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Thursday, August 16, 2018

Whooping Cough Vaccine During Pregnancy Carries No Risk of Autism

From Spectrum News

By Nicholette Zeliadt
August 13, 2018

Children born to women who received a routine vaccine while pregnant are not at an increased risk of autism, according to a study of 82,000 mother-child pairs published in Pediatrics (1).

Defensive dose: Infants whose mothers receive the whooping cough
vaccine during pregnancy are shielded from the disease.

The vaccine, known as ‘Tdap,’ protects against pertussis, commonly known as whooping cough, and other infections. Babies receive the first shot at 2 months, leaving them vulnerable to whooping cough until then.

Because whooping cough can be life-threatening to newborns, the U.S. Centers for Disease Control and Prevention recommends that all pregnant women receive the vaccine in the third trimester (2). The vaccine triggers protective antibodies, which are then transferred to the fetus.

“It’s important to get this vaccine because the risk of getting pertussis and having adverse events, such as hospitalization or death in an infant, is a high risk of concern,” says lead investigator Tracy Becerra-Culqui, a postdoctoral research fellow at Kaiser Permanente Research in Pasadena.

Studies suggest that severe maternal infections stoke an immune response that can disrupt fetal brain development, increasing the risk of conditions such as autism. These studies have raised concerns that maternal vaccines could also harm the developing brain.

The concerns have lingered despite studies showing that the vaccines pose no risk of autism: The new study’s long-term observations jibe with others showing that the Tdap vaccine has no immediate adverse effects on newborn babies (3).

A 2016 study also found no link between autism and prenatal flu shots.

“This should be yet another piece of evidence that should reassure parents,” says Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, who was not involved in the study. The risk “isn’t that the child will develop autism; the risk is that the child won’t be protected against pertussis.”

Calling the Shots

Becerra-Culqui and her colleagues examined the medical records of 81,993 children born in Kaiser Permanente hospitals in Southern California from 2011 to 2014. All of the mothers of these children had been enrolled in the healthcare system from early in their pregnancies and for at least 90 days after the child turned 1. None of the children have chromosomal abnormalities or birth defects.

About 39,000 of the children were born to women who received the Tdap shot while pregnant.

By July 2017, 569 of the children born to these women had a diagnosis of autism, compared with 772 of the children of unvaccinated women. The researchers controlled for various differences between the groups, including autism risk factors such as gestational diabetes or high blood pressure in the mother, advanced maternal age or the child’s premature birth.

They found that children born to vaccinated women are no more likely to have autism than those born to unvaccinated women.

The results held up when the researchers restricted their analyses to children born in the same year (to control for differences in the length of follow-up after birth). They also held up when the researchers focused only on first-born children to control for a family history of autism.

“It’s an excellent study,” says Mark Sawyer, professor of clinical pediatrics at the University of California, San Diego, who was not involved in the work. “This is the biggest study that has addressed this question in a very robust way.”

  1. Becerra-Culqui T.A. et al. Pediatrics 142, e20180120 (2018) Abstract
  2. Liang J.L. et al. MMWR Recomm. Rep. 67, 1-44 (2018) PubMed
  3. Sukumaran L. et al. JAMA 314, 1581-1587 (2015) PubMed

How to Increase Immunity to Truth Decay

From the RAND Corporation

By Melissa Bauman
May 16, 2018

  • Americans have always held differing views about policy issues, but increasingly we don’t agree on even basic facts. It’s a symptom of what RAND calls “Truth Decay,” and it’s doing severe damage to our democracy.


As a Chicago-area teacher, Kristin O'Meara was no stranger to the childhood vaccines that most students got before attending school. But her three children were.

O'Meara's children were among a small percentage of American kids who haven't received the usual childhood vaccines, largely because of their parents' unfounded fear that the shots could cause autism. Then her entire family contracted rotavirus, which can be prevented by vaccination.

“The guilt was overwhelming,” O'Meara says today of watching her 5-year-old daughter and 3-year-old twins suffer more than a week of horrible stomach pain and diarrhea. Originally driven by misinformation and the influence of people around her, O'Meara's views began to shift after the rotavirus outbreak. Today, all three children have received their childhood vaccines.

Kristin O'Meara and her three daughters. Photo courtesy of Kristin O'Meara

O'Meara's experience with vaccines echoes a phenomenon affecting people across the political spectrum on many issues. Increasingly, we selectively gather information, have difficulty identifying facts in a sea of opinion, and don't trust experts. RAND researchers call this phenomenon “Truth Decay” and warn that our growing inability to agree on basic facts imperils our democracy.

“This inability to agree on an established set of facts or to take into account expert analysis is as serious a threat to the United States as any adversary or terrorist group in the world today,” said RAND CEO Michael D. Rich.

Divided on the Issues

Vaccines have virtually eradicated diseases like smallpox, polio, and measles in the United States. Yet polling shows that fewer people support vaccinating children today than a decade ago. A similar divide exists on many other topics: Violent crime has been steadily decreasing, but many people believe the opposite. More Mexican immigrants are leaving the U.S. than are coming in, yet the perception that they're streaming into the U.S. is used to fuel anti-immigration policies.

