AUGUSTA, Ga. (WJBF) – The Means Report’s Mental health matters because you matter series continues as we turn our attention to our children, their mental health, and how we can help them. The pandemic had an impact on our children – just as it did all of us. Also, suicide rates are going up across the country. Why and what can we do? How can we spot the warning signs? Dr. Dale Peeples is a child and adolescent psychiatrist at the Medical College of Georgia at Augusta University and is here to help us understand what our kids may or may not be saying.
Brad Means: My first question is just to look at the pandemic in general now two plus years and counting. Have you seen patients in your office, especially younger patients, whose lives have been impacted and whose mental health has been impacted by the pandemic?
Dr. Dale Peeples: Oh, very much so. I think it’s probably few and far between as far as the kids I work with that haven’t been touched by it in some way.
Brad Means: Wow.
Dr. Dale Peeples: I’d say the most common theme that comes up when I’m working with families tends to be school related. Just that first year of the pandemic particularly threw so many people off course with their education. Many kids are still struggling to make up that lost time, and that’s a huge stressor because that’s what kids do. That’s their job.
Brad Means: I don’t think honestly, as a parent, I’ve taken a moment to step back and really consider what it might’ve done to my two sons who did finish up their high school careers mid pandemic. Why does it affect them? Is it the isolation of just staring at your laptop all day, the break in routine? Help me understand what they feel.
Dr. Dale Peeples: Yeah. Yeah. So I think you hit up on a couple of big factors there. One, you talked about your son’s transitions, that they hit this big milestone in life, and I’m guessing that they lost out on the opportunity for prom,
Brad Means: Yeah.
Dr. Dale Peeples: the opportunity to graduate and be with their friends. So there’s some of that just real legitimate loss that people experienced, and then as you said, it separated kids from their friends, their peer groups. They weren’t able to have that connection. When we were first dealing with all this, I remember talking to so many kids that were just going over to their friends’ houses, waving through the window, but couldn’t actually connect the way they used to. And some kids have had real loss with family members getting sick, dying.
Brad Means: And dying, and they can’t be them, and they also might wave at them through the window as their last interaction. But what about the symptoms that we see when we can tell that some of the things you’ve already described are manifesting themselves in our children? What are they act like?
Dr. Dale Peeples: Right, yeah. So usually what we’re seeing are symptoms of depression and anxiety. Depression, there, we’re talking about, of course, feeling sad, feeling down, but also noticing that you’re having trouble sleeping, that you’re losing your appetite. Your concentration isn’t what it was. Things that used to be fun and meaningful just don’t bring you pleasure anymore. So those are the symptoms that family might pick up on, and, of course, anxiety being that generalized worry, that sense that nothing’s working out, that bad things are gonna continue to happen, and it can also cause you trouble with your sleep, with your concentration, make you moody, make you irritable.
Brad Means: Yeah, but so many of the things that you have described just sounds like kids in general. It sounds like a teenager,
Dr. Dale Peeples: Yeah.
Brad Means: everything you just listed. So how do we draw the line between making sure that they’re mentally healthy and making sure that we’re not just coddling them?
Dr. Dale Peeples: Yeah. Yeah. So not trying to disparage your teen viewers, but you are right that teenagers are a little bit more emotionally reactive
Brad Means: Right. We love them.
Dr. Dale Peeples: than adults.
Brad Means: We love them.
Dr. Dale Peeples: And so you do see that kids will have those phases where, again, they’re dealing with those kind of symptoms for a brief period of time. When we become worried is when it becomes chronic. So when this is going on week after week, yeah, we expect kids to have bad days here and there. That’s normal. That’s natural. But when it’s a week turning into a month, that suggests to us that there’s a problem.
Brad Means: The whole time you’ve been answering these questions, I’ve been picturing high school-aged kids. Is that the age range you see in your office, or do you see younger or older?
Dr. Dale Peeples: Yeah, I see a full age range. So I definitely work with grade school and sometimes preschool kids, but when we’re talking about depression, that is something that becomes a lot more common after you’ve hit puberty, so that does tend to be much more teenagers compared to kids.
