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Friday, October 21, 2016

Side Effects of Meds Weigh Heavily on Children with Autism

By ANN Griswold
October 12, 2016

A sweeping study of military health records reveals that children with autism are at risk for a host of obesity-related health issues, such as high blood pressure and diabetes. These issues are especially common among children who take drugs to ease autism features (1).

The findings highlight the complexity of treating anxiety and repetitive behaviors in children with autism without creating or exacerbating chronic health problems. These children often have trouble controlling their weight even when not taking medications, because many are picky eaters or get little exercise.

But “sometimes children with autism do need to be medicated,” says lead researcher Cade Nylund, assistant professor of pediatrics at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. “Parents need to understand the risks; providers need to explain the risks.”

The study, published in August in the Journal of Pediatrics, is the largest yet to explore autism’s ties to obesity. Nylund’s team examined military health records from 292,572 children aged 2 to 18, including 48,762 children with autism. The researchers compared rates of obesity, type 2 diabetes, and cardiovascular and liver disease in children with and without autism (see graphic below). They also looked at the impact of medication use on obesity rates in children with autism.

The analysis revealed that about 8.2 percent of children with autism are obese compared with 4.7 percent of typical children.

Graphic by Lucy Reading-Ikkanda

These rates are much lower than those reported in another study of 43,777 children, published 5 October in Childhood Obesity. That study set the prevalence of obesity among children with autism at 23 percent compared with 14 percent of controls (2). But it looked at children 10 to 17 years old, and raises the possibility that obesity prevalence shifts with age.

Weight List

The military records study shows that children with autism who take drugs for anxiety, depression or inattention are at a higher risk of obesity than are unmedicated children with autism.

Specifically, the researchers found that mood stabilizers raise the odds of obesity by 40 percent. Antipsychotic drugs, such as risperidone, are linked to an almost 20 percent increase in obesity prevalence, but drugs used to treat hyperactivity and inattention have minimal effects on body weight.

Graphic by Lucy Reading-Ikkanda

Overall, children with autism are more likely than those without the condition to develop obesity-related health issues. Diabetes is about three times as common in children with autism as in the general population. And children with autism are twice as likely as controls to have high blood pressure or elevated cholesterol.

Pediatricians often counsel children with weight-related health problems to exercise and eat a healthy diet. But because these lifestyle remedies can be challenging for children with autism, some clinicians prescribe additional medications to manage obesity and its consequences.

The diabetes drug metformin, for instance, can reverse weight gain in children with autism who take antipsychotic medications. Medications such as diuretics, which fight fluid retention, do not help children lose weight but address complications such as high blood pressure.

Better yet, experts say, would be to prevent obesity in the first place — by helping parents cultivate healthy habits in their children and fully understand medications’ side effects. “It’s very difficult to address these issues once a child with autism is 17 years old and overweight,” Nylund says. “The number one thing is prevention.”

  1. Shedlock K. et al. J. Pediatr. 16, 30657-30663 (2016) PubMed
  2. Must A. et al. Child Obes. Epub ahead of print (2016) PubMed

Catching Psychosis Early

From the APA Monitor
by the American Psychological Association

By Heather Stringer
October 17, 2016

Psychologists are at the forefront of helping young people at risk of mental health crisis.

Brian Malmon seemed to be thriving at Columbia University. He was on the dean’s list, president of his a cappella singing group and sports editor for the college newspaper. But friends began to notice subtle changes in his behavior. Sometimes he seemed unusually withdrawn. During his senior year he visited the student health center, and a counselor noted signs of anxiety, stress and depression.

Malmon returned home to Maryland and met with a psychiatrist, who learned that he had been hearing voices since his freshman year. Malmon had been living with psychosis but told no one. He was diagnosed with schizoaffective disorder and withdrew from school to move home. He started taking medication and seeing a psychotherapist, but struggled deeply with the fact that his life had been put on hold while his peers were graduating from college.

He died by suicide at age 22.