Americans have always held opposing opinions, but for perhaps the first time in history, we can't agree on the very terms of our public debates. This isn't the nation's first experience with Truth Decay, but it seems the most intense. Rich and political scientist Jennifer Kavanagh have researched the topic to understand why Truth Decay is on the rise and how to reverse the trend.

What Is Truth Decay, and Why Does It Matter?

RAND researchers found that Truth Decay is having severe impacts on America's body politic. Since the current trend began in the early 2000s, we've seen an erosion in civil discourse, political paralysis in state and federal government, and uncertainty in national policy. Alarmingly, individual Americans are disengaging from political and civic life.

“Politics drift into dysfunction when debate isn't based on shared facts,” Kavanagh said. “In government, this can lead to delayed decisions, deferred economic investment, and less diplomatic credibility. And we're seeing that play out today.”

Politics drift into dysfunction when debate isn't based on shared facts.

The nation has seen Truth Decay before. Those times were marked by yellow journalism in the 1880s–1890s, tabloid journalism and radio in the 1920s–1930s, and the subjective “New Journalism” that took hold during the Vietnam War. The researchers found that, in each of these periods, opinion began to overwhelm facts, the line between fact and opinion blurred, and the public had less trust in institutions.

However, previous eras do not appear to have experienced the same increasing disagreement about objective facts. This is one of the hallmarks of Truth Decay, and one of the reasons today's Truth Decay is so virulent.

Belief in Science—but Not Vaccines

While parents don't vaccinate for many inaccurate reasons—for instance, that vaccines still contain mercury or that the multiple vaccines overload children's immune systems—O’Meara's concern was the supposed link to autism. Her beliefs were largely driven by misinformation and perpetuated by the people around her.

“I had my mom's support and a close friend's support, so I was in a little bit of a bubble,” she said.

By the time she had her first child in 2010, a 1998 study by Andrew Wakefield that linked vaccines to autism had already been debunked and had just been retracted by the journal that published it. O'Meara decided to seek out information specifically aimed at supporting the anti-vaccines perspective because “of course mainstream medicine would say they were safe.”

O'Meara read several books written by doctors, though she now points out that none of them was a practicing pediatrician. She also read Wakefield's study and became convinced that he was being unfairly maligned and that the medical community was “out to get him.”

Past mistakes by establishment medical institutions also loomed large, she said, citing thalidomide and Vioxx as examples of approved drugs that had dangerous side effects.

Andrew Wakefield (left) answers questions at a news conference in 1998
about his now-debunked study that suggested a link between the
measles-mumps-rubella vaccine and autism. Screenshot from
Brian Deer's 2004 film "MMR: What They Didn't Tell You"

O'Meara now recognizes how her own cognitive bias—a tendency to resist facts that countered her beliefs—led her to what she now sees as a frustrating inconsistency in her views about science.

“Most of the time I'm happy with the brain I was born with; it's very rational,” she said. “To have that same brain somehow rationalize not vaccinating my children, it was really hard for me.”

How Truth Decay Happens

O'Meara's experience in part reflects how Truth Decay occurs. One factor is that Americans increasingly live in bubbles among people who are like themselves politically and economically. Also, the rise of 24-hour news coverage and social media have changed the news environment—and not always for the better.

Opinion is an inexpensive way to fill the 24-hour news cycle, and misinformation gets disseminated on social media, where algorithms guide you toward stories and information that confirm your expectations and beliefs.

Declining Trust in Facts and Institutions Imposes Costs on Society

Our own brains tend to keep us in our bubble, since cognitive bias attracts people to facts that support their position. And there's no sign that the digital natives coming up through the nation's schools will be any more media-savvy than their elders. Competing demands leave educators with less time to teach civics, media literacy, and critical thinking.

Finally, people, organizations, or foreign agents can also intentionally or unintentionally amplify the effects of Truth Decay for their own political or economic gain.

The way vaccines were portrayed as villains is an example of the damage done by Truth Decay.

The way that vaccines were portrayed as villains is a prime example of the damage done by Truth Decay. In the 1950s, people clamored to get the new vaccines at a time when polio, smallpox, measles, and other diseases were crippling and killing people around the world.

In 1998, the Lancet published Wakefield's autism study and then retracted it in 2010 after journalists pointed out his conflicts of interest and editors found falsifications in the manuscript.

By 2015, support for vaccinating children had dropped by 10 percent overall compared with 2001—and significantly more among younger parents on both sides of the political spectrum. The median coverage rate for one of the most common vaccines—the measles, mumps, and rubella vaccine known as MMR—varies widely by state, from a low of 87.1 percent in Colorado to a high of 99.4 percent in Maryland and Mississippi.

Measles poster at Venice Family Clinic, Los Angeles. Photo:Lucy Nicholson/Reuters

A Respected Friend and a Change of Heart

When her twins were born, O'Meara, already the mother of a daughter, began having concerns about not vaccinating them. She worried about her children—and her integrity: If one child got infected, the others would, too. Was she expecting others to vaccinate so her kids would be safe?

