Episode Transcript
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Dr. Elise Fallucco (00:21):
Welcome back
to Child Mental Health for
Pediatric Clinicians.
I'm your host, Dr.
Elise Fallucco, childpsychiatrist, and mom, I'm
really excited that you'rejoining me for this 2025 year in
review where we're gonna talkabout some highlights and then
go over at the top three thingsI learned this year while doing
the pod.
And while this podcast isostensibly about sharing child
(00:44):
mental health knowledge to helpall of you take really excellent
care of the patients and thekids and families in your
practice and in your community,as a bonus, it's really fun for
me.
To do lit reviews and to readarticles about things that I
haven't thought about in awhile, and just to try to stay
current and up to date on thelatest in child mental health so
(01:08):
that I can share it with youall.
So let's get to highlights.
One of the big highlights ofthis year is that we have
surpassed the 50th episode mark,which is a big milestone for us.
And if you listen to theperfectionism episode last week,
you probably realize that thenext thing in my mind is like,
okay, now we've gotta get to 100and beyond.
(01:30):
I'm also really excited to thankall of our listeners across the
globe.
We have downloads in all of thecontinents except for
Antarctica.
Not sure what's going on there.
And we have a lot of listenersin the region of Oceania, and
I'm.
Embarrassed to admit that I wasnot aware that that's the term
(01:50):
that describes Australia and NewZealand and a bunch of islands
in the Pacific Ocean.
Um, somehow I missed that duringmy geography education.
All of this to say.
I'm sorry.
And also thank you Oceania forlistening.
Another highlight of the yearwas that we started a video
version of the podcast onYouTube.
(02:11):
And for those of you who arewatching right now, i'm waving
at you.
And also you may be able to seethe stockings hung by the
chimney with care behind me.
Not shown is the major mess thatis going on in other rooms right
now.
So back to another highlight ofthe year is that we tried out
some new episode formats, thefirst of which was this concept
(02:33):
of the idea of mystery cases.
And for those of you who knowme, I love the practice of
working through a mystery.
I remember being in pediatricsmorning report when I was in
medical school, and the chiefresident would write down a
one-liner on the whiteboard.
Like last night, one of ouradmissions was a 7-year-old who
presented with fever, and thenwe'd all have to raise our hands
(02:54):
and think about what's thedifferential diagnosis, what
could be going on.
The chief resident would give usmore information and we'd start
going down a certain diagnosticpath, and eventually we'd figure
out what's happening and thentry to talk about different
treatment options and pros andcons for each of them.
So the mystery case format isbasically like a child mental
health version of morningreport, except much less
(03:15):
stressful and hopefully muchmore fun.
Here's an excerpt from our firstmystery case.
Today's mystery case is a nineyear old boy with anxiety who's
been having behavior problems inschool, as well as some
hyperactivity, insomnia, andimpulsivity.
Your job is to figure out whatis causing these new symptoms
(03:36):
and how you can help.
And if you wanna listen to thewhole mystery case and figure
out what was going on, I'm gonnainclude links in the show notes
to episode 49, which was ourfirst mystery case.
So this brings us to anotherhighlight of the year, which was
a different episode format thatwe tried out that involved
talking to parents about theirexperiences raising kids with
(03:58):
mental health problems.
It was through this format oftalking to parents of kids with
mental health challenges that Ilearned one of the top three
things that we all need to knowabout kids with child mental
health problems.
The first of the top threethings has to do with
understanding how kids with ADHD can mask their symptoms.
(04:19):
And it was during this podcastwhere two parents, Ashley and
Lauren talked about the conceptof their kids intentionally
covering their symptoms duringthe day in order to better fit
in socially.
And before this episode, I wasreally familiar with the idea of
masking in neurodivergent kids,but specifically in kids with
autism.
(04:39):
And I was surprised to learnthat there are a lot of kids
with A DHD who are also maskingthroughout the day.
And I really appreciated theirdescriptions of what is it like
to mask, what does that looklike, and social interactions
and how it really negativelyimpacts the kids and.
How taxing it is to have to masksymptoms or downplay your own
(05:02):
symptoms during the day atschool and how that can
ultimately lead to kids feelingcompletely worn out and melting
down at the end of the day afterschool.
