Is Your Child's Psychiatrist an Autism Expert?

Consortium will offer fellowships in Developmental Neuropsychiatry in 2016

Posted Aug 24, 2015

Source: pixabay

One percent of Americans have been diagnosed with autism, and a staggering seventy percent of this population suffers from co-morbid psychiatric conditions such as affective disorders, anxiety, and OCD. So I was shocked to learn that psychiatrists actually receive very little training specific to autism and other developmental disorders. “Most child psychiatrists see fewer than five outpatients and ten inpatients with autism or intellectual disability during their entire 2-year child fellowship training,” Dr. Matthew Siegel, Director of the Developmental Disorders program at Maine Behavioral Healthcare, told me. Maine Medical Center is one of nine universities and hospitals that have formed The Developmental Neuropsychiatry Training Consortium, a group that wants nothing less than to create a new generation of autism experts. The Consortium’s proposed fellowship in Developmental Neuropsychiatry would offer “a concentrated training experience where fellows would treat hundreds of patients in a year, under the guidance of highly respected doctors in the field,” Siegel explained.    

            Advanced fellowship training is already offered in other specialized fields within psychiatry, including palliative care, sleep medicine and pain medicine. Fellows in these official sub-specialties of the American Board of Medical Specialties (ABMS) are eligible for federal funding, but that journey from initial program conception to endorsement by the ABMS typically takes up to ten years. In the meantime, the Consortium has spent the last nine months appealing to prominent autism groups, such as Autism Speaks, for support. “We’re trying to raise about $275,000 from one or more sources,” Siegel told me. “While the bulk of the fellowship costs would be borne by the host institutions, this money would fund the infrastructure necessary to administer the program. And more importantly, it would help us attract high-quality fellows by allowing us to offer more compensation, or perhaps give some student loan relief. Getting physicians who have already had a long educational path to do additional training at a training salary, where they might have to move, is not a small endeavor.”

            But while every group the Consortium approached has been enthusiastic about the fellowships, not one has agreed to fund them. “Training isn’t as sexy as the next great discovery,” Siegel said. Still, it’s hard for me to believe that this program – which would produce doctors educated not only in psychopharmacology, but in a range of assessments and multi-modal, evidence-based interventions including applied behavior analysis (ABA), communication supports, occupational therapy, and family counseling – has received so little support. Because parents face legitimate risks when they take their autistic children to psychiatrists with minimal training. “There’s an increased probability of misdiagnosis,” Siegel said. “There’s a risk of under or over diagnosing, of missing a co-occurring psychiatric disorder because the practitioner doesn’t recognize what anxiety or mood disorders look like in autistic patients. There’s also the risk of relying too heavily on a single modality, like psychopharmacology.” He has seen kids come into his specialized inpatient unit on over a dozen medications, as their previous providers responded to each failed medication trial by simply adding something else.

            The only reason my son Jonah is not in a residential treatment facility now is because of the amazing doctors who were able to medically stabilize his severely aggressive and self-injurious behavior. So I know how critical it is for families to find practitioners that are educated and experienced in caring for individuals with autism. Given how many parents are struggling, and how much these fellowships would help identify psychiatrists with the appropriate training, I couldn’t help asking Siegel if he had considered….crowd sourcing? If every family touched by autism coughed up $10, the Consortium would have enough money to fund hundreds of fellowships.

            He laughed. “I don’t think the institutions we all work for are that familiar or comfortable with that kind of fund raising,” he said. But fortunately, even without philanthropic support, four of those institutions are planning to fund fellowships on their own. This fall, Columbia University, Cincinnati Children’s Hospital, Stanford University and Maine Medical Center will all be advertising for applicants to start in July 2016. “Maybe if we build enough momentum, the funding will come around,” Siegel said. He’s hopeful that big donors will appreciate the value of supporting the Developmental Neuropsychiatry fellowships. While it costs more than $2.5 billion to develop a new drug, it costs less than $100,000 to train an experienced practitioner who can theoretically practice for fifty years. As Siegel observes, “That’s a huge return on investment.”