Responding to the Alarming Rise of Depression in Adolescent Girls

Gain a deeper understanding of the challenges faced by adolescent girls and the proactive steps clinicians can take to support them.

When and how to send kids to the emergency room

“The first thing I would say to any clinician is that it’s never wrong to send a child to the emergency room,” said Amy Dryer, MD, pediatrician and REACH faculty member.

Having spent 10 years in a hospital emergency department, Dr. Dryer is intimately familiar with the criteria ER physicians use to decide to admit psychiatric patients: a medical condition, suicidal ideation with a lethal plan, homicidal ideation, or active psychosis.

However, she emphasized that your decision to refer to the ER doesn’t hinge on whether the patient is likely to be admitted. “If what they’re telling you makes you uncomfortable,” she said, “go ahead and refer them.”

After you screen for anxiety, then what?

As you’ve heard, the US Preventative Service Task Force (USPSTF) recently issued draft guidelines recommending that primary care providers (PCPs) screen all adults aged 19 to 64 for anxiety disorders. Guidelines recommending anxiety screening for children aged 8 to 18 were finalized last week. The question is, if the screener indicates that anxiety is an issue, then what do you do? Patty Gibson, MD, a psychiatrist on the REACH Adult Behavioral Health faculty, shared some basics from the course to answer the question.

Is it ADHD? Or something else?

Attention-deficit hyperactivity disorder (ADHD) is one of the most common behavioral health disorders, affecting approximately 9% of all children and adolescents. About 75% of pediatric patients with ADHD have comorbid mental health conditions, ranging from oppositional-defiant disorder to anxiety and mood disorders.

What is a busy clinician to do? How do you discern whether a child who is, say, having difficulty focusing at school and at home has ADHD, anxiety, both, or something else?

Assessing and treating substance abuse

“The risk of substance use starts at about age 10,” said Sam Chang, MD, a child and adolescent psychiatrist on the REACH faculty. “Prevention has to start before that. By the time kids reach adolescence, the horse has left the barn.”

Assessment & treatment of eating disorders in adolescents

Eating disorders are life-threatening mental health conditions—and they are not limited to affluent white girls! Eating disorders affect people of lower socioeconomic status, members of non-white ethnic groups, preteen children, and boys. LGBTQIA young people are at particular risk.

DSM-5 defines four main categories of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder, along with several atypical disorders.

Screening for trauma in pediatric primary care

Asked the top three things a pediatric primary care provider (PCP) needs to know about child trauma, Brooks Keeshin, MD, said, “Trauma happens. That’s numbers 1, 2, and 3.”

In fact, up to 80% of children experience trauma by the time they are 18. A large body of evidence indicates that childhood trauma affects physical and mental health, both short term and long term.

Dr. Keeshin, a child abuse pediatrician and child psychiatrist, is developing a new REACH Institute course to teach PCPs to assess and treat child trauma.

“Trauma reactions can look like other mental health conditions,” said Dr. Keeshin. “Traumatic stress can present with symptoms of ADHD, depression, or anxiety. If the pediatrician knows a child has been exposed to trauma, that changes what they do. But first they need to know.”

Helping patients deal with trauma

A medical appointment can be intimidating and scary for a child with a history of trauma. Still, this visit might be the first time a patient shares that they have been sexually or physically abused or that they are terrified to live with their fighting parents during COVID-19. Your role as a primary care provider (PCP) is critical. Your interactions with your patient need to feel safe. As constrained as your time is, you must make every minute count toward establishing a connection.

GLAD-PC Toolkit Is Here to Help You Treat Depression

The new edition of Guidelines for Adolescent Depression in Primary Care (GLAD-PC) is now available on The REACH Institute website. This practical toolkit offers dozens of resources to help pediatric primary care providers diagnose and treat depression.

How to Manage School Refusal

Ryan, age 12, has missed almost three weeks of school so far. He complains of nausea and headache most school days and has to be cajoled into getting out of bed, but his mother says he is fine on weekends. The mother, who is eight months pregnant, is frantic; she can’t afford to take any more time off work before she delivers. School refusal can have serious consequences. On the short term, the child falls behind academically, both the child and the family experience disruption and distress, and there can be legal and financial ramifications. Long-term consequences for school refusers include violent behavior, school dropout, early marriage, and unemployment. “The main goal of treatment is to get the child back to school as soon as possible,” says Lisa Hunter Romanelli, PhD, REACH Institute CEO and clinical psychologist. “Being absent from school is highly reinforcing.” Like many school refusers, Ryan presents somatic complaints. After you rule out physiological causes– not only for these complaints but also for any underlying conditions that can produce depression or anxiety–what’s next?