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Friday, March 23, 2018

Pediatricians Call for Universal Depression Screening for Teens

From NPR's Health Blog "Shots"

By Allison Aubrey
February 26, 2018

Only about 50 percent of adolescents with depression get diagnosed before reaching adulthood. And as many as 2 in 3 depressed teens don't get the care that could help them.

It's easy to mistake adolescent depression for something else, child psychiatrists
say; the signs can include misbehavior, eating problems or sleep trouble.

"It's a huge problem," says Dr. Rachel Zuckerbrot, a board-certified child and adolescent psychiatrist and associate professor at Columbia University.

To address this divide, the American Academy of Pediatrics has issued updated guidelines this week that call for universal screening for depression.


"What we're endorsing is that everyone, 12 and up, be screened ... at least once a year," Zuckerbrot says. The screening, she says, could be done during a well-visit, a sports' physical or during another office visit.

Zuckerbrot helped write the guidelines, which have been in development for a while. The U.S. Preventive Services Task Force also recommends depression screening, and many pediatricians have already woven the screenings into their practices.

"Teenagers are often more honest when they're not looking somebody in the face who's asking questions," about their emotional health Zuckerbrot says. So, most pediatricians use a self-reported questionnaire that teens fill out themselves, either on an electronic device or on paper.

"It's an opportunity for the adolescent to answer questions about themselves privately," she says.

The questionnaires contain a range of questions. For instance, one version, asks: 'Over the past two weeks, how often have you been bothered by any of the following problems: feeling down, depressed or hopeless? Or, little interest or pleasure in doing things?'

Teens are also asked questions such as, 'Are you having difficulty with sleep, either too much or too little?' 'Any problems with eating?'

The new recommendations also call for families with a depressed teen to develop a safety plan to restrict the young person's access to lethal means of harm. Suicide is a leading cause of death for children aged 10 to 17, and "adolescent suicide risk is strongly associated with firearm availability," according to an AAP report.

There's growing awareness in the U.S. of the need for young people to have good access to mental health care, says Dr. Doug Newton, a child psychiatrist at Kaiser Permanente in Colorado. "As a nation this has become part of the dialogue; it increasing"

"People are aware of what's happening in our schools and the importance of mental health," Newton says. Kaiser Permanente has a stigma-reduction campaign called Find Your Words.

"Stigma is a huge challenge," he says, "specifically for adolescents. Often times they're not coming in to get help because of the stigma attached."

It's not easy to talk about depression, yet the problem is fairly common. During the teenage years, there's about a 20 percent [chance] of having depression or anxiety, research suggests.

"It's highly prevalent," Newton says. The goal of the "Find Your Words" campaign is to help make depression easier for everyone to talk about.

Another challenge to diagnosis is that families often don't detect depression, or they confuse it for something else.

"Sometimes teens are acting out or misbehaving," Zuckerbrot says. They're seen as being hostile or bad. "When, instead, they're really suffering from depression."

Cognoa’s AI Platform for Autism Diagnosis Gets First FDA Stamp

From Tech Crunch

By Natasha Lomas
February 21, 2018

Cognoa has gained regulatory recognition for its machine learning software as a class II diagnostic medical device for autism — meaning the digital health startup is now positioned to submit an application for full FDA clearance.

It’s a first but important regulatory step for a business that was founded back in 2014, and plays in a still nascent digital health space where untested ‘wellness’ apps are far more plentiful than medical technologies with robust data to prove out the efficacy of their interventions.

Discussions with the FDA started in early 2017, says Cognoa CEO Brent Vaughan, adding that it’s hoping to gain full FDA clearance this year.

He says the ultimate goal for the US startup is to become a standard part of domestic health insurance-covered medical provision — and for that FDA clearance is essential to opening the doors.

We first covered the Cognoa at launch in 2014 and the following year when it was still being careful to describe its technology as a screening rather than a diagnostic system.

It’s since gathered enough data to be confident in using the ‘D’ word — having run a pilot with 250,000 parents, offering free screening for their children so it could gather more data to refine its machine learning models.

“We were lucky that we had investors,” says Vaughan. “There’s not a huge business model in providing free screening services to kids, right, because we were certainly never going to sell ads. That wasn’t the goal.

“It took a little patience but in the process of providing free screening and at least showing parents how to navigate their way to the front of a line as more of an information service, we were able to build the data models to support a development of a diagnostic device actually a couple of years sooner than we originally thought we would. So it ultimately paid off for us.”

Cognoa has raised $20.4M to date. Its main investor is the Chinese private investment group Morningside. Vaughan tells TechCrunch it’ll likely be looking to raise another round by the end of this year.

