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Part of our guide: A Parent’s Guide to Child and Teen Mental Health
A child psychiatric evaluation is a detailed look at what your child is experiencing, gathered through interviews with you and your child along with history from home and school. According to the American Academy of Child and Adolescent Psychiatry, it usually requires a few hours over one or more office visits. Blood tests, x-rays or other special assessments are added only if needed.
By the end, you should have an explanation of what may be going on, along with recommendations. Below is what to expect, and how to prepare. Details differ between clinicians, so ask for specifics when you book.
Why families seek an evaluation
NIMH suggests considering help if behavior or emotions last for weeks or longer. An evaluation can help when you are unsure what you are seeing, when a teacher has raised concerns, when therapy has not helped as hoped, or when someone has mentioned medication and you want a careful opinion first. It does not commit you to any treatment. If you are deciding where to begin, read when a child should see a psychiatrist vs a therapist.
What the clinician will cover
AACAP says an evaluation frequently includes:
- A description of current problems and symptoms
- Health and treatment history, including medications
- Parent and family psychiatric history
- Your child's development
- School and friendships
- Family relationships
- Interviews with both the child and the parents
- Labs or special assessments, such as psychological or speech and language testing, if needed
NIMH describes something similar, noting that the parent interview covers developmental history, temperament and relationships, and that school information such as test scores and behavior reports may be gathered. This practice's child and adolescent page notes that its assessment considers developmental stage, family dynamics, school, sleep, routine and physical health.
What it may look like, step by step
The order varies, but many evaluations include these parts.
1. Paperwork and history
You may be asked to complete forms in advance. These save time and give you a chance to think about when things started.
2. Time with parents or caregivers
You will likely describe what you have noticed, what makes it better or worse, and what has been tried. You may want to tell the clinician ahead of time if there is something you would rather not discuss in front of your child.
3. Time with your child
The conversation should fit your child's age. Younger children may play or draw, since AACAP notes that playing, drawing and pretending, as well as talking are ways children express feelings. Teens are usually asked directly about mood, sleep, friends, school, stress and sometimes substance use or relationships. Ask at the start how the clinician handles privacy with your teen. This article on teen therapy and confidentiality explains why this matters.
4. Questions about safety
Clinicians commonly ask about thoughts of self-harm or suicide, even when nothing suggests a problem. It can be startling to hear, but studies show that asking does not cause or increase such thoughts. If your child's answer raises concern, the clinician should talk with you about next steps for safety.
5. Information from others, with your permission
With parental permission, the psychiatrist may contact your family doctor, school staff or relatives. You can ask what will be shared and why.
6. Additional testing, if needed
Lab work or psychological testing may be suggested when questions remain. Ask what the test would answer and whether it would change the plan. Which tests are ordered depends on the clinician, so ask the intake team what applies.
How to prepare
What to gather
- A short timeline: when the concerns started and what changed around then
- Medications and supplements, past and present, and any reactions
- Medical conditions, allergies, and major events such as illness or loss
- Report cards, teacher notes, and any 504 plan or IEP
- Reports from earlier evaluations or therapy
- Family mental health history, as far as you know it. This article on family history in psychiatric evaluations explains why it matters
What to tell your child
Tell them the truth in simple words: the visit is to understand how things have been going and figure out what could help. There may be questions and talking, and they can tell the clinician if something is hard to answer. Avoid surprises, and avoid making it sound like a punishment. This guide on how to talk to your child about starting therapy has more ideas.
Coordinate with other caregivers
If another parent or caregiver sees your child often, try to include their view. Ask ahead of time what consent is needed, particularly if custody arrangements apply. This overview of minors and consent in New York gives general background.
What you should leave with
AACAP says the psychiatrist develops a formulation that explains the problems in terms parents and child can understand, combining biological, psychological and social factors with your child's development, history and strengths. Families should have time to ask questions. If a treatable problem is found, the psychiatrist gives recommendations and a specific treatment plan.
Before you leave, or at a follow-up, try to get clear answers to these:
- What do you think is going on, and how confident are you?
- What else could explain this?
- What do you recommend first, and why?
- What happens if we choose to wait?
- If you suggest medication, what are the benefits, risks and alternatives, and how would it be monitored?
- How will progress be evaluated? How long should treatment last?
- Who will coordinate care among therapists, doctors and school?
- Will we receive a written summary?
A diagnosis may not be clear after one visit, especially when symptoms overlap, and it may be revised as your child grows. Being told "we need more information" can be a sign of care. You can always ask questions or seek a second opinion. AACAP adds that parents should ask for an explanation of any word or term they do not understand.
Common worries
"Will they just put my child on medication?"
An evaluation does not have to lead to medication, and you take part in the decision. This site's child page says medication is considered when symptoms significantly affect a child's functioning or wellbeing, with decisions made collaboratively with caregivers. Therapy, school support and medication are all options that may be discussed.
"Will a label follow my child?"
A diagnosis is a tool to guide care and may support help at school. You can ask how it will be recorded and who can see it. Decide with the clinician what to share with the school.
"What if my child won't talk?"
That's common and clinicians expect it. Your observations and the school's still help, and it can take more than one meeting to build comfort.
After the evaluation
Next steps often include therapy, parent guidance, school planning, more testing or follow-up visits. NIMH points out that when several providers are involved, information should be shared and coordinated to get the best results. If you want to compare this with an adult's experience, see what happens during a psychiatric evaluation.
To begin here, request a consultation; the intake team confirms fit, scheduling and costs. The psychiatric evaluation page and fees and insurance have more detail.
FAQs
Does my child need to be there the whole time?
Usually not. Many evaluations include time with parents and time with the child, and the balance depends on age. Ask how the visit will be arranged.
Can a child psychiatric evaluation be done by telehealth?
Sometimes, where the clinician is licensed and if it suits your child's age and needs. Ask whether any part needs to be in person.
Is it the same as ADHD testing?
Not exactly. A broad evaluation looks at many possible causes. ADHD testing focuses on attention and related concerns. See ADHD evaluation if that is your main question.
