child pyschiatrist, is this the right avenue to take?

[brandy77]

Son is 6, has medical problems, school attendance problems due to hating school and struggling, behavioural difficulties since day he was born.

School had agreed my son could attend at 10.40am, tried my hardest this morning to get my son into school. 2nd attempt culminated in me forcefully stripping him, and forcefully dressing him in a fashion, whilst being headbutted, screamed at, sworn at, punched, kicked, bitten (hes never done that before . I absolutely loathed doing it but felt I had to try to shut people up!

Anyway I got him down to the school in the car but didnt even attempt to get him out as he would have attacked me and said he would hit the teacher in the face. I feel so sorry for him, he was soooo angry and his little heart was pumping so bad i thought it would pop out of his chest. I left him in the car and went in too see the head, she was understanding and didnt know what support to offer. I told her that my son needs assessing (turned down for SA but will be appealing) and that this behaviour is not normal and not down to parenting as camhs imply.

Phoned doctor in desperation and told her, they know me very well, she said its not normal behaviour and he needs assessing but has to go via camhs. She said she will email them suggesting my son sees a pyschiatrist? Is this the right route? She said she will try her hardest but didnt know if it would do any good, she also said she has a few names for a private EP. I know there is an underlying problem and want to be made aware of what it is so i can support my son more. I feel so terribly frustrated with the system. The older my son is getting the more verbal he is getting, hes never sworn during a tantrum before.

His paed in London is sending a letter to say he needs assessing, but im confused who i should be chasing and for what service!?!

Hes calmed down now and sitting on his laptop and just said "youre my friend again now mummy, love you", hes blanked me since this morning

Poor you Brandy - I am not experienced enough to give advice but there are lots and lots of people on here who are. We are only just entering into the whole diagnosis process ourselves. Just wanted to offer some support

thankyou shugarlips

I think CAMHS is probably the right route to go down, we have ben referred there recently for Dd3 who maybe has an ASD.

When your son gets an appointment you could be seen by someone who makes sure that you have been referred to the right place.

As you go through the system a desision will be made about whether you son needs a diagnosis for his difficulties.

Camhs can make a diagnosis or can refer to someone else.

Don't let them grind you down, keep a diary and include any strategies you use for dealing with challenging behaviour.

The wheels turn very slowly, we have been in the system for 20 months now, I began the assessment process with Dd3 when she started to get too big for me to physically manouver[sp] her when she was having a tantrum or had decided she wasn't moving.

Good luck .

I would get your gp to refer him to phyciatrist if they can.

My dd had been under camhs for 2 years and we werent happy with her treatment or diagnosis and our gp referred her straight to phyciatrist. We were very lucky and got an appointment quickly and this route has been the most helpful to us, and she is still under camhs just sees a different person.

We have seen so many people and various organisations it is hard to know sometimes where to go and I know alot depends on where you live for the help needed.

I hope this might help and that you get some advice soon. At least you tried to get him to school sorry it didnt go well and remember he does love you despite it all

my son has been under camhs for 2 years on tier 2, ive found them absolutely useless, i wrote telling them i didnt want to see them anymore as their underlying comments and not offering support were making me feel so frustrated. they have left his file open for 2months. i think its our area, my gp and the school say they are useless

Could school also put a referral in as this is affecting his education.

As I said before it is hard to know who can help most but if you got a ccouple of organisations to put the referral in maybe they will get the message and you would maybe get the help quicker.

tinsel, hi thankyou, i should have mentioned that ive had probs with camhs and didnt wish to use them anymore

kitakat, what would a psychiatrist do then? please

kitakat, perhaps i should ring the school and ask them to refer him to be seen by an ed psyche as il also have his paeds letter to back up that he needs assessing? the head had mentioned this morning but i presumed it would be done as part of the statutory assessment IF they agree to assess him, its all so bloody confusing!!

Hi brandy77, is there a particular condition you want your child to be assessed for?

In some areas CAMHS are responsible for developmental conditions such as ASD/ADHD, in others it is done by a Child Development Centre. It can be dxd by a psychiatrist or a paediatrician.
Do you know what is the usual route in your area?

I have had difficult experiences with CAMHS and I felt that they tend to look initially at parenting/social issues first before considering other possibilities as a last resort. So I can understand your reluctance to deal with CAMHS again.

You might want to ask for a referral to a paed instead, or insist that if you're referred to a psychiatrist, that they're a specialist in ASD, as not all psychiatrists have relevant experience in that area (I think from previous posts you've said you think your DS may have AS?).

