Pediatric Meltdown

In this milestone episode of Pediatric Meltdown, host Dr. Lia Gaggino takes a few minutes and celebrates an incredible achievement—reaching episode #200 and marking nearly four years of engaging, insightful, and impactful discussions centered on children’s mental health and emotional well-being. She expresses profound gratitude to her global audience, spanning six continents, and reflects on the journey that has brought her and her listeners to this point.

Dr. Gaggino reminisces about some of her favorite episodes and gives thanks to her mentor Mark Sloane who inspired her venture into mental health. She also extends her appreciation to the many pediatricians, mental health clinicians, and parents who have contributed to the podcast, advocating for better mental health care for children.

In closing, Dr. Gaggino encourages listeners to continue their journey together, emphasizing the unique position they hold in making a positive impact on children's lives. She invites them to explore her new initiative, the Building Better Workflows podcast and workbook, and hints at future episodes filled with practical strategies and heartfelt conversations.

Referenced in this Episode :

https://pediatricmeltdown.com/episodes

  01 Words Matter- Talking about Weight and BMI

  02 Caring for Children in Foster and Kinship Care with Moira Szilagyi

  03 Pediatric Hero: Building Safe Spaces for Kids Emotions with Dr. Mark Sloane

  29 Goldilocks, Tigger and Eeyore: Regulation and Childhood Behaviors

128 Trauma and Resilience: “Connect Before You Correct”

114 Palliative and Hospice Care: A Conversation on Grief and Joy

Building Better Workflows Podcast

Building Better Workflows 

**Transcript of Episode Available upon request**

THANK YOU FOR YOUR SUPPORT!

Pediatric Meltdown was listed as a Top 20 Pediatric Podcast on FeedSpot.

If you’d like to connect with me, you can Tap the “What Are Your Thoughts” button at the top of the notes or you can find me on LinkedIn, Facebook, Instagram, and Twitter, or email me at [email protected]. To learn more about me visit https://www.pediatricmeltdown.com/ or reach out, DM me on IG, FB or LI and if you’d like to chat set up a discovery call to talk about your needs and challenges:  https://calendly.com/gagginol/discovery-call

Imagine a world where children with OCD and Tourette’s can manage their symptoms without relying solely on medications. In this episode of Pediatric Meltdown, we explore innovative interventions like Habit Reversal Training and ERP Therapy that offer new hope for young patients. Dr. Lia’s guest is a listener’s favorite, Dr. Colleen Cullinan. She has a gift for taking you inside the child’s mind and telling you exactly what they’re thinking.  She’ll talk about the profound impact of intentional, compassionate care and the crucial role of family support in the treatment process. Tune in to discover effective strategies for tackling the emotional and psychological struggles these children face and how these methods pave the way for lasting improvements.

[03:13 -17:21]  Understanding Isolation and Negative Reinforcement in Mental Health

• Concept of breaking the cycle of negative reinforcement and the importance of compassionate interventions.
• Connection between emotional regulation in various scenarios and therapies like cognitive behavioral therapy and acceptance and commitment therapy.
• Discussion on how the brain’s problem-solving nature struggles with internal experiences, leading to anxiety.
• Therapies offer solutions that counter the brain's intuitive problem-solving approach.

[17:22 - 29:42]  Exposure and Response Prevention (ERP) for OCD  

• Emphasis on intentionally facing fears without engaging in compulsive behaviors.
• Insights into how ERP can be rewarding for families affected by OCD.
• Challenges and solutions in treating internal obsessions and related mental compulsions.
• Significance of ERP in helping individuals understand their fears are not dangerous.

[29:43 - 41:52]  Nonpharmacologic Therapies for OCD, Tics, and Tourette's

• Overview of therapies like exposure and response prevention, habit reversal training, and comprehensive behavioral intervention for tics.
• Discussion of the non-logical and visceral nature of these behaviors and breaking the cycle of negative reinforcement.
• Strategies for managing compulsive skin picking, including competing responses and awareness.
• Practice and gradual exposure to triggers as critical parts of treatment.

[41:53 - 55:12] Resources and Tools for Comprehensive Behavioral Intervention for Tics

• Introduction to CBIT as a detailed treatment involving awareness building and breaking down tics.
• Challenges in finding CBIT-trained therapists and resources to locate such providers.
• Mention of the Tourette Association of America and the TLC Foundation for Body Focused Repetitive Behaviors.
• University training programs in clinical psychology as potential access points for therapists trained in habit reversal training.

