When should I bring my child to a psychiatrist?

Consider a psychiatric evaluation if your child's emotional or behavioral difficulties persist for more than a few weeks, are significantly impairing school performance, friendships, or family life, include talk of self-harm or suicide, involve severe aggression or property destruction, are not improving with therapy alone, or if their pediatrician recommends it. A child psychiatrist can determine whether symptoms represent a diagnosable condition and whether medication or other interventions are appropriate.

What is the difference between a child psychiatrist and a child psychologist?

A child psychiatrist is a medical doctor (MD) who completed medical school, a general psychiatry residency, and a fellowship in child and adolescent psychiatry. They can prescribe medication, order medical tests, and provide or coordinate therapy. A child psychologist has a doctoral degree (PhD or PsyD) in psychology and specializes in therapy and psychological testing but cannot prescribe medication in most states. Both are important members of a treatment team.

Is it safe to give children psychiatric medication?

When prescribed by a board-certified child psychiatrist who monitors appropriately, psychiatric medications are generally safe and can be highly effective for children. FDA-approved medications for children have been studied in pediatric clinical trials. The key is careful diagnostic assessment, starting at the lowest effective dose, close monitoring for side effects, and regular follow-up. Dr. Sultan's JAMA research on antipsychotic prescribing patterns specifically focused on ensuring responsible prescribing practices for youth.

What conditions does a child psychiatrist treat?

Child psychiatrists treat the full spectrum of psychiatric conditions in children and adolescents, including ADHD, anxiety disorders (generalized, social, separation, phobias), depression, OCD, autism spectrum disorder, bipolar disorder, eating disorders, PTSD and trauma-related conditions, oppositional defiant disorder, conduct disorder, tic disorders and Tourette syndrome, substance use disorders in adolescents, and self-harm and suicidal behavior.

How do I prepare my child for their first psychiatry appointment?

Be honest with your child in age-appropriate language. You might say, 'We are going to see a doctor who helps kids with their feelings and worries.' Reassure them they are not in trouble. Bring report cards, teacher feedback, prior evaluations, and a list of behaviors or symptoms you have observed with approximate dates of onset. For adolescents, let them know they will have private time with the doctor. The first appointment is primarily an evaluation -- medication is not typically started on the first visit.

Can my child's school request a psychiatric evaluation?

Schools cannot require a psychiatric evaluation, but they can recommend one and may suggest it as part of the process for obtaining an Individualized Education Program (IEP) or 504 Plan. A child psychiatrist's evaluation can support requests for school accommodations, provide documentation for IEP meetings, and help the school understand your child's needs. Many parents find that a psychiatric evaluation strengthens their advocacy for appropriate school support.

How long does a child psychiatric evaluation take?

A comprehensive child psychiatric evaluation typically takes 60-90 minutes for the initial appointment. This includes meeting with the parents to gather developmental, medical, family, and school history; meeting with the child individually for a mental status examination; discussion of observations and preliminary diagnostic impressions; and a collaborative treatment plan. Some evaluations may require additional visits, psychological testing, or collateral information from schools or other providers.

Does my child need medication or just therapy?

This depends on the diagnosis, severity, and impairment. For mild to moderate anxiety and depression, therapy alone (particularly CBT) is often the first-line approach. For ADHD, medication is typically the most effective treatment, often combined with behavioral interventions. For moderate to severe conditions, the combination of medication and therapy generally produces the best outcomes. A child psychiatrist can help determine the right approach for your specific child based on evidence-based guidelines.

Home → Child Psychiatrist NYC

Child & Adolescent Psychiatrist in NYC: Expert Care at Columbia University

Creator: Ryan S. Sultan, MD
Published: 2026-03-29
Keywords: child psychiatrist NYC, pediatric psychiatrist, child and adolescent psychiatry, teen psychiatrist

By Ryan S. Sultan, MD
Assistant Professor of Clinical Psychiatry, Columbia University Irving Medical Center
Board-Certified in Adult Psychiatry and Child & Adolescent Psychiatry
March 29, 2026

Dr. Ryan Sultan is a board-certified child and adolescent psychiatrist at Columbia University Irving Medical Center. He treats the full range of childhood psychiatric conditions -- ADHD, anxiety, depression, OCD, autism spectrum disorder, and behavioral disorders -- with an emphasis on evidence-based prescribing. His landmark JAMA study on antipsychotic prescribing in youth (411+ citations) reflects his commitment to responsible, research-informed treatment for young patients. He practices at Integrative Psych, 80 Eighth Avenue, Chelsea, Manhattan.

