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I Think I Can I Think I Can

Matthew Flanagan, PsyD| Child Clinical psychology fellow, university of kansas school of medicine – wichita

I think I can, I think I can….  

As a mental health clinician, when I hear about problems in school, I conceptualize them as the symptoms of a deeper and more complex issue. According to the U.S. Department of Health and Human Services, it is estimated that 1 in 5 U.S. children ages 3–17 has a mental, emotional, behavioral, or developmental disorder. ADHD, learning disorders, sensory sensitivities, anxiety disorders, and trauma can all contribute to poor mental health and disruptive behaviors in a school environment. These individuals would likely benefit from a course of Cognitive-Behavioral Therapy (CBT) with a trained mental health professional. Yet for many Kansas families, access to these services remains limited. According to HRSA’s Health Provider Shortage Area (HPSA) interactive map, 96 out of 105 counties in Kansas are shortage areas for mental health providers.  

Pediatricians are particularly positioned to support children’s and families’ mental health. Thinking of my own experience as a patient and as a parent, primary care providers can develop a very therapeutic relationship with the families they encounter. Pediatricians also have a unique opportunity to identify risk factors early and intervene before emotional or behavioral difficulties become significantly impairing. 

In the American Academy of Pediatrics’ 2019 policy statement, and reaffirmed in 2025, the AAP outlines several competencies for pediatric practice focused on mental health. In these competencies, pediatricians are encouraged to grow in their competence to prevent, assess, and treat mental health disorders using their already developed clinical skills and interventions.  

One of the competencies highlighted by the AAP is the use of brief psychological interventions that can be incorporated into everyday pediatric practice. Although these interventions may sound complex, their core principles can be illustrated through a familiar children’s story: The Little Engine That Could. For those who do not know the story of the Little Engine, a small locomotive breaks down and is unable to deliver its load of toys and food for the children on the other side of a mountain. Several trains pass this broken-down locomotive and are each in turn asked for help. One is a Rusty Old Engine. Without even attempting to pull the small train, the Rusty Engine tells the sad toys and broken engine “I cannot pull even so little a train as yours over the mountain. I cannot.” In the story, the Little Engine thinks “I can” rather than “I cannot.” Importantly, the Little Engine succeeds not simply because she thinks positively, but because she is willing to try despite uncertainty. 

I love this children’s book because this phrase, “I think I can,” in a way, illustrates the cognitive-behavioral triangle.  

CBT uses the cognitive-behavioral triangle, which shows that thoughts, emotions, and behaviors are interconnected. When a child interprets a situation negatively, they may feel distressed and engage in avoidance or other unhelpful behaviors. Those behaviors often reinforce the original thought. Interventions can target any corner of the triangle, helping children develop more accurate thoughts, healthier emotional responses, and more adaptive behaviors. 

In CBT, the goal is not blind optimism but developing realistic, helpful thoughts that support effective action. The Little Engine is naturally a little anxious considering she has never been over the mountain before, and she has not been used before for carrying cargo. However, she does not think, “that mountain is too high” or “this load looks too heavy.” She tells herself that she can do it, and indeed experiences success. 

With the start of the 2026-2027 academic year, some children may be feeling excited for the start of school. For them, school may bring with it renewed social connection, feelings of academic or athletic competence.  

However, many parents and kids might not feel so positive about the start of school. “I feel like I wasted this summer,” “I am not going to be able to handle the workload,” and “I hate school” are all statements I have heard from one child or another as we approach the start of the school year. They may be anticipating a difficult year before it has even begun. 

Parents, too, can dread the start of school. Perhaps they remember dozens of calls from the school administration last year for their child’s aggression and elopement from class. Or their child was a victim of bullying, and school is a place of misery contributing to their child’s poor self-esteem. For a child with a neurodevelopmental disorder or learning disorder, school can feel like an insurmountable mountain, and parents often feel alone navigating neurotypical expectations with their child’s neurodivergence.   

An often-immediate reaction when hearing the words, “I cannot” is to reassure. The child hears things like, “Yes, you can,” or perhaps something more negative like, “Don’t talk like that! Think positively.” Although comments like these are well-intentioned, children may sometimes hear them as a message that their fears are not fully understood. Before offering reassurance, it can be helpful to spend time exploring what is driving the concern. 