"The most salient emotion I experienced was a deep belief that if Brian’s friends had known what he was experiencing and if he had felt comfortable reaching out for help, his life would be so different," says Alison Malmon, Brian’s younger sister. The experience led her to found a national young adult mental health advocacy group called Active Minds.

Malmon died in 2000. Since then, awareness of the importance of early intervention in psychosis has been elevated to the national agenda. Between 2000 and 2009, the National Institute of Mental Health (NIMH) started directing more funding to early psychosis research because studies were uncovering better strategies to identify individuals at risk—and there was mounting evidence about the consequences of delaying treatment once psychotic symptoms appeared, says Robert K. Heinssen, Ph.D., director of the NIMH Division of Services and Intervention Research.

"Previous studies showed that when treatment was delayed, people experiencing a first episode of psychosis did not respond as well to initial intervention and that long-term recovery was impaired," says Heinssen. Then in 2014, the federal government specifically designated funding for programs aimed at helping people after their first episode of psychosis. That year, Congress set aside an additional 5 percent of state mental health block grant money for these programs, and in 2016, the grant money set aside doubled to 10 percent.

"The earlier someone gets into care the better their outcome," says Rachel Loewy, Ph.D., associate professor in the department of psychiatry at the University of California, San Francisco. The symptoms of psychosis often start during the late teens or early 20s, she says. "These young adults are not only dealing with symptoms of a mental disorder but also the fact that the changes are happening at a critical time in their lives when they are developing their identities."

Psychologists at the Forefront

In a study published in 2015, researchers found that the median duration of untreated psychosis (DUP) was 74 weeks among participants. The people in the study represented 21 states throughout the country and had sought treatment in community clinic settings (Psychiatry Services, 2015).

"These data are extremely important because it represents a starting point in understanding DUP and how it is related to treatment outcomes," says Carina Iati, Psy.D., a clinical psychologist in the Prevention and Recovery in Early Psychosis program at the Massachusetts Mental Health Center.

Iati was interested in finding ways for clients to access treatment earlier. She and Rachel Waford, Ph.D., a former colleague from Emory University, discussed the issue and realized that people who knew their patients often noticed changes and wanted to help, but didn’t know how. Those people included family members, friends, teachers, police, coaches and guidance counselors.

There is mounting evidence about the consequences of
delaying treatment once psychotic symptoms appear.
The earlier someone gets into care, the better.

In an effort to educate non-clinicians about how to intervene and help young people who may be experiencing psychosis, Iati and Waford, a clinical psychologist at Emory, developed the "Psychosis Response Guide: How to Help Young People in Psychiatric Crisis."

The book, published this year, covers the warning signs of psychosis, such as isolation from friends and activities, academic struggles, irritability, substance use and lack of self-care such as bathing, eating or sleeping. While some of these behaviors may be common in adolescents, people suffering from psychosis will feel like the changes are happening to them involuntarily rather than by choice, Iati says.

The guide also explains how to have a conversation with someone about getting help. It’s important to understand that people dealing with psychosis may feel that the world has become scary and perceive things differently, Iati says.

"If someone believes the government is watching him or her, our gut reaction is to explain that this isn’t happening," she says. "But we ask people to avoid confronting delusional content. It’s more constructive to affirm that this sounds terrifying, and suggest talking to someone about their fears."

Coordinated Specialty  Care

Although early intervention is critical, equally important is the right kind of treatment. A first episode of psychosis typically results in a brief inpatient hospitalization with high doses of medication, followed by long-term outpatient treatment, Loewy says.

Traditionally, outpatient community mental health clinics provide patients with a case manager and medication, often at the same high doses of drugs that were used in the hospitalization, which can lead to intolerable side effects, she says.

"Patients on these high doses may suffer from lack of motivation and lower energy, fuzzy cognition and weight gain, and consequently they stop taking the medication," she says.

A more effective treatment strategy includes a coordinated combination of interventions, including individual or group therapy, pharmacological treatment, family support and education, and support in returning to work or school. This multidisciplinary approach has proven successful in Australia, England and other countries, but it wasn’t until recently that the National Institute of Mental Health dedicated funding to evaluate the effectiveness of this strategy in the United States.