[55:13 - 59:58]  Closing segment Takeaways

Links to resources mentioned on the show

International OCD Foundation:  https://iocdf.org 

Tourette’s Association of America: https://tourette.org

TLC Foundation for Body-Focused Repetitive Behaviors https://www.bfrb.org

AACAP Facts for Families OCD:

In this second part of a 2-part series from last week’s show, host Dr. Lia talks with Dr. Erica Greenberg about some of the surprising research looking at the association between autoimmune and inflammatory conditions and higher rates of OCD. Dr. Greenberg discusses the neuroscience around OCD from genetic to environmental factors, and the puzzling overlap of symptoms in disorders like Tourette's and OCD.  She stresses the crucial need for interdisciplinary research to shed further light on these intricate associations. 

You’ll get insights into why certain treatments are recommended with caution and why controversy still remains around PANDAS and the desperate need for collaboration and comprehensive research to truly understand these complex conditions. You’ll also hear about the role of stress-induced inflammatory responses and how they render some individuals more susceptible to immune-related dysfunctions, shedding light on the significant impact of environmental factors like lead exposure on basal ganglia circuitry. Dr. Lia’s conversation with Dr. Greenberg reveals the interconnected nature of disorders such as OCD, Tourette syndrome, and other neuropsychiatric ailments, underscoring the necessity for further research. 

Conversations like these illuminate the path forward, emphasizing that the key to understanding and treating these conditions lies in collaborative research efforts across various disciplines.

[01:46 -12:40]  Understanding PANDAS and PANS Origins and Symptoms

• PANDAS is specifically linked to post-infectious streptococcal etiology.
• PANDAS involves the sudden onset of tics and/or OCD.
• PANS shares a similar characteristic of sudden, rapid onset of a complex of symptoms.
• Importance of understanding the specific triggers and symptoms associated with both PANDAS and PANS.

[12:41 - 23:32] Understanding the Clinical Outcomes of PANS/PANDAS Treatment  

• Sudden onset of symptoms such as tics, OCD, and separation anxiety is notable in these conditions.
• Some children experience complete recovery back to baseline after antibiotic treatment within a week.
• There is ongoing research into the different potential clinical courses following a PANS/PANDAS diagnosis.
• Emphasis on the importance of recognizing and understanding the diverse range of clinical outcomes.

[23:33 - 35:37]   Genetic and Environmental Influences on OCD and Tourette Syndrome

• Studies show significant associations between OCD, Tourette syndrome, and increased rates of throat infections.
• Research indicates higher odds ratios of developing OCD and Tourette in youth with infection histories.
• A dose-response relationship exists between strep infections and OCD/Tourette symptom severity.
• Studies find higher rates of autoimmune disorders in individuals with OCD and Tourette and their family members.

[35:38 - 48:00]  Key Information and Challenges Surrounding PANS and PANDAS

• Need for more thoughtful, nuanced, safe, appropriate information for parents.
• There's evidence that PANS and PANDAS have a more negative impact on families compared to typical OCD
• OCD and Tourette syndrome develop slowly, while PANS and PANDAS show abrupt changes.
• Families face significant trauma, especially when providers dismiss their concerns.

[48:01 - 55:17]  Closing segment Takeaways

Links to resources mentioned on the show

Erica Greenberg, MD PANDA AND PANS Presentation Swipe Files

How do mental compulsions, such as intrusive sexual thoughts and reassurance-seeking behaviors, manifest in children with OCD?

What are some common co-occurring conditions with OCD in children, and how do they complicate diagnosis and treatment?

These questions are answered in this week's episode of Pediatric Meltdown, where Lia sits down with child psychiatry expert Dr. Erica Greenberg to unravel the complexities of obsessive-compulsive disorder (OCD) in children. Dr. Greenberg shares her journey into child psychiatry and sheds light on the diagnostic criteria for OCD, the common and individual themes that kids with this condition struggle with, and the impact OCD has on their lives. Erica explains the common categories like contamination and intrusive thoughts and dispels myths regarding the treatment and prognosis of pediatric OCD.  By discussing various treatment strategies, from exposure response prevention therapy to medication options, this episode underscores the importance of comprehensive care. For parents and caregivers, recognizing the early signs and seeking appropriate treatment can make all the difference in a child's developmental journey. Curious about an unconventional strategy that’s making waves in OCD treatment? This episode is the ultimate guide!

     [03:22 -18:14]  OCD Symptoms in Children: Key Diagnostic Criteria and Common Presentations

• To diagnose OCD, a child must have obsessions and/or compulsions, which are often both present.
• Obsessions are unwanted, repetitive, intrusive ideas, thoughts, images, or urges that cause significant distress.
• Compulsions are behaviors, either mental or physical, performed to get rid of the distress caused by obsessions.
• Examples of mental compulsions include body checking and repetitive counting to alleviate intrusive thoughts.

[18:15 - 28:13] Impact of OCD on Daily Life and Family Dynamics  

• OCD can consume significant time daily, impacting children’s social and developmental trajectories.
• Children may miss social cues or avoid activities due to obsessions, leading to social withdrawal and alienation.
• Constant reassurance seeking from peers can alienate children, exacerbating their fears of social rejection.
• OCD affects families, often leading to strained relationships and the need for family involvement in therapy.

[28:14 - 37:32]   Medication Treatment for Pediatric OCD: Key Insights

• SSRIs are the main medication used to treat OCD in children, with common choices including fluoxetine, sertraline, and escitalopram.
• Studies show that most of the beneficial effects of SSRIs can be observed within the first 2 to 4 weeks of treatment.
• Higher doses of SSRIs may be necessary for some children, but it's important to monitor for any side effects, especially activation symptoms in younger kids.
• The combination of fluvoxamine and clomipramine may be beneficial, though fluvoxamine is not inherently superior to other SSRIs for OCD treatment.

[37:33 - 55:37]  The Relationship Between Tourette Syndrome and OCD in Children

• Tourette syndrome involves at least two motor tics and one vocal tic for a duration of at least a year, which can overlap significantly with OCD symptoms.
• Tics are suggestible and can be simple (e.g., shoulder shrug) or complex (e.g., more deliberate movements or sounds), making them sometimes hard to distinguish from OCD compulsions.
• Up to 85% of individuals with Tourette syndrome have a co-occurring condition, with OCD being a common comorbidity.
• The presence of tics often signals the need to monitor for other conditions such as ADHD, anxiety, mood dysregulation, and sensory...

How can primary care providers and pediatricians play a role in educating families and children about the importance of sleep and identifying sleep issues early on? 

Join Dr. Lia and her guest, Sleep expert, Dr. Jess Shatkin have the answers to that question and many more! This episode delves into various aspects of pediatric sleep health, from exploring pediatric sleep medications to offering practical tips on establishing solid sleep hygiene for kids. Understanding the intricate relationship between children's sleep disorders and their mental health is crucial for providing comprehensive care to children and adolescents. Dr. Jess's insights into the effectiveness of Cognitive Behavioral Therapy for Insomnia (CBTI) highlight effective treatment strategies that emphasize long-term well-being over quick fixes. By incorporating sleep education, implementing evidence-based approaches like CBTI, and advocating for holistic health practices, we can pave the way for a brighter, more well-rested future for our youth. Join us in unraveling the mysteries of pediatric sleep problems and mental health, and discover the transformative power of a good night's rest!

[03:13 -13:50]  Understanding Pediatric Insomnia and Its Prevalence

• Insomnia is identified as the most common pediatric sleep problem.
• Highlighted the essential nature of sleep for both kids and adults.
• Emphasis on the importance of routine for improving sleep in children.
• Discussion emphasizes the various factors impacting sleep quality and quantity.

[13:51 - 29:50] Pediatric Sleep Hygiene and Its Limitations  

• Sleep hygiene is frequently discussed as an essential component of managing sleep problems.
• The data supporting the effectiveness of sleep hygiene on its own is not promising.
• Integrating sleep hygiene with CBTI can lead to better outcomes for children.
• It’s crucial to combine different strategies to effectively manage pediatric sleep problems.

[29:51 - 38:21]  Finding a Therapist for Cognitive Behavioral Therapy for Insomnia (CBTI)

• It can be challenging to find professionals specializing in CBTI.
• Resources for locating CBTI therapists may be limited.
• Workshops on CBTI are conducted at annual conventions.
• Preparing through sleep education is crucial for effective CBTI..

[38:22 - 58:42]  Addressing Sleep Problems in Children with Psychiatric Disorders

• Children often present with sleep issues when treated for other conditions like ADHD or depression.
• Sleep problems are common among these pediatric patients, even if not the primary reason for consultation.
• Many children are already deeply entrenched in sleep medication routines before they receive specialized care.
• CBTI techniques in treatment routines for children suffering from psychiatric disorders is suggested.

[58:43 - 1:08:20]  Closing segment Takeaways

Links to resources mentioned on the show

His website:Dr. Jess P. Shatkin - Home (drjesspshatkin.com)

Host of About Our Kids on Doctor Radio SiriusXM 110

FB: Facebook 

X (Twitter) @‌DrJessPShatkin                             ...

Summary: 

In this special episode of Pediatric Meltdown where Dr. Lia shares personal insights and heartfelt reflections on the journey of parenting adult children and stepping into the joyous role of a grandparent. As Lia celebrates her birthday, she takes a moment to delve into the complexities and rewards of these intergenerational family relationships. Grandparenting tips are sprinkled throughout the episode, offering valuable advice to listeners who are navigating similar life stages. She emphasizes the importance of balancing advice and support for adult children, noting how her preferred approach is to offer help only when asked. Lia draws from one of her favorite books, "Walking on Eggshells, Parenting Your Adult Child," which underscores the wisdom of refraining from unsolicited advice and simply being present when needed. 

This approach, she finds, is essential to maintaining healthy and respectful relationships with adult children. She candidly admits to having been a helicopter parent at times, but stresses that letting children face challenges and failures is crucial for their growth and independence. Lia's reflections eloquently capture the essence of parenting adult children by acknowledging that each generation might do things differently but with the same core love and intent. In essence, her stories remind listeners that letting go is part of the process, and it is often the hardest, yet most rewarding part of parenting adult children.

Her reflections serve as a gentle reminder of the importance of savoring these precious intergenerational family relationships and the joy they bring, a fitting contemplation as she marks another year of her life's journey.

Bullet points of key topics 

• Reflections on Parenting and Grandparenting and the Impact on Mental Health
• Parenting Adult Children and advice from her favorite  book.
• Respecting children’s different parenting methods.

Calls to action:

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• Book a Discovery Call Here

Are you a pediatric care provider feeling overwhelmed by complex mental health cases? Discover a solution that’s transforming pediatric care in Michigan and beyond! In the latest episode of Pediatric Meltdown, Alyssa Wealty and Dr. Nasuh Malas teach us about the MC3 program (Michigan Child Collaborative Care) and how it’s making waves by providing tools like the Clinical Pearls educational series, that’s proving to be a lifeline for primary care providers who are grappling with mental health issues in young patients. From leveraging expert consultations to utilizing targeted educational resources, and handling cases of anxiety, aggression, or substance use, this episode is a gold mine for those on the front lines of pediatric health care. At the center of MC3’s offerings is the power of connection and education. Like addressing urgent mental health needs in pediatric settings or providing accessible educational tools like the Clinical Pearls video series. No matter where you are in your healthcare journey, the MC3 resources offer concise, expert-driven advice that can dramatically improve your care strategies. Interested in enhancing your clinical skills with quick, impactful lessons? Get your pen and paper ready.  This episode is packed with information.

PRO Tip: These resources aren't limited to healthcare professionals; parents and educators can gain insights too! 

[03:47 -09:04]  Integrating Mental Health Education in Primary Care

• Designed to deliver concise insights on common pediatric mental health conditions for primary care providers.
• The program's educational component underscores the importance of mental health knowledge in primary care.
• Enhances primary care providers' ability to diagnose and manage pediatric mental health.
• Program grows to support schools and perinatal care providers for integrated mental health.

[09:05- 21:28]  Clinical Pearls Series - A Resource for Pediatric Mental Health Education

• "Clinical Pearls" features key learning videos on fundamental mental health topics.
• The series includes a resource list and self-assessment for provider education.
• It enriches learning with extra materials alongside the main videos.
• The series is accessible globally, benefiting clinicians in Michigan and worldwide.

[19:18 -29:30]  Advancing Primary Care through Educational Support and Teleconsultation

• Primary care providers get guidance on conducting thorough evaluations with fellow mental health professionals.
• Feedback from participants in the MC3 program informs the creation of  practice-enhancing content.
• Merging mental health and primary care responds  to the need for increased support in managing pediatric cases.
• The MC3 teleconsultation service  outreach includes critical care points,like emergency rooms and schools.

[29:31 - 33:11]  Closing segment Takeaway

Links to resources mentioned on the show

• MC3:  https://mc3michigan.org 
• MC3 Clinical Pearls:  https://mc3michigan.org/clinical-pearls-video-series/

Other episodes you may like:

For all episodes, go to Episodes - Pediatric Meltdown

Ep #139 School Based Health:  Literally Meeting Kids Where They Are!

Ep #128 Trauma and Resilience: “Connect Before You...

Tune into this week’s episode where we sit down with the Dr. Nancy Rappaport, who shares her groundbreaking approach to comprehending and managing children’s behaviors, including anxiety-related and oppositional tendencies as well as the theory of why stepping back as a parent and allowing your children to encounter and navigate challenges by themselves is crucial for their development. Dr. Rappaport provides an in-depth look at how structured environments and small rituals can significantly improve how children cope with everyday stresses and transitions. From addressing the influences of trauma to understanding normal age-appropriate curiosity, Dr. Rappaport provides a balanced perspective on navigating sensitive topics. She emphasizes the necessity of not misinterpreting behavioral cues, as they can vary significantly depending on a child’s personal experiences and challenges. Are you ready to learn how to respond playfully and effectively to children’s complicated behaviors? Tune in to gain unique strategies that could not only revolutionize your approach to parenting but alter how you perceive and interact with childhood behaviors forever!

[03:13 -19:31]  Understanding and Managing Anxiety-Related Behaviors in Children

• Discussion on how unstructured times, transitions, social demands, and unexpected changes can trigger anxiety-related behaviors in children.
• Emphasis on the importance of creating structured environments during typically unstructured times to provide stability for anxious children.
• Introduction of tools like emotional thermometers and comfort boxes to help children manage their anxiety.
• Strategies for preparing anxious children for impending changes to reduce stress and behavioral issues.

[19:31 - 32:18]  Addressing Oppositional Behaviors in Children  

• Exploration of the antecedents to oppositional behaviors, including environmental triggers and emotional distress.
• The use of encouragement cards, affirmations, and undirected play to positively influence children's behaviors.
• Importance of understanding the meaning behind behavior as a form of communication rather than simply reacting to the behavior itself.
• Psychological insights revealing that a third of children who completed suicide had shown oppositional behaviors. 

[32:19 - 46:04]   Strategies for Building Rapport with Withdrawn Children

• Not making assumptions about withdrawn behaviors, as these can vary drastically between children.
• Insights into how parents' personal characteristics can influence their perception of a child's withdrawn behavior.
• Methods for engaging withdrawn children in communication and activities at a pace comfortable for the child.
• Highlighting the reasons behind withdrawn behavior, including possible underlying health issues or past traumas.

[46:05 - 50:06]  Effective Use and Concerns of Medications in Managing Child Behavior

• The use of stimulant medication and its effects on participation in regular classroom activities and field trips.
• Overprescription of antipsychotic medications for behavior management and the ensuing need for skill-building and robust support systems.
• Contrast between the child psychiatrists and pediatricians to behavior management and the synergies of their collaboration.
• The value of pediatricians in the ongoing health and wellness journey of children, especially aligned with psychiatric insights.

[50:07 - 57:37]  Closing segment Takeaways

Links to resources mentioned on the show

Her website:

In this episode of Pediatric Meltdown, we dive into the complexities of disruptive mood dysregulation disorder (DMDD) and how the DSM-5's new classification aims to solve the puzzle of childhood bipolar misdiagnosis by distinguishing DMDD from other behavioral disorders like conduct disorder and oppositional defiant disorder. Join host Dr. Lia Gaggino and child psychiatry expert Dr. Gabrielle Carlson as they explore the intricate challenges of diagnosing and treating irritability and outbursts in children.  This episode is essential for anyone struggling to understand or manage aggressive behavior in children, providing a roadmap to better interventions and outcomes. You’ll find that today’s discussion with Dr. Gabrielle will bring some much-needed clarity to the often-misunderstood world of Conduct Disorder. 

[03:21-05:54] Understanding Disruptive Mood Dysregulation Disorder (DMDD)

• Concerns of overdiagnosis of bipolar disorder in children as per changes in DSM-5.
• Discusses the need for a "diagnostic home" for children exhibiting chronic irritability and frequent outbursts.
• Differentiates DMDD from bipolar disorder, highlighting less episodic mood change and more persistent irritability.
• Discusses using medical and psychiatric collaborative approaches for accurate diagnosis.

