Your child is struggling at school, at home, maybe both. You have talked to the pediatrician. You have met with teachers. Something still feels off, and now someone has used the words “child psychiatrist.” If you are not sure what that means or what happens next, this page is for you.
My name is Gonzalo Laje, MD. I am a board certified child, adolescent, and adult psychiatrist, and I founded this practice in Chevy Chase. What follows is an honest account of the work. It covers what child psychiatry involves, when it makes sense for a family, how medication decisions actually get made, and what the process looks like here.
In short – a child psychiatrist is a medical doctor who can diagnose, prescribe, and coordinate the whole picture. The signal that it is time is usually a pattern lasting weeks, a plateau in therapy, or a medication question nobody has answered well.
Medical disclaimer – This content is educational and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about any condition or treatment option for your child. Nothing here replaces an evaluation by a clinician who has met your child.
What a Child Psychiatrist Is, and How They Differ from Other Providers
A child and adolescent psychiatrist is a medical doctor who completed medical school, a general psychiatry residency, and an additional fellowship in child and adolescent psychiatry. That training is what allows one clinician to hold the whole clinical picture at once: development, diagnosis, medication, and the medical conditions that can look like psychiatric ones.
Parents often ask how this differs from the providers they have already seen. The distinctions matter more than they look on paper, because starting with the wrong specialist can cost a family several months and a second round of intake paperwork.
| Provider | Degree | Prescribes? | Main role |
|---|---|---|---|
| Child psychiatrist | MD or DO | Yes | Diagnosis, medication, care coordination |
| Child psychologist | PhD or PsyD | No | Psychological and cognitive testing, therapy |
| Child therapist | Master’s degree | No | Talk therapy, behavioral treatment |
| Developmental pediatrician | MD or DO | Yes | Developmental delays, autism, learning differences |
| Pediatrician | MD or DO | Yes, limited | Primary care, early mental health screening |
At WBMA the child psychiatry model keeps psychiatric evaluation, therapy, neuropsychological testing, and genetic testing under one roof. For families who have been bouncing between disconnected providers, that coordination is often what changes the trajectory. Our psychiatric evaluation and medication management team communicates directly about shared patients.
Conditions a Child Psychiatrist Treats
Child psychiatry covers a wide range of presentations. Some arrive with a diagnosis already attached and some arrive with nothing but a worried parent and a teacher’s note. These are the presentations we support most often, and most of them overlap more than parents expect.
ADHD
ADHD is one of the most common and most frequently mismanaged reasons families come to us. Anxiety, learning differences, sleep disorders, and trauma can all imitate ADHD symptoms in a classroom. Accurate diagnosis means ruling out those contributors first, before any medication conversation begins.
Autism Spectrum Disorder
Many children arrive with an autism diagnosis made elsewhere, still struggling with co-occurring anxiety, OCD, sleep difficulty, or emotional dysregulation. We take a neurodiversity-affirming approach. The goal is to support your child’s quality of life and reduce suffering, not to make them neurotypical.
OCD
OCD in children often looks nothing like the adult version. It shows up as excessive reassurance-seeking, rigid routines, or distress a parent cannot trace to a cause. Treatment usually pairs Exposure and Response Prevention therapy with medication when clinically indicated. Our OCD treatment approach keeps both coordinated.
Anxiety and Depression
Anxiety is widespread in this age group. National Institute of Mental Health data puts lifetime prevalence of any anxiety disorder among US adolescents aged 13 to 18 at 31.9%, with 8.3% experiencing severe impairment. Depression in children also presents differently than in adults, often as irritability rather than sadness.
Behavioral and Developmental Concerns
Oppositional behavior, trauma responses, and developmental delays all fall inside child psychiatry. When a full cognitive and academic picture is needed alongside psychiatric care, our psychoeducational testing services provide it. Results feed directly back into the clinical conversation rather than sitting in an unread report.
Warning Signs Your Child Needs a Child Psychiatrist
There is no single moment when a child officially needs psychiatric evaluation. Certain patterns do suggest the situation has moved past what therapy alone or a pediatrician visit can address. Consider reaching out when you notice any of the following.
If your child is in immediate danger, do not wait for an appointment.
Call or text 988 to reach the 988 Suicide and Crisis Lifeline, available 24 hours a day across the United States. For a medical emergency, call 911 or go to your nearest emergency department. A scheduled psychiatric evaluation is not a substitute for emergency care.
Looking for a psychiatrist for your child is not a sign that something is irreparably wrong. It is a sign that you are paying attention and willing to get the right level of support. Earlier evaluation tends to lead to better outcomes for children and for families.
What to Expect at Your Child’s First Appointment
One of the harder parts of this process is simply not knowing what is coming. Parents tell us the uncertainty is worse than the appointment itself. Here is what a first visit at WBMA generally involves, and what you can do beforehand to make the time count for your child.
