MY APPROACH
While young brains are still sparking neurogenesis, they mold and shape themselves at remarkable rates. This ongoing process presents the most spectacular opportunity to guide the brain's hardwiring to develop resiliency in any child, regardless of our genetic roadmap. Most of my patients know my practice catchphrase that I say pretty much every day: "Be Boss of your Brain."
I specialize in the areas of ADHD, anxiety, and developmental disorders. There is a spectrum of symptoms, diagnosis, and severity with kids: humans don't always fit into tidy diagnostic pigeonholes. The spectrum of anxiety disorders includes generalized anxiety, obsessive-compulsive disorder, social anxiety, panic, and overarching self-esteem issues. Both ADHD and higher levels of impairing anxiety can tire the brain, and a tired brain becomes a more depressed brain. ADHD and Anxiety disorders often overlap with a lack of self-confidence, avoidant behaviors, depressive symptoms, and even major depressive disorder.
The human brain is possibly the most complicated piece of living matter discovered thus far in our universe. At the same time, we sometimes forget that the brain is an organ like any other body part, and not something that we can make better by willpower alone. Awareness of the constant body and brain connection is part of the path towards integrating the balance of mental wellness on the most holistic level.
Treatment Strategies
Several elements determine our levels of attention, motivation, stress, anxiety, and mood. I incorporate pharmacological, cognitive, behavioral, exercise, mindfulness, nutritional, and parenting strategies to tailor my approach to meet the specific needs of each patient and family. I've highlighted the way I approach these treatment elements below.
Therapy
Mastery of any new skill requires PRACTICE, PRACTICE, PRATICE to make changes in the human brain. We are not born with the immediate nerve cell connections to excel in lacrosse, understand algebra, or make glorious music come from an instrument—PRACTICE is a learning process that changes nerve cell structure and connections (neuroplasticity). Likewise, practicing OVER AND OVER the skills learned in therapy remodels the brain, teaching it new ways to respond to stress.
In medical school, one of the many reasons I chose the field of child psychiatry was my passionate excitement at the potential for new treatment opportunities on the horizon. It marked the dawn of research proving that certain forms of psychotherapy alone were effective for many conditions. Some therapies even showed neuroimaging changes in the structure and function of nerve cell networks. Thanks to NIH experts like Dr. Jay Giedde, neuroimaging research continues to show that the sculpting of the teen brain is a work in neuroplastic progress. In fact, the teen brain doesn't even get to its more fixed adult form until the later 20s.
To take maximum advantage of this neuroplasticity, I incorporate elements of multiple evidence-based therapies into my practice. These include cognitive behavioral therapy, mindfulness and meditation, and acceptance and commitment therapy, which I tailor to each patient to achieve the most engaging and active treatment possible.
When working with kids, I love teaching them that even though their situation and symptoms can cause such frustration and suffering, there is a yin and yang: almost every negative, someday, has some positive hidden in it if we look hard enough. I help kids figure out that when something bad happens, we can try our best to MAKE at least something good come out of it. Learning our blind spots, controlling the things we can, and teaching kids to understand their own brains—with our automatic default thinking errors and worry loops in real-time—these are some of the ways I teach kids to see our brains in action and start to be the “BOSS OF OUR BRAINS.”
Medication
For some mental health disorders, including ADHD, anxiety, and depression, medication is an effective component to consider for successful evidence-based treatment outcomes. With overwhelming anxiety, sometimes the brain gets caught in a fearful, frozen state. Instead of processing information logically, it applies a negative or fearful lens to new experiences. Sometimes, medication can help return the brain to its natural state and provide a bridge to develop healthy thinking patterns hardwired through therapy and daily practice.
Using an evidence-based approach to medications, I integrate traditional, complementary, and holistic therapies to find the best fit to optimize balance. Depending on the diagnosis and severity of symptoms, I sometimes start therapy, make behavioral recommendations, and instill holistic lifestyle changes before considering medications.
For any medication to work, the brain must be functioning at its best. It must be constructed of the best nutritional material scaffolding through diet, and I strongly support this path to health. I avoid the use of medications associated with a risk of dependence. I consider ongoing therapy and behavioral change a vital part of optimizing any treatment with medication.
Integrating Wellness:
Exercise, Nutrition, and Behavioral Change
I am particularly emphatic about incorporating a mindfulness-based, behavioral, and holistic foundation as the basis of all treatment plans. Exercise, nutrition, sleep, and structured mindfulness practice are the pillars of wellness.