Many other countries have the advantage of a single-payer health insurance system, which makes it easier to fund early psychosis programs, says Kim Mueser, Ph.D., executive director of the Center for Psychiatric Rehabilitation at Boston University. To explore whether these programs could be adapted to the U.S. health-care context, the NIMH launched an initiative called "Recovery After Initial Schizophrenia Episode" or RAISE.

As part of the RAISE initiative, Mueser helped to develop and study a treatment psychosis called NAVIGATE. This program includes individualized pharmacological treatment, family psycho-education and resilience-focused individual therapy. The program also provides supported employment or education. This involves assistance with searching for a job or educational setting and follow-up support to facilitate success in school and the workplace. Counselors also work with patients to determine how to disclose their psychiatric disorder.

"In this program, the primary goal is helping people get their lives back in order and achieve goals," Mueser says. "They have a right to the same kind of life that we do, but unfortunately our current system gives them the opposite message."

For example, colleges and universities make it difficult for patients to go back to school by imposing strict requirements for students who return with serious mental illnesses. "It’s my opinion that schools do this because they have a disproportionate concern over safety, and they don’t realize that people with a first episode of psychosis who have received treatment pose little risk to others," Mueser says.

But the NAVIGATE program can help, Mueser’s research has found. In a study of 404 patients who had experienced one episode of psychosis, overall quality of life scores increased about 31 percent over two years for those who went through NAVIGATE compared with 18 percent for those who received usual community care. The quality-of-life scale included interpersonal relationships, engagement in community activities and sense of purpose and motivation.

The NAVIGATE participants’ involvement in school or work also increased 58 percent during the study, compared with a 6.1 percent increase for community care participants (The American Journal of Psychiatry, 2016).

Quick Facts About Psychosis

  • 100,000 - Number of Americans who have a first onset of psychosis each year
  • 74 weeks - The duration of untreated psychosis for the subjects in the NIMH RAISE study across 21 states
  • 39 - Percentage of the subjects who were not receiving medication consistent with guidelines in terms of agent or dose at the time of enrollment into the RAISE trial
Source: NIMH

As a result of the recent increase in state mental health block grant funding for early psychosis, the number of clinics that offer this type of specialized care for psychosis will be increasing dramatically in the coming years, Loewy says. "This is a really exciting area to get involved in for psychology students in graduate school," she says. "It’s fulfilling to impact someone’s life at a critical stage."

At present, most clinics support these programs by combining Medicaid reimbursement with mental health block grant funds. There are some clinics, however, that also accept private insurance, Heinssen says. As more facilities implement this new model of care, NIMH’s next goal is to evaluate outcomes for patients and whether the programs are consistent with the coordinated specialty care model.

Transitioning Back to College

Henry (who preferred not to give his last name) was one college student who found specialized services three months after his symptoms escalated in 2015. Early in his freshman year, he started having psychotic delusions that he had evolved to a superior race. He believed he was a rap music star on par with Eminem and slept little. He couldn’t stop creating new songs for anyone he met—friends and strangers—and eventually found himself on a roof during a party. His friends contacted campus protective services. Henry was diagnosed with bipolar I disorder.

He started a 15-week program for college students with serious mental illness at Boston University called Niteo. The program reflects the NAVIGATE model, and is specifically geared for college students. Henry is learning such wellness strategies as the importance of maintaining a sleep schedule, avoiding substance use, and managing the stresses of an academic environment given his bipolar disorder.

"Before the program, I felt lost and regret about how I’d been acting, but now I fully accept my situation," he says. "I’m not going back to the same school, but I’m going to a university closer to home with good academic and athletic programs. I believe I will be able to succeed there."

Who is at risk?

While early intervention is the frontier in psychosis care now, some psychologists are leading research efforts aimed at identifying risk factors early enough to possibly prevent psychosis in the future. Elaine Walker, Ph.D., a professor of psychology and neuroscience at Emory University, is studying patients who exhibit prodromal symptoms—symptoms that precede the onset of psychosis.

