Question 1

What is a psychiatrist?

Accepted Answer

A psychiatrist is a medical doctor who specializes in diagnosing, preventing, and treating mental illnesses and disorders. Unlike psychologists, who provide therapy and counseling but cannot prescribe medication in most jurisdictions, psychiatrists have the authority to prescribe medication to treat mental health conditions. Their medical training allows them to understand the complex relationship between emotional and physical health, and they can evaluate medical and psychological data to formulate treatment plans.

Question 2

What is autism?

Accepted Answer

Autism, formally known as Autism Spectrum Disorder (ASD), is a complex, multifaceted developmental disorder that affects a person's social skills, communication, relationships, and self-regulation. It encompasses a wide range of symptoms, skills, and levels of disability. ASD is called a "spectrum" condition because it affects individuals differently and to varying degrees.
 
Key Characteristics of Autism:
Social Communication and Interaction Challenges: Individuals with autism may have difficulty with verbal and non-verbal communication. This can include challenges in understanding and using gestures, making eye contact, and navigating social nuances. They might find it hard to engage in conversations or to understand others' thoughts and feelings.
Repetitive Behaviors and Restricted Interests: People with ASD may display repetitive behaviors, routines, or activities. These can include repetitive movements, such as rocking or flapping, strict adherence to routines, and intense or focused interests in specific subjects.
Sensory Sensitivities: Many individuals with autism experience hyper- or hypo-sensitivity to sensory input. This means they may be particularly sensitive or under-responsive to sounds, lights, textures, tastes, and smells.
Developmental Differences: While autism is often associated with intellectual disability, this is not always the case. Some individuals with ASD may have average or above-average intelligence. Autism can also co-occur with other conditions, such as ADHD, epilepsy, and anxiety disorders.

Causes and Diagnosis:
The exact cause of autism is unknown, but it is believed to involve a combination of genetic and environmental factors. There is no single cause for ASD, and research suggests that both genetics and environment play critical roles.

Diagnosing ASD typically involves a multi-disciplinary evaluation, including a neurological assessment, genetic testing, and observations of the child's behavior. Early diagnosis and intervention can significantly improve outcomes for individuals with autism.

Treatment and Support:
While there is no cure for autism, there are various treatment and support options available that can help individuals manage symptoms and develop social, communication, and academic skills. These include behavioral therapy, speech and occupational therapy, and personalized education plans. Medication may also be used to manage co-occurring conditions or specific symptoms.

Supporting someone with autism involves understanding their unique needs and challenges and providing a supportive and accommodating environment. Awareness and acceptance of autism have grown significantly, leading to better resources and support systems for individuals with ASD and their families.

Dr. Taggart has an unusually deep background and training in autism. He has been known widely as a community expert in autism to whom other practitioners have referred, and has treated hundreds of autistic patients. He also trained at the Yale Child Study Center under multiple international experts in autism, including Dr. Fred Volkmar. He also offers a targeted social skills group therapy in autism called Friendly Faces.

Question 3

Can my own anxiety affect my child? What can I do about it?

Accepted Answer

Parental anxiety can significantly impact children, affecting their emotional, psychological, and behavioral development. Children are highly perceptive and often pick up on their parents' emotional states, sometimes even adopting these feelings as their own. Here's how parental anxiety can affect a child:

Emotional & Psychological Effects
Increased Anxiety and Stress: Children of anxious parents are at a higher risk of developing anxiety disorders themselves. They may learn to view the world as a threatening place and can become overly cautious or fearful of new situations.
Behavioral Mimicry: Children often model their behavior on their parents'. If they observe their parents responding to situations with anxiety or fear, they might mimic these responses, leading to similar anxious behaviors.
Emotional Regulation Difficulties: Parents who struggle with anxiety may have difficulty regulating their own emotions, which can hinder their ability to teach their children effective emotional regulation strategies. This can leave children less equipped to manage their own emotions.
Attachment Issues: High levels of parental anxiety can affect the parent-child bond, potentially leading to attachment issues. Secure attachment is crucial for a child's emotional development and future relationships.