It has also conducted multiple studies over the last 2.5 years across the US, including blinded control trials and side-by-side comparisons of its different versions — working with children’s hospitals and secondary care centers. It now bills its technology as a “pediatric behavioral health diagnostics and digital therapeutics platform”.

The initial machine learning model, which was targeted at screening for autism, was based on the work of Stanford pediatrics and psychiatry professor Dennis Wall. The model itself was built by combining and structuring existing datasets of behavioral observations on about 10,000 children.

Though, as noted above, Cognoa has continued to refine its autism model with structured contributions from parents participating in the pilot and inputting data via its app. (Aka: If an AI service is free, you’re the training data.)

“In our last study we were able to come through with a sensitivity of greater than 90 per cent,” Vaughan tells TechCrunch. “In our first algorithm… targeting autism, we would find it over 90 per cent of the time — and when we said it was autism it was correct well over 80 per cent of the time.

“What we see when we look in the data, and that we’re quite interested by, is when we say it’s autism or it looks like autism and it wasn’t… we were able to show [the FDA] that they were often very similarly related conditions.”

Vaughan says a lot of the team’s early work focused on figuring out how to create a product that enables non-healthcare professionals (i.e. parents) to capture robust data in a reproducible way.

“One of the… questions that came up quite early, even from early potential investors and clinicians, was can you actually get parents to give you the information on which you could base a clinical diagnostic decision? Can you get them to do this reproducibly without a clinician being in a room?… So we certainly had to address that.

“I remember sitting down with one venture capitalist who looked at me and said, you know what — you’re never going to find 5,000 parents that are going to do this. And that are going to be able to do this reproducibly,” he continues.

“Within a couple of years we were up over a quarter of a million parents that had actually done it — and we learned a lot about how to reproducibly collect information on which you can build a clinical diagnosis but collecting it outside of the clinical setting. Parents providing us information in their living room in the evening. So that was certainly one major step for us. And in doing that we showed that the unmet need was much, much bigger than we originally had estimated.”

As well as aiming to support earlier diagnosis than parents might be able to get if they had to wait for specialist appointments for their child to be monitored in person, Cognoa’s platform provides guidance on actions (it calls them “activities”) parents can take themselves to help manage their children’s condition. Which in turn provides more opportunities for response data to be fed back so its models can keep learning and refining recommendations.

While the first focus is autism, with the aim of trying to shrink intervention times to improve long term outcomes for children — given what Vaughan describes as a “well-documented” link between earlier intervention and better autism outcomes — the intent is to address other behavioral conditions too, in time, such as ADHD.

“For us we see this — even the autism clearance that we’re looking forward to in the future — that’s just a step down the path of being able to be the platform that can diagnose an entire spectrum of these developmental conditions,” he says.

Interestingly, Vaughan concedes that the learning element of AI-based technologies can cause unintended problems in healthcare service provision, saying some clinicians it talked to early on raised concerns that by widening access to autism screening the startup risked making an existing diagnosis bottleneck worse by increasing demand for specialist services without there being a parallel increase in resource to avoid creating even more of a backlog.

Which is exactly the kind of serious, knock-on consequence that’s possible when unproven ‘disruptive’ technologies change existing dynamics and bring new pressures to bear on a critical and sensitive industry like healthcare. It also seems especially true of AI technologies which need to be fed with lots of data before they can learn to become really useful.

So how to conduct responsible training of machine learning models presents something of an existential challenge for AI and healthcare startup initiatives — and one which has already opened up operational pitfalls for some very well resourced tech giants.

“Back in 2014 and 2015 we were really starting down the path of let’s just prove that we can triage these kids and find them earlier. And a lot of people embraced that, but there was certainly some that were pretty thoughtful who said if you guys find the kids earlier and the problem in the system is that kids that are identified and referred to specialists for appointments are currently waiting between one and three years to get a diagnosis, aren’t you just going to be making the problem worse?” he says.

“So then we had to sit down and say listen, step one is being able to show that we can just screen these kids. But longer term we think we can really aid in getting a faster diagnosis. But we were very careful to not say, publicly, that we thought that we could diagnose these kids because we thought it would just be too controversial.

And, the idea of using an AI-based platform, the idea of collecting information primarily from the parent, from the caregiver and from the child, that was pretty controversial.”

Another change that’s being driven by AI-based software targeting the healthcare industry is to regulatory regimes — with regulators like the FDA needing to come up with new systems and processes for assessing and managing software designed to get better over time.

“The FDA is struggling with how to regulate AI-based software because the idea of the FDA is they look at a version of a product and that product once cleared by the FDA does not change — and the idea of AI and machine learning, which is what our product is based on, is that it’s learning and it gets better,” says Vaughan, talking about its discussions with the FDA.

