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Sunday, May 31, 2015

Why Your Dog Can Get Vaccinated Against Lyme Disease and You Can’t

From NPR's WBUR 90.9 FM

By Curt Nickisch
June 27, 2012

Eleven-year-old “Ned Kelly” is in for his annual physical at a clinic in Boston’s Jamaica Plain neighborhood. As part of his check-up, he’s getting a booster shot to protect him against Lyme disease. Ned doesn’t like needles, but he holds still while Dr. Joel Kaye squeezes the pink serum under his skin.

“Little pinch,” says Dr. Kaye, “we’ll be home free. All right, good job!”

Ned is lucky, because he’s one of the select few who can get the vaccine that gives him immunity against Lyme disease.

Ned is lucky because he’s a dog.

At the MSPCA Angell Animal Medical Center, dogs are regularly vaccinated against Lyme. Ned’s owner, Joe Turchin, lives in Falmouth. Ticks are bad there and Lyme is prevalent.

Turchin’s glad he can protect his dog. But he wishes there were a human vaccine, too.

“You know, if there were a vaccine,” Turchin says, “our doctors would be suggesting it to us, certainly for those of us on the Cape and the islands. Because it’s a horrendous plague!”

Actually, modern science has given us a human vaccine against Lyme disease.

Too bad we don’t use it.

“Lyme disease is the only infection I know of where we have a safe and effective vaccine, but it’s not available to the public,” says Dr. Allen Steere, the physician who uncovered the disease. Steere was 33 years old back in 1975 when he was sent to the Connecticut town of Lyme to look into a mysterious cluster of kids who had gotten arthritis.

Dr. Allen Steere, the discoverer of Lyme disease.
(Josh Berlinger for WBUR)

“Four or five months into the investigation, we came to suspect that ticks may be involved,” Steere said of his team’s work. They had found a previously unknown disease, and ever since, Lyme has been Steere’s life’s work.

After the discovery, he and other scientists first isolated the spiral-shaped bacterium that causes Lyme disease, and then they looked for ways to make people immune to it. Today, Steere’s laboratory is at Massachusetts General Hospital. He says finding a biological pathway to vaccinate against Lyme was a major milestone.

“Lyme disease was epidemic in certain locations, particularly in the northeastern United States,” Steere says. “So here was the possibility ofreally changing that.”

By the mid-1990s, two pharmaceutical companies began trials of candidate vaccines.

Dr. Gregory Poland is a vaccinologist at the Mayo Clinic. He says the vaccines helped people build up lots of antibodies that killed the Lyme agent relatively quickly. “So that when a tick bites you and sucks your blood, it is sucking up the antibodies out of your blood,” Poland says. “Those antibodies go into the tick’s gut, kill the Lyme organisms so that when that tick then regurgitates into your skin, you don’t get Lyme disease.”

Poland says as innovative as these vaccines were for killing the Lyme bacterium before it even got into your body, they weren’t perfect. You had to get booster shots, so it took a year to become immune. It wasn’t approved for children 14 and under. Still, for those 15 and above, it worked pretty well. Human trials conducted by Steere showed that about 80 percent of those vaccinated gained immunity.

“People are fed up! This is a terrible situation we’re in, which means that a vaccine still makes sense.”
– Sam Telford, veterinarian

Introduced in 1998, the vaccine sold well at first. But then opponents spoke out: self-described ‘vaccine victims’ — perhaps similar to people today who claim the MMR vaccine causes autism. Back then, they said that the Lyme vaccine gave them arthritis.

“And this sort of got into popular lore,” Poland recalls. “It got on the Internet. There were a number of East Coast lawyers who started putting together class-action lawsuits. There were anti-vaccine advocacy groups that were formed.”

And there were threats against the scientists who had worked to help protect people against the disease. Poland had to hide where he lived. Steere got a security detail.

The clinical data did not back up any of this. The trials had not shown such side effects. The Food and Drug Administration and the Centers for Disease Control looked into the claims, and then continued to recommended that people exposed to tick-infested areas get the vaccine.

But it was too late. Sales had plummeted. Four years after offering people immunity against Lyme, SmithKline Beecham stopped making the vaccine. The second vaccine-maker, Pasteur Mérieux Connaught, saw what had happened and never put out its own product.

The vaccine kills lyme bacteria in the tick before they
even make it into the dog’s body. (Curt Nickish/WBUR)

“Now with the withdrawal of the vaccine, people are doing all kinds of things,” Poland says.

Poland notes that since then, Lyme has become more widespread and is now the most common tick-borne disease in the country.

“I’m personally aware of individuals, who in desperation have gone to veterinarians and remarkably convinced the veterinarian to inject them with the canine vaccine,” he says.

Despite the growing demand for access to a human vaccine, many drug companies say not they’re not interested in working on one.

“There are so many diseases,” notes Farshad Guirakhoo, senior director of external in North America at Sanofi Pasteur, the vaccines division of the drug giant Sanofi. His company is working instead on a vaccine for dengue fever.

“For diseases like Lyme disease, the medical need is smaller,” Guirakhoo says. “So we need to put our resources toward where the medical need is greater and then you can make the vaccine.”

With little to no interest from drug companies, some people want government to step in — even state government. Earlier this month, at a hearing of the new Massachusetts Lyme Disease Commission, veterinarian Sam Telford suggested the Bay State license GlaxoSmithKline’s FDA-approved vaccine.

“We all know that the market has changed,” Dr. Telford said then. “People are fed up! This is a terrible situation we’re in, which means that a vaccine still makes sense.”

Telford argues the state could make it at the UMass Biologics Laboratory in Jamaica Plain, a facility that has made other vaccines before. GlaxoSmithKline would not say whether it would consider such an option.

So for now, there’s no sign of any vaccine becoming available. And if there were, Poland says the old opponents are already promising to fight the introduction of any new Lyme vaccine.

“So we know scientifically how to develop a vaccine that would protect against all this human misery,” Poland says with an air of regret. “And yet, for these societal and cultural reasons, not scientific reasons, that will not be done in the foreseeable future in the U.S.”

Steere is a little more hopeful. The man who first connected the mysterious affliction to the ticks of Lyme, Conn., back in 1975, has worked on the disease his entire professional life. Losing the human vaccine that he had helped along, he admits, was a major setback. But he doesn’t want to assign blame.

“Multiple things happened,” Steere says. “What I’d like to see happen now, is that it’s possible to move on. Even make a better vaccine. I think that’s still possible.”

Until that day, people are going to have to try to protect themselves. Long pants. Insecticides. Body inspections. People are going to have to keep living with Lyme.

Saturday, May 30, 2015

Anxious Students Strain College Mental Health Centers

From The New York Times' "Well" Blog

By Jan Hoffman
May 27, 2015

"Anxiety has now surpassed depression as the most common mental health diagnosis among college students, though depression, too, is on the rise."

One morning recently, a dozen college students stepped out of the bright sunshine into a dimly lit room at the counseling center here at the University of Central Florida. They appeared to have little in common: undergraduates in flip-flops and nose rings, graduate students in interview-ready attire.

But all were drawn to this drop-in workshop: “Anxiety 101.”

As they sat in a circle, a therapist, Nicole Archer, asked: “When you’re anxious, how does it feel?”

“I have a faster heart rate,” whispered one young woman. “I feel panicky,” said another. Sweating. Ragged breathing. Insomnia.

Causes? Schoolwork, they all replied. Money. Relationships. The more they thought about what they had to do, the students said, the more paralyzed they became.

