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Thursday, April 30, 2015

68 MA Legislators Sign Safe and Supportive Schools Budget; TLPI to Co-Chair Commission

From Massachusetts Advocates for Children


April 30, 2015

You answered the call, and so did 68 Representatives, when we asked them to Co-sign Representative Ruth Balser’s budget amendment to support Safe and Supportive Schools funding. This news comes out of MAC’s Trauma & Learning Policy Initiative, where the response is called, “phenomenal!”

Learn more at http://traumasensitiveschools.org.

Thanks to your help and the extraordinary leadership of Representative Balser, today the House responded by including the line item in its consolidated budget! The next step is to ask the Senators to co-sponsor the line item.

As background, on August 13, 2014, provisions of An Act Relative to Safe and Supportive Schools were enacted into law and signed by the governor as part of the omnibus Act Relative to the Reduction of Gun Violence. These provisions establish a statewide “safe and supportive schools framework” to assist schools to create whole-school safe and supportive learning environments and cultures “that improve educational outcomes for students.”

The law includes a groundbreaking definition of “safe and supportive schools” as,

“… schools that foster a safe, positive, healthy and inclusive whole-school learning environment that (i) enables students to develop positive relationships with adults and peers, regulate their emotions and behavior, achieve academic and non-academic success in school and maintain physical and psychological health and well-being and (ii) integrates services and aligns initiatives that promote students’ behavioral health, including social and emotional learning, bullying prevention, trauma sensitivity, dropout prevention, truancy reduction, children’s mental health, foster care and homeless youth education, inclusion of students with disabilities, positive behavioral approaches that reduce suspensions and expulsions and other similar initiatives.”

The law also provides tools for schools to become safe and supportive, a Safe and Supportive Schools Grant program and a Safe and Supportive Schools Commission to make recommendations to the legislature about implementing the framework statewide. It also provides for the development of a community of practice across the state through conferences, trainings, technical assistance, development of model protocols and more.

Please stay tuned for updates on this legislation, as your participation and outreach to your legislators as we turn to the Senate can help make the difference in keeping the momentum of establishing safe and supportive cultures that benefit all children.

In addition, TLPI will co-chair the Safe & Supportive Schools Commission.

The Trauma & Learning Policy Initiative (TLPI), a joint program of MAC and Harvard Law School, continues to forge a leadership role on supporting schools to create whole-school environments that address the needs of all students, including those who have been exposed to traumatic experiences.

This past month, TLPI was selected to co-chair with the Department of Elementary and Secondary Education the Safe and Supportive Schools Commission created under new law passed in 2014, “An Act Relative to Safe & Supportive Schools.” Members of the Commission include 19 key stakeholder associations and organizations representing schools and parents across the Commonwealth.

TLPI’s leadership and advocacy over the past 12 years helped lead to the 2014 passage of the landmark legislation, as described in the Fall 2014 issue of the Harvard Law Bulletin. The law creates the Safe and Supportive Schools Framework to assist schools in creating environments where all students can learn.

TLPI is working on a research study to assess student and school culture outcomes in three demonstration schools that use TLPI’s inquiry-based process to become trauma-sensitive safe and supportive school environments.

.................................................................................................

Mike Gregory, Esq.
In other news, TLPI’s Michael Gregory was promoted to Clinical Professor at Harvard Law School, as part of the Education Law Clinic and the Trauma & Learning Policy Initiative, effective in January, 2015. As part of the TLPI Team, Mike is a co-author of both volumes of TLPI”s landmark report, Helping Traumatized Children Learn, and is also a co-author of Educational Rights of Children Affected by Homelessness and/or Domestic Violence, a manual for child advocates.

TPLI will also welcome a new staff person, Colleen Armstrong, to its team, as Lead Organizer/Program Coordinator.

Low-Income Schools See Big Benefits in Teaching Mindfulness

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

By Katrina Schwartz
January 17, 2014

“Before we can teach a kid how to academically excel in school, we need to teach him how to have stillness, pay attention, stay on task, regulate, make good choices...”

On his first day teaching at Coronado Elementary School in Richmond, California, students threw rocks at Jean-Gabrielle Larochette, pretending he was a police officer. He spent fifteen minutes of every class calming down a handful of kids in this low-income-neighborhood public school who wouldn’t follow directions or behave.

Larochette began practicing meditation and mindfulness to cope with his own stresses of teaching and supporting traumatized kids. He believed the breathing techniques that helped calm his fears might work for his students too, so he founded the Mindful Life Project.

“Before we can teach a kid how to academically excel in school, we need to teach him how to have stillness, pay attention, stay on task, regulate, make good choices,” said Larochette. “We tell kids be quiet, calm yourself down, be still. We tell them all these things they need in the classroom, but we’re not teaching them how to do that.”

The project has since grown and is now being incorporated in a group of elementary schools in Richmond, in an attempt to improve academic performance and create a more positive school culture by teaching students mindfulness. Mindfulness is the ability to exist in the present moment and practicing it often looks like meditation.


Schools across the country are beginning to use mindfulness as part of an effort to address the social and emotional needs of children, improving student achievement in the process. 

“When we look at low performing schools it’s not that these children are unable to learn, it’s that very often they are unavailable to learn.”

“My hour of lost teaching time because of behavior problems went down to about 15 minutes a day –that meant almost a whole other day of teaching,” Larochette said. “I had to figure out what I could do to bring this to the rest of the schools in our area.”

Check out what the Mindful Life Project looks like in action.

