Child Mental Health for Pediatric Clinicians

63. Top 3 Things I Learned in 2025

• Elise Fallucco • Episode 63

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Dr. Elise Fallucco reviews the highlights from 2025 and the TOP THREE things she learned about Child Mental Health from 2025 podcast episodes. Celebrate surpassing 50 episodes, explore exciting new episode formats like 'mystery cases,' and gain insights from impactful discussions with parents about ADHD and anxiety in children. 

 Tune in for excerpts from some of the most memorable episodes, including from the MOST downloaded episode of the year!

00:00 Introduction and Year in Review Overview

00:50 Podcast Milestones and Global Reach

02:05 New Episode Formats: Mystery Cases

03:16

03:49 Highlight: ADHD Masking in Children

06:21 Highlight: Hormonal Impact on Mental Health

08:49 Highlight: Gender Differences in ADHD

11:21 Most Downloaded Episode of 2025

12:22 ADHD vs. Bipolar - in Relationships

13:27 Conclusion and Thank You

LINKS:

Watch this episode on YOUTUBE: https://youtu.be/2fDrk1GIsJs

49. Mystery Case - 9 yo w/ anxiety and sudden behavioral problems

https://podcasts.apple.com/us/podcast/child-mental-health-for-pediatric-clinicians/id1696529206?i=1000695757771

54. Masking: Can you hide ADHD with Ashley and Lauren

https://podcasts.apple.com/us/podcast/child-mental-health-for-pediatric-clinicians/id1696529206?i=1000723572616

59. PMDD How Hormones can affect teenage girls with Laurina

https://podcasts.apple.com/us/podcast/child-mental-health-for-pediatric-clinicians/id1696529206?i=1000733846317

52. ADHD. in Girls - all the things you should know

https://podcasts.apple.com/us/podcast/child-mental-health-for-pediatric-clinicians/id1696529206?i=1000718448053

TOP EPISODE OF 2025 - 51. Is it ADHD or Bipolar? with Dr. John Walkup

https://podcasts.apple.com/us/podcast/child-mental-health-for-pediatric-clinicians/id1696529206?i=1000700737488

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

Dr. Elise Fallucco:

Welcome back to Child Mental Health for Pediatric Clinicians. I'm your host, Dr. Elise Fallucco, child psychiatrist, and mom, I'm really excited that you're joining me for this 2025 year in review where we're gonna talk about some highlights and then go over at the top three things I learned this year while doing the pod. And while this podcast is ostensibly about sharing child mental health knowledge to help all of you take really excellent care of the patients and the kids and families in your practice and in your community, as a bonus, it's really fun for me. To do lit reviews and to read articles about things that I haven't thought about in a while, and just to try to stay current and up to date on the latest in child mental health so that I can share it with you all. So let's get to highlights. One of the big highlights of this year is that we have surpassed the 50th episode mark, which is a big milestone for us. And if you listen to the perfectionism episode last week, you probably realize that the next thing in my mind is like, okay, now we've gotta get to 100 and beyond. I'm also really excited to thank all of our listeners across the globe. We have downloads in all of the continents except for Antarctica. Not sure what's going on there. And we have a lot of listeners in the region of Oceania, and I'm. Embarrassed to admit that I was not aware that that's the term that describes Australia and New Zealand and a bunch of islands in the Pacific Ocean. Um, somehow I missed that during my geography education. All of this to say. I'm sorry. And also thank you Oceania for listening. Another highlight of the year was that we started a video version of the podcast on YouTube. And for those of you who are watching right now, i'm waving at you. And also you may be able to see the stockings hung by the chimney with care behind me. Not shown is the major mess that is going on in other rooms right now. So back to another highlight of the year is that we tried out some new episode formats, the first of which was this concept of the idea of mystery cases. And for those of you who know me, I love the practice of working through a mystery. I remember being in pediatrics morning report when I was in medical school, and the chief resident would write down a one-liner on the whiteboard. Like last night, one of our admissions was a 7-year-old who presented with fever, and then we'd all have to raise our hands and think about what's the differential diagnosis, what could be going on. The chief resident would give us more information and we'd start going down a certain diagnostic path, and eventually we'd figure out what's happening and then try to talk about different treatment options and pros and cons for each of them. So the mystery case format is basically like a child mental health version of morning report, except much less stressful and hopefully much more fun. Here's an excerpt from our first mystery case. Today's mystery case is a nine year old boy with anxiety who's been having behavior problems in school, as well as some hyperactivity, insomnia, and impulsivity. Your job is to figure out what is causing these new symptoms and how you can help. And if you wanna listen to the whole mystery case and figure out what was going on, I'm gonna include links in the show notes to episode 49, which was our first mystery case. So this brings us to another highlight of the year, which was a different episode format that we tried out that involved talking to parents about their experiences raising kids with mental health problems. It was through this format of talking to parents of kids with mental health challenges that I learned one of the top three things that we all need to know about kids with child mental health problems. The first of the top three things has to do with understanding how kids with A DHD can mask their symptoms. And it was during this podcast where two parents, Ashley and Lauren talked about the concept of their kids intentionally covering their symptoms during the day in order to better fit in socially. And before this episode, I was really familiar with the idea of masking in neurodivergent kids, but specifically in kids with autism. And I was surprised to learn that there are a lot of kids with A DHD who are also masking throughout the day. And I really appreciated their descriptions of what is it like to mask, what does that look like, and social interactions and how it really negatively impacts the kids and. How taxing it is to have to mask symptoms or downplay your own symptoms during the day at school and how that can ultimately lead to kids feeling completely worn out and melting down at the end of the day after school. And in this excerpt from episode 54, Lauren talks about how she was able to see her daughters masking in school firsthand when she visited her during lunch. And also how her daughter was able to describe to her what it was like to mask and why she was doing it. Fascinating. Here's an excerpt from that episode number 54.