Brad Means: Something else that used to just be associated with the onset of puberty was suicide. The suicide rates reflected that. I saw during the pandemic, though, where, shockingly, there were children as young as five either attempting suicide or certainly having those thoughts. Have you seen any of that in your office, and can you help us understand when it’s time to get help for our child when it comes to suicidal thoughts?
Dr. Dale Peeples: Yeah.
Brad Means: Or threats.
Dr. Dale Peeples: Right. Yeah. So that’s the big thing we all worry about when it comes to psychiatry-related issues with kids, suicide.
Brad Means: Right.
Dr. Dale Peeples: And it’s something we definitely wanna take seriously because the best predictor of a suicide attempt is prior attempts or having discussion about it. Most kids actually do talk to someone before committing suicide. So really family being aware, being on the lookout is vital, and it is key. When we talk about the younger kids versus the older kids, they probably are dealing with two separate phenomena. With the young kids, those who haven’t gone through puberty yet, one of the bigger risk we actually see for suicide attempts and suicide completion is impulsivity. So we’re talking about kids who just react, that they’re under stress, they don’t know what to do, and they engage in a self harm behavior without thinking about it. Usually, you don’t see that long history of depression preceding it for those younger kids. For the older kids, it does tend to be people who’ve been struggling a little bit more with depression, that they’ve been dealing with these thoughts for awhile. Like I said, there’s a good chance that they’ve tried to reach out, tried to talk to people, tried to get help. So with the older kids, sometimes it’s a little bit easier to identify.
Brad Means: What’s self harm behavior? What are some examples?
Dr. Dale Peeples: So self harm, usually when we’re using that in the medical sense, we’re talking about intentionally hurting yourself, but usually we’re differentiating it from a suicide attempt. So you’re hurting yourself, but you weren’t actually trying to kill yourself.
Brad Means: All right.
Dr. Dale Peeples: We’re looking at it as more of a coping strategy that’s maladaptive, that kids are stressed. They’re trying to deal with it. This is the only thing they know how to do, but it’s really not gonna help ’em in the long run.
Brad Means: How can parents differentiate between something that just might be a line that a child says to get your attention or get back at you? “Well, maybe it will be better if I just wasn’t here, or maybe I should just kill myself.” How do you know the difference between them just saying that in the heat of the moment and knowing that you need to grab them and take them to Dr. Peeples’s office?
Right. Yeah, so that can be challenging, I’d say.
Brad Means: ‘Cause you don’t wanna ignore it.
Dr. Dale Peeples: Right, and it’s better to err on the side of caution and seek help. I’d say you wanna look at the overall mood of the child. How have they been looking lately? Again, if you’ve been picking up on some of those signs of depression, obviously, your radar’s gonna be a lot higher than if the child’s generally been doing well. You also want to think about is this looking like that there could be some secondary gain? Is this looking like that it might help a child get out of trouble? That still doesn’t remove all the risk, but if that’s what you’re worried about, then getting your child to express their needs in a healthier, more positive fashion, identifying what they’re working towards, what they’re trying to achieve with that statement, and getting them to tell you that so you can help them with that would be the best approach. But, again, I’d really be cautious, really try to sit down with the child, explore what they’re dealing with, what they mean by this, what kind of stressors they’re facing right now because kids can be really impulsive. And even though it might not seem like a big thing to an adult, sometimes it does seem catastrophic to a child.
Brad Means: Well, that’s a great point. So what’s treatment look like? Once they do come see you, what do you do in that first session perhaps to try to begin to turn things around?
Dr. Dale Peeples: Yeah, so first session with pretty much any provider, whether we’re talking about psychiatrist, psychologist, a social worker, usually it’s gonna be sitting down, getting to know you and the family, running through a full history, trying to explore the symptoms that people have been experiencing, and getting to a diagnosis, a picture about what’s going on. After that, hopefully we’ve got a little time to do a little bit of education on depression, what it means, and what are the basic steps we can take to manage it. Usually it’s gonna be at subsequent visits where we’re talking about, do we really need to think about long-term therapeutic approach, like a cognitive behavioral therapy, lifestyle interventions, trying to minimize child’s stresses, or medication or some combination of the above.
Brad Means: And no matter what you choose, can you make that child better eventually?