Studies of mindfulness programs in schools have found that regular practice — even just a few minutes per day — improves student self-control and increases their classroom participation, respect for others, happiness, optimism, and self-acceptance levels. It can help reduce absenteeism and suspensions too. A mindfulness practice helps reduce activity in the amygdala, the brain’s emotional center responsible for fear and stress reactions.

“The other thing we know mindfulness does with the brain is it increases the activity in the prefrontal cortex,” said Vicki Zakrzewski, education director at the U.C. Berkeley Greater Good Science Center, which studies the science behind mindfulness. “This is where we make our decisions, how we plan, our abstract thinking,” she said.

Educators at Nystrom Elementary school in Richmond are seeing some of those positive effects in their students. “This year is much better,” said third-grade teacher Glenna Hamilton. “Last year, it was just horrible.”

One of Hamilton’s most disruptive students became more respectful and responsible since he began receiving mindfulness training. “If he does something incorrect, instead of being argumentative with me, he really thinks about it and realizes, ‘I didn’t make a good choice,’ and I see him self-correcting,” she said.

Nystrom’s school culture has shifted since the student began mindfulness training, said Principal LeDonna Williams. Students now have a common language to use when they want to calm each other down and fewer students are being sent to her office. When a student does act up, Williams will sometimes ask them to practice mindfulness before she addresses the problem. “Then, you see the little fists releasing and their temperament coming down and they’re willing to talk to you a little more candidly about what their issues are,” Williams said. “They use it, they really do and it’s nice to see that.”

Coping Mechanism for Trauma

Many students at Nystrom directly know people who have been killed and others experience trauma secondhand from living in a violent neighborhood. In 2013, there were four homicides, 39 armed robberies and 47 assaults with a deadly weapon reported to the police in South Richmond.

“There’s a lot of grief and loss,” Williams said. “A lot of students experience violence on a daily basis, either in the home or in the community. And it’s coming out in their school work, in their interactions with other students, the climate of the school, it affects that.”


All the schools the Mindful Life Project works with have seen drops in detentions and referrals, said Larochette. At Nystrom, 18 kids accounted for 82 percent of the suspensions. At the beginning of their mindfulness training those kids were suspended 62 times in the first trimester. After three trimesters of mindfulness practice, that rate had dropped to 20.

“When we look at low-performing schools it’s not that these children are unable to learn, it’s that very often they are unavailable to learn,” said Madeline Kronenberg, a West Contra Costa County school board member. “They’re not able to focus; they’re so fixated on other things that are going on in their lives that it’s difficult for them to be able to find space for learning. Our job is to educate these kids and the way you educate them is that they need to be available to learn."

At Nystrom, students report using mindfulness in a variety of situations. “When there are older kids, we were playing football and he hit me pretty hard on purpose,” said sixth-grader Tayshawn Newman. “We were going to get into a huge argument, and I just said, ‘Forget it.’ I took a deep breath and said, ‘Forget it.’”

Another student reported that the mindfulness training makes him feel calmer and that he uses it when he feels like hitting someone. Another boy said he uses his mindfulness practice when he has trouble falling asleep.

The mindfulness instructors understand that for many kids the ability to create inward calm is crucial when external quiet is hard to come by.

“The idea was to really create a grassroots movement,” said Larochette. “A movement that’s within, that stays within, that solidifies within and then meeting our kids when they get to middle school and high school and sustaining those opportunities and having a mindful life project instead of just mindfulness for eight to 10 weeks or a couple of years.”

The project is in the process of finalizing contracts with two of the biggest middle schools in the area. They hope mindfulness will follow elementary school graduates, helping them navigate middle school and eventually high school. Ultimately, Larochette would love to have high school mindfulness students come back to mentor younger students.

My Three Daughters are Autistic. I Despise Autism Awareness Month.

From The Washington Post

By Kim Stagliano
April 2, 2015

"The best way we can support Autism Awareness Month is to turn it into Autism Action Month. People with autism deserve a bright – not just a blue – future."


Today (April 1st), you’ll be seeing a lot of blue: World monuments will be cast in blue lights, your co-workers will be wearing blue clothes, and companies will be hawking blue products. Why? April 2 is World Autism Awareness Day, when advocacy group Autism Speaks “celebrates” its international Light It Up Blue Campaign.

But while you’ll be seeing blue everywhere, I’ll be seeing RED. The feel-good frippery of Light It Up Blue cloaks an often debilitating disorder in an air of festivity, with balloons, sparkling lights and pep rallies. The campaign implies autism is a party, rather than a crisis. For families living with autism, reality is far more sober, and their needs extend far beyond “awareness.”

I dread April, which has been designated as Autism Awareness Month. As mom to three young women with autism – ages 20, 18 and 14 – I eat, sleep and live autism every day. My youngest daughter, Bella, can’t speak a word and was abused on a school bus, leading to a criminal case. My oldest, Mia, had hundreds of grand mal seizures a year from ages 6 to 10. My middle child is wracked with anxiety.

For all three, I have to cut their food, tend to their monthly feminine needs, and bathe them. They will need that daily living assistance forever; when I die, a stranger will have to do those things for them.

That is why I bristle at the festive tone of April, the suggestion that the circumstances of my daughters’ existences are to be celebrated. For me, this should be a month of solemn acknowledgement and education about a global crisis.

Yet, Autism Speaks talks about World Autism Awareness Day as an event that “celebrates the unique talents and skills of persons with autism.” I’m all for honoring the achievements of people with autism, but the term “unique talents and skills” hardly connotes a global crisis. That’s the tone increasingly used in conversations about this disorder.

