News/Media
One teen, 10 psychiatric drugs. This must stop!
On August 27, The New York Times ran an article by Matt Richtel titled “This Teen Was Prescribed 10 Psychiatric Drugs. She Is Not Alone.” It documents the practice of “polypharmacy”: prescribing multiple medications—most of which have not been tested either in children or in combination with one another—to manage young patients’ depression or anxiety.
That young patients are being prescribed potent cocktails of untested drugs is obviously wrong. The question is, how did we get to this point, and what can we do about it?
Read MoreIEP and 504 school accommodations for mental health needs
Children with mental health diagnoses may need special accommodations in order to succeed in school. Patients with attention-deficit hyperactivity disorder (ADHD) or autism come immediately to mind. However, children with depression and anxiety disorders may also struggle in the classroom.
Pediatric primary care providers (PCPs) and therapists can help families get the school accommodations their children need. Mark Wolraich, MD, REACH faculty member and retired professor of pediatrics at the University of Oklahoma Health Sciences Center, emphasizes that children are best served when professionals take a team approach to mental health care.
Read MoreADHD medication “holidays”?
As summer rolls around, families may ask whether their children can have a “holiday” from their psychoactive medication, especially for attention-deficit hyperactivity disorder (ADHD). We asked Lawrence Amsel, MD, MPH, a REACH faculty member and associate professor of psychiatry at Columbia University, to lay out the pros and cons.
Read MoreOvercoming anxiety about the news
In the wake of the Texas school shooting tragedy, your young patients–and their families–may be experiencing anxiety that can affect normal functioning. That anxiety can manifest in many ways, from reluctance to go to school to increased aggressive tendencies.
In fact, pediatric primary care providers (PCPs) have been observing the effects of news consumption on their young patients for years now. The spike in anxiety at the beginning of the Covid pandemic is another example. Families may be experiencing trauma as they watch scenes of devastation and displacement in Ukraine. Every act of terrorism or mass violence inspires more fear. The examples go on.
As your families’ trusted PCP, you can influence how patients and families deal with anxiety over recent events and the continuous barrage of bad news that characterizes today’s media culture.
Read MoreScreening 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.”
Read MoreAssessment & 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.
Read MoreChild abuse and neglect
In a study sponsored by the Centers for Disease Control and Prevention, 10.8% of adults reported having been physically abused as children, and 11.1% reported psychological abuse. Infants and young children are at greater risk than older children; neglect is more commonly reported than physical, psychological, or sexual abuse, according to the National Child Abuse and Neglect Data System.
As a pediatric primary care provider (PCP), you play a vital role in detecting and preventing child abuse and neglect.
Read MoreHelping African-American children with mental health issues
Last week I saw two children, both African American, who were having suicidal thoughts. In neither case did the child or the parents come in asking for mental health support.
One, a 13-year-old girl I’ll call Simone, wrote on her PHQ-9 depression screener that she had attempted suicide. In our interview, she revealed that she had had sex with a man she met online and that she had been cutting herself. Yet the reason she and her parents came in was an ADHD medication check!
Pediatric primary care providers (PCPs) need to realize that African-American families may not seek help for mental health issues. The reasons for the lack of disclosure are rooted in the stigma around mental health in the African-American community. The stigma, in turn, is rooted in the trauma associated with being Black in America.
Read MoreNew treatments for ADHD
Newer treatments approved by the Food and Drug Administration (FDA) for pediatric patients with attention-deficit/hyperactivity disorder (ADHD) include two medications that address some of the common issues families have with standard stimulant treatments. Another development is use of devices to manage ADHD symptoms.
Read MoreHelping families deal with holiday stress
“In some ways the holidays this year will be harder than last year for many people,” said Deborah Buccino, MD, pediatrician and REACH board member. “Earlier, we had pretty clear-cut rules about what you could and could not do safely. This year, we have a lot more gray areas.”
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