And in this excerpt from episode54, Lauren talks about how she
was able to see her daughtersmasking in school firsthand when
she visited her during lunch.
(05:23):
And also how her daughter wasable to describe to her what it
was like to mask and why she wasdoing it.
Fascinating.
Here's an excerpt from thatepisode number 54.
Lauren (05:34):
Yeah, I actually noticed
it with my daughter.
I went to visit her at schoolone day for lunch, and I went in
and she was so quiet, just shutdown.
Really?
She was shutting down in thelunchroom, but all of her
friends are having very animatedconversations.
And normally at home, she wouldbe the one, my husband calls her
chicharona, which is likeItalian for Chatty Cathy and
(05:57):
she's the one you describedbefore she interrupts.
She's constantly talkative.
But now she's in a socialsituation at lunch and just
completely quiet.
What is that?
She ended up talking to me aboutit and she said she didn't feel
like she could be herself atschool.
She's always afraid that she'sgonna interrupt somebody and
that's gonna make them mad.
And so she's just quiet and shefeels like a shell of herself.
(06:19):
She was really describingmasking.
And then she would come home andboth of my kids would come home
and they'd be exhausted and havemeltdowns.
Dr. Elise Fallucco (06:29):
Thanks again
to Lauren and Ashley for being
willing and open to share yourexperiences on the pod so that
we can better understand them.
This brings us to another of thetop three things that I learned
this year on the podcast, andthat is really developing a
deeper understanding of howhormones impact symptoms of A
(06:51):
DHD, anxiety and frankly, mooddisorders in our teenage girls.
And while I know many of us arefamiliar with the concept of
PMDD, premenstrual DysphoricDisorder, I hadn't realized that
I should be talking more to mypatients and to people I know
with mental health problemsabout how your symptoms can get
(07:11):
worse in the week before yourperiod.
It's not just that you'redeveloping PMS, but you can also
have worsening anxiety,worsening attention and
concentration.
And as a side note.
Being a woman of a certain age,it's also made me think about
how my own symptoms ofinattention or forgetfulness or
irritability might be moreprominent, let's say during
(07:36):
certain weeks of the month.
I got interested in this duringa discussion with Laurina, who
is another parent who sharedabout her experience and her
perspective of raising adaughter with A DHD and anxiety,
but who also experiencedpremenstrual exacerbation and
PMDD.
in this excerpt, Laurina istalking about her perspective as
(07:56):
a mom, but also information thather daughter bravely shared with
her about what it is like andwhat it feels like.
To be inside her body and hermind in the week before her
period.
Laura (08:08):
She told me that for the
week before she would start her
period, she said she actuallyavoided mirrors because she, if
she saw herself in the mirror,she would start to cry.
Dr. Elise Fallucco (08:18):
I wonder why
that was.
Laura (08:20):
Just being so emotionally
overwhelmed, I think is how what
she described it as she said,she was just so exhausted and,
and tired.
I remember in December, Bethcame to me one night and she was
just in meltdown mode, and itwas right before she was
supposed to go to bed, eight 30at night and just absolutely
(08:43):
falling apart and saying, Ican't do this anymore.
I don't want to exist.
I want the world to just swallowme up.
I can't do this.
she just was so emotionallyoverwhelmed and she just felt
hopeless, she said.
Dr. Elise Fallucco (09:03):
Another huge
thank you to Laurina and to her
daughter for helping usunderstand what some of our
patients are going through.
So this brings us to the thirdmajor thing that I learned in
2025 related to the podcast.
And interestingly enough, thisalso has to do with gender.
Back when I was in training, wetalked about gender differences
(09:23):
in A DHD, but at the time weknew so little and essentially
what I learned was, well, girlswith A DHD tend to present with
more inattentive symptoms andthey tend to be quieter, and so
they're not as disruptive andtherefore it's not as obvious to
the people around them that theyhave a DHD.
And so they don't get detecteduntil they're older.
Whereas boys tend to be morehyperactive, impulsive climbing
(09:47):
on things, disruptive at schoolstereotypically, and so they're
often diagnosed earlier.