“And so understanding with the FDA how we were going to control and document that learning — those were some of the discussions where we walked in with ideas but not very clear understanding what the outcome would be.”

While he believes the FDA will likely take a case-by-case approach to the challenge of regulating AI platforms, he suggests companies will probably have to operate using a versioning system — whereby they restrict ongoing machine learning to the research lab, releasing a next version of a model into the wild only once the step change in their software has also gained regulatory approval.

“It’s the algorithm part of the device that [the FDA] feel the strongest about in terms of how they regulate it,” he says. “And keep in mind this is evolving, and their thinking might also evolve on this, but for us they look at the algorithm part and we can certainly, in our software, lock down a current version of the algorithm. And we can allow that to not change in the production version of the product — and at the same time we can have a research arm that’s continuing to evolve. And you could start to think about versioning coming out in the future.”

“So I think it’ll be a little bit more of a stair-step approach,” he adds. “With periodic reviews by the FDA. And I think that they’re in parallel trying to think of a way to streamline that approach going forward because of the flexibility that these products have. So I think it’ll be a little bit of a hybrid between continuous machine learning which seems quite difficult and the old style, which was quite waterfall.”

Thursday, March 22, 2018

Tips for a Successful Parent-Teacher Conference

From The Onion

March 22, 2018

Parent-teacher conferences can be a valuable way to foster a better learning environment for children both in and outside of the classroom. The Onion offers tips to both teachers and parents for making the most of this meeting.

1.) Begin by acknowledging there’s more than enough blame to go around.

2.) Teachers can create a comfortable, relaxing environment by removing anything from the room that will remind parents of their kid.

3.) Teachers should pick a fight with the largest parent to exert their dominance.

4.) Parents must be prepared to respond to any mention of their child’s troubling behavior by crossing their arms and saying, “That doesn’t sound like Jacob at all.”

5.) Worried parents should remember that sexting technically counts as a type of writing.

6.) Educators should avoid using too much educational jargon with the parents, like “AR-15” or “ballistic trauma.”

7.) Parents should be crystal-clear with one another before inviting a teacher to their bedroom.

8.) It’s absolutely imperative that both teacher and parents do their best to not let on that they have no idea what the hell they’re doing.

Record Numbers of College Students Are Seeking Treatment for Depression and Anxiety — But Schools Can't Keep Up

From TIME Magazine

By Katie Reilly
March 19, 2018

Dana Hashmonay, now 21, took a medical leave during her sophomore year
of college after struggling with anxiety at school. Eva O'Leary for TIME

Not long after Nelly Spigner arrived at the University of Richmond in 2014 as a Division I soccer player and aspiring surgeon, college began to feel like a pressure cooker. Overwhelmed by her busy soccer schedule and heavy course load, she found herself fixating on how each grade would bring her closer to medical school.

“I was running myself so thin trying to be the best college student,” she says. “It almost seems like they’re setting you up to fail because of the sheer amount of work and amount of classes you have to take at the same time, and how you’re also expected to do so much.”

At first, Spigner hesitated to seek help at the university’s counseling center, which was conspicuously located in the psychology building, separate from the health center. “No one wanted to be seen going up to that office,” she says.

But she began to experience intense mood swings. At times, she found herself crying uncontrollably, unable to leave her room, only to feel normal again in 30 minutes. She started skipping classes and meals, avoiding friends and professors, and holing up in her dorm. In the spring of her freshman year, she saw a psychiatrist on campus, who diagnosed her with bipolar disorder, and her symptoms worsened. The soccer team wouldn’t allow her to play after she missed too many practices, so she left the team.

In October of her sophomore year, she withdrew from school on medical leave, feeling defeated. “When you’re going through that and you’re looking around on campus, it doesn’t seem like anyone else is going through what you’re going through,” she says. “It was probably the loneliest experience.”

Spigner is one of a rapidly growing number of college students seeking mental health treatment on campuses facing an unprecedented demand for counseling services. Between 2009 and 2015, the number of students visiting counseling centers increased by about 30% on average, while enrollment grew by less than 6%, the Center for Collegiate Mental Health found in a 2015 report.

Students seeking help are increasingly likely to have attempted suicide or engaged in self-harm, the center found. In spring 2017, nearly 40% of college students said they had felt so depressed in the prior year that it was difficult for them to function, and 61% of students said they had “felt overwhelming anxiety” in the same time period, according to an American College Health Association survey of more than 63,000 students at 92 schools.

As midterms begin in March, students’ workload intensifies, the wait time for treatment at counseling centers grows longer, and students who are still struggling to adjust to college consider not returning after the spring or summer breaks. To prevent students from burning out and dropping out, colleges across the country — where health centers might once have left meaningful care to outside providers — are experimenting with new measures.

