Welcome to the Breakwater Center!

We will see infants as young as 4 months of age if they are at high risk of developmental delay. We do not generally take new referrals for evaluations if older than 16 years; however we do provide medication management for our current patients until they can be transitioned to a physician who cares for adults.

This question is difficult to answer without gathering a lot of information; which is why the mandatory initial consultation is so important. We really need to understand a child's medical and developmental history, as well as review previous documentation from therapists, physicians, prior evaluations, in order to make the judgement about an assessment. Ultimately, the goal of the caregiver consultation ( which includes thorough review of all submitted documents ) is intended to help guide families to the most efficient and economical option to obtain care and services. Sometimes that leads to an evaluation with us; but sometimes the best first step is a community resource. If together we decide to wait on scheduling the comprehensive assessment, the intake from the caregiver consultation is valid for 6 months ( under 5 years ) or 1 year ( 5+ years). After the respective amount of time has passed, we would need a separate appointment to update important information, before scheduling an assessment.

While we conduct comprehensive assessments and cognitive testing when appropriate; we do not conduct formal IQ testing. Our testing will reveal information about school readiness, autism risk, relative learning strengths, possible risk for learning disability, and often gives us global view of abilities that can guide recommendations and inform next steps. We DO partner with an incredible neuropsychologist who can complete higher level cognitive assessments if we feel this testing is indicated.

There are some DBPs who have built practices based on delivering comprehensive care that includes general pediatrics, but this is not currently offered at our clinic. It is imperative that you continue to engage with your child's Pediatrician for routine care and sick visits, and we look forward to being part of the medical team.

While we encourage collaboration with you child's healthcare team, we do not order or interpret labs/imaging/tests requested by other clinicians. We also do not make medical decisions based off of external labs. We will order labs that we feel are medically necessary and may alter our intended treatment plan.

Developmental and Behavioral Pediatricians (DBPs) have the medical expertise and advanced subspecialty training to evaluate, diagnose, and manage developmental, learning, and behavioral concerns. DBPs have completed four years of medical school, three years of pediatrics residency, board certification in general pediatrics, and an additional three years of subspecialty training in developmental and behavioral pediatrics. DBPs are able to diagnose, manage, and treat the following conditions: ​ Learning disorders including dyslexia, writing difficulties, math disorders, and other school-related learning problems Attention and behavioral disorders including attention-deficit/hyperactivity disorder and associated conditions including oppositional-defiant behavior, conduct problems, depression, and anxiety disorders Tics, Tourette syndrome, and other habit disorders Regulatory disorders including sleep disorders, feeding problems, discipline difficulties, complicated toilet-training issues, enuresis (bedwetting), and encopresis (soiling) Developmental disabilities including cerebral palsy, spina bifida, intellectual disability, autism spectrum disorder, and visual and hearing impairments Delayed development in speech, language, motor skills, and thinking ability Behavioral and developmental problems complicating the full range of pediatric chronic illnesses and disabling conditions (for example, genetic disorders, epilepsy, prematurity, diabetes, asthma, cancer)

While DBP has some overlap with Psychiatry and Neurology; we are not able to manage or coordinate: psychiatric conditions such as bipolar disorder or schizophrenia active suicidal ideation inpatient hospitalization epileptic conditions eating disorder treatment substance use disorder While we do perform extensive testing when indicated, to include the ADOS and all measures required for medical eligibility for state services in South Carolina, we do not perform forensic or court-ordered custody evaluations.

We welcome the opportunity to offer home-visits, but do charge an additional fee for time traveled. The fee is equal to our hourly rate for the "round-trip" time as calculated from our West Ashley Office to the location of your choosing.

The physician-patient relationship is of utmost importance to us. All virtual intakes and feedbacks are scheduled on a HIPAA compliant platform to ensure privacy.

