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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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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.

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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)

Check out our website PsychEd4Peds.com for more resources.
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