Adolescent and Child Psychiatry and Psychology

Children and adolescents aren’t small adults. They have unique needs, especially when it comes to mental health issues. At MetroHealth, we understand. Our Division of Child and Adolescent Psychiatry and Psychology provides a wide array of outpatient services and inpatient consultation for mental health concerns. Our nationally known experts focus on child psychology, psychiatric health and behavioral health. Our programs are designed to meet the needs of the community we all share.

Many people are referred to us by their primary care physicians. However, you don’t need a referral; learn more about referrals for Adolescent and Child Psychiatry.

Personalized Mental Health Care

Our child and adolescent psychologists, psychiatrists and therapists see children and teens of all ages. We treat all of these kids with respect and individualized care. We work closely with patients and their parents to develop personalized behavioral health treatment plans. Sometimes that means medication. Other times, therapy can make a world of difference. Behavior training that includes family and care providers often helps patients feel better and function better. Whether it’s psychiatry, psychotherapy or a combination, we will partner with your family to find the right approach.

We’re pleased to offer unique, specialized programs right here in Greater Cleveland:

  • The MetroHealth Autism Assessment Clinic (MAAC) evaluates children as young as 24 months. Our experts meet one-on-one with kids to diagnose behavioral issues, and we pull together personalized treatment plans that can help children—and families—move forward.
  • Kids’ Pride is a clinic designed for transgender and gender nonconforming kids and teens. We partner with pediatrics and endocrinology to provide comprehensive services for these patients. This unique program feeds into MetroHealth’s Pride Network, which offers a full range of mental, physical and hormonal care for adults.

Behavioral Health Care at MetroHealth

A hospital-based setting makes all the difference. MetroHealth is able to meet behavioral health needs that community providers can’t.

Our Child and Adolescent Psychiatry and Psychology team includes board-certified specialists and nationally-known experts. And our academic setting emphasizes research, which means we’re always learning and exploring new approaches to care. We have faculty involved in multisite, federally-funded research projects. And we offer a doctoral clinical psychology internship accredited by the American Psychological Association. This exciting program trains doctoral students in child clinical and pediatric psychology.

Connecting with the patients and families we serve is a priority. That’s why we have bilingual providers who speak Spanish. They can evaluate patients and provide therapy en español.

We also offer telehealth behavioral health services for those families that cannot come to appointments in our offices.

What To Expect From a Psychiatry or Psychology Appointment

You’ll be asked to sign a general release. This will allow us to communicate with your insurance carrier and your child’s health care providers, including your child’s pediatrician. We disclose only general information, such as diagnosis and treatment plans. All information about you and your family is strictly confidential. We won’t share detailed information from psychotherapy notes with another health care provider unless you sign an additional release. And unless your child’s well-being is in danger, we won’t release anything in your child’s records without your written permission or a court subpoena.

Keep in mind that psychiatric and psychological care calls for different consents from regular pediatric treatment. MetroHealth may require permission from both parents.

Getting the right child care can make your appointment successful. If the provider is meeting with only parents and caregivers for that particular appointment, find a babysitter for the child. And if you have other children, your best bet is to find other care for them during the appointment or bring another adult caregiver who can supervise the other children. Keep in mind that kids under age 8 cannot be left alone in our waiting room.

Plan Ahead for Medication Refills

If you need a medication refill, there are a few things to consider. Federal law prohibits us from calling in refills for certain prescriptions. You must have a written prescription each time those need to be refilled. Plus, we need a two-day notice for all refill requests. Keep an eye on how much medication is left so that you can plan ahead.

Why Is Children’s Mental Health Important?

Mental health — an essential part of children’s overall health — has a complex interactive relationship with their physical health and their ability to succeed in school, at work and in society. Both physical and mental health affect how we think, feel and act on the inside and outside.

For instance, an overweight young boy who is teased about his weight may withdraw socially and become depressed and may be reluctant to play with others or exercise, which further contributes to his poorer physical health and as a result poorer mental health. These issues have long-term implications on the ability of children and youth to fulfill their potential as well as consequences for the health, education, labor and criminal justice systems of our society.

