Child Mental Health for Pediatric Clinicians

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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

Check out our website PsychEd4Peds.com for more resources.
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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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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.

Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds

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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 1⁄2 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.
Follow us on Instagram @psyched4peds

Send us a text

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.

Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds