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Child & Adolescent Psychiatry

Welcome to Child and Adolescent Psychiatry Services at the University of Michigan. We are one of the national leaders in integrating significant advances in genetics, neurobiology, and the behavioral sciences into a more comprehensive understanding of human development and behavior that allows us to provide state-of-the art patient care.

Our mission is to: 

  • Deliver a broad range of innovative clinical services to young people and their families
  • Provide subspecialty consultation to clinicians throughout the state of Michigan
  • Conduct programmatic research on psychiatric disorders affecting youth and their families
  • Provide excellent multidisciplinary training to the next generation of mental health providers and investigators
  • Represent the mental health needs of children and adolescents at all levels of policy planning

Our multidisciplinary training programs have been preparing mental health clinicians and scholars to address the unique needs of children, adolescents, and their families since the 1960's. Our clinical programs serve a large and diverse patient population, including a focus on underserved youth. We also work with clinicians throughout the state of Michigan to provide consultations and assessments, using innovative technology to connect with patients and providers in rural areas. Our outstanding faculty and staff have broad and diverse expertise in areas ranging from molecular biology research to innovative community treatments that address risk as early as a child’s first year of life.

 

Outpatient Services

Attention Deficit Hyperactivity Disorder

You should consider referring to this clinic if your child suffers from any of the following symptoms:

  • Hyperactivity
  • Impulsivity
  • Distractibility
  • Poor attention span
  • Difficulty following directions
  • Academic problems

The main function of the clinic is to provide diagnostic services to children and adolescents, between the ages of 4 and 18 years, with suspected attention deficit hyperactivity disorder.

This condition is widely regarded as the most prevalent psychiatric/behavioral disorder of childhood. A significant number of patients suffer from other psychiatric disorders, such as, depression; anxiety disorder; and autism. Untreated ADHD is often associated with school problems; conduct disorder; and, in some cases, substance abuse.

Patients receive a standardized and a comprehensive physical; neuropsychological; and psychiatric assessment, performed by experienced staff. The total duration of the evaluation is 5 to 6 hours.
Cases for ongoing treatment are accepted depending on such factors as distance from the clinic; availability of local resources; presence of family support etc.

Autistic Spectrum Disorders

The mission of the clinic is to provide diagnosis and treatment to children and adolescents with autistic spectrum disorders (ASD). Occasionally, adults are also evaluated in the clinic.

What are Autistic Spectrum Disorders (ASD)?

The ASD are a group of disorders which begin in early childhood, often as early as 2-3 years of age. Affected individuals present with social and communication problems with a tendency to focus excessively on certain topics or behaviors. Sometimes referred to as Pervasive Developmental Disorders (PDD), these conditions often persist through out the life span.

Categories:

The main categories are autism and Asperger syndrome. When an individual does not show all the symptoms of autism or Asperger syndrome, the label of Pervasive Developmental Disorder Not Otherwise Specified (PDDNOS) is used.

Comorbidity:

Most of the referred patients also suffer from other psychiatric and behavioral symptoms, such as, hyperactivity, depression and anxiety. Studies suggest that as many as 70% of referred children and adolescents with ASD have co-occurring psychiatric and medical conditions.

Evaluation:

Diagnosis is reached after a comprehensive multi-disciplinary assessment consisting of: neuropsychological testing; speech and language evaluation; a semi-structured interview of the care-givers; direct observation of the patient; and a full medical/psychiatric examination.

  • Diagnostic clarification of difficult cases
  • Teasing out the presence of other medical and psychiatric symptoms
  • Consulting with school authorities about treatment strategies
  • Training residents in child psychiatry; pediatrics; and other disciplines
  • Conducting research
  • Educating and informing parents about the diagnosis and treatment
  • Providing psychopharmacologic treatment where feasible
  • Organizing short-term groups for care-givers and patients

Depression Center Specialty Programs

The Depression Center's Specialty Programs provide consultation and treatment services for a wide variety of mood disorders. We focus on bipolar disorder and difficult-to-treat major depressions. Internationally recognized physicians with more than 15 years of specialty experience lead these programs. The programs consist of a panel of experts in the psychotherapies relevant to mood disorders (cognitive behavioral therapy, dialectical behavioral therapy and interpersonal psychotherapy), and draw from a team of nurse practitioners, social workers and psychologists who provide assessments and therapy recommendations.

Family and patient support and education are integral to this program; we advertise weekly events at the clinics. Sleep disorders testing and sleep hygiene interventions are available for those with accompanying sleep problems. We emphasize education and self-management. The Adult program interacts with the Child-Adolescent programs through the Youth and Young Adult Mood Disorders Clinic, which is designed to provide assessment and ongoing care for the adolescent and young adult age group.