For the first time last fall, UCLA offered all incoming students a free online screening for depression. More than 2,700 students have opted in, and counselors have followed up with more than 250 who were identified as being at risk for severe depression, exhibiting manic behavior or having suicidal thoughts.

Virginia Tech University has opened several satellite counseling clinics to reach students where they already spend time, stationing one above a local Starbucks and embedding others in the athletic department and graduate student center. Ohio State University added a dozen mental health clinicians during the 2016-17 academic year and has also launched a counseling mobile app that allows students to make an appointment, access breathing exercises, listen to a playlist designed to cheer them up, and contact the clinic in case of an emergency.

Pennsylvania State University allocated roughly $700,000 in additional funding for counseling and psychological services in 2017, citing a “dramatic increase” in the demand for care over the past 10 years. And student government leaders at several schools have enacted new student fees that direct more funding to counseling centers.

But most counseling centers are working with limited resources. The average university has one professional counselor for every 1,737 students — fewer than the minimum of one therapist for every 1,000 to 1,500 students recommended by the International Association of Counseling Services. Some counselors say they are experiencing “battle fatigue” and are overwhelmed by the increase in students asking for help.

“It’s a very different job than it was 10 years ago,” says Lisa Adams Somerlot, president of the American College Counseling Association and director of counseling at the University of West Georgia.

As colleges try to meet the growing demand, some students are slipping through the cracks due to long waits for treatment and a lasting stigma associated with mental health issues. Even if students ask for and receive help, not all cases can be treated on campus.

Many private-sector treatment programs are stepping in to fill that gap, at least for families who can afford steep fees that may rise above $10,000 and may not be covered by health insurance. But especially in rural areas, where options for off-campus care are limited, universities are feeling pressure to do more.

"I needed something the university wasn’t offering."

At the start of every school year, Anne Marie Albano, director of the Columbia University Clinic for Anxiety and Related Disorders (CUCARD), says she’s inundated with texts and phone calls from students who struggle with the transition to college life.

“Elementary and high school is so much about right or wrong,” she says. “You get the right answer or you don’t, and there’s lots of rules and lots of structure. Now that [life is] more free-floating, there’s anxiety.”

That’s perhaps why, for many students, mental health issues creep up for the first time when they start college. (The average age of onset for many mental health issues, including depression and bipolar disorder, is the early 20s.)

Dana Hashmonay was a freshman at Rensselaer Polytechnic Institute in Troy, New York in 2014 when she began having anxiety attacks before every class and crew practice, focusing on uncertainties about the future and comparing herself to seemingly well-adjusted classmates. “At that point, I didn’t even know I had anxiety. I didn’t have a name for it. It was just me freaking out about everything, big or small,” she says.

When she tried to make an appointment with the counseling center, she was put on a two-week waitlist. When she finally met with a therapist, she wasn’t able to set up a consistent weekly appointment because the center was overbooked. “I felt like they were more concerned with, ‘Let’s get you better and out of here,’” she says, “instead of listening to me. It wasn’t what I was looking for at all.”

During her freshman year, Hashmonay sought out help
on campus after she started having anxiety attacks before
her classes and crew practices. Eva O'Leary for TIME
Instead, she started meeting weekly with an off-campus therapist, who her parents helped find and pay for. She later took a leave of absence midway through her sophomore year to get additional help. Hashmonay thinks the university could have done more, but she notes that the school seemed to be facing a lack of resources as more students sought help.

“I think I needed something that the university just wasn’t offering,” she says.

A spokesperson for Rensselaer says the university’s counseling center launched a triage model last year in an effort to eliminate long wait times caused by rising demand, assigning a clinician to provide same-day care to students presenting signs of distress and coordinate appropriate follow-up treatment based on the student’s needs.

Some students delay seeing a counselor because they question whether their situation is serious enough to warrant it. Emmanuel Mennesson says he was initially too proud to get help when he started to experience symptoms of anxiety and depression after arriving at McGill University in Montreal in 2013 with plans to study engineering.

He became overwhelmed by the workload and felt lost in classes where he was one student out of hundreds, and began ignoring assignments and skipping classes. “I was totally ashamed of what happened. I didn’t want to let my parents down, so I retreated inward,” he says. During his second semester, he didn’t attend a single class, and he withdrew from school that April.

For many students, mental health struggles predated college, but are exacerbated by the pressures of college life. Albano says some of her patients assume their problems were specific to high school. Optimistic that they can leave their issues behind, they stop seeing a therapist or taking antidepressants. “They think that this high school was too big or too competitive and college is going to be different,” Albano says. But that’s often not the case. “If anxiety was there,” she says, “nothing changes with a high school diploma.”