Dr. Dale Peeples: Yeah. Kids are resilient. That’s why I love working with kids. They do a lot of the work for me. They do get better, and a lot of times, it’s just giving them the support and structure that they need to overcome these immediate stresses, teaching them coping skills about how to manage those stresses in the future, and like I said, sometimes medication is part of the treatment but not always.
Brad Means: I wanna take a break in a moment, but I wanted to ask you real quickly. Does insurance cover most of the things you’ve described so far?
Dr. Dale Peeples: The majority, yes. Most kids either will have insurance coverage through their parents or can qualify for Medicaid. So the majority of kids will be able to receive these services.
Brad Means: Okay, good. Good to know, Dr. Peeples. Dr. Dale Peeples, our special guest on “The Means Report.” What about ADHD and ADD? So many children are diagnosed with that, it seems, more and more these days and at much younger ages than perhaps when the rest of us were growing up. We’ll talk about that, treatments and over treatments, perhaps, when “The Means Report” continues, focusing on mental health.
Brad Means: Welcome back to “The Means Report.” Our focus all month long is on mental health. Dr. Dale Peeples is a child and adolescent psychiatrist at the Medical College of Georgia at AU. Dr. Peeples, I told the viewers, we’d talk about ADD and ADHD when we came back from the break, and I know you treat a lot of patients with those issues. So our focus is on mental health. Are those mental illnesses or mental health issues?
>>Yeah, we definitely do consider the mental health disorders. So ADHD is a perfect topic for today.
Brad Means: ADHD, don’t we all have it?
Dr. Dale Peeples: So-
Brad Means: I don’t wanna diminish it.
Dr. Dale Peeples: Yeah, yeah, yeah. We all have trouble with attention at some time, and a lot of times when we’re talking about when we’re calling something a disorder, we do set a arbitrary cutoff. So high blood pressure, is it 140 over 90, or is it 130 over 80?
Brad Means: Right. I think these things. Yeah. No, I think about that.
Dr. Dale Peeples: It does change. So with ADHD, we’re talking about kids who are on the real extreme of that bell curve with our attention, right? So the kids who really do have the most trouble with their focus and concentration.
Brad Means: What’s the most common treatment if you had to pick one? It has to be give them all a bottle of Adderall, isn’t it?
Dr. Dale Peeples: Medication is considered the gold standard of treatment with ADHD. Now there are other things we can talk about and discuss as far as treatment options go, but in head-to-head trials with medication versus cognitive behavioral approaches and that sort of thing, typically, you are gonna see the best outcomes when medication is involved.
Brad Means: Let me ask you this, and the question is what are the warning signs? And I suspect there what you mentioned in our first segment, when it came to other mental illnesses, behavior over time.
Dr. Dale Peeples: Yeah, yeah. So ADHD, it’s chronic. It doesn’t come and go, okay?
Brad Means: Okay.
Dr. Dale Peeples: It is really present from early childhood. Again, it shouldn’t be appearing in your 20s or your 30s. And even though we talked about how everyone has trouble with attention, everything in psychiatry, when we’re talking about it being a disorder, we say that it’s causing functional impairment. It’s causing problems in your life. It’s causing trouble at school, at home, multiple settings. So this isn’t just, “I’m having a bad time in one class.” This is year after year in school. “I’m really struggling across the board.”
Brad Means: So let’s talk about therapy first, and then we’ll talk about medication. What might therapy look like where you can teach someone to pay better attention?
Dr. Dale Peeples: Well, let me broaden the conversation of therapy. One, there are very reliable school interventions that can be made for ADHD.
Brad Means: That’s true, yeah.
Dr. Dale Peeples: So yeah, there are accommodations
Brad Means: Accommodations.
Dr. Dale Peeples: in the classroom that can be put in place and help people out. But when we’re moving into working with a therapist, you can work on parenting strategies, helping parents really figure out how to manage kids who really are struggling with their attention and hyperactivity because it is different approach than what your average kid’s gonna need. You can also work on organizational skills with the child, helping them to keep that folder and backpack managed and organized, the work gets turned in, working on chore reminders, that sort of thing. So yeah, definitely through your own will and efforts to organize, you can see improvement. And there are also some therapies, like trigeminal nerve stimulation and some game-based therapies that have been shown to help improve attention as well as what we call neurofeedback. Now, the science behind those isn’t quite as good, so usually, I’m not suggesting those as first line.
