For any patient, wellness includes the way they act, feel, and develop. For pediatric patients, this is especially true, and early interventions can positively impact lifelong health. Assessing these facets and evaluating their overall health is a necessary soft skill for all providers.
As every pediatric provider is aware, demand for behavioral and developmental services has never been higher. Maryfrances Porter, PhD, a child and adolescent psychologist and the director of the new Riverside Developmental & Behavioral Health Center, shares ways providers can support their patients. And when it's time to help them with a referral.
What made you decide to focus on psychology?
My interest in psychology doesn’t come with a compelling origin story. I was surely influenced by my father, a research psychologist, who introduced me to B.F. Skinner at a talk in 1986. As long as I can remember, I wanted to be a psychologist. Once I got to college, I singularly pursued this goal. My interest in child and adolescent psychology and attachment theory crystallized when I was working as a lab manager, prior to graduate school, at the University of Denver in the mid-1990s.
What’s your favorite thing about practicing as a specialist?
Every child, adolescent, adult, or family I work with teaches me something new about the world and how people experience it. Every single day, my mind becomes more open.
How can referring providers help their patients with early detection and diagnosis?
Many people, including physicians, can feel shy or uncomfortable asking about emotions and how people are doing. However, asking, listening, and communicating understanding are the most powerful interventions there are. Simply asking your patients how they are doing, if they’ve been sad or down, anxious and uncomfortable, or had any thoughts of suicide can be the first step to helping to connect them with opportunities for wellness and thriving.
I also work with children and adolescents who are neurodiverse. Early signs for an eventual diagnosis of neurodivergence are sensory differences. Any child who has more than one sensory difference might end up with a neurodiversity diagnosis (ADHD, autism spectrum disorder, Tourette’s syndrome, etc.).
Some sensory differences include:
- Difficulty regulating emotions
- Difficulty settling at bedtime
- Clumsiness
- Extremely picky eating
- Requiring more or less physical touch or movement
- Sensitivity to light, sound, texture, etc
Neurodivergence often becomes a challenge for children at times when social and behavioral expectations increase: entrance to preschool or kindergarten, 3rd grade, middle school, or high school.
What risk factors should referring providers be on the lookout for?
It is important to ask children, adolescents, and their parents about changes in behavior and/or mood; even neurodivergence often is accompanied by emotional distress. Isolating from friends or family more, more crying, anger, fear, or separation anxiety than usual, drops in school performance or attendance, and/or a loss of interest in activities they’ve usually enjoyed can all be early signs of emotional distress.
What’s something about your specialty you wish every referring provider knew?
Asking, listening, and communicating understanding about emotions – even big emotions like suicidal thoughts – doesn’t create more emotions. Active listening most often sooths and reduces the intensity of emotions. Also, believe what your patients tell you; some of the experiences neurodivergent people have can sound unlikely to neurotypical people.
What’s one thing that every primary care doctor could start doing today to help their patients?
Give everyone – or their parent – a PHQ-9 or other depression screening questionnaire. Not only will you be more likely to pick up on any symptoms of depression, but it can be a great way to start a more general conversation about emotional health and wellness.
What’s your approach to working with referring providers?
My approach to working with referring providers depends on the need of the patient and the desire of the provider. When needed or desired, I’ve worked very closely with referring providers, keeping them updated on diagnosis and progress, and even discussing psychiatric medication options.