Some advocates suggest autism is advantageous – even a gift. Before backtracking on his comments last year, Jerry Seinfeld said he believed he was on the autism spectrum, casting it not as a disorder, but “an alternative mindset.” It made me angrier than the Soup Nazi.

Let’s be clear: Autism is no walk in the park for those who have it, nor for their loved ones. The National Autism Association, the leader in autism safety information, reports that 48% of autistic children wander or run away from a safe environment, a rate nearly four times higher than their non-autistic siblings. Accidental drowning accounts for 91% of deaths of autistic children under 14 years old after those wanderings.

These children also face horrific bullying and teasing. For instance, an Ohio high school student with Asperger’s Syndrome, a type of autism, was the victim of an Ice Bucket Challenge “prank” (really, an assault) last year when three teens dumped a mixture of urine, tobacco and spit on his head.

Even after high school, young adults with autism face a bleak quality of life, with lower employment rates than those with other disabilities. One study found that just 35 percent of autistic young adults had attended college and just 55 percent had been employed during their first six years after high school.

I understand the impetus to raise awareness about autism. Much of the world does not think about autism 24-7 – at least not yet. Today, about one in 68 children is diagnosed with autism spectrum disorder, a sharp increase from the autism rate just a decade ago. It is the fastest growing developmental disorder.

Certainly, a disorder so common deserves at least a month dedicated to educating people about its effects and raising money for critical social programs that can make autistic people’s lives happier, healthier and safer.

"What the autism community needs isn’t a party, but a sense of urgency and true crisis."

But illuminating the Eiffel Tower in blue does more to promote an organization than to improve the lives of autistic people and their caretakers. Celebrating talents does little to educate the public on the intense challenges of the diagnosis and the tough aspects of living with the disability. What the autism community needs isn’t a party, but a sense of urgency and true crisis. They need advocates committed not only to getting them the acceptance they deserve, but also the critical help they require to survive, in the form of social programs, education, safety and employment opportunities.

If you’re compelled to contribute to Autism Awareness Month, I suggest you make a donation to a local organization that is actively helping families in your area. Instead of attending pep rallies and wearing blue bracelets, give to an organization that provides service dogs for autistic children or volunteer as an autism buddy. If your child has a classmate on the spectrum, invite that classmate to your child’s next birthday party. You know that cashier at the grocery store who doesn’t look at you as she takes care of your order? Smile at her, even if she does not smile back.

The best way we can support Autism Awareness Month is to turn it into Autism Action Month. People with autism deserve a bright – not just a blue – future.

........................................................

Kim Stagliano has authored a novel and two books on parenting daughters with autism. She is managing editor of Age of Autism.

Wednesday, April 29, 2015

Adverse Childhood Experiences Linked to Asthma

From PsychCentral

By Traci Pedersen
April 26, 2015

Children exposed to an adverse childhood experience (ACE) are 28% more likely to develop asthma, according to a new study published in the Annals of Allergy, Asthma & Immunology. The asthma risk increases even more with each additional ACE exposure.


“Asthma is one of the most common chronic childhood conditions, currently affecting seven million, or 9.5 percent, of children in the U.S.,” said researcher Robyn Wing, M.D., an emergency medicine physician at Hasbro Children’s Hospital in Providence, R.I.

“The biological risk factors for asthma onset and severity, such as genetics, allergens, tobacco smoke, air pollution, and respiratory infections, have been well established by previous studies. But, psychosocial factors, such as stress, which we know can be physically harmful, are now being examined as a risk factor for asthma in children.”

The researchers analyzed data from nearly 100,000 children and teens in the 2011-2012 National Survey of Children’s Health and compared parent or guardian reports of a child having asthma to whether a child had experienced an ACE at home.

An ACE is considered to have happened if the child has ever lived with a parent or guardian who experienced one of the following: got divorced, died, or served time in jail or prison.

An ACE could also include living with anyone who was mentally ill or suicidal, or severely depressed for more than a couple of weeks; living with anyone who had a problem with alcohol or drugs; or witnessing parents, guardians or any other adults in the home slap, hit, kick, punch, or beat each other up.

The findings showed that children exposed to one ACE had a 28 percent greater risk of developing asthma compared to those with no ACEs. These rates increase with each additional ACE, with children exposed to four ACEs having a 73 percent increase in reported asthma.

Earlier asthma studies have focused mostly on neighborhood and urban-related issues, such as family poverty, poor quality housing and access to community resources. But, disruptive family relationships within the home can be a significant source of psychosocial stress for children.


“Psychosocial stressors activate the sympathetic nervous system, which controls our ‘fight or flight’ responses when we experience stressful situations,” said Wing.

“Increased activity of this system releases cortisol, a stress hormone, which has been shown to affect the activity of immune cells. Occasional increases in these hormones are protective, but excessively high or prolonged exposures, such as those experienced by children exposed to ACEs, can be harmful.”

Wing hopes this study, and others like it, will highlight the complex causes of asthma, enabling clinicians to better target preventative medications and other interventions.

“Physicians taking care of children with asthma should take the time to ask about the child’s home situation,” said Wing.

“For children experiencing stressors at home, encouraging efforts to increase the child’s capability of handling stressors, using methods such as individual or family therapy, may help target pediatric asthma.”

“Stress should be viewed as a risk factor for asthma development and asthma exacerbations, much like tobacco smoke and dust mites. At the very least, clinicians can share with parents the impacts of ACEs on their child’s asthma, perhaps acting as a motivating factor for parents to remove or shield a child from a stressful home situation.”