Before the Visit
We gather developmental history, school records, and any previous evaluations in advance. Coming with teacher reports and prior provider documentation lets us spend appointment time on your child rather than on paperwork reconstruction. If your child has taken psychiatric medication before, bring the names, doses, and what happened on each.
The Evaluation
The first visit is a full assessment. With younger children, most of the conversation happens with parents. With adolescents, we balance direct time with the teen against parent input. We are building an understanding of your child as a whole person: their strengths, their history, and what an ordinary day actually looks like.
Genetic Testing for Medication Selection
When medication enters the conversation, WBMA offers pharmacogenomic testing. This type of test may help guide medication selection based on how your child’s body processes certain drugs. It does not diagnose conditions and it does not predict outcomes. We will discuss whether it fits your child’s situation rather than running it by default.
The Treatment Plan
After the assessment we lay out recommendations in plain language. That may mean therapy, medication, school consultation, further testing, or some combination of them. You should leave the appointment knowing what the plan is and why we arrived at it. Individual results vary, and no single approach works for every child.
How Medication Decisions Get Made
This is the question parents ask most and get answered least. Search results are full of dosing charts and forum arguments, and almost none of it explains how a psychiatrist actually reasons about medicating a child. Here is that reasoning, including the part most pages leave out.
What Comes Before Medication
Medication is rarely the first move and is never the only one. Before prescribing, we work to confirm the diagnosis, rule out medical causes, review sleep and school environment, and understand what non-medication treatment has already been tried. For many children, therapy and school accommodations do enough that medication stays off the table.
When medication does make sense, the reasoning is specific to the child. Age, diagnosis, symptom severity, other conditions, family history, and previous medication responses all shape the choice. This is why a dose that fits one eight-year-old tells you almost nothing about the right dose for another.
The FDA Boxed Warning on Antidepressants Under 25
Every antidepressant approved in the United States carries a boxed warning about young patients. Most parents encounter it as a frightening paragraph on a pharmacy printout with no one available to explain it. It deserves a direct explanation, so here is the current labeling language itself.
“Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies.”
“These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk with antidepressant use in patients aged 65 and older.”
Read the second sentence as carefully as the first. The elevated risk the studies found sits in the under-25 group and did not appear in older patients. What the warning does not say is that these medications should be avoided in young people. Untreated depression carries its own risk of suicide, and that is the other half of the judgment.
What Monitoring Looks Like
The labeling does not tell prescribers to avoid these medications in young people. It tells them how to use them. For patients of all ages starting antidepressant therapy, the instruction is to “monitor closely for worsening and for emergence of suicidal thoughts and behaviors.” The label also directs prescribers to “advise families and caregivers of the need for close observation and communication with the prescriber.”
In practice that means frequent contact early on. We schedule closer follow-up during the first weeks and tell you exactly which changes warrant a call. A parent reporting that something feels wrong is clinical information, not an interruption. You can read more about how we structure psychiatric medication management across ages.
What the Labels Say About Age
Some antidepressants carry pediatric approvals and some do not, which is worth knowing before any conversation about options. Fluoxetine’s FDA-approved labeling reports efficacy for major depressive disorder in patients aged 8 to 18 and for OCD in patients aged 7 to 18, and states that it is not approved below age 7. Escitalopram is indicated for major depressive disorder from age 12.
| Medication | Pediatric indication in FDA labeling | Approved from |
|---|---|---|
| Fluoxetine | Obsessive-compulsive disorder | Age 7 |
| Fluoxetine | Major depressive disorder | Age 8 |
| Sertraline | Obsessive-compulsive disorder only. Pediatric depression trials were not sufficient to support that indication | Age 6 |
| Escitalopram | Major depressive disorder | Age 12 |
Prescribing outside an approved age range is legal, common, and sometimes correct, but it should be a stated decision rather than a silent one. If a medication is being suggested for your child off-label, you are entitled to hear that, along with the reasoning. General background on these medication classes is available from the National Institute of Mental Health.
When Medication Is Not the Answer
Sometimes the right conclusion is that medication is not indicated, or that it has already been tried far enough. WBMA also offers non-medication treatment including neuromodulation, and the FDA has cleared transcranial magnetic stimulation for use in adolescent patients meeting specific criteria. Whether any of it fits your child is an evaluation question, not a website question.
- What are we treating, and how confident are you in that diagnosis?
- What did we try before this, and why is medication the next step now?
- Is this medication approved by the FDA for my child's age and condition, or is it being used off-label?
- What should improve if it works, and roughly when would we expect to see it?
- Which side effects should I call you about, and which ones can wait until the next visit?
- How often will you see my child in the first two months?
- What is the plan for stopping, if we decide to stop?
