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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?

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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.

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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

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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.

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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. 

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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

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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.

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ADHD and Anxiety and highly intertwined, so how can you tease them apart?
Join us as Dr. Jeffrey Strawn shares clinical pearls about how to detect whether a child has ADHD, anxiety, or both! We discuss:

* the consequences of untreated ADHD (especially social and educational impacts)
* how ADHD and anxiety are related  and that 30% of kids w/ ADHD have anxiety, too!

Some take home messages are:

1 – When screening kids for ADHD, also consider using the SCARED-5 to screen them for anxiety!

2 – Good clinical question to ask kids about anxiety

o   “How good are you at worrying?”

o   “What would happen IF (the thing they fear occurred)?”

3 – To distinguish between clinical anxiety disorder and an anxiety trait..

            Ask, is [ the thing they are worried about] reasonable/expected?

            Is the anxiety proportional to the stressor?

Dr. Jeffrey 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.

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What do you do when your patient doesn’t tolerate or doesn’t respond to an SSRI for depression? Join us as we discuss this issue and talk about non-SSRI medication‘s for depression.

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It's time to talk about the mental health impact of *parenting*... and what we can do about it. Join me and our special guest, Ashley, a working mom, as we explore practical tools and exercises to recognize and address signs of BURNOUT.  This episode is for parents AND for all of us who need to take care of ourselves so that we can care for others.  We talk about practical tools like:

** The stress continuum: Are you green, yellow, orange, or red?

** 'What's on your plate' or 'What's on your mind?': Exercises to assess and reprioritize responsibilities. 

*** Self-care that WORKS to recharge mentally and physically:  including social connections, creative expression, and exercise 

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How can you tell if a teenager is depression or if it is just normal moodiness, stress, grief, or even demoralization?  Dr. John Walkup joins us to talk about the cardinal features of depression... and how it LOOKS different than other forms of low mood.
We talk about:
1 - the distinct change in mood seen in teens with depression and how it is different from sadness

2 - how you can use a simple question, "Can you tell me about something fun you have done recently?",  to help you figure out whether a teen has clinical depression

3 - why kids with depression can *think* they have ADHD

Guest: Dr. John Walkup is an internationally-recognized child and adolescent psychiatry and the President Elect of the American Academy of Child and Adolescent Psychiatry.  He is Chair of the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children's Hospital in Chicago. He is also the Margaret C. Osterman Board Designated Professor in Child and Adolescent Psychiatry. 

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As pediatric practices incorporate  more telehealth, what tips and tricks can help us navigate the challenges of virtual healthcare? Pediatrician Dr. Rachel Schare joins us to share the Good, the Bad, and the Funny in the world of Pediatric Telehealth.
We discuss:

Practical strategies for how to incorporate telehealth into busy pediatric practice:

• Focus mainly on follow-up visits for established patients
• ADHD follow-ups are great, sometimes also depression/anxiety 
• Offer same-day telehealth during last minute schedule openings to accomodate patients who call with urgent issues 

Tips to address common telehealth challenges:

• To manage connection issues, allow extra time for visits
• Make sure you have working phone numbers before the visit
• Send multiple reminders (text, email) with the connection link
• Engage kids with virtual stickers, reaction buttons, backgrounds, etc.

How to limit distractions and ensure pt/family safety:

• Clearly communicate your rules for telehealth before the visit
• Set boundaries, remind families of rules during the visit (i.e. no driving during the visit)

Dr. Rachel Schare is a board-certified pediatrician with extensive experience incorporating behavioral health in primary care pediatrics. For the past 4-5 years, she has been practicing telehealth in both urgent care and primary care settings.

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Welcome to Season 2 of PsychEd4Peds!  To start this season, the Academy of PsychEd4Peds shares the winners of the 5 major PsychEd4Peds podcast awards from 2023.
Featured Awards include:
Best Ensemble - * the most popular episode featuring a group of hosts *
Best Short Episode  - * most helpful content in  an episode ~10 minutes *
Super Science Episode - * best episode about highly complex scientific topics made simple and practical*
Host's Choice - * episode that taught the host the most *
People's Choice - * most popular episode with most downloads *

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Any conversations that involve *weight* can be really challenging and require a really thoughtful approach. This week, we chat with Dr. Peggy Greco, pediatric psychologist who specializes in eating disorders,  about how to talk with parents when 

• you're concerned about their child's health and weight OR
•  the parent is *overly* concerned about their child's weight. 