Parenting Children with Developmental Disabilities: “Developing” into the Role through Community

From The Doctor's Tablet
The Blog of the Albert Einstein College of Medicine

By Lisa Shulman, M.D.
April 21, 2015

Editors’ Note: Last week, Einstein neurodevelopmental pediatrician Lisa Shulman wrote about the tough experience of telling parents their child has autism. The news is often life-altering. This week, she shares how attitudes and priorities of parents change over time.


"...having the support of a community of other parents and caring professionals provides new perspectives, a stronger sense of purpose and the realization that you’re often more creative and resilient than you ever imagined."

I am fortunate as a clinician to have the opportunity to follow long-term many of the children whom I diagnose with a developmental disability. I may be an expert on infants and toddlers, but in the course of following my patients, I revel in the developmental milestones and progress of my patients as they become preschoolers, elementary-age children, adolescents and then young adults.

But as an expert on development, one thing I have come to appreciate over the years is that parents develop, too. I watch parents change, learn and develop new priorities and perspectives. Mothers and fathers who were dragged kicking and screaming into the world of parenting a child with a developmental disability have turned into impressive advocates, teachers and graduate students studying special education and social work.

Other parents, who stormed out of my office angry, stormed back in with creative solutions and strategies born out of love and acceptance of their role as the parents of a child with a developmental disability.

Recently, we held the third annual “Parent Workshop” at Albert Einstein College of Medicine’s Children’s Evaluation and Rehabilitation Center. The event is spearheaded, organized and run by four young and enthusiastic clinician colleagues, including social workers as well as speech and language therapists, who work closely with many of the families and children we see at the center.

The day consisted of 16 sessions relating to parenting a child with a developmental disability. Topics ranged from behavior management to coping with bullying, indications for medication, strategies for homework, sex education, use of technology to promote development and more. Workshops were led by CERC clinicians and many were held in both English and Spanish.

Eighty-seven parents participated. I had the honor of giving the keynote address and decided to create an interactive presentation on parental identity in the setting of raising a child with a developmental disability. The talk was titled “Who Do You Think You Are?”

I took the parents through the idea that other people can’t define us, only we can; that we all have multiple identities, and being the parent of a child with a developmental disability is just one. During the event, we examined how experiences change us.

We had the parents form groups and asked them to give advice to President Obama about the unmet needs of families with children with developmental needs. We asked them to share what they wanted their child’s doctors, therapists and teachers to know. The parents gave advice to those whose children were just diagnosed. Many of them spoke about the most important support they had in raising a child facing these challenges.

We ended the session asking parents to consider the following: “When you walk into a room, in that moment you are the parent of a child with a disability, but you are SO much more . . . who are you? Take a moment to think of a word to describe yourself.” Parents rose from their seats one by one and called out: “brave,” “afraid,” “proud,” “a role model” and “my child’s advocate.”

A few days earlier, I had recommended the workshop to a parent I had just seen. The mother had been teary in the office. She noted that her younger son seemed to be surpassing the older boy who was my patient, and as is often the case, that observation began to make things clear in a way no discussion held in advance could. She came to the workshop, telling a clinician that she was too overwhelmed and emotional to speak up. Instead, she became the second parent to stand and contribute at my interactive event. She shared how this was the first time that she had acknowledged out loud that her son has autism: “It’s been like a brick I’ve been trying to hold up by myself,” and now she had found others to help hold it up, so that she could take a breath.

It was a very moving day for all of us. Some things don’t get easier with time . . . but as this event showed, having the support of a community of other parents and caring professionals provides new perspectives, a stronger sense of purpose and the realization that you’re often more creative and resilient than you ever imagined.

About Lisa Shulman, M.D. 

Lisa Shulman is a neurodevelopmental pediatrician, an associate professor of pediatrics at the Albert Einstein College of Medicine and Director of Infant and Toddler Services and the RELATE program at Einstein's Children's Evaluation and Rehabilitation Center.

Tuesday, April 28, 2015

New Research Finds No Evidence That Thimerosal-Containing Vaccines Affect Neurodevelopment and Behavior in Infant Primates

From lbrb
Left Brain Right Brain

By Matt Carey
April 26, 2015

"... the data in this primate study overwhelmingly provides support for the safety of pediatric vaccines.”

Below is a press release from the Johnson Center (formerly Thoughtful House). It is about a recent follow-up study they performed (discussed here). I’ll give the press release below with no further comment except to highlight this statement by the lead researcher: “Despite these limitations, the data in this primate study overwhelmingly provides support for the safety of pediatric vaccines.”

New Research Finds No Evidence That Thimerosal-Containing Vaccines Affect Neurodevelopment and Behavior in Infant Primates


(Austin, Texas) – February 18, 2015 – A research study published today in Environmental Health Perspectivesreported that vaccination of infant macaques with thimerosal-containing vaccines did not negatively impact neurodevelopment, cognition, or behavior. In this study animals received several pediatric vaccines containing thimerosal (a mercury-based preservative) in a schedule similar to that given to infants in the 1990s. Other animals received just the measles-mumps-rubella (MMR) vaccine, which does not contain thimerosal, or an expanded vaccine schedule similar to that recommended for US infants today. Control animals received a saline injection. Regardless of vaccination status, all animals developed normally.

“This comprehensive study of infant primate development, including analyses of learning, cognition, and social development, indicated that vaccinated primates were not negatively affected by thimerosal or the MMR vaccine; the same was true for animals receiving an expanded vaccine schedule” explained Dr. Laura Hewitson of The Johnson Center for Child Health and Development, the principle investigator of the study.