For instance, a boy named Bobby is being physically abused by his father and often acts out aggressively at school. His behavior is a natural reaction to the abuse, but his behavior may also mark the beginning of undiagnosed conduct disorder. His teachers simply see him as a troublemaker and continually punish his behavior. Later, Bobby drops out of school as a teenager because he finds it a harsh and unwelcoming environment and is anxious to leave his abusive home and fend for himself. However, holding down a job is difficult because Bobby often clashes with his coworkers and supervisors due to his aggression. Bobby has also begun to self-medicate by abusing alcohol and has been arrested a number of times for drunken disorderliness. By the time Bobby finally receives a proper diagnosis of his conduct disorder and substance abuse, he is in his thirties and his mental health problems have become deeply entrenched. They will require extensive therapy, which Bobby probably cannot afford without a job that provides adequate health insurance. Things could have been very different if Bobby was referred to a psychologist in his childhood who could have diagnosed him, offered effective treatment, and alerted the authorities about the abuse.

All children and youth have the right to happy and healthy lives and deserve access to effective care to prevent or treat any mental health problems that they may develop. However, there is a tremendous amount of unmet need, and health disparities are particularly pronounced for children and youth living in low-income communities, ethnic minority youth or those with special needs.

How Many Children Have Mental Health Disorders?

An estimated 15 million of our nation’s young people can currently be diagnosed with a mental health disorder. Many more are at risk of developing a disorder due to risk factors in their biology or genetics; within their families, schools, and communities; and among their peers. There is a great need for mental health professionals to provide the best available care based on scientific evidence, good clinical expertise, and that takes into account the unique characteristics of the child or adolescent. However, it is estimated that only about 7 percent of these youth who need services receive appropriate help from mental health professionals (Dept of Health and Human Services, 2001 — Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda).

What Does Psychology Have to Offer?

Research in psychology has contributed to the development of more effective treatment and prevention of mental health disorders in children, youth, and families, including programs targeting expectant mothers, children in school settings, and youth transitioning into adulthood and programs working at the following levels:

  • Individual — e.g., therapy or counseling for those with mental health disorders
  • Peer — e.g., peer-assisted learning programs aimed at improving reading, math, and science
  • Family — e.g., parent education on the needs of children at each stage of development
  • School — e.g., strategies for teachers for effective classroom management
  • Community — e.g., violence prevention programs administered through community/recreational centers or churches
  • Systemic — e.g., coordination of services in the health, juvenile justice, education, and child protection systems.

Psychologists working with children and youth are also trained to take into account developmental considerations on:

  • Identity,
  • Emotional,
  • Social,
  • Cognitive and
  • Biological bases.

Culture, ethnicity and language also mediates the behavior of children and adolescents in numerous ways and as a result affects the methods of prevention and treatment of mental health disorders.

Psychologists have developed tools to assess the risk and protective factors for the mental health of children and youth, to test them for behavioral or emotional problems, and to continually monitor treatment progress.

Psychologists have also designed programs that effectively engage families, schools and communities, that is, the critical social supports that can guarantee lasting well-being for children and youth. For example, one successful family-centered program aimed at decreasing alcohol use in preteens engages parents and caregivers by training them on parenting skills such as setting limits, expressing clear expectations about substance abuse, communication and discipline while also simultaneously training youth on resistance skills and how to develop negative attitudes toward alcohol.

How Does One Find a Psychologist for Children and Youth?

Psychologists working with children and youth can be found in many settings:

  • In schools
  • In community health centers
  • In hospitals working in partnership with pediatricians and psychiatrists
  • In research centers
  • In private practice

You can find a psychologist in your area.

You can also call 1 (800) 964-2000 or visit the APA Help Center.

ADHD in Children and Depression

ADHD in Children
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobiological disorder characterized by developmentally inappropriate impulsivity, inattention, and in some cases, hyperactivity. All of us have occasional difficulty sitting still, paying attention, or controlling impulsive behavior. For some children and adults, however, the problem is so pervasive and persistent that it interferes with their daily lives at home, at school, at work, and in social settings.