For example, someone experiencing a prodromal symptom may hear a voice calling his or her name when no one is there, but attribute it to his or her imagination, Walker says.

"Once someone crosses the threshold to thinking the voices or visions are real, then they have moved into the category of having mental illness," Walker says.

Studies have shown that only about one-third of people who experience prodromal symptoms of psychosis go on to develop the disorder. Another third continue to have prodromal symptoms but do not escalate to psychosis, and one-third stop experiencing symptoms altogether, Walker says.

She is working with investigators who are part of the North American Prodrome Longitudinal Study to understand which people with these early signs are most at risk of developing a psychotic illness. They discovered that brain volume in the cortex decreased more in participants who eventually developed psychosis than those who did not (Biological Psychiatry, 2015).

Other research groups have found decreases in the volume of the hippocampus. These individuals also had differences in brain electrical activity, and elevated biomarkers of neuro-inflammatory processes, Walker says. The researchers also found evidence that exposure to stress and trauma was associated with a greater likelihood of developing a psychotic illness (Biological Psychiatry, 2013).

Proven Treatment Strategy

A combination of interventions, such as therapy, medications, family support and education, and support in returning to work or school appears most effective.

"We are trying to understand the underlying neural mechanisms so we can shed some light on the causal factors and maybe even prevent psychosis," Walker says.

For now, though, early intervention after the onset of psychosis is gaining momentum, and Walker hopes psychologists can continue to disprove the myth that the outlook is dismal for people with this disorder.

"I work with young people every day with psychosis and see them make huge strides," Iati says. "They go back to school and work and reconnect with friends, and start to enjoy life again."

Thursday, October 20, 2016

ADHD Diagnosis Puts Girls at Much Higher Risk for Other Mental Health Problems

via ScienceDaily

By Stuart Wolpert
October 4, 2016

Girls with attention deficit hyperactivity disorder are at higher risk than girls without ADHD for multiple mental disorders that often lead to cascading problems such as abusive relationships, teenage pregnancies, poor grades and drug abuse, UCLA psychologists report in the journal Pediatrics. 

The researchers, who conducted by far the most comprehensive analysis of girls and ADHD, report:
  • 37.7 percent of girls with ADHD met criteria for an anxiety disorder, compared with only 13.9 percent of girls without ADHD.
  • 10.3 percent of girls with ADHD were diagnosed with depression compared with only 2.9 percent without ADHD.
  • 42 percent of girls with ADHD were diagnosed with oppositional defiant disorder, compared with just 5 percent of girls without it. Oppositional defiant disorder is characterized by angry, hostile, irritable, defiant behavior. To meet the diagnosis for oppositional defiant disorder, a child must display at least four of eight symptoms for at least six months that result in significant academic, social and family problems.
  • 12.8 percent of girls with ADHD were diagnosed with conduct disorder compared with only 0.8 percent without ADHD. Conduct disorder is similar to oppositional defiant disorder, but with more severe behavioral problems, such as committing violent acts, setting fires and hurting animals.

"We knew the girls with ADHD would have more problems than the girls without ADHD, but we were surprised that conduct disorder and oppositional defiant disorder were at the top of the list, not depression or anxiety," said Steve Lee, a UCLA associate professor of psychology and senior author of the study.

"These conduct disorders, more than anxiety and depression, predict severe adult impairments, such as risky sexual behavior, abusive relationships, drug abuse and crime."

Symptoms of ADHD include being easily distracted, fidgeting, being unable to complete a single task and being easily bored. The disorder occurs in approximately 5 percent to 10 percent of children in the United States, and figures in many other industrialized countries with compulsory education are comparable, Lee said. ADHD can begin in pre-school kids and can persist into high school and into adulthood, especially when it's accompanied by oppositional conduct disorder.

The psychologists analyzed 18 studies of 1,997 girls, about 40 percent (796) of whom had ADHD. Most of the girls were between ages 8 and 13. Most ADHD studies focused on boys, or compared girls with ADHD to boys with ADHD -- not to girls without ADHD.

