Raising Good Humans: Episode Summary Title: To Medicate or Not to Medicate? Dr. Jaffe on ADHD & Anxiety: Finding the Right Path for Your Child
Host/Author: Dear Media, Aliza Pressman
Release Date: December 13, 2024

Introduction

In this insightful episode of "Raising Good Humans," host Dr. Aliza Pressman engages in a deep conversation with Dr. Jaffe, a board-certified child and adolescent psychiatrist. Dr. Jaffe brings a wealth of experience from his roles at Mount Sinai Hospital in New York City, focusing on ADHD, anxiety, and Tourette's disorder. The discussion centers on navigating the complex decisions parents face when considering medication for their children’s mental health challenges.

Current State of Child Mental Health

Dr. Jaffe opens by acknowledging the overwhelming surge in mental health diagnoses among youth, exacerbated by the COVID-19 pandemic. He notes, "there are definitely rising rates of mental illness across our young people" (02:11). The conversation delves into the dual narratives of overdiagnosis versus underdiagnosis, highlighting the confusion parents experience amidst conflicting information. Dr. Jaffe emphasizes the importance of parental intuition, stating, "Parents know their kids best" (04:30), encouraging caregivers to trust their instincts when they sense something amiss in their child's behavior or academic performance.

Causes and Contributing Factors

Dr. Jaffe discusses the multifaceted nature of rising mental health issues, attributing them to various factors:

• Increased Awareness: More diagnoses may reflect greater awareness and reduced stigma.
• Environmental Pressures: Modern life presents heightened stressors for adolescents, from academic demands to social media influences.
• Technology Overload: The constant influx of information can be overwhelming, impacting cognitive processing.
• Sleep Deficiency: Highlighting the critical role of sleep, Dr. Jaffe shares, "It's an insanely small amount of sleep" (07:05), underscoring how poor sleep hygiene can significantly affect mental health.

He further explores the impact of technology and social media, recognizing both their benefits and potential harms. The rapid dissemination of unvetted information can lead to self-diagnosis and misinterpretation of symptoms.

Genetics vs. Environment

Dr. Jaffe underscores the interplay between genetics and environment in mental health conditions. He explains, "everything that we see in psychiatry has a genetic component" (08:54), particularly in conditions like ADHD, which have a high genetic predisposition. However, environment plays a crucial role in how these genetic factors manifest. He advocates for comprehensive evaluations that consider both biological and environmental influences to tailor effective treatment plans.

Evaluation and Diagnosis Process

Dr. Jaffe outlines his thorough evaluation process for diagnosing ADHD and anxiety:

1. Initial Assessment (90 minutes): Meeting with parents to discuss the child's history from pregnancy to the present, focusing on current symptoms and overall functioning.
2. Individual Evaluation (45 minutes): Direct interaction with the child or teen to assess their experiences and behaviors.
3. Family Debrief: Summarizing findings and discussing treatment options with the family, emphasizing a holistic understanding of the child's environment and strengths.

This meticulous approach ensures that diagnoses are accurate and tailored to each child's unique situation.

Treatment Options: Medication vs. Therapy

A significant portion of the discussion centers on the decision to medicate. Dr. Jaffe emphasizes that there is no one-size-fits-all answer:

• Severity Matters: For severe impairments, medication may be necessary to stabilize the child enough to engage in therapy effectively. "The more impairing... the more I'm kind of like, let's... empty the toolbox here" (15:10).
• Mild to Moderate Cases: Often, starting with therapy is recommended, using medication as a supplementary measure if symptoms persist.
• Combination Approach: Research supports that combining medication with therapy yields better outcomes for conditions like anxiety and depression.

Dr. Jaffe also mentions an upcoming book, "Start Low and Go Slow, A Parent's Guide," aimed at addressing misconceptions and providing guidance on psychiatric medications for children.

Addressing Parental Concerns about Medication

Parents often worry that medication might alter their child's personality. Dr. Jaffe reassures them, stating, "these are not personality changing medications" (45:43). He acknowledges potential side effects but emphasizes that appropriate dosing and ongoing monitoring can mitigate these risks. He encourages parents to maintain open communication with their healthcare providers and to report any significant changes immediately.

Social Media and Self-Diagnosis

The influence of social media on mental health is a double-edged sword. While it can destigmatize conditions, it also spreads unvetted information leading to self-diagnosis. Dr. Jaffe advises clinicians to seek clarity by asking detailed questions about what individuals mean when they use certain terms, ensuring accurate diagnosis and treatment.

General Strategies for Parents

In response to audience questions, Dr. Jaffe offers universal strategies for supporting children with ADHD and anxiety:

1. Unconditional Love: "There is no substitute for an abundance of love."
2. Modeling Behavior: Demonstrate organizational skills and resilience.
3. Establish Boundaries: Limit distractions, such as excessive phone use, to foster a supportive environment.
4. Promote Resilience: Encourage children to overcome challenges, reinforcing their capabilities.

These strategies help create a nurturing environment that supports both therapy and, when necessary, medication.

Conclusion

This episode of "Raising Good Humans" provides a balanced, nuanced perspective on managing ADHD and anxiety in children. Dr. Jaffe offers valuable insights into the complexities of diagnosis and treatment, emphasizing individualized care that balances medication with environmental and behavioral interventions. By fostering open communication and trusting parental instincts, families can navigate the challenges of mental health with greater confidence and understanding.

Notable Quotes:

• "Parents know their kids best." – Dr. Jaffe (04:30)
• "There is no substitute for an abundance of love." – Dr. Jaffe (43:22)
• "These are not personality changing medications." – Dr. Jaffe (45:43)

Listening Notes:

For those unable to attend the live session or access Dr. Jaffe directly, this episode serves as a comprehensive guide to understanding the critical considerations in treating ADHD and anxiety in children. Dr. Pressman's empathetic hosting ensures that complex topics are accessible and actionable for parents seeking support on their parenting journey.

Please note: This summary excludes commercial segments and focuses solely on the content discussed between Dr. Pressman and Dr. Jaffe.