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Would you be surprised to learn that there has been a MAJOR INCREASE in child mental health visits in primary care?  A recent study published in JAMA Network Open found clinically significant increases in child mental health visits over a 10-year period.  While ADHD remained the most common MH concern, ANXIETY visits rose by 300% from 2014-2023. 

We know that it can be challenging and sometimes nearly impossible to connect these children and families with specialty child mental health care.  AND we know that families often PREFER to receive care from their trusted pediatric clinician in the comfort of their medical home.  

To support YOU and other pediatric clinicians, we are excited to announce the launch of our new Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

Available online at:

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

This on-demand, AUDIO-BASED course features 5 mini-modules on:

• ADHD Evaluation Essentials
• ADHD Differential Diagnosis: Recognizing Comorbidities and Look-Alikes (Anxiety, Traumatic Stress, mood disorders like BIPOLAR)
• ADHD TREATMENT: Stepwise approach to treatment with stimulants, managing side effects, addressing common parental concerns
• ADHD with ANXIETY TREATMENT: Which to treat first? Algorithmic approach to choosing medications, including stimulants and non-stimulant medications (alpha-agonists, norepinephrine reuptake inhibitors)
• Advanced ADHD Treatment: What to do when meds stop working

In addition, we have downloadable clinical tools, patient handouts, clinical pearls that you can use the next day in your office! We hope you check out the course and share it with a friend!

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

Study: Pediatric Primary Care Visits with Mental Health Needs by Dr. Gallagher KM et al available online at: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2849123

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WEBSITE: PsychEd4Peds.com for more resources!

SOCIAL: Instagram or threads @psyched4peds

On-demand CME Course online at:

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

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Dr. Elise Fallucco reviews five practice-changing lessons from the previous season of Child Mental Health for Pediatric Clinicians: 

• 1 - Ask better questions 
  • For example, use Dr. Waxmonsky’s ADHD assessment prompt, “When is the hardest time of day, and what is going on there?” to guide ADHD medication choice
• 2 - Look for the problem behind the problem 
  • Ask teens about energy drinks/caffeine and sleep timing, recognizing energy drink use may signal sleep deprivation; 
• 3 - Update how we talk to families about stimulants 
  • Emphasize that stimulants support wakefulness, alertness, and motivation rather than directly improving attention (based on Dr. Nico Dosenbach’s Cell study)
• 4 - Remember the brain prefers gradual change
  • Review Dr. Jeff Strawn’s SSRI cross-titration approach while monitoring serotonergic side effects; 
• 5 -  Prioritize clinician wellbeing!

00:00 Season Lessons Overview

00:19 Ask Better ADHD Questions

01:07 Energy Drinks and Sleep Clues

02:37 What Stimulants Really Do

03:54 Brain Prefers Gradual Med Changes

04:29 Cross Titration SSRI Switching

06:41 Clinician Wellbeing Matters

07:26 Thanks and Stay Connected

Links to Episodes Referenced:

69. How to Switch SSRIS with Dr. Jeffrey Strawn

71. ADHD stimulants do NOT impact the brain’s attention networks with Dr. Nico Dosenbach

74. Burnout in Healthcare: “The Pitt”, Stats, and Solutions!

75. Beyond the Buzz: Energy Drinks, Teen Health, and Safer Ways to Stay Energized with Roshni Patel

Sign-up for our NEWSLETTER: https://child-mental-health-for-pediatric-clinicians.kit.com/3bf4aeedfc

WEBSITE: PsychEd4Peds.com for more resources!

SOCIAL: Instagram or threads @psyched4peds

On-demand CME Course online at:

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

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Highly caffeinated energy drinks are taking the teenage world by storm! While the AAP (Peds) says that these beverages are NOT safe, a growing number of kids and teens use them.  To help us learn the latest about the health risks, join this conversation with Registered Dietitian, Roshni Patel! We talk about:

• What is really INSIDE these eye-catching, bright, metallic cans?
  • Hint: potentially toxic amounts of caffeine plus sugar  
• What are risks for teens?
• What are HEALTHY but practical alternatives for our sleep-deprived, overstretched teens? 
  
  

Roshni Patel, MS, RD works at the Mayo Clinic in Jacksonville, Florida in the Division of Obesity Medicine.

Sign-up for our NEWSLETTER: https://child-mental-health-for-pediatric-clinicians.kit.com/3bf4aeedfc

WEBSITE: PsychEd4Peds.com for more resources!

SOCIAL: Instagram or threads @psyched4peds

On-demand CME Course online at:

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

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Let's talk about clinician wellbeing and burnout...

