Child Mental Health for Pediatric Clinicians – Details, episodes & analysis

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Welcome to our new segment called Mystery Case Files where we walk through a clinical case that presents a bit of mystery. Using the latest research and evidence, we discuss practical approaches to help YOU care for your patients effectively.

This episode features the case of a nine-year-old boy with anxiety who develops new onset of behavior problems. 

00:00 Introduction to Mystery Case Files

00:27 Today's Mystery case

00:27 Presenting the Case: A 9-Year-Old with Anxiety

00:54 Initial Thoughts and Differential Diagnosis

01:32 Reviewing the Patient's History

02:04 Choosing the Right Medication for Anxiety

02:10 What is the best medication for anxiety?

03:34 Four Weeks Later: Follow-Up Visit

03:58 Analyzing New Symptoms and Possible Causes

05:01 Is the anxiety medication making him worse?

05:26 Exploring ADHD and Medication Side Effects

07:09 Understanding Activation Syndrome

08:45 Pharmacokinetics and Genetic Factors

10:25 Solving the Mystery and Next Steps

11:02 Conclusion and Call to Action

Visit us on our website or message us with YOUR MYSTERY CASE that we can discuss!

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In this episode of Psyched for Peds, Dr. Elise Fallucco and her teenage son, Chase Fallucco, discuss the seasonal surge of mental health symptoms, termed the 'emotional flu,' impacting teenagers during October and November.  They discuss:

** What are the symptoms and signs of the emotional flu?

** Why are October and November high-risk periods for the Emotional Flu?

** What can we do to "vaccinate" teens against the Emotional Flu?

Check out our website PsychEd4Peds.com for more resources.
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Did you know that PARENTS of preschoolers are at HIGH risk for depression? 
*In the first 4 years of a child's life, 1 in 10 dads and 1 in 4 moms experience depression.*
And depression in parents increased the risk of behavioral and emotional problems in children.  In this episode, we talk about why and how to support parents of preschoolers... so that we can help preschoolers with their own social and emotional development.

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Around one and 10 preschool age, children, struggle with significant emotional and behavior problems, but it can be incredibly difficult to tell. How can you tell When a preschool age child might need further evaluation?
In this episode, we talk about how to use a brief tool to determine whether a preschools behavior is normal, or may benefit from further evaluation. This tool is called the brief early childhood screening assessment, or the brief ECSA  for short.

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What is the most important thing the parents can do to help older teen athletes? How can we harness sports another activities to help kids develop true confidence? For answers to these questions join us as we continue our convo with grit.org’s  Brian and Jen Harbin.

Guests: Brian and Jen Harbin are the leaders of grit.org whose mission is to improve, physical, mental, and emotional resilience in kids.

Check out our website PsychEd4Peds.com for more resources.
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Do you want to learn strategies to help kids develop grit and character through sports and LIFE? We talk with Brian and Jen Harbin of Grit.org about how they use sports to help kids become more physically, emotionally, and mentally resilient. They share strategies about :
** Using mantras to help kids push through challenges
** How to shift your focus from WINNING to personal growth
**  Training kids to focus on the POSITIVE


Our Guests: Brian Harbin is the founder of Grit.org whose mission is to help kids and adults become mentally, physically, and emotionally resilient.  Jen Harbin is a former 5-year collegiate rower and helps to lead Grit Camp as well as Grit.org's non-profit foundation called Faith, hope, and Lunges. They are the proud parents of 3 boys .

Website: Grit.org

Check out our website PsychEd4Peds.com for more resources.
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If you play sports or know a child who plays sports, you MUST listen to this podcast!  
Our guest is Coach Peter Verhoef, who has decades of experience preparing kids and teens for national and world competitions.  We discuss ways that parents can keep kids involved in sports and prevent burnout.  Key Points include:
** Sports can be Transformational  

** Tips for How WE can Keep kids ENGAGED in Sports

·      Help children to experience achievement (apart from wins/losses)

·      Recognize and manage emotional/physical exhaustion

 ** Crying in Waffles: The Hardest time for a Student Athlete

** Benefits and Risks of taking time off from sports

** When/If to Specialize in One sports vs. playing multiple sports

Coach  Peter Verhoef is the head coach and aquatics director at the Bolles School Swimming Program. He coaches athletes to regional, national,  and world competitions, including the Olympics over his career, which has spanned decades.

Coach Peter himself is a former youth athlete, having been a finalist at the Olympic swimming trials in 2004 and 2008. He has competed at the world level and was USA team captain representing the United States at the world championships of swimming.