A therapy dog named Sparky gives some love to Ashley Perez, 18,
and Nik Keebler, 22, during an event at the University of Central
Florida's Center for Counseling and Psychological Services.
Credit: Douglas Bovitt for The New York Times

Anxiety has now surpassed depression as the most common mental health diagnosis among college students, though depression, too, is on the rise. More than half of students visiting campus clinics cite anxiety as a health concern, according to a recent study of more than 100,000 students nationwide by the Center for Collegiate Mental Health at Penn State.

Nearly one in six college students has been diagnosed with or treated for anxiety within the last 12 months, according to the annual national survey by the American College Health Association.

The causes range widely, experts say, from mounting academic pressure at earlier ages to overprotective parents to compulsive engagement with social media. Anxiety has always played a role in the developmental drama of a student’s life, but now more students experience anxiety so intense and overwhelming that they are seeking professional counseling.

As students finish a college year during which these cases continued to spike, the consensus among therapists is that treating anxiety has become an enormous challenge for campus mental health centers.

Like many college clinics, the Center for Counseling and Psychological Services at the University of Central Florida — one of the country’s largest and fastest-growing universities, with roughly 60,000 students — has seen sharp increases in the number of clients: 15.2 percent over last year alone. The center has grown so rapidly that some supply closets have been converted to therapists’ offices.

More students are seeking help partly because the stigma around mental health issues is lessening, noted Stephanie Preston, a counselor at U.C.F.

Stress kits were distributed at an event at the University of
Central Florida's Center for Counseling and Psychological Services.
The kits included a stress ball, mints and crayons.
Credit: Douglas Bovitt for The New York Times

Ms. Preston has seen the uptick in anxiety among her student clients. One gets panic attacks merely at the thought of being called upon in class. And anxiety was among a constellation of diagnoses that became life-threatening for another client, Nicholas Graves.

Two years ago, Mr. Graves, a stocky cinema studies major in jeans, a T-shirt and Converse sneakers, could scarcely get to class. That involved walking past groups of people and riding a bus — and Mr. Graves felt that everyone was staring at him.

He started cutting himself. He was hospitalized twice for psychiatric observation.

After some sessions with Ms. Preston, group therapy and medication, Mr. Graves, 21, who sat in an office at the center recently describing his harrowing journey, said he has made great progress.

“I’m more focused in school, and I’ve made more friends in my film courses — I found my tribe,” he said, smiling. “I’ve been open about my anxiety and depression. I’m not ashamed anymore.”

Anxiety has become emblematic of the current generation of college students, said Dan Jones, the director of counseling and psychological services at Appalachian State University in Boone, N.C.

Because of escalating pressures during high school, he and other experts say, students arrive at college preloaded with stress. Accustomed to extreme parental oversight, many seem unable to steer themselves. And with parents so accessible, students have had less incentive to develop life skills.

“A lot are coming to school who don’t have the resilience of previous generations,” Dr. Jones said. “They can’t tolerate discomfort or having to struggle. A primary symptom is worrying, and they don’t have the ability to soothe themselves.”

Social media is a gnawing, roiling constant. As students see posts about everyone else’s fabulous experiences, the inevitable comparisons erode their self-esteem. The popular term is “FOMO” — fear of missing out.

And so personal setbacks that might once have become “teachable moments” turn into triggers for a mental health diagnosis.

“Students are seeking treatment, saying, ‘I just got the first C in my life, my whole life just got shattered, I wanted to go to medical school and I can’t cope,’” said Micky M. Sharma, president of the Association for University and College Counseling Center Directors and head of Ohio State University’s counseling center.

Stephanie Preston, a mental health counselor at the University
of Central Florida, says that more students are seeking help for
mental health issues. Credit: Douglas Bovitt for The N.Y. Times

Anxiety is an umbrella term for several disorders, including social anxiety disorder and agoraphobia. It can accompany many other diagnoses, such as depression, and it can be persistent and incapacitating.

Students who suffer from this acute manifestation can feel their very real struggles are shrugged off, because anxiety has become so ubiquitous, almost a cliché, on campus.

Alexa, 18, has been treated for an anxiety disorder since middle school, when she was still feeling terrorized by monsters under the bed. She has just finished her freshman year at Queens College in New York.

If she had a severe episode during a test, afterward she would try to explain to her professors what had happened but they would dismiss her. “They’d say, ‘Your mind isn’t focused,’ or ‘That’s just an excuse,’ ” said Alexa, who wrote her college application essay about grappling with the disorder. She asked not to be fully identified for privacy reasons.

More often, anxiety is mild, intermittent or temporary, the manifestation of a student in the grip of a normal developmental issue — learning time management, for example, or how to handle rejection from a sorority.

Mild anxiety is often treatable with early, modest interventions. But to care for rising numbers of severely troubled students, many counseling centers have moved to triage protocols. That means that students with less urgent needs may wait several weeks for first appointments.

“A month into the semester, a student is having panic attacks about coming to class, but the wait list at the counseling center is two to five weeks out. So something the student could recover from quickly might only get worse,” said Ben Locke, associate director of clinical services at Penn State University and the lead author of the Penn State report.

By necessity, most centers can only offer individual therapy on a short-term basis. Ms. Preston estimates that about 80 percent of clients at U.C.F. need only limited therapy.

“Students are busting their butts academically, they’re financially strapped, working three jobs,” she said. “There’s nothing diagnosable, but sometimes they just need a place to express their distress.”

Even with 30 therapists, the center at U.C.F. must find other ways to reach more students — especially the ones who suffer, smoldering, but don’t seek help.

Like many college counseling centers, U.C.F. has designed a variety of daily workshops and therapy groups that implicitly and explicitly address anxiety, depression and their triggers. Next fall the center will test a new app for treating anxiety with a seven-module cognitive behavioral program, accessible through a student’s phone and augmented with brief videoconferences with a therapist.

It also offers semester-long, 90-minute weekly therapy groups, such as “Keeping Calm and in Control,” “Mindfulness for Depression” and “Building Social Confidence” — for students struggling with social anxiety.

The therapists have to be prepared to manage students who present a wide array of challenges. “You never know who is going to walk in,” said Karen Hofmann, the center’s director. “Someone going through a divorce. Mourning the death of a parent. Managing a bipolar disorder. Or they’re transgender and need a letter for hormone therapy.”

Indeed, Dr. Locke and his colleagues at Penn State, who have tracked campus counseling centers nationwide for six years, have documented a trend that other studies have noted: Students are arriving with ever more severe mental-health issues.

Half of clients at mental health centers in their most recent report had already had some form of counseling before college. One-third have taken psychiatric medication. One quarter have self-injured.

The fundamental goal of campus counseling centers is to help students complete their education. According to federal statistics, just 59 percent of students who matriculated at four year colleges in 2006 graduated within six years.Studies have repeatedly emphasized the nexus between mental health and academic success. In a survey this year at Ohio State’s center, just over half of the student clients said that counseling was instrumental in helping them remain in school.

Anxiety-ridden students list schoolwork as their chief stressor. U.C.F.’s center and after-hours hotline are busiest when midterm and final exams loom. That’s when the center runs what has become its most popular event: “Paws-a-tively Stress Free.”

The other afternoon, just before finals week, students, tired and apprehensive, trickled into the center. The majority were not clients.

Students gathered around a therapy dog during an event at U.C.F.
Credit: Douglas Bovitt for The New York Times

At a tent outside, their greeter was the center’s mascot and irresistible magnet: a 14-pound Havanese, a certified therapy dog whom many clients ask to hold during individual sessions, stroking his silky white coat to alleviate anxiety.

“Bodhi!” they called, as he trotted over, welcoming them to his turf with a friendly sniff.

For the next two hours, some 75 students visited the center, sitting on floors for a heavy petting session with therapy dogs.

They laughed at the dogs’ antics and rubbed their bellies. They remarked on how nice it was to get a study break.