Lauren:

Yeah, I actually noticed it with my daughter. I went to visit her at school one day for lunch, and I went in and she was so quiet, just shut down. Really? She was shutting down in the lunchroom, but all of her friends are having very animated conversations. And normally at home, she would be the one, my husband calls her chicharona, which is like Italian for Chatty Cathy and she's the one you described before she interrupts. She's constantly talkative. But now she's in a social situation at lunch and just completely quiet. What is that? She ended up talking to me about it and she said she didn't feel like she could be herself at school. She's always afraid that she's gonna interrupt somebody and that's gonna make them mad. And so she's just quiet and she feels like a shell of herself. She was really describing masking. And then she would come home and both of my kids would come home and they'd be exhausted and have meltdowns.

Dr. Elise Fallucco:

Thanks again to Lauren and Ashley for being willing and open to share your experiences on the pod so that we can better understand them. This brings us to another of the top three things that I learned this year on the podcast, and that is really developing a deeper understanding of how hormones impact symptoms of A DHD, anxiety and frankly, mood disorders in our teenage girls. And while I know many of us are familiar with the concept of PMDD, premenstrual Dysphoric Disorder, I hadn't realized that I should be talking more to my patients and to people I know with mental health problems about how your symptoms can get worse in the week before your period. It's not just that you're developing 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 of inattention or forgetfulness or irritability might be more prominent, let's say during certain weeks of the month. I got interested in this during a discussion with Laurina, who is another parent who shared about her experience and her perspective of raising a daughter with A DHD and anxiety, but who also experienced premenstrual exacerbation and PMDD. in this excerpt, Laurina is talking about her perspective as a mom, but also information that her daughter bravely shared with her about what it is like and what it feels like. To be inside her body and her mind in the week before her period.

Laura:

She told me that for the week before she would start her period, she said she actually avoided mirrors because she, if she saw herself in the mirror, she would start to cry.

Dr. Elise Fallucco:

I wonder why that was.

Laura:

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, Beth came to me one night and she was just in meltdown mode, and it was right before she was supposed to go to bed, eight 30 at night and just absolutely falling apart and saying, I can't do this anymore. I don't want to exist. I want the world to just swallow me up. I can't do this. she just was so emotionally overwhelmed and she just felt hopeless, she said.

