Dealing with doctors Q&A
If you're worried about your child's behaviour, the first port of call is often your GP. And if the GP refers your child, you will also need to see a specialist who makes the diagnosis.
Use the tips below to get the most from your appointments.
How to prepare for your appointment with a GP
Give some thought to the problems you and your child are having before your appointment.
The more information you give, the easier it is for your doctor to ensure you get the help you need.
- Describe your child's symptoms as accurately as you can. Try to be specific – 'for some time' can be anything from days to years.
- Make a list of symptoms. Writing them down means you're less likely to forget something important. It also helps the doctor to not miss any issues. Your GP probably won't have time to look through a lot of information with you during the consultation and may find it more helpful to do so afterwards.
- Check your list is complete. Don't dismiss things that worry you about your child's behaviour as minor – that's what your GP is there to help with.
- Try to request a double appointment. The average appointment time is just eight minutes, which isn't enough to deal with a complex problem like ADHD. Don't be put off if the receptionist asks why – everything you say inside the surgery should be confidential, which also applies to the receptionists. If a double appointment system isn't run, it's likely you’ll need a few appointments to get all the issues looked at.
- Take stock of medicines. Make sure you know the names of all the medicines your child is taking, including ones you've bought over the counter.
- Talk to your relatives about their health. This is because family history of disease can be important, especially with new symptoms.
What happens at the first appointment
If you're worried about your child's development, or are responding to concerns raised by the school, your GP is the first step to getting help. But because of the complexities of diagnosing ADHD, it's not one a GP will make without the help of a specialist.
So what can you expect from the first appointment?
With all the bad press that ADHD gets – and for that matter any mental health or learning difficulty – you may be nervous about broaching the subject with your GP.
But media and general attitudes are different to a GP's perspective – afterall, ADHD is recognised as a medical condition, as are a whole range of childhood behavioural disorders. Therefore, it's likely your GP will be sympathetic and helpful.
You need to explain what your specific concerns are about your child – this is where your preparation comes in handy.
After listening to your concerns, the doctor will:
- ask about your child's general health
- check what medication, if any, that they are taking
- ask further questions to clarify your concerns – for example the extent the problems affect your child
- ask about your child’s medical history and your family medical history.
Your GP might also perform a simple physical examination and check your child’s hearing or sight.
All these questions and tests are there to rule out other causes for their behavioural problems.
It's important to keep in mind that your child's demeanour and behaviour, in the setting of a GP's consulting room, may not be entirely typical or representative of what's usual for them – eg in unstructured or less supervised settings.
Don't be put off or embarrassed by this – an experienced and sympathetic GP will take this into account.
In some circumstances, you may wish to take the opportunity to discuss your concerns and describe behaviours without your child present. Children and young people may be upset to hear negative comments made in front of them.
After this preliminary assessment, your doctor will decide whether your child needs to be referred to specialist services for assessment, diagnosis and management.
What sort of specialist your child needs to see first, eg paediatrician, child psychiatrist etc, depends partly on the nature of the problem and partly on local availability. For example, if tummy pains are prominent, these may need to be looked at by a paediatric specialist first.
Questions you may want to ask the doctor
The consultation is a two way process, and at some stage you’ll want some answers to your own questions.
Examples of things to think about and be clear on are:
- how long will I have to wait for referral?
- what help can I get now?
What happens at the specialist appointment
The aims of this second appointment with a specialist are to make a diagnosis and then draw up a treatment plan, if required.
Any one or more of these specialists may be involved in assessing your child:
- psychiatrist
- psychologist
- paediatrician
- speech and language therapist
- occupational therapist.
What the specialist will ask you
The specialist will need to know your child's medical, family and psychiatric history – as well as a detailed account of your child’s behaviour problems, including any previous difficulties.
Some assessment services send on a detailed developmental and behavioural questionnaire in advance of the appointment and will have this handy to help in the assessment.
You may also be asked a specific set of questions about your child's behaviour, using prepared questionnaires known as rating scales.
What the specialist will ask your child
The specialist will ask your child some questions about her behaviour and how she feels about her problems.
This is an important part of establishing a rapport with your child, making older children feel included in the process and so more likely to comply with any treatment plan.
How the specialist evaluates your child
- Physical examination: the specialist will carry out a further physical examination of your child to make sure there's no underlying medical cause for the development problems, eg a hearing problem. Depending on the results, a specialist may occasionally order specific tests, such as blood tests, to confirm or rule out certain conditions.
- Educational history: the specialist will look at comments from your child's teacher or school. They may decide a more formal assessment by an educational psychologist is necessary.
- Clinical observation: because of the artificial environment of a clinic, it can skew your child's behaviour – they may act up or tone down her actions. For this reason, the specialist will sometimes arrange to observe your child in another setting (eg at home or school) before making a diagnosis.
- Development tests: the specialist may use physical tests to assess your child's motor skills (which affect development) – for example by testing your child's ability to catch a ball or write. Written or oral tests may be used to check how well your child understands what's being said and ability to express themselves.
Conclusion
After all these tests and questions, the specialist will make a diagnosis. Depending on what is or isn't causing your child difficulties, the specialist will draw up a treatment plan.
At this stage, you may have a number of questions. Again, don't be afraid to ask because it could save you a lot of anxiety later.
Questions you may want to ask the specialist
- How severe is the problem?
- What does your diagnosis mean for my child?
- What treatments are available?
- Would simple alteration of lifestyle help?
- Does my child need medicines?
- If so, what side-effects could there be?
- How long will the treatment need to be given?
- How often will you be checking on my child’s progress?
- How quickly will the medication take effect, and does it need to be taken every day?
- What happens if one treatment doesn't work?
- Will the problem ever go away, so my child can stop treatment?
- Would you be willing to see my partner and explain the situation to him or her?
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