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Monday, October 16, 2017

Despite Dearth of Data, Firms Sell Brain Training As Autism Antidote

From Spectrum News

By Hannah Furfaro
October 9, 2017

On the website of the company Neurocore, an illustration of an anthropomorphized human brain, complete with hopeful eyes and a wide smile, is pumping iron. “A stronger brain makes anything possible,” says the tagline next to the cheery brain.

This concept — body-building for the brain — is the premise behind the Michigan-based company’s popular therapy. Known as neurofeedback, the therapy is based on the idea that by monitoring and adjusting electromagnetic signals, or waves, emanating from the brain, people can improve their mood, for example, or alleviate a headache.

Neurocore offers its therapy for, among other conditions, attention deficit hyperactivity disorder (ADHD), depression, stress, anxiety — and autism. The notion is that people with autism can learn to recalibrate their aberrant brain rhythms.

There’s no solid evidence that neurofeedback works as a treatment for autism. Most studies of neurofeedback have significant flaws. Still, its lofty promises spell big business: Apart from Neurocore, there are hundreds of centers offering neurofeedback as a therapy in the United States and elsewhere. (The brain-training market, which includes neurofeedback, is worth an estimated $2 billion worldwide.)

The therapy has been available for decades, but drew intense scrutiny this past year because Neurocore is financially backed by billionaire Betsy DeVos, the U.S. Secretary of Education. DeVos and her family have invested millions in the company, and she is a former member of the company’s board. DeVos did not respond to several requests for comment.

An investigation by Spectrum has shown that U.S. federal agencies with oversight in this area have not taken any action against Neurocore and other companies, even after several consumer complaints. This is despite the fact that there are nearly 100 instances in which Neurocore claims its technique can alleviate certain conditions.

“I have grave concerns about the marketing of these programs to families of children with autism spectrum disorder or ADHD or any other disorders at this point, because they’re not well-established treatments,” says Joseph Raiker, director of the Program for Attention, Learning and Memory at Florida International University in Miami.

The therapy’s recent popularity has also prompted the National Institutes of Health to look at it more closely. The agency spent just $7.9 million on neurofeedback research between 1997 and 2009. Since then, however, it has funneled about $53 million to 168 studies on the approach, including clinical trials for autism, ADHD and obsessive-compulsive disorder.

So far, the only moderately promising results for autism come from small studies. For example, the results of one trial, published in February, involved 10 children with autism and 7 controls, but no placebo group (1). Another study, published in September, involved 17 people with autism and 10 controls (2).

Real-time Readout

The idea that people might be able to control their brain waves dates back to the late 1960s, when neurobiologist Barry Sterman tested the idea in cats. Sterman monitored cats’ brain waves using a technique called electroencephalography (EEG). Using food as a reward, he trained the animals to activate a certain brain frequency at will.

In the 1970s, individual practitioners first used the therapy on themselves and then on clients; the first neurofeedback clinic opened in 1973 (3). In 1978, Sterman reported that six of eight people with epilepsy showed a significant decline in seizures after three months. In the mid-1990s, commercial companies began marketing neurofeedback devices to consumers and therapists. They promised to improve cognitive performance or offered drug-free relief from depression, migraines and the like.

A few years later, studies hinted that a band of 8- to 13-hertz brain waves called the mu rhythm may be abnormal in some people with autism (4). Because the mu rhythm is linked to a circuit involved in social imitation, the researchers suggested that irregularities in this rhythm lead to the social challenges in people with autism. Some companies and practitioners began offering neurofeedback for autism.

Brian Perez was about 10 when a family friend mentioned neurofeedback. Perez has autism, and throughout his childhood, he had frequent emotional outbursts at school and at home. His parents tried various treatments to help him, but nothing worked. On the family friend’s recommendation, his parents enrolled him in neurofeedback training twice each week. It eased his behavior so well that they continued the sessions.

Now 26, Perez attends college and works part-time, says his mother, Lisa. She says the therapy placed an enormous financial burden on the family, and is not convinced it is responsible for his achievements. “Did it cure anything? No,” she says. “But he’s not ready to give it up.”

Perez still attends weekly training sessions at the Brain Healing Center in Coral Springs, Florida, which cost $175 per session; his insurance doesn’t cover the treatment. (Neurocore’s costs are comparable: A 30-pack of sessions at the company costs nearly $2,000.)

During each session, Perez watches a computer screen while electrodes attached to his scalp pick up the collective electrical activity in his brain. His therapist, Gerald Gluck, tailors the type of game or visual task Perez will see, and compares Perez’s EEG to a database of control scans to determine which rhythms need to be changed.

Once Gluck chooses the brain waves Perez should try to alter, Perez concentrates on the visual task at hand. For example, in the ‘green dot’ task, a green dot appears on the screen, and a bell rings when Perez successfully manipulates a brain wave. He can choose to see EEG feedback of his brain waves on a separate screen or learn to concentrate without that visual reminder.

The real-time visual and audio feedback is supposed to teach Perez to adjust his brain waves in real-world contexts — say, to help him improve his memory.

(At Neurocore, too, therapists measure and compare the clients’ baseline brain frequencies with a “normative database,” says Elyse Kemmerer White, chief science officer at the company. “When we find differences in activity, we can personally address those changes by bringing up some frequencies that may not have enough power and trying to lower frequencies that have too much power.”)

On the Brain Healing Center’s website, a list of frequently asked questions includes the question: “Are the results permanent?” The answer: “In most cases of ADD/ADHD, learning disorders, brain injury, yes.”

More than two years ago, Gluck told Perez that his EEG readings show he no longer has autism. (EEG scans are not part of the generally accepted diagnostic criteria for autism.)

“It’s a very big claim,” Perez says. Still, he says, neurofeedback helped him overcome social awkwardness and continues to help improve his memory and organizational skills. “I feel like it has helped me significantly, and I do use the word significantly. But I still think it needs more research.”