Dr. Elise Fallucco:

Another huge thank you to Laurina and to her daughter for helping us understand what some of our patients are going through. So this brings us to the third major thing that I learned in 2025 related to the podcast. And interestingly enough, this also has to do with gender. Back when I was in training, we talked about gender differences in A DHD, but at the time we knew so little and essentially what I learned was, well, girls with A DHD tend to present with more inattentive symptoms and they tend to be quieter, and so they're not as disruptive and therefore it's not as obvious to the people around them that they have a DHD. And so they don't get detected until they're older. Whereas boys tend to be more hyperactive, impulsive climbing on things, disruptive at school stereotypically, and so they're often diagnosed earlier. But my knowledge of gender differences in A DHD pretty much started and ended there until I was able to do some deep digging and to find out about some really cutting edge research and findings that suggest that there are more nuanced differences in A DHD symptoms in girls. And it made me think we may need to even be asking different questions for some of the girls who we're evaluating in our office to be able to detect whether they're having a DHD. This also makes me think that some of the questionnaires that we're currently using to assess for A DHD, like the Connors and the Vanderbilt. Are fantastic and well validated, and they may not do as good of a job at assessing A DHD symptoms in girls in particular. As a little teaser, I'm gonna share an excerpt from episode 52, A DHD in girls, all the things you should know. IIn this excerpt I talk about why girls with A DHD tend not to get recognized until around middle school. There's also a particular developmental stage where we tend to see a second wave of kids with ADHD in our office, and that would be the transition to middle school. This is a time where the academic load massively increases compared to elementary school and also the social demands are much higher. And so kids who maybe have been able to skirt along through elementary school just fine, begin to have problems in middle school with their grades dropping or having more obvious social impairment. Girls tend to connect with one another verbally and through conversation. So if you're a girl with a lot of a DHD related impulsivity and you're interrupting conversations or talking nonstop or blurting out answers, you may have trouble seamlessly connecting with other girls. And now the moment that we have all been waiting for, which is the big reveal of the most downloaded episode in 2025 on child mental health for pediatric clinicians. A discussion with a huge friend of the show, Dr. John Walkup. I'm delighted that I've had the opportunity to have so many conversations with John and that he has graced us by sharing his thoughts, his clinical experience, and his really practical tools for understanding child mental health with all of us. So without further ado, the number one top most downloaded episode of 2025 is episode 51. Is it A DHD or bipolar with Dr. John Walkup. Since kids with undiagnosed bipolar could be walking around with a diagnosis of A DHD, let's talk about what types of things would make you worry about bipolar in somebody with a diagnosis of a DH. D.

Dr. John Walkup:

You know everybody loves the ADHD kid even though he's not on stimulants. They're fun, they're funny, they're in the world with you, they just have a hard time managing themselves.

Dr. Elise Fallucco:

They're fun loving, they're class clowns. they're very likable typically.

Dr. John Walkup:

The bipolar kids burn up relationships in the way that no other disorder burns up relationships. People are tired of them. They wear out relationships. And so they even wear out their relationship with their parents. And it's very hard for parents to Give up on their kids a little bit, but these are kids where parents are on that edge where they just, they don't understand their kid. They can't manage their kid and the lack of engagement and the lack of responsiveness. The lack of respect for the relationship, all of that kind of goes out the window with bipolar disorder, because again, these folks are above it all.

Dr. Elise Fallucco:

And a huge thanks to Dr. John Walkup for continuing to come on the pod and for sharing his experiences. And if you have not gotten a chance to listen to this episode, it is gold. Really fantastic. So this brings us to the end of our year in review of 2025. Thank you for listening. I really wanna send a message to all of you who have found us on Spotify or Apple Podcasts or even YouTube. Thank you so much for being a part of our child mental health crew of friends and colleagues. And if you've not yet signed up to get our. Email newsletter. Make sure to go to the website at psyched the number four peds. That's P-S-Y-C-H-E-D, number four peds.com. And scroll down to signed up to become a friend and colleague of Child Mental Health, and that way we can keep you up to date on everything that's going on. Final note, best wishes. Looking forward to reconnecting in 2026. Take care.