On the way out, the students were handed a smoothie and a “stress kit,” which included a mandala, crayons, markers, stress balls and “Smarties” candy.

Also tucked into the kit was a card with information about how to contact the center, should they ever need something more.

Friday, May 29, 2015

Tips to Keep Your Kids Safe in the Water

From MassPAC
The Federation for Children with Special Needs

May 26, 2015

Kids love water and pool season is almost here. Learn more about what you can do to keep kids safe at your own pool or at community pools and spas by visiting for Parents and Families.

For more water safety resources and fun activities, please visit:

Secret Teacher: I Am All for Inclusion in Principle, but It Doesn't Always Work

From The Guardian

By the Secret Teacher
May 23, 2015

Keeping children with special educational needs in mainstream schooling can deprive them of expert care – and their classmates of a decent education. 

‘Children are individuals, so the solution needs to be individual,’
says Secret Teacher. Photograph: Alamy

“Either he goes, or I’m taking my daughter out of the school.”

This is what a parent told me in confidence last summer. They were referring to a boy with Down’s syndrome, and associated behavioural difficulties, who had been in their daughter’s class for the six years of primary school. The boy was demonstrating behaviours that would see another child excluded. This included hitting, kicking, biting (students and staff), damaging property, swearing and disrupting lessons to the point that the classroom had to be evacuated several times a week – and their daughter was struggling to cope with the disorder.

We are an inclusive school, and were committed to meeting his needs, determined not to fail him. Special educational needs (SEN) experts had been involved from the start and full-time, one-to-one support was in place. Educational psychologists suggested a child-centred programme of study; speech and language therapists delivered communication therapy; occupational therapists designed programmes of activities to be done three times a day, requiring designated space and costly equipment.

We accommodated all of this and more in our one-form entry primary school where both space and cash are at a premium, driven by his parents’ unwavering insistence that mainstream school was the only place he could ever reach his full potential. Other children with similar needs had succeeded here – why not him?

But in striving for inclusive education, we had unwittingly turned a blind eye to the elephant in the room. If inclusion requires a child to be excluded from the same experiences and boundaries as everyone else just to remain on the premises, then it’s not inclusion. I’ve lost count of the number of times I’ve been told to put the child first, but why only the child with SEN?

What about the 29 other children whose education is hindered and – in some cases – personal safety jeopardised? I am responsible for those children too.

I am for inclusion, but not at all costs. In this case, the cost was not only the child’s happiness and progress, but the happiness and progress of everyone else in the school. We lost two good members of staff after they had been reduced to tears on numerous occasions by feelings of utter helplessness. On bad days, senior leaders would take over, trying every trick in the book but managing little more than babysitting to give staff respite and minimise collateral damage.

We had hoped that things would improve with more time and strategies. But as the child got bigger, more independent, physically stronger and emotionally aware, it was apparent we couldn’t offer the right help. We ran out of options.

Thankfully, the boy is now in specialist provision and, with the right support, is doing much better. But it was too late for some of his classmates who transferred schools to ensure their own education could proceed more effectively.

I recall the headteacher explaining that our school “believed in inclusion” and that we wanted our students to grow up understanding and tolerant of differences, prepared for the “real world”. But that’s not what was happening. In the real world, nobody would force someone with SEN to stay in an environment where they were coping so badly. The rest of the children in his class may well now have a negative view of people with Down’s syndrome, unfairly tainted by one experience.

Most primary teachers receive very little training in how to teach SEN students and it is often left to teaching assistants, who are even less qualified, to provide the necessary support. I remember his parents saying: “You can’t just put any learning support assistant with him, he needs a specialist with expertise in his area of need.”

I completely agreed, but such specialists aren’t common and those with the skills the child needed tend to work in special schools, not as support assistants in mainstream primaries.

In year 2 we have a little girl with autism. She is doing well, but is prone to outbursts and sometimes lies down and refuses to move – it’s her way of coping. Her classmates have learned not to react to this and if she lies down they simply walk round her so lessons can continue. This is, in some ways, a positive thing: they accept her and don’t bat an eyelid when her behaviour is unusual.

However, I can’t help but feel we’ve brought up a cohort of children who, when they see someone with special needs in distress, would assume they should just walk by without offering help.

Inclusion in principle is the right sentiment but, at best, it can come at a high price and, at worst, it can be a complete injustice. Children are individuals so the solution needs to be individual. There are plenty of examples of children with SEN who are successfully integrated in mainstream schools to the benefit of themselves and their peers.

But if we want children with SEN to have the same opportunities to succeed as others, we should not feel guilty about admitting they may need a different environment in which to do it. Furthermore, our responsibility is to all kids equally, not just those with SEN.

We need to be very careful that well-meaning ideals are not depriving children of their right to the specialist provision they need, nor indeed – if we are being truly inclusive – depriving others in the process. Inclusion, yes, but not at any cost.

Thursday, May 28, 2015

Executive Function Not a Panacea for Education Ills

From The Boston Globe

By Amy Crawford
May 24, 2015

One of the hottest topics across the American education system is a set of cognitive skills called executive function. Curriculums based around improving executive function have been deployed in some of the country’s top schools to make their top students even better. And it’s been rolled out in poor schools to help close the yawning achievement gap between underprivileged students and their well-to-do peers.

Some researchers liken executive function to an air traffic control system, which coordinates the thoughts and impulses arriving on the different runways of the brain’s busy airport. It allows us to stay focused in the face of distraction, resist urges, control emotions, and direct our actions toward a goal. Not surprisingly, scientists have found that these abilities are highly correlated with academic performance and success in later life. And executive function also appears to be malleable, meaning it can be strengthened through targeted training exercises.

The prospect is tantalizing: Improve executive function, better reading and math skills should follow. And the pressure is on. The standards movement demands schools, teachers, and curriculums to produce results, close performance gaps, boost achievement, and get more bang for the educational buck.

But despite the promise and the hype — not to mention the many millions of dollars spent — it turns out there isn’t solid evidence that improving executive function actually leads to better grades. That’s the startling finding of a new meta-analysis, published in the journal Review of Educational Research, which looks at 67 studies of school-based programs that target executive function. In fact, this latest research found no support for the idea that improving those skills can lead directly to better test scores in reading or math.

“We’re really surprised by the lack of support for the notion. Even though intuitively it is super appealing, there just isn’t a lot of really solid evidence out there that shows the link,” says Robin Jacob, a scientist at the University of Michigan’s Institute for Social Research, who conducted the review along with Julia Parkinson, now at the American Institutes for Research in Washington, D.C. She called the findings disappointing.

Executive function is a seductive idea, and along with growing interest on the part of educators and researchers and the general public, the past several years have seen an explosion in books, software and curriculums designed to whip children’s executive function into shape. KIPP, an acclaimed nationwide chain of charter schools with five campuses in the Boston area, stresses a set of character traits, including grit and self-control, that overlap considerably with executive function.

Tools of the Mind, a buzzy preschool and kindergarten curriculum used by more than a dozen school districts in Massachusetts, promises to develop children’s self-regulation through regimented dramatic play. Lumosity, the hugely successful San Francisco startup, and Cogmed, a subsidiary of textbook giant Pearson, claim their apps and video games can train the brains of children and adults alike; they and other computer-based programs are now used in hundreds of US classrooms.

Meanwhile, the K-12 sector of the cognitive training industry is predicted to grow to $600 million by 2020 up from $175 million in 2012, according to a study from SharpBrains, a firm that tracks the market.

Most of the studies Jacob and Parkinson reviewed found a correlation between executive function and academic performance, and many showed that children’s executive function skills can indeed be improved (at least in the short term) by interventions like a specially designed curriculum or games meant to flex certain cognitive muscles. None, however, demonstrated a causal relationship with achievement in reading or math.

