Child Mental Health for Pediatric Clinicians

Elise Fallucco M.D.
  • 4.8 (37)
  • Medicine
  • Updated Weekly

Child Mental Health for Pediatric Clinicians podcast - formerly PsychEd4Peds -is the child mental health podcast designed for pediatric clinicians - helping you help kids. The host, Dr. Elise Fallucco, M.D., is a board-certified child and adolescent psychiatrist and mom of three who teaches pediatric clinicians to identify, manage, and support kids and teens with mental health problems.  Dr. Fallucco interviews experts in the fields of child psychiatry, psychology, and pediatrics to share practical tools, tips, and strategies to help pediatric clinicians take care of kids and teens.

  1. 6d ago

    76. 5 Things That Will CHANGE Your Practice

    Send us Fan Mail 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 choice2 - 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 changeReview 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

    10 min

  2. Jun 2

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

    Send us Fan Mail 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

    22 min

  3. May 13

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

    Send us Fan Mail 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-playbookFinally, 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

    14 min

  4. Apr 28

    73. ADHD Clinical Pearls: Measuring what matters with Dr. James Waxmonsky

    Send us Fan Mail 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 task00:00 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

    16 min

  5. Apr 21

    72. Can we develop Tolerance to stimulants? with Dr. James Waxmonsky

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

    22 min

  6. Apr 7

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

    Send us Fan Mail 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 experiencewhy ADHD can be a misnomer how video games/TikTok exploit variable reward scheduleshow this changes what we tell patients and families about stimulantsOur 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 Check out our website PsychEd4Peds.com for more resources! Follow us on Instagram @psyched4peds

    25 min

  7. Mar 31

    70. Anxiety that has failed 2 SSRIs: How to switch and which med to choose next with Dr. Strawn

    Send us Fan Mail 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 SNRIRationale: 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 150-200mgConsider grouping 3 of the SSRIs by their similar metabolic pathways (2C19): Sertraline, Citalopram, and EscitalopramIf 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 groupFluoxetine 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 timeThe 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 Check out our website PsychEd4Peds.com for more resources! Follow us on Instagram @psyched4peds

    17 min

  8. Mar 24

    69. How to Switch SSRIs with Dr. Jeffrey Strawn

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

    20 min
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About

Child Mental Health for Pediatric Clinicians podcast - formerly PsychEd4Peds -is the child mental health podcast designed for pediatric clinicians - helping you help kids. The host, Dr. Elise Fallucco, M.D., is a board-certified child and adolescent psychiatrist and mom of three who teaches pediatric clinicians to identify, manage, and support kids and teens with mental health problems.  Dr. Fallucco interviews experts in the fields of child psychiatry, psychology, and pediatrics to share practical tools, tips, and strategies to help pediatric clinicians take care of kids and teens.

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