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What is child and adolescent psychiatry?

If your child needs psychiatric care, you may feel overwhelmed and nervous—perhaps, even guilty or ashamed. But it’s important to remember that mental health conditions can affect anyone, including children.
Mental health conditions are treatable in children and adolescents, and appropriate care can make a huge difference in your child’s symptoms and overall quality of life.
At Talkiatry, we offer virtual comprehensive mental healthcare for children and adolescents.
If you think your child might benefit from mental healthcare, child and adolescent psychiatry is a great place to start.
Child and adolescent psychiatrists are specialized physicians who receive rigorous, comprehensive training. This includes 4 years of medical school, at least 3 years of specialized residency training for general psychiatry, and an additional 2-year of fellowship in child and adolescent psychiatry—that’s a minimum of 9 years of experience in caring for children and supporting their families through a variety of circumstances.  
This additional training makes child and adolescent psychiatrists uniquely equipped to provide the best possible psychiatric care for your child. Among other topics, child and adolescent psychiatrists are trained in family dynamics, the impact of trauma, how to engage kids during a session, and how underlying medical conditions can present with psychiatric symptoms.  
A high level of specialization is important because mental health conditions in children can be quite complex. Signs and symptoms of mental health conditions as well as how they are treated differ between children and adults.  
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How does child and adolescent psychiatry differ from adult psychiatry?

One main difference between child and adolescent psychiatry and adult psychiatry is the role you, as the parent or guardian, will play in your child’s care.
As a parent or guardian, you will be present during your child’s first appointment and must be available for all follow-up appointments.  If your child’s psychiatrist recommends medication as part of their treatment plan, you’ll be informed of the risks and benefits and must provide consent, while your child will provide assent. Starting your child on a new medication may feel overwhelming. Rest assured, adolescent psychiatrists are experts in medication management and will work with you and your child to find a medication or other treatment option that works for them.
Child and adolescent psychiatry is a team effort. Your child’s psychiatrist may also recommend involving members of their care team or other medical providers in their treatment, including their pediatrician, school psychiatrist, and/or any other therapists they may be working with.
You may be worried that your child won’t “get anything” out of a session with a psychiatrist—especially if they struggle in formal or structured settings. Rest assured that your child’s psychiatrist is specially trained to work with children with a range of behavioral and mental health challenges. You may find that sessions with your child’s psychiatrist feel more informal and relaxed than other medical appointments you’ve brought your child to. This is intentional; a way to make your child feel comfortable and at ease.
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How do I know if my child needs to see a psychiatrist or another medical provider?

As a parent or guardian, it can be hard to know if your child needs psychiatric care or support. That’s OK. Part of the job of our highly trained child and adolescent psychiatrists is to evaluate whether children need professional psychiatric care, or whether another type of care—like play therapy, occupational therapy, physical therapy, or speech therapy—would be more appropriate.
If you’re unsure what your child needs, ask for help. The way to start is to set up a professional evaluation with a psychiatrist. If a different service is more appropriate for your child, the psychiatrist can offer you a referral to the right provider(s). If psychiatric care is appropriate, they will offer your child an accurate diagnosis and treatment plan.
Taking this critical first step does not necessarily mean your child has a mental health condition or needs medication; rather, it’s a way to ensure they get exactly the right care—whatever that may be.
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When should I seek care for my child?

Every child is different, and there are no set “rules” for when an evaluation by a psychiatrist is appropriate. However, there are some general signs and symptoms that might indicate your child could benefit from professional support. These include:
  • Behavioral issues at school or home
  • Trouble sleeping
  • Changes in hygiene or eating
  • Withdrawl from favorite activities or isolation
  • A recommendation from your child’s teacher
  • A recommendation from your child’s pediatrician
  • Excessive screen time: social media, video games, etc.
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What is the benefit of taking my child to see a psychiatrist?

