Bill Klaproth (Host): This is Columbus Community Hospital Healthcasts. I'm Bill Klaproth. In this episode of Healthcasts, behavioral pediatric psychologist Dr. Tara Sjuts shares how family-based care, community support, and practical strategies help children and teens build resilience, strengthen relationships, and thrive at home and school. Dr. Sjuts-- and I'm going to call you Dr. Tara during the interview-- Dr. Tara, welcome.

Tara Sjuts, MD: Thanks. Thanks for having me, Bill.

Host: Dr. Tara, it's great for you to be here, and this is a great topic and glad you're with us today to talk about this. So, let's start with this. What does your day-to-day work with children, teens, and parents in our communities look like?

Tara Sjuts, MD: Yeah. So, most of my day-to-day work is a mix of therapy and evaluations. I do a lot of work with families, which spans that age range from 12 months old to maybe 19 years old or so. With my younger kids, I'm doing a lot of family-based therapy. And with some of my older teens, I do a lot of the individual therapy. Family therapy is very problem-solving focused. So, I'm doing a lot of work on kind of figuring out what's been going on, what behaviors are getting in the way of kind of optimal functioning for families, and then what kind of work can we do to kind of clean things up so that kids can be successful across settings.

Host: So, you're really focusing in on families. That's what I got out of that. So, your approach is very family-based. So, why is involving parents and caregivers such a critical part of helping kids develop positive behaviors and emotional skills?

Tara Sjuts, MD: Yeah. I mean, I'm a pretty firm believer that parents are the most important people in children's lives. And it's never my goal to replace a parent. And so, when someone wants someone for their child to talk to, you know, to talk about hard things, I don't actually want to replace the parent in that role. I would rather work on, you know, what barriers are getting in the way of good parent-child communication and see if we can address those so that the parent can be the absolute best person for the child to talk to. I am essentially meant to be a temporary figure in this child's life. And, you know, ideally, that parent is there for a very, very long time into adulthood as a solid support for that child. And so, instead of me being the person that's going to talk to the child all the time, I really want parents to play a pretty big role in that. And beyond that, I see kids for a short session every couple of weeks, whereas parents are with their kids day in and day out. And so, if we want good change to happen, parents have so much more contact time than I do.

And so, my approach is probably more of an indirect approach when it comes to working on behaviors. Because I'm working through the parents, I'm transferring kind of therapeutic school skills to the parents so that they can use them day in and day out with their child so they can manage the environment around the child and make sure that behaviors that we want to see more of are getting reinforced in that behaviors we don't want to see so much of are maybe getting reduced or discouraged. And so, parents have a lot more power in that aspect than I do. They see the child so much more than I do.

And then, for little kids, we know that kids run on attention as fuel. We can learn how to use that attention pretty strategically so that kids are encouraged to use the kind of behaviors that we want to see them using. And we're then building up that parent-child relationship. We're strengthening that. We're giving everyone good tools to kind of work together.

Host: So, I understand the family focus now when you explain that. That really makes sense to give parents those skills and tips so they can properly manage the child. Because as you say, they're with the child a lot more often. So, that really makes a lot of sense.

So, you use several therapeutic approaches. I'll name a few of them: PCIT, CBT, ACT, and DBT. How do you decide which strategies are the best fit for a child or family?

Tara Sjuts, MD: Yeah. The first time I meet a family, I spend that whole session just learning about the family, and about the child and where they've been, where they want to go. And so, I'm learning of course about the presenting problem, as you would call it. You know, what are they coming in for? But then, there's so many kind of other factors that might be contributing to what's going on. And so, I'm asking questions about sleep. I'm asking questions about anxiety. So, I really want to make sure we're not missing anything. So, I take all of that information, and I try to figure out what's the child's needs, and what's maybe getting in the way.

From there, we also have to be considering, you know, what's developmentally appropriate for this child. You know, if I'm working with a 2-year-old, CBT is definitely not appropriate. There's kind of age ranges that some of these things are appropriate based on the insight and awareness and cognitive level of the child. And then, you want to consider, you know, what's realistic for this family, what foundational groundwork needs to be done before we can get to certain skills, and what supports does the child need, that kind of thing. What does the family need? You know, what barriers are these families facing?

So after that, I like to think of these different therapeutic approaches as kind of a menu of options. And there's so much overlap between the different therapeutic approaches. And kind of conceptually, you can see where they overlap, where they complement each other, fill each other's gaps. So then, I kind of order à la carte to order from this menu of strategies of what does this family need and how can I piece it together based on these evidence-based strategies and what can I pull together to put together the best meal.

Host: That's really important that you do that, so you really understand that child and the family and what that person is going through to come up with individualized treatment plans. So, that makes a lot of sense. So, many families have concerns about ADHD or autism. What are some early science parents should be aware of, and how can psychological evaluation help guide next steps?