It would be useful to see an Ed Psych but they won't be able to dx something like ASD, although they can offer classroom strategies that would help, regardless of dx.

A child would definitely be seen by an Ed Psych as part of a stat assessment, but it's also possible to refer a child to the Ed Psych before a SA, just for advice on strategies/teaching methods etc.

If you're planning to appeal against refusal to assess, I would seriously consider getting a report from a private EP if you can afford it. A private EP will give an independent opinion and will probably write a much more comprehensive report than the LA EP, with more specific recommendations for provision.

hi sugar candy, yes i spose i am thinking it could be ASD/aspergers, both have been mentioned lightly before, once by my gp (aspergers) and a private psychiatrist report from when he was aged 2.5 but i didnt think that held much weight actually as she basically typed up everything i had told her about my son then said she agreed that he could have ASD.

His paed at GOSH has mentioned ADHD and said many of his patients have behavioural difficulties then wrote severe emotional disturbance on his notes. I spose ive never really kicked up too much fuss with finding out exactly what is wrong because he was so young, but im still being told it could be developmental, thats camhs psychologist said that at the last TAC meeting and the parenting comments. And now hes in schooling and its proving so problematic and so bloody stressful i know im not going to get him in again tomorow, im not going through a repeat of this morning again

ive been studying full time at home, mental health at the moment funny enough! and ive got to email my tutor now because i cant study with my son here, giving up work was bad enough and losing my friends but giving up my study is cutting me off even more, i hate it...and i know im not the only one. thankyou.xx

sugar candy, i think camhs have been blaming the hospital admissions for his behaviour, but even when hes not been in hospital for a while his behaviour continues, i think its a cop out on their part.

also it annoys me school say hes fine, even though his attendance is so poor where he hates it and when does go the teacher says he quiet, needs someone sitting on him to do anything and has terrible concentration. that doesnt appear fine to me. wish they could witness what happens in the car on the way home if i even mention the word school to him

so my sons paed being an endocrionologist (hormone man) couldnt diagnose a behaviour disorder then? would it have to be a different paed?

I'm not sure if your son's paed could diagnose ASD - it's often quite a complex dx, involving a multi-disciplinary team (e.g. SALT, psych, OT, paed). There are specific tools used to diagnose (e.g. ADOS questionnaire) and the paed would have to be trained in using it.

ADHD dx needs a Connors questionnaire completed by parent and school - the behaviour has to be present in at least 2 different settings.

Would you be able to call your doctor again and ask her to confirm you'll be referred to a psych who has experience in behaviour/developmental disorders? Or a referral to a developmental paed?

Do you want to try chatting to people on the home education section of Mumsnet? Some of them may have experienced similar with their children. I remember dragging DS2 out from under a table at home in order to bring him unwillingly to school :(

I was also told repeatedly that 'He's fine at school' :( Hmm, we still have the gouge marks in the wooden bannisters and kitchen furniture from when he used a large kitchen knife on them. Happy and fine, my foot!

He's a different person now, 3 years on :)

As sugarcandyminx said camhs seem to look more at environmental side of things first and we spent a long time having help with routines, behaviour management and also issues with dd's low self esteem, but didnt felt they really helped get to the cause of the problem.

Our GP could see there was more wrong qith her and this was not the first gp to notice which is why we had the referral to phyciatrist. They did various assessments and looked more at the problems within the child not the environment they are in.

We got a diagnosis of add very quickly (when previously told this was not the case) and within a few months a possible asd diagnosis and are now waiting for further assessments with another department who specialise in this.

Physciatrist also prescribed medication some of which has worked well and others that didnt so no longer use. We can see a difference in dd and feel we are taken more seriosly now rather than being judged for the situation.

www.dcsf.gov.uk/everychildmatters/healthandwellbeing/mentalhealthissues/camhs/fourtierstrategicframework/fourtierstrategicframework/

Ok, here's the camhs outline in brief (proper explanation on dcsf website above) :
tier 1 is general workers applying generic skills. Includes GPs, health visitors, school welfare, social work. Some know loads and are very effective. Others don't.
Tier 2 is 'camhs specialists' but NOT doctors. It's usually counsellors, but can be nurses or social workers. Specialist can be a misnomer. They don't do anything else. But training and experience vary widely.
Tier 3 These are proper multidisciplinary teams, with psychologists, child psychiatrists, psychiatric nurses, psychiatric social workers, OTs etc.
Tier 4 is regional, for highly complex cases. Mostly in patients, rare conditions and second opinions.