Brad Means: Right. I hadn’t heard of that.
Dr. Dale Peeples: But the parents who are really looking for anything but medication, sometimes, there are other options to explore.
Brad Means: But man, that medication, I lightheartedly mentioned Adderall a couple of questions ago. It’s everywhere, and those pills are flowing on college campuses. I’m not directing this question to you or how you treat. I’m just saying overall, doctor, do you think we, as a society, as a medical society, over treat in some cases?
Dr. Dale Peeples: It’s a little bit of a paradox in that we both over treat and under treat. If you look at the data, about 25% of individuals’ families surveyed who say their children have ADHD aren’t receiving treatment. So there’s a lot of folks who just don’t get treatment despite the diagnosis. At the same time, you do have individuals who, again, might not really have had that history throughout all childhood. They get to college. “Oh no. I’m suddenly struggling.” Talk someone into working with the diagnosis of ADHD, get a Adderall prescription, that does happen.
Brad Means: It does, yeah.
Dr. Dale Peeples: So there is a little bit of a mismatch. There are many people out there who aren’t receiving the treatment that they need, and there are some people out there who maybe are getting the treatment that isn’t really appropriate to them.
Brad Means: Okay, so can you grow out of ADHD or ADD? Or let’s just make it a super broad question. Can you grow out of mental health issues?
Dr. Dale Peeples: Yeah. Again, it’s one of the beauties of working in child psychiatry. Age and development are on my side. My patients get better on their own. I’m just along for the ride, and so ADHD in particular, attention, concentration, those naturally improve with age. Each year that goes by, kids get a little bit better on their own. So you do have a good mini kids later in high school have outgrown the need of it, college have outgrown the need for it.
Brad Means: Dr. Peeples, I wanna take our last couple of minutes and ask you a couple of questions that I’ve asked you before, but I need people to hear your answers. A child’s brain, a person’s brain isn’t fully developed just at the conclusion of childhood. It’s into their 20s if I remember correctly, right?
Dr. Dale Peeples: Yeah, that’s correct. There’s not a hard and fast date, but usually, people will say approximately age 25, yeah.
Brad Means: Okay, so that made me, when you told me that, just as a parent to try to be more patient because you look at a child who’s 18, 19, 20. Well, they’re still developing, right?
Dr. Dale Peeples: Oh, absolutely, yeah, and the last part of our brains to develop is the prefrontal cortex, which helps with our executive functioning, our decision making, our ability to wait, evaluate risk before we react, and kids, again, they just aren’t where adults are at when it comes to all that.
Brad Means: They don’t see long term. They don’t see the big picture. What about social media? Can you please ha give us some advice, especially for parents of younger children? Have we figured out an age where they should start to have access to social media?
Dr. Dale Peeples: Yeah. From a legal perspective, usually, companies don’t want kids on their platforms before the age of 13. So I usually tell parents that, “Hey, let’s all follow the rules.” I think that’s a good example for kids. So usually I would say that’s a place to consider starting, but honestly, probably the longer you can keep kids off of social media, with the evidence we have, I’d probably say it’s working in their favor the longer that can be delayed.
Brad Means: Are you okay with us checking their phones when they’re not looking? And when I say, are you okay with that, we’re not gonna hurt them from a mental health standpoint if we snoop?
Dr. Dale Peeples: Yeah. Every family’s gonna be a little bit different, and I think the wisest approach is starting off where parents are in complete control. Kids are handing over the devices at the end of the day. We’re using the devices in the same room. As kids demonstrate responsibility, demonstrate maturity, giving them more and more and more freedom, I think, is appropriate. But parents, when it comes down to it, yeah, you’re the parent, and I think it does make sense for parents to have the ability to look if they’re worried or concerned.
Brad Means: Boy, great points, great points, one and all. Dr. Peeples, thank you for being with us once again, and thank you for helping us raise our children right.
Dr. Dale Peeples: Thank you.