Quick Answer: A child and adolescent psychiatrist is a medical doctor with extra fellowship training in how mental health conditions present in young people. They can diagnose, prescribe, and provide therapy. If your teen's mood, anxiety, or focus is affecting school, sleep, or friendships, and it's been going on for weeks rather than days, that's the point at which a psychiatric evaluation is worth arranging.

Most parents start searching after something has been building for a while. The hard part isn't deciding to get help. It's working out who to call, when every website says something slightly different and no one explains the difference between the titles.

Psychiatrist, Psychologist, Therapist: Who Does What?

• A psychiatrist is a medical doctor (MD or DO) who completed medical school, a psychiatry residency, and often a fellowship. Psychiatrists diagnose, prescribe and manage medication, and many also provide therapy.
• A child and adolescent psychiatrist is a psychiatrist who completed an additional fellowship specifically in treating children and teenagers.
• A psychologist holds a doctorate in psychology. They provide therapy and psychological testing. In Colorado, psychologists don't prescribe medication.
• A therapist or counselor (LPC, LCSW, LMFT) provides talk therapy and is often the right first step on their own for many teens.
• A psychiatric nurse practitioner can also diagnose and prescribe, with training that follows a nursing rather than a medical path.

Not every teen needs a psychiatrist. If the question is "my teen is struggling and needs someone to talk to," a therapist may be exactly right. A psychiatrist matters most when there's a diagnostic question, when medication is on the table, or when something hasn't responded to therapy alone.

Why Child and Adolescent Training Matters

Teenagers aren't small adults. Depression in a 15-year-old often looks like irritability, exhaustion, and withdrawal rather than sadness. ADHD frequently gets missed in teens who did well academically until the workload grew. Anxiety can arrive as stomachaches and school refusal. Bipolar disorder, in its early stages, can look a great deal like depression.

Fellowship-trained child and adolescent psychiatrists spend those extra years learning how these conditions actually present at this age, how they differ from ordinary adolescence, and how medication works differently in a developing brain.

At Confluence Psychiatry, Dr. Shankar Nandakumar is board certified in psychiatry and specializes in child, adolescent, and adult mental health. Dr. Nandakumar completed medical training at UT Health San Antonio, a residency at Baylor College of Medicine, and a fellowship at the University of Colorado and Children's Hospital of Colorado.



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When to Consider a Psychiatric Evaluation

Consider booking an evaluation if, over several weeks, you've noticed:

• A lasting change in mood, irritability, or withdrawal from friends and family
• Grades slipping, or school becoming a fight
• Sleep or appetite changes that aren't explained by anything else
• Anxiety that's stopping your teen from doing things they used to do
• Focus problems affecting schoolwork, especially if they've worsened as demands increased
• Something you can't quite name, but which you know isn't how your teen usually is

You don't need a diagnosis before you call. Working out what's going on is the psychiatrist's job, not yours.

If your teen has talked about harming themselves or about suicide, don't wait for an appointment. Call or text 988, the Suicide and Crisis Lifeline, or go to your nearest emergency department. Colorado Crisis Services is also available at 1-844-493-8255.

What the First Appointment Looks Like

The first visit is a comprehensive evaluation, usually around an hour. The psychiatrist will take a full history: symptoms and how long they've been present, school, sleep, friendships, family history, any past treatment, and medical background.

Expect part of the appointment to be with your teen alone. That isn't about excluding you. Teenagers tell a doctor things they won't say in front of a parent, and that information matters. You'll usually be brought back in to talk through what comes next.

Medication is not a foregone conclusion. Sometimes the recommendation is therapy. Sometimes it's a combination. Sometimes it's more information before deciding anything. Ask how the practice handles confidentiality and what gets shared with you, so everyone knows the rules up front.

Questions Worth Asking

1. Are you fellowship-trained in child and adolescent psychiatry?
2. Who conducts the evaluation, and how long is it?
3. Do you provide therapy as well as medication management, or will we need a separate therapist?
4. How do you approach medication decisions with teenagers?
5. How does confidentiality work with my teen, and what will you share with me?
6. How quickly can we be seen, and how often are follow-ups?

At Confluence, psychiatric evaluation, medication management, and psychotherapy are all provided by the same doctors, so nothing gets lost between providers.

What It Costs in Denver

Our standard fees:

• Comprehensive evaluation (about an hour): $320
• Follow-up visit (25 minutes): $160
• Follow-up visit with therapy (55 minutes): $280

We aren't currently in network with insurance, so these are self-pay rates. All fees are discussed with you before you schedule.