PsyDactic - Child and Adolescent Psychiatry Board Study Edition

Let me know what you think! - Dr. O'Leary discusses his critical perspective on Oppositional Defiant Disorder (ODD) and argues that ODD is not a primary diagnosis but rather a "risk syndrome," a set of symptoms (defiance, irritability, and vindictiveness) resulting from various underlying conditions like ADHD, anxiety, or trauma. He explains that conceptualizing ODD as a stand-alone disorder often leads to the risky treatment pathway of off-label antipsychotic medication, whereas recognizing it as a syndrome necessitates an etiology-focused approach to treat the true root cause, typically with safer, condition-specific interventions. Dr. O'Leary traces the evolution of ODD criteria through the DSM manuals and urges clinicians to use comprehensive evaluations rather than relying on simple screeners, especially when an ODD diagnosis is present.A more in depth discussion with references can be found here: https://sciencebasedpsych.blogspot.com/2025/10/oppositional-defiant-disorder-not.htmlReferenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - This is part 3 of a series on pediatric trauma, delving into the treatment of trauma and stress-related disorders in children. Dr. O'Leary emphasizes that therapy is always the starting point for these conditions, highlighting Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) as highly effective, evidence-based interventions for PTSD. For attachment disorders, the focus shifts to improving the caregiver-child relationship through programs like Attachment and Biobehavioral Catch-up (ABC), while for acute stress and adjustment disorders, early CBT and psychoeducation are crucial. The discussion also addresses pharmacological interventions, noting that no medications are FDA-approved specifically for pediatric trauma, but they may be used to manage co-occurring symptoms, always with a preference for therapy as the primary approach and strong cautions against benzodiazepines and antipsychotics for routine use.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - This is the second of a three-part series on pediatric trauma, delveing into the epidemiology and underlying mechanisms of trauma-related disorders in children and adolescents. Dr. O'Leary discusses what might increase risk of developing PTSD after trauma. The discussion also explores the neurobiological impact of trauma, detailing how it can dysregulate the hypothalamic-pituitary axis, alter neurotransmitter systems, and affect crucial brain regions like the amygdala, hippocampus, and prefrontal cortex. The episode highlights the profound effects of early deprivation on attachment disorders and outlines the diverse manifestations of trauma across various developmental stages, from infancy through adolescence, underscoring the importance of considering age-specific presentations and potential regressions when assessing affected youth.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Dr O'Leary discusses post-traumatic stress disorder, reactive attachment disorder, disinhibited social engagement disorder along with the other diagnostic boxes defined in the DSM.  In particular, he discusses how a developmentally appropriate approach is necessary and why there are different criteria for those aged 6 and under.Find additional case vignettes in the show transcript.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - In this episode Dr. O'Leary delves into the complex world of Pediatric Anxiety Disorders. Learn about Separation Anxiety Disorder, Selective Mutism, Specific Phobias, Social Anxiety Disorder, Panic Disorder, Agoraphobia, and Generalized Anxiety Disorder. Through clinical vignettes and DSM-5-TR criteria, this episode explores the nuances of diagnosis and when typical childhood anxiety crosses into a disorder. Dr. O'Leary also covers prevalence, etiology, and evidence-based treatments including Cognitive Behavioral Therapy (CBT) and pharmacotherapy like SSRIs. Key takeaways include the importance of accurate diagnosis, understanding child-specific presentations, and the nuances of medication use in children. This is essential listening for anyone interested in child and adolescent mental health, or studying for psychiatry board exams.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Dr. O'Leary delves into the complex and often controversial topic of diagnosing Pediatric Bipolar Disorder and its differentiation from other conditions, particularly Disruptive Mood Dysregulation Disorder (DMDD). Dr. O'Leary explores the DSM-5-TR diagnostic framework, the history of Pediatric Bipolar diagnosis, the debate surrounding irritability as a diagnostic criterion, and the challenges of distinguishing it from ADHD, Autism Spectrum Disorder, ODD and trauma-related disorders. Using case vignettes and drawing on both personal knowledge and AI-assisted research, the episode aims to provide a comprehensive and nuanced understanding of this challenging area of child psychiatry.This episode has been released in both the PsyDactic and PsyDactic - CAPS podcast feed.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - This Episode covers major depressive disorder in children and adolescents.  