We discuss how to- use the "Yes AND" approach to :
- address parental fears and feelings about their child's weight
- AND shift the conversation from weight to health

We also talk about the importance of
- reflecting on your own experiences with weight, food, eating, etc.
- connecting with a larger team to care for kids with eating disorders, obesity

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Dr. Peggy Greco shares practical tips for navigating challenging conversation with teens who have eating disorders and/or obesity including:

*  How to shift the conversation from WEIGHT to focus instead on HEALTH 
* How to focus on non-weight metrics of health such as:
·       mood

·       energy levels

·       activity levels

·       healthy eating habits

·       clarity of thinking
* How to understand why teens with eating disorders may be resistant to treatment

Dr. Peggy Greco, PhD is a pediatric psychologist with over 30 years of clinical experience. She serves as the Assistant Vice President, and Chief Patient Experience Officer for a large children’s healthcare system. One of her clinical areas of interest is in working with kids and families with eating disorders.

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Dr. Elise Fallucco interviews Dr. Sarah Garwood, a professor of pediatrics who specializes in eating disorders, about screening and managing eating disorders in primary care. They discuss screening tools, medical workup, and practical steps that pediatric clinicians can take to support children with eating disorders.

• Practical tools to  identify kids who are struggling with eating disorders including:
  • growth chart changes
  • SCOFF - 5 question eating disorder screening tool
  • NIAS - 9 item avoidance screener
• what pediatricians can do  to help patients with eating disorders 
  • medical work-up
  • comprehensive labs
  • establish regular eating patterns
• when to hospitalize a child/teen with eating disorders

 Dr. Garwood is a Professor of Pediatrics at Washington University School of Medicine who specializes in eating disorders.  Dr. Garwood’s work through the Adolescent Center in the Department of Pediatrics focuses on the unique health care needs of adolescents.  In August 2017, Dr. Garwood co-founded the Washington University Transgender Center at St Louis Children’s Hospital in order to support comprehensive medical and mental health services for transgender children and young adults.  Advocacy related to this role has included a TEDx Talk in 2019 

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How can we identify kids at risk for eating disorders  in pediatrics? How can we promote healthy relationships with food and with eating?  Our guest, Dr. Jennifer Leah Goetz, a double board-certified psychiatrist specializing in eating disorders, discusses:

·      the variety of eating disorders in kids, 

·      the prevalence, and risk factors for developing an eating disorder

·       how eating disorders come in bodies of all shapes and sizes 

·       questions that pediatric clinicians can ask to see if a child/teen is at risk of developing an eating disorder

·      Positive ways to talk about food with children to mitigate their risk of developing an eating disorder

Jennifer Leah Goetz, MD: is double board certified in general psychiatry and child and adolescent psychiatry. She completed her internship in pediatrics at Massachusetts General Hospital and her general psychiatry and child/adolescent psychiatry training at MGH and McLean. She previously served as medical director of the child and adolescent inpatient unit at Johns Hopkins Hospital and helped run the eating disorder clinical service. She is an attending psychiatrist at McLean hospital and an Instructor in Psychiatry at Harvard Medical School. She specializes in the care and treatment of those with eating disorders. 

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"Help! My preschooler has been kicked out of child-care and no one in our area can evaluate and treat young kids!" When and how should you prescribe medication for preschoolers with emotional and behavioral problems? Dr. Elise Fallucco shares her thoughts and suggestions on evaluating and treating these children. In cases where children have failed or are unable to access parent-child interaction therapy, she walks you through how to diagnose and understand these problems.  In cases of preschool ADHD, she discusses an evidence-based approach to judicial use of methylphenidate and amphetamine salts, and challenges the use of alpha-agonists in this age group. 

Dr. Elise Fallucco is a child psychiatrist, mom, and host of PsychEd4Peds.  She is a Professor of Pediatrics and Child and Adolescent Psychiatry with over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

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 Parenting young children with behavioral outbursts can be very challenging. Dr. Joyce Harrison, early childhood psychiatrist from Kennedy Krieger / Johns Hopkins shares practical parenting tips and referral resources for families of young children.

