Finding and assessing your provider options

Dr. Jacqueline Amato

Utilizing medical options for treating autism spectrum disorder requires more than simply finding a provider and following his or her protocol. Parents play a crucial role as advocates for their child as they enter into active partnership with their doctor.

The major questions to be considered in this article include trust issues, decision processes and when to make significant changes in direction. None of these topics are easy to deal with but must be faced head-on when raising a child with autism.

The trust that you must develop in others is one of the key aspects of getting help for your child. My main message in this regard has to do with choice of providers. Many parents start with a pediatrician, who may initially suspect the diagnosis. Some of these doctors refer to tertiary care centers (university setting) or other subspecialists, such as child and adolescent psychiatrists or developmental pediatricians.

This referral may be complicated by the fact that there are very few of these subspecialists in the country! There are only approximately 7,000 child psychiatrists in the U.S., and of those only 3,500 are “board certified.” This added certification means that the doctor has completed extensive study and taken further examinations to expand his or her knowledge. Many of these specialists have waiting lists of two months or more. Don’t be discouraged as this level of care may be just what is needed at the time.

How do you know if the child psychiatrist is the right one?
On this I would advise you to trust your gut instinct. If you walk in and feel at ease, there is probably a reason. On the other hand, if you feel talked down to, for example, this is probably not a person you want to be relying on in a crisis when a “team” approach is necessary. Someone who is knowledgeable AND kind is what you are after. This is someone who will be psychologically supporting you and your child for many years.

Another way to inquire about possible options includes asking associates, colleagues or friends who they have seen or heard about. There is some wisdom in that “grapevine.”

Whose decision is this anyway?
Do parents have to wait for the pediatrician to refer to the subspecialist or should they just consult the specialist on their own? Sadly, one of the deciding factors in this area is insurance coverage. The financial aspect plays a significant role at times. Often parents must “trust their gut” and seek help when the child is not improving or is becoming more problematic. Funny how crises lead us to make changes and seek alternatives!

The benefits of subspecialists include that they only take care of a limited range of disorders and, therefore, are better informed; in this case, they specialize in aspects of the brain. Also, it is likely that the child psychiatrist has dealt with many similar cases and has experience in helping to solve the problem behaviors he or she is presented with.

When is a change of direction warranted?
Many parents know when they are at “the end of their rope” with their child. One of the red flags is when the hair on the back of your neck stands up. For example, if you feel your own safety is threatened or are fearful for the safety of others, it is time to get help. Uncontrolled violence or extended rage episodes are other major areas for concern and reasons to seek outside assistance. Other indicators of the need to reach for help include concern from other care providers and a definite change in behavior without an explainable cause.

Taking a child with autism to a specialist can bring about internal conflicts for parents. Some believe that they can handle whatever comes their way with no medications while others believe in a “magic pill.” The bittersweet reality is that there may be a solution some parents will refuse to consider. I strongly recommend that, when appropriate, you work with a subspecialist whom you trust completely and that you “trust your gut.”

Dr. Jacqueline “Jake” Amato is a board certified in psychiatry and child and adolescent psychiatry and practices at Peacehealth Medical Group in Oregon. In her rare free time, “Jake” enjoys running, swimming, and walking on the beach with her beloved golden retriever, “Parker Grace.”

Courtesy of AAPC

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