We understand this is somewhat unusual, but our availability takes into account the work, school, and childcare requirements of our staff and our families. Intake and feedback appointments are generally scheduled in a convenient time for the family, virtually, before or after working hours. Evaluations are scheduled in the early evenings or on the weekends.

We are currently only accepting new referrals from our community partners.

We are based in Charleston, and our office is co-located with Paragon Pediatrics. We frequently travel as needed for community partnerships or in-home evaluations. We are currently onboarding affiliate pediatricians, and hope to evaluate patients within their medical care home on an as needed basis.

Yes! Whenever possible, we prefer telehealth delivery of care. Many of our patients live quite a distance from Charleston, and we understand that it is not feasible for caregivers to take an entire day off of work, for a multi-visit evaluation. Our initial consultation and feedback sessions are always virtual. Occasionally, evaluations may be completed virtually; but this is dependent upon the types of evaluation, and what is required by your insurance to determine medical eligibility for some services.

The policies that determine medical eligibility for services differ between insurance companies. This means that insurance companies may require different tests or levels of documentation before they approve services for your child. We take great care in understanding these requirements in South Carolina, and knowing your insurance company helps ensure our evaluations and recomendations will lead to approval of services.

Evaluation cost can vary based on the child's age, parental concerns, medical history, and extent of other evaluations completed prior. The estimated cost will be discussed following a caregiver consultation, and is based on an average of regional hourly rates from cash-based psychiatry and developmental medicine practices.

We currently do not accept insurance. On request, we will provide you with a "superbill" which you can use to request reimbursement from your insurance company.

A great deal of time and energy goes into preparing for your appointment so that you can get the most value out of your time with us. Similarly, we appreciate you valuing our time and understanding that missed appointments or same-day cancellations are subject to a full charge of the agreed amount. Appointments canceled within 2 business days notice, are subject to 50% of the cost of the visit.

We do not currently set up payment plans for patients. Payment in full is required at least 24 hours before your appointment time.

Though we love to manage complex medications, we are currently only taking referrals for med management from a community partner.

If a pharmacy has notified you that you need prior authorization for a medication, please have them fax over the rejection claim with all of your insurance information. Remember that once we have submitted the medication request to the insurance, it may take up to five business days for them to respond.

We are more than happy to make medication recommendations to your child's primary care physician. We welcome the opportunity to set up a virtual meeting with your primary care physician and answer any questions they have about starting or managing medications.

Established patients who want the Breakwater Center to manage complex medications are required to sign up as a direct care member. This model of care is similar to a subscription plan, where you pay a single monthly fee for unlimited access; as opposed to a set rate for a single follow-up visit. We do this for a number of reasons, but primarily to ensure our patients have reliable access. There is good evidence to support that starting and modifying medications in very young children with ADHD/ASD/Anxiety can be particularly challenging. These children can have dramatic or paradoxical reactions to small medication changes. While we anticipate and discuss this with our families, the lived experience can be very stressful. In our experience, our families are more likely to continue life-changing medications, or tolerate challenging adjustment periods, when they know they have reliable access to their developmental pediatrician. Instead of waiting days to receive a response to questions, patients whose medications are managed through Breakwater will have direct access to their DBP, with reasonable limitations. This access proves to be particularly helpful when navigating stimulant shortages. We can often re-send medication to an updated pharmacy within the hour. Because of the high level of access, our medication management panel is limited to patients we have directly evaluated or those referred by community partners, and only after our evaluation determines medication as a likely recommendation. We do not take-over medications written by outside physicians.

Importantly, the increased access of our membership plan, does NOT grant all hours availability for prescription refills. As a general rule, we only refill medications Monday through Thursday and we do not refill stimulant medications on the weekends. If we choose to make an exception, we can not guarantee a specific turnaround time. If on a controlled substance, the child must be seen every 3 months ( at least ), and every other visit can be virtual. Our physicians reserve the right to limit prescriptions to one month, or require in-person visits, to properly evaluate side effects.