After her family contracted rotavirus, additional events brought her to rethink her position. A California measles outbreak traced to Disneyland occurred a few months later, and her husband began questioning why the children weren't vaccinated. In addition, her oldest child's school began requiring a medical reason to exempt a student from the required vaccinations.

Perhaps the most important influence may have been a colleague—a high school science teacher—whom O'Meara admired and respected.

“When I told her my stance on vaccines, she said, ‘You know that makes me angry that someone as smart as you would make that decision.' She reacted decisively—but kindly,” O'Meara said.

“I think that's probably one of the big missing pieces in changing people's minds is there has to be someone in your life who you respect who disagrees with you. An influencer who will calmly say, ‘I think you've made an error in your logic there.'”

O'Meara decided to do her research again—but this time, she looked specifically for information that supported vaccines. “My mistake early on was that I didn't go deeper. There's a common laundry list of anti-vaccine rationales. What I didn't do and have done since is read the rebuttals from doctors or medical organizations that dissect that laundry list and point out why every single one of those points is mistaken.”

How Did Truth Decay End in the Past?

Although the vaccination battle isn't over, states like California, Mississippi, and West Virginia are making it more difficult for students to get an exemption from the vaccinations that schools require for enrollment, and parent refusals to vaccinate appear to be leveling off in certain areas. That pattern bears some similarities to how periods of Truth Decay have faded in the past.

First, as in the case of vaccines, science experts, journalists, and government officials got active. A revival of fact-based and investigative journalism ushered in a return to reality, and government reforms to increase accountability and transparency helped reestablish trust in its institutions. Second, social and political turmoil during those periods eventually abated, which eased some societal pressures that might have contributed to Truth Decay.

For example, a return to economic prosperity and the patriotism sparked during World War II helped calm societal unrest in the 1940s. Similarly, many vaccine opponents have had a change of heart.

“It's possible that Truth Decay is a byproduct of these types of unrest and upheaval. It doesn't seem to end on its own—it requires conscious actions. But we need more research to figure out exactly which actions to take today to put an end to Truth Decay,” RAND's Kavanagh said.

“We All Want the Best for Our Children”

Soon after O'Meara had her change of heart and got her children vaccinated, she wrote an essay for a pro-vaccines website. Several news outlets interviewed her, and her story went viral among vaccine opponents.

“Before you know it, my face is plastered all over, and I'm being called a fraud, a paid plant by the pharmaceutical industry,” O'Meara said. “It was so wild seeing how quickly the anti-vaccine people made up their own conspiracy theory about me in order to debunk me.”

She also received “menacing messages” on Facebook. “At the time, I was freaked out and anxious. But now looking back on it I think, ‘That's how they do it. They didn't come back with facts. They just tried to shame me into silence. That's how they deal with their own cognitive dissonance.'”

O'Meara interacted with some of her critics on social media and, though no one admitted changing their minds, most eventually understood her reasoning after some respectful conversations.

“My tack, which I use with concerned parents at work, is this: We all want the best for our children,” she said. “I think being graceful and honoring that with people who are anti-vaccine is the only way any headway will be made.”

Healing Truth Decay

O'Meara's own conversion and her suggestion that empathetic, respectful dialogue can help create common ground represent one way to attack Truth Decay. RAND will continue to seek insight that helps confront Truth Decay on other fronts. But recognizing our common goals—and agreeing on common facts—are the only real solutions to this damaging phenomenon.

Wednesday, August 15, 2018

Don’t Be in Any Doubt – ADHD is an Illness and It Must Be Treated

From The Guardian (U.K.)

By Ann Robinson
August 13, 2018

Britain is right to take a more cautious approach than the U.S., but we should be prepared to fund a range of treatments.

 There is no doubt that rates of prescription for ADHD in the U.K. have risen
significantly since the 1990s.’ Photograph: Murdo Macleod for the Guardian

Imagine a neurological condition that affects one in 20 under-18s. It starts early, causes significant distress and pain to the child, damages families and limits the chances of leading a fulfilled life as an adult. One in 20 children are affected but only half of these will get a diagnosis and a fifth will receive treatment. If those stats related to a familiar and well-understood illness, such as asthma, there would be little debate about the need to improve intervention rates.

But this is attention deficit hyperactivity disorder (ADHD), and the outcry is muted. If anything, we hear warnings that too many children are being labelled this way, and too many given prescriptions.

In the United States, ADHD is diagnosed at more than twice the incidence in Britain. The true prevalence is likely to be the same on both sides of the Atlantic. So what’s the story? Is the U.S. too gung-ho, or is the U.K. dragging its heels? Are American doctors too quick to medicate children, or British doctors too slow?

Ritalin-type drugs best to treat ADHD in children, shows study.

Emily Simonoff, co-author of a new meta-analysis in the journal the Lancet Psychiatry, says the problem in the U.K. is “predominantly about undermedication and underdiagnosis”. Her study examined a range of drug treatments compared to placebo, and it shows that methylphenidate (better known by under the brand name Ritalin) works best for children and amphetamines for adults.

It can seem counterintuitive that stimulants work for ADHD. In fact, both treatments are thought to increase the activity of the chemicals dopamine and noradrenaline in the brain, neurotransmitters that play a role in executive functions such as learning, planning and exerting control over our behaviour and thoughts. The side-effects such as agitation, weight loss, sweating, sleep disturbance and high blood pressure can occur whether you take the drugs for ADHD or recreationally.