According to the American Board of Psychiatry and Neurology, content related to depressive disorders constitute 7 to 9 percent of the board exam, so it’s worth a second, third and even fourth look.  Again, I will leave you in the competent hands of my AI co-hosts, Algernon and Alisa, or Allen and Alberta.  They don’t care what you call them, just call them maybe.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Now that we carry around casinos in our pockets, the rates of gambling disorder among adolescents is skyrocketing.  Yet, gambling disorder may be the most under-diagnosed disorder in the DSM.  This is an exhaustive treatment of the neurobiological, psychological, and societal aspects of gambling addiction, featuring discussions on the brain's reward system, cognitive distortions, and the impact of advertising and the design of gambling products.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - This is a general overview that highlights common features of substance use disorders in youth and discusses in more detail substances like alcohol, nicotine, cannabis, and opioids.  It is a curated A.I. generated podcast.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - This episode delves into the epidemiology, neurobiology, and differential diagnosis of Developmental Coordination Disorder (DCD), including its frequent co-occurrence with autism intellectual developmental disorder or ADHD, and stresses the importance of occupational and physical therapies to improve outcomes, highlighting that DCD should be identified and addressed rather than being subsumed into other conditions.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Enjoy today’s A.I. generated discussion of ADHD etiology, epidemiology, and diagnosis.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.comReferenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Dr. O'Leary tries something new by feeding an artificial intelligence a series of peer reviewed papers about autism spectrum disorder and having it generate an audio discussion of the content.  This episode focusses on the differential diagnosis of ASD and how to rule out other neurodevelopmental disorders and even OCD or an anxiety disorder.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - This episode focuses on communication disorders in children, specifically language, speech sound, fluency, and social communication disorders. It differentiates these disorders through case vignettes, comparing and contrasting DSM-5 TR criteria, and highlighting key features of each disorder.Language Disorder is characterized by persistent difficulties in language acquisition and use, impacting both comprehension and production.Speech Sound Disorder involves persistent difficulty with speech sound production, interfering with intelligibility.Childhood-Onset Fluency Disorder (Stuttering) is characterized by disturbances in speech fluency and time patterning, including repetitions, prolongations, and blocks.Social (Pragmatic) Communication Disorder presents as persistent difficulties in the social use of verbal and nonverbal communication.These disorders can co-occur and that careful assessment is necessary for accurate diagnosis and differentiation from other conditions.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - This episode begins with a case vignette about a 7-year-old boy, Tommy, who exhibits global developmental delays and impaired adaptive functioning. Dr. O'Leary explores the DSM-5 criteria for ID, emphasizing deficits in intellectual functions and adaptive functioning during the developmental period. Severity levels are based on adaptive functioning and range from mild to profound. The episode distinguishes ID from other neurodevelopmental disorders and highlights the importance of a comprehensive assessment and individualized support. Key points include recognizing comorbidities, heterogeneity, and focusing on strengths.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - In the last episode, I introduced behaviorism, which took a strikingly different approach to human learning and development by basically assuming that everything we are on the inside is somehow learned from the environment, except for some of the most basic things we need for survival.  Our inner life and the reasons we give for our decisions are more or less illusions.  What we are is what we are conditioned by our environment to be.  I started with classical conditioning, Pavlov, dogs, and scaring babies.  Today I am going to move on to operant conditioning with Skinner, Thorndike and Seligman who liked to put animals into boxes and at times even shock them into complacency. Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - I have so far discussed some of the early psychosexual, psychosocial and cognitive approaches to child development, but I would be remiss if I did not also mention a group of theorists who attempted to study humanity by completely ignoring the fact that they have thoughts and emotions.  The behavioralists tried to simplify the study of humans by massively simplifying their assumptions about humans.  In fact, they are primarily criticized for vastly oversimplifying humans.  For instance, they assumed that behaviors were basically just reactions to the environment without any deeper meaning.  These responses are learned based on environmental inputs.  Whatever else is happening on the inside is either irrelevant or extraneous.  