I have recently made an appointment for my son to be tested for ADD. The appointment was with a Child Psychiatrist. There was no testing done at all. The Dr. had a 15 minute private meeting with my son and then proceeded to prescribe medications for him. I explained to the Dr. that I had expected several hours of testing to determine if my son had ADD He said that to have him tested I would need to take him to a Child Psychologist.
I was going to take my son to another Dr. anyways, because I didn’t feel comfortable with prescribing an Amphetamine based medication based on a 15 minute meeting. But, this got me wondering what the difference is between a psychologist and a psychiatrist. I thought that they were the same thing except that one could prescribe medications while the other could not. Can someone explain the difference to me, please? Thank You.
A psychiatrist may prescribe medicines because s/he is a full MD. They have attended medical school and then specialized in psychiatry. A psychologist will usually, but not always, have advanced degrees, preferrably a doctorate, in psychology.
So…I was right? One difference being that a psychiatrist can prescribe medications, while a Psychologist cannot. Wow. I can’t believe that I was right.
Psychiatrists are M.D.'s (medical doctors) who specialize in what one might call “psychological disorders.” As doctors, they can prescribe medication. They are often accused of prescribing medication in a rather mechanistic way. You need a psychiatrist (or any M.D. actually) to prescibe things like anti-depressants, etc. They need expertise in psychopharmacology (pharmaceutical goods that treat the mind) to this well
Psyche is the Greek word for “soul” and “iatry” comes from the Greek word for “healing.”
Psychologists, who hold a Ph.D., are also “doctors”, but are not M.D.'s, and cannot, therefore, prescribe medication. Their training often involves much greater emphasis on psychological testing and a whole range of fields relating to human psychology, and their treatment is usually talking therapy, of which their are many versions (cognitive to Jungian to Freudian). There are lots of folks who work in psychology who are not Ph.D.'s; they have masters degrees in Social Work (LSW’s), Marriage and Family Therapists (MFT’s), MFCC’s, etc.
A psychoanalyst is a special version of a psychologist. They sometimes have no training in testing, etc., and are usually graduates of psychoanalytic institutes. Their focus is long term talking therapy. Many psychoanalysts are not psychologists; they sometimes have Ph.D.'s in other humanistic or social science fields, and go through an intensive program at a psychoanalytic institute for their training.
There are also psychologists who hold a PsyD, rather than a Ph.D. I believe the difference is that their training is more intensely focused on therapy, rather than on conducting experiments in order to write their thesis. Someone with a Ph.D. in psychology does not necessarily end up doing therapy - they could just spend their career studying the mind (if they can find funding for their research). Someone with a PsyD is always going to do therapy. Both are called Doctors.
The “basic” difference usually given is:
A psychologist is someone who has studied for at least six years at a tertiary level, in the area of psychology. They cannot prescribe drugs.
A psychiatrist is a medical doctor that has completed further training in psychiatry. They are able to prescribe drugs and generally utilise medication within their treatment.
What this doesn’t explain is that while a Psychiatrist does have an actual medical doctorate. The degree is usually in the general medical field. Then they’ll specialize in psychiatry and focus on the mental and behavioral aspects of their patients. Prescribing medications for known ailments is the common approach. They are usually referred after a diagnosis is made by a psychologists who recognizes the treatment requires medication. They also get paid more.
Psychologists with a doctorate have studied nothing but the brain and behavior of their patients for at least six years. Their main focus on treatment is behavior management and various types therapy or counseling. They often make the primary diagnosis in medical/mental disorders and refer these patients to a Psychiatrist for further treatment where drugs are effective.
They get paid less. Your son’s school should have a psychologist (at least) on staff. Get them to make an evaluation and see if they’ll refer.
Caution, IMHO AD/HD is an over diagnosed disorder in this country. The prescription of Rotali is abused by the schools. Be very careful and get a second opinion AND do some research on your own as well. If the diagnosis is correct then I’d agree…but if not the stupifying of children in the classroom is what we’re talking about. Overdoses of amphetamines will cause psychosis and catatonia and much more and worse symptoms.
This is simply my opinion, although I did do my graduate studies in biological psychology at UT.
good luck
Why didn’t the psychiatrist say, when you said you wanted your son tested for ADD, that he doesn’t do testing for ADD and that you needed to contact a different type of doctor? I’d be very annoyed if that happened to me.
I was very annoyed, and let him know I was annoyed. I calmed down when he explained that his appointment takers should have known this and that I would not be charged for the visit.
I still do not think that a 15 minute meeting with a 10 year old is enough to prescribe the sort of medications he was suggesting. But, IANAD and so I am taking him to someone else for a second opinion.