ADHD is often harder to detect in girls than in boys because girls with the disorder may appear disengaged, forgetful or disorganized, and perceived as "spacey" and stay "under the radar" without being referred for assessment and treatment, said lead author Irene Tung, a UCLA graduate student in psychology and National Science Foundation graduate research fellow.

What should concerned parents do?

If a child's negative behavior lasts for months and is adversely affecting her or his social relationships and school performance, then it's worth having your child evaluated by a psychologist or psychiatrist for ADHD and other mental disorders.

Parents of girls with ADHD should carefully monitor signs of disruptive behavior, anxiety and depression, Tung said. "Early management of ADHD and related symptoms will be critical in helping young girls function successfully at school and socially, and feel confident," she said.

"People tend to think of girls as having higher risk for depression and anxiety disorders, and boys as being more likely to exhibit conduct disorders, but we found that ADHD for girls substantially increases their risk for these conduct disorders," Tung said. "In many cases, the school can provide support, including an evaluation by a school psychologist."

Approximately five to seven percent of elementary school students have oppositional defiant disorder and approximately one to two percent of elementary school students have conduct disorder, Lee said. Fewer girls than boys have these disorders.

The good news, the psychologists said, is that there are effective treatments -- some involving pharmaceuticals, and others that involve seeing a therapist, as well as effective parenting strategies to manage the behavior.

"Kids with ADHD need structure and consistency, more than the average child; they need to know the rules and the rules need to be applied consistently," Lee said.

Lee and Tung recommend that parents provide positive reinforcement for good behavior; this does not have to be monetary.

"For some of these kids, getting negative attention may be their only way of getting attention," Tung said.

"Catch your child being good, and reward that," Lee said. Children will sometimes react negatively to rewards in the beginning, and parents at that point will often stop, but should continue, he added. "The child's behavior will often get worse before it gets better."

Children with ADHD are two to three times more likely than children without the disorder to develop serious substance abuse problems in adolescence and adulthood, Lee and colleagues reported in 2011.

To receive a diagnosis of ADHD by a child psychologist or psychiatrist, a child must have at least six of nine symptoms of either hyperactivity or inattention, the child's behavior must be causing problems in his or her life, and the symptoms must not be explainable by any medical condition or any other mental disorder.

In addition, the symptoms must have started before age 12, must be present in multiple settings -- at home and school, for example -- and must be adversely affecting functioning.

Many more children meet the criteria for ADHD than are being treated for it, and many children may benefit from treatment who are not receiving it, Lee said.

Journal Reference
  • I. Tung, J. J. Li, J. I. Meza, K. L. Jezior, J. S. V. Kianmahd, P. G. Hentschel, P. M. ONeil, S. S. Lee. Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis. PEDIATRICS, 2016; 138 (4): e20160430 DOI: 10.1542/peds.2016-0430

Grad-Rate Rise for Special Education Students Beats That of Overall Population

From Education Week's Blog
"On Special Education"

By Christina Samuels
October 17, 2016

Graduation rates among students with disabilities rose from 59 percent in the 2010-11 school year to 64.6 percent in the 2014-15 school year—a 5.6 percentage point increase that is higher than the 4.2 percentage point increase seen among the overall student population in the same time period.

The graduation rate among students with disabilities still trails the overall student graduation rate, though. The graduation rate for all students was 83.2 percent, which is 18.6 percentage points higher than the rate for students with disabilities.

That overall graduation rate is the highest it has been since the federal government first started requiring all states to use the same method of calculating how many students graduate from high school on time with a standard diploma. States must calculate how many 9th graders leave school with a diploma four years later, after making adjustments for transfers both into and out of the class.

The growth in the overall graduation rate, however, was seen by President Barack Obama as a cause for celebration on Monday. My colleagues at Politics K-12 covered the president's visit to Benjamin Banneker High School in Washington D.C., a rigorous public magnet school, where he talked about the graduation results and the administration's work in education in general.