If your child is struggling with mental health challenges, seeing a psychiatrist is a positive step. Psychiatric treatment is very effective with children and adolescents at reducing problems at home, in school, and in relationships. The earlier a child receives help, the sooner you are likely to see improvements and the less likely the child is to develop other mental health conditions down the road.
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Confidentiality in child and adolescent psychiatry

Confidentiality is a cornerstone of psychiatric and medical treatment. “Doctor-patient privilege” encourages patients of any age to speak freely about their concerns so that their psychiatrist can provide the best possible treatment.
Children and adolescents may not be ready to share certain information with trusted family members or caretakers and they benefit from having a safe and private space to discuss concerns with their psychiatrist.
For parents who want to help their children thrive, it can be nerve-racking to not be informed of the details discussed during a session. Your child’s psychiatrists are trained to understand this balance and provide care that respects privacy and promotes healing.
Your child’s safety is always a top priority for child and adolescent psychiatrists and there are certain exceptions to confidentiality including:
  • Concern that the patient has thoughts or plans to harm themself
  • Concern that the patient has thoughts or plans of harming someone else
  • Concern that the patient is a danger to the public
  • Concern that there has been physical, sexual, or emotional abuse
  • Other concerns that there is an immediate risk to the patient’s wellbeing
While it's the psychiatrist's duty to inform others when any of these concerns are raised (either the parents, the authorities, or both), a psychiatrist will also encourage the child or adolescent to share the information with the parents during the session with the psychiatrist present to help support and facilitate. Most patients are relieved when important adults in their life learn what has been so troubling and is enlisted to help.
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How does Talkiatry treat children and adolescents?

Our team
At Talkiatry, we have a team of board-certified child and adolescent psychiatrists led by Dr. Ilisse Perlmutter, a double-board certified, award-winning psychiatrist with decades of experience treating children and adolescents.
Prior to joining Talkiatry, Dr. Perlmutter held leadership positions at some of the nation’s top hospitals. She was the Chair of Behavioral Health and Addiction Services at Bergen New Bridge Medical Center and the Director of Inpatient Psychiatry at Montefiore Medical Center-Wakefield in New York. She is a Distinguished Life Fellow of the American Psychiatric Association, a Fellow of the American College of Psychiatrists, and a Distinguished Fellow of the American Academy of Child and Adolescent Psychiatry.
She has received awards for her contributions both locally and nationally. Dr. Perlmutter was included in Castle Connolly’s “America’s Top Doctors” list from 2006-2011 and 2017, as well as “Best Doctors in America” from 2009-2012. She is also a Clinical Associate Professor of Psychiatry and Behavioral Science at George Washington University School of Medicine and Health Sciences in Washington, D.C.
Conditions we treat
Anxiety: Fears and worries are common in young children, but when your child doesn’t outgrow these fears and it begins to affect their behavior at school, at home, or with friends, they may have an anxiety disorder. Common symptoms of anxiety disorders include:
  • Physical symptoms like stomach aches or headaches
  • Behavioral symptoms like refusal to engage in activities, social isolation, a disproportionate attachment to their caretaker, or perfectionism (for example, an extreme reaction to a bad grade or getting disciplined)
  • Angry outbursts or meltdowns
Depression: Occasional sadness is a normal part of every child’s life, but if your child is experiencing persistent hopelessness and/or a lack of interest in things they once enjoyed, they may be experiencing depression. It's important to note that some children with depression will not seem “sad” at all; they may seem angry, defiant, or experience episodes of “acting out.”
Other signs and symptoms include:
  • Feeling sad or hopeless all/much of the time
  • Sleeping more or less than normal
  • Not wanting to participate in fun activities
  • Changes in energy: acting sluggish or tired, or tense and restless
  • Self-injury or self-destructive behavior
  • Declining grades
Insomnia: Sleep can be a challenge for all children, and research shows that sleep problems can have adverse effects on daytime functioning. Signs that your child’s insomnia might require the attention of psychiatrist include:
  • Feeling sad or having difficulty falling asleep independently and staying asleep all/much of the time
  • Frequent nightmares or night terrors
  • Sleepwalking
  • Sleep paralysis
  • Daytime symptoms, including fatigue, difficulty concentrating, problems with social or academic performance, poor impulse control and moodiness
  • Staying up late messaging friends or watching videos
Post traumatic stress disorder (PTSD): Most of the time, children recover well from stressful events, however exposure to repeated or extreme trauma can have long-term effects. Signs of PTSD in children include:
  • Avoidance of/fear around situations that remind your child of their trauma
  • Nightmares or sleep problems
  • Reliving the trauma over and over
  • Irritability or outbursts
  • Lack of positive emotions
  • Intense ongoing fear or sadness
Attention-deficit/hyperactivity disorder (ADHD): ADHD symptoms typically appear before age 12; sometimes they are even present in children as young as 3. Often, teachers are the first to notice these symptoms, as they can show up as behavioral issues in the classroom. It’s important to note that both boys and girls can be affected, and ADHD can present in several ways, including hyperactivity or inattention. Symptoms include:
  • Having trouble focusing on tasks, making careless mistakes
  • Appearing not to listen when spoken to; easily distracted
  • Difficulty following through on tasks or chores
  • Constant fidgeting or squirming
  • Talking too much in class or blurting out answers to questions
  • Running or climbing in situations where it’s not appropriate; constantly in motion
Obsessive-compulsive disorder (OCD): All children experience bothersome thoughts, but if those thoughts begin to interfere with their daily lives or prompt them to engage in compulsive behaviors, they might be suffering from OCD. Symptoms include:
  • Unwanted thoughts that cause excess distress or anxiety
  • Saying or doing something over and over: For example, counting aloud, repeating words, hand washing, placing things in a specific order, checking the same things over and over, like a door lock
  • Superstitious beliefs
Other conditions
Bipolar disorder: Most likely, a child with bipolar disorder will not be treated at Talkiatry. This condition, involving extreme shifts in mood and energy levels, is rare in children and adolescents. Shifts are much more severe than everyday mood swings, and can include bouts of mania (extreme euphoria, irritability, or restlessness) and depression (extreme sadness or hopelessness). Although our team of psychiatrists can offer this diagnosis, generally, in-person care is recommended for the treatment of bipolar disorder in children and adolescents.
Substance use: Drug use in children may start as young as ages 12-14. Some early signs include:
  • Frequent change of friends
  • Defensiveness or anger
  • Withdrawing from usual family activities or routines
  • Decrease in communication
  • Breaking curfew
  • Slipping grades at school or skipping classes
  • Depression
  • Mood instability
  • Apathy
  • Asking for or stealing money
Ages we treat
At Talkiatry, we treat patients aged 5 and up.
Treatment approaches
Our child and adolescent psychiatrists will diagnose and offer treatment for your child in a safe, online clinical space. Together with you and your child, they will help develop a management plan that everyone is comfortable with, and will monitor your child to make any necessary adjustments.
If talk therapy is also recommended, your Talkiatry psychiatrist will refer your child to a therapist who can meet with them on an ongoing basis. Your child’s psychiatrist can also offer referrals for any other specialists your child might need.
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How to get started