Counselors point out that college students tend to have better access to mental health care than the average adult because counseling centers are close to where they live, and appointments are available at little to no cost. But without enough funding to meet the rising demand, many students are still left without the treatment they need, says Ben Locke, Penn State’s counseling director and head of the Center for Collegiate Mental Health.

The center’s 2016 report found that, on average, universities have increased resources devoted to rapid-access services — including walk-in appointments and crisis treatment for students demonstrating signs of distress — since 2010 in response to rising demand from students. But long-term treatment services, including recurring appointments and specialized counseling, decreased on average during that time period.

“That means that students will be able to get that first appointment when they’re in high distress, but they may not be able to get ongoing treatment after the fact,” Locke says. “And that is a problem.”

"We’re busier than we’ve ever been."

In response to a growing demand for mental health help, some colleges have allocated more money for counseling programs and are experimenting with new ways of monitoring and treating students. More than 40% of college counseling centers hired more staff members during the 2015-16 school year, according to the most recent annual survey by the Association for University and College Counseling Center Directors.

“A lot of schools charge $68,000 a year,” says Dori Hutchinson, director of services at Boston University’s Center for Psychiatric Rehabilitation, referring to the cost of tuition and room and board at some of the most expensive private schools in the country. “We should be able to figure out how to attend to their whole personhood for that kind of money.”

At the University of Iowa, Counseling Director Barry Schreier increased his staff by nearly 50% during the 2017-18 academic year. Still, he says, even with the increase in counseling service offerings, they can’t keep up with the number of students coming in for help. There is typically a weeklong wait for appointments, which can reach two weeks by mid-semester.

“We just added seven full-time staff and we’re busier than we’ve ever been. We’re seeing more students,” Schreier says. “But is there less wait for service? No.”

The university has embedded two counselors in dorms since 2016 and is considering adding more after freshmen said it was a helpful service they would not have sought out on their own. Schreier also added six questions about mental health to a freshman survey that the university sends out several weeks into the fall semester.

The counseling center follows up with students who might need help based on their responses to questions about how they’d rate their stress level, whether they’ve previously struggled with mental health symptoms that negatively impacted their academics, and whether they’ve ever had symptoms of depression or anxiety.

He says early intervention is a priority because mental health is the number one reason why students take formal leave from the university.

As colleges scramble to meet this demand, off-campus clinics are developing innovative, if expensive, treatment programs that offer a personalized support system and teach students to prioritize mental wellbeing in high-pressure academic settings. Dozens of programs now specialize in preparing high school students for college and college students for adulthood, pairing mental health treatment with life skills classes — offering a hint at the treatments that could be used on campus in the future.

When Spigner took a medical leave from the University of Richmond, she enrolled in College Re-Entry, a 14-week program in New York that costs $10,000 and aims to provide a bridge back to college for students who have withdrawn due to mental health issues. She learned note-taking and time management skills in between classes on healthy cooking and fitness, as well as sessions of yoga and meditation.

Mennesson, the former McGill engineering student, is now studying at Westchester Community College in New York with the goal of becoming a math teacher. During his leave from school, he enrolled in a program called Onward Transitions in Portland, Maine that promises to “get 18- to 20-somethings unstuck and living independently” at a cost of over $20,000 for three months, where he learned to manage his anxiety and depression.

Another treatment model can be found at CUCARD in Manhattan, where patients in their teens and early 20s can slip on a virtual reality headset and come face-to-face with a variety of anxiety-inducing simulations — from a professor unwilling to budge on a deadline to a roommate who has littered their dorm room with stacks of empty pizza boxes and piles of dirty clothes.

Virtual reality takes the common treatment of exposure therapy a step further by allowing patients to interact with realistic situations and overcome their anxiety. The center charges $150 per group-therapy session for students who enroll in the four-to-six-week college readiness program but hopes to make the virtual reality simulations available in campus counseling centers or on students’ cell phones in the future.

This virtual reality program — developed by Headset Health in partnership
with the Columbia University Clinic for Anxiety and Related Disorders — allows
students to confront their anxiety in a simulated college scenario.

Hashmonay, who has used the virtual reality software at the center, says the scenarios can be challenging to confront, “but the minute it’s over, it’s like, ‘Wow, OK, I can handle this.’ She still goes weekly to therapy at CUCARD, and she briefly enrolled in a Spanish course at Montclair State University in New Jersey in January.

But she withdrew after a few classes, deciding to get a job and focus on her health instead of forcing a return to school before she is ready. “I’m trying to live life right now and see where it takes me,” she says.

Back at the University of Richmond for her senior year, Spigner says the attitude toward mental health on campus seems to have changed dramatically since she was a freshman. Back then, she knew no one else in therapy, but most of her friends now regularly visit the counseling center, which has boosted outreach efforts, started offering group therapy and mindfulness sessions, and moved into a more private space. “It’s not weird to hear someone say, ‘I’m going to a counseling appointment,’ anymore,” she says.

