Maimonides’ Life Forward Program: HIV/AIDS Is Not The End


The Life Forward Program at Maimonides was founded to provide the best medical care and social services for Brooklyn patients with HIV and AIDS. Dr. Monica Ghitan discusses how the Life Forward Program offers psychological support, nutritional counseling, among other services, in addition to excellent medical care.

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Deborah Howell (Host): You know, the Coronavirus pandemic has a lot of us wondering are the kids all right. Joining us today to talk about the pandemic’s impact on pediatric mental health is Dr. April Toure an Attending Psychiatrist at Maimonides Medical Center’s, Department of Psychiatry. This is Maimo Med Talk. I’m your host, Deborah Howell. Welcome Dr. Toure. It’s so nice to have you with us today.

April Toure, MD (Guest): Thank you. I’m really grateful to be here.

Host: So I think one of the goals we have as parents and physicians is to try to get an overall picture of our kids’ mental health, kind of a before and after the pandemic picture, how are some ways we can do this and really, how are our kids doing these days?

Dr. Toure: Well, you know, I think the short answer is that the kids are struggling. I think just like everyone else has been. One way to think about it though, just to put it into context, is that even before the pandemic started, at least over the last decade, there’s been a lot of data and evidence showing that different mental health concerns have been on the rise for some time in kids. That includes like increased rates of depression, increased like emergency department visits for psychiatric concerns. And unfortunately death by suicide has become one of the top leading causes of death in teenagers.

So we already knew that there was you know, a lot of concern and a lot of things we needed to be paying attention to before the pandemic hit. But that was just kind of like a lightning rod moment that really exacerbated concerns that were already growing. And so since that time, unfortunately, we have seen those trends continue to take off.

Host: Now in-person school was eliminated for our kids in the New York public school system. In some cases for a year or more for some who didn’t elect to do hybrid, what kind of impact can that have?

Dr. Toure: Yeah. I mean, again, that, that has been quite far reaching and complicated as well. So I think one of the top concerns that come to mind within the mental health space is really around social isolation. And so, you know, social development, like learning how to make friends and making like, your peer group and navigating social situations is actually a super crucial part of growing up.

And so obviously that has been a real struggle with the isolation that’s happened during quarantine and during school going virtual. The other thing that’s been coming up is, you know, I think pretty obviously the academic concerns and so, you know, school is already hard and can really be a place where there can, it can be a source of stress. And so going virtual, just like a lot of kids that I talked to just really struggled with online learning, but then there’s also that adjusting now to going back full-time in-person. And the other effect that we’ve seen is that a lot of mental health services really are co-located in schools, or schools can be a place of referral.

You know, kids spend so much time with their teachers and what their counselors at school that sometimes they’re really, you know, frontline in a good position to kind of tell when things are not going well, bring that to parents attention and then give them resources to try to get connected to additional support. So with kids not being in school in-person for so long, certain concerns like that maybe were missed and delayed.

Host: Right. Can you give us some basic definitions for depression and anxiety?

Dr. Toure: Yeah, of course. So, you know, the way I actually talk about it with the kids I work with and with their families and what I find to be a helpful analogy is actually thinking about it in relation to other medical concerns like hypertension, for example, high blood pressure. So the way I think about it, that you know, everyone has a blood pressure and there’s a range of blood pressures that are healthy, right and considered normal and safe. But when your blood pressure gets too high for too long, we know that can cause all kinds of other problems. And that’s when we consider it to be a conditionm hypertension or high blood pressure that needs intervention or treatment. So, I think of anxiety and depression and explain it very similarly that these are anxiety and depression are feelings, they’re emotions that all of us need to experience and they play their role. And they’re very important. But when that emotional state kind of takes over and it’s too intense for too long, and it makes it hard for us to do the things that we need to do and function like we want to, that’s when we get concerned and start to consider it something that may be a disorder or something that needs intervention or needs additional help.

Host: Are there any other symptoms to look out for on our children? And if so, which symptoms should be a cause for concern?