The National Center for Education Statistics lists the overall, and state-by-state, graduation rates.

Challenges Tracking Graduation Rates Among Students with Disabilities

As I've mentioned in other articles about graduation rates, observers have to be careful about these percentages. As I wrote last year, states may have different definitions for what a counts as a "regular high school diploma" for a student with a disability.

Also, states may have different definitions of a "student with a disability." Some states may consider those who started high school with an individualized education program to fit the definition, while others may consider only students who graduated with an IEP in place to be students with a disability.

And, students with disabilities are allowed to stay in school until age 21, so they may take longer than four years to earn a regular high school diploma (though students who stay in school longer generally have more severe disabilities and are on an alternate academic track.)

America's Promise Alliance, an advocacy organization pushing for a 90 percent graduation rate by 2020, said that states would have to continue to close graduation gaps among some student groups to reach that goal.

"While we are pleased to see continued progress in raising graduation rates, we realize that much work remains," said Alma Powell, the chairwoman of the Alliance, in a statement.

"Too many young people are still being left behind. There are currently nearly 700,000 16-19 year olds who are not in school and do not have a high school diploma. If we are to reach 90 percent, we must redouble our efforts to close graduation gaps for key subgroups, including students of color and students from low-income families, English-language learners, homeless students, and students with disabilities."

Wednesday, October 19, 2016

Family Stressors and Traumatic Childhood Experiences Linked to ADHD Diagnoses in Children

From Montefiore Health System
via ScienceDaily

October 11, 2016

Children who experience family and environmental stressors and traumatic experiences like poverty, mental illness and exposure to violence are more likely to be diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), according to new research by investigators at the Children's Hospital at Montefiore (CHAM). 

Their report, titled "Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity," was published in Academic Pediatrics.

ADHD is the most common neuro-behavioral disorder of childhood. There has been a significant increase in parent-reported ADHD prevalence over the last decade, and there has also been an associated rise in stimulant medication use.

Current ADHD clinical practice guidelines recommend evaluating for other conditions that have similar symptoms to ADHD, such as disruptive behaviors, impulsivity, and issues with memory, organization and problem-solving, but few pediatricians routinely ask about psycho-social factors that could be effecting a child's health during ADHD assessment.

Exposure to Adverse Childhood Experiences (ACEs), commonly referred to as family or environmental stressors, such as divorce and familial incarceration, is one way that behaviors similar to those exhibited by children with ADHD, can be triggered.

Research has shown that this is because ACEs may increase a child's risk for toxic levels of stress, which in turn may impair brain development, behavior, and overall physical and mental health.

"If clinicians aren't routinely discussing exposure to traumatic experiences and identifying ACEs, particularly among children with behavioral concerns such as ADHD, there may be a heightened risk of missing an underlying trauma history or misattributing some of the symptoms of traumatic stress as solely those of ADHD," said lead author Nicole M. Brown, M.D., M.P.H., M.H.S., attending pediatrician, Division of Academic General Pediatrics, CHAM, and assistant professor of Pediatrics, Albert Einstein College of Medicine.

"We sought to examine the link between ADHD and ACEs in an effort to improve ADHD assessment and management."

Dr. Brown and co-investigators at CHAM used a nationally representative sample of 76,227 children from the 2011-2012 National Survey of Children's Health, to identify children 4 - 17 years old whose parents reported both the presence and severity of ADHD and their child's exposure to nine ACEs -- socioeconomic hardship, divorce, death, domestic violence, neighborhood violence, substance abuse, incarceration, mental illness in the family, and discrimination.

The analysis found that children with parent-reported ADHD were more likely to have two or more ACEs exposures, compared to children without parent-reported ADHD.

Most significantly, children with socioeconomic hardship, parent/guardian divorce, familial mental illness, neighborhood violence, and familial incarceration were more likely to have an ADHD diagnosis, and those with socioeconomic hardship and familial mental illness were more likely to have moderate to severe ADHD, according to parental reports.

Children with parent-reported ADHD represented 8.8 percent of the 76,227 children, and were more likely to be male, aged 12 - 17 and non-Hispanic white.