She attended an open mic event on Richmond’s campus earlier this semester, where students publicly shared stories and advice about their struggles with mental health. Spigner, who meets weekly with a counselor on campus, has become a resource to many of her friends because she openly discusses her own mental health, encouraging others not to be ashamed to get help.

“I’m kind of the go-to now for it, to be honest,” she says. “They’ll ask me, ‘Do you think I should go see counseling?’” Her answer is always yes.

Mindfulness in Schools

From NESCA News & Notes

By Ann-Noelle McCowan, M.S., RYT
March 5, 2018

Open Google, type in "Mindfulness in Schools" and you are presented with a buffet of resources. What was once seen as an alternative idea has been mainstreamed. But what is Mindfulness and why is it something that deserves a place in schools?

Mindfulness was originally developed as part of the 8-Fold Path of Buddhism. With mindfulness, your attention would be turned inward, and also impact your relationship with the world through mindful actions and behaviors.

Now it is scientifically studied and found in locations from professional locker rooms, jails and hospitals to Fortune 500 companies like Nike, Google and Apple.

Advancements in brain imaging show that a regular mindfulness practice creates increased activity in the areas of the brain associated with working memory, executive function, emotional regulation, perspective taking and empathy, with decreases in the areas of the brain associated with depression, PTSD and stress (correlated with a decrease in amygdala size).

Mindfulness’ increased popularity may be due to the fact that it is an adaptable, take-with-you-anywhere antidote to a society that is increasingly fast-paced and technology-focused. In a global world, it helps us feel both connected to ourselves and grounded where we are.

More of us are stressed, anxious and depressed, and mindfulness can help soothe our worries without negative side affects.

Schools are responsible for teaching children skills and information across many content areas, yet how often are children taught the best way to pay attention, or how to use attention? Attention is the lens through which all of our experiences are filtered, yet it is rarely directly and specifically taught!

Mindfulness is at its core simply focusing on a single thing at time, in a particular way, without evaluation. It is an invaluable life skill for helping children become successful students, as well as happy, well adjusted and connected.

An informal survey of my colleagues and friends found that yoga and mindfulness is being adapted to various school settings. From class transitions that begin with listening bells, rounds of belly breathing before assessments, calming scented oils on cotton balls in the nurse's office, books clubs with teachers, introductions to mindfulness apps in health class and mindfulness or yoga activities and clubs. mindfulness is staking its place in schools.

When introducing mindfulness in classrooms and schools the following steps help outline ways to weave mindfulness into classrooms and schools.

1.) Learn more.

Starting with this blog post, the internet is full of articles and videos to explore.

2.) Model Mindfulness and practice yourself.

You can’t teach what you don’t know. Practicing mindfulness will help you be aware of your own reactions if at first your students are squirmy or resistant. Keep in mind that students may not use the words you expect to describe their experience, listen for what is behind their words.

3.) In an age appropriate way, explain how mindfulness is beneficial for them.

My teens love learning about how their brain works and that mindfulness is a form of training for their brain.

Some videos for younger kids:

4.) Teach about the monkey or animal mind.

Children of all ages enjoy the practice of noticing how many places their thoughts go and how quickly thoughts connect to others. There are fantastic books for younger kids such as Moody Cow Meditates and Mindful Monkey, Happy Panda.

Teens understand that if they walk into class and see their friends laughing with peers after glancing towards them, their thoughts immediately race to.... “what did I do” ...“ they are mad”...“I’m not going to have a partner for this project”... “ there goes my secrets, begin the rumors”... “I’ll be left out of the weekend plans” … “I’ll be alone forever”.

Teach them to acknowledge the chatter but not get caught in it.

5.) Start small.

Begin with 1-3 minutes at the start of class directing kids to feel their seat in their seat, their feet on the floor, their hands on their lap and intentionally take 5-10 long inhales and exhales.

Other ideas:
  • Practice silent snack one day a week. Take a mindful walk as a class and have them focus on their senses and record them in their own journals ( words or visuals) when back in the classroom. Create a mindful space in a corner of your room with coloring books, pencils, cushions as a safe break place.
  • For kids, it may be hard to focus on a single item at a time, so use manipulatives. A Hoberman Sphere, Pinwheels or feathers to demonstrate breath. Build Worry Jars, adapt Chutes and Ladders or other familiar games with mindful exercises. Use one of the many Yoga Card Decks. 

6.) There’s an App for this!