Why Bethesda and Chevy Chase Families Choose WBMA
WBMA sits in Chevy Chase, MD, directly adjacent to Bethesda and reachable from Potomac, Rockville, Kensington, and Washington DC. For Montgomery County families looking for a child psychiatrist near Bethesda, the location is practical. Families weighing local options may also find our guide to choosing a psychiatrist in Bethesda useful.
We prioritize in-person appointments for child and adolescent psychiatric care. Evaluating a child means being in the room, watching how they respond to questions and how they carry themselves. Telehealth has a real place in ongoing care, but for a first evaluation, in-person serves children better.
What separates a multi-service practice from a solo provider comes down to coordination. Our psychiatrists, therapists, and diagnostic specialists work in the same building and talk directly about shared patients. Your child’s psychiatrist knows what is happening in child therapy, and the therapist understands the medication reasoning.
The practice was founded by Gonzalo Laje, MD, our Medical Director, who is board certified in child, adolescent, and adult psychiatry and brings a clinical research background in psychopharmacology. We accept many major insurance plans and maintain working relationships with schools and pediatricians across Bethesda and Montgomery County, including direct coordination on IEP and 504 processes.
Frequently Asked Questions
At what age can a child start seeing a child psychiatrist?
There is no fixed minimum. We evaluate children from early childhood through adolescence, and the approach changes considerably with developmental stage. With very young children, the evaluation relies heavily on parent report, observation, and developmental history rather than direct interview.
How is a child psychiatrist different from a developmental pediatrician or a pediatric neurologist?
A developmental pediatrician focuses on developmental delays, autism, and learning differences. A pediatric neurologist treats conditions of the brain and nervous system such as seizures. A child psychiatrist handles psychiatric diagnosis and treatment, including medication, and often coordinates with both.
Does my child need a referral to see a child psychiatrist?
In most cases a formal referral is not required to schedule at WBMA, though some insurance plans require one for coverage. Many families come to us directly on the recommendation of a pediatrician, school counselor, or another mental health provider.
Does WBMA accept insurance for child psychiatry in Bethesda?
WBMA accepts many major insurance plans common in Bethesda and Montgomery County. Coverage varies by plan and by service type, and psychiatric evaluation and testing are sometimes covered under different benefits. Call our office to confirm what your specific plan covers before you schedule anything.
What does a first evaluation cost and how long is the wait?
Cost depends on your plan, the service, and whether testing is included, so a general figure would mislead more than it helps. Wait times shift with clinician availability and time of year. Our office can give you both numbers for your situation on a single call.
Will psychiatric medication change my child's personality?
Medications, when appropriately selected and dosed, are intended to reduce symptoms that interfere with functioning rather than alter who your child is. Every child responds differently, so medication management is an ongoing process rather than a single decision. We monitor closely, stay in contact with families, and adjust when something is not working.
How long does treatment usually last?
It varies with the diagnosis and how the child responds. Some children work with us for several months around a specific problem. Others, particularly with conditions that persist across development, stay in periodic care for years with appointments spacing out as things stabilize.
How do I prepare my child for a first psychiatric appointment?
Tell them the truth in age-appropriate terms. Explain that they are meeting a doctor who helps with feelings, focus, and worries, that no shots are involved, and that they will not be in trouble. Avoid framing the visit as a consequence for behavior.
Do you work with Bethesda and Montgomery County schools?
Yes, and it is a routine part of the work rather than an exception. We coordinate regularly with schools across Bethesda, Chevy Chase, and Montgomery County. That includes providing documentation for IEP and 504 evaluations, sharing records with appropriate consent, and in some cases joining school team meetings directly.
What if my child refuses to talk to the psychiatrist?
It is common for children to arrive reluctant or anxious, and we do not push against that. We start where the child is comfortable, build trust gradually, and gather meaningful clinical information through parent interview and observation. Willingness usually develops once the relationship feels safe to them.
Can you help with a psychoeducational evaluation for school?
Yes, and families often request one to support an IEP or 504 application or to clarify a diagnosis. WBMA offers psychoeducational evaluations covering cognitive functioning, academic skills, and related areas. Results are integrated with psychiatric findings when both are relevant. Related ADHD and autism testing is available in the same practice.
Schedule a Child Psychiatry Consultation in Bethesda
If your child is struggling and you have reached the point of researching a child psychiatrist, that is a signal worth acting on. The path forward starts with a full evaluation that gives your family real answers instead of more uncertainty about what is happening.
We work alongside families to build a clear picture and a realistic plan for addressing it. That plan may involve medication, therapy, testing, school coordination, or some combination, but it starts with understanding your child. Our Chevy Chase location serves families across Bethesda, Potomac, Rockville, and the DC metro area.
Medical disclaimer – This article is educational and does not constitute medical advice, diagnosis, or treatment recommendations. Treatment outcomes vary by individual. Consult a qualified healthcare professional for guidance specific to your child’s situation. If your child is in crisis, call or text 988.
