Who’s Who?

Who’s Who?

It is as plain as day that professionals don’t have a good enough understanding of the skills and knowledge of their colleagues and the contributions that they can offer.  I believe that this leads to missed opportunities that could considerably improve children’s outcomes and the experiences of families and staff.

I recently sat in a Paediatricians office with a friend whose son **NEEDS** a Speech and Language Therapist (SLT) REALLY BADLY.  When I asked the paediatrician about the possibility of a referral, the look on her face said “Tickets to the moon? There is no way we can do that”.

Honestly, we are talking about a very articulate 12 year old boy with a social communication disability that is crippling his life: daily.  “Social Communication Disability” I wanted to say to her – “The clue is in the name.” 

I didn’t waste my breath.  Frustrated at witnessing the massive decline in this child’s social and emotional functioning I contacted the local SLT team by Facebook and they were able to help.  Yes really, you read that right, I just asked for help.  Via Facebook for goodness sake! How hard would it have been for that paediatrician to make the referral?  How many other children and families are struggling because professionals know next to nothing about the role of their colleagues and how, together, they could make the lives of children easier.

Again it had occurred to me just how little some ‘professionals’ know about the people that can help bright children with an autism spectrum disorder.  It reminded me of the time that I spoke to a really lovely, experienced, teacher who asked me, rather sheepishly, “Is there difference between an Educational Psychologist and a Clinical Psychologist?”.

Then I thought of another friend, whose child very clearly displayed sensory processing difficulties; her paediatrician said there was no need for an Occupational Therapy (OT) referral but he would “do one any way”.  It turns out that, for this child, the OT’s advice and information has been the most useful of all she has received.  It has impacted and helped her functioning daily – her life has been changed because of that OT assessment and intervention.  There is no doubt that the referral was appropriate.  It would never have happened if her mum didn’t have a very bossy friend (!) ‘encouraging’ her to constantly be assertive and insistent on being provided with appropriate help.

There is no doubt whatsoever that the primary school staff responsible for Peter had not the first clue about the important role that the OT and Clinical Psychologist played in his life, nor how they could help them to support him appropriately at school.  They wasted many hours in obstructing their involvement and made no effort to hide their feelings.  His OT appointments were marked as unauthorised and the writing assessment the OT completed was literally thown at her in a meeting with a terse “well I would have made him do it again”.

So, with this in mind here is some information about some of the professionals out there.  I might add to it in future (so please comment with advice on that) but here is some information for now.  I hope that it clears away some of the mystery and confusion.  Even better, I hope that it will lead to more children having the specialist input that can make life changing differences.

Education Psychologists have usually trained and worked as teachers before doing further study in educational psychology.  Often this is to a clinical doctorate level (see comments section for more information about this).  They are concerned with helping children or young people who are experiencing problems within an educational setting, with the aim of supporting their learning.  Educational psychologists offer cognitive assessments, advise on interventions, such as learning programmes and work collaboratively with teachers or parents.  They also provide in-service training for teachers and other professionals on issues such as behaviour and stress management.  See here for professional guidelines on how the EP should contribute to the EHCP process.

Clinical (child) Psychologists train for 8-10 years.  They complete a degree in psychology and then acquire 2 – 3 years clinical experience.  Next they undergo a Clinical Doctorate (see comments for more detail) in mental health difficulties, including all ages and psychological disorders.  Finally, they carry out post-qualification specialism work with children and their families.  Some may do additional therapy or assessment training to specialist further.

Child psychologists work to understand the reasons for the child’s difficulties.  This is done using a range of approaches. They then work with the children and their families to find the best way to help.  They can help with emotional difficulties and behaviour that is thought to be different from that of other children.

Child Psychologists are trained to carry out cognitive assessments and some can also carry out types of educational assessments, such as for dyslexia.

Child and Adolescent Psychiatrists are doctors.  They complete a medical degree (5 years), foundation training (2 years) and specialty training (6 years).  They specialise in working with children and young people who have mental health problems.   A large part of a child psychiatrist’s work is to identify the problem for the young people and advise about what may help.  Psychiatrists prescribe and monitor medication as part of their practice.

Child and Adolescent Mental Health Services (CAMHS) are often described as being in four tiers.  For more information / a brief outline of these please click here.  

