Doctor, psychologist, psychiatrist--who's best for ADHD?

Many types of professionals diagnose and treat ADHD.   Different types of professionals have different types of strengths and biases in their treatment style.  There are also geographical variations among different states and school districts in whom is allowed to make a diagnosis for the purposes of obtaining school accommodations, an important part of treatment.  This is  post is a guide to different types of professionals who may diagnose and treat ADHD.

Pediatrician/family doctor/internist.  Generalist physicians are trained to diagnose and treat a variety of common bodily and mental conditions.   Young children especially should be first seen by their generalist doctor to rule out physical conditions, such as hearing and vision issues, that may be affecting their behavior.  Generalists may refer to a specialist if the doctor or the patient has doubts as to the diagnosis, or if treatment is not going well.  Some generalists will refer all patients with ADHD, but many feel comfortable with the first few medications.   They may not feel comfortable if there are a lot of other mental conditions in addition to ADHD, such as anxiety or autism.  However, they may feel more comfortable than a specialist if there are many other physical conditions in addition to ADHD, such as asthma or sleep apnea.  A generalist is usually easier to get an appointment with than a specialist, which is handy if you have side effects from medications and need to see someone right away.  However, a generalist may not have a long time to spend with you if you have many concerns.  

Psychologist/mental health therapist/social worker/coach.  Generalist mental health professionals are trained to diagnose and treat a variety of mental conditions using counseling or behavioral means.  They are unable to prescribe medication, but they may suggest particular medications as possibilities.  Mental health professionals generally have more time to spend with their patients than medical doctors.  They usually have more to offer in the way of specific strategies that can be used to address specific behavioral or emotional issues.  At times a psychologist may be hired by a school district to suggest specific strategies to be used in the classroom.  ADHD coaches typically work with adults who already carry a diagnosis of ADHD, on specific life issues, such as organization, time management, parenting, or job problems.  You should look for one who has training in counseling or professional certification, as ADHD coaching is a new field with variable regulation.  

Developmental pediatrician.  This medical specialist deals with children who have developmental delays.  Now, most patients with garden variety ADHD would not necessarily be considered developmentally delayed like a child with cerebral palsy is, and yet their performance may not match that of their peers socially and academically.  If your child has other developmental delays, though, this is the best person to sort out what component of the behavioral difficulties you see are due to ADHD and what may be due to autism or other types of delay.

Neurologist.  This medical specialist deals with people with nervous system and brain disorders.  While they do see patients with ADHD only, people with ADHD and other neurological issues such as tics, seizures, or sleep disorders, may benefit most from seeing a neurologist.

Psychiatrist.  This medical specialist deals mostly with mental health related medication.  Gone are the days when psychiatrists would spend hours listening to your problems.  Typical psychiatrist visits are brief medication checkups only--the talk therapy is left to the psychologists.  Still, psychiatrists are experts in dealing with ADHD medication, and if your child has failed several medications or if there is suspicion of other mental disorders, such as bipolar disorder, depression, or anxiety, this may be the person to see.

Neuropsychologist.  This type of specialized psychologist usually only gets involved for diagnosis.  They administer highly specialized testing to understand your brain's specific strengths and weaknesses, and they may suggest specific types of behavioral strategies to address the weaknesses.

Optometrist.  Optometrists typically are not able to diagnose ADHD on their own.  However, some children with ADHD like symptoms have actually have difficulty with visual tracking (that is, following a moving target with their eyes, or moving their eyes along a line to read).   An optometrist may be helpful in diagnosing and treating this condition.  If your child seems to have difficulty with reading, has visual complaints, or seems to have difficulty with tasks requiring visual tracking (such as playing catch), an optometrist may come into play.

Occupational Therapist.  Occupational therapists may be able to give an occupational therapy diagnosis of impaired function due to attention deficits, or sensory processing disorder,  but usually refer to a medical doctor for a diagnosis of ADHD.  Typically, an occupational therapist prescribes devices, exercises,  and strategies to deal with difficulties a person may have functioning in their daily life.  For example, they may prescribe grippers and a writing program for children who have trouble with handwriting.  If you want a weighted vest, typically it is prescribed by an occupational therapist.  Sometimes occupational therapy may be part of a program administered by a school and may be paid for by a school district.  

I may have left some important people out.  This is because many people treat ADHD and the people who do vary somewhat from region to region.   If you can think of any professional you have seen who treats ADHD, whom I have left out, please leave a comment!

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