**What parenting tips could pediatric clinicians share with parents of preschool-aged children?

o   Stay calm

o   Positive instructions; tell what they SHOULD be doing; + instead of “stop”

o   Catch them doing something good/right thing; PRAISE

o   Ignore negative behaviors

o   Consequences in the moment – be consistent, avoid idle threats

o   Child centered time, money in the bank ($) = TIME IN

o   Practice Effective Time outs 

o   Parents need time outs, too

** Any resources that you could recommend for pediatricians to help them take care of preschool-aged kids w/ behavioral problems?

1. Statewide child psychiatry access phone hotlines/ Pediatric mental health case access programs can help you find resources for young children in your area
2. Local AAP chapter may also know about local resources
3. The national AAP offers Early Childhood ECHOs for education
4. The AAP sells their Toolkit for managing BEP in kids younger than 5

About Dr. Joyce Harrison: 

·       Associate Professor of Child and Adolescent Psychiatry at Johns Hopkins University School of Medicine and Faculty at the Kennedy Krieger Institute

·       Previous and first Medical director of Maryland Behavioral Health Integration in Pediatric Primary Care program (CPAP)

·       Project director for Kennedy Krieger Institute’s Early Childhood ECHO programs

·       Co-chair of AACAPs Infant and Preschool Committee

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Temper tantrums can be so frustrating - for the child, the parent, the teacher, and everyone involved!  On episode 20 of PsychEd4Peds, Dr. Joyce Harrison, child and adolescent psychiatrist at Kennedy Krieger Institute/Johns Hopkins, shares with us an "8 S" framework for evaluating kids with temper tantrums. 

Q: What is on the differential diagnosis for a 4 year old with temper tantrums?

A: Thinking alphabetically, 

** A = ADHD, anxiety, and/or autism,

** C= communication difficulties, 

** D = developmental delay/intellectual disability, 

** T=trauma or adverse childhood experiences

Q:  What questions could the pediatrician ask the parent to sort through some of these possible issues?   

A:  It can be helpful to use the "Eight S framework"

§ 1 - Safety first

· Is this child safe?

· Are the people around this child safe? 

· Is this child safe to be treated in the setting that they're in? 

§ 2 - Specific behaviors 

· What is the child doing that makes the parent think something is wrong

· What is the most problematic thing? 

· What are you most concerned about?

§ 3 – Setting

· Where are the behaviors happening? (childcare/preschool, home, out w/ other people)

§ 4 - Scary/trauma 

· Has anything scary happened to this child/family? 

§ 5 - Services!!!!! 

· what kinds of services is the child getting now? (OT, PT, behavioral tx, meds)

§ 6 - Sleep

· How well are they sleeping? Any nightmares?

§ 7 - Social interactions

· Does your child have friends? 

· Does your child get invited to other things?

§ 8 - Speech problems

Dr. Joyce Harrison is an Associate Professor in the Division of Child and Adolescent Psychiatry at Johns Hopkins University School of Medicine. She is also on the Faculty at Kennedy Krieger Institute, a hospital serving children with developmental disabilities.  She is a nationally-recognized educator in early childhood mental health and its integration in primary care. She is the Project director for Kennedy Krieger Institute’s Early Childhood ECHO programs, and  Co-chair of AACAPs national Infant and Preschool Committee.  She served as the founding  Medical director of Maryland Behavioral Health Integration in Pediatric Primary Care program. She is President of the Association for Infant Mental Health, Maryland-DC chapter.

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If you think you may be experiencing burnout, what can you do? To answer this question, Dr. Fallucco discusses strategies to combat healthcare burnout with Dr. Jessi Gold, Chief Wellness Officer at the University of Tennessee Health System. 

 WE discuss:
*  That systemic changes in Healthcare are urgently needed to reduce burnout.
*  Individual strategies to address burnout in the current healthcare system including:
----- practicing self-reflection -  and asking, "How Do *I* feel?" and "How is my job affecting my health?"  
-----practicing self-compassion and gratitude, which can help counterbalance the natural tendency for our brain to focus on negative things and threats, 
---  We discuss the “Three Good Things” exercise which  can help reduce burnout and increase well-being. Three Good Things and other free tools are available at the Duke Center for Healthcare Safety and Quality online at: https://hsq.dukehealth.org/tools/ 

Dr. Jessi Gold is an Associate Professor of Psychiatry at UT Health Science Center. Dr. Gold is not only a psychiatrist, but she is a mental health advocate and fantastic writer whose work has appeared in the New York Times, The Atlantic, InStyle, Slate, and Self. 

https://www.drjessigold.com/
@drjessigold

Dr. Gold's new memoir is called
 How Do You Feel? One Doctor's Search for Humanity in Medicine available on Amazon at
https://www.amazon.com/exec/obidos/ASIN/1982199776?tag=simonsayscom

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Can we use information from our DNA to predict which medication will work for each of us? In this episode, Dr. Elise Fallucco talks about the latest information about pharmacogenetic testing and personalized medicine, and how they can (or cannot) be useful for treating ADHD, anxiety, and depressive disorders. She shares when and how pharmacogenetic testing can be useful.  In addition, she introduces Sequence2script, an online tool to help translate pharmacogenetic test results into clinical prescription recommendations. 