If your child needs a psychiatrist, Talkiatry can help. Here’s how to get started:
Tip #2
If your child is a fit for Talkiatry, complete your first visit.
  • Expect to hear a bit about your psychiatrist’s background, and then to share exactly what brought you in. If your child’s guardians are divorced or separated, we’ll need to know who has decision-making power on behalf of your child and to see a copy of any custody/visitation agreements or medical powers of attorney.
  • Expect to be present and on camera with your child for this visit. If your child is under 10, or uncomfortable talking to a provider without you, you’ll likely remain for the entire session. If your child is over 10, your Talkiatry psychiatrist may want the opportunity to speak to your child alone.
  • You may be asked about your child’s medical history, family history, day-to-day life, and your goals and expectations for treatment. If you’re nervous about a particular element of treatment—say, starting your child on medication—we want to hear about that, too! Your Talkiatry psychiatrist knows that the best treatment plan is the one your child will stick to, so they’ll make sure Talkiatry is the best fit for your family and work with you to come up with a strategy that everyone is comfortable with.
Tip #3
Receive your child’s personalized treatment plan, which may include a combination of medication and supportive therapy.
Tip #4
Continuous care will include adjusting your child’s treatment plan as needed.
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About Talkiatry

Talkiatry is a national psychiatry practice that provides in-network, virtual care. Co-founded by a patient and a triple-board-certified psychiatrist, Talkiatry has over 300 doctors, 100 insurance partners, and first visits available in days. Get started with a short online assessment.
The information in this article is for educational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.
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Read about other conditions we treat

Conditions we don't treat

Virtual psychiatry isn't right for every condition. To see if we’re the right fit for you, get started with our online assessment.

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