Sunday, March 05, 2006

Pediatrician as Psychiatrist?

Dr. Hebert (Homepage) asked if it would be possible to ease the shortage of child psychiatrists, by offering pediatricians a one-year fellowship in child psychiatry.  Personally, I think it would be a good idea.  That is not because it would be an ideal solution, but because it would be a practical solution.  

Ordinarily, it takes five years of training (after medical school) to become a child psychiatrist.  Obviously, there is no way to duplicate that in a single year.  Thus, any such program would have to have fairly modest goals.  The goals would be to enhance the pediatricians ability to recognize and manage ADHD and depression.  The ADHD part would be fairly straightforward.  The depression part is more difficult, because recognizing depression in children and adolescents is complex.  

One of the more perplexing aspects of the history of psychiatry is the fact that it was long believed that children and adolescents do not get major depression.  It is hard to be sure of the reason for that, but part of it has to do with the fact that nuanced verbalization of emotions requires verbal abilities that are still developing when a person is young.  As an aside, there are some who believe that the reason men are less likely to be diagnosed with depression, compared to women, is that men have a harder time recognizing and verbalizing their emotions.  

Young people certainly do express emotion, so the problem is not in the absence of expression.  The problem is that it is hard for adults to calibrate their interpretation of the intensity of the expressed emotion.  Also, I think it is hard for kids to know what to do, when it is evident that what they have to say is not being heard or appreciated.  

Anyway, it does seem as though a one-year fellowship would be sufficient for someone already qualified as a pediatrician to get a pretty good understanding of those two conditions.  Pediatricians already have a lot of experience communicating with kids, and trying to understand them.  Most of them probably are pretty good at listening to kids.