Quick Summary: Finding the right child psychiatrist is one of the most important decisions a parent can make. Child and adolescent psychiatrists complete medical school, a full psychiatry residency, AND an additional fellowship specifically in treating children and adolescents -- a total of 13+ years of training after college. This specialized training allows them to understand developmental considerations in diagnosis and treatment, prescribe medications safely with pediatric-specific dosing and monitoring, differentiate between normal developmental variation and psychiatric illness, and coordinate care with schools, pediatricians, and therapists. This page covers when to seek help, what conditions child psychiatrists treat, what to expect at a first visit, and Dr. Sultan's approach to child and adolescent psychiatric care.

What Is Child and Adolescent Psychiatry?

Child and adolescent psychiatry is a medical subspecialty devoted to the diagnosis, treatment, and prevention of psychiatric disorders in children, adolescents, and their families. It is one of the most rigorous training pathways in medicine: after completing college (4 years), medical school (4 years), and a general psychiatry residency (4 years), a child psychiatrist completes an additional 2-year fellowship focused exclusively on treating young patients.

This extended training is not arbitrary. The developing brain is fundamentally different from the adult brain. Psychiatric conditions manifest differently in children than in adults. Medication dosing, metabolism, and side effect profiles differ. The diagnostic process must account for developmental stage, temperament, family dynamics, school environment, and peer relationships. A child who is "hyperactive" at age 4 may be exhibiting normal behavior for their developmental stage, while the same behavior at age 10 warrants careful evaluation. Distinguishing normal from pathological requires deep expertise in child development.

As a board-certified child and adolescent psychiatrist at Columbia University, I bring both academic rigor and clinical experience to this work. My research -- particularly my JAMA Internal Medicine study examining antipsychotic prescribing patterns in youth, which has been cited over 411 times -- has focused on ensuring that children receive appropriate, evidence-based treatment and are not subjected to unnecessary or potentially harmful medications.

When to Bring Your Child to a Psychiatrist

Parents often struggle with the decision to seek psychiatric evaluation for their child. Some worry about stigma, others question whether their child's behavior is "bad enough" to warrant professional help, and many are uncertain about what a psychiatrist will do differently from their pediatrician or a therapist.

Consider a child psychiatric evaluation if your child is experiencing:

Academic decline that is not explained by learning disabilities or environmental factors
Persistent sadness, withdrawal, or loss of interest lasting more than two weeks
Excessive anxiety or worry that interferes with school, friendships, or family activities
Difficulty with attention, impulsivity, or hyperactivity that is present across settings (not just at home or just at school)
Severe tantrums or emotional outbursts that are disproportionate and difficult to manage
Repetitive behaviors, rituals, or intrusive thoughts suggesting OCD
Social difficulties, restricted interests, or sensory sensitivities suggesting autism spectrum disorder
Self-harm, suicidal thoughts, or talk about wanting to die
Substance use in adolescents
Dramatic changes in sleep, appetite, energy, or behavior
Symptoms that have not improved with therapy alone
A recommendation from their pediatrician, school, or therapist

There is no "too early" for an evaluation. If you are concerned, getting an assessment does not commit you to medication or any particular treatment. It provides information and options. The earlier psychiatric conditions are identified and treated, the better the long-term outcomes -- this is one of the most robust findings in child psychiatry research.

Common Conditions in Child and Adolescent Psychiatry

ADHD (Attention-Deficit/Hyperactivity Disorder)

ADHD is the most common neurodevelopmental disorder, affecting approximately 9.4% of children in the United States. It involves persistent patterns of inattention, hyperactivity, and/or impulsivity that impair functioning across multiple settings. ADHD is a neurobiological condition -- not a result of bad parenting, too much screen time, or lack of discipline.

Stimulant medications (methylphenidate and amphetamine-based) remain the most effective treatment for ADHD, with response rates of 70-80%. Non-stimulant alternatives include atomoxetine, guanfacine, and viloxazine. Behavioral interventions, parent training, and school accommodations are important complements to medication. For a comprehensive overview, see my Complete ADHD Guide.

Anxiety Disorders

Anxiety disorders affect approximately 7.1% of children aged 3-17. In children, anxiety may manifest differently than in adults -- as somatic complaints (stomachaches, headaches), school refusal, clinginess, excessive reassurance-seeking, or meltdowns. Separation anxiety disorder is particularly common in younger children, while social anxiety and generalized anxiety become more prevalent in adolescence.