Dr. Elise Fallucco is a child psychiatrist, mom, and host of PsychEd4Peds.  She is a Professor of Pediatrics and Child and Adolescent Psychiatry with over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

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How can we address family concerns about ADHD medications? What can we do to minimize and/or manage potential side effects? Join me as we discuss: 

1-  How to Address Common Parental concerns about meds for ADHD

o   Will his turn my kid into a Zombie? Mood changes? – stop if you notice these

o   Are they addictive? – No.

o   Potential for diversion of meds

 2 -    The risks of untreated ADHD

 3 - How to manage common ADHD medication side effects

·      Nausea, abdom pain, decreased appetite – take w/ a meal, calorie boost after med wears off

·      mild headaches

·      rebound hyperactivity, irritability – non-medication vs. medication approaches

·      sleep

·      cardiovascular effects

Dr. Elise Fallucco is a child psychiatrist, mom, and host of PsychEd4Peds.  She is a Professor of Pediatrics and Child and Adolescent Psychiatry with over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

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Which med do you choose for ADHD? What do you do if the first med doesn't work? Join me as we review a step-wise approach for prescribing meds for ADHD.

Key points:
*Stimulants are first-line treatment for ADHD

Step 1: Choose which “class/type” of stimulant to start

Step 2: Decide whether short or long-acting

Three types of stimulants in my order of preference:

1.     MPH – my fave b/c fewer mood side effects

2.     Amphetamine salts – great also

3.     Focalin IR/XR – for those who don’t tolerate one of the other ones above

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Join me as I share some tips for how to evaluate kids for ADHD.  We will 

• review a clinical case of a 9 yo boy with behavior problems
• go through the differential diagnosis
•  share tools used in the evaluation
•  discuss how to talk to parents about a diagnosis of ADHD
• and how to explain to kids what it means to have ADHD

Dr. Elise Fallucco is a child psychiatrist, mom, and host of PsychEd4Peds.  She is a Professor of Pediatrics and Child and Adolescent Psychiatry with  over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

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How do you ask kids about suicidality in a way that helps them feel comfortable enough to talk about it? And how do you tell unsuspecting parents that their child is suicidal? We provide a framework and some tips for approaching these challenging and important conversations with families. 

 Along the way, we talk about the importance of

·      Normalizing

·      Doing “Vibe Checks”

·      Offering hope

 Dr. Brian Kurtz is a child and adolescent psychiatrist and Director of the Child and Adolescent Psychiatry Residency Training Program at Cincinnati Children’s hospital.  He serves on the Pediatric Behavioral Health Clinical Advisory Panel for Ohio Minds Matter. He helped to develop educational materials for the Ohio Minds Matter website on multiple topics, including youth suicide risk assessment. 

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 The AAP/Bright Futures recommend screening all kids 12 years and older for suicide risk.  Realistically, how do you incorporate another screening tool into your practice? Join us as we learn from Dr. Alisa Minkin,  a primary care pediatrician  who has spearheaded an effort to integrate screening for suicide risk in her large network of  practices in the New York metropolitan area.  We discuss:

*If you are already screening for depression with the PHQ9/A, do you really need a separate screener for suicide risk? (YES!)

*What is an efficient, fast, effective way to screen for suicide risk?

·      The Ask Suicide Screening Questionnaire (ASQ) - a 5 yes/no question tool

*How do you handle positive ASQ screens?

·      The ASQ toolkit provides follow-up questions to ask

*At which visits do you screen for suicide?

·      Well-visits for kids 11 years and older

·      Mental health “sick” visits

*What additional resources can help pediatricians in helping kids with suicidal thoughts?