Gluck says he has treated more than 100 people with autism since around 2000. Up to 90 percent of the people he treats substantially improve, he says, and some can decrease the amounts of medication they take. “Traditional medicine has very little to offer, for the most part” in treating autism, Gluck says.

Little Oversight

In the U.S., at least two government agencies have regulatory authority over companies that offer neurofeedback. The U.S. Food and Drug Administration (FDA) polices medical devices, although it exempts devices (including those used for neurofeedback, such as EEG machines) when they are used for relaxation training or other non-medical applications. The Federal Trade Commission (FTC) enforces rules that prohibit deceptive advertisements of treatments not covered by the FDA.

An analysis by Spectrum of FDA records shows the agency has issued warning letters to neurofeedback and biofeedback device manufacturers at seven companies. In 2012, for example, it warned a California-based manufacturer called EEG Info about “violations,” including claims that its device can be used as a ‘therapeutic application’ for autism and other conditions. But the agency has never recalled a neurofeedback device or prohibited its production.

Information obtained from a Freedom of Information Act request filed by Spectrum shows that the FTC has received at least seven consumer complaints since 2006 about companies that manufacture neurofeedback devices or offer the therapy. One person complained about unwanted solicitations in the mail from Neurocore. Another said she developed “pre-seizure/post-concussion symptoms that lasted for five months” after using a neurofeedback device sold by a company called the Clear Mind Center.

She also said that the “company does not provide sufficient training of equipment allowing unlicensed techs to run,” according to the FTC’s records. But the agency has not required Neurocore and other companies to refund consumers or otherwise compensate for any damage or inconvenience. An FTC spokesperson confirmed this analysis.

In August, the National Advertising Division (NAD), the Better Business Bureau’s investigative arm, asked Neurocore to voluntarily cease advertising its services as treatments.

A spokesperson for the NAD says the organization scrutinized Neurocore’s advertising as part of its routine monitoring of advertisements for new products and ones that target vulnerable populations.

In its 17-page recommendation, the NAD took particular issue with Neurocore’s claims that neurofeedback decreases the severity of autism features by 25 percent.

Careful Claims

Before September, Neurocore’s website cited a study reporting a 26 percent decrease in “reported symptoms” on an autism evaluation checklist. It also cited another study that “noted improvements in executive functioning, thought to be a central concern in autism.” Both sentences have since been deleted from the website.

“Although we believe we were clear this was a third-party study and not a Neurocore study, we decided to remove it to avoid any confusion,” Mark Murrison, Neurocore’s chief executive officer, told Spectrum about the removal of the 26 percent statistic.

“We are very careful to not make claims specifically about autism itself,” he says. “We have always stated we treat the symptoms of autism — which include a high co-occurence of anxiety, mood and attention issues.”

The NAD’s censure has no legal teeth, but if an independent advertising board agrees with its conclusions, the board can submit its concerns to the FTC. Murrison says the company plans to appeal the recommendation.

“The public has a right to receive accurate and truthful information about the alternatives to chemical treatments for these conditions, and we have provided it,” he says.

Even though the company advertises its services for people with autism, most people who visit Neurocore do not have the condition, company officials say.

When Spectrum asked what the company would tell a parent about the effectiveness of the therapy for autism, Kemmerer White said, “Good question,” and deferred the reply to Nick Bolhuis, Neurocore’s director of clinical operations. “The body of research needs to continue to grow in the field of neurofeedback as it specifically relates to [autism],” Bolhuis said.

Neurocore’s website is less tentative, stating, “Neurocore can help with autism.”

Long Road

From a basic-research perspective, there is, in fact, much to learn about neurofeedback, other researchers say.

“It’s definitely an area of growth and an area of great promise,” says Ralph-Axel Müller, professor of psychology at San Diego State University and co-investigator on the February study on autism. “But how can we specifically target certain brain abnormalities in a given individual child with [autism]? That’s still a big challenge.”

In the meantime, although neurofeedback is unlikely to be harmful, it can waste parents’ time, energy and money. Families may forgo proven treatments to spend their resources on neurofeedback, says Kevin Pelphrey, director of the Autism and Neurodevelopmental Disorders Institute at George Washington University in Washington, D.C.

“There’s so many of these kinds of brain-training small companies, or even quite large companies, that charge people for unproven technologies,” Pelphrey says. “And they’re really giving science a very bad name.”

If anything, neurofeedback should be used in combination with behavioral treatments, Pelphrey says. “If we want to [use neurofeedback to] help people respond to other evidence-based treatment, I think that we’re close,” he says.

Meanwhile, Neurocore has changed some of the wording on its website. As of late September, the company had removed statements about the efficacy of neurofeedback for autism.

For example, the statement, “There is currently no cure for autism, but the symptoms can greatly improve through Neurocore’s proven, natural autism treatment program,” was removed. Another statement, “In some cases, children’s medication may be able to be reduced,” was also removed.

And the company is continuing to pursue its own research on the treatment: Its website now advertises a clinical trial for older adults with memory concerns.

  • Datko M. et al. Eur. J. Neurosci. Epub ahead of print (2017) PubMed
  • Ramot M. et al. Elife Epub ahead of print (2017) PubMed
  • Thibault RT. et al. Cortex 74, 247-261 (2016) PubMed
  • Bernier R. et al. Brain Cogn. 64, 228-237 (2007) PubMed

Has Eva Moskowitz Overplayed Her Hand on Parent Accountability?

From the Thomas B. Fordham Institute's Blog

By Robert Pondiscio
October 10, 2017

"Many high-performing charters talk about parents as partners in their children’s education. Success Academy mandates it, monitors it, and holds parents to account for honoring the agreement they signed when enrolling their children."

Leveraging the power of parent engagement is one of the under-appreciated ways in which Eva Moskowitz and her New York City-based network of Success Academy charter schools has significantly improved upon the work of pioneering “no excuses” charter schools.

Many high-performing charters talk about parents as partners in their children’s education. Success Academy mandates it, monitors it, and holds parents to account for honoring the agreement they signed when enrolling their children.