For mild to moderate anxiety, cognitive-behavioral therapy (CBT) is the first-line treatment. For moderate to severe anxiety, the combination of CBT and an SSRI (typically sertraline or fluoxetine) produces the best outcomes, as demonstrated in the landmark CAMS (Child/Adolescent Anxiety Multimodal Study) trial.

Depression

Major depressive disorder affects approximately 3.2% of children and 12.8% of adolescents. In children, depression often presents as irritability rather than sadness. Other signs include loss of interest in previously enjoyed activities, social withdrawal, changes in sleep or appetite, fatigue, difficulty concentrating, feelings of worthlessness, and in severe cases, thoughts of death or suicide.

Fluoxetine (Prozac) is the best-studied antidepressant in children and adolescents and is FDA-approved for pediatric depression. Escitalopram is also FDA-approved for adolescent depression. The combination of medication and CBT produces the best outcomes, as shown in the Treatment for Adolescents with Depression Study (TADS).

OCD (Obsessive-Compulsive Disorder)

OCD affects approximately 1-2% of children and adolescents. It involves intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) performed to reduce the distress caused by the obsessions. In children, common obsessions include contamination fears, harm fears (something bad happening to themselves or loved ones), symmetry/ordering needs, and forbidden or taboo thoughts. Common compulsions include excessive handwashing, checking, counting, and reassurance-seeking.

Exposure and Response Prevention (ERP) -- a specialized form of CBT -- is the gold standard treatment for pediatric OCD. SSRIs (particularly fluoxetine, fluvoxamine, and sertraline) are effective adjuncts for moderate to severe cases.

Autism Spectrum Disorder (ASD)

ASD is a neurodevelopmental condition characterized by persistent differences in social communication and interaction, along with restricted, repetitive patterns of behavior, interests, or activities. The prevalence is approximately 1 in 36 children (CDC, 2023). There is no medication for the core features of autism, but medication plays an important role in treating co-occurring conditions -- anxiety, ADHD, irritability, sleep difficulties -- that are common in autistic children.

My training under Jeremy Veenstra-VanderWeele, the division director of child and adolescent psychiatry at Columbia and a leading autism researcher on the SFARI scientific advisory board, gave me specialized expertise in managing the psychiatric aspects of ASD. For more information, see my page on ADHD vs. Autism.

Behavioral Disorders

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) involve persistent patterns of defiant, hostile, or antisocial behavior. These diagnoses are sometimes overused and can mask underlying ADHD, anxiety, depression, trauma, or autism. A thorough evaluation is critical to identify what is driving the behavior before deciding on treatment. Parent management training (PMT) is the most evidence-based intervention for disruptive behavior in children. See my guide on Tantrums and Emotional Dysregulation in Children.

Medication in Children: Safety, Evidence, and My Approach

The question of whether to use psychiatric medication in children is one I take seriously. My JAMA Internal Medicine study on antipsychotic prescribing in youth found significant patterns of off-label prescribing -- medications being used for conditions where evidence did not support their use, in populations where safety data was limited. This research has been cited over 411 times and has informed prescribing guidelines nationwide.

My prescribing philosophy for children and adolescents:

Accurate diagnosis first: Medication should treat a specific, well-established diagnosis -- not just "behavior problems." I invest significant time in the diagnostic evaluation before considering medication.
Evidence-based choices: I prescribe medications that have been studied in pediatric populations and have FDA approval or strong evidence for the condition being treated. Off-label prescribing is sometimes appropriate but should be the exception, not the rule.
Start low, go slow: Children are not small adults. I start at the lowest effective dose and titrate gradually, monitoring closely for both therapeutic response and side effects.
Regular monitoring: Growth (height and weight), vital signs, metabolic parameters (for antipsychotics), cardiac monitoring (for stimulants), and behavioral/emotional changes are tracked systematically.
Medication is rarely the only treatment: For most conditions, the best outcomes come from combining medication with therapy, family involvement, and school accommodations.
Periodic reassessment: I regularly reevaluate whether medication is still needed, whether the dose is optimal, and whether it should be discontinued.

Teen-Specific Issues

Cannabis Use in Adolescents

As a researcher whose career has focused significantly on cannabis and its effects on the developing brain, I am deeply concerned about adolescent cannabis use. The adolescent brain is still undergoing critical development -- particularly in the prefrontal cortex, which does not fully mature until the mid-20s. Regular cannabis use during this window is associated with impaired cognitive development, increased risk of psychotic disorders (particularly with high-THC products), worsened anxiety and depression over time, lower academic achievement, and increased risk of cannabis use disorder.