"Our research shows there are significant associations between ACE exposures and having an ADHD diagnosis, and we encourage pediatric providers to more frequently evaluate for ACEs as part of ADHD assessments," said Dr. Brown.

"Ultimately, this may lead to more trauma-informed approaches to care, particularly for children whose response to stimulant medications or targeted behavioral therapies are poor."

Read the full report HERE.

Curriculum and Instruction: Social and Emotional Learning in Massachusetts

From the Massachusetts DESE
Department of Elementary and Secondary Education

October 13, 2016

This website is an introduction to Social and Emotional Learning in Massachusetts Public Schools. The Department uses the Collaborative for Academic, Social, and Emotional Learning (CASEL's), definition of Social and Emotional Learning (SEL):

SEL is the process of developing students' and adults' social and emotional competencies—the knowledge, skills, attitudes, and behaviors that individuals need to make successful choices.

There is a range of other definitions for Social and Emotional Learning that may also be viable.

Social Emotional Learning is a core component of the Department's fifth strategic priority: to support students Social, Emotional, and Health needs. The goal of this strategy is to promote tiered systems of supports that foster safe, positive, healthy, and inclusive whole-school learning environments that:

  • enable students to develop social emotional competencies, achieve academic and non-academic success in school, and maintain physical and psychological health and well-being; and,
  • integrate services and align initiatives that promote students' behavioral health, including social and emotional learning and other similar initiatives.

In April of 2016, the Board of Elementary and Secondary Education (BESE) held a special meeting on Social and Emotional Learning to provide an opportunity for members to hear a number of key ideas, information, and examples from experts in research, policy, and practice, and have the opportunity to discuss the topic of SEL. Resources from that meeting are available on the BESE website.

This website includes information about:

  • CASEL's Collaborating States Initiative
  • Developing SEL Competencies within a Tiered System of Supports
  • Additional ESE Guidance

For more information about any of these resources, or to share work that your organization is involved with, please email

Collaborating States Initiative
Massachusetts is one of eight states participating in the Collaborative for Academic, Social, and Emotional Learning (CASEL's) two-year Collaborating States Initiative (CSI). The CSI is an inter-state partnership on the development of policies, learning standards or goals, and guidelines to support statewide implementation of social and emotional learning (SEL).

Other participating states include: California, Georgia, Minnesota, Nevada, Pennsylvania, Tennessee, and Washington.

While the needs and approaches of supporting social and emotional outcomes vary from district to district, ESE intends to partner with our stakeholders to establish a common language and shared vision of positive social and emotional competencies for all students.

Partnership with CASEL and other participating states will allow ESE to achieve those goals by:
  • Engaging with our stakeholders, especially our teachers, administrators, and specialized instructional support personnel (SISP);
  • Integrating SEL principles with existing policies, resources, and initiatives; and,
  • Building useful, well-aligned resources.

To receive occasional updates about the progress of this initiative or to submit comments about social and emotional learning in Massachusetts, fill out this short form.

CASEL's website has a wealth of information about Social and Emotional Learning, including a meta-analysis of 213 school-based, universal SEL programs which showed that, compared to controls, SEL participants demonstrated significantly improved social and emotional skills, attitudes, behavior, and academic performance that reflected an 11-percentile-point gain in achievement.

Developing SEL Competencies within a Tiered System of Supports

ESE recommends a tiered approach to SEL, where all students get high quality instruction in core competencies of SEL, some students will need supplemental supports for these core competencies, and a few students will need intensive supports for these core competencies. The distinction between supplemental and intensive supports will vary based on need and student population.

CASEL has provided the following descriptions of Social and Emotional Learning (SEL) as core instruction for all students.

Five Core Competencies of SEL

Self-awareness: The ability to accurately recognize one's emotions and thoughts and their influence on behavior. This includes accurately assessing one's strengths and limitations and possessing a well-grounded sense of confidence and optimism.