Tara Sjuts, MD: Yeah. First, kids are allowed to be a little bit quirky, right? Like we just need to give kids a little bit of grace to be kids and give them the wiggle room to do some of the, you know, quirky things that kids do. But if we start to notice that there's a pattern where, you know, the child is struggling developmentally or socially or academically, emotionally, behaviorally, you know, if we're starting to see what we would call an impairment in functioning, then it's time to take a closer look. Or if the pediatrician or the teacher or, you know, a speech therapist says, "Hey, I think maybe we should look a little further at this."

And then, honestly, mom's instinct is pretty spot on usually. So if mom has just concerns that something's not quite right, I'd say, come on in. Moms aren't wrong very often. But doing that evaluation then kind of helps us highlight the problem areas and the strength areas and kind of figure out what's a roadmap that we need to put together of supports to help this child be as successful as possible at home and at school and in the community.

Host: Follow mom's intuition. Always a good idea.

Tara Sjuts, MD: Yeah.

Host: Absolutely. So, you were mentioning before you look at things like sleep and anxiety. So, I'm wondering, I'm sure you emphasize lifestyle factors like sleep, diet, exercise. How do these everyday habits impact a child's mental and emotional health?

Tara Sjuts, MD: Yeah. So, kind of going back to that evaluation question, you know, I'll have families come in sometimes. And, you know, maybe they have ADHD concerns. Because their child is having a hard time paying attention at school. You know, they're crabby at home. They're having a hard time managing their emotions. And we start talking and I learn that this child snores every single night. Snoring is never normal, so to speak. If a child is snoring, it might indicate that there is a medical reason. There might be restricted airway, which is leading to reduced oxygen while they're sleeping, which leads to lots of sleep disruptions. And then, you can kind of piece it together from there. If you're having a hard time getting consistent, solid, deep sleep during the night, you are a lot more likely to show signs of chronic sleep deprivation, so crabbiness, difficulty focusing. Kids kind of go-- instead of kind of shutting down when they're tired, they ramp it up and they get even more hyperactive. They might have a hard time coping with anxiety. So, maybe they need to have kind of that breathing issue or that snoring issue addressed medically. And once that's taken care of, there might actually not even be a need for an ADHD evaluation anymore. That's a critical thing to kind of consider.

But sleep, you know, it's not just snoring that disrupts sleep, it's phones and TVs in the bedroom, and just difficulty with sleep hygiene and bedtime routines and things like that. So, sleep's pretty critical for supporting all mental health. But diet, exercise, other lifestyle things are incredibly important too. So, take exercise, for example. There's data to show that exercise can be just as effective for treating anxiety and depression as antidepressants, and that's for mild to moderate depression. But even then, it can be a significant boost in addition to medication for treating more severe forms of anxiety or depression. And I talked too with teens, you know, you got to hang out where joy is hanging out, right? Like if you want to feel joy, you got to hang out where joy is hanging out. So if you are laying in bed watching TV all day, there's very little chance that joy is going to come land on you, right? But if you are out connecting with other people and you're moving around and you're doing things that are fun, physical and social, there's a much greater chance that joy will come and land on you. It's not a guarantee, of course, but it's better odds. So, making sure that we're moving and we're connecting is super important.

And then, diet. We talk about the gut-brain axis. Most of your neurotransmitters are actually made in your gut. So, your serotonin, your dopamine, your melatonin, those are made in your gut and not necessarily by your human cells, so to speak, but by your healthy gut bacteria. And so, making sure that we are eating foods to support that healthy gut bacteria supports our mental health. We're making sure we're getting all the building blocks we need to support what our body needs to do to have good mental health. So, that's just like surface level. There's so much more to it.

Host: No, that's really good what you said and important for people to understand how things like that can impact a child's mental and emotional health. One thing I didn't ask you, and I think this is a big one, what about social media? When we talk about everyday habits that impact a child's mental and emotional health, can you just quickly touch on social media for a minute?

Tara Sjuts, MD: Yeah. It's a big one. Social media, that is tricky because it's designed for connection, right? And there are positives, like you can learn all sorts of cool things. You know, you can watch a YouTube video and learn how to change your oil or whatever, right? But if that's how it's designed, it doesn't necessarily mean that's how it is used or what the end resulting factor ends up being.

So, we know that it is linked to higher rates of anxiety, depression, eating disorders, suicidal ideation, cutting, bullying. It's a mess. And we have seen kids' mental health absolutely plummet since the advent of social media. So, numbers right now are the worst that they've ever been. And we saw screen time increase during COVID, of course, because kids were home. But then, once restrictions let up, the numbers never went back to normal. That became the new standard of just being on screens. And so, screens end up getting in the way and replacing in-person social connection. Kids have more of a screen-based childhood instead of a play-based childhood. And so, the risk-taking that's actually really healthy for kids. You know, learning body awareness, things like that. Even grip strength, we see, you know, kids, their ability to grip a pencil appropriately, that's a struggle because they're used to kind of the swiping, the gentle swipe motion. Attention spans are way down. It's a mess. So, I'm a big advocate for limiting screen time.