The difference is that people with ADHD are more likely to benefit, and prescribed doses are carefully controlled and monitored. As an NHS G.P., I can only prescribe these drugs using a special protocol that lays down follow-up arrangements. The idea that we dole them out in a cavalier manner is just not true.

ADHD isn’t some sort of catch-all term for bad behaviour, but a clearly identifiable set of symptoms (including inattention, impulsivity and hyperactivity), with strict diagnostic criteria and evidence-based treatment options. People with neurodevelopmental disorders such as ADHD, autism, dyslexia, dyspraxia and dyscalculia have brains that are structurally and functionally different to those of neurotypical people.

It’s a widespread misconception that ADHD equates to disruption in classrooms; a more common presentation is anxiety and difficulty with learning. “A kid with ADHD may be well-behaved and academically able,” says Tony Lloyd of the ADHD Foundation. Identifying that there is a problem and providing the right support is critical.

Treatment doesn't always or only mean medication. Nice recommends a multimodal approach.

So where does the scepticism about ADHD come from? Perhaps it’s an understandable reluctance to label kids while they are still developing, or a wariness about medicalising normal variation in behaviour.

Oftsted’s chief inspector, Amanda Spielman, speaks for many when she voices concerns that the drugs used in the treatment of ADHD are a “chemical cosh”, are overprescribed and disguise bad behaviour that should be managed in other ways.

There is no doubt that rates of prescription for ADHD in the U.K. have risen significantly since the 1990s. The prospect of a U.S.-style situation in which one in 10 children aged two to 17 (rising to one in five boys aged 14 to 18) are diagnosed with ADHD, and two-thirds of those diagnosed are on medication, raises justifiable questions.

But this scenario is a long way from the reality in the U.K., where the NHS imposes vigorous diagnostic guidelines and, crucially, there are no financial incentives for NHS doctors to write prescriptions.

Caution about the action of psychoactive drugs on developing brains is entirely appropriate. The short-term safety data we have is reassuring, though more research is needed into long-term effects. But this caution has to be weighed against the harms, if other treatments aren’t suitable or effective, of doing nothing.

Without diagnosis and treatment, children become prone to anxiety, self-harm and school failure. Around a third will continue to have problems into adulthood and some people will only be diagnosed once they are adults.

U.K. children with ADHD wait up to two years for diagnosis, say experts.

Earlier this year a Demos report highlighted the social and economic cost to society of adult ADHD, as impulsivity, poor concentration and risk-taking behaviour interfere with work and relationships. The inability to regulate emotions and tendency to become overloaded by external stimuli has been described as “like driving a Ferrari with bicycle brakes”.

Treatment for ADHD doesn’t always or only mean medication; the National Institute for Health and Care Excellence’s guidelines recommend a multimodal approach including support for parents, cognitive behavioural therapy (CBT) and stress-reduction strategies. Lloyd says the Nice guidelines are great but mostly aren’t being followed.

My experience as a G.P. would certainly back that up. Children tend to be seen quicker than adults, but often the only treatment given is medication, with other interventions such as parenting support and CBT failing to materialise.

The cautious U.K. approach to ADHD may be preferable to the more enthusiastic U.S. one. But it would be a shame to let scepticism get in the way of good medicine. And that means casting aside any doubt that ADHD is a medical condition, and demanding funding for a range of treatments, including but not limited to drugs. Unfortunately, it seems that is still a long way off.

Ann Robinson is a G.P.

Why Italy's U-Turn on Mandatory Vaccination Shocks the Scientific Community

From CNN

By Gianluca Mezzofiore
August 7, 2018

An amendment from Italy's anti-establishment government that removes mandatory vaccination for schoolchildren is sending shock waves through the country's scientific and medical community.

It suspends for a year a law that requires parents to provide proof of 10 routine vaccinations when enrolling their children in nurseries or preschools. The amendment was approved by Italy's upper house of parliament on Friday by 148 to 110 votes and still has to pass the lower house.

The law had originally been introduced by the Democratic Party in July, 2017 amid an ongoing outbreak of measles that saw 5,004 cases reported in 2017 -- the second-highest figure in Europe after Romania -- according to the European Centre for Disease Prevention and Control (ECDC).

Italy accounted for 34% of all measles cases reported by countries in the European Economic Area, the center said.

Italy's Five Star movement and its coalition partner, the far-right League, both voiced their opposition to compulsory vaccinations, claiming they discourage school inclusion.

League leader and Interior Minister Matteo Salvini said in June that the 10 obligatory vaccinations, which include measles, tetanus and polio, "are useless and in many cases dangerous, if not harmful," according to ANSA news agency.

"I confirm the commitment to allow all children to go to school," he added. "The priority is that they don't get expelled from the classes."

Health Minister Giulia Grillo, a Five Star member, said the government wants to "spur school inclusion and simplify rules for parents."

Why It's Dangerous

Doctors and experts have warned that the amendment might invert a positive trend that saw Italy's inoculation coverage rising after spending years lagging behind the World Health Organization's recommended 95% coverage level to ensure "herd immunity."