Another question (Probably outside the scope of the SDMB): Does anyone know what sort of treatment a Psychologist can offer for ADD (if my son is determined to have the condition) other than refering us to another Psychiatrist for medication? Are there ways to treat or learn to work with the dissorder without using medication? I have known children of friends and family that have taken Ritalin and they were not the same child while on the meds.
To imply that a psychologist doesn’t have medical knowledge or understand pharmocology is incorrect. I had six semesters of general biology, two semesters pharmocology, two semester chemistry and every psych class offered to get my bachelors degree in science. Then at grad school I had another two years studying the brain and behavior in which I took two more semester of advanced psycho-pharmacology, several more biology classes (specific to the brain) and another advanced chem class. Not to mention a slew of courses in various behavioral sciences and more.
At the doctorate level…well I couldn’t afford to go. My wife and daughters health had become an issue and I had to quit school.
Which is better…well, that’d depend on the practitioner IMHO.
Greathouse
Why did you go to the MD in the first place? It might explain why he just started writing scripts…
There’s been debate about allowing psychologists write prescriptions for their patients for awhile. I think they should, the last general MD knew jack shit about the brain and it’s functions much less its reactions to certain chemicals. He was trying to explain the functions of various parts of the brain to me and he didn’t know himself.
He’s got a book, an old book, one that he hasn’t read since he got his diploma. They get the license and quit studying. It pisses me off, obviously.
Sorry if I sounded like I was casting doubt on any practitioners ability to treat any condition. Pretty much anyone would know more about this than me.
I took him to the Dr. because of his problems in school. His teachers say that he will fidget with things on his desk or basically just have a hard time paying attention in class. When he is at home, he can’t seem to stay focused on anything longer than a few minutes. My parents were the old school, “We’re gonna bust your ass” type of parents when it came to school. I admit, I used to be the same way. But when it obviously wasn’t working, I had to try something else. I’m not going to just keep punishing him and punishing him if it isn’t getting any results. I wanted to take him to the Dr. to find out if he had ADD or Dyslexia. I wanted to either rule it out as the problem or treat it if he does have the condition. If it turns out that he doesn’t have either of the conditions, then it is time to try something else.
I didn’t mean that YOU implied anything. It is a common misperception however. Many psychiatrists even present themselves as “superior” in some way because theirs is a medical degree. They studied for years about things which rarely pertain to the disorders of the brain howver. Sorry, that is just one of my little pet peeves.
Your school didn’t have a counselor? There are some non-medical approaches that have shown some benefits in behavior for AD/HD patients. Check around for some behavioral modifications and limitings tasks to w/ 20 minutes or less. Dietary restrictions and others…damnit G/H I’m late for an appointment ow or I’d like to go over some of these in detail.
I’ll be back tomorrow probably…if you’re still interested. take care t/k
Several points, some of which repeat what was said or are slightly different, but I think about this issue a lot (used to study psychology, a brother is PsyD, close friend is psychiatrist, siste in law is an MD, etc.):
Most Clincal Psychologists have a PhD, but there is also a less know degree abbreviated PsyD that is also clincal and often focuses more exclusively on testing. A psychiatrist will have an MD and should be “board certified” in psychiatry (specifically, a doctor can be certified, I think, in Child Psychiatry, but I’m not certain if that is required for licsensing or just another sign of additional training and study in that particular domain.) You might find some PhDs and MDs that also have additional training. (Of course, a DO is the same as an MD in this categorization. I might forget to say DO, but I mean them when I say MD. There is some reason to think a DO might be a bit more inclined to spend more time than a MD, but maybe not in the current economics of medicine, see below.)
Psychologists and psychiatrists often seem to “not play well together” when it comes to deciding the answer of “who can do this or that better?” Politically, there is tension between these professions over the right of only doctors to prescribe medication. (Some states are doing a trial where a PhD with some additional year or two of training can write scripts for drugs, not sure how that’s going. Every clinical psychologist I know is just as certain as the doctors that their side is right.) I give you this just to know that you will see doctors and psychologists somewhat roll their eyes, like this: :rolleyes: at the discussion of what one said or did. Ignore people who are testy on this difference between them and don’t see anybody who agressively bad mouths the other profession.
The difference in talent is, as you might guess, one of personal committment and knowledge, and not just of training. Picking the right care for your child won’t come down to the difference, of course you know that, but just to put that out there. (Oh and this is NOT medical advice to cover my tail.)
Sadly, the HMO and insurance world has intruded a lot here. The more patients a doctor can see in a day, the better from the managment’s point of view (true of private practice, too, but not quiet the same as they can set their own rates or decide on case by case). I’m also aware that their are a lot of burn out, lazy, behind the times, or just plain bad psychiatrists out there. Some of psychologists, too, however.