Behavioral & Developmental Impacts
Social Withdrawal or Avoidance: Children exposed to persistent parental anxiety might become withdrawn or avoidant in social settings, reflecting learned anxious behavior from their parents.
Academic Performance: Anxiety in the home environment can disrupt a child's concentration, sleep, and overall well-being, potentially impacting academic performance and engagement in school activities.
Physical Health: Chronic stress and anxiety in the home can also manifest physically in children, leading to issues like sleep disturbances, headaches, or stomach problems.

Strategies for Mitigating Effects
Seek Support: If parental anxiety is affecting family life, seeking professional support from a psychiatrist or psychologist can be beneficial. Therapies like cognitive-behavioral therapy (CBT) are effective for managing anxiety.
Open Communication: Maintaining open and honest communication with your child is important. Explain emotions and reassure them that they are safe and loved, making sure to adapt the explanation to their age level.
Modeling Healthy Coping Strategies: In my experience, this is one of the most important things parents can do: modeling for their children the healthy management of anxiety. (If necessary, with the help of a professional as above.) Demonstrating healthy ways to manage stress and anxiety can teach children effective coping mechanisms. This includes problem-solving, positive thinking, and relaxation techniques.
Maintain Routines: Consistent routines provide a sense of stability and security for children, helping to reduce anxiety.
Prioritize Self-care: Taking care of your own physical and mental health sets a positive example for your child and improves your capacity to support them.
Foster Independence: Encourage your child to take on new challenges and activities at their own pace, supporting them to build confidence and resilience. This is another big area where I see parents able to make a big positive impact on their kids: doing the sometimes difficult (and sometimes scary) work of encouraging your child to begin to face some challenges. (Since this one can be tough, my advice is to seek professional guidance on this from a child/adolescent psychologist or psychiatrist.)

Understanding the impact of your anxiety on your child and taking steps to manage it can help mitigate potential negative effects, promoting a healthier and more supportive environment for your child's development.

Question 4

What are the effects of divorce on children?

Accepted Answer

The effects of divorce on children can vary widely and depend on several factors, including the child’s age, personality, the circumstances of the divorce, and the family dynamics before and after the separation. However, research has identified several common emotional and behavioral effects that divorce may have on children. Here are some of those effects:
Emotional Stress and Anxiety: Children may experience a range of emotional responses, including sadness, anger, confusion, and anxiety. They might worry about the future, fear being abandoned, or feel they are to blame for the divorce.
Behavioral Problems: Some children may exhibit behavioral issues as a response to their emotional stress. This can include acting out, aggression, defiance, or withdrawal from social interactions.
Academic and Cognitive Impacts: The stress and emotional turmoil of a divorce can affect a child's concentration, leading to difficulties in school, including lower grades and decreased academic performance.
Social and Relationship Issues: Divorce can affect children's ability to form and maintain relationships. They might struggle with trust issues or develop a fear of commitment and intimacy in their own relationships later in life.
Adjustment Difficulties: Adjusting to the changes in family structure, such as moving to a new home, changing schools, or living with one parent instead of two, can be challenging. These adjustments can further contribute to stress and anxiety.
Health Problems: The emotional impact of a divorce can also manifest physically. Children may experience health issues such as sleep problems, changes in appetite, or more frequent illnesses due to stress.
Positive Effects: While much of the focus is on negative impacts, it's important to acknowledge that divorce can also have positive effects on children in some circumstances. For example, removing children from a high-conflict environment can lead to improved well-being and stability. (This is one that, in my experience, many parents often under-appreciate.) Additionally, children can learn resilience and gain a more realistic understanding of relationships.

It's crucial for parents to provide support and stability for their children during and after a divorce. Open communication, reassurance of both parents' love (in my experience the biggest thing), and professional support, such as counseling, can help mitigate the negative effects of divorce on children.

Question 5

I have questions about my medication. Where can I get reliable information?

Accepted Answer

Finding reliable information about medication is crucial for making informed health decisions. Here are several reputable sources where you can find accurate and trustworthy information about medications:

