Discussing Daughter's Behavioral Problems with Her Dr. in Front of Her??

If they won’t do phone consultation go in and talk to the doc. I would insist. There must be a provision for this. Even if you have to pay for an office visit it wouldn’t be that much.
And as someone else said, I’ll be looking for a new provider.

My daughter has seen multiple psychologists, psychiatrists, therapists, in addition to medical specialists (just so you know that we have been through the behavioral stuff on many levels).

First off, I'd like to suggest that perhaps you are focusing too much on speaking to a primary care physician for your daughter's issues. It doesn't sound as though your daughter has medical diagnoses that would impact her behavior. Your PCP is the person to speak to regarding immunizations, infections, diseases, well-child exams, etc.

I would immediately schedule a psychiatric appointment (with a psychiatrist, who is also a medical doctor and who can prescribe meds if absolutely necessary, rather than a psychologist, who would be good to see after diagnoses were made by the psychiatrist). If you can't find one by looking at www.healthgrades.com, or searching doctors on your local hospital's website, then call your insurance company and ask them for some names. You want a psychiatrist who sees young children specifically.

As for talking to the doctor with your child present, that's not always a bad thing if done properly and with the doctor's guidance. The parent shouldn't express outright frustration (like "she's driving me crazy and I can't take another minute of her attitude"). The parent can address both the doctor and the child, and can be honest ("I admit I'm at a loss about how to help [daughter] when she gets so angry" or "it seems like [daughter] is having problems at school and I'd like to hear your suggestions about how to deal with them"). Take the child into the conversation, using her name, and inviting her to weigh in. It can be really helpful to have a professional to whom to be accountable when dealing with a behavior. The doctor can lay out a plan which includes the parents and the child ("when [child] starts having a temper tantrum, parents are to stay calm, and lead the child to her room" or "parents will schedule meeting with the teacher and ask these specific questions, then report back to me").

Having both the parent and child at a psychiatrist's appointment can give the doctor valuable insight as to how the parent is acting, and how the child is acting. It's important to make sure your attitude is a willing and receptive one, and that you're going to be able to take advice well. It won't work if you storm out of the appointment grumbling "that shrink thinks I don't know how to be a mother to my own kid" or "how dare that doctor tell me I'm not listening to my kid". There will be, almost inevitably, some specific suggestions about how to parent a challenging child. My husband and I both have college degrees, but we had to sit at a little table with our doctor and our daughter and both learn how to handle her severe aversion to food (due to a medical issue) when she was 2 1/2 years old. We already had a son but we had to be willing to be told that what we were trying (which was EVERYTHING) wasn't ever going to work. So your attitude is important.

Our doctor's office said that they must have the child there in order to bill the insurance company. You might try to schedule an appointment when your husband (or someone else can come) and then ask if they can step out for a moment while you talk to the doctor.

Honestly, though, you might simply need a referral to a psychologist. Our son saw a psychologist when he was 4, and they we saw them (because the first one retired) a few more times before finding the right services for him. Each time we went, the psychologist spent some time talking to all of us, talking to our son alone and talking to use without our son present.

I understand what you are saying, but your primary physician might not be able to help much beyond giving you a referral.

Why wouldn’t you contact the place that did the referral since it’s been a year later (as they recommended)?
Since they specialize in mental health issues, why not consult with them or ask them for a referral to someone who specializes in behavior issues? I’m sure your daughter’s school also has a list of referrals.

You might also want to let the school principal know your daughter has been evaluated. The psychological evaluation may make her eligible for basic services at her school.

I agree with the other poster...this does not sound like a medical issue, so I would stop focusing on the PCP.

Can you go back to the Dr where you got the psych eval, since they have the prior test results for your daughter? Also, they told you to wait until she went to school and see how it went. You did, and now you can go back to them and tell then how it is going (she is struggling).

I do find your ped's insistence on this to be unusual. I have had private conversations with my pediatrician about concerns I had with my kids when I didn't think it appropriate to talk with the child in the room. But, those were medical issues, and I think that the ped isn't the right person to help you with your child's behavior struggles anyway, so go back to the psych eval.