One takeaway is the need for more research, Jacob says, noting that, while they looked at 15 years worth of research, more than half date to 2010 or later, an indicator of how new this line of inquiry still is. Jacob and Parkinson also found that only a handful of studies used randomized, controlled trials, the scientific gold standard. More of these will be needed to prove whether or not executive function training ultimately can boost reading and math skills.

Nonetheless, the meta-analysis holds significance beyond academia. Schools are already investing lots of money and valuable classroom time in programs that target executive function. Jacob argues that both might be better directed elsewhere. “It’s so intuitively appealing, and it’s easy to move ahead,” she acknowledges.

In fact, the impetus for the study was her own work, along with colleagues at Michigan and Harvard, on a curriculum called SECURe (for “social, emotional, and cognitive understanding and regulation skills”) that combines reading instruction with lessons on self-regulation. “It’s not that I don’t think that there is a potential,” she says. “I think there really is. But if you’re choosing among a variety of different interventions that you could be using, I think we should be choosing the ones that have the strongest evidence behind them. I’d rather see more cautious experimentation, and let schools intervene in ways we know work before they invest a lot of money in programs that we’re really not sure about.”

It’s a message that many in education’s trenches may be loath to hear, but they would do well to listen, says Douglas Fuchs, a professor at Vanderbilt University’s Peabody School of Education. “If I had a kid who was struggling in school, and I had a choice between some sort of executive function training and traditional tutoring, I would not choose executive function,” he says. “Right now, it would be a poor bet, a poor use of resources. This meta-analysis goes against the grain of popular wisdom, on which you’ve got companies like Lumosity making God knows how much money. Robin’s study punctures that.”

Clancy Blair, a cognitive psychologist at New York University, shares Fuchs’s concern. “This field of executive function and self-regulation is really hot, and it will take a while until it irons out,” he says. But Blair, a coauthor on several of the studies Jacob and Parkinson examined, also believes that the meta-analysis is flawed. “Methodologically, it’s very well done,” he says. “But it’s far too inclusionary. It measures several things that are like executive function but [aren’t] executive function.”

The paper may be controversial in some circles — “I’ve heard from lots of people,” Jacob says, “and they either really like it or they really hate it” — but Blair’s concern speaks to something that most in the field agree on: Executive function is slippery to define and even harder to measure.

Neuroscientists locate executive function in the brain’s prefrontal cortex, right above a person’s eyes. It is generally broken down into several sub-skills, which interact and overlap and are hard to tease apart from other abilities, especially the sort of general intelligence that IQ tests aim to measure. Among the commonly recognized processes that make up executive function, inhibitory control is the ability to suppress automatic reactions — like the urge to call out an answer in class without raising one’s hand first.

Working memory, which seems especially crucial for problem-solving, is the ability to hold information in the mind and manipulate it — putting a list of numbers in order, for example — over a short period of time. Attention control allows us to ignore distractions and focus on the task at hand, while cognitive flexibility lets us shift our attention and change our responses as the situation requires.

Since executive function was first recognized four decades ago, psychologists have developed various ways to assess it, some of which may appear a little absurd to an outside observer. In the so-called Walk-a-Line-Slowly task, for instance, children are asked to walk along a 6-foot-long piece of string taped to the floor, then to repeat the performance as slowly as they can, suppressing the natural urge to move more quickly. Other tests ask people to sort cards, or to watch a parade of images on a computer screen and press a button only when an assigned target — say, a chair — appears.

The problem, Blair says, is that many of these tests only gauge executive function indirectly. “A good example is delay-of-gratification — the famous marshmallow test,” he says, referring to an experiment first conducted by the psychologist Walter Mischel at Stanford in the 1960s. Children were told that if they resisted eating a proffered treat, they could have two treats later. “People love to call that executive function, but it’s kind of hit or miss. For some kids, a major form of getting through that task is distraction. Distracting oneself is not an executive skill.”

While some more narrowly targeted tests are useful, Blair says, “Executive function is most noticeable by its absence. When individuals have damage to the prefrontal cortex, or some other neurological issue, they have pronounced difficulties in their lives — making decisions, dealing with emotions, coming to conclusions based on reasoning.”

The stark evidence provided by people with profound pathologies drives home the importance of executive function, and even those who urge caution believe it’s important to continue developing and testing school-based training methods that could strengthen it.

“The fact that we have a lot of different ways of measuring executive function is a reflection of the fact that we don’t really understand it,” says Fuchs, who like Jacob is involved in a major study of an executive function-based curriculum, funded by the US Department of Education. “That means there needs to be a lot more work done.”

While Fuchs has harsh words for commercial enterprises attempting to profit off the popular fascination with cognitive training without the backing of solid science, he understands why schools are reluctant to wait on something with so much common sense appeal. It remains an attractive idea that, by tinkering with children’s brains, we can help them learn skills faster, retain more knowledge, and overcome circumstances like poverty and prejudice that might otherwise hold them back.

“It’s hard to say to schools, ‘Take a break for five years while we figure this out,’ ” he says. “The school bus still comes every morning. You have to do something with these kids.”


Amy Crawford is a writer in Massachusetts. Follow her on Twitter @amymcrawf.

U.S. Supreme Court Declines to Take Up Special Education Case

From Education Week's Blog
"School Law" 

By Mark Walsh
May 18, 2015

The U.S. Supreme Court on Monday followed the advice of President Barack Obama's administration and declined to take up a case involving an important interpretation of federal special education law.

The court last fall had asked for the administration's views in the case, Ridley School District v. D.R.(No. 13-1547). The administration came back this spring with a brief saying the case was not a good one for review by the justices.

The Pennsylvania school district, joined by several school groups, had asked the high court to interpret an aspect of the "stay-put" provision of the federal Individuals with Disabilities Education Act. That provision means a child stays in his or her current educational placement during administrative and legal proceedings over a disputed education plan. That often can mean the child will stay in a private school placement, with a public school district footing the bill during lengthy proceedings.

The question in Ridley was whether the stay-put requirement ends when a state or federal trial court issues a final judgment in a dispute, or whether the provision continues until all court appeals are exhausted. The federal courts of appeals are divided over that issue, with school districts in some places facing higher bills for private schooling of students where the stay-put provision has been ruled to stay in force during what are often lengthy appeals.

The question arose in the case of an elementary school student with multiple learning disabilities whose parents enrolled her in a private school after a dispute over the child's individualized education program, or IEP. Because a hearing officer ruled in the family's favor at one point, the private school became the child's stay-put placement.

A federal district court and the U.S. Court of Appeals for the 3rd Circuit, in Philadelphia, ultimately ruled for the Ridley school district that the child's public school IEP was appropriate. But in a separate action, a federal district court and the 3rd Circuit court said the school district was obligated to pay for the child's private school placement through the time of the first appellate decision in the case.

The school district appealed the reimbursement ruling to the Supreme Court, which asked the administration for its views.

In an April 10 brief filed by U.S. Solicitor General Donald B. Verrilli Jr., the federal government said the lower court rulings were correct and were required by regulations issued by the U.S. Department of Education.

The appeals court ruling "is consistent with the IDEA's goal of providing stability for children with disabilities until there is a final resolution of a legal dispute over their educational placement," says the administration's brief, which was also signed by Education Department lawyers.

"If the stay-put provision terminated after a district court decision and while an appeal was pending, parents would be faced with the untenable choice of either (1) removing their child from a private school that the court of appeals ultimately might find appropriate, or (2) risking being responsible for the cost of the private school for the duration of the appeal," the solicitor general's brief said.

The Ridley district had been joined by the National School Boards Association and the National Association of State Directors of Special Education, which had filed a friend-of-the-court brief arguing that the stay-put provision should only remain in force through trial court proceedings.

