Mental Health of Pediatric Diabetic Patients

Podcast Transcript

Dr. Scott Steele: Butts and Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Dr. Scott Steele: Hi again, everyone, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And today, I'm very pleased to welcome Dr. Taylor Stephens, who is a pediatric psychologist in the Center for Pediatric Behavioral Health at Cleveland Clinic Children's. And we're going to talk a little bit about mental health of pediatric diabetic patients. Dr. Stephens, thanks so much for joining us here on Butts and Guts.

Dr. Taylor Stephens: Thank you so much for having me.

Dr. Scott Steele: So, we always like to start out with a little bit about you. So, why don't you tell us a little bit where you're from, where'd you train, and how'd you come to the Cleveland Clinic?

Dr. Taylor Stephens: Yeah, so originally, I hail from Arizona actually, and I'm completed my PhD in clinical psychology with a child and family emphasis from Palo Alto University. And I've actually been here at the Cleveland Clinic since residency and fellowship in pediatric psychology, and I'm now the endocrinology psychologist in our Center for Pediatric Behavioral Health here.

Dr. Scott Steele: That sounds very specialized, and we're glad to have you here. So today, we're going to talk a little bit about mental health of specifically pediatric diabetic patients. So, to start, can you share a little bit more about the Center for Pediatric Behavioral Health here at Cleveland Clinic Children's?

Dr. Taylor Stephens: Yeah. We are a group of 40 plus doctors and clinicians serving both the medical and mental health needs of children and teens throughout the greater Northeast Ohio area. We provide a variety of mental health services and the clinic span throughout the region. And we also offer a number of disease-specific programs, where non-pharmacological interventions have shown to be beneficial for the management of medical conditions that are co-occurring with mental health conditions like GI conditions, hematology, oncology, and, of course, endocrinology.

Dr. Scott Steele: So, are psychological services at the center offered to family members in addition to patients?

Dr. Taylor Stephens: Yes, it does. It can get tricky in terms of who is seeing each of the different people in the family, but we definitely take a family approach and try to provide services for all of those that are involved. One of the things that is most important when considering that, though, is the trust and the privacy of the identified patient. So, making sure that we're making their therapy experience positive and keeping that private for them. But we do offer services for all family members.

Dr. Scott Steele: Okay. Now, I have got to delve in a little bit deeper here. So, diabetes can be life-changing at any age. We know that mental health is an issue that can occur at many different ages. And so, we're talking about mental health of pediatric diabetic patients. So, can we go in a little bit about that? Are there any mental conditions that can specifically develop in diabetic pediatric patients following a diagnosis?

Dr. Taylor Stephens: Yes, and this is actually my favorite question. And one of the most challenging things about diabetes is we know that there's a bi-directional relationship between mood and diabetes. So, we might see an impact on your mood if your blood sugar is high or if you're feeling kind of low that day, we might notice your blood sugars are then impacted by that. So, mental health is really key when we're looking at diabetes and any chronic illness.

We know for kids and teens that are diagnosed with a chronic illness like diabetes, one of the first things we want to look for is adjustment difficulties. Whether that's adjusting to the diagnosis, adjusting to the treatment regimen. So initially, the first thing we're looking for is any increase in stress and anxiety and difficulties engaging in the treatment they're being asked.

Additionally, we know there's higher rates of both anxiety and depression in pediatric chronic illnesses, and actually, research suggests that one in five adolescents in the US without type 1 diabetes meet criteria for a mental health condition, yet those with type 1 diabetes experience mental health conditions at a rate two to three times higher than their peers without type 1 diabetes. So, we know there is an increased potential that they could experience those. It's not a guarantee, though.

Dr. Scott Steele: So, truth or myth: mental struggles related to diabetes can present at any time after diagnosis.

Dr. Taylor Stephens: Very, very true. We know that the struggles with diabetes occur at any and truly all times after diagnosis. I always say there's ebbs and flows to adjustment to a chronic illness, and you might find that you find a good routine and then a new life experience happens that throws you for a loop. So, we always know that there can be ebbs and flows.

And one thing we specifically look for in diabetes is what we call diabetes burnout, where just the day in and day out of caring for diabetes gets to be too much and you feel burnt out and over it. So that is one thing that we do see across the lifespan and diagnostic journey for those with diabetes, and it can occur at multiple times throughout the lifespan.

Dr. Scott Steele: Okay. So, I am a parent, and my daughter is extremely moody. So, when should a parent or legal guardian seek psychological services for their diabetic child? I mean, when is it something that's more than just "moodiness?"

Dr. Taylor Stephens: Yes, this is a tricky one, and one of the things I just want to call out from the outset is while us in behavioral health are generally considered experts on mental health, parents and guardians are the experts on their child. So, one of the things I always say is rely on your intuition and that gut instinct. Seeking services and getting support is never going to be a negative thing, even if there's no concern. We can teach coping skills.

So, if you notice difficulties with engaging in typical activities, not even their medical care, but just typical things they like to enjoy. If they start to become less interested in those things, they start to pull away a little bit more, whether from family or friends, kind of intentionally isolate. When you start to see those things, we really want to take a closer look and see if there's any support we can provide.

Dr. Scott Steele: So, I'm a listener, and I decided that I'm going to come see you with my child. What can they expect during that visit?

Dr. Taylor Stephens: So, treatment starts with what we call an initial evaluation, or what we would call the intake appointment. So that's really where we're going to gather a lot of information about what's going on for you guys across, not just diabetes, but general life.

And then after that, treatment typically looks like 45 to 60-minute therapy visits, depending on the age of the kid. The parent may or may not be heavily involved. And with that, we are teaching coping skills. How do we make diabetes feel the least worst possible? We might be managing how do we deal with the stress of having our continuous glucose monitor beep in class and how do we handle that? So, a lot of what we're working on is coping skills, but also processing what it means to have this chronic illness.