That agreement includes faithful adherence to school policies on things like bringing kids to school and picking them up on time and in uniform; avoiding unexcused absences and tardiness; and monitoring homework and maintaining their child’s reading logs.

“We've never believed that we could educate kids without the parents,” Moskowitz told me recently. “We're not that good.”

Success Academy is now pushing its belief in parent engagement to a level that may be unprecedented in U.S. public education. With little fanfare, the network has in the past week begun sending home “Parent Investment Cards” evaluating how well—or how poorly—parents are fulfilling their promise to honor Success Academy’s “parent responsibilities” in three areas: “school readiness,” “homework supervision,” and “parent responsiveness and investment.”

In each category, the parent is adjudged as “meeting expectations” (green), “approaching expectations” (yellow), or “not meeting expectations” (red)—a color-system that echoes the behavior chart in every Success Academy classroom. It’s no longer just a child who might “finish the day on red” but his parents, too. Some parents are not pleased.

Sample of Success Academy
Parent Investment Card
I first heard about the reports from a pair of well-off white parents who send their kids to Success Academy’s Upper West Side school, one of the most ethnically and economically diverse of the network’s 46 schools. One mother was ruefully amused; the other was appalled, describing the Investment Card as a “parent report card.”

My initial reaction was that Moskowitz and Success Academy were quietly putting their stake in the ground, establishing that even as the network’s stellar results attract more upscale families in comparatively well-off New York neighborhoods like Cobble Hill, Union Square, and the Upper West Side, their primary focus would remain serving low-SES families, many of whom might not have gotten the word about reading to children, for example, and need to be coached, coaxed, or prodded along.

While parental hopes and aspirations may be uniformly distributed, parent engagement is not: A recent Pew study showed that 71 percent of parents with a college degree say they read aloud to their children daily, compared to only 33 percent of those with a high school diploma or less.

It obviously wouldn’t be acceptable to send a “parent investment card” to one set of schools or parents and not to others in the same network. By the same token, many families—rich and poor—might not fully believe that Success means what its leaders and team members say about attendance, uniforms, and homework. Spoiler alert: They mean it.

As with so many controversies that have attached themselves to Moskowitz and Success Academy, no one can accuse the network of being anything other than clear and candid, even to a fault. Every new Success Academy family signs a contract promising “to abide by all of Success Academy’s culture policies and values.”

The network’s Parent Handbook plainly sets forth those policies and values, and—for as long as Success Academy has existed—failure to live up to them has prompted school administrators to bring parents in for pointed conversations. Critics, meanwhile, have charged those strict policies are a mechanism for counseling out students who don’t mesh with the schools’ exacting culture.

In her new memoir, Moskowitz tells the story of one mother who wouldn’t read at home to her child even after repeatedly promising that she would change her ways.

“I invited her to a meeting at which there was a surprise guest: her mother, whom I’d met one day when she was picking up her grandson from school and seemed to be more responsible than the mom.” The grandmother was furious with her daughter and assured her that it wouldn’t happen again. The anecdote, Moskowitz explains, “reflects our philosophy of not giving up.”

Perhaps so, but there may be a difference between an uncomfortable conversation when there’s a clear and obvious problem, and having your child’s school assign every parent a grade, an evaluation, and a color. A low-income South Bronx Success Academy mom, whom I’ve gotten to know well, was seething over her “report card” when I ran into her in a church on Sunday. “I’m doing everything that I can,” she said. “How are you gonna give me ‘approaching expectations’ when I’m killing myself?”

This parent, who has been supportive of Moskowitz and Success Academy, is planning to speak to her child’s middle school principal about it—the very outcome Moskowitz says she wants to encourage—but she said she first needs to figure out how to approach it without getting upset. “It was an insult,” she said flatly.

To her credit, Moskowitz refuses to perform what she calls “bypass surgery” on parents. “I think there's something very disrespectful about it, to sort of say, ‘You brought these children into the world but now we, the school, will take over,’” she told me when I asked her recently about the new initiative. “I think there's a tendency, particularly when you serve poorer parents, to just work around them.”

In Moskowitz’s view, the Parent Investment Cards arriving at pupils’ homes this month are nothing new. Success Academy, she insists, has always tracked “culture data,” which is even the title of one the chapters of her memoir. “We’ve had a lot of different communications systems and we thought that we needed to make it a little easier for parents to read the data and understand the state of affairs,” she says. “There’s utterly nothing new about the underlying design principle. This particular incarnation is new.”

My Fordham colleague Checker Finn has long supported a move like this. When I told him of Moskowitz's action, he said "Gutsy and much needed. If schools and parents are truly to share responsibility for educating children, each needs in some way to be accountable to the other."

Another Moskowitz fan I mentioned it to was also impressed. “Holy s—t, talk about cojones!” he cheered. “The anti-reformers have forever said we should hold parents accountable. They will surely find a reason to oppose this anyway.”

Without question, but so might some of Moskowitz’s best and most loyal supporters: her parents. If the small handful of Success Academy parents I’ve spoken to about this are an indication, Moskowitz might for once be overplaying her hand.

Robert Pondiscio is a Senior Fellow and the Vice President for External Affairs at the Thomas B. Fordham Institute.

Sunday, October 15, 2017

Study: Too Many Structured Activities May Hinder Children's Executive Functioning

From Education Week's Blog
"Teaching Now"

By Ellen Wexler
July 2, 2014

When children spend more time in structured activities, they get worse at working toward goals, making decisions, and regulating their behavior, according to a study.

Instead, kids might learn more when they have the responsibility to decide for themselves what they're going to do with their time.

Psychologists at the University of Colorado and the University of Denver studied the schedules of 70 six-year olds, and they found that the kids who spent more time in less-structured activities had more highly-developed self-directed executive function.

Self-directed executive function develops mostly during childhood, the researchers write, and it includes any mental processes that help us work toward achieving goals—like planning, decision making, manipulating information, switching between tasks, and inhibiting unwanted thoughts and feelings. It is an early indicator of school readiness and academic performance, according to previous research cited in the study, and it even predicts success into adulthood.