ETA: I see that you added that you can't go back to the original dr who did the psych eval. I still wouldn't go to the ped for this. I'd take a copy of that eval (hopefully you have it, if not the ped is legally required to give you a copy upon request) and find a different pediatric psychiatrist for a follow-up eval.

You need to change doctors. Period.

Your PCP is not a child psychologist. There ARE child psychologists out there for preschoolers and your doctor wasn’t interested in telling you this. Now your child is in her 2nd year of school and needs PROFESSIONAL help. NOT with the PCP.

You said that you had tests done. The hospital that did the psych evals should be able to give you the name of someone. Start there. No more putting up with your unhelpful PCP.

C.

Sounds like you need a new pediatrician. Or clarify with your pediatrician WHY they feel the child MUST be present for this discussion. It could be about insurance and billing it could be the doctor feels your child needs to hear your concerns and that you are TRYING to help her.

Your daughter needs to hear you fight for her and help her. She's struggling. It sounds as if she needs a psychologist instead of a pediatrician. Ask your insurance for referrals since your pediatrician won't refer. Ours can't "refer" they can give a list of doctor's they work with and then you can ask - if this were YOUR child, which one would you go to? And they will typically respond.

Go to your daughter's school and talk with the teachers and guidance counselors. They can also get you a referral for an evaluation.

Yes, your daughter IS human but she NEEDS to know what is going on. She needs to be able to SEE interaction and how to deal with things. She needs to use her words at home like she would at school. She HAS to know how to behave and what is expected of her.

I would also suggest letting this go with the PCP, as few have the kind of expertise that you want.

I am wondering if the behavior therapy you did when she was 4 was helpful? Did you see improvements, did you like the therapist? Did the assessment that was completed fit with what you were seeing? Did any specific recommendations come out of that assessment? For example, if your daughter has sensory processing challenges, they might have recommended Occupational Therapy? For anxiety and/or ODD, they might have recommended a good family therapist, to help you learn how to better help her. This therapist could be a psychologist, a social worker, or a psychiatrist, each might have somewhat different emphases, but all could treat the issues you are describing.

Maybe these things had already been addressed when she was 4, and you and the old therapist felt things were going well enough that no further work at that time was necessary? If you agreed, and you liked them, why not return now that she is struggling again? Maybe you felt surprised and/or let down that they didn’t recommended any kind of ongoing therapy, and you would prefer to find someone else? If so, ask around in your community for recommendations. Sometimes it can take a while to find a good fit for you and your daughter, but you should put your energy into finding a good child therapist, don’t worry about the PCP.

If your daughter is struggling at school, you can also ask them to complete an assessment there, which will focus on the ways her behavior challenges might be impacting her learning. They can offer her support in the classroom that will be helpful to her with whatever her struggles are.

When we went through this recently with my mom who has mental health issues because of her disease, we had to have her present and discuss them in front of her. It was awkward. The thing is, you may as well get them out in the open. Easier in long run.

My kids have had motor skill issues, one was evaluated for special needs, mental health issues, etc. Typically we have addressed during their appointments with them there if I think back. Sometimes (older ones) have met one on one themselves (we've stepped out) for a moment.

We had to write a letter to my mom's doctor. That is how we addressed the issues before the appointment to bring them up - so that seems typical. My mom was upset - but that's because it felt like we blindsided her. So tell your daughter beforehand what appointment will be about.

Honestly, depending on your daughter's age and how many other evaluations she will have - I don't think she has to feel upset or different. This is who she is, and her behavior. Surely she is already feeling a little left out. I would treat it more like you are just getting help for her so that things are easier for her. Approach it like that. I wouldn't say 'behavioral issues'. Maybe write a letter to her pediatrician that you'd like to approach it like that - how you discuss - that you want help for her. We did that with one of my children - she has anxiety.