Dr. Scott Steele: So, as you said, this isn't just a one-time only fix, it's kind of a therapy over time. And so, what does that treatment look like over time for these pediatric patients that come to your center?

Dr. Taylor Stephens: Yeah, one thing I think that's unique about treatment with any kid or teen with a chronic illness is there's what we call episodes of care. It may be that we have a stressor right now, we're going to work on it, and then things seem to be settling down a bit, and then a new thing may come up. So, you may have episodes of care where you have a few sessions targeting a specific thing, or there may be long-term care. This is something that our kids and teens are dealing with lifelong, so this is something where we would have that long-term care. And again, as they age, it may involve more or less their parents depending on what we're working on.

Dr. Scott Steele: Yeah. So, you mentioned, again, that the pediatric patient be going into those teen years, so how does treatment work as that pediatric patient then enters adolescents?

Dr. Taylor Stephens: I think this is one of those crucial moments and referencing that privacy and that trust, this is one of those moments when really highlighting the teenagers and adolescents' independence in their care. We want to promote their engagement in their care. So, we may start to see less involvement of the parents as they become older, which is appropriate and healthy for their successful development. However, we'll start to also deal with typical adolescent things. How do we manage driving with diabetes? There are safety concerns. How do we manage going to prom with diabetes and having our continuous glucose monitor showing? So, the topics may change as well as who is engaged in the treatment.

Dr. Scott Steele: So, for parents out there that have a diabetic child, for example, but they have other mental health issues, can they still see you for that? If maybe they're seeing a therapist elsewhere, can they come and see you at this center?

Dr. Taylor Stephens: So typically, what we recommend for therapy is you don't want too many cooks in the kitchen, if you will. So typically, what we recommend is the therapist should be targeting a specific aspect. So, I do provide holistic care and address both mental health and diabetes. However, if a patient already has an existing therapist and they have a good relationship with them, we want to keep that care there; that's successful and that's working. So sometimes, it might mean they come to me every once in a while, for just diabetes-specific therapy. Or sometimes they transition their care completely over to us and kind of isolate it in one section. But typically, we don't want too many therapists at once working on the same things because sometimes that can create convoluted information.

Dr. Scott Steele: So, are there any advancements on the horizon for treating mental health conditions of pediatric patients at the behavioral health center here at Cleveland Clinic Children's?

Dr. Taylor Stephens: There are many different advances happening, and I think a lot of them obviously involve technology. There are some programs that are providing CBT-based therapy through an online platform. So, I know one of our psychiatry colleagues, in particular, is leading a project on that.

Myself, I'm working with a nutrition professor actually from Case Western Reserve University, and we are putting together expanding her existing curriculum on a diabetes nutrition family-based program. So, it's a group where we teach them education on diabetes management from the nutrition aspect, and we're expanding that to include the psychosocial aspect. And they make a meal during the group, so it also engages them in their actual practice of carb counting and administering their insulin. So, we're working on creating innovative ways to engage these families in their typical practices.

Dr. Scott Steele: That's fantastic. Do you notice that if you have an uncontrolled diabetic and we just focus on the glucose aspect of it that you'll have better mental health, or do they have to go hand in hand?

Dr. Taylor Stephens: They definitely go hand in hand. But I think each child is different, and some, that may be a real area that we can target. For others, it may really need to be targeting both. And so, I think it's really individualized.

Dr. Scott Steele: Okay. So now it's time for our quick hitters, a chance to get to know you a little bit better. So, first of all, what is your favorite food?

Dr. Taylor Stephens: Got to go with cheese. I'm not a blue cheese girl, but pretty much every other cheese in the book.

Dr. Scott Steele: So, you can give me either to play or to watch. What's your favorite sport?

Dr. Taylor Stephens: To play, I would say soccer.

Dr. Scott Steele: Tell me a little bit about a great trip that you have been on or, conversely, and/or that you would like to go on one day.

Dr. Taylor Stephens: That is a good question. I think because I am such a big foodie, I hope to one day travel through the different aspects of Italy and Europe and try all the wonderful food, particularly the cheese.

Dr. Scott Steele: Fantastic. And so finally, obviously coming from Arizona, the Ohio climate, especially here in Northeast Ohio, is a little bit different, but tell us something that you like about living here.

Dr. Taylor Stephens: Well, actually, I am the hottest human known to man, so I love the weather here. But one of the things I really like about living in Cleveland is you can really find anything to do that meets your interest. So, I've really enjoyed getting to explore the arts and culture scene. One of my favorite things I did recently was actually do a glass blowing class.

Dr. Scott Steele: Fantastic. I've actually done one of those as well, and that was a lot of fun.

Dr. Taylor Stephens: Really cool.

Dr. Scott Steele: So, give us a final take-home message about mental health in pediatric diabetic patients.

Dr. Taylor Stephens: I think the thing I want to make very clear is that this is not something that should be punitive or viewed negatively. We know that mental health and diabetes go hand in hand, so seeking support and seeking services should not be viewed negatively, though we know it is somewhat stigmatized in the larger society. So, I think the thing I want to say is we know those things are important, and so seeking services is just an additional support to your team, just like your other medical providers.

Dr. Scott Steele: That's fantastic advice. And so, to learn more about mental health care offered through the Center for Pediatric Behavioral Health at Cleveland Clinic Children's, or to schedule a consultation, please call 216-444-KIDS. That's 216-444-5437. You can also visit our website at clevelandclinicchildrens.org/behavioralhealth. That's clevelandclinicchildrens.org/behavioralhealth. Taylor, thanks so much for joining us here on Butts and Guts.

Dr. Taylor Stephens: Thank you so much for having me.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts and Guts.