Children with higher executive function will be healthier, wealthier, and more socially stable throughout their lives.

The researchers asked parents to record the activities of their six-year-olds for a week, and then they measured how much time each child spent in structured and less-structured activities. The researchers define structured activities as anything organized and supervised by adults—like music lessons or community service.

For an activity to be less-structured, the child must be in charge of deciding what to do and figuring out how to do it. All forms of free play counted as less-structured activities.

The researchers conjecture that when children are in control of how they spend their time, they are able to get more practice working toward goals and figuring out what to do next. For instance, the researchers write, a child with a free afternoon ahead of her might decide to read a book. Once she's finished, she might decide to draw a picture about the book, and then she'll decide to show the drawing to her family.

This child will learn more than another child who completes the same activities, but is given explicit instructions throughout the process.

At the end of the week, the researchers tested the children on skills like vocabulary and verbal fluency to measure their executive function. The more time the children spent in less-structured activities, the higher they scored.

"Structured time could slow the development of self-directed control, since adults in such scenarios can provide external cues and reminders about what should happen, and when," the researchers write in the study.

The study is the first of its kind, and the researchers believe it's relevant to debates parents are already having on blogs and at soccer games—but it's also resonating with educators advocating the importance of free play in classrooms.

"The ability to self-direct can spell the difference between an independent student, who can be relied upon to get her work done while chaos reigns around her, and a dependent, aimless student," former teacher Jessica Lahey writes in The Atlantic. "When we reduce the amount of free playtime in American preschools and kindergartens, our children stand to lose more than an opportunity to play house and cops and robbers."

The researchers acknowledge that their study only proves correlation, but not causation. That is, it's possible that children with better executive functioning may prefer to participate in less-structured activities more often, they write, while children with worse executive functioning may be more likely to seek out activities already structured for them.

"This isn't perfect, but it's a first step," psychology and neuroscience professor Yuko Munakata, senior author of the study, said in a press release. "Our results are really suggestive and intriguing. Now we'll see if it holds up as we push forward and try to get more information."

Education is the Surest Path Out of Poverty, Even if The Atlantic Reports Otherwise

From Better Conversation
via EducationPost

By Peter Cunningham
October 9, 2017

One of the favored tactics of education reform opponents is to blame underperformance of schools on problems we cannot easily solve in order to avoid solving the actual problems that are within our powers to address. The latest example of this comes from progressive journalist Rachel Cohen in The Atlantic.

Under a headline that flatly states, “Education Isn’t the Key to a Good Income,” Cohen cherry-picks data, anecdote and opinion to build a flimsy case that education is not the path out of poverty.

Instead, she cites factors like segregation, family structure, income inequality, hunger, inadequate health care and lack of social capital for poor kids.

School and teacher quality are barely mentioned and there is no consideration of evidence linking higher incomes with educational outcomes.

Picked Chrries and Plucked Anecdotes

Cohen cites one study from Raj Chetty that suggests geography is a greater factor than educational quality in determining incomes. I suppose that if one kid grows up in thriving Silicon Valley and the other one grows up in a dying rust-belt community, geography may carry extra weight—but does that mean we shouldn’t expect better results in schools?

Then she turns to a working paper from Berkeley economist Jesse Rothstein who concludes that labor markets and marriage patterns, “seemed to make much more of a difference than school quality.”

What “seemed” true in her narrative morphs into blunt certainty in the conclusion: “We can’t educate people out of this problem,” says Rothstein.

For further evidence, Cohen turns to New York City math teacher, author and blogger José Vilson, who says, “Access to food and healthcare have a bigger impact than schools.”


No one denies that sick, hungry kids have trouble learning, but that doesn’t explain away the millions of healthy, well-fed kids who are still struggling in school or the millions of middle-class kids who need remedial education in college.

It’s also astonishing that a teacher would be arguing that schools don’t have much impact.

Cohen cites several other pieces of academic guesswork before landing on her final point, which is that unionization “seems to be another critical factor helping poor people escape poverty.” There’s that word “seems” again.

(It should be noted that Cohen is writing for a media outlet that has received more than a million dollars in the past year from a national teachers union. It should also be noted that one of Education Post’s funders, Emerson Collective, just bought a majority stake in The Atlantic.

For the record, I support unions, though I disagree with some of their positions on education.)

What 'Seems' May Not Be

Cohen’s article fails the smell test. For one thing, there is no consideration of any evidence linking education to better economic outcomes.

For example, in 2012, The Pew Charitable Trusts released a report called, Pursuing the American Dream: Economic Mobility Across Generations.” It says, in no uncertain terms, “Having a college degree improves Americans’ chances of surpassing their parents’ family income and wealth.”

The report compares the income levels of high school and college graduates and finds that, among America’s poorest quintile, 53 percent of college grads make it into the top three-fifths of the income scale—a pretty good proxy for middle class—compared to 27 percent of high school graduates.

All told, 90 percent of low-income kids with college degrees moved at least one rung up the ladder compared to 53 percent of those with only high school degrees. We also know that, on average, people who don’t finish high school earn much less than those who do.

Others, including advocates for greater investment in anti-poverty programs, have read the Pew data differently. They point out that rich kids (in the top quintile) with only a high school degree are more likely to remain rich than poor kids with a college degree are to get rich.


To me, that only proves that inherited wealth can keep you wealthy and the social capital that accompanies wealth protects undereducated rich kids. It hardly disproves the value of education for poor kids looking to move up the economic ladder.

Cohen concludes:

"Most Americans would probably agree that leaders should work to build great schools, and that individuals who work hard should be able to improve their economic earnings over time. Devoting the bulk of one’s attention to the former in the hopes that it causes the latter, however, might prove to be a real mistake."

Actually, we know what most Americans think. The most recent PDK poll shows overwhelming support for career and technical education, suggesting the public clearly links education with the economy.