Ironic perhaps to use technology, but most kids love technology and it offers choice and control. Try “”, “Stop, Breathe and Think”, “Smiling Mind” or the “Insight Meditation Timer” (after medications my kids love to check out the world map and see all the locations where people are meditating!). Try a classroom program such as

7.) Be consistent.

Greater benefits and habits are created when mindfulness is done repeatedly. Colleagues who practice mindfulness daily, even for a few minutes notice the impact is greater than if done sporadically.

Mindfulness is good for us and our children and has a natural place in our schools. Benefits abound like enhanced attention, self-regulation, social competence, as well as greater kindness and compassion. After I have practiced mindfulness with my students or clients they look different, calmer and more relaxed, and they ask for it again.

I too notice the rest of my day feels more manageable and my smile is broader. Enjoy adding mindfulness to your classroom or express your hope to your child’s teacher or school leaders that mindfulness be a part of your child’s school experience.


Ann-Noelle McCowan has worked with children and adolescents since 2001, and practiced yoga and meditation since 2005. Since 2003, she has been employed as a school counselor in a local high-performing school district, and prior to that was worked in the San Francisco Public Schools.

She received her dual Masters Degree (M.S.) in Marriage, Family and Child Therapy (MFCC), and School Counseling from San Francisco State University in 2002, her B.A. from Union College in New York, and her 200 hour-Registered Yoga Credential (RYT) from Shri Yoga.

McCowan completed additional Yoga trainings including the Kid Asana Program in 2014, Trauma in Children in 2016 and Adaptive yoga for Parkinson’s in 2014.

Wednesday, March 21, 2018

ADHD Drugs Increase Brain Glutamate, Predict Positive Emotion in Healthy People

From Brown University
via ScienceDaily

March 14, 2018

Summary: New findings offer clues about how misused drugs affect healthy brains and hint at an undiscovered link between glutamate and mood.

A new study used MRI to show how ADHD drugs affect the brains of
healthy people. The study found that the drugs were associated with a surge
in the neurotransmitter glutamate in key regions of the brain. That surge was
associated with reports of positive emotion. Credit: White Lab / Brown University

A new study shows that healthy people who take attention deficit hyperactivity disorder (ADHD) drugs experience a surge in the neurotransmitter glutamate in key parts of the brain. And that increase in glutamate is associated with subsequent changes in positive emotion.

The findings, published in the journal Neuropsychopharmacology, not only provide clues about how these drugs affect healthy brains, they also hint at a previously undiscovered link between glutamate and mood.

"This is the first time that an increase in brain glutamate in response to psychostimulant drugs has been demonstrated in humans," said Tara White, an assistant professor in the Brown University School of Public Health and lead author of the new study.

"That's important since glutamate is the major neurotransmitter responsible for excitation in the brain, and affects learning and memory."

Even more interesting, White said, the rise in glutamate predicted the magnitude and the duration of positive emotional responses to the drug.

"Given the timing of these effects -- the glutamate effect comes first, and the positive emotion comes later -- this could indicate a causal link between glutamate and positive emotion," White said. I think what we're seeing here is not just a drug effect, it's how positive emotion works in humans."

Drug Effects on the Brain

Millions of kids nationwide take prescription medication to treat ADHD. But in addition to prescribed usage, there's a thriving black market for these drugs, which young people use to improve attention, mood, and work and school performance. Yet little is known about what effects these drugs have on healthy brains, White said.

In this new study, subjects were first screened for mental and physical health and then underwent MRI spectroscopy scans designed to detect the concentration of neural compounds in specific regions of their brain.

From the medical literature on psychostimulants, White and her team wanted to look in the anterior cingulate cortex, which is a "hub" brain region that connects multiple brain networks involved in emotion, decision-making and behavior.

They found that two ADHD medications, d-amphetamine and Desoxyn, significantly increased the overall amount of glutamate in the right dorsal anterior cingulate cortex, even after controlling for possible confounding factors, such as volume of gray matter in the region.

The rise in brain glutamate predicted both the duration and the intensity of positive emotion, measured by participant ratings about whether they liked the drug or felt high after consuming it.

The authors caution that while this was a placebo-controlled study, the research demonstrates only an association between glutamate and positive mood, and not necessarily a causal relationship. However, the fact that the mood changes consistently followed changes in glutamate is suggestive of causality, though more research is necessary.

Glutamate is the most abundant neurotransmitter in the brain, White said, and its roles in learning and memory are well established. A potential link between glutamate and mood would be a novel finding.

"This is the first time we've seen a link between increases in brain glutamate and increases in positive emotion in healthy people -- with both changes happening in real time," said White, who is based at Brown's Center for Alcohol and Addiction Studies. "I think it's going to open up a whole new way of thinking about emotion in humans."

