Dr James Schaller
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Child & Adolescent Depression

Part 1

What Type of Physician Should Treat a Child or Adolescent for Depression?

Depressed children are often not diagnosed for years. Some adults recall being depressed since children, and their old diaries or photos confirm their recollection. Unfortunately there is a significant shortage of child and adolescent psychiatrists, and other's who treat children often do not have the years of specialized training or the time to treat subtle forms of depression. Pediatricians and Family Doctors who treat children are often told they are quite able to treat children for depression. When the reality is their ability is due to the fact they are merely the easiest and cheapest option.

I suppose some are told they can really know a child in 15-20 minutes, in a sterile white medical exam room. It is hard to believe. In the same way I am very poor at looking in ears and determining the level of infection behind the ear's inner membrane, these doctor's can treat many things, but cannot touch the ability of a well rounded, up to date child psychiatrist.

I once gave a free talk to some Florida pediatricians, and instead of the oldest dog appreciating that I was coming as a service, he proceeded to correct me like a drunk heckles at a stage performer. His haughty "corrections" were so eccentric in content, it showed me that some folks are convinced they can fly around the moon. Hearing him quote ten-year old data showed he was indoctrinated as to his abilities -- it was comical. He actually believed that one could merely dose medicine based on weight, when in real clinical child psychiatry, there are at least 5 other variables.

He also seemed to think that ADHD and ADD were routinely disorders that existed alone, when the extensive research over decades shows that dozens of disorders exist with ADHD and ADD including depression,trauma, social problems, chronic illness, learning disorders or anxiety disorders. And depression can look different in a child with ADHD or ADD, or a child with trauma, or a child being teased, or one with a chronic illness, or one with a small learning disability, or one with an anxiety disorder, or the other hundred possibilities.

By the way, that socially impaired obnoxious pediatrician -- He is the most respected "thinking" pediatrician in one part of the state. I would not let him do psychopharmacology on a newt, let alone any child I knew or loved. But I guess his specialty medical society and a few continuing education courses, has convinced him he can touch a child's head, do a Spock-like Vulcan mind-meld on the child, and know all their thoughts and feelings, all in 5-10 minutes. Sounds like a circus. Medicine for children is not to be dispensed by clowns.

"Adolescent Psychiatrists"

True adolescent psychiatrists complete a full year of specialty training. While it is half the training of a child and adolescent psychiatrist, it is a fully acceptable start.

My concern is with another game. Adult psychiatrist's bypass any supervised and serious training, take some cassette programs or a weekend course and become convinced they actually understand adolescents.

The bottom line is that adolescents are not "little adults." Indeed both boys and girls are developmentally different every additional year. Using your common sense, please recall that a boy who is 13, 15, 17 or 19 is different than a man who is 25 years old. Every year a child changes emotionally, intellectually, physically, educationally, hormonally and socially. Often a reasonable adult psychiatrist helps an adult family member, and then is asked to treat a relative who is under 21. Even college students are not average adults. Anyone that thinks their world is the normal adult world is not in touch with college issues and emotions. My belief is that any patient under 21 should be referred out to an adolescent psychiatrist or a child and adolescent psychiatrist for the best care. My only exception is if no child psychiatrist is available.

Some states have a clear shortage of child and adolescent psychiatrists. That is one reason I have been offering consults by email or phone to all of these states for some time. It has been delightful to see that I am able to help those with poor access and the pateints feel they are being helped. You can read about this under my non-patient consult section button on the home page.

In conclusion, if you were going to get a shoulder operation or a knee replacement or eye surgery, you would not go with the cheapest or the closest doctor for the surgery. Indeed, most people like to say: "Dr. Jones is doing my knee surgery. I've looked around and done the research, and they are the best around."

Some states have a clear shortage of child and adolescent psychiatrists. Tha tis one reason I have been offering consults by email or phone to all of these staters for some time. It has been delightful to see that I am able to help those with poor access and the pateints feel they are being helped. You can read about this under my non-patient consult section button on the home page.

States that are very low in child psychiatrists are: Florida, Alaska, Wyoming, Montana, South Dakota, Oklahhoma, Utah, Arizona, Iowa, Alabama, Missouri, Louisiana, Washington, Indiana, Tennessee, Georgia, Illinois and Ohio. But even states like New York, Texas and California, which have hundreds of child and adolescent psychiatrists, have many locations where there is a shortage. I also get many contacts from these latter three states.

Why would we do less for our children or grandchildren? Especially when the research shows that depression is poorly treated in primary care settings.


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