Another Excuse to Avoid Accountability

Arguing that education isn’t a significant factor in lifting poor people out of poverty is akin to the argument advanced by union leaders and others that teachers have only a minimal impact on student achievement and therefore should not be held accountable for results.

Both arguments are excuses to evade accountability.


Worse yet, they undermine public confidence in public education and weaken the case for greater investment. If education doesn’t have much impact, then what’s their argument for investing more in schools or improving teacher quality with higher pay?

I’m not suggesting that factors like poverty, segregation, and family structure are irrelevant and I support every effort to address them. And I’m not suggesting that education alone will move every poor person into the middle class.

But the existence of these big macro problems, which we have been combating for decades with mixed results, at best, is not an excuse to avoid issues we can address today, right now—like school and teacher quality.

Every day, in classrooms all across America, great teachers and school leaders are proving that low-income kids can achieve at the highest levels despite factors like poverty.

I would also argue—and a new working paper from Nobel Prize-winner James Heckman, among others, affirms it—that other challenges in society like incarceration, mental health, voter participation and welfare dependence, are ameliorated through better education.

To me, the case is clear: do all we can to solve society’s problems but invest more in schools and teachers and hold them accountable for results. It’s the single best bet we have.


Peter Cunningham is the executive director of Education Post. He recently served as assistant secretary for communications and outreach in the U.S. Department of Education during the Obama Administration’s first term. Prior to that he worked with Arne Duncan when he was CEO of the Chicago Public Schools.

Peter is affiliated with Whiteboard Advisors, a DC-based education policy, research and communications firm. He serves on several non-profit boards, including Oakland-based Great Schools, which provides school quality information to parents through a national on-line platform, The Montessori School of Englewood, a Chicago public charter school, Manufacturing Renaissance, a career education program that trains public high school students for jobs in manufacturing, Unbounded, an organization supporting teachers in schools that are transitioning to higher standards, and, focusong on financial literacy for students.

Saturday, October 14, 2017

We Need to Talk About Kids and Smartphones

From TIME Magazine

By Markham Heid
October 10, 2017

As experts debate the role smartphones play in adolescent mental health, teen depression and suicide rates continue to climb.

Nina Langton had no right to be depressed. At least, that’s how she saw it.

She had a great group of friends, lived in a prosperous neighborhood, and was close with her parents. Like most 16-year-olds at her Connecticut high school, Nina spent much of her free time on her smartphone. But unlike many of her classmates, she was never “targeted” on social media—her word for the bullying and criticism that took place daily on sites like Snapchat. “Part of what made my depression so difficult was that I didn’t understand why I was feeling so sad,” she says.

Later, after her attempted suicide and during her stay at a rehabilitation facility, Nina and her therapist identified body image insecurity as the foundation of her woe. “I was spending a lot of time stalking models on Instagram, and I worried a lot about how I looked,” says Nina, who is now 17. She’d stay up late in her bedroom, looking at social media on her phone, and poor sleep—coupled with an eating disorder—gradually snowballed until suicide felt like her only option. “I didn’t totally want to be gone,” she says. “I just wanted help and didn’t know how else to get it.”

Nina’s mom, Christine Langton, has a degree in public health and works at a children’s hospital. Despite her professional background, she says she was “completely caught off guard” by her daughter’s suicide attempt. “Nina was funny, athletic, smart, personable . . . depression was just not on my radar,” she says.

In hindsight, Langton says she wishes she had done more to moderate her daughter’s smartphone use. “It didn’t occur to me not to let her have the phone in her room at night,” she says. “I just wasn’t thinking about the impact of the phone on her self-esteem or self-image until after everything happened.”

It seems like every generation of parents has a collective freak-out when it comes to kids and new technologies; television and video games each inspired widespread hand-wringing among grown-ups. But the inescapability of today’s mobile devices—coupled with the personal allure of social media—seems to separate smartphones from older screen-based media.

Parents, teens and researchers agree smartphones are having a profound impact on the way adolescents today communicate with one another and spend their free time. And while some experts say it’s too soon to ring alarm bells about smartphones, others argue we understand enough about young people’s emotional and developmental vulnerabilities to recommend restricting kids’ escalating phone habit.

The latest statistics on teen mental health underscore the urgency of this debate.

Between 2010 and 2016, the number of adolescents who experienced at least one major depressive episode leapt by 60%, according to a nationwide survey conducted by the U.S. Department of Health and Human Services. The 2016 survey of 17,000 kids found that about 13% of them had a major depressive episode, compared to 8% of the kids surveyed in 2010. Suicide deaths among people age 10 to 19 have also risen sharply, according to the latest data from the Centers for Disease Control and Prevention.

Young women are suffering most; a CDC report released earlier this year showed suicide among teen girls has reached 40-year highs. All this followed a period during the late-1990s and early 2000s when rates of adolescent depression and suicide mostly held steady or declined.

“These increases are huge—possibly unprecedented,” says Jean Twenge, a professor of psychology at San Diego State University and author of iGen, which examines how today’s super-connected teens may be less happy and less prepared for adulthood than past generations.

In a peer-reviewed study that will appear later this year in the journal Clinical Psychological Science, Twenge shows that, after 2010, teens who spent more time on new media were more likely to report mental health issues than those who spent time on non-screen activities.

Using data collected between 2010 and 2015 from more than 500,000 adolescents nationwide, Twenge’s study found kids who spent three hours or more a day on smartphones or other electronic devices were 34% more likely to suffer at least one suicide-related outcome—including feeling hopeless or seriously considering suicide—than kids who used devices two hours a day or less. Among kids who used electronic devices five or more hours a day, 48% had at least one suicide-related outcome.

Twenge also found that kids who used social media daily were 13% more likely to report high levels of depressive symptoms than those who used social less frequently. Overall, kids in the study who spent low amounts of time engaged in in-person social interaction, but high amounts of time on social media, were the most likely to be depressed.