·      Consider hiring a social worker to help with mental health referrals 

·      Call your state’s child psychiatry access program hotline to consult with a social workers and/or child psychiatrist

Alisa Minkin, MD is a primary care pediatrician from Oceanside, New York, and a mental health champion.  She is  the host of the JOWMA podcast which shares preventative health information geared to members of the Orthodox Jewish community.

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Youth suicide is the second leading cause of death in children, teens, and young adults in the US.   Yet, there are so many things we can do to try to prevent morbidity and mortality.  Dr. Brian Kurtz, child and adolescent psychiatrist and medical educator extraordinaire at Cincinnati Children’s hospital, joins me to discuss how pediatricians can help prevent suicide.

**What increases risk for youth suicide?

•  Previous suicide attempt
•  Non-suicidal self-injury
•  Mental health problems (*including ones you would not necessarily associate with suicide, like ADHD)      
• Family history of death by suicide, suicide attempts
• History of TRAUMA

** How pediatricians can reduce risk for suicide

** The importance of helping kids and teens feel a sense of belonging and connection 

Dr. Brian Kurtz is a child and adolescent psychiatrist and Director of the Child and Adolescent Psychiatry Residency Training Program at Cincinnati Children’s hospital.  He serves on the Pediatric Behavioral Health Clinical Advisory Panel for Ohio MInds Matter. He helped to develop educational materials for the Ohio Minds Matter website on multiple topics, including youth suicide risk assessment. 

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Interviewing kids with traumatic stress can be very challenging .  Join me as I walk through a clinical case to review how to approach these challenging conversations with kids.
 
 We will cover:
 ** "red flags" indicating that a child might have traumatic stress 

** the differential diagnosis for a child with "temper tantrums" or "outbursts" 
 ** how to use the PTSD screener in clinical practice

** how to talk to kids about trauma
 ** how to find trauma-focused CBT in your community

Dr. Elise Fallucco, child psychiatrist, mom, and host of PsychEd4Peds, specializes in adolescent depression and suicidality.  She is a Professor of Pediatric and Child and Adolescent Psychiatry with  over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

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Did you know that 10% of kids in primary care are suffering from post-traumatic stress? We talk with Dr. Brooks Keeshin, child abuse pediatrician and child psychiatrist, about how to use the Pediatric Traumatic Stress Screening Tool to recognize the signs of PTSD, intervene and get kids the help they need.

Key points include:
1. Some kids with PTSD can seem like they are doing fine
2. PTSD  symptoms can be confused with ADHD, anxiety, and/or depression
3. Screen all kids 11 years and older using the Pediatric Traumatic Stress Screening Tool
4. Assess all kids with a positive screen for safety
5. Refer kids with PTSD to Trauma-focused CBT
6.  Try to address 1 impairing symptoms (usually sleep) at the visit

To access the Pediatric Traumatic Stress Screening Tool, visit https://utahpips.org/cpm/

Our guest: Brooks Keeshin, M.D., is a child abuse pediatrician and child psychiatrist in the Division of Child Protection and Family Health at the University of Utah and the Center for Safe and Healthy Families at Intermountain Healthcare’s Primary Children’s Hospital.

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How do primary care pediatricians take care of the growing volume of mental health problems in the setting of a busy private practice? Drs. Wendy Sapolsky, Kim DalPorto and Chanley Dudley, pediatric mental health champions in their large pediatric primary care private practice, Carithers Pediatric Group, share Time-saving Tips for managing the challenges of limited time, and increased volume and complexity of child mental health problems in this episode.  Tips include:  
** 1 - Use screening tools at well-visits and for symptomatic patients
** 2 -Invest in time-saving dictation software for notes
** 3 - When charting, include measurable behavioral outcomes 
** 4 - See complex pts before lunch, at end of the day or schedule a separate appt
** 5 - Monitor your burnout
** 6 – Take advantage of telehealth
** 7 – Check in w/ families in between appts via phone calls/patient portal
** 8 – Develop a relationship w/ a child psychiatrist
** 9 –  Medical Education!
** 10 - Know your community MH resources

Dr. Wendy Sapolsky, MD, FAAP has been in practice for 28 years at Carithers Pediatric Group. She received her medical degree from the University of South Florida College of Medicine, completed her pediatric residency at Wake Forest University/Bowman Gray School of Medicine. Her professional interests include ADHD, adolescents, and weight management.

Kim DalPorto MD, FAAP has been in practice for 28 years at Carithers Pediatric Group. She received her medical degree from the University of South Florida College of Medicine,  completed her pediatric residency at the University of Alabama at Birmingham. In addition to her work in the US, she is involved with global missions and helped to launch a permanent primary care medical clinic in Uganda, associated with Okoa Refuge.

