Carolinas HealthCare System
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Physician Referral

Developmental & Behavioral Pediatrics of the Carolinas most commonly addresses behavioral and medication management issues related to:

  • Developmental delay with or without behavioral symptoms
  • ADHD plus mild co-morbidities such as anxiety and dysthymia
  • Autism diagnostic clarification and medication management of target behaviors
  • Genetic syndromes with behavioral symptoms

However, while it has been customary to take all developmental and behavioral patients, realistically our practice is not equipped to handle more significant co-morbidities such as:

  • Conduct disorder
  • Severe mood disorders such as bipolar or major depressive disorder
  • Concerns for psychotic processes

Children with these co-morbidities will be directed to psychology and/or psychiatry for further assessment and treatment.  

Children who need eligibility determination for a learning disability are best initially assessed by a psychologist.  As physicians, we cannot perform the necessary psychoeducational testing (quantitative analysis) needed to establish a “learning disability” diagnosis, and can only provide overview of the evaluation process when a learning disorder is suspected.  

There are also certain cases that may be initially addressed with therapy alone, including:

  • Adjustment disorders
  • Separation anxiety
  • Family psychosocial problems, etc  

The following types of concerns/symptomatology are best addressed by psychiatry:

  1. Bipolar disorder
  2. Conduct disorder (i.e. serious rule breaking, violent behaviors, fire starting, threatening behaviors, etc.)
  3. Psychotic disorders (hallucinations, thought disorder, delusional thinking)
  4. Severe depression (suicide ideation, anhedonia, recurrence, self-cutters, history of past psychiatric admission)
  5. Severe anxiety (i.e. panic attacks, social phobia, severe GAD)
  6. Personality disorders

The following types of concerns/symptomatology should initially be addressed by a therapist, LCSW, and/or psychologist: 

  1. Family problems
  2. Adjustment to life circumstances
  3. Parental discipline
  4. Attachment problems (i.e. reactive attachment disorder)
  5. Mild anxiousness or phobic fears
  6. Mild depressive symptomatology, low self-esteem

If psychoeducational testing has already been completed, our developmental and behavioral pediatricians will interpret the data and assist with the formulation of a treatment plan.  However, the following types of initial presenting concerns are best addressed with a psychologist:

  1. Actual assessment of IQ and adaptive measures to determine the degree of cognitive impairment (rule out mental retardation)
  2. Actual psychoeducational testing to rule out learning disabilities
  3. ADHD inattentive subtype in the context of discrepant parent-teacher reporting, co-occurring LD, or co-occurring mood disorder where additional assessments are indicated
  4. Complex learning issues where extensive psychometric testing is needed to better discern the learning profile and provide specific educational recommendations

The following types of presenting concerns/symptomatology are best initially addressed by a neurologist:

  1. Cerebral palsy
  2. Movement disorders
  3. Global developmental regression (rule out metabolic or mitochondrial disorders)

Please feel free to call our office with any questions.


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