Healthcare Providers: Your primary source of reliable information should be healthcare professionals like your doctor, pharmacist, or nurse practitioner. They can provide personalized advice based on your medical history, current health condition, and specific needs.
National Health Services Websites:
U.S. National Library of Medicine's MedlinePlus (medlineplus.gov): Offers comprehensive information on medications, including usage, side effects, and warnings.
FDA (U.S. Food and Drug Administration) (fda.gov): Provides information on drug approvals, labeling changes, and drug safety alerts.
NHS (National Health Service, UK) (nhs.uk): Contains detailed guides on various medications, including how to take them, possible side effects, and interactions.
Professional Medical Associations:
American Medical Association (ama-assn.org): Offers various resources, including drug information and health education materials.
American Pharmacists Association (pharmacist.com): Provides resources for medication information and patient care.
Academic or Research Institutions: Websites of reputable medical schools or research institutions often have patient education sections with reliable information about medications.
Patient Information Leaflets (PILs): These leaflets come with medication packaging and provide essential information about the medication, including how to take it, possible side effects, and contraindications.
Medical Journals and Databases:
PubMed (pubmed.gov): A database of medical and life sciences journal articles that can provide research-based information on medications.
Cochrane Library (cochranelibrary.com): Offers high-quality, independent evidence to inform healthcare decision-making.
Trusted Health Information Websites:
Mayo Clinic (mayoclinic.org): Provides easy-to-understand information on diseases, conditions, and medications.
WebMD (webmd.com): Offers a wealth of information on medications, including user reviews, though it's important to consult a healthcare provider for personalized advice.

When searching for medication information online, it's crucial to consider the source's credibility. Look for information from government health agencies, professional medical organizations, and academic institutions to ensure the information is accurate and up-to-date. Always discuss any information or concerns with a healthcare provider before making changes to your medication regimen.

Question 6

Does Dr. Taggart accept my insurance?

Accepted Answer

I am very much a holistic practitioner. I prioritize getting to know each patient - not as just a checklist of symptoms - but as the complex human being they are. I believe that only with this kind of depth of understanding can a practitioner really know how to help someone heal.

This is why I do not take insurance. Believe me, I feel very conflicted about this, but the decision was not made lightly. Insurance is what makes healthcare affordable for so many families - including mine. But as you may know, even the "good" managed care plans end up disincentivizing practitioners from spending the time necessary to get to the root of their patient's challenges. (I am not saying this is intentional on the part of insurance companies, and I am not “knocking” our managed care system: without it, many Americans could not access the care they and their loved ones need.) But I want the care I provide to be between you, the patient, and myself, your psychiatrist. I want us to have the time to fully understand your struggles, and get to the bottom of what may be causing them - not be pressured into any snap judgments. I want to educate you about your condition, and fully inform you about the complete range of treatment options - not be pressured to offer options that might be preferred by a managed system. And, I want to have the time to answer any questions you have. I find that fully informed patients who have received such comprehensive care from a practitioner who isn’t pressured to rush to judgment get better much more quickly, and more sustainably.

I aim to make my services accessible and affordable for individuals and families in need of psychiatric care. Therefore, I am committed to assisting my patients with supplying the necessary documentation to facilitate reimbursement from their insurance, provided they have "out of network" benefits. Additionally, for those who can show financial hardship, I am happy to offer reduced fees on a sliding scale.

Question 7

Does Dr. Taggart offer Telehealth (video conference appointments over the internet)?

Accepted Answer

Yes. I do offer telehealth, however I believe it’s best used only for follow-up appointments, and not for an initial in-person evaluation. And at least every six months we should have an in-person appointment.

Also, for your proper care, I strongly prefer an in-person appointment rather than telehealth when there are any significant concerns, such as severe symptoms or side effects of medications.
 
Please also see my FAQ “What do psychiatrists think of Telehealth?” For the reasons I detail there, in-person appointments are generally preferred over telehealth.

Question 8

What do psychiatrists think of telehealth? What are its pros and cons?

Accepted Answer

Telehealth, including tele-psychiatry, refers to the delivery of psychiatric assessment and treatment through telecommunications technology, such as video conferencing. This approach has gained significant traction, particularly in the context of global events like the COVID-19 pandemic, which necessitated physical distancing measures. Here are some of the pros and cons of Telehealth in psychiatry:

Pros of Telehealth in Psychiatry
1.     Increased Access to Care: Tele-psychiatry can dramatically increase access to mental health services, particularly for individuals in remote or underserved areas where psychiatric services are scarce or unavailable.
2.     Convenience: Patients can receive care from the comfort of their own homes, eliminating travel time and costs. This convenience can be especially beneficial for individuals with mobility issues, busy schedules, or those who live in areas with poor access to mental health services.
3.     Reduced Stigma: For some individuals, receiving mental health care in a private setting (like their home) instead of a traditional clinical setting can reduce the stigma associated with seeking psychiatric help, encouraging more people to access the care they need.
4.     Flexibility: Telehealth offers greater scheduling flexibility, making it easier for patients to fit psychiatric appointments into their lives, which can improve adherence to treatment plans.
5.     Continuity of Care: Tele-psychiatry facilitates continuity of care, allowing patients to maintain regular contact with their psychiatrist even when physical attendance is not possible, such as during travel or relocation.