The difference in services, (setting aside what your insurance is more likely to pay for AND setting aside the medicine management) is that psychologists use a lot of testing materials in addition to just talking and asking questions. They also have greater training in the implications of many disorders for complex social and personality traits. For instance, children with ADHD often have trouble making friends. A doctor is not likely to have lots to say on that, but a psychologist should (again you might find that a great doctor is better than an average psychologist, and all those usual your mileage may vary). In fact, a doctor might not even ask about that in the “medical review” session that often last just 15 minutes.
If you can afford it and think it is worthwhile, some testing or even just an hour with a psychologist might just give you, and your kid, a better picture as to how this problem, if it exists, relates to other aspects of their life. More extensively, a psychologist should be able to work on behavioral and cognitive skills a child with a disorder might need to learn more explicitly that other kids picked up at an earlier age. For instance, a bright kid with ADHD might get by in school for many years by just using their smarts, but then crash in high school or college because they aren’t organized or experienced in dealing with complex assignments and deadlines which they could just ignore at lower levels and still do ok or even very well based on their smarts (not that all kids with ADHD are smarter than the rest, that’s a weird factoid that’s out there that seems dubious). If it affects their schoolwork, like sloppiness, they can provide (or referr) to a tutor to work on learning strategies. If it affects their friendships they can learn some social skills and how to handle when they feel an urge to interupt or get “spazzy”. Sports might be recommended, etc.
If medication is warranted, the PhD will have to send you to a doctor who, if they are any good, will want to see the notes from the PhD or TALK TO THEM about the patient. You should insist on this if you have the doctor manage the medication and the pscyhologist do work on other things.
As much as there is some tension between the two fields there is tension betwen people in each of the fields. Some of these docs and phds will disagree about medication amounts and kinds. It can be frustrating. Shop around. A diagnosis without any discussion with you is horrible, in my non-expert opinion (not medical advice ).
Final observation, many things that are not ADHD can look like ADHD. Anxiety, depression, OCD and other things have some similar features and interconnections in some people. As much as some people think ADHD is overdiagnosed, I think that these might be cases of general or specific anxiety disorders and/or mild depression or mild cases of intrusive thoughts that mild OCD can have.
I know of fair amount about this having gone to psych grad school myself and later becoming a patient. I will try to give you the simplest answer possible which is obviously not accurate across the board because their can be overlap.
Psychiatrists prescribe and manage psychiatric medications. They may have a little chat with the patient about problems caused by their condition etc. but it is not really the same as full therapy. It is very common for psychiatrists working in a hospital and clinic setting to schedule patients in 15 minute blocks. I got a new psychiatrist 3 months ago. He was very blunt and said that the hospital didn’t give in him to talk to me very much. I could an appointment for medication checkups about once a month and use him in case of emergency but that was it. That was fine with me because I have a psychologist too.
Psychologists give intensive talk therapy and work with the patient based on their thereoritical approach to therapy. Psychologists are also generally the ones that do behavioral assessments, interventions, psychological testing for disorders and things like IQ. In my experience, many psychologists also talk about medication with the patient. Many are quite knowledgeable about psychopharamacology and while they can’t write prescriptions on their own, they often have a psychiatrist collegue that will write them based on their advice.
Personally, I would be skeptical about the dietary stuff. To be cautiously skeptical about people treating your child is very smart, but lets not toss out science because some clinicians aren’t doing what we think is helpful. I would also recommend looking up ADD or ADHD on the websites of the National Institute of Mental Health. They have some great online stuff and you can order some things from them I believe for free. There’s a doctor at Harvard who had some good books out on this in the early/mid 1990s “Driven to Distraction” is the name of one, I believe. A room-mate had a copy of it, and it seemed sound. Something up to date by that author might be worth a look.
Sorry to single this part out. I did find the whole post very interesting and helpful. But on this point it seems a little wierd. Both of his teachers have told my ex-wife and myself that he has absolutely no problem at all making friends. They say that he is one of, if not the most popular kid in class.
After checking my insurance web site I have found a psychologist and made an appointment for Monday. Hopefully it will go well, but I am prepared for anything. I am almost positive that he suffers from some sort of depression, and has every since the divorce.
Quick note: A medical doctor will have NO experience in assessing dyslexia. A PsyD or a PhD will have to be seen. It can take up to a day or even day and a half depending on all the tests (school records might be good substitutes and they are at least additional information that should be used by the psychologists). It can be very pricey, over $1,000. Insurance companies might have special rules on this, so talk to them and get educated on all that.
Making friends was just an example of possible related problems. It isn’t conclusive of anything. I was just trying to think of things that might be out of the range of doctors to even thing or ask about, let alone treat, that a psychologist would.
I will talk to my insurance company, but even if they have a problem with it I’ll probably have him tested. I don’t mind spending the money if it will help with his frustration with regards to school.
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