Dr. Toure: Yeah. So that’s a great question. So kind of drilling in a little bit more specifically about what anxiety and depression are and how they show up in kids. Anxiety, I think it’s helpful to think of as just excessive worry or fear. And so that can be either being very worried about things that have happened in the past already and just kind of being stuck on them and replaying them or worrying about things that haven’t yet happened.

And like, that’s kinda like the, what ifs, like what if this happened or what if that happens or what if this goes wrong? Either way, it takes us out of the moment. And when that anxiety gets really excessive, what we see a lot is one, we can get really irritable, which is a way it can really show up a lot in kids. Or we may try to avoid the thing that’s making us anxious. So I think about a lot of my kids who are really struggling with going to school right now, and they may just like really shut down and not go at all or go but not participate. And it can also cause a lot of physical symptoms like stomach aches or headaches that maybe even seem unexplained or trouble with sleep.

With depression, we often think a lot about, you know, some people think of like your, like the Winnie the Pooh character, right? Like he just kind of like a big lump who just seems sad and down, and kind of even moves and talks in slow motion. And the truth is like in adults, it does often look like that. Like someone who’s like really sad and slow motion, maybe having crying spells. For kids, it tends to be more like intense irritability, like do not touch me, do not bother me. Like, why are you talking to me? And it can also cause problems like sleep changes, appetite changes. I think one thing that probably stands out a lot besides the irritability is like, when your kid doesn’t even want to do the fun stuff anymore, like when they can’t even get out the bed to like play their video games or talk to their friends or get outside.

And then the most concerning thing, I mean, all of these things, all of these symptoms can really cause problems and impairments in so many different ways. But one of the more concerning symptoms that we think about is when a person gets to the point where they start to feel like hopeless and a burden and like life would be better off without me because that kind of thinking can lead to thoughts about ending your life or about suicide. And that is considered, you know, an urgent or emergent concern that needs to be addressed.

Host: Absolutely. And are there differences between younger kids and teens and how they may behave when they’re anxious or depressed?

Dr. Toure: Yeah, so a little bit. So, when we think about the differences between younger kids and older kids and younger kids, I usually am thinking like, you know, pre-puberty more or less, right. And so in and younger kids, anxiety and depression actually may be more likely to show up in what some people say, like behavioral ways, meaning they may be much more likely to have like significant tantrums. You know, that’s really expected around two or three years old. Right. You know, everyone, I think knows about like the terrible twos, but if you have a five-year old or a seven year old, who is having a lot of similar tantrums like what you saw them when they were younger, that’s actually sometimes a sign or a symptom of anxiety or depression.

Another way that it may be a little bit more likely to show up with younger kids versus older kids is more what we call somatic complaints, which is just meaning, like there’s all these ways that our emotions really are experienced in our bodies physically. And so for younger kids, they, especially when they maybe don’t have as much words to describe how they’re feeling. It may come out in like stomach aches or headaches that just don’t seem to go away or don’t really seem to have a clear cause. So it may show up more in like physical symptoms for them. And like I said, kids in general, including teenagers compared to adults, might, may be much more likely to present with like a lot of intense irritability, rather than maybe the more stereotypical picture of like someone who’s just looks really sad and crying and withdrawn.

Host: So, you know, we’re not totally out of the woods yet with this pandemic. About how long do you think it’ll be until we fully understand the impact of the pandemic on our kids’ mental health?

Dr. Toure: Yeah. I mean, I really wish we had a clear answer to that. And I think just what we do know about previous you know, natural disasters that have happened or significant global events is that the likely answer is you know, years, maybe even decades, one to both fully understand and investigate what impact it’s having, but also like actively dealing with the fallout from it.

Host: So, if you think it’s a longterm process, what do we know now?

Dr. Toure: So, what we do know now is that we really need to work on one, like these conversations that we’re having now to just spread awareness. So people can have some words and some language to describe like oh, maybe that’s what’s going on right now with me in my own house. Right. And then to be able to be aware of the ways to go about addressing it both in your own home, but also through, you know, seeking additional help.

