Psychiatric care for adolescents and young adults

Theodore Germanos, MDTriple board-certified — adult, child & adolescent, and addiction medicine

Adolescent psychiatry is its own specialty for a reason: the same symptoms mean different things at fifteen than at forty, the history that matters goes back further, and the people who see it most clearly are usually not in the room. I am board-certified in child and adolescent psychiatry alongside adult and addiction medicine, and I see adolescents and young adults across California by secure video.

A longer evaluation, because there is more to evaluate

An evaluation for an adolescent runs about 90 minutes rather than the 60 typical for an adult. The extra time is not padding. It covers developmental history, how school is actually going as opposed to how the transcript reads, sleep, social and family context, substance exposure, and structured input from a parent — because a fifteen-year-old and their parent frequently describe two different situations, and both descriptions are data.

Diagnosis first, and the differential is wide

Attention problems at school can be ADHD. They can also be anxiety, a mood disorder, a sleep problem, a learning disorder, an autism spectrum presentation that was never assessed, or a home situation nobody has asked about directly. ADHD and autism co-occur often, and adolescents assessed for only one of them are among the most commonly missed. Getting the diagnosis right is not a preliminary step before the real treatment — it is the step that determines whether the treatment has any chance of being the right one.

Where parents fit

Parents are part of the evaluation and part of the treatment, and I say so at the start rather than leaving it ambiguous. At the same time, an adolescent who believes nothing they say stays private will not say much worth hearing. How that balance works — what gets shared with parents routinely, what does not, and the safety situations where that changes — is explained plainly to everyone at the first appointment, before it matters.

What treatment looks like

Depending on the diagnosis, treatment may include medication management, targeted therapeutic work, and practical structure around sleep, school, and load. Medication is used when it is clinically the right addition, not as the default opening move, and no medication outcome is promised before an evaluation. Follow-ups are scheduled at a rhythm the treatment actually needs.

When telehealth is the right setting — and when it is not

For evaluation, medication management, and therapeutic work with adolescents, video works well, and for a teenager who talks more freely from their own room than across a desk it sometimes works better. It is not the right setting for everything. Acute safety concerns, presentations that need in-person assessment, and situations calling for a higher level of care belong elsewhere, and if that is what I find, I will say so directly and help point toward the right setting rather than treating around it.