Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.

**Peter Attia, MD** (0:11)
Hey everyone, welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. My guest this week is Dr. Trenna Sutcliffe. Trenna is a developmental behavioral pediatrician and the founder and medical director of the Sutcliffe Clinic in the Bay Area, which partners with patients and their families to evaluate and provide supportive care for children dealing with issues such as behavioral changes, developmental differences and school struggles. In my conversation with Trenna, we explore her journey into developmental and behavioral pediatrics. In fact, she was the first person to be practicing under this designation at Stanford when she arrived about 20 years ago. This includes her background in genetics, pediatric neurology, and her current work in leading multidisciplinary teams around the care of children with autism, ADHD, and anxiety. We spoke about the diagnostic processes for autism, ADHD, and anxiety, which she calls the three A's, discussing how these behavioral diagnoses are made based on clinical traits and the criteria depending on the age of a child. We focus on the overlap between the three A's and how comorbidities are common in children with each of these conditions. Trenna emphasizes the importance of a personalized treatment plan to consider the whole child, including their environment at home and school. We talk about the changing diagnostic criteria for autism between the DSM-IV and the DSM-V and what some of the drivers might be for the increase in the prevalence of autism today. This is a very hotly discussed topic. Trenna provides a very thorough discussion of what the factors are that may be contributing to this. We discuss the various therapies, including Applied Behavioral Analysis, or ABA, for autism, behavioral interventions, and parental training for ADHD. We cover pharmacologic options, particularly for ADHD and anxiety, including the use of stimulants, non-stimulants and SSRIs. Trenna explains how these medications are used alongside behavioral interventions to help children manage symptoms and improve their daily lives. And we talk about the challenges families face in accessing care, particularly outside of major urban areas and the importance of bridging health care and education to create a more holistic approach to support children with these developmental conditions. So, without further delay, please enjoy my conversation with Dr. Trenna Sutcliffe.
Well, Trenna, thank you so much for coming all the way out to Austin. Really nice to meet with you in person. I've heard a lot of things about you from various colleagues in the Bay Area. And frankly, this is just a topic that I think a lot of people are interested in. Obviously, many of them parents, but I just think people in general are kind of interested. And so, maybe just before we jump into it, let's spend just a couple of minutes on your background so people understand who you are and why I wanted to spend so much time with you. So, you trained in pediatrics, developmental and behavioral. Well, let me not try to summarize what you've done. Tell me what you've done.

**Trenna Sutcliffe, M.D.** (3:54)
Okay. Well, initially, I did an undergrad and master's degree in genetics, and then went on to medical school. After medical school, I went on and did a residency in pediatrics, but ultimately wanted to do developmental behavioral pediatrics for numerous reasons, because it just was a really good fit with my interests and passions. So, I did actually a year in pediatric neurology and then a full fellowship in developmental behavioral pediatrics before moving to California.

**Peter Attia, MD** (4:25)
Your interests today primarily revolve around behavioral therapy for three things that we're going to spend quite a bit of time talking about. I won't commit to the order yet because that'll come out of our discussion, but somewhere along the way, we're going to talk about autism. We're going to talk about ADHD, and we're going to talk about anxiety. So, coming at this through the lens of what you do today, which is running a really large, successful, multidisciplinary clinic, I assume this is just for children, so this is up to 18 years old, basically, is your patient population?