The research also found evidence of gender differences in drug effects. Women in the sample showed a larger increase in glutamate compared to the men in the sample. Women also responded more strongly to Desoxyn, compared to d-amphetamine. The gender difference is consistent with prior studies in animals, which show greater stimulant drug effects in females compared to males.

The differences between the two drugs also indicate that ADHD medications can have different effects on glutamate and other compounds in the brain.

White and her colleagues say there's evidence to suggest that the increase in glutamate involved drug-induced changes in enzymes and glutamate precursors. That suggests that the glutamate signal the researchers saw was from newly produced glutamate, rather than reuptake. With further research, the new data could help scientists to better understand how individuals respond differently to drugs, and changes in positive emotion over time.

"[The] present findings provide the first evidence in humans that drug-induced changes in [glutamate] correlate with subjective experiences of drug liking and drug high following drug ingestion" White and colleagues wrote.

The research was supported by grants from the National Institute on Drug Abuse (DA R21 029189), National Science Foundation (DGE 1058262), and the National Institute on Alcohol Abuse and Alcoholism (AA P01 007459).

Journal Reference
  • Tara L. White, Mollie A. Monnig, Edward G. Walsh, Adam Z. Nitenson, Ashley D. Harris, Ronald A. Cohen, Eric C. Porges, Adam J. Woods, Damon G. Lamb, Chelsea A. Boyd, Sinda Fekir. Psychostimulant drug effects on glutamate, Glx, and creatine in the anterior cingulate cortex and subjective response in healthy humans. Neuropsychopharmacology, 2018; DOI: 10.1038/s41386-018-0027-7

Education Law Center: Many Schools Funded Far Below What's Needed to Achieve Average Outcomes

From the Education Law Prof Blog

By Derek Black
March 20, 2018

A new policy brief, authored by researchers at Rutgers University and released by Education Law Center, shows that most U.S. states fund their public schools at a level far below what is necessary for students in high-poverty districts to achieve at even average levels in English and math.

The full report, entitled "The Real Shame of the Nation: The Causes and Consequences of Interstate Inequity in Public School Investments," is the first of its kind to examine the relationship between school funding, student achievement, and poverty levels across all states and the District of Columbia in the United States.

The report builds on the comparisons in state school funding systems in the "National Report Card, Is School Funding Fair?"

The report presents a new "National Education Cost Model" that uses a unique dataset of school spending, student achievement, student and family income levels, and other factors to construct estimates of how much states and school districts would need to spend for their students to reach the national average in English and math.

Among the key findings in the report:

  • In numerous states - including Arizona, Tennessee, Alabama, Michigan, and Georgia - only the lowest-poverty districts have sufficient funding to reach national average student achievement outcomes.
  • Mississippi, New Mexico, West Virginia, Nevada, and Louisiana spend so little that even their lowest-poverty districts can't reach national average student achievement outcomes.
  • Only a few states - including New Jersey and Massachusetts - have higher levels of funding across all districts and have near-average outcomes, even in the highest-poverty districts.
  • The cost of achieving national average outcomes in very high-poverty districts is three times higher - or $20,000 to $30,000 per pupil - than in low-poverty districts.

The report also debunks the common misconception of a nationwide "failure" in U.S. public education based on international outcome comparisons.

When viewed from a state-by-state or district-by-district lens, there is wide variation in spending and student achievement outcomes, with strong performance in a few high-investment states and in low-poverty districts - even those in under-performing states - that rivals that of other high-performing nations.

"The extreme variations in funding and student achievement across the states strike at the heart of the national interest in preparing our students for post-secondary education, the workforce and citizenship," said Bruce D. Baker, lead author.

"Some states need to increase school funding across the board to ensure equitable outcomes for their students. Others need to target increases to higher-poverty districts. And the federal government should find new avenues to support states with comparatively less ability to boost school funding on their own," Dr. Baker added.

The report authors recommend a dramatic change in federal policy by pooling federal education dollars to address the wide disparities in state spending and performance, with an emphasis on raising funding levels in states with large spending gaps, low overall student achievement outcomes, and limited fiscal capacity to close those gaps on their own.

The authors also recommend that the federal government use its spending power to incentivize low-performing states with higher fiscal capacity to take action to boost funding levels, especially for high poverty districts.

"This groundbreaking report should serve as a wake-up call to policymakers and educators around the nation," said David Sciarra, Executive Director of Education Law Center.

"The U.S. education system as a whole is far from failing," said Mr. Sciarra. "Instead, particular states and regions of the country are letting their students and the entire nation down by failing to provide the resources needed for students to reach their potential."

Please visit to view the report and policy brief, explore findings with interactive graphics and download complete datasets for further analysis.

Education Law Center Press Contact

Sharon Krengel
Policy and Outreach Director

973-624-1815, ext. 24