Sunday, January 25, 2015

Inside that Special Needs Village: the doctors

I have broken down the professionals in your child's village into three groups: doctors, therapists, educators. This post will concentrate on the doctors.

To begin read the CDC's comprehensive website on development disabilities HERE.


Psychiatrist: is a medical doctor who did their residency and fellowships in psychiatry.  Psychologists are generally therapy oriented PhDs. Here is an article on the differences. I have placed psychologists among the therapists. It is also important that the psychiatrist have a background in developmental issues. It has been shown that psychiatric drugs can and do react differently in the autistic brain, and a psychiatrist should be aware of these studies. Psychiatrists also specialize in pediatric, adolescent and adult psychology.

Pediatrician: a medical doctor who specializes in children's issues. (Yes, I know you knew that.)   

Here is a list of pediatric specialties. 
Developmental pediatrician is a subspecialty.
Read: Developmental Pediatrics and Autism: The Basics 
Click HERE for a slideshow describing a developmental-behaviorist pediatric practice.

Endocrine doctor: Defined HERE.
Remember that your child will need a pediatric endocrinologist if they have thyroid, growth or hormonal issues. As they enter adulthood if the endocrine issues remain then they should switch to a regular endocrine doctor. I include this doctor separately in the list separately simply because for some reason endocrine issues do effect those on the autism spectrum in a higher percentage than the rest of the population of children.

Neurologist: Defined HERE. 
Confused as to whether your child should see a neurologist or a psychiatrist? Read this article from Discover magazine as a place to start. Still confused? In the end it's a matter of  preference. It is important to remember though that if you decide to go to a neurologist just for a seizure disorder (as opposed to for all the neurological issues) that they also have an understanding of your child's developmental issues as well. Not all do. It has been shown that approximately 30% of those with autism spectrum disorders also live with seizure disorders so this is no small issue.

To make it all the more confusing both the National Institute of Neurological Disorders as well as the National Institute for Mental Heath list autism as a medical condition that they both treat.

Internist (when your child outgrows the pediatrician it is essential that their main doctor understand that they have special needs and they will need to deal with them a little differently than with other patients). This is rather self-explanatory. This doctor is simply the one you may use as long as they are attuned to your child's special needs when it comes to care. Most general practitioners will garner information from specialists in order to proactively treat your now adult child.

Important legal healthcare note: Once your child reaches 18 years of age, they are legally adults. You will need to get them to sign a healthcare proxy (a copy should be given to their doctors). Additionally,  most doctors will ask for a list of persons that a patient will allow them to talk to about their health issues. Make sure that your child lists both parents and/or adults who have been instrumental in their healthcare. In the alternative, if you need to seek a conservatorship or guardian status for your adult child those papers must be given to the doctor.

Also if your adult child is admitted into a hospital for any reason you need to show them the healthcare proxy/guardianship papers, and/or have the child sign papers that the doctors can talk to you. [Also remember that once they are adults you cannot, unless under certain extreme situations (which tend to involve lawyers), have them committed for psychiatric support without their permission.] If healthcare papers are not signed, it is quite possible that the doctors will make decisions about your adult child's care without your input or permission, even if your child is not capable of making decision on their own at that time. (This may seem highly illogical to those of us raising autistic children, especially since we know that on a maturity level our offspring do mature later in life, but you are dealing with the law and it is geared toward the most typical in society, so be prepared.)

It is also important to remember, that the laws governing the dissemination of private medical information included all typical offspring as well. So it would behoove parents to have their typical children sign healthcare proxies and healthcare directives. Also note that if your adult child (typical and autistic) goes to college, they must sign the FERPA form whereby the school will talk to you not only about their grade, but their health as well. If your over 18-year-old child has any issues, be it behavioral, legal or medical, without that signed FERPA form, the school will not notify you nor discuss any issues with you.


Again if you would like to share another doctor-practice that you have visited and found helpful you can add them in the comments. But remember, I will not post "doctors" that have practices outside FDA, AMA, AAP, or CDC approval. While you may have found them helpful, I feel it would be irresponsible on my part to include questionable practices.