In this episode, Dr. Elise Fallucco shares results from the recent AMA national survey about physician and APP burnout, and then shifts to talk about the portrayal of burnout and boundaries in a scene from HBO's "The Pitt".  

She shared resources to address SYSTEMIC issues that contribute to burnout -

• The  AMA's “Saving Time Playbook” found at:  
• https://www.ama-assn.org/practice-management/sustainability/saving-time-playbook

Finally, we talk about a  simple, grounding exercise

• Pay attention to - 3 things you can see, 3 things you can hear, and 3 things you can feel... to reset during stressful moments.

Sign-up for our NEWSLETTER: https://child-mental-health-for-pediatric-clinicians.kit.com/3bf4aeedfc

WEBSITE: PsychEd4Peds.com for more resources!

SOCIAL: Instagram or threads @psyched4peds

On-demand CME Course online at:

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

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Three Clinical Pearls for Evaluating and Treating ADHD 

Dr. Elise Fallucco chats with Dr. James Waxmonsky (Chair of Child Psychiatry at Penn State) about practical strategies to evaluate and treat children and teens with ADHD.

 Clinical Pearl #1 - Ask Patients about their biggest Challenge and define their Goals, Set Relevant Finish Lines

• Dr. Waxmonsky emphasizes starting with family- and patient-defined functional goals rather than symptom scores, 
• Keep in Mind: stimulant sensations like alertness or “academic confidence” can fade with physiologic tolerance and may not reflect real-world improvement. 

Clinical Pearl #2 - Ask about the hardest time of the day

• Ask about the family WHEN is the hardest time-of-day and WHAT is the specific problem (e.g., meds may help careless errors and pacing more than organization). 

 Clinical Pearl #3 Ask about Drift Time

• He also recommends measuring “drift time” by asking how many minutes of a class period the student is on task

00:00 73. 3 ADHD Tips with Dr. James Waxmonsky

01:00 TIP #1 - Ask Patients about their biggest Challenge and define their Goals, Set Relevant Finish Lines

03:07 Measuring Evidence of Real Focus and Motivation

06:22 TIP#2 - Ask about the hardest time of the day

08:37 Need Branded Concerta not generic

10:01 TIP#3 Ask about Drift Time

13:48 Recap of Clinical Pearls

About our Guest:  Dr. James Waxmonsky

Professor, Vice Chair for Children's Services and University Chair in Child Psychiatry, Department of Psychiatry and Behavioral Health

Penn State Neuroscience Institute

Sign-up for our NEWSLETTER: https://child-mental-health-for-pediatric-clinicians.kit.com/3bf4aeedfc

WEBSITE: PsychEd4Peds.com for more resources!

SOCIAL: Instagram or threads @psyched4peds

On-demand CME Course online at:

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

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Does our brain adapt to stimulant medication over time, develop tolerance, so that we require higher doses to achieve the same effect?

When patients tell us their stimulant doesn't seem as helpful (after working well for a while), could this be tolerance? ... or could it be something else? 

To answer these questions, Dr. Elise Fallucco chats with Dr. James Waxmonsky, co-PI for NIMH-funded study: Examining Tolerance to CNS Stimulants in ADHD. 

00:00 Introduction of Dr. James Waxmonsky

01:26 What Is Tolerance?

02:10 Clinical Evidence for Tolerance

02:57 Longer-term Tolerance to stimulants

03:40 "The Brain Moves Its Targets"

04:16 Clinical Considerations in evaluating when "meds not as helpful": Changing Life Demands or true tolerance?

06:30 Management of Stimulant Tolerance

06:56 Clinical Pearl: Ask about increases in executive functioning and life demands

07:40 Taking a break from stimulant medication

08:14 Waxmonsky Longitudinal Study

09:00 Weekend Holiday Design

09:32 Recap - Do weekend holidays matter and reduce the need for higher doses?

11:46 Quicker dose escalation in continuous vs. holiday groups

14:00 Weekend Dosing Tradeoffs

15:45 Growth vs Dose Myth and Mg/Kg Dosing

17:35 Recap of how to Manage Tolerance

17:57 Toolbox for Recapturing Effect

18:37 Closing Thoughts

19:04 Final Recap

Dr. James Waxmonsky is the Division Chief of Child Adolescent Psychiatry at the Hershey Medical Center, the University Chair in Child Psychiatry at Penn State and a Professor of Psychiatry at the Penn State College of Medicine. He serves as Co-PI for an NIMH-funded study, Examining Tolerance to ADHD Stimulants.

Sign-up for our NEWSLETTER: https://child-mental-health-for-pediatric-clinicians.kit.com/3bf4aeedfc

WEBSITE: PsychEd4Peds.com for more resources!

