and easy.

Sounds like a video consultation might not be a disaster after all. Glad to hear it can work well.

I'm doing trauma therapy which is really intense via zoom. It's actually better than in real life.

I’m really pleased to hear all these positive comments about Teams/ Attend anywhere sessions.
I work in CAMHS and as a practitioner I find them just as if not more effective.
As a parent I have to take less time off work/ dc off school and no more driving for miles to hunt for parking for an outpatient appt.
It’s definitely the future.

On a separate note, is a low weight typically a counter indication for ADHD meds? I mentioned a potential eating disorder but it's more to do with secret eating, not avoiding food, so she is not low weight due to this if that makes sense, she is still following her growth chart curves as always. But she has always been rather slight. I wonder if they will hesitate to prescribe anything, as I know these meds can act as an appetite suppressant.

We are just getting a bit desperate. We have tried to manage her symptoms without any meds for more than two years now and it's sad to see how she is being held back in life through no fault of her own. I understand that medication doesn't always help everyone, but she is trying so hard to improve her focus and it's just not working, so we are at the point where we feel that it would be unfair her to not at least try all the available strategies.

Hi @itsacat our DD and DS have both done a mix of phone and online appointments with psychiatrist/psychologist and Paediatric ADHD team through the pandemic

Generally it’s been positive apart from the point when DS desperately needed his meds increased but wasn’t able to do face to face to get a dose increase

I have weighed, measured done BP and pulse at home for the clinic records to facilitate care

DS is very low weight ( zero percentile) due to natural build and coeliac disease. We’ve had to prove he’s not losing weight to stay on meds but he’s not actually been refused treatment so long as he bobs along

@Tomnooktoldmeto thank you. So helpful. I hope your DS is getting all the right treatment

My DS has obsessive compulsive eating linked to his ADHD. He's always been at the top end of healthy weight (I work like crazy to stop him going into overweight)

The ADHD meds took about 5 months before they started impacting his eating (he felt less hungry but still compulsive ate). He s stayed the same weight since starting the meds last Feb which for him is great as he's also grown.

The trick is to get them to eat after the meds' effects wear off. He eats very little at breakfast and lunch but from 4pm eats loads. I make sure its healthy snacks and hes fine.

The meds have had an amazingly positive impact on DS. I cannot begin to explain the difference. He is 10 and loves them and their effect in his concentration.

You can always try them and see. Nothing says you have to take them forever.

@InvincibleInvisibility good to hear the meds have been helpful to your son. We are thinking we will give them a try, if DD is a suitable candidate. I know there are potential side effects, but this is really having an impact on school and the activities she loves, so we feel we must explore this.