Cons of Telehealth in Psychiatry
1.     Technology Limitations: Access to reliable internet and appropriate devices can be a barrier for some patients. Technical issues during sessions can also disrupt the therapeutic process and affect the quality of care. It can also make the monitoring of certain factors, such as medication side effects that may not be apparent over videoconferencing, more difficult.
2.     Privacy and Security Concerns: Although Telehealth platforms are designed to be secure and compliant with healthcare privacy laws (like HIPAA in the United States), there are still concerns about data breaches and the confidentiality of sensitive health information.
3.     Reduced Personal Connection: Some argue that Telehealth can diminish the personal connection between psychiatrist and patient, which is a crucial component of effective psychiatric care. Non-verbal cues and body language can be harder to interpret through a screen.
4.     Licensing and Regulation Challenges: Licensing and regulatory frameworks for telehealth vary by region, which can complicate the provision of services across state or national borders, limiting the reach of telepsychiatry.
5.     Not Suitable for All Patients: Telehealth may not be appropriate for patients with severe mental health issues who require close monitoring or immediate intervention. It may also be less effective for those who struggle with severe technological or environmental distractions at home.

While Telehealth in psychiatry offers many advantages, particularly in terms of accessibility and convenience, there are also significant challenges to consider. The decision to use telehealth services should be made on an individual basis, considering the specific needs, circumstances, and preferences of each patient. As technology and regulations evolve, the potential of telehealth in psychiatry will likely continue to expand, addressing some of the current limitations.

Question 9

What are the concerns about technology and kids?

Accepted Answer

The integration of technology into the daily lives of children has sparked a broad spectrum of concerns among parents, educators, and health professionals. While technology can offer significant educational and developmental benefits, its excessive or inappropriate use raises several issues. Some of the primary concerns about kids and technology include:

1.     Screen Time and Physical Health: Excessive screen time is linked to various negative physical health outcomes, including obesity, eye strain, and disrupted sleep patterns. The sedentary nature of many technology-based activities can contribute to a lack of physical exercise, which is essential for healthy development.
2.     Impact on Mental Health: There are growing concerns about the impact of social media and excessive technology use on children's mental health. Issues such as anxiety, depression, and low self-esteem have been associated with the use of social media platforms, partly due to cyberbullying, social comparison, and the pressure to maintain a certain online image.
3.     Cognitive Development: While technology can be a valuable educational tool, there is concern that overreliance on digital devices may impact children's cognitive development, including attention, memory, and problem-solving skills. There's also worry about reduced opportunities for imaginative play and critical thinking, which are vital for cognitive and social development.
4.     Social Skills: Excessive technology use can impede the development of face-to-face social skills in children. Real-world interactions are crucial for developing empathy, communication skills, and understanding social cues—abilities that cannot be fully replicated in digital environments.
5.     Privacy and Safety: Children's privacy and safety online are significant concerns. Young users may be unaware of the risks associated with sharing personal information online or may inadvertently access inappropriate content. Additionally, there's the risk of encountering predators in online spaces.
6.     Addictive Behaviors: The design of many digital games and social media platforms can lead to addictive behaviors in children. These platforms often use mechanisms that encourage continuous engagement, which can be particularly compelling for young minds and lead to problematic technology use.
7.     Educational Disparities: While technology has the potential to enhance learning, there's concern about the digital divide and educational disparities. Not all children have equal access to technology and the internet, which can exacerbate existing educational inequalities.

Addressing these concerns requires a balanced approach that recognizes the benefits of technology while mitigating its risks. Strategies may include setting limits on screen time, encouraging physical activity, monitoring online activity, fostering open discussions about digital citizenship, and promoting a healthy balance of online and offline activities.
Please see my other FAQ on what parents can do about technology and their kids.