Twenge is quick to acknowledge that her research does not prove a cause-and-effect relationship exists between smartphones and depression. “It’s possible that depressed kids are just more likely to spend time on their devices,” she says. “But that doesn’t answer the question of what caused this sudden upswing in teen depression and suicide.”

Some experts have pointed to the aftermath of the Great Recession, or rising student workloads, as possible non-device explanations for young people’s recent struggles. “But when you look at the economic or homework data, it doesn’t line up with the rise in teen suicide or depression,” Twenge says. Youth smartphone ownership does.

“I’m open to exploring other factors, but I think the more we learn about kids and smartphones, the more we’re going to see that limiting their exposure is a good idea.”

Others agree it’s time to approach adolescent device use with greater caution. “What this generation is going through right now with technology is a giant experiment, and we don’t know what’s going to happen,” says Frances Jensen, chair of neurology at the University of Pennsylvania’s Perelman School of Medicine. While the science on kids and technology is incomplete, Jensen says what we already know about the minds of tweens and teens suggests giving a young person all-the-time access to an Internet-connected device “may be playing with fire.”

The Teenage Brain

To understand how device use may be affecting a young person’s mental health, it’s important to recognize the complex changes occurring in an adolescent’s still-developing brain.

For one thing, that brain is incredibly plastic and able to adapt—that is, physically change—in response to novel activities or environmental cues, says UPenn’s Jensen, who is the author of The Teenage Brain.

Some research has already linked media multitasking—texting, using social media and rapidly switching among smartphone-based apps—with lower gray-matter volume in the brain’s anterior cingulate cortex (ACC), a region involved in emotion processing and decision making. More research has associated lower ACC volumes with depression and addiction disorders.

“We know for a fact teens have very underdeveloped impulse control and empathy and judgment compared to adults,” Jensen says. This may lead them to disturbing online content or encounters—stuff a more mature mind would know to avoid. Teens also have a hyperactive risk-reward system that allows them to learn—but also to become addicted—much more quickly than grown-ups, she says.

Research has linked social media and other phone-based activities with an uptick in feel-good neurochemicals like dopamine, which could drive compulsive device use and promote feelings of distraction, fatigue, or irritability when kids are separated from their phones.

Even if smartphones aren’t the root cause of a teen’s anxiety or other issues, Jensen adds, they may turn out to be an accelerant—the gasoline that turns a flicker of adolescent angst into a blaze.

Another area of the brain—the prefrontal cortex—is critical for focus and interpreting human emotion, and doesn’t fully develop until a person’s mid-20s, says Paul Atchley, a professor of psychology at the University of Kansas. “During our teenage years, it’s important to train that prefrontal cortex not to be easily distracted,” he says. “What we’re seeing in our work is that young people are constantly distracted, and also less sensitive to the emotions of others.”

While the research on smartphones is preliminary, Atchley says he believes studies will eventually show a clearer connection between the negative trends in teen mental health and rising smartphone use. But some scientists contend there isn’t enough cause-and-effect evidence to condemn smartphones.

“I see the rise in depression, especially among girls, and I understand why people are making these connections with new technologies,” says Candice Odgers, a professor of psychology and neuroscience at Duke University who has published research on teens and tech. “But so far, we have very little data to suggest mobile technologies are causing anxiety or social impairments.”

She points to evidence that some young people, particularly marginalized groups like LGBT youth, can derive benefits from online communication through supportive exchanges with friends and family.

Odgers adds that jumping to conclusions and vilifying smartphones may lead us away from factors that may turn out to be more significant—a worry raised by other experts. “This is such a serious and polarizing issue that I think we need to set aside our assumptions until we have stronger data,” she says.

At the same time, she doesn’t condone unrestricted smartphone access at any age. “I’m certainly not advocating giving an 8-year-old a smartphone,” she says. “But if you ask me what age is appropriate, or how much use is safe, I don’t think the existing evidence provides those answers.”

As researchers debate appropriate public health messaging, kids are receiving their first smartphone at ever-younger ages—the average is 10, according to one recent estimate—and they’re spending more and more time on their devices.

“I am probably on my phone 10 hours a day,” says Santi Potočnik Senarighi, a 16-year-old eleventh grader in Denver. Even when he’s not actively using his phone, Santi says it’s always with him, and he never considers taking a break. “This is part of my life and part of my work, and [that] means I need to be in constant contact.”

Santi’s dad, Billy Potočnik, says he worries about his son’s phone habit, as Santi is struggling in school. But every one of Santi’s friends has a smartphone and uses it constantly, and so Potočnik says confiscating his son’s phone feels oppressive. “If I try to take it away from him, he tells me he’s not doing anything bad on it,” which Potočnik says is usually true, “and it turns into a struggle.”

He and other parents say enduring that struggle day after day feels overwhelming. And to complicate matters, many schools and after-school groups now use social media or online platforms to coordinate events, or to post grades and homework. “It’s not as simple as saying, okay, time to take a break from your phone,” Potočnik says.

How Teens ‘Talk’

Colleen Nisbet has been a high school guidance counselor for more than two decades. One of her duties at Connecticut’s Granby Memorial High School is to monitor students during their lunch periods. “Lunch was always a very social time when students were interacting and letting out some energy,” she says. “Now they sit with their phones out and barely talk to each other.”

This scene—of kids collecting in parks or at one another’s houses only to sit silently and stare at screens—comes up over and over again when talking with parents and kids. “When you’re with people you don’t know well or there’s nothing to talk about, phones are out more because it’s awkward,” says Shannon Ohannessian, a 17-year-old senior at Farmington High School in Connecticut.

That avoidance of face-to-face interaction worries Brian Primack, director of the University of Pittsburgh’s Center for Research on Media, Technology, and Health. “Human beings are social animals,” he says. “We evolved over millions of years to respond to eye contact and touch and shared laughter and real things right in front of us.”