"The 3rd Circuit's extension of school districts' obligations to pay for private school placements while stay-put continues through litigation—including appeals of trial court rulings in a school district's favor—creates a perverse incentive for parents to prolong appeals simply to reap the benefit of private school tuition funded by public dollars," the school groups' brief says.

The justices denied review on May 18 in a brief, one-sentence order without any recorded dissent.

Wednesday, May 27, 2015

Mindful Eating, ADHD and Nutrition

Taking time for what matters.

By Mark Bertin, M.D.
May 26, 2015

Poor eating habits, eating disorders, and being overweight all may relate to ADHD...

The words attention deficit are so strongly associated with attention deficit/hyperactivity disorder (ADHD), many people overlook other far-reaching consequences of the disorder. Among them are poor eating habits, eating disorders, and a higher-than-average risk of becoming overweight as a result of having ADHD.

For example, a recent study linked ADHD to binge eating. How these eating issues happen makes a lot of sense when you understand the impact of ADHD on life management as a whole.

Executive function includes cognitive abilities that act as the brain’s manager. ADHD is essentially a consequence of poor executive function, not inattention or impulsiveness. That means it undermines skills such as time management, decision making, organization, and planning. For people with ADHD all these management-level mental abilities can be difficult.

The ADHD Executive Chef

While research shows eating issues common around ADHD, if you are an adult with ADHD or have a child with it, all this might come as a surprise—for good reason. “The relationship between ADHD and eating is vastly under-recognized even in the eating disorders and ADHD communities,” says Roberto Olivardia, Ph.D., a leading expert on the topic.

Executive function supports everyday decision making around food. With ADHD, the inability to plan on its own may cause last minute, rushed dietary choices. It also leads to rushed reliance on fast food or quick snacks laden with fat, carbohydrates, or sugar.

In addition, children and adults with ADHD frequently feel a need to eat right now when hungry, fed by their ADHD-related reactivity and impulsivity. And out of stress, boredom or overstimulation amplified by ADHD they often develop emotional overeating.

How people with ADHD eat also becomes problematic. The craving for stimulation inherit to the condition may lead to eating too quickly. Engaging in other activities while eating, such as watching television or driving, leads to missing body cues that signal satiety. This causes people to eat past the point of being full.

Not only is nutrition compromised for people with ADHD, the condition puts many of them at risk for an eating disorder. “Typically eating disorders with ADHD are the more impulsive types, such as binge eating disorder and bulimia,” Dr. Olivardia says.

“Since most people think of ADHD as impulsive in nature, those with compulsive eating disorders like anorexia are often under-diagnosed and missed. This restriction around food can be an attempt to quell the chaos that someone living with ADHD feels.”

A Domino Effect

Even if someone with ADHD is not overweight, executive function may impact healthy eating. And poor eating habits do not only affect nutrition. Difficulty with planning, distractibility, and time management frequently have a domino effect.

For example, Dr. Olivardia tells the story of a patient who because of ADHD had intense trouble managing time. He’d usually skip breakfast to get to his job on time. He’d often forget (another ADHD symptom) to take lunch with him, and then get hyperfocused on work and skip eating during the day anyway. Each night he arrived home starving and ate an enormous, unhealthy volume of food.

“Although he kept a healthy weight, eating this way resulted in poor sleep,” says Dr. Olivardia. “He felt bloated, gassy and had acid reflux. Sleeping badly resulted in less focus and concentration the next day, which lead to an overreliance on caffeine, which led to appetite suppression and hyperfocus, which triggered the pattern all over again. He did not feel healthy, even though his weight was fine.”

Mindful Eating Habits

Mindfulness and eating are a natural fit. What other activity do we give as little attention to while we’re doing it, while relying on habits to make choices, not always to our benefit? Healthy eating develops with moment-to-moment awareness, conscious decision making, and responsiveness (instead of reactivity) when under stress. Eating like this means nothing more artificial then aiming to pay attention to eating while eating—much easier to say than to do.

With or without ADHD, in the moment most of us do not attend much to eating. We tear through a favorite food with little awareness at all. We make choices around food to eat or buy without much thought. And we frequently eat based on how we feel emotionally; comfort food is called comfort food for a reason. Even when overall we think about health and nutrition a lot, we all too often fall into autopilot.

Mindfulness is an effective and increasingly studied solution for resolving an array of eating issues from overeating to losing weight to eating disorders. Mindfulness leads to more intentional food choices and fewer unhealthy eating habits. Like anything, mindful eating gets easier and more instinctual with practice. Below are some ideas of how to get started—choose from Menu A, Menu B, or fill free to mix and match:

Menu A: Mindful Eating
  • Pay attention to what drives you to eat. Notice the influence of each of the five senses in decisions. For example, how often do you eat only because something looks good or smells good? Are you only eating because you’re hungry?
  • Notice habits when shopping or eating. Habitual behaviors are difficult, but not impossible, to change. Without self-judgment for whatever has happened before, pause before making choices. Make intentional decisions about what you buy and eat next.
  • Pause often while eating. Put your utensil down between bites. Check in with your body cues before taking a second helping. Paying attention in this way makes it simpler to stop when full, not when your plate is clean.
  • For any meal or snack (or even for the first few bites), aim to pay attention to each of your five senses. In an unforced way, as if savoring a spectacular meal, notice the sight, sound, smell, touch, and taste of your food. Turn off distractions, like the television or your phone. Gently refocus your attention whenever you become distracted. If you’re having a meal with family or a friend, bring your full attention to that social experience too.
  • Be patient with yourself. Avoid negative self-talk when you do not succeed in what you set out to do. Recognize any tendency to criticize yourself as a habitual, not so helpful voice. Give yourself credit for changes, however small, and return to your better intentions without expectations of perfection.

Menu B: Nutritional Guidelines for ADHD

Here are Dr. Olivardi’s recommendations for people with ADHD for common nutritional issues:
  • Eat breakfast. Like the patient Dr. Olivardi described, many people with ADHD skip breakfast due to oversleeping and rushing. Hours later, they end up painfully hungry and grab whatever is nearby. Value breakfast, set yourself reminders about it, and plan ahead.
  • Get plenty of protein in your diet. Protein fuels your body for longer periods of time. There is even some suggestion that healthy, high-protein breakfasts help ease daytime ADHD symptoms. Avoid too much sugar and junk food, which tend to affect mood and exacerbate a cycle of increasing hunger over the day.
  • Eat throughout the day. Many people skip meals due to hyperfocus and losing track of time. This sets their body up to hold onto fat and increases cravings for fat and sugar. Extreme hunger also leads to impulsive decision-making. Again, set alarms if needed, and during breaks consider a healthy snack.
  • Work towards getting adequate sleep. Sleep deprivation lowers our body's ability to burn fat. It also exacerbates ADHD and stress, and undermines our ability to stick to plans.
  • Most of all, get support. Share tips and strategies with an ADHD buddy or a professional familiar with the field who understands how establishing a pattern of healthy eating can be hard.

Adapted from Psychology Today


Mark Bertin, M.D., is a developmental pediatrician and Assistant Professor of Pediatrics at New York Medical College. He's author of The Family ADHD Solution and Mindful Parenting for ADHD. Follow Mark on Twitter and Facebook and check out his website,
Your Untrusted Source of Health News for Over 0 Years

By Doktor Spudd
May 26, 2015

SPOKANE, WA – A local town council was looking for volunteers to help them move the giant, heavy goalposts on the soccer field so that maintenance crews could fix the Astroturf. They were overwhelmed by the amount of people who showed up.

“We were really blown away. We had more people than we ever could have hoped for” explained organizer Nancy Turlington. “We had a lot of families showing up who said they had a lot of experience in moving the goalposts. ”

Anti-vaccine advocates turned out in droves to help with the move.