Hewitson worked with a team of researchers at the Center on Human Development and Disability Infant Primate Research Laboratory and the Washington National Primate Research Center (WaNPRC) at the University of Washington, Seattle WA. According to Hewitson, the study was designed to compare the safety of different vaccination schedules, including the schedule from the 1990s, when thimerosal was still used as a preservative in multi-dose vaccine preparations. Although in 1999 the FDA and the American Academy of Pediatrics recommended that thimerosal be removed from vaccines in the US, it is still used as a preservative in multi-dose flu shots, which are recommended for pregnant women and children 6 months of age and older.

“This is the first time the safety of the entire pediatric vaccine schedule has been investigated in a relevant animal model,” said Dr. Judy Van de Water from the UC-Davis MIND Institute, who was not involved in this study.

Hewitson also noted, “As with any animal study, assessments were implemented under controlled laboratory conditions. We did not test all of the interacting variables that could contribute to an adverse outcome, such as birth weight, gestational age, genetic vulnerability, or in utero and post-natal chemical exposures. The interaction between multiple environmental exposures or genetic factors that may impact vaccine response, which is an important aspect of the vaccine debate, was not addressed in this study. Despite these limitations, the data in this primate study overwhelmingly provides support for the safety of pediatric vaccines.”


Citation

Examination of the Safety of Pediatric Vaccine Schedules in a Non-Human Primate Model: Assessments of Neurodevelopment, Learning, and Social Behavior. Britni Curtis, Noelle Liberato, Megan Rulien, Kelly Morrisroe, Caroline Kenney, Vernon Yutuc, Clayton Ferrier, C. Nathan Marti, Dorothy Mandell, Thomas M. Burbacher, Gene P. Sackett and Laura Hewitson. Environmental Health Perspectives, Feb 18, 2015; doi:10.1289/ehp.1408257. Once the embargo lifts, this article can be downloaded for free at http://ehp.niehs.nih.gov/1408257.

This study was supported by The Ted Lindsay Foundation, SafeMinds, National Autism Association, the Vernick family, and the Johnson family. This work was also supported by WaNPRC Core Grant RR00166 and CHDD Core Grant HD02274.

Editor's Note

The Johnson Center for Child Health and Development, in Austin, Texas, was formerly known as Thoughtful House. Thoughtful House was established in 2004 by, among others, Andrew Wakefield, principal author of the now-discredited Lancet paper that purportedly linked autism to MMR vaccination. That paper was later retracted and, in disgrace, Wakefield was stripped of his license to practice medicine in the U.K. In 2010, Wakefield resigned from Thoughtful House, which shortly thereafter changed its name, presumably to distance itself from him. It also changed its mission statement. Previously, they had engaged in research related to Wakefield's claims and provided "alternative" autism therapies; now, The Johnson Center says they work,"to advance the understanding of childhood development through clinical care, research, and education."

SafeMinds is a strident (albeit lately, more moderate in tone) anti-vaccine organization established to combat what they perceive to be a vaccine-driven autism epidemic. It still subscribes to theories of vaccine toxicity and sponsors research "intended to determine whether the vaccine-injury risk has risen to an unacceptably high level, in comparison to disease-injury risk, which would indicate that smart action is needed to make the current USA vaccination schedule safer and more effective." Note the presupposition that there is significant "vaccine-injury risk" and that the current schedule is unsafe.

It is very interesting that their own research validates the safety of vaccination.

The Corrosive Cult of Compliance in our Schools

From Al Jezeera America

By David M. Perry
April 21, 2015

Rise of zero-tolerance policies strips school officials of the ability to exercise common sense.

 
Kayleb Moon-Robinson is a 12-year-old boy who lives in Virginia. One day at school, he kicked a trash can and was charged with disorderly conduct in juvenile court. A few weeks later, he disobeyed a new rule (made just for him) that he stay behind in the classroom while his peers left. When the school resource officer (SRO) arrived to take him to the principal’s office for disobedience, Kayleb reportedly struggled and swore. The officer allegedly slammed the boy down on a desk and handcuffed him.

Kayleb is now being charged with felony assault on a police officer, and his future is very much in doubt.

Kayleb is autistic and African-American. The state of Virginia wants to brand him a criminal. The Center for Public Integrity names it as the state most likely to send students to jail. Virginia was also home to the Reginald “Neil” Latson case, in which a young man with autism encountered a police officer, didn’t comply with orders, started walking away and ended up in a brutal fight. He spent years in solitary confinement as a result before finally being pardoned.

Kayleb’s story has become national news, thanks to a new report from the Center for Investigative Reporting and the Center for Public Integrity. His case, unfortunately, is not at all unusual. Across the country, children are being severely punished for acting in atypical ways. A disproportionate number have disabilities or are nonwhite.


Salecia Johnson, a 6-year-old girl in Georgia, was arrested for having a tantrum. In Virginia a 4-year-old boy with attention deficit disorder was cuffed and shackled. Colton Granito, an autistic 8-year-old in Tennessee, was placed in a straitjacket and charged with assault. No matter what these children were doing, anytime the solution involves placing a child in shackles, the people in charge have grotesquely failed.

These cases of arrest and restraint are just the ugliest and most visible ways that children who are different get excluded. The same justification — that everyone must comply with the rules — informs other kinds of actions by schools.


In Kansas a young athlete with Down syndrome was told to remove his letter jacket because there was no policy supporting special-needs athletes’ earning of letters. A parent had complained that the young man didn’t deserve the jacket. Another school recently took away a blind child’s cane and replaced it with a pool noodle because he waved the cane in the air. In effect, the school punished mild misbehavior by removing his eyes.

A deaf boy, just 3 years old, was told he could no longer sign his name with an H because it looked too much like a gun. These cases didn’t end up with a child in jail, but they reveal the depth of the problem.

