Dr. Eric R. Williams, MDChild, adolescent and adult psychiatrist in Lexington, South Carolina

How I evaluate

I start every new patient with a full evaluation, usually about an hour. For a child or teen, I want time with the parents and time with the young person alone. Kids tell me things they will not say in front of their parents, and parents tell me things they do not want to say in front of their kids. Both halves matter.

Before the visit I ask for whatever already exists: report cards, teacher comments, prior testing, previous medication trials and what happened on each one. I read it. A rating scale is useful data, but I do not diagnose from a questionnaire. I want to know when the problem started, what it looks like at home versus school versus with friends, how the child sleeps, and what else is going on in the family. A nine-year-old who cannot sit still in class may have ADHD. He may also be anxious, not sleeping, struggling with a reading disorder, or reacting to something at home. The treatment for each of those is different, so the diagnosis has to be right first.

With adults, the same rule applies. I want the history, not just the symptom list. Many of the young adults I see have never been in a psychiatrist's office and are not sure they should be. Part of my job in the first visit is to say clearly whether I think there is a diagnosis, what it is, and what I think it is not.