SOCIAL: Instagram or threads @psyched4peds

On-demand CME Course online at:

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

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Bench to Bedside: How ADHD Stimulants Really Work—Arousal and Reward, Not Attention Networks

Dr. Elise Fallucco launches a new “Bench to Bedside” series and interviews Dr. Nico Dosenbach, senior author of a ground-breaking fMRI study published in CELL  that found that  stimulants do NOT significantly change the brain’s attention networks!?!?! 

Instead, effects are strongest in arousal (less drowsy, more wide awake) and reward/motivation systems (increasing predicted reward and tolerance of “drudgery”). 

We discuss:

• how these findings align with patient experience
• why ADHD can be a misnomer 
• how video games/TikTok exploit variable reward schedules
• how this changes what we tell patients and families about stimulants

Our conversation highlights implications for destigmatizing ADHD, reframing stimulants as helping wakefulness and motivation rather than “making you smarter,” and how strategies like habit pairing and gamification can make necessary tasks more rewarding.

00:00 Welcome to Bench to Bedside Series

01:34 What We Thought We Knew about Stimulants

03:30 Examining brain networks in ADHD

04:03 No Attention Network Effect

04:50 Patient reaction to the paper's fundings

05:30 Where in the brain are stimulants working?

05:45 Arousal Signature

06:29 Stimulants also affect the Dopaminergic REWARD and Motivational systems

06:41 "More Tolerant of Drudgery"

07:18 Stimulants affect Arousal

08:08 Stimulants act on Motivation and Reward

08:50 Why motivation matters in kids with ADHD

09:21 Findings consistent with other human behavioral data and macaque data

09:47 Raking Leaves and Hacking the Reward Systems

11:24 Clinical Implications of Study

11:41 Implications for ADHD Treatment

12:58 Did Einstein need stimulants?

13:16 Hyperfocus and Real Life Examples: Deer Hunting

15:24 Reward Hacking : Video Games and TikTok

16:42 Non Prescription Tricks to Hack the Reward System

18:15 Procrastination in ADHD and dopamine

19:01 Different ADHD distribution in medicine?

19:34 Reframing ADHD

20:26 Gamifying Life

22:09 Closing Recap - Clinical Implications

About Our Guest, Dr. Nico Dosenbach:

https://dosenbachlab.wustl.edu/

For access to the full paper, Stimulant medication affect arousal and reward, not attention networks:

https://www.cell.com/cell/fulltext/S0092-8674(25)01373-X

Sign-up for our NEWSLETTER: https://child-mental-health-for-pediatric-clinicians.kit.com/3bf4aeedfc

WEBSITE: PsychEd4Peds.com for more resources!

SOCIAL: Instagram or threads @psyched4peds

On-demand CME Course online at:

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

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SSRI Switching in Pediatrics: When to Try a Third SSRI, When to Use Luvox, and Key Metabolism Pearls

Dr. Elise Fallucco continues her discussion with child psychiatrist Dr. Jeffrey Strawn (University of Cincinnati; co-author of Stahl’s DePrescribing) on practical tips regarding how to stop/decrease an SSRI and switch to another SSRI (or SNRI) for pediatric anxiety. 

Highlights from the Episode:

• After trying 2 different SSRIs for pediatric anxiety, in most cases, it makes sense to try a third SSRI as opposed to an SNRI
  • Rationale: SSRIs tend to be more effective and have fewer side effects than SNRIs
• "We Don't Talk about LUVOX": Luvox can be a great option for youth with OCD OR anxiety (generalized, social, separation)
  • Dosing strategy: start at 25mg with the plan to titrate up to a target dose of 150-200mg
• Consider grouping 3 of the SSRIs by their similar metabolic pathways (2C19): Sertraline, Citalopram, and Escitalopram
  • If your patient develops significant side effects on a low dose of one of these 3 meds, they MIGHT be a 2C19 poor metabolizer, which means that you may want to avoid trials of the other 2C19 meds in the group
• Fluoxetine has a LOOOOONg half-life: and it's related 2D6 inhibition will persist 4–5 weeks after stopping Fluoxetine - and affect the metabolism of other 2D6-metabolized meds during that time
  • The 2D6 group includes meds like Fluoxetine, Paroxetine and 2 of the SNRIs: Duloxetine and Venlafaxine

-- And Check Out  Dr. Jeffrey Strawn's new book which I highly recommend - Stahl's Deprescriber's Guide available on Amazon!

00:00 Introduction of Dr. Jeffrey Strawn

00:38 Preview of Episode: Switching SSRIs, when to use FluVOXamine or SNRIs, plus 2D6 and 2C19 metabolism of antidepressant medication

01:59 Try 2 different SSRIs or Duloxetine?