For those like Kayleb who live at the intersection of race and disability, these manifestations of what I call the cult of compliance can destroy lives. It threatens anyone who might fall outside the dominant norms. The cultural forces that punish diversity aren’t new. In the past, however, such perceived deviance might have met with bullying from peers or various forms of exclusion by teachers and other staffers. Today, jail beckons.

There are two major factors at work. First, the rise of zero-tolerance policies strips school officials of the ability to exercise common sense, leading security expert Bruce Schneier to call them “zero-discretion” policies. Such policies have long been criticized as being unfair to marginalized groups of all sorts.


Second, SROs have increasingly been deployed on school grounds over the last few decades, a process that keeps intensifying after high-profile school shootings such as Columbine (1999) and Sandy Hook (2012). Meanwhile, SROs are experiencing mission creep. While de-escalation is usually the optimal response to challenging behavior situations, many teachers and administrators instead respond by calling in an SRO to apply restraints and arrest the student, thereby starting the process of criminalization. That’s how the school-to-prison pipeline begins.

"In a just society, we don’t send children to jail for being disorderly."

Charles A. Bell, a doctoral candidate in sociology at Wayne State University and a critic of zero-tolerance policies and their costs on African-American youth, calls such responses “irrational.” When a child acts disruptively, he said, the worst thing you can do is to restrain or criminalize them. That’s true for people with and without disabilities. These policies, he said, “ignore all the socioemotional research that calls for deeper investigation into the causes behind problematic behavior in the classroom.”


When disabilities are part of the situation, he added, there’s often an individualized education plan that requires certain kinds of behavior interventions, but too often these plans are not followed adequately.

Despite the research, it has been hard to fix these policies. One problem is that organizations tend to focus too much on single categories — race, class, gender, ability, sexual orientation, religion, etc. — rather than look for intersections. That has to change.

“[Kayleb’s] story very much speaks to the terrible atrocities that occur at the intersection of mental disability and race,” said Zach Richter, a graduate student in disability studies at the University of Illinois at Chicago. “The combined categories of autism and blackness have painted this young man as stereotypically violent and unreasonable.”

Lydia Brown, an autistic activist, wrote a blog post calling for a joint response to Kayleb’s impending incarceration. In an email, she said, “We need to urge organizations working for racial justice, disability rights and the end of mass incarceration to acknowledge the intersectional complexities of what is happening to Kayleb and to unite in collective demands for real justice.”

The Autistic Self-Advocacy Network (ASAN) has released a statement condemning the arrest and calling for Gov. Terry McAuliffe to pardon Kayleb. (There’s also a petition. The governor’s office did not return a request for comment.) ASAN characterized the school-to-prison pipeline in Virginia as:


“...a systemic misapplication of school disciplinary procedures that disproportionately targets students of color, students with disabilities and students of color with disabilities, resulting in harsher discipline and students being funneled into the juvenile justice and prison systems at younger and younger ages.”

ASAN’s president, Ari Ne’eman, urged policymakers to look beyond the specific problems of zero-tolerance policies, saying, “These incidents are a function of the fact that there’s often not sufficient investment of teaching general education teachers how to de-escalate and adequately support students who are experiencing some form of [behavioral] challenge.”

Teachers obviously need more training in de-escalation, and students with and without disabilities need better protections. We need to recognize that despite the real challenges teachers face, in a just society, we don’t send children to jail for being disorderly.

When Kayleb and other children like him become victims of the cult of compliance in our schools, there is an incalculable cost, borne directly by those who are incarcerated and their families. And when educational institutions elevate bad policies over the well-being of individuals, they teach everyone the wrong lesson. It sends the message that compliance trumps empathy.

Instead, our schools should demonstrate the value of our shared humanity and all types of diversity, including neurological diversity.

..........................................................................................

David M. Perry writes on language and power at How Did We Get Into This Mess? He is a history professor at Dominican University.

Monday, April 27, 2015

MUST READ - NCD Response to Controversial Peter Singer Interview Advocating the Killing of Disabled Infants: "Professor, Do Your Homework"

From the National Council on Disability

April 23, 2015

On Sunday, April 16, contentious Princeton Professor Peter Singer once again argued that it is “reasonable” for the government or private insurance companies to deny treatment to infants with disabilities. Singer’s remarks were made on “Aaron Klein Investigative Radio,” which is broadcast on New York’s AM 970 and Philadelphia 990 AM.

In the interview, which was perhaps ironically conducted as part of a press tour Singer is currently on promoting his new book about charities, “The Most Good You Can Do: How Effective Altruism Is Changing Ideas About Living Ethically,” the professor advocated the shocking claim that health care laws like the Affordable Care Act should be more overt about rationing and that we should acknowledge the necessity of “intentionally ending the lives of severely disabled infants.”

During the controversial segment, talk show host Aaron Klein quoted from a chapter of Singer’s “Practical Ethics” titled “Taking Life: Humans,” published in 1993.

Singer, who is known for his provocative and often contradictory views on animal liberation and infanticide, also repeatedly referred to disabled infants as “it” during the interview. Without offering any scientific evidence to support what amounts to a return to eugenics, Singer routinely contends the “right to life” is related to a being’s capacity for intelligence and having preferences, which in turn is directly related to an undefined capacity to feel and/or comprehend ethereal concepts like pain and pleasure.

He told Klein that health care rationing is already happening, and surmised that hospitals routinely make decisions not based on need, but rather on cost.