All we can really see are behaviors, so we should only study behavior.  This episode focuses on Classical Conditioning.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - In episode 8, I started discussing temperament theory with an introduction to Alexander Thomas and Stella Chess.  They first developed a temperamental formulation by following 141 children longitudinally and proposed 9 dimensions of temperament that can be reduced to three basic categories: Easy, Difficult, or Slow-to-warm-up temperament.  There were many researchers to follow and today I am going to compare and contrast a number of them, including Jerome Kagan, Jeffery Allan Gray, Mary Rothbart, and then highlight researchers who focussed extra attention on parenting and social development’s interactions with temperament - Nancy Eisenberg, Alice Schermerhorn and John Bates.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - While it may seem quaint today, the radical contribution that Alexander Thomas and Stella Chess made to child development was to look at children as unique individuals with very different innate approaches to the world that were present at birth.  While processes like attachment and their psychosocial context help to determine a child’s outcome, what Thomas and Chess emphasized was a child’s temperament, their own style of thinking and of interacting with the world.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Attachment theory began when John Bowlby rebelled from the psychoanalytic establishment by, for the first time, observing families interacting in order to understand individuals.  Bowlby was later joined by Mary Ainsworth who developed on of the most iconic clinical tools in the history of child psychology: The Strange Situation.  This episode begins with Bowlby and Ainsworth and explores the difference between their conceptions of attachment and those later proposed by Rudolf Schaffer and Peggy Emerson.  It ends by relating how different parenting styles, as conceptualized by Diana Baumrind, Eleanor Maccoby and John Martin, can affect the development of attachment styles.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Erik Erikson's psychosocial theory of development focuses on the social and emotional aspects of human growth.  A child’s cognitive development underlies what Erikson describes and arguably, without the cognitive skills described by Piaget, the psychosocial stages that Erikson describes would not be possible.  Erikson's stages emphasize an individual's main psychological struggles or conflicts they are likely to experience as they age. These psychological conflicts are either resolved or not because of interactions with the social environment.  He proposes a more or less binary solution to identify formation at each phase of life.  For example, a child either establishes a basic trust in others that their needs will be met, or they develop mistrust.  Each of these outcomes will carry deep consequences for the future.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Jean Piaget's description of cognitive development is markedly different from psychosexual and psychoanalytic approaches.  He was concerned primarily with cognitive abilities.  Instead of basically just making up a complex inner life and mode of relating to mommy’s breast, he described the kinds of cognitive tasks children are actually increasingly able to do as they age.  Unlike Sigmund Freud and Melanie Klein and more like Anna Freud and Mahler, he actually studied child development in the real world.  He advanced the science of child psychiatry not by speculating about why children do what they do, but actually describing what they do.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Following Freud, there were many researchers trying to make sense of child development using his psychosexual approach as a framework.  Among those that adopted the psychoanalytic approach was his daughter, Anna Freud, who has been called “the mother of child psychoanalysis.”  Other mothers include the developers of Object Relations including Melanie Klein and Margaret Mahler.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Sigmund Freud's psychosexual approach proposes that human development unfolds in a series of stages, each focused on a different erogenous zone. Successful resolution of conflicts in each stage is crucial for healthy personality development. Dr. O'Leary gives a brief breakdown of Freud's psychosexual stages.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Dr. O'Leary reviews the basic developmental milestones children are expected to reach by age 5.  https://cdc.gov/ncbddd/actearly/milestones/milestones-2mo.html Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.

Let me know what you think! - Dr. O'Leary introduces PsyDactic - CAPS Edition, explains the goal of this podcast, and how it was produced.This podcast is intended as a study aid for the American Board of Psychiatry and Neurology (ABPN) Child and Adolescent Psychiatry board exam.Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com Feedback can be emailed to [email protected] OR submitted via a form at https://psydactic.com.This is not medical advice. Please see a licensed physician for any personal questions regarding your own or your child's health.