Paediatric Occupational Therapists complete a clinical degree in occupational therapy and then specialise in paediatrics.  Many complete post graduate qualifications such as in sensory integration.  Among other things, including assessment of skills required in everyday life occupational therapists carry out activity analyses to understand the processes behind motor perceptual integration in the child.  Some of the things they assess can include executive function, fine motor skills, gross motor skills, proprioceptive input, hypo and hyper-sensitivity to different stimuli, auditory processing, posture, pencil grip and central coherence.  They can then consider these findings along side the child’s cognitive abilities and the stage of their development.

Where discrepancies are apparent, they work to understand the nature of these, so that a plan can be considered.  The plan will vary depending on whether the difficulties require support to develop skills (to reduce the discrepancy) or there is a requirement for equipment or compensation so that the impact of the discrepancy is minimised.  The aim of the assessment and recommendations, is to help children to live, play and learn as independently as possible.

Speech and Language Therapists complete a degree and a year of practice before specialising in paediatrics.  They work with children and families to support COMMUNICATION – of course children with and excellent speech and superior range of vocabulary can have severe communication difficulties and support with this hidden disability can be critical to the functioning of many children and adults.  Some of the aspects of communication they can assess for are attention, comprehension, expressive language, social communication, pragmatic understanding, reciprocal conversation, non verbal communication and social relationships.  For example of how a SLT can help children in school, potentially removing barriers to learning socialising and preventing mental health difficulties see here.

 If you are reading this and are from one of the disciplines I have outlined, and have anything to add or amend PLEASE let us know!  We would like to make this as accurate and comprehensive as possible.

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6 thoughts on “Who’s Who?

  1. “It reminded me of the time that I spoke to a really lovely, experienced, teacher who asked me, rather sheepishly, “Is there difference between an Educational Psychologist and a Clinical Psychologist?”.”

    And yet these are the same school staff refuting legitimate diagnoses by professionals. Professionals who they have no clue what their job is and yet see fit to deny their qualified assessment results.

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  2. Please could anyone answer my question of what exactly a ‘paediatric psychotherapist’ is? Offspring due to see one within the next couple of weeks; I’ve been firmly corrected by practitioners at CAMHS on a couple of occasions when I have used the term ‘psychologist’ in reference to this forthcoming appointment, but nobody within the ‘system’ of CAMHS appears able to provide a definition of the difference between the two roles. The only details I can find seem to suggest that ‘psychotherapist’ is merely a fancy word for ‘counsellor’; given our experience thus far of the ‘counselling’ at CAMHS, this isn’t filling me with any hope for the future, so I would be very grateful for any clarification.

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    1. There is definitely a difference. Psychotherapy is much more than counselling BUT sometimes psychological therapies, as an umbrella term, is shortened to psychotherapy. Does that make sense? If you google train to be a psychotherapist you might have more luck. I cant explain it properly as i dont quite know enough, but psychotherapy is more long term and focuses on relationships in the broadest sense i think! I hope it goes well. I think it can take a while to ‘get onto’ so give it time to settle in xxx lots of luck.

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    2. Be cautious of psychotherapy if this is for an autistic child. Psychotherapy involves deep analysis of feelings and the cause for them, something the average autistic would really struggle with. Do some research to be sure psychotherapy would fit your child’s needs as some therapies can even be harmful for autistics. Especially with complex co-morbidities such as phobias and panic disorder. Most autistics are emotionally and developmentally younger than their chronological age by about 3-4 years. So expectations by a professional who (1) is not expert in autism and (2) does not know your child as an individual may be contraindicated.

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  3. We’ve been ‘assured by an expert’ that offspring isn’t autistic. “He just has a lot of autistic traits …” (The expert was consequently found to have very little experience in diagnosing autism.) We’ve also been told, however, that the case is ‘extremely complex’; we also have clear evidence that he’s emotionally younger by about six years than others in his class. Thank you for your replies; I’m slowly gathering my written notes & questions for this latest meeting.

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  4. From Anon – more information about a ‘Clinical Doctorate’:
    About your excellent article about professionals – educational and clinical psychologists don’t complete a PhD – it is a clinical doctorate that they do. There is a vast difference between the two, a clinical doctorate is taught and has a research component similar to a masters level. A PhD is 100% research based and once achieved allows the Individual to conduct research independently. It may seem a small difference but it is important. There are also clinical psychologists who have completed a PhD before their clinical training who I’m sure would appreciate the double recognition!

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