[05:55 - 18:49]  Diagnostic Challenges in Pediatric Psychiatry  

• Explores the complexity of diagnosing behavioral disorders in children, stressing the influence of parental worries.
• Differences between conduct disorder and oppositional defiant disorder in the context of purposeful aggression and core outbursts.
• Highlights how the underestimation of trauma impacts behavioral assessments.
• descriptive codes to assist in more accurate diagnosing, particularly in children with overlapping symptoms.

[18:50 - 33:15]  The Role of Environmental Factors and Parental Involvement

• Discussion on the triggers and antecedents in aggressive behavior management in pediatric patients.
• Examines the impact of environmental factors, especially in relation to ADHD and pediatric bipolar disorder.
• Highlights parental involvement as crucial in the management and treatment of behavioral issues.
• The challenges of finding effective medication for aggression treating irritability specifically in relation to autism.

[33:16 - 4613]  Resources and Treatment Approaches in Child Psychiatry

• Details on Gabrielle's routine evaluation process including her developed rating scale ‘emo eye’.
• The utility of the ACAP (American Academy of Child and Adolescent Psychiatry) Resource Center resources for clinicians and families. [ACAP Resource Center](https://www.aacap.org)
• Talks about the necessity of evidence-backed treatment options and FDA approvals for therapy tools.
• Covers the importance of educating parents using resources such as medication guides available through ACAP.

[46:14 - 55:23]  Closing segment Takeaway

Links to resources mentioned on the show

AACAP Outbursts, Irriitability, and Emotional Dysregulation Resource Center:

https://www.aacap.org/AACAP/Families_Youth/Resource_Centers/AACAP/Families_and_Youth/Resource_Centers/Emotional_Dysregulation/Home.aspx

AACAP Parent’s Medication Guide:

Are you navigating the complex world of psychiatric medication management in primary care? Look no further! In this episode of Pediatric Meltdown Dr. Lia talks frankly about the hesitancy of pediatric clinicians to prescribe psychotropic medications as one of the biggest barriers to providing mental health care in pediatric settings.  While she acknowledges that pediatricians are not child psychiatrists, Dr. Lia believes that pediatricians have the skills to address common mental health disorders including ADHD, anxiety and depression, and to do it well.  She emphasizes the need to be mindful of suicide risk and to screen regularly for suicidal ideation, especially in patients with mental health disorders.  And, always consider trauma when assessing for mental health and behavior concerns.  When it comes to prescribing medications, get comfortable with a few SSRI’s and both stimulant and non-stimulant ADHD treatments, and before switching from one psychotropic to another, she advises maximizing dosing titration while simultaneously monitoring for side effects.  Remember that in your role as a primary care provider, you have an incredible opportunity to impact the stability and quality of life for children facing mental health struggles.  For more tips, expert advice and in-depth knowledge, don't hesitate to explore all of the resources available at pediatricmeltdown.com. Know better, do better!

[01:26 -03:50] Understanding the Role of Medication

• Primary care providers don't need to be psychiatrists but should be equipped to prescribe SSRIs.
• Familiarize yourself with a few SSRIs such as fluoxetine, escitalopram, and sertraline and understand their characteristics.
•  It’s vital to maximize doses carefully before switching between medications and to be aware of side effects.

[03:51 - 06:18]  Navigating ADHD Medication Challenges  

• Not all cases of ADHD are straightforward; comorbid conditions can complicate diagnosis and treatment.
• Stimulant medications can quickly indicate effectiveness; doses should be carefully adjusted based on response.
• Monitoring for side effects such as appetite loss, weight changes, and sleep disturbances is necessary.

[06:19 - 10:44]  Managing Complex Cases and Atypicals

• Always explore the possibility of trauma influencing behavioral symptoms, as it can mimic various conditions.
• Exercise caution when inheriting a patient on multiple medications; consult specialists rather than abruptly stopping treatment.
• Monitor physical health markers when prescribing Atypicals like hemoglobin A1C, lipids, and prolactin levels, considering adjunctive treatments like Metformin.

Links to resources mentioned on the show

Episode #44 with Dr. Jeffrey Strawn.   Anxiety Disorders in Children:  Treatment Options https://pediatricmeltdown.com/44-anxiety-disorders-in-children-treatment-pearls/

Episode #37 with Dr. Lisa Horowitz.  Screening For Suicide Risk Using the Ask Suicide Screening Questions Tool

https://pediatricmeltdown.com/37-screening-youth-for-suicide-risk-using-the-ask-suicide-screening-questions-tool/

Episode #132 with Dr. Brooks Keeshin. Psychopharmacology:  Considerations Before Prescribing