Chanley Dudley, MD has been in practice for 10 years at Carithers Pediatric Group.  She received her medical degree from the University of Florida College of Medicine. She completed her pediatric residency at  Harvard /Massachusetts General Hospital in Boston. She has a special interest in children and adolescents with complex medical or social situations and in those who struggle with speech/language disorders and other learning differences.

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HALF of all healthcare workers are Burned Out.  But most of us typically power through without recognizing the classic signs.  How can you tell when you're going through burnout? And more importantly, what is it about the culture of medicine and healthcare that increases our risk of experiencing burnout? 
To help us sort through these issues and RECOGNIZE signs of burnout, we talk with Dr. Jessi Gold, Psychiatrist and Chief Wellness Officer of the University of Tennessee Health System.  She is the author of a memoir called How Do You Feel? One Doctor's Search for Humanity in Medicine.  This book highlights her experience taking care of healthcare workers during the pandemic, and  emphasizes the *emotional toll that it is involved when we're taking care of others*. 

** What are the signs of burnout?

** Why is it so hard to recognize burnout?

** How can we start to notice when we are going down the path of burnout?

Dr. Jessi Gold is an Associate Professor of Psychiatry at UT Health Science Center. Dr. Gold is not only a psychiatrist, but she is a mental health advocate and fantastic writer whose work has appeared in the New York Times, The Atlantic, InStyle, Slate, and Self. 

https://www.drjessigold.com/

Her new memoir is called
 How Do You Feel? One Doctor's Search for Humanity in Medicine available on Amazon at
https://www.amazon.com/exec/obidos/ASIN/1982199776?tag=simonsayscom

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How do you choose which SSRI to start for child/teen depression? Dr. Elise Fallucco and Dr. Michaela Denison discuss the 3 SSRIs w/ best evidence for depression treatment in kids and teens :

o   Fluoxetine (Prozac)= FDA-approved for depression 8 yo+, activating, long half-life;  Good for kids with fatigue, low motivation

o   Sertraline (Zoloft)=  Works quickly, dose at night to help with sleep; Good for kids w/ initial insomnia

o   Escitalopram (Lexapro)=  FDA-approved for depression 12 yo+,weight gain; Response/side effects moderated by cytochrome p450 2C19 phenotype

** Potential challenges in treating depression

***3 questions to ask kids at follow-up on antidepressant meds

1 – Compliance: (and what time of day are yout taking it?)

2 – Benefit: have you noticed improvement in mood, sleep, energy, motivation?

3 – Side effects: activation, sleep problems, HA, GI side effects ?

***We also talk about our Magic SSRI dosing card to help pediatric clinicians treat DEPRESSION AND/or ANXIETY-       available our website Psyched4Peds.com 

Dr. Elise Fallucco, child psychiatrist, mom, and host of PsychEd4Peds, specializes in adolescent depression and suicidality.  She brings over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

Dr. Michaela Denison, child psychiatrist, mom, and co-host of this episode of PsychEd4Peds,  is the founding Director of the Lockbag program to prevent youth overdoses at the University of Florida College of Medicine - Jacksonville. (UF-Jax) She also serves as the Associate Program Director for the child and adolescent psychiatry fellowship at UF-Jax.

Follow us on Instagram @psyched4peds or visit our website at Psyched4Peds.com 

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How can you tell if a teen has depression? Dr. Elise Fallucco and Dr. Michaela Denison discuss how depression is a hidden illness, and how you can use a 3-step approach to diagnose depression and suicide risk.

o   What every pediatrician needs to know about depression  – 
   *** 1 in 7 teens have experienced depression
   ***1 in 5 teens have seriously considered suicide

o   The Importance of screening kids 12+ for depression

o   Dr. Fallucco's 3 Step Approach to assessing a teen with a positive depression screen
------  Step 1: Assess for depressive symptoms, timing, context
------  Step 2: Consider differential diagnosis (medical causes, meds/drugs, anxiety, trauma, bipolar, psychosis)
------    Step 3: Safety

o   Suicidal thoughts alone do not require an ED visit

o   Any red flags: suicide plan, attempt, intent require emergency evaluation

Dr. Elise Fallucco, child psychiatrist, mom, and host of PsychEd4Peds, specializes in adolescent depression and suicidality.  She brings over 14 years experience in training pediatric clinicians to identify and treat mental health problems.