"Italy's measles vaccine coverage was par with Namibia, lower than Ghana," said Roberto Burioni, a professor of microbiology and virology at San Raffaele University in Milan. "But the law was working, the coverage was improving. We should strengthen it, not weaken it. Now, children who are not vaccinated will endanger other children at school who are too small for vaccines or cannot be vaccinated because they suffer from immunosuppressive diseases."

Measles tripled in Europe in 2017, European CDC reports

In 2015, child immunization rates in Italy for the first dose of the measles vaccine was 85%, according to World Health Organization figures. The second dose was 83%.

Italians' trust in the efficacy and safety of vaccinations was affected by an infamous ruling in 2012 from a Rimini court that established a link between autism and the combined measles, mumps and rubella vaccination, experts say. While the ruling was overturned three years later, it helped anti-vaccination theories to spread in Italy -- and globally.

"Italy is part of a global trend of distrust in mediators -- doctors and scientists -- who can interpret and explain data," said Andrea Grignolio, who teaches the history of medicine and bioethics at La Sapienza University of Rome.

"With the advent of the Internet, people have the illusion they can access and read data by themselves, removing the need for technical and scientific knowledge."

While European countries behave differently as far as mandatory vaccinations are concerned, and the actual efficiency of forcing parents to inoculate their children is disputed, Grignolio and Burioni agree that, in the case of Italy, the law was having the desired effect.

By 2017, child immunization rates for the first dose of the measles vaccine had increased to 92%, though the second dose remained low at 86%.

The majority -- 89% -- of measles cases in Italy in 2017 were among unvaccinated people, and 6% of infections affected people who received only one dose of vaccine, according to a report from the ECDC.

Distrust in Institutions

Others maintain that the skepticism about vaccines is in line with a more general lack of trust in Italy's institutions, a sentiment that the populist Five Star Movement was able to channel in its political agenda, winning support at the latest general elections.

"Distrust in vaccines is one of the symptoms of a more general distrust in institutions," says Riccardo Saporiti, a data journalist and contributor to Wired Italy who has written about vaccine coverage in Italy.

Saporiti argues that distrust in Italian institutions started in Italy with what was called Tangentopoli (Bribesville), a corruption scandal that shattered the postwar political establishment in the 1990s.

"It destroyed Italians' trust in politics, and then it spread to anyone with a specific expertise," he said. "Five Star's slogan at the 2013 elections was 'One is worth one,' which is the denial to any concept of competence and merit."

In a data analysis for Wired, Saporiti uncovered that in some areas in Italy, one in two children born in 2013 did not get the MMR vaccination.

However, the future is not all dark, according to Grignolio, who says 10% of Italians who are somewhat hesitant about vaccinations that can be convinced to inoculate their children.

"When there's an obligation, they will comply. But the newly approved self-certification is a joke," he said.

Children Return to Schools Without Promised Water Filters to Screen Lead

From The Lens

By Marta Jewson
August 14, 2018

Children are returning to Orleans Parish public schools this month without the water filters to screen lead from drinking water that school officials promised to install last year.

“The lack of urgency is appalling,” said Gail Fendley, executive director of Lead Safe Louisiana.

Thousands of students have passed through school district-owned buildings in the two years since officials first promised to test school water for lead, she said.

No one knows whether New Orleans schools have high lead levels in their water systems. Orleans Parish schools tested for lead in drinking fountains in 1989, shortly after the federal Lead Contamination Control Act became law. But it’s not clear if they’ve been tested since.

Last year, asked when the district last tested its water for lead, a school district spokeswoman said, “We have no records associated with the Orleans Parish School Board conducting testing of that nature.”

“The lack of urgency is appalling.”
— Gail Fendley, Lead Safe Louisiana

The Sewerage and Water Board of New Orleans must check its water system for lead, and those tests have shown it is in compliance with federal guidelines. But lead levels can spike when underground pipes are shaken during road construction or when nearby lead service lines are replaced. The water agency has been criticized for failing to inform residents when nearby projects pose that risk.

On the heels of Flint, Michigan’s lead-in-water scandal, the state-run Recovery School District and Orleans Parish public schools announced in 2016 that they would test school drinking water for lead. A few months later, they decided to forego it.

Instead, the districts decided to install filters on drinking fountains and kitchen taps, which they concluded was a safer move. But that hasn’t happened yet either.

The Orleans Parish school district appeared to be making progress last fall, when it allotted money for filters and put the project out to bid. But problems with the winning contractor’s qualifications sent the project back out to bid.

The district selected a contractor early this year, but they still have not signed a contract.

The delay concerned Fendley.

“Parents should take the initiative and insist on safe drinking water, bottled if necessary,” she said. “All children should be tested.”

A Switch from Testing to Filters

The process started in July 2016. Local officials teamed up to announce they would test school water for lead.

School officials commissioned a plan to test 10 schools for $24,336. If any positive results were returned, then they would test like-schools and fixtures.

Then-superintendent of the Recovery School District, Patrick Dobard, shared the plans with the Sewerage and Water Board of New Orleans in August 2016.