There’s strong research linking isolation to depression, and time spent socializing with improved mood and well-being. If smartphones are getting between an adolescent and her ability to engage in and enjoy face-to-face interaction—and some studies suggest that’s happening—that’s a big deal, Primack says.

But while they’re not always speaking out loud, kids today are talking to each other—and about each other. They’re just doing it on their phones. Not all that talk is friendly. “They tell me they’re making comments or criticizing each other to friends while they’re all sitting together,” says Nisbet, the guidance counselor. Something about the phone just seems to “take the filter off,” she adds.

Backbiting and mean-girl gossip are nothing new, of course. But research suggests that, even among adults, the Internet has a disinhibition effect that leads people to speak in coarser, crueler ways then they would offline.

Maryellen Pachler, a Yale-trained nurse practitioner who specializes in the treatment of adolescent anxiety disorders, says her job used to involve convincing her patients that their fears were largely irrational. “Now I don’t think they’re irrational at all,” she says. “If you raise your hand in class or say something silly, I think it’s likely your classmates will be texting or posting something about it.”

She says the glamor and gleam of social media is also fueling a rise in teen anxiety. “My patients see their friends’ Snapchat or Instagram photos where they look so happy, and they feel like they’re the only ones who are faking it,” she says, referencing what researchers call the highlight reel effect of social media. “I want to tell them, listen, this girl you’re jealous of—she was in here with me yesterday!”

Teens agree social-media whitewashing is the rule, not the exception. “No one’s going to post something that makes them look bad,” Ohannessian says. “I know that, but it’s still hard to separate what you see on social media from real life.”

What’s Next for Teens and Phones

There are doubtless many factors contributing to teen depression. Parents say kids today are busier than ever before—their lives increasingly crammed with the extracurriculars required to gain admission to a good college. But even those researchers who aren’t ready to slam smartphones say it’s important to restrict an adolescent’s device habit, and that too much social media or media multitasking is likely harmful.

“I don’t think these devices are the main cause, but I think they contribute to a lot of the things we worry about,” says David Hill, director of the American Academy of Pediatrics (AAP) Council on Communications and Media. “I speak to parents who are very concerned, and my take is to be much more rigid about setting limits—especially when it comes to phones in the bedroom at night.”

But the AAP’s current guidelines do not offer specifics when it comes to appropriate smartphone limits for children older than 6, and public health officials generally say parents should decide what is right for their kids, without offering specifics.

Educators are also grappling with smartphone-related dilemmas. Most schools allow smartphone use between classes and during free periods, but teachers say keeping students off their phones during class has become a tremendous burden.

Gina Spiers, an English teacher at San Lorenzo High School near Oakland, Calif., says she used to confiscate phones, but students would panic and cause a disruption in class. She and her school are fighting back—with encouraging results.

Starting this fall, San Lorenzo High joined several schools nationwide in working with a company called Yondr to restrict smartphone access during school hours. Yondr makes small, lockable phone pouches that students keep with them, but that can’t be opened until the end of the day.

“The changes have already been profound,” says Allison Silvestri, San Lorenzo’s principal. Kids are more focused and engaged during class, and student journals suggest the high schoolers are feeling less anxious and more relaxed. Silvestri says fewer fights have broken out this semester—a benefit she attributes to the absence of social media.

“They have to look each other in the eye to make conflict happen,” she says. “There’s so much more joy and interaction, and I can’t count the number of parents who have asked me, ‘How do I buy this for my home?’”

The smartphone experiment at San Lorenzo doesn’t meet the standards of the scientific method. But it’s one more piece of evidence linking mobile devices with the troubles today’s teen are facing. While there are no doubt helpful and healthy ways young people could use smartphones to enrich their lives, it’s becoming harder to argue that the status quo—near-ubiquitous teen smartphone ownership, coupled with more-or-less unfettered Internet access—is doing kids good.

A few months after her suicide attempt, Nina Langton addressed her high school classmates and spoke openly about her depression. She described the stigma of mental illness, and lamented the fact that, while many teens experience depression, very few are willing to talk about it or ask for help. “I was worried for so long about opening up about my struggles because I thought I would be judged,” she said.

After she gave the speech, “so many people my age reached out to me about their own experiences with technology and depression and therapy,” she says. “I think this is a big problem that needs to be talked about more.”

Autism Prevalence and Socioeconomic Status: What's the Connection

From the University of Wisconsin - Madison

 By Adityarup “Rup” Chakravorty
October 11, 2017

Children living in neighborhoods where incomes are low and fewer adults have bachelor's degrees are less likely to be diagnosed with autism spectrum disorder compared to kids from more affluent neighborhoods.

The finding is part of a new multi-institution study of autism spectrum disorder (ASD), led by Maureen Durkin of the University of Wisconsin-Madison's Waisman Center, and published recently in the American Journal of Public Health.

Durkin and her team found that the incidence of the disorder increased during the study period. In fact, during the eight years of the study, the overall prevalence of ASD in children more than doubled, increasing from 6.6 to 14.7 cases per thousand children.

"We wanted to see if part of this increase in ASD prevalence was because advances in screening techniques and medical training meant more children from disadvantaged backgrounds were gaining access to ASD diagnoses and services," says Durkin, a professor of population health sciences and pediatrics at UW-Madison. "It doesn't seem that's the case."

Her team analyzed education and health care data for 1.3 million 8-year-old children from a Centers for Disease Control and Prevention population-based surveillance program, with sites in 11 states across the U.S.: Alabama, Arizona, Arkansas, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, Utah and Wisconsin.

The study merged this autism surveillance data with U.S. Census measures of socioeconomic status, such as number of adults who have bachelor's degrees, poverty and median household incomes in the census tracts studied.

It found that regardless of which indicator of socioeconomic status the researchers used, children living in census tracts with lower socioeconomic development were less likely to be diagnosed with ASD than children living in areas with higher socioeconomic indicators.

While not the first study to highlight socioeconomic differences in rates of autism diagnosis, "the continued increase in prevalence of ASD makes understanding its epidemiology critical to ensure services are reaching the children who need them the most," says Durkin.

