By Dr Daniel S. Cohen · Updated: 30 April 2026
Summary
When a family suspects their child needs a psychiatric evaluation, one of the first difficulties is not clinical: it is deciding whom to turn to. There are psychiatrists, psychologists, psychotherapists, neuropsychologists; there is public care and private practice; there are multidisciplinary centres and individual consultations; and the information available online is often confusing or commercially oriented.
This article gathers the objective clinical criteria for making a good choice: when a child or adolescent actually needs a psychiatric evaluation, what each type of professional contributes and what signs should make you mistrust a practitioner. The aim is for you, as a family, to make an informed decision.
When a child or adolescent needs a psychiatric evaluation
Not every emotional difficulty in a child or adolescent calls for a psychiatrist. Paediatrics, psychology and school counselling resolve a good portion of these issues, but there are situations where psychiatric evaluation is necessary:
- Symptoms sustained over weeks or months with functional impact (academic performance, sleep, relationships, self-care).
- Suspected ADHD, moderate or severe anxiety or depression that may require pharmacological treatment.
- Eating disorders with impact on weight, menstruation, vital signs or marked body-image concerns.
- Self-harm, suicidal ideation or sudden marked changes in behaviour or mood.
- Psychotic episodes, marked changes in thought or perception.
- Complex neurodevelopmental disorders or those with significant comorbidity.
- Any clinical picture in which prior psychotherapy or school intervention has not produced improvement after several months.
As a practical rule, the paediatrician is the first sensible interlocutor when there is any concern: they orient, rule out medical causes and, if they consider it necessary, refer to the right specialist.
Differences between psychiatrist, psychologist, psychotherapist and neuropsychologist
This is one of the points that most confuses families:
- Psychiatrist. A medical doctor (graduate in Medicine) who has completed a specialty residency. The only professional who diagnoses mental disorders as a medical act, prescribes medication and issues electronic prescriptions. In Spain, since 2021, the official specialty of Child and Adolescent Psychiatry exists (Real Decreto 689/2021), although many psychiatrists with a child/adolescent focus have equivalent training accredited through their career, rotations or specific competence areas predating that date.
- Clinical or health psychologist. Graduate in Psychology with subsequent training. Carries out psychological assessment, psychological diagnosis, psychotherapy and, in the case of clinical psychologists trained via PIR, clinical care equivalent to psychiatry in non-pharmacological aspects. Does not prescribe medication.
- Psychotherapist. Professional with specific training in one or several modalities of psychotherapy (cognitive-behavioural, systemic family, psychodynamic, etc.). May be a psychologist, psychiatrist or, in some cases, a professional with another base. Treats through psychotherapy, does not diagnose mental illness as a medical act and does not prescribe.
- Neuropsychologist. Psychologist with specific training in the assessment of cognitive functions (attention, memory, executive function, language, learning). Carries out neuropsychological assessments with standardised batteries. Does not provide pharmacological treatment or psychotherapy.
A good evaluation of a child or adolescent with a complex clinical picture usually combines the work of several of these professionals. They are not competing alternatives: they are complementary.
Public vs private care
Both have real advantages. The choice depends on the clinical picture, the urgency and each family’s possibilities.
Public care (Spanish National Health Service and Comunidad de Madrid):
- Access via the paediatrician, who refers to child and adolescent mental health services at the local centre or reference hospital.
- Multidisciplinary teams with psychiatrists, clinical psychologists and mental health nurses.
- In severe cases: day hospitals, brief inpatient units, 24-hour emergency care.
- Main limitation: waiting times. While regulatory indicators establish that priority first appointments should occur within 20 days and routine ones within 100 days, in practice the actual times in some areas of the Comunidad de Madrid can reach several months, even in cases with relevant symptomatology. The regional government has reinforced resources in recent years, but demand has grown faster than supply.
Private care:
- Shorter waiting times: days or a few weeks.
- Clinical continuity with the same professional or team.
- Availability for longer consultations, coordinated family intervention, close follow-up.
- Main limitation: cost and, in some cases, insufficient insurance coverage.
The reasonable approach when facing a relevant clinical issue is not to dismiss either option and, where possible, to combine them (public emergency care for crises, private follow-up for continuity, for example).
Criteria for choosing a child and adolescent psychiatrist
When a family decides to consult a psychiatrist, the objective clinical criteria are:
- Specialist title in Child and Adolescent Psychiatry. Officially recognised in Spain since 2021 through Royal Decree 689/2021. Before that date, many psychiatrists with a child and adolescent focus document equivalent training through their professional trajectory, rotations in paediatric psychiatric hospitals and sustained clinical work with minors.