According to emails and documents reviewed by The Lens, the water agency wanted school district administrators to allow more lead in the water before taking a fixture out of service.

“We have no records associated with the Orleans Parish School Board conducting testing of that nature.”
—Dominique Ellis, spokeswoman, Orleans Parish Schools

The water system uses a threshold of 15 parts per billion. The U.S. Environmental Protection Agency recommends taking a school drinking fountain out of service if it shows more than 20 parts per billion of lead.

But there is no safe level of lead, and children are especially susceptible to lead poisoning.

The schools initially set a threshold of 10 parts per billion. After the Sewerage and Water Board questioned their reasoning, it was raised to 15.

Both levels are substantially higher than the American Academy of Pediatrics’ recommendation to shut off any school water fountain with a lead level higher than one part per billion.

The Sewerage & Water Board wanted to take its own samples, causing the schools’ testing consultant to wonder if they would end up with dueling test results.

But school officials decided to scrap the plan altogether and go with what experts said was the safest and most cost-effective option — water filters.

Officials Said Filters Would Be Installed Last Year

The day after The Lens reported on the aborted plan to test water, officials from the RSD and the Orleans Parish school district told school leaders that filters would be installed in the fall of 2017.

The filters appeared to be on track. In September, the Orleans Parish school district selected a filter company — EcoWater Systems — and made plans to test the water after installation to ensure the filters were working. In October, the school board allotted $800,000 to install them in all district-owned buildings.

But the bidding had to start over because the district decided the filters offered by the companies weren’t properly certified — not for lead, but for microbes that could enter pipes during a citywide boil-water alert.

The district wanted to protect against the microbes to prevent school closures during the advisories.

The district re-bid the project and again awarded the bid to EcoWater in February.

But the contract still has not been signed, Orleans schools spokeswoman Dominique Ellis told The Lens last week.

Once it’s inked, water filter installation should begin within weeks, Ellis said.

Fendley just wants to see the district take action.

“If they do want to go the most conservative route, that’s OK,” Fendley said, referring to filter installation. “But let’s do it.”

Marta Jewson covers education in New Orleans for The Lens. She began her reporting career covering charter schools for The Lens and helped found the hyperlocal news site Mid-City Messenger. Jewson returned to New Orleans in the fall of 2014 after covering education for the St. Cloud Times in Minnesota. She graduated from the University of Wisconsin-Madison with majors in journalism and social welfare and a concentration in educational policy studies.

Tuesday, August 14, 2018

Tips to Help Kids with Back-To-School Anxiety

From KQED's Blog "Mind/Shift"
How we will learn.

By Elissa Nadworny
August 29, 2017

The start of the school year can be rough on some kids. It's a big shift from summer's freedom and lack of structure to the measured routines of school. And sometimes that can build up into tears, losing sleep, outbursts and other classic signs of anxiety.

"Going back to school is a transition for everyone," says Lynn Bufka, a practicing psychologist who also works at the American Psychological Association. "No matter the age of the child, or if they've been to school before."

In the vast majority of cases, this is pretty standard stuff. It doesn't mean it's not painful — for you and your kids. Just watch this viral video -- (Andrew is now in first grade and doing fine).

"If you see that in your kids, don't panic," says John Kelly, a school psychologist in Long Island, N.Y. "For most kids, there's gonna be some level of anxiety."

And, if you think back on it, you can probably remember feeling that way, too.

We talked to some experts about what parents can do to ease the transition — plus, what to watch out for if there's a more serious problem.

Here's their list of tips:

Listen to your kid.

Be available, says Lynn Bufka. If children have questions about school, or, once school starts, something exciting happens during the day, parents should make time to listen. Sharing the excitement can help ease concerns.

Tune into what your kids are talking about. "Emotionally, parents are the safe place for children to experience emotions and to help them develop the language around expressing emotions," says Bufka.

Be specific.

Beyond listening in general, drill down to the specifics. "It's important for parents to explore with their kids what they're feeling anxious about," says Bufka.

If parents know what, exactly, is making students nervous — friends, classes, a new teacher — they can help problem-solve.

Let kids be the experts.

Eleanor Mackey, a psychologist with Children's National Health System in Washington, D.C., suggests asking kids what might make them feel better.

"Let them generate solutions," she says, "Ask them what helps them feel better in other scary situations."

If they need help coming up with ideas, parents can help them role-play tough situations or come up with strategies they can use in situations that make them worried.

Positive messaging.

Create a positive expectation. Talk about things your kids can look forward to in school, past experiences they've enjoyed. Friends or field trips are good examples.

Talk through previous triumphs.

Many kids have been nervous or anxious before, so reminding them of their own successes with similar situations can help.

Try: "Remember last year, when you were feeling this way? You got through it."

Reassuring kids that they have the tools to get through the challenge ahead, because they've overcome their fears in the past, can go a long way, says Lynn Bufka.

Eleanor Mackey says parents may be unsure what to say in situations like this. She offers a template:

"I understand you are scared – that's just fine. I also know that you can manage this. Remember last year when you were so nervous but you did it and made it through and ... made a great new friend, did well in Spanish, etc..."