The study does not prove children from lower socioeconomic backgrounds are not getting the diagnoses and support they need, Durkin says, but it does indicate that's the most likely scenario.

In support of this hypothesis, the study found that children who had intellectual disabilities were equally likely to be diagnosed with ASD irrespective of their socioeconomic backgrounds.

That could be because "children with intellectual disabilities usually have developmental delays that get noticed earlier in life," says Durkin. "They may get referred for comprehensive medical follow-ups, which could then lead to a diagnosis of their ASD as well."

In addition, studies in Sweden and France -- which have universal health care and fewer barriers for citizens to access medical care -- found no association between socioeconomic status and rates of autism diagnoses.

These findings collectively support the idea that children living in poorer or less well-educated areas are being diagnosed with ASD at lower rates because they have less access to health care providers who could make the diagnosis and provide needed support.

Durkin and her colleagues are now analyzing data from 2010 to 2016.

"In 2006, the American Academy of Pediatrics recommended all children be screened for ASD," says Durkin. Future research will focus on assessing if more universal screening can lower the socioeconomic gap in ASD prevalence.

That's important to know, Durkin says, because "if we are under-identifying ASD in certain socioeconomic groups -- as seems likely -- we need to be prepared to provide services at a higher level to more people. We need to find cost-effective interventions and supports and make sure they are distributed equitably and in a way that reaches everybody who needs them."

Durkin is working with researchers and clinicians at the Waisman Center to improve access to ASD screening, diagnosis, and care for underserved communities through a federally-funded program called the Wisconsin Care Integration Initiative.

"This program is focused on 'moving the needle' to improve access to a coordinated, comprehensive state system of services that leads to early diagnosis and entry into services for children with ASD, particularly for medically underserved populations," says Durkin.

Journal Reference
  • Maureen S. Durkin, Matthew J. Maenner, Jon Baio, Deborah Christensen, Julie Daniels, Robert Fitzgerald, Pamela Imm, Li-Ching Lee, Laura A. Schieve, Kim Van Naarden Braun, Martha S. Wingate, Marshalyn Yeargin-Allsopp. Autism Spectrum Disorder Among US Children (2002–2010): Socioeconomic, Racial, and Ethnic Disparities. American Journal of Public Health, 2017; 107 (11): 1818 DOI: 10.2105/AJPH.2017.304032

Friday, October 13, 2017

Eye Movements Reveal Temporal Expectation Deficits in ADHD

From the Association for Psychological Science

September 12, 2017

A technique that measures tiny movements of the eyes may help scientists better understand and perhaps eventually improve assessment of ADHD, according to new research published in Psychological Science, a journal of the Association for Psychological Science.

Emerging evidence shows that small involuntary eye movements (saccades and microsaccades) are a promising new tool for shedding light on the hidden workings of mental processes like attention and anticipation, cognitive processes that are often impaired in individuals with ADHD.

The new study suggests that carefully tracking eye movements offers a new method for empirically monitoring temporal expectation in people with ADHD.

"The eye is restless and eye movements occur constantly, even when observers try to avoid them. Our study shows that this continuous stream of eye movements is temporarily paused before an anticipated visual event," says psychologist and neuroscientist Shlomit Yuval-Greenberg (Assistant Professor at Tel Aviv University), senior author on the study.

"This attenuation in eye movements can be used as an estimate for whether and when the occurrence of regular events was indeed predicted."

Yuval-Greenberg and colleagues found that neurotypical individuals (those without a diagnosis of ADHD) tended to have different patterns of eye movements compared with individuals who had an ADHD diagnosis.

"We found that individuals with ADHD tended to not attenuate their eye movements before a predictable event, which suggests that they were not able to predict the event and/or to act upon predictions," Yuval-Greenberg explains.

The team's findings indicate that careful analysis of eye movements may offer an objective measure to complement other tools used for diagnosis and assessing treatment efficacy.

For their study, Yuval-Greenberg and colleagues collected data from a group of 20 individuals who had an ADHD diagnosis and a group of 20 neurotypical controls. Those in the ADHD group were asked to refrain from taking any ADHD-related medication for 24 hours prior to the testing sessions.

On two different days, the participants came into the lab where they were shown a series of colored shapes on a screen while their eye movements were monitored. The participants were instructed to press a key whenever they saw a red square (which appeared around 25% of the time).

On one day, participants were shown the shapes at predictable intervals: Every two seconds the next shape would appear. On the other day, the time between shapes varied from 1 to 2.5 seconds. Participants were not told that the timing would be different between the two sessions.

When the stimulus appeared at regular, predictable intervals people in the control group responded more quickly than when it appeared at varied intervals. However, the reaction times of those with ADHD did not improve under predictable conditions.

The researchers also found that those in the control group tended to have fewer eye movements immediately before a predicted event. In contrast, those in the ADHD group did not show the same eye movement slowdown in preparation for an upcoming stimulus.

However, the researchers were surprised to find that an ADHD diagnosis was not the best predictor of an individual's ability to stay focused on the task.

"It is well documented that ADHD is a heterogeneous disorder. It is also documented that only some of the individuals with ADHD experience difficulties in maintaining focused attention throughout a monotonous task," Yuval-Greenberg says.

"Yet we were most surprised to reveal that the individual ability to stay focused throughout the task was a better predictor for the attenuation of eye movements than whether or not that individual was diagnosed with ADHD."

This finding is valuable because it demonstrates the importance of assessing the specific neuropsychological functioning of each individual, Yuval-Greenberg explains. And the study highlights the potential use of eye movements as an objective measure of temporal expectation.

Journal Reference
  • Yarden Dankner, Lilach Shalev, Marisa Carrasco, Shlomit Yuval-Greenberg. Prestimulus Inhibition of Saccades in Adults With and Without Attention-Deficit/Hyperactivity Disorder as an Index of Temporal Expectations. Psychological Science, 2017; 28 (7): 835 DOI: 10.1177/0956797617694863