Between 3 to 7 percent of school children are affected by ADHD in the U.S. In the pediatric age group, ADHD is much more common in boys than in girls.

Studies show that patients with ADHD have demonstrable low levels of catecholamine in their brains, and the actual brain volume in certain areas of the brain may also be smaller. Scientists have also isolated certain genes which are specifically associated with ADHD. Essentially, ADHD occurs due to low levels of certain chemicals in the brain.

How to diagnose ADHD?

To make the diagnosis, several of the ADHD symptoms must be present before the age of 12 years, and symptoms must be present in more than one setting. Diagnosis is made mostly by getting history from the parents, caregivers, teachers and other adults who work with the child. Your doctor will ask the parent/caregiver and the teacher to fill out one of several different rating scales. Some of the commonly used rating scales are the Connor’s, Vanderbilt, and Child Behavior Checklist. Then, the doctor will do a very detailed interview with you and the child.

What are the symptoms of ADHD?
ADHD has three sub types, and symptoms will vary accordingly:

  • ADHD inattentive type
  • ADHD hyperactive/impulsive type
  • ADHD combined type

The symptoms of the inattentive type of ADHD include:

  • Makes careless mistakes/poor attention to detail
  • Difficulty sustaining attention in tasks/play
  • Does not seem to listen when spoken to directly
  • Difficulty following instructions
  • Difficulty organizing tasks/activities
  • Avoids tasks requiring sustained mental effort
  • Loses items necessary for tasks/activities
  • Easily distracted by extraneous stimuli
  • Often forgetful in daily activities

The symptoms of the hyperactive/impulsive type include:

  • Fidgets
  • Leaves seat
  • Runs or climbs excessively (or restlessness)
  • Difficulty engaging in leisure activities quietly
  • “On the go” or “driven by a motor”
  • Talks excessively
  • Blurts out answers before question is completed
  • Difficulty waiting turn
  • Interrupts or intrudes on others

What are the treatment options for ADHD?
The Gold standard of treatment is stimulant medication, though there are several other classes of medications also that can be used. Other things that could be used in conjunction are: cognitive behavioral therapy, parent management training, social skills training and educational support at school in the form of a 504 plan and/or an Individualized Education Plan (IEP.)

Will my child ever “grow out of it”?
As the child matures, the hyperactivity and impulsivity decrease, but the inattention is more likely to be a lifelong issue.

We often use the “Rule of Thirds” to break down the potential outcomes of ADHD cases:

  • 1/3 -> complete resolution
  • 1/3 -> continued inattention, some impulsivity
  • 1/3 -> early Oppositional Defiant Disorder/Conduct Disorder, poor academic achievement, substance abuse, antisocial adults

How Preferred Medical Group Can Help

Erica Chapman, Mother of Eriel Chapman

Learning Problems
Many behaviors can be a sign of possible learning problems. Of course, one indicator is poor grades in school. But often, children with learning problems also have trouble learning to take care of themselves at home or in the community independently (e.g., young children may show delays in learning to walk or talk, older children may have trouble learning to keep up their daily hygiene on their own). Other children have very strong abilities in some areas but struggle in one particular area. Sometimes children act out when they have learning problems. They might try to avoid going to school or begin to have physical ailments, such as stomachaches or headaches.

If you suspect your child may have learning problems, talk to your child’s teacher or doctor about your concerns. Learning problems can be diagnosed by completing a psychological evaluation that includes an IQ or developmental test to assess your child’s overall intellectual abilities, an assessment of adaptive behavior skills (i.e., independent daily living skills), and, depending on your child’s age, possibly an achievement test to assess specific academic skills. A comprehensive evaluation is necessary to rule out other problems that may be affecting your child’s grades, such as depression, anxiety, or ADHD. Treatment for learning problems usually includes special instruction or accommodations at school to help your child learn.

How Preferred Medical Group Can Help

Brittany Scott, mother of Mackenzie Scott

Anxiety

Behavioral Management