My research in this area, published in multiple peer-reviewed journals, has examined the relationship between cannabis use and psychiatric outcomes in young people. If your teen is using cannabis, a psychiatric evaluation can help determine whether there is an underlying condition driving the use (such as anxiety, ADHD, or depression) and develop a comprehensive treatment plan. See Cannabis and the Teenage Brain for more information.

Social Media and Mental Health

The relationship between social media use and adolescent mental health has become a major concern. Research suggests associations between heavy social media use and increased rates of depression, anxiety, sleep disruption, body image concerns, and cyberbullying exposure. While the causal relationships are still being studied, I routinely assess social media use as part of my adolescent evaluations and work with families on developing healthy technology boundaries.

Self-Harm and Suicide

Rates of self-harm, suicidal ideation, and suicide attempts in adolescents have increased significantly over the past decade. Suicide is the second leading cause of death among individuals aged 10-24 in the United States. Any expression of suicidal thoughts or self-harm behavior warrants immediate professional evaluation. As a child and adolescent psychiatrist, I am trained in suicide risk assessment, safety planning, and the full range of treatment options for suicidal youth, including crisis intervention, medication management, and coordination with emergency services when needed.

What to Expect at a First Visit

Initial evaluation (60-90 minutes):

Parent interview: I begin by meeting with parents (or caregivers) to gather comprehensive information about the child's developmental history, medical history, family psychiatric history, school performance, social functioning, and current concerns. I ask specific questions about symptom onset, duration, severity, and context.
Child/adolescent interview: I meet with the child individually for a mental status examination and age-appropriate conversation. For younger children, this may involve play-based assessment. For adolescents, I establish rapport and provide confidentiality (with safety exceptions clearly explained).
Observation: Throughout the visit, I observe the child's behavior, attention, mood, anxiety level, social engagement, and parent-child interaction.
Discussion and plan: I share my initial diagnostic impressions with the family, discuss what I observed, recommend any additional testing if needed (such as psychological testing, school evaluations, or medical workup), and develop a collaborative treatment plan.

Important notes for parents:

I do not typically prescribe medication at the first visit. The evaluation comes first.
Bring any prior evaluations, report cards, teacher feedback, and a list of concerns.
Both parents/caregivers are welcome and encouraged to attend.
Your child will not be labeled, judged, or forced to do anything they are uncomfortable with.
You will leave with a clear understanding of my assessment and recommended next steps.

School Accommodations: IEPs and 504 Plans

Many children with psychiatric conditions benefit from formal school accommodations. A psychiatric evaluation can provide the documentation needed to support these requests.

504 Plans provide accommodations for students with a disability that affects a "major life activity" (such as learning or concentrating). Common accommodations include preferential seating, extended time on tests, permission for movement breaks, modified homework loads, and access to a quiet testing environment.

Individualized Education Programs (IEPs) provide more comprehensive support, including specialized instruction, related services (such as speech therapy, occupational therapy, or counseling), and measurable goals. IEPs require that the student meet criteria under the Individuals with Disabilities Education Act (IDEA).

As a child psychiatrist, I regularly write letters supporting accommodation requests, attend school meetings when needed, and help families navigate the sometimes complex process of obtaining appropriate educational support. A child's school environment plays a critical role in their mental health outcomes, and ensuring they receive appropriate support is an integral part of treatment.

My Approach: Evidence-Based, Family-Centered Care

At Integrative Psych in Chelsea, Manhattan, I provide child and adolescent psychiatric care that is rooted in my research at Columbia University and my training at some of the country's leading academic medical centers. My approach is evidence-based (I prescribe and recommend what the research supports, not what is trendy), family-centered (I work with the entire family system, not just the identified patient), developmentally informed (I account for the child's developmental stage in every clinical decision), and collaborative (I coordinate with pediatricians, therapists, and schools to ensure comprehensive care).

I understand the weight of the decision to bring your child to a psychiatrist. My goal is to provide clarity, direction, and expert treatment so that your child can thrive -- at school, at home, and in their relationships.

Concerned About Your Child's Mental Health?

Dr. Ryan Sultan is a board-certified child and adolescent psychiatrist at Columbia University who provides comprehensive evaluation and treatment for children and teens. His research-informed approach ensures your child receives evidence-based, responsible care.

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