Dr. Michaela Denison, child psychiatrist, mom, and co-host of this episode of PsychEd4Peds,  is the founding Director of the Lockbag program to prevent youth overdoses at the University of Florida College of Medicine - Jacksonville. (UF-Jax) She also serves as the Associate Program Director for the child and adolescent psychiatry fellowship at UF-Jax.

Follow us on Instagram @psyched4peds or visit our website at Psyched4Peds.com 

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 What causes autism? Why are there so many more boys than girls with autism? And why is it so important to make sure that children with autism have genetic testing? 
 We discuss this with our guest, Dr. John N. Constantino, child and adolescent psychiatrist and international expert in Autism Spectrum Disorder.

* Boys tend to be more sensitive than girls to genetic risk for autism.

*GENES CAUSE AUTISM
 ** 3/4 of the genetic risk is inherited 
  ---- mainly polygenic risk, which means it requires multiple different gene hits to be involved
----- also  rarely some chromosomal rearrangements
**1/4 of genetic risk is NOT inherited
---- due to  de novo or germline mutations:  DNA changes in the sperm or the egg that makes the baby, that are NOT present in the parents, but are just in the child. 

** It's so important to follow the American College of Medical Genetics recommendations and get genetic testing for our kids with known diagnosis of autism so that we can better understand what caused their form of autism. 

About Dr. John Constantino: His research focuses on understanding genetic and environmental influences on autism spectrum disorder and their implications for treatment and prevention. He developed a well-validated, normed instrument to assess impairments in social-communication skills called the Social Responsiveness Scale (SRS-2). He currently serves as Chief of Behavioral and Mental Health at Children’s Hospital of Atlanta. He has been recognized for his work by numerous awards including the prestigious George Tarjan Award from the American Academy of Child and Adolescent Psychiatry for significant contributions  to the understanding and care of those with developmental disabilities.

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*What if you could identify and diagnose autism in primary care, without having to wait years for children to be seen by a specialty autism center? 
 We discuss this with our guest, Dr. John N. Constantino, a world-renowned child and adolescent psychiatrist who specializes in Autism Spectrum Disorder who has done pioneering work in helping pediatric primary care clinicians distinguish between autism and other conditions.

How/can pediatric clinicians distinguish between autism and other conditions??

 Clinical tips to help pediatric clinicians confirm/make a diagnosis of Autism! 

3 anchors for Diagnostic Assessment of Autism

o   1 – Is the Developmental history c/w autism?

o   2 – Do the child’s symptoms exceed threshold (based on rating scales)?

·         Modified Checklist for Autism (M-CHAT; 16-30 months) or more comprehensive scales like..

·         Social Responsiveness Scale (SRS; 30 months – through adulthood)      

·        Social Communication Questionnaire (SCQ; for kids 4 years and older)

o   3 – Clinical observation by pediatric clinicians

·         Use the Childhood Autism Rating Scale (CARS and CARS-2)

·        quick (15 min), easy to learn, can differentiate autism from other illnesses ADHD, anxiety, psychosis, etc.

Differential diagnosis for 24 month old who is not talking (autism, Specific language impairment, Hearing impairment, Intellectual disability)
 
 About Dr. John Constantino: His research focuses on understanding genetic and environmental influences on autism spectrum disorder and their implications for treatment and prevention. He developed a well-validated, normed instrument to assess impairments in social-communication skills called the Social Responsiveness Scale (SRS-2). He currently serves as Chief of Behavioral and Mental Health at Children’s Hospital of Atlanta. He has been recognized for his work by numerous awards including the prestigious George Tarjan Award from the American Academy of Child and Adolescent Psychiatry for significant contributions  to the understanding and care of those with developmental disabilities.

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When you want to learn about medication treatment for anxiety, who could be better to ask than an international expert on anxiety psychopharmacology, Dr. John Walkup?
In this episode, we learn about the "sharper, sparkly" medication that Dr. Walkup loves along with

•  which medications work best for which kids and teens
• how to safely prescribe SSRIs for anxiety
• how to identify and manage common SSRI side effects
• how to support families who want to try therapy alone first? 