“We have been moving and shifting the goalposts for years, so we felt we needed to come and help” said anti-vaccine cult member Mary Arkisson. “Unfortunately my youngest son couldn’t make it today to help as he is at home with the measles.”

All told over 35 people showed up and the goalposts were successfully moved.

“Success! We did it again” said an excited and exhausted Arkisson. “First it was mercury and aluminum and now this. We’re really on a roll.”

After maintenance crews had finished their work, the volunteers were asked to help move the goalposts back, but refused.



Tuesday, May 26, 2015

Free Talk in Acton Tuesday, June 2nd by Dr. Jeffrey Bostic: Mental Health Issues in Children and Teens

From the Acton-Boxborough SEPAC

May 26, 2015

Jeffrey Bostic, M.D.
The Acton-Boxborough Special Education Parent Advisory Council and the Acton-Boxborough Pupil Services Department are pleased to co-host a workshop by Dr. Jeffrey Bostic, assistant clinical professor of psychiatry at Harvard Medical School and director of school psychiatry at Mass General Hospital. Dr. Bostic's research and clinical interests focus on mental health in school settings.

This presentation will address the topic of mental health issues in children and teens. He will discuss signs of anxiety and depression in children and teens, and provide insight on how to support students' needs in the school setting. 

When:   7:00pm Tuesday, June 2, 2015

Where: R.J. Grey Junior High School Auditorium
                   16 Charter Road, Acton

This event is free and open to the public.


In Texas, Courts Turn Truancy Cases into Cash

From Aljazeera America

By Jyoti Thottam
May 21, 2015

An in-depth look at the Dallas County courts where children as young as 12 are prosecuted as adults for truancy.

SEAGOVILLE, Texas — On a good day, Raquel Fontenot wakes up around 7:30 or whenever the sun comes through the windows of the trailer home where she lives with her mother, grandfather, three siblings, a niece and four dogs. She skips breakfast, and by 8:30, the 16-year-old high-school freshman is out the door and waiting at the bus stop on Modene Street.

Not every day is a good one. Raquel has been in therapy and on medication for depression, attention deficit hyperactivity disorder and a mood disorder since she was about 12. Sometimes, she wakes up and just doesn’t feel right.

“I sit on the couch for, like, 30 minutes. Literally just sit there, then I start, like, slouching around the house,” she says. “Mama’s like, Are you ready for school? And I’m like, no. And I get in an argument with somebody.” Usually her sister Luranetta, who sleeps in the living room with Raquel. “I get angry, and I start crying.”

But days like that are pretty rare now, and that is a relief for Raquel’s mother, Yolanda. She remembers when her daughter’s “troubles” first started, in seventh grade. Raquel became suicidal and at one point was hospitalized for several days, Yolanda says. Her daughter would get into fights at school and on more than one occasion was suspended and escorted home by a police officer. Sometimes, Raquel would tell her in the morning, “Mom, I’m not going to have a good day. I’m going to get sent home.” So Yolanda would let her stay.

The school’s rules are strict: A note has to be submitted within three days of a student’s return to school for an absence to be considered excused. With three other children and an elderly father to care for, keeping up with things like that “becomes overwhelming,” Yolanda says. Occasionally, when her daughter missed school, she would forget to send a note explaining Raquel’s absence.

In accordance with Texas state law, 10 unexcused absences in a six-month period will result in a charge of truancy, and in March, 2013, when Raquel was in eighth grade, Yolanda received a letter informing her that the state had filed a charge of “failure to attend school” against her daughter. She tried to talk to school administrators about it, Yolanda says, but they told her, “All you can do is go to court and just get it straightened out.”

It was Raquel’s first truancy case, and one of 115,782 in Texas during that fiscal year. Her case was heard at one of Dallas County’s special truancy courts, part of a byzantine system in which children as young as 12 are prosecuted and fined for adult crimes. These defendants don’t have the protections offered to children in juvenile court, and sometimes the charges in truancy court can even lead to jail time.

Raquel, for example, had to represent herself in court at the age of 14, was made to sit in open court in handcuffs and at one point was threatened with jail for unpaid fines.

Texas has twice as many truancy cases as the rest of the country. In 2011 and 2012, Texas filed about 115,000 truancy cases each year. In contrast, the rest of the country combined filed only about 50,000. The total number of Texas filings fell to about 94,000 in 2014.

Texas is one of only two states in the United States that prosecutes truancy as an adult criminal offense — Wyoming is the other — and the volume of cases is staggering: In 2013, Texas had more than twice as many truancy cases as the other 49 states combined.

Truancy is also the number one reason children in Texas encounter the criminal justice system. In 2013, more than 67,000 juveniles were referred to juvenile court for crimes other than truancy, ranging from homicide and theft to drug offenses and disorderly conduct. That number was 42 percent fewer than the cases of truancy.

Failure to attend school has also become a revenue stream for Texas. In fiscal year 2014, the state assessed fines and court costs of $16.1 million for truancy convictions, even though 79.4 percent of cases that year involved economically disadvantaged students, according to an analysis by the Austin-based social and economic justice advocacy group Texas Appleseed.

Yet all these prosecutions are doing little to improve overall school attendance rates. In Dallas County, which filed 25,495 truancy charges in 2013, the most of any other county in Texas, attendance has been steady over the last few years at about 95 percent. This is slightly higher than the 93 percent attendance reported by New York, which, like most other states, handles truancy as a civil matter in juvenile court.

The volume of cases, along with growing concerns that Texas’ harsh approach to truancy is ineffective and a violation of children’s constitutional rights, has led state lawmakers to push for decriminalization. Introduced over the objections of judges who insist that harsh penalties are the best way to keep children in school, a bill before the Texas Legislature would make truancy a civil offense and eliminate the fines and threat of jail time for unpaid fines.

The Department of Justice has also launched an investigation into allegations of due-process violations in the Dallas truancy courts. “Our case numbers are out of control, they’re so absurdly high,” says Deborah Fowler, executive director of Texas Appleseed, which has led the effort to decriminalize truancy. “We really need to be able to take a step back and take a look at whether or not court is really warranted.”

If the bill passes, it will represent a huge victory in the nationwide fight to break the cycle of criminalization and incarceration that traps a disproportionate number of minority youth. In Texas, 83.6 percent of truancy cases involved African-American or Latino students in the 2013-2014 school year, although they represent only 64.5 percent of student enrollment. A substantial body of research has found that court involvement in childhood increases the likelihood of being involved in crime in early adulthood.

Juvenile-justice advocates across the U.S. are watching what happens in Texas closely. “It will be very significant because as things stand now, there’s like 100,000 cases filed a year,” says Michael Harris, senior attorney at the National Center for Youth Law in Oakland, California. “That’s 100,000 kids who have an adult criminal record that they’ll have to deal with for the rest of their life.”

Raquel Fontenot

Yolanda Fontenot grew up in Eunice, Louisiana, a town of about 10,000 people best known for its devotion to Acadian dialect and culture. It is home to the Cajun French Music Hall of Fame, and hosts a weekly music radio show in Cajun French, “with enough English spoken so that everyone can enjoy.” As a child, she roamed freely with her five brothers and sisters and grew up eating her mother’s boudin, crawfish and gumbo. “I miss the food badly,” she says.

But with the closest real city, Lafayette, nearly an hour away, finding work was a struggle. Though Yolanda dropped out of high school, she was able to train as a nurse’s aide. Two of her brothers moved to the Dallas area, and in 1995, when her oldest child, Ondene, was about a year old, she joined them. Despite one big setback — Texas didn’t recognize her Louisiana nursing-aide’s license, and she couldn’t afford another student loan to repeat her training, so she found work as a warehouse clerk — Yolanda was dazzled by the city. “It was totally different,” she says. “I didn’t go back.”

