🎙 Episode 18: Always More — Anxiety in High-Achieving Teens

Guest: Nicole Beale, M.Ed., High School Counselor
Host: Matt Butterman
Duration: ~45 minutes

Overview:
Today’s high school students are taking more AP courses, joining more extracurriculars, and aiming higher than ever — but it’s taking a toll. In this episode, we explore the hidden cost of high achievement and the anxiety that often lurks behind perfect GPAs and packed résumés.

Matt Butterman speaks with veteran public high school counselor Nicole Beale about the growing mental health strain on ambitious teens and the pressures they face from school systems, colleges, and well-intentioned parents. Nicole shares compassionate, real-world insights from her 25 years supporting students and her own perspective as a parent of a high-achieving teen.

Topics Covered:

• The culture of perfectionism and how it drives academic overload
• Why AP course loads have skyrocketed — and what’s fueling the trend
• The unintended consequences of class rank, college admissions metrics, and school report cards
• How snowplow parenting and peer comparison amplify anxiety
• Signs that anxiety is becoming unhealthy — and when it’s time to intervene
• Practical strategies for families: setting limits, quitting wisely, and restoring balance
• What gives Nicole hope: increasing mental health support in schools, more compassionate teaching practices, and resilient teens finding their own paths

Key Quotes:

Resources & Links:

• The Race to Nowhere (Documentary referenced in the episode)
• More on AP and college admission trends: collegeboard.org
• For mental health support: Speak with your school counselor, pediatrician, or a licensed therapist

📢 Share This Episode:
Know a student, parent, or educator who needs to hear this? Share the episode or leave us a review to help others find Nimble Youth.

🔗 Visit: www.nimbleyouthpodcast.com for full show notes and past episodes.

🎙️ Episode 17: “When Tantrums Go Too Far: Understanding Disruptive Mood Dysregulation Disorder (DMDD)”
Host: Matt Butterman
Guest: Dr. Gretchen Hoyle, MD, Pediatrician
Duration: ~35 minutes

Episode Summary:
Chronic irritability, frequent temper outbursts, and emotional volatility—these behaviors may go far beyond typical childhood tantrums. In this episode, host Matt Butterman is joined by pediatrician Dr. Gretchen Hoyle to unpack Disruptive Mood Dysregulation Disorder (DMDD), a relatively new but critical diagnosis that helps explain persistent mood and behavior challenges in some children and adolescents.

Dr. Hoyle explains what sets DMDD apart from ordinary moodiness and how it's different from disorders like bipolar disorder. She explores potential causes, including genetics, trauma, and neurodevelopmental factors, and discusses evidence-based treatment approaches ranging from cognitive behavioral therapy (CBT) and parent management training to medications such as atypical antipsychotics in severe cases. The episode also emphasizes the importance of early diagnosis, school accommodations (like 504 plans), and the effectiveness of collaborative care models in managing this complex disorder.

Key Topics Covered:

• What defines DMDD and how it differs from bipolar disorder

  
  

• Risk factors, including trauma, stress, and neurological dysregulation

  
  

• Why emotional regulation is at the core of DMDD

  
  

• Treatment strategies: CBT, parent training, medication, and trauma-informed care

  
  

• How schools and families can collaborate through 504 plans and support systems

  
  

• The role of pediatricians and behavioral health teams in identifying and managing DMDD

Three Takeaway Facts:

1. DMDD affects approximately 2–5% of children and adolescents, with symptoms typically appearing before age 10.

   
   

2. Unlike bipolar disorder, DMDD is chronic and non-episodic, characterized by persistent irritability and frequent behavioral outbursts.

   
   

3. With early intervention and a multi-pronged approach, many children with DMDD experience significant improvements over time.

   
   

Resources & Links:

• NIMH: Disruptive Mood Dysregulation Disorder Overview

  
  

• AACAP: Facts for Families on DMDD

  
  

• Visit our website for full episode archives and additional resources: www.nimbleyouthpodcast.com

  
  

  
  

About Our Guest:
Dr. Gretchen Hoyle is a board-certified pediatrician with over 25 years of clinical experience, specializing in pediatric mental and behavioral health. She is a regular guest on Nimble Youth and a passionate advocate for early intervention and integrated care.

This episode explores how to help kids with anxiety and OCD by changing not their behavior—but the parent’s. Our conversation centers around Dr. Eli Lebowitz's book, Breaking Free of Child Anxiety and OCD.