I think of tier one as school action (can be great but totally hit and miss), tier 2 as SA+ (waste of time), and tier 3 as statement equivalent (or at least statutory assessment level!). So yes, it does sound like the right route for your ds to see a psychiatrist. The other option is a neurodevelopmental paediatrician, but not all areas have one. Make sure your ds gets a proper, thorough assessment, and check (as others have said) that the team includes someone with experience of asd in higher-functioning dc.

thankyou for the latest replies, all so informative!

my son was assessed on tier 3 and saw a child psychiatrist for about 3mins who took him and my teenager out of the room and teenager said he asked my son to catch a ball and asked him a question. came back in and when we left my teenager said that was a waste of time. the psychologist said he had severe anxiety. his paed knows him extremely well and knows there is a behavioural problem, probably due to his ongoing medical problems as its chemical/hormone inbalances due to a underdeveloped pituitary gland

camhs know this, ive supplied enough evidence to them, all they say is he will experience higher anxiety than other kids

milou2, is your son a lot better now because you took him out of school or because he was diagnosed and you learn to strategies with behaviour? thankyou.xx

i spose il have to wait for the paed letter saying that he needs assessing and include that with the tribunal letter and ring the docs in the morning and check that he is being referred to a developmental paed who specialises in asd then, if ive read this right! what a battle! the doc even said she didnt know if the referall would be accepted...funding! but said she would try her best for me. what a sorry state when you know your child could end up growing into an aggressive uncontrollable teen, doesnt bear thinking about.

forgot to say earlier that when i got him in the car he said he hoped id crash so he could die, thats why i think hes worse, hes never ever said anything about dying before, hes only 6 fgs. thankyou for all your replies, i must try and sleep. i keep waking at 2am and cant get back off again.xx

kitakat, that sounds hopeful from your experiences with the psychiatrist.xx

Hi brandy, sounds like the previous level 3 assessment was rubbish. Hope you get a proper one this time. I wonder if your GP knows the last one was so perfunctory. IMO they get a bit p**d off when their referral letters are ignored and their patients messed about. It's worth telling her about the death comment cos she can pass it on and might help her case in getting the referral accepted. Would the head be willing to refer as well? I think they can send to camhs and community paed via the school nurse.

Hope something gets sorted soon [crossed fingers emoticon] PS: namechange but still maria

thankyou mariamagdalena, im going to ring the docs at 8.30 when they they open and ask for him to be referred to a developmental paed, il also make a point of telling them the dying comment. she would have already emailed the referall for the psychiatrist i think, but this would go alongside a developmental paed i take it?

i mite ring the school and speak to the head and ask about the educational psychologist? as the head mentioned this yesterday.

thankyou, it is so nice to speak to people that understand.xx

Both diagnosis/treating as if he had HFA and home edding helped.

In addition I did a lot of reading online, going to an autism support group locally, collecting stacks (I'm not joking) of books/magazines/leaflets/articles about autism, being part of the list on www.he-special.org.uk and confiding in local mothers with children with special needs.

I had a change in mental attitude. I stopped trying to please others and started to care for my children and myself first and foremost. I began to see through the pressure from others, that it might have been coming from their own fears and lack of understanding. It has been a long journey, but helped by the clarity of both my sons' discussions with me.

The approaches and writers which have encouraged me are Floortime, Sonrise, deschooling, unschooling, Stanley Greenspan and Sandra Dodd. I ignore anything they write which does not sit well with us.

I think you're right to have various referrals in parallele. After all, if someone makes a clear diagnosis and starts to give useful input you can always cancel the other appointments

thankyou milou

maria, i went to the docs and asked aobut a devleopmental paed and she said it would be down to camhs although her suggestions in her letter would hopefully be acted on. she hadnt sent the letter, she said it was lengthy, but would be adding on the part about him wanted to die. I asked for a copy of the letter also. thankyou.x

I don't know if it's possible in your area but in our LA, parents can refer their own child to the LA Ed Psych service rather than going through the school. Check on your LA's website to see if it's possible.

If you're not already doing so, start keeping a diary about your son's behaviour and comments like him wanting to die. When you finally get an appointment, it will be useful to type it up and send it to the paed/psch in advance, so you don't have to remember everything during the appt yourself. It also means they're less likely to make a snapshot judgement based on a brief observation, as seems to have happened before.

thankyou sugarcandymix, i started keeping a log of some of the behavioural blow outs and what appears to have caused them, il continue doing that then

Forgot to say, if you request statutory assessment the LA'S educational psychologist will visit the school to make an initial assessment within 6 weeks. Cos that's the timetable to decide if they're going to do a proper SA.