Exercise
The benefits of regular, red-in-the-face, sweaty aerobic exercise cannot be overstated in the treatment of anxiety. Exercise sparks neurogenesis and increases brain GROWTH in the brain's emotion regulation and intellectual regions. I will teach your kids (in a way that excites them) that exercise increases a factor called BDNF (Brain-Derived Neurotrophic Growth Factor). Harvard's Dr. John Ratey, the BDNF guru, has dubbed this protein as "miracle grow" for the brain.
Exercise also builds what is known as parasympathetic tone— the aspect of the human nervous system that calms, quiets, and returns the body to its resting state. For some humans, regular exercise proves superior to medication for anxiety. Want to know more?
Ask me! I love talking about the latest research regarding exercise and the brain, , I will give the motivation for “why” to spark more movement in kids. Like any behavioral change, sometimes we need to start with baby steps…
Nutrition
We're just beginning to understand how significantly what we put into our bodies can impact brain health. Our gut uses the same chemical messengers as our brain. For example, serotonin plays a crucial role in gastrointestinal signaling and mood and anxiety regulation. Certain foods appear to promote sleep, stabilize blood sugar levels, and encourage healthy gut flora—the bacteria that live in our gut—and other foods do just the opposite. Amazingly, the bacteria in our gut can impact our mood and anxiety levels. It sounds like science fiction, but new research reveals the mind-gut link deserves much more attention than we've been giving it!
Dr, Drew Ramsey is doing a lot of evidence-based research in this area. Check out his excellent information on Brain Food and Nutrition.
Multimodal Treatment
I love collaborating with other professionals in my extensive and longstanding network to create the most comprehensive multimodal treatment possible. I work with therapists, primary care physicians, teachers, and parent behavioral experts. Some therapists have skills and training in areas that are not my specialty, and I often refer to them for their talent and essential treatment plan components. I primarily work with therapists with whom I have a working relationship to ensure the safest and most optimal communication and effective collaboration.
It is essential that all kids get better and not miss out on life-changing treatments during the window of neuroplasticity. However, sometimes a patient is not improving as expected with our treatment plan, . Or patients may develop diagnostic concerns or intensive needs requiring a higher level of care that I cannot provide in my solo office-based practice. In those cases, I refer patients to excellent psychiatry practices with more availability, crisis service availability, and comprehensive in-house treatment teams.
As much as I would love to be the one successfully helping every child I see, I will stop at nothing, including referring out when appropriate to ensure every kid gets the level of care most appropriate for their needs and developing brain.
Mindfulness and Meditation
Mindfulness and meditation practice not only sounds good but IS good. Multiple forms of meditation and mindfulness-based stress reduction are solidly backed by hard science. Recent research provides strong evidence that practicing non-judgmental, present-moment awareness (aka mindfulness) changes the brain. Thanks to advances in neuroimaging and rigorous research from top neuroscience departments all over the world, we can now start to SEE the exciting ways in which meditation and mindfulness LITERALLY change the brain.
Practicing mindfulness has been shown to spark neurogenesis—making new brain connections and even THICKENING of the brain cortex itself. Multiple studies have shown how mindfulness and meditation practices, even for short periods a day, can improve emotion regulation, memory, attention, and strengthen brain areas related to perception, body awareness, pain tolerance, introspection, complex thinking, and sense of self. Although originally trained in Transcendental Meditation (TM), Dr. McCarthy is highly experienced with multiple types of meditation and mindfulness practices and LOVES to help kids find the most user-friendly, time-efficient, and do-able practice for each individual.
Adaptability
The trait of Flexibility is highly correlated with success and managing life. In treatment, probably the most essential trait I work to strengthen in patients is to become ADAPTABLE to whatever challenge life brings. Medication and therapy will only work well if the foundation of wellness is optimized through attention to one's daily routines, including adequate exercise, nutrition, and sleep.
Two other components are also critical: minimizing distractions and learning the art of self-compassion. Being fully engaged and present—not being constantly pinged by technology, our phones, video games, or screens—deliberately unplugging is simply necessary for the best brain functioning and focus for humans of any age. Learning self-compassion and recognizing that we are all only human is a life skill that will serve kids well throughout their lives. Moreover, teaching kids not to let social media define them is critical in turning the tide away from the Age of Anxiety.
I work as hard as possible with patients and in my practice to help raise the most adaptable, confident, and empowered kids in this new post-pandemic generation. Through years of daily pandemic global uncertainty, kids, and parents too—we have HAD to develop the wiring for ADAPTABILITY and can now use it almost as a potential superpower for dealing with any future life challenges. With two of my favorite colleagues, I have co-authored a book and signed contract with Workman Publishing for publication in 2023. In our exciting "Parenting Playbook", we propose that our post-pandemic era indeed be heralded as what we see as the “AGE OF ADAPTABILITY."