Our comprehensive assessment of patients with an affective disorder focuses on the needs of the patient. We believe that psychopharmacology considerations and medication management serve as a strong foundation in managing bipolar disorder and moderate to severe depressions. These clinics are also very mindful of the benefit that the psychotherapies and family therapies can provide the patient and family. Our assessment integrates this into the plan and recommendations for treatment, with attention to the timing, focus and duration of therapy.

Comprehensive consultations and ongoing treatments of patients with depressive or bipolar disorders occur through the educational and teaching clinics of the University of Michigan Depression Center. In these clinics, a psychiatrist in training evaluates the patient and presents the clinical information to an attending psychiatrist; together, they meet with the patient for further evaluation and discussion of the treatment plan. Additional assessments such as psychological testing may be arranged for a later date.

The Faculty Executive Consultation Clinic is a new service offered by the University of Michigan Depression Center and the Depression Center's Specialty Programs. Senior faculty members provide this consultation without trainee participation. This consultation service is available primarily to provide input to referring physicians, rather than to provide ongoing care. The amount of consultation time determines the fee structure. The senior faculty psychiatrist provides a consultative report and communicates with the referring physician and patient.

Crisis Support

The goal of the Crisis Support Clinic is to offer acute psychiatric care services and support as patients make the transition from hospital services to a provider in the community. The clinic strives to provide timely appointments for patients post-discharge from hospital services. The hospital service schedules the initial appointment in the clinic directly for additional ease in the discharge process. The clinic is designed for short-term stabilization and bridging services while ongoing care is being arranged and transferred to a provider in the patient’s community. These goals are typically met within one to three months of care within the Crisis Support Clinic.

Infant and Early Childhood

Who does the Infant and Early Childhood Clinic help?

The Infant and Early Childhood Clinic is available to parents of young children (1 to 6 years old) who exhibit challenging behaviors, including children with:

  • high levels of anxiety
  • difficulty in regulation (feeding, sleeping, self-soothing)
  • aggressive behaviors
  • developmental concerns (language, socialization)

Other children who benefit from these services are those:

  • who are in foster care or have a history of early relationship disruptions or losses
  • who are having difficulties with custody/visitation arrangements because of foster care or parental separation/divorce
  • whose families have experienced a traumatic event
  • whose parents themselves struggle with illness

What will the clinic do for me?

Decades of research confirm that the parent-child relationship lays a foundation for children’s emotional and behavioral well-being. Yet many families face challenges that may result from difficult child behavior, family stresses, or other factors and situations that affect family life.

The Infant and Early Childhood Clinic helps parents and infants to develop secure, joyful relationships, which in turn sets them on a healthy developmental path, regardless of diagnosis.

Faculty members are experts in early childhood and represent a range of disciplines, including psychology, psychiatry, and social work. Using evidence-based strategies for evaluating child behavior and development, as well as family strengths and challenges, the team provides families with support and resources to strengthen parenting and address children’s needs. In addition to diagnostic assessment of the child, the PCRC provides parents with individually tailored support and guidance.

What happens in the evaluation session?

The evaluation includes three sessions. In most cases, two of the sessions are on the first day and the final session is usually scheduled a week later. The first day of evaluation typically lasts between two and two and one half hours. The final session lasts about one hour.

  1. Week 1 - The first session is an interview with parents alone. This provides us with an opportunity to hear your concerns, to get to know your child’s developmental history, and to begin to learn more about your family life together. This is immediately followed by a second session, which is a videotaped assessment of the child interacting with clinic staff and parents and engaging in a variety of tasks that allow us to learn more about how your child responds to a variety of situations and experiences.
  2. Week 2 - During the final evaluation session, the videotape is reviewed with parents to highlight important diagnostic markers and support parents in finding ways to best address child needs.

Following the evaluation, children may be referred for ongoing individual or family therapy.

Michigan Child Collaborative Care (MC3)

The MC3 program provides psychiatry support to primary care providers in Michigan who are managing patients with mild to moderate behavioral health problems. This includes children, adolescents and young adults through age 26, and women who are contemplating pregnancy, pregnant or postpartum with children up to a year. Psychiatrists are available to offer guidance on diagnoses, medications and psychotherapy interventions so that primary care providers can better manage patients in their practices. Support is available through educational phone consultations to referring providers as well as remote psychiatric evaluation to patients and families through video telepsychiatry.

At the current time, the program is limited to primary care providers in designated geographic counties. We hope to continue to expand to other geographic areas in the future.