Reach out to the teacher.

"I'm surprised at how reluctant parents are to talk to the teacher," says Mackey. "They don't want to be that parent, or they don't want to label their kid with issues."

And yet, she says, teachers have consistently told her they like hearing from parents.

Educators spend a lot of time trying to figure each kid out, she explains, so if you can save them the time, why not share? Parents are, after all, the experts on their kids.

Maybe your child is scared to answer questions in front of class, or has anxiety about being put on the spot — let the teacher know. She (or he) can use that information to help design the class, or maybe there can be more small-group work instead.

Parents can also tell their kids they've talked to the teacher, which can lower anxiety and send the message that the adults are on their side.

Start the routine early.

"It's always helpful to practice your routines before things start," says Bufka.

Find (and clean!) backpacks, lunch boxes, folders and other supplies. Plan ahead and get the child involved in the planning process — have them get their belongs ready, etc.

"That gives the child a sense of mastery over the situation," Bufka explains. "Getting your child engaged about the new thing will help them feel like it's more under their control."

Often, families try and squeeze in a last fun adventure right at the end, but that can make things worse. Don't wait for the night before, says John Kelly, who is also the president of the National Association of School Psychologists. "You really need to start that adjustment early."

That means getting up earlier — and going to bed earlier too.

It's kind of a no-brainer that sleep is essential, Mackey points out, but patterns can't be adjusted (literally) overnight.

"Kids really get out of rhythm in the summer," she says, and this has a bigger impact than adults realize.

"When we're tired, we're moody, and little things can feel really big," Mackey explains. "Anxiety is much worse if sleep is bad. Make sure you have a good quiet routine and early enough bedtime that your child can get sufficient sleep."

Oh, and turn off that tablet or smartphone before bed, too.

Do a dry run.

If it's a new school or a new neighborhood, introduce students to that situation before the big day. Visiting the school, or walking to and from the bus stop, can go a long way, says Mackey. You may have to do this more than once to make it seem familiar, she says. "Just once may lead to more anxiety."

A dry run can help even if it's not a new school. Kelly calls it: Say Hello To the School Again.

It's a great way to remind anxious kids they've been here before. Many schools are open the week before Day 1, often teachers are around too. If the school has an orientation, don't miss it.

Social connections.

When kids can make social connections before they start school, that's a really helpful step, says Kelly. Many kids have anxiety around friends, 'Who's going to be in my class? Who can I sit with at lunch? Ride the bus with?'

Especially for older students, comparing schedules with friends can help.

Don't ignore clothing anxiety.

Parents may not think that what you wear on the first day matters, but for kids it can be huge. Especially, John Kelly says, in the middle and high school years.

Read some books.

Kelly recommends School's First Day of School, by Adam Rex. It's about how nervous the school itself is. First Day Jitters by Julie Danneberg is helpful for kids starting new schools.

And, Kelly says, for really young kids try Nancy Carlson's Look Out Kindergarten, Here I Come. Carlson's book also has a Spanish version: Preparate, kindergarten! Alla voy!

Chill out after school.

Give kids a break after school, says Mackey. They don't need a lot of time, 5 to 10 minutes is just fine. Kids, she explains, need this after a hectic day when their brains are in overdrive.

Try doing it with them. A few minutes of quiet or light conversation can be great for the whole family — and it's another opportunity to connect with your kids.

Remember: Easing anxiety can take time.

Not everyone is going to adjust to a new situation on the first day. Be patient. Each day can bring new challenges. This is especially true for older students, who are navigating new classes, different teachers and changing schedules.

It's very normal for kids to have trouble for a week or two weeks into the school year. "It's all new," says Kelly. "They're re-starting routines, or starting routines for the first time, and that can take a while."

Parents have anxiety, too.

"It's important for parents to realize that schools are filled with professionals who work with children all the time," says Bufka. Remember, Kelly adds, kids are going to pick up cues from parents, so making sure you're comfortable too is an important piece.

Signs that it's not normal.

There are some warning signs that your child may need some extra help. Kelly ticks off a few: If you really see your child struggling, having a really difficult time just getting to school or feeling increasingly anxious at night time.

Lynn Bufka says as a parent, you're in the best position to observe changes in their behavior.

"If the child is refusing to do things that they've normally done, or that they've not had difficulty doing before," she says, "that's a sign that something isn't going right."

Maybe it's a bully, or your child is really overwhelmed and they need some extra work with a psychologist.

Bufka says that in some cases anxiety around school can develop into school refusal, where kids flat out refuse to go. And that's definitely the time to reach out to a professional.

Trauma Can Make It Hard for Kids to Learn. Here’s How Teachers Learn to Deal with That.

From Chalkbeat
Education news. In context.

By Adeshina Emmanuel
August 1, 2018

Childhood trauma can make it hard for students to focus or behave in classrooms.

There’s no debating that childhood trauma seriously impacts how students learn. Researchers have tied stressful events such as divorces, deportations, neglect, sexual abuse and gun violence to behavioral problems, lower math and reading scores, and poor health.

The latest research, from the University of Wisconsin-Madison, finds that children who endure severe stress are more likely to suffer heart attacks and mental health disorders.