Question 10

I’ve read about the concerns about kids and technology. As their parent, what can I do about it?

Accepted Answer

Addressing the challenges associated with technology use among children involves proactive and balanced strategies. Here are practical steps parents can take to mitigate the negative impacts of technology while promoting its positive aspects:

1.     Set Clear Limits on Screen Time: Establish rules around the amount of time children can spend on screens daily, emphasizing the importance of a balanced lifestyle. The American Academy of Pediatrics provides guidelines for screen time that can serve as a reference. (It’s amazing how many American families are not aware of this important guidance.)
2.     Encourage Physical Activity: This is a big one. (In our busy lives, this is something that can often be let slide …in my family too.) Make sure children have ample opportunities for physical play and exercise. Encouraging outdoor activities, sports, and hobbies that do not involve screens can help balance their lifestyle.
3.     Monitor and Guide Internet Use: Keep computers and devices in shared family spaces to monitor usage. Use parental controls and filters to restrict access to inappropriate content. Teach children about safe internet practices and the importance of privacy.
4.     Foster Open Communication: Talk openly with children about the benefits and risks of technology. Encourage them to share their online experiences and discuss any concerns they may encounter, such as cyberbullying or inappropriate content.
5.     Promote Quality Content: Guide children towards educational apps, games, and websites that promote learning and creativity. Many platforms offer content that can supplement school learning or encourage creative expression.
6.     Model Healthy Technology Use: Children often emulate their parents' behaviors. By modeling healthy technology use and maintaining a balance between digital and non-digital activities, parents can set a positive example.
7.     Encourage Social Interactions: Promote face-to-face interactions and social activities that help develop interpersonal skills. Arrange playdates, family gatherings, and community activities that encourage socialization outside of digital platforms.
8.     Create Tech-Free Zones and Times: Establish certain areas of the home, such as bedrooms and dining tables, as tech-free zones. Designate tech-free times, especially during family meals and before bedtime, to help improve sleep quality and family bonding.
9.     Educate About Digital Citizenship: Teach children about the responsibilities of being a good digital citizen, including respecting others online, understanding the impact of their digital footprint, and recognizing the importance of consent in sharing personal information.
10. Seek Professional Help if Needed: If you notice signs of technology addiction or if technology use is impacting your child's mental health, seek support from professionals specializing in child and adolescent mental health.

Some of these are tough to implement. I know. I’m a parent too. But they can be so helpful, and important to healthy child development. And by taking these steps, parents can help their children navigate the digital world more safely and develop a healthy relationship with technology.

Question 11

Will medication change my personality?

Accepted Answer

Introduction:
The decision to start medication for mental health concerns is often met with a multitude of questions and concerns, one of the most common being: Will medication change my personality? It's a valid concern, as our personality is a core aspect of who we are. Let's delve into this question and unpack what medication can and cannot do in terms of personality.

Understanding Personality:
Personality encompasses the patterns of thoughts, feelings, and behaviors that make each of us unique. It's influenced by various factors, including genetics, upbringing, experiences, and even mental health conditions. Personality traits are relatively stable over time but can be influenced by different factors, including medication.

The Role of Medication:
Medication for mental health conditions, such as antidepressants, mood stabilizers, or antipsychotics, primarily targets symptoms rather than personality traits. These medications work to rebalance brain chemistry and alleviate symptoms like depression, anxiety, or mood swings. While they can affect mood and behavior, their primary aim isn't to alter personality traits.

Potential Effects on Personality:
Some individuals may notice subtle changes in their personality when taking medication. For instance, a person experiencing severe anxiety might appear more relaxed and outgoing once their symptoms are under control. Similarly, someone with depression might regain interest in activities they once enjoyed, which can alter their outward demeanor.

However, these changes are often attributed to symptom relief rather than a direct alteration of personality traits. It's essential to distinguish between changes in mood or behavior due to symptom improvement and changes in fundamental aspects of personality.

Maintaining Authenticity:
One of the concerns about medication altering personality is the fear of losing one's authentic self. It's crucial to recognize that personality is multifaceted and resilient. While medication may influence certain aspects temporarily, it's unlikely to fundamentally change who you are as a person.

Moreover, the goal of medication is to enhance your well-being and quality of life, allowing you to function more effectively in various domains. Feeling more like yourself, free from the burden of debilitating symptoms, can actually align you more closely with your authentic personality.

