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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.html

Referenced resources can be found within the show transcripts at https://psydactic_caps.buzzsprout.com

Feedback can be emailed to feedback@psydactic.com 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.

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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 feedback@psydactic.com 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.

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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 feedback@psydactic.com 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.

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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 feedback@psydactic.com 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.

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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 feedback@psydactic.com 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.

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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 feedback@psydactic.com 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.

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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 feedback@psydactic.com 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.

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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 feedback@psydactic.com 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.