- Verified registration with the corresponding Medical Council. In the Comunidad de Madrid this is ICOMEM.
- Experience with the specific age and clinical picture. Evaluating a preschooler with suspected ASD, an adolescent with an eating disorder or a young person with suicidal ideation are not equivalent tasks.
- Coordinated work with psychotherapy. In most clinical pictures, psychiatry does not work in isolation. A psychiatrist who actively coordinates with a psychotherapist and, when needed, with a neuropsychologist, paediatrician and school, offers a better prognosis.
- Availability and clinical continuity. Does the same professional handle follow-up appointments? Are they available for reasonable urgencies between visits? Do they remain in contact with the family beyond the consultation?
- Languages, when relevant. In expat or binational families, consulting in the child’s mother tongue clearly improves the clinical quality of the work.
- Coordination with the school. Particularly useful in ADHD, learning disorders and clinical pictures with academic impact.
Red flags: when to be cautious
Some signs should prompt you to look for another professional:
- Hasty diagnosis in a short first consultation (less than 30-45 minutes) and without information from the school or family environment.
- Immediate recommendation of pharmacological treatment without a thorough explanation of the clinical picture, alternatives and side effects, or without having considered prior non-pharmacological interventions.
- Refusal to coordinate with other professionals already treating the child (psychotherapist, paediatrician, school).
- Lack of clarity about training or registration: any registered doctor can be verified on the corresponding council’s website. In Spain there is the professional validator of the General Council of Official Medical Associations.
- Promises of quick recovery or guaranteed results. No serious mental health treatment is promised this way.
The role of the multidisciplinary team
In most child and adolescent clinical pictures —ADHD, anxiety disorders, depression, eating disorders, learning difficulties— treatment is more effective when several professionals work in coordination than when each works on their own. The psychiatrist evaluates and, when appropriate, prescribes; the psychotherapist works on emotional regulation, self-esteem and social functioning; the neuropsychologist provides the cognitive profile when there are diagnostic doubts; the paediatrician monitors physical development; the school implements adjustments.
When these professionals share a single clinical approach and communicate with each other —whether within the same centre or in a coordinated network— the prognosis improves clearly. When they work in silos, results are significantly worse.
When to seek a second opinion
Seeking a second opinion in child and adolescent mental health is not disloyal to the first professional: it is a basic clinical right of the family and the child. It is particularly justified when:
- The recommendations received are difficult to understand or do not align with information available from reliable sources.
- A treatment with significant impact is proposed (long-term medication, hospitalisation, school leave) without intermediate options having been exhausted.
- The family feels they have not been heard or that the clinical picture has not been evaluated in its complexity.
- After several months of follow-up there is no improvement and the plan is not being reconsidered.
When to consult
Some signs warrant a professional evaluation without delay:
- Marked changes in behaviour, mood or academic performance sustained for several weeks.
- Symptoms affecting sleep, appetite, social life or self-esteem.
- Suspicion of self-harm, suicidal ideation or substance use.
- Frequent somatic complaints with no clarified medical cause.
- Clinical pictures with relevant academic impact or repeated complaints from the school.
If you recognise several of these situations as a family, it makes sense to start with the paediatrician and, depending on their orientation, consider a psychiatric evaluation. More information on specific clinical pictures in the articles on ADHD in children and adolescents and anxiety and depression in adolescents.
Conclusion
Choosing well the professional who will evaluate and, if needed, treat your child is an important clinical decision that is worth taking time over. Objective criteria —training, experience, coordination with other professionals, transparency, clarity— matter more than geographical proximity or how quickly an appointment can be obtained. A good child and adolescent psychiatrist does not decide alone: they work as part of a team, listen to the family and keep the door open to second opinions and to revising the plan. Taking time to choose well at the start changes the course of treatment.
Clinical references
- Real Decreto 689/2021, of 3 August, establishing the title of medical specialist in Child and Adolescent Psychiatry. BOE-A-2021-13266. Access
- Orden PCM/205/2023, of 2 March, training programmes for Psychiatry and Child and Adolescent Psychiatry. BOE-A-2023-5700. Access
- Comunidad de Madrid. Comprehensive psychiatric care for children and adolescents. Access
- Save the Children Spain. Mental health waiting lists for children and adolescents. Access
- General Council of Official Medical Associations of Spain. Professional validator. Access
- ICOMEM (Official Medical Association of Madrid). Professional validator. Access
About the author: Dr Daniel S. Cohen. Psychiatrist in Madrid, specialist in child and adolescent psychiatry and adult psychiatry. Medical Director of Clínica Colev. Registration No. 28/4003040 (ICOMEM). Consultations in English, French, Hebrew and Spanish. View professional profile.