Singer then used the presumed practice to rationalize the killing of disabled infants by arguing in support of “non-voluntary euthanasia” for human beings who he contends are not capable of understanding the choice between life and death, including “severely disabled infants, and people who through accident, illness, or old age have permanently lost the capacity to understand the issue involved.”

When asked whether denying treatment to disabled infants has become more common in the United States under the Affordable Care Act, Singer speculated: “It does happen. Not necessarily because of costs” and continued:


“If an infant is born with a massive hemorrhage in the brain that means it will be so severely disabled that if the infant lives it will never even be able to recognize its mother, it won’t be able to interact with any other human being, it will just lie there in the bed and you could feed it but that’s all that will happen, doctors will turn off the respirator that is keeping that infant alive.”

“I don’t know whether they are influenced by reducing costs,” Singer said before using what critics claim is inflammatory and speculative language to defend the practice.

“Probably they are just influenced by the fact that this will be a terrible burden for the parents to look after, and there will be no quality of life for the child... We are already taking steps that quite knowingly and intentionally are ending the lives of severely disabled infants. And I think we ought to be more open in recognizing that this happens.”

Klein followed up by asking whether the killing of severely disabled infants should be encouraged to reduce health-care costs. “Do you think in the future in order to ensure a more fair rationing of health-care and health-care costs,” asked Klein, “that it should actually be instituted more? The killing of severely disabled babies?”

Singer responded, by stating if “you had a health-care system in which governments were trying to say, “Look, there are some things that don’t provide enough benefits given the costs of those treatments. And if we didn’t do them we would be able to do a lot more good for other people who have better prospects,” then yes, I think it would be reasonable for governments to say, “This treatment is not going to be provided on the national health service if it’s a country with a national health service. Or in the United States on Medicare or Medicaid.”

Without offering any concrete measure on how quality of life could or should be determined, Singer admitted, “I don’t want my health insurance premiums to be higher so that infants who can experience zero quality of life can have expensive treatments.”

As NCD wrote in 1997, “Under the federal Rehabilitation Act and the Americans with Disabilities Act, the United States, through the Department of Justice, is responsible for enforcement of requirements that people with disabilities not be discriminated against by federal, state, and private hospitals and other health care providers.”

On numerous occasions, NCD has discussed and documented the existence of widespread and virulent discrimination on the basis of disability. The existence of such discrimination and the deleterious effect that it has upon citizens with disabilities and our nation were primary reasons that in 1986 the Council proposed what became the Americans with Disabilities Act (ADA).

When the ADA was enacted over two decades ago, Congress recognized "historically, society has tended to isolate and segregate individuals with disabilities, and despite some improvements, such forms of discrimination continue to be a serious and pervasive social problem." [1] NCD continues to receive calls, reports and messages about pervasive prejudice and discrimination daily. Unlike Singer’s provocative guesswork, ivory tower speculation this is not.

Further, Congress acknowledged the real-world reality that individuals with disabilities "have been faced with restrictions and limitations, subjected to a history of purposeful unequal treatment, and relegated to a position of political powerlessness in our society. [2] The deep-seated nature of discrimination on the basis of disability has been widely acknowledged and documented by numerous other authorities. [3]

Discrimination because of disability is not likely to be reduced by Singer’s positions, or the logical policy positions that would emerge from them. Discrimination is not solely a philosophical concept it remains a regular occurrence for individuals with disabilities.

One of the hallmarks of societal attitudes toward disabilities has been a tendency of people without disabilities, including media savvy philosophers, to overestimate the negative aspects and underestimate the positive features of the lives of those who have disabilities. The attitude of "I don't see how you can live with that" -- sometimes expressed more dramatically as "I'd rather be dead than have [X disability]" -- is one that people still shockingly profess openly in encounters with people with disabilities.

The U.S. Commission on Civil Rights has described the "extremely extensive" negative connotations of disability: "To the fact that a [person with a disability] differs from the norm physically or mentally, people often add a value judgment that such a difference is a big and very negative one." [4] Even without evidence to support this supposition, philosophers like Singer are not immune from this bias. In fact, their views seem to emerge from it when divorced from the reality of the lives that disabled people actually live.

In contrast to Singer’s ivory tower speculations, the United States Supreme Court has acknowledged that "society's accumulated myths and fears about disability are as handicapping as are the physical limitations that flow from actual impairment." [5] Regulations and courts addressing job discrimination based on disability under the ADA and other laws have expressly identified the discrimination that results from misperceptions and unrealistically low expectations of what people with disabilities are able to do. [6]

One legal commentator has written that "[t]he image of a [person with a disability] as one who is not able to do many things, who is unable to fill a proper role in society, and who is not a success in terms of achievements or happiness is widespread and deep-seated." [7]

Increasingly, negative predictions of quality of life have little to do with the actual life experiences of people with disabilities. People with disabilities commonly report more satisfaction with their lives than others might expect. Though it might surprise Singer and those with limited imaginations, even people with disabilities who encounter obstacles, prejudice, and discrimination, derive satisfaction and pleasure from their lives.

For example, a nationwide poll of people with disabilities, conducted by Louis Harris and Associates reported that "[d]espite their disadvantaged status and frequent exclusion from activities enjoyed by most Americans, a large majority of disabled Americans are satisfied with their lives"; the Harris organization described this as "a remarkable finding in light of the portrait of hardships revealed in these survey findings." [8] Even individuals who identified themselves as having very severe disabilities tended to report that they were very or somewhat satisfied with their lives. [9]

While Singer has certainly proven himself as adept at getting press by spinning yarns that are decades if not centuries removed from the lived experience of disability, thankfully polls, social scientists and disabled people themselves are telling a different story.