03:45 CYP 2D6 Inhibition with Fluoxetine

04:28 Clinical Pearl: Fluoxetine 2D6 inhibition continues 4-5 weeks after stopping

05:05 2D6 Metabolized Antidepressants: Venlafaxine, Duloxetine, Paroxetine

05:31 Choosing a Third SSRI

05:48 SSRIs generally more effective, fewer side effects than SRNIs in youth

06:49 Only 1 SNRI for child anxiety

07:27 People forget about Fluvoxamine

08:30 Sertraline and Es/Citalopram 2C19 metabolism

09:32 Fluoxetine to FluVOXamine cross-titration

11:16 Gratitude for Dr. Strawn

11:31 Check out Stahl's DEPrescribing Guide

12:23 Recap of Advanced SSRI and SNRI case discussion

Sign-up for our NEWSLETTER: https://child-mental-health-for-pediatric-clinicians.kit.com/3bf4aeedfc

WEBSITE: PsychEd4Peds.com for more resources!

SOCIAL: Instagram or threads @psyched4peds

On-demand CME Course online at:

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

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3 Ways to Switch SSRIs in Kids: Direct Switch vs Taper vs Cross-Titration 

Dr. Elise Fallucco continues a conversation with child psychiatrist and anxiety GURU Dr. Jeffrey Strawn about evidence-informed ways to switch SSRIs in pediatric patients when an adequate trial hasn’t led to remission. 

They review 3 strategies:

1.    direct stop/start

a.    Stop SSRI#1 then start SSRI#2: best for patients with side effects on the 1st SSRI, but creates a gap in antidepressant coverage during the transition

2.    taper-then-switch

a.    Taper SSRI#1 off then start SSRI#2: best for patients who are highly sensitive to medication changes, but leaves a LONG time without effective antidepressant/SSRI coverage 

3.    cross-titration

a.    Continue SSRI#1 while adding SSRI#2 with the plan to later taper down on SSRI#1: best for patients without side effects on 1st SSRI as it allows for optimal SSRI coverage in the transition between meds; watch out with SEROTONERGIC SIDE EFFECTS (nausea, vomiting, diarrhea, flushing) while 2 SSRIs on board

Clinical Pearl: Dr. Strawn emphasizes that higher starting doses don’t speed time to steady state, so start the new medication at LOW doses

Clinical Case: Teen on sertraline 150 mg switches to fluoxetine

·      How to cross-titrate

·      How to monitor for serotonergic side effects 

·      How to taper sertraline

Bonus Psychopharm: They receptor pharmacology considerations and the need to distinguish withdrawal effects from new-medication side effects, illustrated by an atomoxetine (Strattera) -to- fluvoxamine (LUVOX) switch affecting ADHD symptoms.

Sign-up for our NEWSLETTER: https://child-mental-health-for-pediatric-clinicians.kit.com/3bf4aeedfc

WEBSITE: PsychEd4Peds.com for more resources!

SOCIAL: Instagram or threads @psyched4peds

On-demand CME Course online at:

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1

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What is the safest, most effective way to taper or stop psychotropic meds in children and teens? Dr. Elise Fallucco kicks off a new Deprescribing series with guest Dr. Jeffrey Strawn, coauthor of Stahl’s Deprescriber’s Guide.  

 They discuss how  clinicians and patients “deprescribe” in real life, and what can happen when tapering off or abruptly stopping medication including:

•  how to distinguish discontinuation (withdrawal) from relapse 
  • Focus on timing, symptom pattern (including dysesthesias/“brain zaps” and dizziness), and symptom trajectory
• how to manage cases of discontinuation
  • pause - then more slowly taper off of medication
• how to manage relapse
  • pause - and potentially increase back to the original dose

Dr. Jeffrey Strawn is a Professor of Psychiatry at the University of Cincinnati (UC) and the Director of Anxiety Disorders Research Program.

Stahl's Deprescriber's Guide by Dr. Jeffrey Strawn and Dr. Stephen Stahl available at Amazon:

https://www.amazon.com/Stahls-Deprescribers-Guide-Jeffrey-Strawn/dp/1009642200

Sign-up for our NEWSLETTER: https://child-mental-health-for-pediatric-clinicians.kit.com/3bf4aeedfc

WEBSITE: PsychEd4Peds.com for more resources!

SOCIAL: Instagram or threads @psyched4peds

On-demand CME Course online at:

Pediatric Mental Health CME Toolkit - Cracking the ADHD Code: Essentials for Pediatric Clinicians. 

https://ce.nemours.org/content/podcast-series-cracking-adhd-code-essential-skills-pediatric-clinicians#group-tabs-node-course-default1