Check out our website PsychEd4Peds.com for more resources.
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Did you know almost 70% of kids drop out of sports by age 13?  We talk with Dr. Joel Brenner,  pediatric sports medicine physician and national expert in youth sports, about how to keep kids involved in sports.  Dr. Brenner is the co-author of the  American Academy of Pediatrics' recent Clinical Report on on overuse injuries over-training and burnout in young athletes. He shares practical strategies to  reduce burnout and over use injuries in our young athletes. Most importantly, we're going to find out how early is too early for kids to specialize in one sport. 

Our Guest:  Dr. Brenner is a pediatric sports medicine physician and Director of the Sports medicine, Sports concussion, and Dance medicine programs at Children's Hospital of the King's daughters in Norfolk, Virginia. 

Check out our website PsychEd4Peds.com for more resources.
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It's time for some Advanced Q+A with Dr. Jeffrey Strawn about medication treatment for ADHD +/- Anxiety!

?Q:? When do you use alpha agonists (like Clonidine, Guanfacine)??
A:  as adjunctive treatment for kids who are having trouble tolerating stimulants,  and/or who have residual impulsivity when they're being treated with stimulants. 

Q: How can you prescribe alpha-agonists to kids who cannot swallow pills?
A: We've talked about the possibility of using compounding pharmacies to help create liquid formulations of certain short acting alpha agonists for kids who have trouble swallowing pills.

Q: When/ would you *start* treatment for ADHD with an alpha-agonist?
A: Almost Never.  Start with stimulant medication when you're considering medication treatment for ADHD, regardless of how old the child is.   So for preschool aged children with ADHD for whom you're considering medication treatment, start with stimulant medication as opposed to non-stimulant medication. 

Side note: Atomoxetine or Straterra is not as effective as first-line treatments for ADHD, nor is it as effective as our first-line treatments for anxiety.

And finally we covered the amazing resource of Case Studies: Stahl's Essential Psychopharmacology: Volume 4: Children and Adolescents by Jeffrey R. Strawn and Stephen M. Stahl | Nov 9, 2023 available on Amazon and through Cambridge University Press

Check out our website PsychEd4Peds.com for more resources.
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Is there a go-to medication to treat a child with both ADHD and anxiety?  Join us as we continue the conversation with Dr. Jeffrey Strawn from Cincinnati Children's Medical Center to discuss how to approach medication treatment for a child with ADHD and anxiety.  

We talk about which stimulants are better tolerated, when to use alpha 2 agonists (like clonidine and guanfacine), and finally what to know about the norepinephrine reuptake inhibitors, Viloxazine (Qelbree) and atomoxetine (Strattera). 

Key Points:

1 – treat ADHD first, then address residual anxiety (unless anxiety is Severe)

2 – When treating ADHD, start with stimulants;  Methylphenidate (MPH) stimulants are less likely to cause mood/anxiety sxs than mixed-amphetamine salts; MPH stimulants also have  ½ incidence of appetite suppression relative to the mixed-amphetamine salts

3 – When to use alpha 2-agonists

o   Clonidine is “a little messier” – hits multiple receptors (alpha 2a, 2b, 2c; hits imidazoline receptor), more likely to affect BP, sedation; best for problems initiating sleep 

o   Guanfacine – “much more selective for alpha 2 A receptor”,

o   Guanfacine XR can be dosed once daily (vs. clonidine xr which is still BID) 

o   Dosing and titration of Guanfacine XR stay below 6mg, 0.1 mg/kg/day

o   Guanfacine XR considered as adjunctive med in addition to SSRI for anxiety

o   Good to help w/ impulsivity

4 – Viloxazine/Qelbree (NRI) “what’s hype vs. what’s clinically relevant pharmacology?”

o   Works more rapidly than atomoxetine: Even within first couple of weeks, noticing improvement in symptoms

o   Little 2D6 metabolism, but not affected by 2D6 metabolizer status like atomoxetine (did you know fda recommends different dosing/titration based on metabolizer status in atomoxetine)

o   Potent CYP 1A2 inhibitor (which metabolizes caffeine/energy drinks)  increase caffeine exposure (blood level over time) six fold 

** ADR2A genetic polymorphism means 2/3 people do NOT experience anxiety when they consume caffeine

Dr. Jeff Strawn is a Professor of Psychiatry and Behavioral Neuroscience at the University of Cincinnati College of Medicine.  Dr. Strawn directs the Anxiety Disorders Research Program and conducts clinical trials and neuroimaging studies in patients with anxiety and related disorders.  He is an internationally recognized expert int he field of child and adolescent anxiety disorders.

Check out our website PsychEd4Peds.com for more resources.
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