A better approach may be to lean in and ask a question. Why do they believe they cannot succeed in school? What do they hate about school? What are they scared about? Rather than trying to solve the problem, you can collaborate with the family to identify the problem. Attention difficulties, learning problems, social and emotional deficits, bullying at school, bullying online, stress at home, etc. Then, together with this information and more insight, parents and children can approach school as a team. 

As the school year begins, and you meet with families during their sports physicals and well-child visits, consider asking: 

• What went well for your child at school last year? 

• What is your child most worried about this year? 

• What would help this school year go a little better? 

These questions can uncover concerns related to learning, attention, social relationships, bullying, anxiety, and family stress while also helping families feel heard and supported. Even brief conversations that help children identify the connection between a worry (“I’m going to fail”), an emotion (anxiety), and a behavior (avoidance) can plant the seeds of cognitive-behavioral skills and help families approach challenges more effectively.

Members

Welcome, New Members!

Whether you’re just starting in your career or bringing years of experience, we’re glad to have you join our growing network of pediatricians across the state. Our chapter is all about supporting each other, sharing knowledge, and speaking up for the health and well-being of Kansas children—and we can’t wait to work with you to make a difference.

Elizabeth Loughman, MD, FAAP

Elizabeth Loughman, MD, FAAP, is a pediatrician and neonatologist at Children’s Mercy Kansas City and a Clinical Assistant Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine. She earned her medical degree from the University of Kansas School of Medicine and completed her pediatric residency and neonatology fellowship at Children’s Mercy.

Dr. Loughman provides care for newborns and infants with complex medical needs, with a particular interest in neonatal and critical care. Her work also includes research focused on neurodevelopmental outcomes in infants with critical congenital heart disease.

Dr. Loughman is passionate about providing evidence-based care and supporting families throughout their child’s medical journey. She is excited to share her expertise and experience with our pediatric community.

Medical Students

• Caitlyn Young

Resident Members

• Melissa Acosta, MD
• Olubumi Braimah, MD
• Devon Cruzan, MD
• Anthony Nickel, MD

Candidate Members

• Gavin Randhawa, MD

Progress In Pediatrics Conference

A Sneak Peek at the Progress in Pediatrics Fall 2026 Speakers

We decided to pull back the curtain early on this year’s Progress in Pediatrics Fall 2026 speakers. Get a sneak peek from a few of our sessions and hear in their own words why you should join them in the Little Apple on Friday, October 30th, 2026. Don’t forget to register to see their sessions live at the K-State Student Union.

How does your topic address a current trend or challenge in the industry?

Stephen Thornton, MD, FACEP

ILL FROM ONE PILL: Low Dose Poisons in the 21st Century
New and potent drugs, both illicit and otherwise, are being introduced into homes, putting children at risk for serious toxicity from even small exposures. Traditional “one pill can kill” teaching focuses primarily on prescription pharmaceuticals or older products that may no longer be commonly found in homes. Meanwhile, newer threats, such as high-potency THC products, fentanyl and other illicit drugs, have become significant concerns but are often underappreciated.

April McNeill-Johnson, MD, FAAP

Improving Health and Well-Being of Youth in the Juvenile Legal System Through Pediatric Care
Most pediatric clinicians are already seeing youth involved in the juvenile legal system in their everyday practice, often without realizing it. That’s because national efforts to keep youth out of confinement mean most of these kids are living in the community, not in confinement. Recent policy changes now require Medicaid coverage and care coordination for youth before and after release from juvenile facilities, creating a real opportunity for pediatric clinicians to close gaps in their care.

George Phillips, MD, MBA, CAQSM, FAAP

Pediatric Hot Topics
Hot Topics is precisely how the Progress in Pediatrics Fall 2026 Conference will make sure we address current trends and challenges in our practices. We survey our attendees in advance to learn what their needs are and what they need to learn more during the conference. I then curate those suggestions, along with occasional “presenter’s prerogative”, to provide information that is evidence-based and cutting edge, balanced with some humor and fun along the way.