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What if we could tell who was at risk for developing anxiety, and take action to help parents PREVENT or minimize anxiety in their child?  Dr. John Walkup, international expert on anxiety in kids and teens, shares his wisdom about ways that pediatric clinicians can :
-   identify kids at risk for anxiety
-   help parents prevent/minimize anxiety in their child
-   determine when anxiety becomes a disorder
-   use personalized screening for anxiety in practice

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In this episode, we continue our conversation with pediatric psychologist extraordinaire, Peggy Greco, PhD about practical Interventions to help kids with anxiety

• Ways to make the home environment more consistent, predictable
•  Strategies that kids, teens can practice to reduce their anxiety
• Online/Apps for anxiety that can be used with little kids, teens, and even parents

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We talked with pediatric psychologist extraordinaire, Peggy Greco, PhD about how to better understand and identify anxiety in kids.

• Signs of anxiety in kids
• How parents describe kids with anxiety, and why it is hard for parents to know what is ”normal”
•  How do you know when you cross-over from normal anxiety to an anxiety problem?
• ·      USPSTF recommends screening for anxiety in ALL kids 8-18 yo
•  Practical ways to screen for anxiety 
  • The free Screen for Child Anxiety Related Disorders (SCARED) 
  • The Brief Early Childhood Screening Assessment (ECSA)

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What is PsychEd4Peds all about? 

• Dr. Elise Fallucco is a child psychiatrist and mom of 3 who trains and supports pediatric clinicians in child mental health care
• She interviews other experts to share practical tools, tips, resources, and strategies to help pediatric clinicians take care of kids and teens with mental health problems

Check out our website PsychEd4Peds.com for more resources.
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Join us as we wrap up our first year of PsychEd4Peds and prepare for a summer break!

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Do you ever wish you had a child psychiatrist on speed dial? Well, now you can!  This week, we talk about how to get connected to a Pediatric Mental Health Care Access Program (PMHCAP) near you that offers:
* phone consultation with child psychiatrists to help you care for kids in your office
* care navigation services to help you find resources
I will walk you through what to expect when you call your local PMHCAP and how they can be helpful for you and for your patients.

For a list of statewide PMHCAPs near you, check out:
https://mchb.hrsa.gov/programs-impact/programs/pmhca-awardee-teleconsultation-phone-lines

Link also available on our website, PsychEd4Peds.com

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In this episode, meet Dr. Lia Gaggino, pediatrician and host of the child mental health and clinician well-being podcast, Pediatric Meltdown.  She shares resources and tips to help practicing pediatricians including her now podcast, Pediatric Mental Health: Building Better Workflows.  This new podcast is about how to implement change in pediatric practices from how to get buy-in for change, set goals, and engage your team in implementing  change, plus tips on billing and coding and more.

Dr. Lia Gaggino's Podcast: Pediatric Meltdown
Website: Pediatricmeltdown.com

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In honor of the release of Taylor Swift’s 11th album, The Tortured Poet's Department, this is a special episode where I am joined by my tween daughter Julia, to share highlights from Swift's albums as well as from PsychEd4Peds episodes.  I bet you never thought about how the album, Red, is related to ADHD meds. 

#childmentalhealth #swiftie #tsttpd #adhd #anxiety #parentmentalhealth

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Between 80-90% of US teens report that they use social media, but we are only beginning to understand how social media use affects mental health.  I had the opportunity to talk about this with WAVYTV10 News Anchor, Sarah Goode. In this episode, I share clips from our conversation about how to help kids navigate social media, share tips for talking with teens about their social media use, and share resources to help families develop a plan for healthy use of social media.

For more information and to listen to an extended version of this interview, check out the NBC Affiliate, WAVYTV10 at the link below:

https://www.wavy.com/10-on-your-side/kids-on-social-media-what-to-know-about-their-mental-health/

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Do you have patients with severe ADHD who are just not getting better?  Did you know that they *might* have undiagnosed bipolar?  

In this episode, Dr. Fallucco and Dr. John Walkup talk about how to distinguish bipolar disorder in children and teens from ADHD. They provide clinical pearls for clinicians and share examples from kids and teens with bipolar.  

Some Key differences between ADHD and BIPOLAR highlighted include :

- the nature of relationships in ADHD vs. BIPOLAR

• Kids w/ ADHD tend to be fun, likable while kids with BIPOLAR have more serious problems in relationships, including with their own parents

-  extreme impulsivity

• Kids and teens with Bipolar have more extreme, intense impulsive aggression and emotional reactions

** Early identification and consultation with psychiatry is key to helping support these kids and families best.**

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