Self-management: The ability to regulate one's emotions, thoughts, and behaviors effectively in different situations. This includes managing stress, controlling impulses, motivating oneself, and setting and working toward achieving personal and academic goals.

Social awareness: The ability to take the perspective of and empathize with others from diverse backgrounds and cultures, to understand social and ethical norms for behavior, and to recognize family, school, and community resources and supports.

Relationship skills: The ability to establish and maintain healthy and rewarding relationships with diverse individuals and groups. This includes communicating clearly, listening actively, cooperating, resisting inappropriate social pressure, negotiating conflict constructively, and seeking and offering help when needed.

Responsible decision making: The ability to make constructive and respectful choices about personal behavior and social interactions based on consideration of ethical standards, safety concerns, social norms, the realistic evaluation of consequences of various actions, and the wellbeing of self and others.

Four Approaches to SEL Instruction

CASEL has identified four general approaches to SEL instruction in the classroom:

  • Free-standing lessons that provide explicit, step-by step instructions to teach students social and emotional competencies across the five core competency clusters;
  • General teaching practices that create classroom and school-wide conditions that facilitate and support social and emotional development in students;
  • Integration of skill instruction and practices that support SEL within the context of an academic curriculum; and,
  • Guidance to administrators and school leaders on how to facilitate SEL as a school-wide initiative.

ESE Guidance

PreK-K Standards: These Standards were developed as a collaborative initiative with the Department of Early Education and Care (EEC) and the University of Massachusetts/Boston with funding from the Race to the Top-Early Learning Challenge Grant. The standards bring attention to critical areas of development and learning that positively impact student outcomes and can be used to guide efforts to strengthen curriculum, instruction, assessment, professional development and family engagement.

Guidelines on Implementing SEL: This document contains guidelines for schools and districts on how to effectively implement social and emotional learning curricula for students in grades K-12. The information provided relates to leadership, professional development, resource coordination, instructional approaches, policies and protocols, and collaboration with families.

Guidebook for Inclusive Practice: Created by Massachusetts educators, this Guidebook includes tools for districts, schools, and educators that are aligned to the MA Educator Evaluation Framework and promote evidence-based best practices for inclusion following the principles of Universal Design for Learning, Positive Behavior Interventions and Supports, and Social and Emotional Learning.

Tuesday, October 18, 2016

Study: Autism Moms Face Greater Risk of Heart Disease

From DisabilityScoop

By Shaun Heasley
September 23, 2016

Raising a child with autism may take a deeper toll than previously thought, with new research suggesting that such moms face a heightened risk of heart disease.

Mothers of kids on the spectrum who have chronic stress were more likely than less-stressed moms of neurotypical children to experience cardiovascular risk factors.

The findings, reported this month in the journal Brain, Behavior and Immunity, come from a study looking at 31 moms of kids with autism and 37 mothers of typically-developing children. All of the women were nonsmokers between the ages of 20 and 50 and both groups included moms of similar ages with comparable body mass indexes and other risk factors.

Among mothers of kids with autism, 30% had high levels of what’s considered “bad” cholesterol compared to 8% of other moms.

Meanwhile, those with a child on the spectrum generally had lower levels of progenitor cells which are believed to provide a protective effect against plaque buildup in the blood vessel linings that can trigger heart attack and stroke.

“Even knowing the challenges these mothers face, we were surprised by the differences in cardiovascular risk,” said Kirstin Aschbacher of the University of California, San Francisco, who led the study.

Despite the greater risk faced by moms of those with autism, researchers found that little changes can make a big difference. Mothers who reported a greater number of positive interactions with their families during a given week had higher levels of protective cells, the study found.

“For all parents studied, those small daily interactions with their child, positive or negative, predicted the level of protective progenitor cells. That means that even if you are a caregiving parent, your daily responses may protect you from risk,” said Elissa Epel of the Univ. of California, San Francisco, a senior author of the study.

“Parenting support groups, or classes that teach stress resilience such as mindfulness, can help parents feel less shame and self-blame about their child’s behavior, and help them focus more attention on the small positive interactions.”