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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

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

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

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

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

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

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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.

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