The Importance of Monitoring:
Communication with healthcare providers is paramount when starting or adjusting medication. Monitoring for any unexpected changes in mood, behavior, or personality can help ensure that the medication's effects are beneficial and not adverse. If you or those close to you notice significant shifts that cause concern, it's essential to discuss them with your healthcare provider promptly.

In many cases, adjusting the dosage, trying a different medication, or incorporating other forms of therapy may achieve the desired balance between symptom management and personality preservation.

Conclusion:
The question of whether medication will change your personality is complex and nuanced. While medication can influence mood and behavior, its primary goal is symptom relief rather than altering fundamental personality traits. Recognizing the distinction between temporary changes related to symptom improvement and enduring aspects of personality is key.

Ultimately, the decision to pursue medication for mental health concerns should be made in collaboration with healthcare professionals, weighing the potential benefits against any perceived risks. By maintaining open communication and monitoring for changes, individuals can navigate medication use while preserving their authenticity and well-being.

Question 12

Does a mental health medication have to be forever?

Accepted Answer

Introduction:
The decision to start mental health medication can often sometimes come with the assumption, or the worry, that it will be a lifelong commitment. However, this may not always hold true. Exploring the question of whether mental health medication has to be forever opens up a nuanced discussion about treatment options, individual needs, and the evolving nature of mental health care.

Understanding Maintenance and Acute Treatment:
In mental health care, medications serve various purposes. Some medications are prescribed for acute treatment, targeting specific symptoms during periods of crisis or exacerbation of mental health conditions. These medications might be used for a limited duration until symptoms are adequately managed. Some other medications are for use on an as-needed basis.

On the other hand, maintenance medications are prescribed for ongoing management of chronic mental health conditions like depression, bipolar disorder, or schizophrenia. These medications aim to stabilize mood, manage symptoms, and prevent relapse over the long term.

Individual Variability:
The duration of mental health medication usage can vary significantly from person to person. Factors such as the severity of the condition, individual response to medication, presence of co-occurring disorders, and lifestyle factors all play a role in determining the appropriate treatment approach.

For some individuals, short-term medication use may be sufficient to address acute symptoms or manage transient stressors. Others may require long-term or even lifelong medication to maintain stability and prevent recurrence of symptoms. Such is usually the case when very concerning or life-threatening symptoms have been successfully treated by the medicine. However even with the long-term use of most psychiatric medications, most psychiatrists are trained to periodically assess and discuss with the patient whether the medication is still needed.

Treatment Goals and Preferences:
The decision regarding the duration of mental health medication should align with individual treatment goals and preferences. Some individuals may prioritize symptom relief and functional improvement, while others may prioritize minimizing medication use or exploring alternative therapies.

It's essential for individuals to have open and honest discussions with their healthcare providers about their treatment preferences, goals, and concerns. Collaborative decision-making allows for personalized treatment plans that consider both the benefits and potential risks of medication use.

Exploring Alternatives:
While medication can be an effective tool in managing most mental health conditions,  it's often not the only option available in the treatment of many of these conditions. Therapy, lifestyle modifications, support groups, and holistic approaches can complement or even substitute medication in some cases.

For individuals who are hesitant about long-term medication use or experience side effects that impact their quality of life, exploring alternative treatment modalities under the guidance of qualified professionals can be empowering.

Regular Evaluation and Adjustment:
Regardless of the initial treatment plan, regular evaluation and monitoring are essential components of mental health care. Conditions and treatment needs can change over time, necessitating adjustments to medication dosage, type, or duration.

Healthcare providers should engage in ongoing dialogue with patients to assess treatment effectiveness, monitor for side effects, and explore opportunities for optimization or modification of the treatment plan.

Conclusion:
The question of whether mental health medication has to be forever underscores the complexity and individuality of mental health care. While some individuals may require long-term medication for symptom management and stability, others may find that short-term or alternative treatments better align with their needs and preferences.

Ultimately, the duration of medication usage should be guided by personalized treatment goals, ongoing evaluation, and collaborative decision-making between individuals and their healthcare providers. By fostering open communication and exploring all available treatment options, individuals can navigate their mental health journey with agency, empowerment, and resilience.

Dr. William Taggart
Psychiatrist, MD

FAQs

Frequently Asked Questions