Child Mental Health for Pediatric Clinicians

Elise Fallucco M.D.
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  • MEDICINE
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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. 4D AGO

    72. Bench to Bedside - 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

  2. APR 7

    71. Bench to Bedside: 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

  3. 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

  4. 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

  5. MAR 3

    68. Deprescribing - The Science and Art of Stopping Medication with Dr. Jeffrey Strawn

    Send us Fan Mail What is the safest, most effective way to taper or stop psychotropic meds in children and teens? Dr. Elise Fallucco kicks off a new Deprescribing series with guest Dr. Jeffrey Strawn, coauthor of Stahl’s Deprescriber’s Guide.    They discuss how  clinicians and patients “deprescribe” in real life, and what can happen when tapering off or abruptly stopping medication including:  how to distinguish discontinuation (withdrawal) from relapse Focus on timing, symptom pattern (including dysesthesias/“brain zaps” and dizziness), and symptom trajectoryhow to manage cases of discontinuationpause - then more slowly taper off of medicationhow to manage relapsepause - and potentially increase back to the original doseDr. Jeffrey Strawn is a Professor of Psychiatry at the University of Cincinnati (UC) and the Director of Anxiety Disorders Research Program. Stahl's Deprescriber's Guide by Dr. Jeffrey Strawn and Dr. Stephen Stahl available at Amazon: https://www.amazon.com/Stahls-Deprescribers-Guide-Jeffrey-Strawn/dp/1009642200 Check out our website PsychEd4Peds.com for more resources! Follow us on Instagram @psyched4peds

    17 min

  6. FEB 24

    67. From Screen Addiction to Sextortion: Your Guide to Digital Safety with Tech Insider Ashley

    Send us Fan Mail On Part 3 of our Series on Tech and Child Mental Health, Dr. Elise Fallucco continues her conversation with Ashley (Tech Insider, Senior Manager of Global Risk Assessment at Twitch)  about: "Screen addiction" How to talk with kids and teens about online privacy and potential dangers like groomers and sextortion in an age-appropriate way Go-to resources for families navigating the digital world like The Family IT Guy on Social Media and online App/game parental control webpagesCommon Sense MediaHow to take down inappropriate content online Report directly to the app/platform Where/how to report child sexual exploitationThe National Center for Missing and Exploited Children's CyberTip line When to involve the FBIAre kids with ADHD  more vulnerable to problematic screen use and cyberbullying?Can heavy screen use cause inattention, impatience, impulsivity and ADHD-like symptoms? Check out our website PsychEd4Peds.com for more resources! Follow us on Instagram @psyched4peds

    18 min

  7. FEB 17

    66. Keeping Kids Safer Online with Tech-Insider Ashley: Parental Controls, Hidden App Risks, and Tech Alternatives to Smartphones

    Send us Fan Mail How can parents set real boundaries around kids’ screen use when every app has different settings—and kids can get around them? In part two of this tech safety series, Dr. Elise Fallucco continues her conversation with tech trust-and-safety insider (and mom) Ashley, senior manager of global risk assessment at Twitch. They break down why parents need to set parental controls inside each individual app (not just on the device), what to watch for in hidden or unexpected features like messaging and photo uploads (even in seemingly harmless games), and how kids may disguise apps to bypass rules. Ashley also shares practical tips like avoiding identifying details in usernames and profile photos, plus creative alternatives to a smartphone.  They also discuss safer ways for kids to listen to music, including risks on platforms like Spotify and a workaround  Finally, Ashley answers the question, “WHEN IS THE RIGHT time to introduce social media?” She talks about how to weigh factors like child maturity, family values, platform differences, ads, and risks like influencer content and mental health impacts— 00:00 Introduction 01:20 Setting Parental Controls and App Monitoring 02:29 Set Parental controls for EACH app!? 03:20 Monitoring Parental Controls 03:32 Apps in Disguise 04:45 Color By Number Surprises 06:13 Messaging and Grooming Risks 06:49 Practical Tips for Securing Tech Use for Kids 07:36 Username and Profile Picture Safety 09:21 Smartphones: Balancing risks and benefits 13:06 Music Players without graphic content 15:35 Social Media: When is it safe for kids to use? 17:59 Ashley's approach to thinking about Social Media Listen to Part ONE of this Tech Series 65. Digital Dangers: Tips from a Tech Insider https://www.buzzsprout.com/2182143/episodes/18649898 About Ashley: She is Senior Manager of Global Risk Assessment for Twitch, the world’s leading live-streaming platform. Check out our website PsychEd4Peds.com for more resources! Follow us on Instagram @psyched4peds

    20 min

  8. FEB 10

    65. Digital Dangers: Tips from a Tech Insider

    Send us Fan Mail Just when you thought it was safe to let kids play online... a Tech Insider shares surprising information about online/digital safety.  Dr. Fallucco chats with a seasoned professional in the trust and safety field about... How to balance the benefits of technology while minimizing RISKS like exposure to violence, cyberbullying, and grooming. How to set up a Child Tech contract - that defines WHEN a child can use technology, WHERE they can use it, and HOW they can use it (i.e. which apps/games are safe and approved)The NUMBER one rule for Tech Safety - DO NOT USE SCREENS IN THE BEDROOM.... and why this is so importantSend us YOUR  questions about tech safety! Drop us a comment at our instagram site @psyched4peds, leave us a "chat" on our website, Psyched4peds.com, or reply to our mailing list with YOUR QUESTIONS ABOUT TECH SAFETY! Check out our website PsychEd4Peds.com for more resources! Follow us on Instagram @psyched4peds

    21 min
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4.8
out of 5
36 Ratings

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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