We talked about coping skills and ways for her to feel empowered. We never addressed it as a problem (although it certainly felt like one at the time). We said "Would you like to see someone so that it's a little easier for you?". Tools, techniques.. maybe have it like that. When one of ours needed help with motor skills - same thing. We had OT come to our home and instead of making her feel embarassed about not being able to print at her level, we said would you like help on being able to catch up? So in meeting, we didn't say "She's not cutting or printing at same speed as everyone else". We would say "She finds it a bit hard to complete her work and would like help ..." ... (so she didn't feel badly).

We said "Would you like help?". We will be seeing someone to get you help.

I don't know if that helps.

When you see the specialized therapists, then you can see separately (we saw them on our own to discuss progress/issues we were encountering so we could parent/help more effectively) and they could bill it between us and our child - depending on how much coverage we had left.

Good luck :)

ETA: Nice to see you back MilitaryMom :)

i don't have personal experience in this, but i agree with you that it's important for you to be able to have a frank discussion with the doctor without your daughter present, in addition to being there for her evaluation.

it may also be important for a good doctor to have sessions with her without YOU present.

your pediatrician is probably not really qualified to deal with all of these particular issues. good for you for starting there, but since your questions go beyond her purview, and the first psych evaluator you went to has punted the ball, i'd seek out another one.

good for you for continuing to follow through and advocate for your daughter.

khairete
S.

That's not normal, in my experience. Maybe it's an insurance thing? I've been able to get some private time with my kids' pediatrician during appointments. I would either call in advance to let them know that I would need a few minutes privately or would mention it at check-in if I hadn't been able to reach them via phone prior. We've discussed family issues, behavior, weight, drug testing and other sensitive topics. With psychological issues, it's routine for parents to have several full sessions with a provider before the child is brought in. I would find another PCP.

FWIW, you don't have to use your doctor for this at all. I would just request another evaluation through your child's school. Let them do the tests that they think are useful, and request a functional behavioral assessment as part of that so that they observe her in the classroom, in the lunchroom, at recess, etc. Once you have the data from the evaluation, you can figure out what the next steps are in terms of accommodations, therapy, etc.

Skip the PCP all together - they will never be able to help you (or at least almost never) in this arena. PCPs are for strep throat and sprained ankles, not complex mental health issues involving ongoing therapy protocols and medication management issues. Just start from scratch - either contact your county's children's mental health department for a referral, or reach out to your insurance company's mental health advocate (most of them have one believe it or not - extremely under utilized resource) for referrals. If neither of those are a go, looks for a therapy place that does a "diagnostic assessment" and make an appointment at a children's psychiatrist. You should be able to get the DA done relatively quickly so when you get the appt at the psych office (which could take 6 months) you will have the DA handy. You could try the school to see if they have a Behavioral Clinic they work with that would do an evaluation, but you should be careful involving the school early on. They can muddy the waters depending on the school and the teachers involved (we've had great luck and terrible luck - it really depends).

As far as your question regarding having the child involved with the appointments? Believe it or not, that is pretty common. However, I'd not do it with a person untrained in the ways of emotional or behavioral health. With our one psych, he would do an appt first with me, then with both me and the child - however, that was more rare than you would think.

Good luck!

Chances are the conversation between you and the doctor will go right over her head.
If the doctor wants her there - he wants her there for a reason.
If her behavior is so off the charts that she growls - face it - she IS different - and she's not embarrassed to act like this in public.
Why would you think a conversation between you and the doctor about her would phase her at all?
Your daughter needs help.
You can not afford to be 'extremely uncomfortable'.
Get over it, listen to the doctor(s) and get your daughter the help she needs.

I suggest family and play therapy with LCSW.
Where you go with your daughter, she meets with therapist alone, then you together, then you with therapist. This way she can get a better accessment of issues and dynamics.

Very helpful with my kids. My younger daughter wanted to go after seeing her brother do play therapy.

First, get yourself a child psychiatrist. Have them evaluate. Then, do what they tell you.
Second, sign your child up for Karate. They will teach her more than you can imagine.
Third, speak with the teacher. Volunteer in her classroom. Find out for yourself exactly what goes on all day every day.