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 Dr. Elise Fallucco continues this series on non-stimulant medication for ADHD and shares practical tips about using Norepinephrine Reuptake Inhibitors (NRIs): viloxazine ER (Qelbree) and atomoxetine (Strattera) for pediatric clinicians.

Who can benefit from NRIs? What are the potential benefits, drawbacks, and side effects? 

Working through the case of a 12-year-old girl with inattentive ADHD and anxiety  who cannot tolerate methylphenidate or amphetamine , she explains why she generally prefers Viloxazine ER (Qelbree)

• FDA approval for ADHD in children ages 6+
• Quicker onset (often within 1–2 weeks vs 4–6 weeks for atomoxetine)
• Better tolerability
• More straightforward dosing 
• Unlike Atomoxetine (Strattera), you can dose this medication without worrying about significant genetic variability in drug metabolism

00:00 NRIs for ADHD

00:38 When to Use

01:07 Case Introduction

02:51 Stimulant Trials Fail

04:09 Considering NRIs

04:30 Why Qelbree First

05:51 Atomoxetine Caveats

07:23 Treating Sophie

08:45 Clinical Pearls Recap

09:50 Wrap Up and CME

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

Check out our NEW CME Audio-based, 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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While stimulant meds are first-line treatment for ADHD, they do NOT work for everyone... or sometimes they only PARTIALLY help.  So, what can you do in these situations?

• When is the right time to try a non-stimulant medication like Guanfacine and Clonidine (a.k.a - alpha-agonists?)? 
• In which clinical situations can these alpha-agonists be helpful?  
• How do you know when to switch from one stimulant to another stimulant
• When should you try adding on or switching to an alpha-agonist?

In this episode, Dr. Elise Fallucco talks about guanfacine XR (Intuniv) and clonidine (Kapvay/Onyda XR)—and how to decide whether to switch stimulants or augment them. Using an 11-year-old with improved attention on a stimulant but persistent impulsivity/oppositionality and dose-limiting side effects, she explains that switching is best when there’s little benefit or unacceptable side effects, while augmentation makes sense with partial response. She reviews key scenarios for alpha agonists: residual impulsivity/hyperactivity/behavior dysregulation, ADHD with tics, possible adjunct use in ADHD with anxiety (not primary anxiety treatment), and late-day rebound near bedtime. She describes “peanut butter and jelly” synergy with stimulants, monitoring vitals, dosing/titration, sedation differences (more with clonidine), and the need to taper to avoid rebound hypertension.

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

Check out our NEW CME Audio-based, 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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It’s back-to-school season—and that often means a surge of ADHD concerns as academic demands ramp up, especially around key school transitions like 3rd, 6th, and 9th grade. 

In this episode of ADHD, Anxiety, and More, Dr. Elise Fallucco  shares a practical, confidence-building approach to picking stimulant treatment for children and teens, answering questions like:

Which ADHD medication should I start first?

When should you use methylphenidate medications like Ritalin or Concerta?

When should you use amphetamine-salt medications like Adderall or Vyvanse?

How does family history help direct treatment choices?

When does it make sense to try a d-methylphenidate medication like Focalin?

 00:00 Podcast Rebrand Update

00:30 Back to School ADHD Surge

01:09 ADHD Evaluation Basics

02:36 Case Introduction Third Grader

03:04 Rule of Three Transitions

04:09 Parents Nervous About Meds

04:45 Family History Medication Clues

06:06 Step One Start Methylphenidate

06:33 Short Acting First Rationale

08:05 When to Use Long Acting

08:30 Long Acting Coverage Limits

09:27 Step Two Try Amphetamines

10:59 Step Three Consider Focalin

11:52 Wrap Up Simple Stimulant Toolkit

12:43 Bonus Algorithm and Course

14:00 Closing and Next Week Preview

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

Check out our NEW CME Audio-based, 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 can we learn from an Elite Coach about how to help young athletes THRIVE through sports? Join us as we chat with Coach Peter Verhoef, head coach and aquatics director at the Bolles School Swimming Program and former Olympic Trials finalist (2x).

We discuss:

•  Why do so many kids quit organized sports by age 13?
• How can we prevent burnout?
• When are teens MOST vulnerable to burnout? 
• How much time off/rest is reasonable? Does it very by sport?

03:36 Benefits of Youth sports

06:04 Preventing Burnout in Youth Sports

06:32 Engagement in Youth Sports and Burnout

06:44 Promoting Individual Achievement

08:35 Managing Physical and emotional exhaustion

09:13 Driver's License BURNOUT

12:00 Tips for Parents to help Preventing Burnout

16:21 TIME OFF

20:58 Multi-Sport Athelte vs. Specialization

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

Check out our NEW CME Audio-based, 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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Summer sports physical season is here! Before you sign that next pre-participation physical, are you asking the questions that could help prevent burnout, overuse injuries, and early sports dropout? 

In this timely replay, pediatric sports medicine expert Dr. Joel Brenner shares practical, evidence-based strategies to help young athletes stay healthy—and stay in the game. Learn why early sports specialization may do more harm than good, how much rest young athletes really need, and the two simple questions every pediatric clinician should ask during every sports physical. 

Whether you're counseling a recreational athlete or the next aspiring Olympian, this episode will give you practical pearls you can use in clinic today. 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. Joel Brenner is the co-author of the American Academy of Pediatrics' 2024 Clinical Report on overuse injuries over-training and burnout in young athletes. 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!
Follow us on Instagram @psyched4peds

Check out our NEW CME Audio-based, 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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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

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

Check out our NEW CME Audio-based, 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

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

Check out our NEW CME Audio-based, 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.

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

Check out our NEW CME Audio-based, 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.

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

Check out our NEW CME Audio-based, 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

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

Check out our NEW CME Audio-based, 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