For additional information about this program please visit their website.

Parent-Child Relational Clinic

Who does the PCRC help?

The Parent-Child Relational Clinic (PCRC) is available to parents of young children (1- to 6- years old) who exhibit challenging behaviors, including those with:

  • high levels of anxiety
  • difficulty in regulation (feeding, sleeping, self-soothing)
  • aggressive behaviors
  • developmental concerns (language, socialization)

Other children who benefit from these services are:

  • in foster care or have a history of early relationship disruptions or losses
  • having difficulties with custody/visitation arrangements because of foster care or parental separation/divorce,
  • those whose families have experienced a traumatic event,
  • those whose parents themselves struggle with illness.

What will PCRC do for me?

Decades of research confirm that the parent-child relationship lays a foundation for children’s emotional and behavioral well-being. Yet many families face challenges that may result from difficult child behavior, family stresses, or other factors and situations that affect family life.

The PCRC helps parents and infants to develop secure, joyful relationships, which in turn sets them on a healthy developmental path, regardless of diagnosis.

Faculty members at the PCRC are experts in early childhood and represent a range of disciplines including psychology, psychiatry, and social work. Using evidence-based strategies for evaluating child behavior and development, as well as family strengths and challenges, the team provides families with support and resources to strengthen parenting and address children’s needs. In addition to diagnostic assessment of the child, the PCRC provides parents with individually tailored support and guidance.

What happens in the evaluation session?

The evaluation includes three sessions usually scheduled in successive weeks.

  1. The first session is an interview with parents alone. This provides us with an opportunity to hear your concerns, to get to know your child’s developmental history, and to begin to learn more about your family life together.
  2. The second session is a videotaped assessment of the child interacting with clinic staff and parents, engaging in a variety of tasks that allow us to learn more about how your child responds to a variety of situations and experiences.
  3. During the third session videotape is reviewed with parents to highlight important diagnostic markers and support parents in finding ways to best address child needs.

Following the evaluation children may be referred for ongoing individual or family therapy.

Pediatric Anxiety and Tic Disorders

This program offers individualized clinical treatment services for children and their families, conducts innovative research aimed at better diagnosing and treating anxiety, and provides training for future mental healthcare professionals. Our interdisciplinary clinical team is staffed with child psychiatrists, child psychologists, social workers and researchers, all of whom specialize in the recognition, assessment and treatment of pediatric anxiety and related disorders, such as tics.

What will happen at my visit?

By combining state of the art psychometric measures with important details from child and parent clinical interviews, our clinicians are able to provide expert assessments of children and adolescents, and can also measure change in symptoms over time. The clinical services that we provide include:

  • Consultation and evaluations for diagnosis and treatment recommendations
  • Medication management
  • Cognitive behavioral therapies

Pediatric Collaborative Care

The intent of this clinic is to provide:

  • Support to UMHS pediatricians managing child and adolescent patients with mild to moderate mental health problems, and
  • Recommendations that would help the pediatricians feel more comfortable with treating these children on an ongoing basis.

The child psychiatrist does not provide ongoing treatment or medication prescriptions, but rather supports the referring pediatrician in diagnosis and medication recommendations.

Examples of appropriate consults are for:

  • Children/adolescents with mild to moderate depression/anxiety/ADHD who have failed one or two medication trials.
  • Children/adolescents who may have depression or anxiety, but are patients for whom additional guidance and recommendations on diagnosis or treatment would be helpful.

Referrals can be made by pediatricians within the UMHS system. Patients and families are informed prior to the referral that this is a one-time consultation and that they will not be receiving prescriptions at these appointments.

Trauma and Grief

The Trauma and Grief Clinic provides trauma informed assessment, intervention, consultation and community outreach to children, adolescents (between the ages of 7-17 years) and families who anticipate or have significant histories of traumatic- and/or grief-exposed circumstances, broadly defined, to promote understanding of responses and healing. To service this population with a best practices approach that is individually tailored keeping in mind developmental, cultural, and other diversity considerations.

Treatment Resistant Disorder (TRD)

The treatment resistant disorder (TRD) clinic provides services to adolescents and children who suffer from severe mood disorders (depression or bipolar disorder) and psychotic disorders that have failed to respond to conventional treatment. Patients receive a comprehensive evaluation with specific attention to co-existing conditions that may interfere with treatment response. Some patients in this clinic may be offered treatment with electroconvulsive therapy (ECT). ECT is generally initiated during a brief hospitalization after the completion of additional evaluations and under the supervision of highly skilled clinicians. Close follow-up is provided throughout treatment, at which point patients return to the care of their outside provider.

 

Inpatient Services