What we also know is that we really need to ramp up the types of services that we have both in hospital settings, but also at schools to try to help address like the current concerns that are going on with our kids.

Host: Okay. Now I’m hoping you can give us some action steps, what parents can do in terms of professional help, but also what they can do themselves to be supportive.

Dr. Toure: Yeah. So, I really love this question. And I love it when parents that I’m talking with and working with bring this up themselves too. And so I think there’s a couple of one, I want to say that I think that the approach really is going to be not one size fits all right. Like every person and every family is so individual. So it’s going to be a process of figuring out what works best for your family. Some general ideas though, is that I think it does help to start with finding some trusted resources, to even just educate yourself about what’s going on and trying to set up practices within your home that do allow opportunities for your kids to share what’s happening because you know, that can be really powerful.

April Toure, MD (Guest): For example of trying to work towards having shared

family dinners has been shown to be a helpful way to create opportunities to connect.

Dr. Toure: And also just give opportunities for you all to talk as a family and to have a sense of what’s happening. And just asking maybe some open-ended questions like what is the best thing that happened in their day that day. And what’s maybe one of the worst things that happened in their day that day to try to get them just talking.

And another thing that I think is super important for parents right now, especially with the school piece is I really encourage parents to be as active as they can and as proactive as they can in touching base with the teachers and other professionals at their child’s school to have a sense of what is going on for their kid in the classroom, ways that they can try to support them at home, just because we know this can be a really big source of stress for kids, and also trying to see what supports may even be already available within their school to help with what’s going on.

Host: Got it. Just two more questions is there anything else parents should know as we continue to navigate these pandemic waters with the kids under our roof and also awake.

Dr. Toure: So, you know, I guess in general, I think I would just encourage parents to figure out what’s going to help them. You know, like, meaning we, we often use like the, the airplane oxygen analogy that you have to, you know, put on your mask first, before you can help someone else. And this is actually really panned out a lot, even at looking at data around depression in parents and how, when that parent gets help for their depression, whether whether it’s you know, a mother or a father that it can reduce the depression that’s being seen in the kid. And so I think that’s just a powerful example of how it can be really hard when you are actively trying to take care of this human being who really needs you and you really care about to like figure out like how do I also prioritize taking care of myself, but we know that kids are struggling, but that their parents are struggling too. Right. And so I think as parents are trying to address what’s going on with their kids, I just really encourage them to not lose sight of what’s going to help them be their best self too.

Host: Beautifully said, is there anything special about how Maimonides treats pediatric and adolescent mental health that sets us apart?

Dr. Toure: You know, I think one of our biggest strengths is that we have such a diverse staff here. And so, you know, again, kind of going back to what I was saying before about there is no one size fits all for how to address these concerns. Cause everyone is different. An important part of that are things like language, culture. For some people, it is really important that they work with a provider who they feel like has some shared potential background with them. And so that’s one thing that I’m really proud of as a Black woman. My colleagues are so diverse in that we that we bring a lot of that to bear to the table when we’re working with different families.

So I think it really is a place that reflects the diversity of Brooklyn itself. And it’s a place where anyone can come and feel comfortable. Another thing that is really new and unique about our services is that we’ve recently started an LGBTQI clinic for both adults and kids. So again, thinking about the impact of the pandemic, we know that certain populations, including certain ethnic minorities, as well as LGBTQI kids have especially sensitive to all the myriad of fallout that’s happened as a result of this. And so again, just trying to pioneer services that really reflect the population that we’re trying to work with and that everyone has a place that they can get quality treatment and feel safe.

Host: Absolutely wonderful. It’s been such a pleasure to have you on with us today. Thank you so much for your time and for all you do for our parents and kids during these tough times.

Dr. Toure: Thank you so much for having me. It was really a pleasure talking with you.

Deborah Howell (Host): Dr. April Toure is an Attending Psychiatrist at Maimonides Medical Center’s Department of Psychiatry. To make an appointment with Adult or Child Mental Health Services, call 718-283-7864. For general information, visit This has been Maimo Med Talk.

I’m your host, Deborah Howell. Stay well. And thanks for listening.

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