Host: Limiting screen time sounds like the thing. And making sure you're monitoring. I never heard that phrase before screen-based childhood. But when you say that, really makes a lot of sense.

Tara Sjuts, MD: If you haven't read The Anxious Generation, I highly recommend it.

Host: Okay. Good tip. Well, thank you for passing that along. So, Dr. Tara, I know you and your family chose to return to Columbus for the sense of community. How does practicing in a smaller, close-knit town influence the care you're able to provide?

Tara Sjuts, MD: My husband and I both grew up in Columbus. So, moving back was kind of a homecoming. And part of that, we wanted a childhood for our kids that was more similar to what we had in that close-knit community. And part of that is there's just so much overlap. You see the same people in so many different settings. And so, it's kind of more of that village mentality. And I think I bring that into my work also. You know, I want to be part of the village for families, because our village looks different. And I say that in the sense that it takes a village to raise children, right? Like, I want to be part of that village.

And so, I feel like I actually get to be-- because I see kids out in the real-world, so to speak-- and I get that enthusiastic wave or that shy smile from kids sometimes, and that's always fun. But I also get to see kids at football games and I get to see them, I end up seeing some of my patients performing in the band or playing basketball. It's just fun to see them outside of the clinic too. And that's also true with the other providers that I work with. I have more personal relationships with other providers. And so, that makes it very easy to call them up and help collaborate on a patient's case and make sure that we're covering all the bases and providing kind of that well-rounded care and we're not missing anything.

Host: Well, that smaller, close-knit town feel influence really is important, and it is a great thing.

Tara Sjuts, MD: Yeah.

Host: So, Dr. Tara, for parents who may be feeling overwhelmed or unsure about seeking behavioral health support, what encouragement or advice would you like to share?

Tara Sjuts, MD: I think that's normal to feel a little overwhelmed or intimidated or unsure about seeking help. I think especially with social media, there's a million ideas on how to raise kids and it's hard to know who to trust. I think it's very normal to have those concerns. And I think too, being in a smaller town, maybe you're afraid that, you know, someone's going to judge or that someone's going to talk about stuff. Confidentiality is near and dear to my heart. So, I try very hard to protect that for kids to the point where, you know, I'll tell kids, you know, "If I see you in public, I won't say hi unless you say hi first." And if they say hi first, obviously, I love that. But they aren't required to. Of course, I'll never talk about anything clinical if I see someone out in the real-world. So, privacy is super important.

And then, I'm never going to judge, right? I think when you have been doing this for a while, you start to see so many commonalities just kind of in humans. There's a lot more that we have in common that we're struggling with, that nobody really talks about, even myself. I have kids, I have a family. I know what it's like to try to balance everything. I know what it's like to be tired at the end of the day and to try to be a good parent anyway. I feel like sometimes I have a lot more in common with families, and that makes it really easy to relate to them and understand them. So, I guess I would just want families to know that it's a non-judgmental, private, hopefully fun space for kids and families.

Host: Well, when you learn more about your child and you can help your child, if he or she is struggling with something, then parenting does become more fun then, especially if you have strategies and you know what's going on and you know what to do in the moments throughout the day. So, that makes sense.

Tara Sjuts, MD: Absolutely.

Host: Yep. So, I guess it's normal to feel a bit of apprehension. But like you said, nonjudgmental, you're all in this together. We all have stuff in our lives. So, no need to worry about that. Good to get in and see someone like yourself and get the care that your child needs to help manage whatever they're dealing with.

Tara Sjuts, MD: Yeah. And I would say too, you know, a lot of what I do see is actually pretty normal hiccups in childhood. I'm not here to kind of overpathologize something in a child. There's a lot of things that are normal in childhood that we don't necessarily have to put up with, you know, like biting. It's very, very common for toddlers to bite, but that doesn't mean that we're going to put up with it.

Host: Dr. Tara, this has been great. I appreciate your time today. Before we wrap up, is there anything you want to add?

Tara Sjuts, MD: I would just encourage families to live real life. Get out of the living room in terms of sitting in front of the TV or sitting next to each other, scrolling on their phones, but connect and be together and interact and get out of your room in the basement, that kind of thing.

Host: Get outside, like you said, right? Good to be out outdoors and exercise. That helps too. So when you're outside running around, you're exercising as well. So, that's all good. Dr. Tara, thank you for your time. This has really been great.

Tara Sjuts, MD: Absolutely. Thank you.

Host: You bet. Once again, That is Dr. Tara Sjuts. And for more information and resources, please visit columbushosp.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Healthcasts. Thanks for listening.