So, we know trauma affects kids, but how do we teach educators to confront it? That’s where Dr. Colleen Cicchetti comes in.

Dr. Colleen Cicchetti
A child psychologist at Lurie Children’s Hospital and an assistant professor at Northwestern University’s medical school, she helps lead the hospital’s efforts to improve how local schools handle trauma. The goal: to train teachers to spot and respond to warning signs in kids.

Last Tuesday and Wednesday, about 150 aspiring teachers with Golden Apple’s scholars program attended day-long training sessions.

It’s not the job of a teacher to become a mental health provider, said Cicchetti, who earlier this year was named Public Educator of the Year by the National Alliance on Mental Illness. “It’s really their job to try to understand what barriers are making it hard for them to do their job.”

Chalkbeat Chicago interviewed Cicchetti about training teachers, the cost of childhood trauma in Chicago communities, how it takes a toll on classrooms, and what teachers can do to promote healing in schools.

What are some examples of the different types of trauma Chicago children might be dealing with?

Seeing someone shot, seeing someone stabbed. It could be sexual abuse, it could be physical abuse. It could be parents incarcerated, divorced, separation, death. It can be someone that you know being killed, someone you know in a car accident.

What are some ways that trauma finds its way into the classroom?

Flashbacks, difficult sleeping, difficulty eating, choosing not to — or being unable to — enjoy the things you used to enjoy. Being hyperalert where you are scanning the space because you don’t feel safe, which impacts your learning. There’s that hopelessness and sense that the world is dangerous. They might be getting in fights. Another thing we sometimes see is frequent absences.

We see some kids who are spending a lot of time in the nurse’s offices, complaining of stomachaches and headaches — their biology is triggered.

We often see it manifest in difficulty negotiating relationships with other people. Some days they can be really engaged with the teacher, the next day they’re really angry and throwing temper tantrums.

How do you teach teachers to recognize trauma?

We do these trainings called Trauma 101. We show them pictures of brains and which areas of the brain are impacted by that flight-or-fight response being triggered all the time. We talk about the ACES studies.

(Many studies on Adverse Childhood Experiences, or ACES, have linked childhood trauma with the development of diseases like diabetes and heart disease, behavioral problems, substance-abuse disorders in adults, and self-harm. But chronic trauma also can disrupt brain development, impair learning, and make it hard to cope with emotions.)

We look at the symptoms you would see [of PTSD] and what that would look like in a classroom. For example, a kid having flashbacks: You might see a kid who is distracted or looking out the window, or they’re having nightmares so they’re coming into class and putting their head on their desks and they’re sleeping during class because the classroom feels safe and they can’t sleep at night.

We sort of try to walk between the clinical symptoms and the manifestations you may see in the classroom.

How do you teach teachers what to do once they see signs of trauma? What are they supposed to do?

The first level is to be aware of kids you think are likely to be experiencing trauma in your classroom. What do you do to create a sense of safety, and do that self-regulation and peer building in your classroom? But if you have kids who are sort of experiencing more challenges and those things aren’t working, in Chicago Public Schools we have something called a request for assistance.

Teachers can fill out a form and submit it to their social worker or their behavioral health team. Somebody in the school will do a more in-depth assessment or screening. Those kids are then linked to services, either provided by the school or, in some cases, there’s community providers.

There are few — if any — jobs harder than teaching. What are the limits to what teachers can really do?

In a lot of schools, it’s not very safe for a teacher to say ‘I’m struggling with this student.’ But when teachers feel very isolated, and then feel bad and get angry at themselves and at the student, that’s where burnout comes in.

What we’re trying to create is a culture within a school, not just the teachers, but from the administration to all the adults in the buildings, that says it’s our job to take care of the whole child here. If a child is struggling, it’s not a bad teacher, it’s a situation we need to modify.

We try to only go into schools and have these conversations when we’re invited in at the systems level, where the administrators are talking about understanding professional development and reflective learning practices for new teachers, and mentoring, so they can understand why this work is crossing over into their home lives, why they’re coming home grumpy, or overeating or drinking, and don’t want to go back to work.

It’s hard, but we can teach you what you can do to set your classroom up to be successful, and also make sure you have the right kind of supports, so if you’re seeing a kid who’s struggling — and you’re struggling — that you can reach out to other adults in the building.

What does a safe classroom look like in practice for a kid who has experienced trauma, maybe multiple forms of trauma in their lives?

It’s predictable. [Students] know what expectations are, what they need to do to be successful. There’re different parts of the day where it may be getting hard for them to focus, but then they get breaks.

If you didn’t get your homework done it’s not super punitive. We want to hold people accountable and help them be successful, but let’s say maybe they took three buses to get to school and they were babysitting their siblings last night, so they don’t have enough time for an assignment. Are you going to get a zero or will you be coming in during your recess or lunch break to get this done?

It’s an environment that says, I believe you can be successful, and I’m going to stack the deck for your success. I’m going to provide both physical safety and emotional safety. We’re going to have rules around respecting differences and how we talk to one another. We’re going to have restorative conversations and practices around discipline, so we can not be so reactive. And we’re going to foster relationships both with kids and between each other.