Yolanda arrived in Texas when the nationwide movement to get tough on crime was taking off. The Federal Crime Bill of 1994 supported more police and more prisons, along with tougher sentences for a variety of offenses committed by adults and juveniles. The following year, Texas passed a law that made failure to attend school a criminal offense for children age 12 to 18, classifying it as a class C misdemeanor, meaning that offenders would be tried in adult court or, in small counties, juvenile court.

The law, in keeping with the “tough on crime” ethos of the time, gave law-enforcement officers the power to arrest children suspected of truancy and put the burden on the defendant — the child — to show “by a preponderance of the evidence” that his absences were excused or couldn’t be avoided.

In 2001, Texas tightened the laws, mandating that school districts file a truancy complaint within 10 days of a student’s 10th unexcused absence in a six-month period. To handle the ballooning volume of cases, in 2003 the state authorized Dallas County to operate a truancy-court system to handle the cases. 

"[The truancy fine will] follow me until I turn 17, and then I would have to sit it out — in jail. Until I got the whole balance paid."
--Raquel Fontenot

Raquel was 14 when she had her first hearing in truancy court. She says she knew what “truancy” meant but was confused when the judge asked her to enter a plea of guilty, not guilty or no contest. “I was looking at my mom for all the answers, and she couldn’t talk,” Raquel remembers. Children charged with truancy, unlike those facing more serious crimes, have no right to court-appointed counsel if they can’t afford it, and many judges will not allow parents to speak for their children. A frustrated but helpless Yolanda says: “You’re standing there in silence. You want to say something, but you’re not allowed.”

Over the next several months, Raquel had three more court dates for this case, changed her plea from not guilty to no contest, was convicted and ordered to pay $180 in fines and court costs. “I knew I had to get to school so Mama wouldn’t have to pay no money that we didn’t have,” she says. The judge warned her that either she or her mother would have to pay the fine. “It’ll follow me until I turn 17, and then I would have to sit it out — in jail. Until I got the whole balance paid.”

In September, with $107 still unpaid and two more unexcused absences, she was summoned to court again. This time, the judge ordered her to do community service in lieu of paying the fine and threatened to hold her in contempt of court if she missed any more days of school. On Feb. 19, 2014, he followed through on that threat, and sent Raquel to Dallas County’s Truancy Enforcement Center.

The TEC, run by a local nonprofit group called Dallas Challenge, describes its mission as helping young people stay in school and out of the criminal-justice system. It promises “instantaneous intervention” for children who are charged with contempt and serves about 2,000 children every year, with $587,135 a year in grants from Dallas County, as per 2012 figures.

A project on New Zealand that Raquel recently completed in world history
class. “It’s a big project — 20 percent of your grade. Most of the class don’t
do their projects, but I do it.” Allison V. Smith for Al Jazeera America

Raquel and Yolanda remember the TEC workshop and lecture they attended only vaguely. “Everything they said was mentioned in the courtroom, and then I felt that we were in church,” Yolanda says. But they recall the hours prior in vivid detail. When the judge found Raquel in contempt, he ordered a bailiff to handcuff her. She sat in the courtroom with her hands bound behind her back for more than two hours as the rest of the day’s cases were heard. “You’re watching your child actually be put in handcuffs,” Yolanda says. “That’s the hardest thing.”

Raquel’s lowest point came afterward, when she was taken to the TEC in handcuffs. In a document prepared by Dallas County in response to a request by Texas Appleseed, Dallas County Judge Clay Jenkins addresses the concerns raised by advocates about this practice: “The handcuffs are a safety factor for the officers who are transporting and also prevent any assault crime that might occur when more than two students are being transported together.”

Raquel, who has wanted to become a police officer since the age of 10, feels differently. Riding in the back of a car with another kid and a police constable, she believed she was being taken to jail. “I was just thinking, My career’s over. I can’t be what I want to be anymore.”

Judges in Dallas County have sometimes put children in handcuffs in truancy court while they wait to be transported to other facilities, a practice that has been widely criticized.

Because truants in Texas are prosecuted as adults, all of the proceedings — hearings in which children and their families must answer personal questions about ordinary adolescent conflict and their sometimes-painful struggles with poverty — are held in open court. This makes it possible to report that in truancy proceedings during the first week of May in six different courts in three Texas cities, the burdensome fines, inadequate representation and threats of jail time that Raquel experienced are not at all unusual.

“If you go and watch court then you’ll quickly realize that this system is not set up to do what they say it’s doing, which is to help students attend school,” says Harris, of the National Center for Youth Law. “This is just a very cynical system where it’s all about its own self-preservation: One, generating revenue through fees that are imposed on parents and students. And, two, exercising power over kids. … The number one mechanism to enforce social control is to fine them.”

Dallas County assessed fines and court costs on children and families totaling $2.8 million last year, money that goes toward the courts’ expenses, including salaries for clerks, constables and five full-time magistrates.

Revenue collected by Dallas County Truancy Courts (pg 1)
Dallas Country's truancy courts collected $2.96 million in revenue in fiscal year 2012, from fines and court fees assessed against children and parents. That revenue funds the operations of the court, including judges and administrators' salaries, creating what some advocates say is a financial incentive for the county to handle truancy through the courts rather than the schools.

As part of their work, the judges issue court orderto collect the fines that help pay their salaries. This system preys on poor students and families who are already struggling, says Harris. “It incentivized sending kids to court as opposed to having the school educators deal with the problem at the school.”

In the Garland, Texas, courtroom of Judge John Sholden, a 17-year-old high school senior — just a month away from getting his diploma — came in with a fistful of cash, $142 in small bills, hoping to pay off some of the fine he owed. Sholden said he would recall the warrant for the boy’s arrest if the balance was paid off within four weeks.

He berated another 17-year-old who appeared in court with neither his truancy fine nor the book report he had been assigned to write as punishment. Sholden held him in contempt of court and suspended his ability to get a driver’s license until he paid the fine. He also told the boy, whose father did not appear with him, “Your dad wants me to put you behind bars. That’s part of why he’s not here today.”

In Judge Larry Rayford’s court, the same one where Raquel was handcuffed, there were other examples of lack of due process, which critics say is prevalent in the system. These included children and families pressured to plead guilty, or no contest — a legal gray area in which the defendant does not admit guilt but can nevertheless receive a conviction.

José Sanchez, a baby-faced sixth-grader two days shy of his 13th birthday, represented himself in Rayford’s courtroom on May 5 while his mother, Maria, followed the proceedings through an interpreter. “Your son has had a huge number of absences,” Rayford told her, warning that unless she goes to school to check that he is in class, a case will be filed against her as well. “I have been going,” she says. In the end, José pleaded no contest and accepted a fine and court costs of $180.

After his case was heard, José tells Al Jazeera America that he doesn’t skip class, but is often late in the mornings because he walks to school — he is ineligible to be picked up by the school bus since he lives within two miles of the building. (In some school districts, students who arrive late can be counted as absent.) Asked whether he understood what “no contest” meant, José says, “It’s yes and no. ’Cause sometimes I miss class.” His mother, who works as a housecleaner, says she isn’t sure how she will pay the fine and keep tabs on her son. “They expect the parents to be after the kids 24/7, but we have to make a living.”

"4 of 5 students prosecuted for truancy are poor..."

José was not the youngest person in the courtroom that day. That was the 5-month-old daughter of Mychela Redden, 17, who came to court with both her infant and her mother, Iris. Mychela was facing a truancy charge for several days when she was counted absent during the last month of her pregnancy. “Toward the end it was getting tough,” Iris Redden says, and her daughter was sometimes late to school. But rather than pull her daughter out of school for more court dates to fight the charges, she agreed to pay a $200 fine and plead guilty. “If you don’t, then you have to come back,” she says. “It ain’t even worth it.”