But my knowledge of genderdifferences in A DHD pretty much
started and ended there until Iwas able to do some deep digging
and to find out about somereally cutting edge research and
findings that suggest that thereare more nuanced differences in
(10:10):
A DHD symptoms in girls.
And it made me think we may needto even be asking different
questions for some of the girlswho we're evaluating in our
office to be able to detectwhether they're having a DHD.
This also makes me think thatsome of the questionnaires that
we're currently using to assessfor A DHD, like the Connors and
the Vanderbilt.
(10:31):
Are fantastic and wellvalidated, and they may not do
as good of a job at assessing ADHD symptoms in girls in
particular.
As a little teaser, I'm gonnashare an excerpt from episode
52, A DHD in girls, all thethings you should know.
IIn this excerpt I talk aboutwhy girls with A DHD tend not to
get recognized until aroundmiddle school.
(10:54):
There's also a particulardevelopmental stage where we
tend to see a second wave ofkids with ADHD in our office,
and that would be the transitionto middle school.
This is a time where theacademic load massively
increases compared to elementaryschool and also the social
demands are much higher.
And so kids who maybe have beenable to skirt along through
(11:16):
elementary school just fine,begin to have problems in middle
school with their gradesdropping or having more obvious
social impairment.
Girls tend to connect with oneanother verbally and through
conversation.
So if you're a girl with a lotof a DHD related impulsivity and
you're interruptingconversations or talking nonstop
or blurting out answers, you mayhave trouble seamlessly
(11:39):
connecting with other girls.
And now the moment that we haveall been waiting for, which is
the big reveal of the mostdownloaded episode in 2025 on
child mental health forpediatric clinicians.
A discussion with a huge friendof the show, Dr.
John Walkup.
I'm delighted that I've had theopportunity to have so many
(12:02):
conversations with John and thathe has graced us by sharing his
thoughts, his clinicalexperience, and his really
practical tools forunderstanding child mental
health with all of us.
So without further ado, thenumber one top most downloaded
episode of 2025 is episode 51.
(12:24):
Is it A DHD or bipolar with Dr.
John Walkup.
Since kids with undiagnosedbipolar could be walking around
with a diagnosis of A DHD, let'stalk about what types of things
would make you worry aboutbipolar in somebody with a
diagnosis of a DH.
D.
Dr. John Walkup (12:43):
You know
everybody loves the ADHD kid
even though he's not onstimulants.
They're fun, they're funny,they're in the world with you,
they just have a hard timemanaging themselves.
Dr. Elise Fallucco (12:53):
They're fun
loving, they're class clowns.
they're very likable typically.
Dr. John Walkup (12:59):
The bipolar
kids burn up relationships in
the way that no other disorderburns up relationships.
People are tired of them.
They wear out relationships.
And so they even wear out theirrelationship with their parents.
And it's very hard for parentsto Give up on their kids a
little bit, but these are kidswhere parents are on that edge
where they just, they don'tunderstand their kid.
(13:21):
They can't manage their kid andthe lack of engagement and the
lack of responsiveness.
The lack of respect for therelationship, all of that kind
of goes out the window withbipolar disorder, because again,
these folks are above it all.
Dr. Elise Fallucco (13:35):
And a huge
thanks to Dr.
John Walkup for continuing tocome on the pod and for sharing
his experiences.
And if you have not gotten achance to listen to this
episode, it is gold.
Really fantastic.
So this brings us to the end ofour year in review of 2025.
Thank you for listening.
I really wanna send a message toall of you who have found us on
(13:59):
Spotify or Apple Podcasts oreven YouTube.
Thank you so much for being apart of our child mental health
crew of friends and colleagues.
And if you've not yet signed upto get our.
Email newsletter.
Make sure to go to the websiteat psyched the number four peds.
That's P-S-Y-C-H-E-D, numberfour peds.com.
(14:20):
And scroll down to signed up tobecome a friend and colleague of
Child Mental Health, and thatway we can keep you up to date
on everything that's going on.
Final note, best wishes.
Looking forward to reconnectingin 2026.
Take care.