Redden recently lost her job in customer service and her daughter works part-time at Original Pancake House. Asked how she will pay the fine, she says, “Slowly but surely.”

Rayford says that he does everything he can to make sure that the process in his court is fair. “I go out of my way to make sure that they understand,” he says. “I realize that some people believe that there should be [court-appointed] representation. Right now the process doesn’t provide for that.” He also says that he no longer puts students in handcuffs, instead allowing parents to take their children to the TEC, and he downplays the financial incentives for prosecution.

“Personally, I don’t let money factor into my decisions.” But he acknowledges that the fines do serve a purpose. “My understanding is that when the program first started, there were not fines, and some of the judges felt that without the fines the parents were not taking it seriously.”

Sholden and Chavez did not respond to requests for comment.

For all the discussion of fines and punishment, there are very few interactions between the judges and the children about the underlying issues that caused students to miss school, whether that’s difficulty with transportation, medical issues or learning disabilities, or bullying at school. Some judges say that they do refer children to social service organizations. Rayford, for example, says that he refers every repeat offender in his court to a truancy case manager.

Raquel Fontenot dances after school in her family's home.
Allison V. Smith for Al Jazeera America

Advocates who work with students in Texas truancy cases say these courts are not designed to deliver social services, and that’s why these cases do not belong in court at all. “These courts are created to efficiently prosecute and collect fines from a large number of people,” says Dustin Rynders, supervising attorney with Disability Rights Texas, a legal services and advocacy organization. “They are not created to provide therapeutic service in a meaningful way.”

During that miserable day in handcuffs, Raquel did have one lucky break. She met Fowler, of Texas Appleseed, who had been making regular visits to truancy courts to talk to students about their experiences. Fowler, who has been working on the school-to-prison pipeline for the past decade, notes that there is a large body of recent research in juvenile justice showing that threats, fines and other harsh tactics aren’t effective in addressing juvenile crime or truancy.

“The problem is that because the judges who are hearing these cases now are operating completely outside our juvenile-justice system, they haven’t been exposed to a lot of the training and technical resources and research that our juvenile-justice stakeholders have been receiving over the last 10 years about what works with kids,” Fowler says. In addition to the special truancy courts in two counties (Dallas and Fort Bend, a suburb of Houston) in Texas, municipal-court judges and justices of the peace also hear truancy cases.

“When I go into many of these courts, I feel like I’ve stepped into a time warp, and I’m back in 1994 or 1995 and there was so much talk about being tough on crime and … this sort of broken-windows approach,” she said. “That’s just not where we are anymore. All of those approaches have been debunked in the last 20 years.”

But Rayford doesn’t think “we’re being too tough,” explaining that in most cases he is simply issuing court orders to make sure that children are attending school and going to tutoring, things that they should be doing anyway. “It’s not a punitive thing.” And, he adds, some parents welcome his intervention and want him to be tougher on their kids.

Raquel and her mother Yolanda Fontenot at home in Seagoville,Texas
Allison V. Smith for Al Jazeera America

In Raquel’s case, she and her mother say they desperately needed help. Fowler introduced Raquel to a pro bono attorney, who successfully argued that her truancy charges were due to the school’s failure to provide her with special-education services that she was entitled to because of her mental illness. After several months of hearings, she was found not guilty at a trial last fall.

But the very next day, the state of Texas filed another truancy case against Raquel for absences during her freshman year at Seagoville High School. The school’s automated attendance system reported her absences to Dallas Independent School District, which triggered the automatic filing of a case with Dallas County Truancy Court. It was processed by the Student Attendance Monitoring System, or SAMS, a software system developed by the school district to file cases within 10 days of the 10th absence, regardless of a child’s specific circumstances.

In theory, this allows the school district to meet its statutory obligations with maximum efficiency. But in practice, advocates for reform say, it perpetuates a system in which a software program, rather than a human being, decides whether a child’s absences merit legal action by taking discretion over filing truancy cases out of the school’s hands.

Though he declined to comment on any specific truancy case, Michael Jones, principal of the high school, says that the school has “multiple safeguards and interventions” in place to help any child who is habitually absent, from home visits to weekly attendance roundtables at which teachers and administrators discuss individual cases. Once a student hits that 10-day threshold, however, the software takes over. “It’s essentially a probable-cause determination made by a computer,” says Rynders, of Disability Rights Texas.

A spokesman for the Dallas Independent School District did not respond to requests for comment.

‘I know you’ve got the machine calculating it, but you’ve got the lady sitting at the desk. How are you going to let a machine make a decision over a child’s health?’
--Yolanda Fontenot, Raquel's Mother

Yolanda says she tried to explain Raquel’s situation to the school’s attendance clerk, but to no avail. “I know you’ve got the machine calculating it, but you’ve got the lady sitting at the desk,” Yolanda says. “How are you going to let a machine make a decision over a child’s health?”

These automatic filings are just one of the alleged due-process violations raised in a 2013 complaint filed with the Justice Department on behalf of several students by Harris’, Rynders’ and Fowler’s organizations against Dallas County and the school districts that utilize the county’s truancy courts. In the complaint, they also criticized the lack of representation for children in court, especially those with disabilities, and alleged Title IX violations against students who were considered truant because of absences related to pregnancy.

On March 31, the Justice Department announced that it had opened an investigation into the Dallas Truancy Courts, with then-Attorney General Eric Holder promising to make sure “the children of Dallas County can receive the meaningful access to justice that all Americans deserve.”

The federal investigation may be overtaken by the state’s own efforts at reform. In November 2014, Texas state Sen. John Whitmire, a Democrat, introduced a bill that would decriminalize truancy, turning it into a civil offense, and eliminate the fines and possibility of jail time for unpaid fines. Former Gov. Rick Perry vetoed a previous legislative effort at overhauling truancy.

But the recent conservative movement that supports criminal-justice reform as a way of limiting government has given truancy reform new momentum. Perry also has joined the conservative Right on Crime campaign. Whitmire’s bill has broad bipartisan support and could pass by June 1, the end of the current legislative session.

While the truancy-reform bill has been making its way through the Legislature, Raquel and her new attorney, Meredith Parekh, from Disability Rights Texas, have been trying to get her enrolled in Seagoville High School’s special-education program. On April 2, she was placed in special education as a child with an emotional disturbance; while that status doesn’t prevent the state from filing truancy charges against her, it will strengthen her argument that the school’s failure to provide these services sooner led to her truancy.

But on April 3, SAMS caught up to her again — this time for absences before April 2, and she may soon have to appear before Rayford to defend herself against yet another truancy charge. “It’s a self-perpetuating system,” says an exasperated Parekh.

For her part, Raquel is doing her best to use the new tools she has learned in counseling to manage her anxiety. She goes straight to class in the morning, avoiding the cacophony of more than 1,000 teenagers milling in the hallways. She can’t handle the crowds in the cafeteria and can’t afford to buy snacks from the vending machines, so she skips this meal, too, and spends her 30-minute lunch period talking to a couple of friends.

Whenever her anxiety seems too much to handle, her teachers allow her to step outside the classroom to take a breather for a few minutes or write in her journal. She’s passing all her classes and getting B’s in her favorites, dance and English, in which she is reading “Romeo and Juliet.” Raquel has acquired some new ambitions, too — she wants to become a choreographer, perhaps, or a helicopter rescue medic. “I like being in the sky,” she says. “It just feels like I’m free.”

For more on how low-income families and kids with disabilities are being disproportionately sent to adult court, watch the America Tonight investigation on the truancy trap.