The realities of quality of the lives of Americans with disabilities is obscured by the misguided projections and low expectations of others, for as one disability authority has observed, "when society opts to judge the quality of life for an individual with a disability, it does so from the perspective of a fear of disability and historical prejudice and discrimination." [10]

Recognizing this fact, NCD categorically rejects any calculus that assumes to ascribe a measurable, immutable quality of life to another human being – disabled or not. There are simply too many variables to consider in making “quality of life” assumptions. Such conjecture should be left in the classroom alongside brainteasers about moving trains and traveling at the speed of light.

People with disabilities have also frequently seen firsthand that medicine, not unlike philosophy, is more of an art than a fixed, immutable status quo, particularly when it comes to the imperfections of medical prognosticating. It is not uncommon for individuals with disabilities and parents of children with disabilities to receive fervently bleak, but inaccurate predictions by members of the medical professional about options, opportunities or potential.

Evan Kemp, former chairman of the Equal Employment Opportunity Commission, who was diagnosed with a progressive neuromuscular disease at age 12, once wrote:

“Upon diagnosis, my parents were informed by the physicians treating me that I would die within two years. Later, another group of physicians was certain that I would live only to the age of 18. Yet here I am at age 59, continuing to have an extraordinarily high quality of life. The majority of families I have encountered in my lifetime, and who have been close enough to share details of their extended family life, have had at least one member who defied the medical establishment by living a far longer and more productive life than expected.” [11]

One noteworthy example of erroneous medical fortunetelling was a widely publicized court case [12] in which permission was sought to discontinue a ventilator for a comatose young woman named Karen Quinlan. There was no dispute among the medical experts consulted that without the assistance of the ventilator Ms. Quinlan would die in a matter of days or weeks, if not hours. After New Jersey courts approved discontinuance of the ventilator, it was removed, but Quinlan lived, breathing on her own, for almost ten years.

However one feels about the court's decision in the Quinlan case, it is clear that the medical forecasting was substantially erroneous even in this highly visible, arguably carefully considered, fully-litigated situation.

This is not to suggest that most or even a substantial portion of medical projecting is erroneous, but rather that people with disabilities are aware of enough instances of dramatic mistakes that many have a healthy and appropriate degree of skepticism when it comes to medical predictions, particularly as it relates to assumptions about one’s quality of life.

Medical personnel are not always very knowledgeable of special education and rehabilitation techniques, specialized accommodations, independent living philosophy, and other factors that may spell the difference between a direly limited or satisfying and fulfilling future for an individual with a disability. And it seems, neither are some philosophers on media tours to sell their latest book.

NCD suggests that this should be taken into account when considering the validity of their views, as should the practical and understandably disturbing policy implications of sound bite sensationalism. Hypothetical supposition should be expected in the classroom, but when presented as fact we would be wise to consider the real-life consequences of provocative discourse – especially when those positions, after careful examination, are exposed as spurious speculation.

In short, we offer this simple but indispensable advice: “Professor, do your homework.”

Citations

[1] 42 U.S.C. §12101(a)(2).

[2] Id. §12101(a)(7).

[3] See, e.g., Accommodating the Spectrum of Individual Abilities 17-42, 159; Alexander v. Choate, 469 U.S. 287, 295-96, 286 (quoting 117 Cong. Rec. 45,974 (1971) (statement of Rep. Vanik); 118 Cong. Rec. 526 (1972) (statement of Sen. Percy)) (1985); S. Rep. No. 116, 101st Cong., 1st Sess. 9 (1989); H.R. Rep. No. 485, 101st Cong., 2d Sess. pt. 2, at 32 (1990) (Education and Labor Committee) [hereinafter Education & Labor Committee Report]; Task Force on the Rights & Empowerment of Americans with Disabilities, Equality for 43 Million Americans with Disabilities: A Moral and Economic Imperative 8 (1990), quoted in Education & Labor Committee Report, at 31-32; Louis Harris & Assocs., The ICD Survey of Disabled Americans: Bringing Disabled Americans into the Mainstream 70, 75 (1986); Louis Harris & Assocs., The ICD Survey II: Employing Disabled Americans 12 (1987); City of Cleburne v. Cleburne Living Center, 473 U.S. 432, 454 (Stevens, J., joined by Burger, C.J., concurring) (1985); id. at 461, 462 (Marshall, J., joined by Brennan & Blackmun, JJ., concurring in part and dissenting in part).

[4] U.S. Commn on Civil Rights, Accommodating the Spectrum of Individual Abilities 26 (1983)

[5] School Board of Nassau County v. Arline, 480 U.S. 273, 284-85 (1987).

[6] 29 C.F.R. 406 (app. to pt. 1630) (commentary on §1630.2(l)) (1993) (can prove discrimination "by demonstrating that the exclusion was caused by one of the `common attitudinal barriers' toward individuals with disabilities such as an employer's concern about productivity, safety, insurance, liability, attendance, cost of accommodation and accessibility, workers compensation costs, and acceptance by coworkers and customers"); Wooten v. Farmland Foods, 58 F.3d 382, 385 (8th Cir. 1995) (the "regarded as" prong of the definition of disability encompasses "archaic attitudes, erroneous perceptions, and myths"). Several ADA decisions have recognized employers' "myths, fears and stereotypes associated with disabilities." See, e.g., Freund v. Lockheed Missiles and Space Co., 930 F.Supp. 613, 618 (S.D.Ga. 1996); EEOC v. Texas Bus Lines, 923 F.Supp. 965, 975 (S.D.Tex. 1996); Howard v. Navistar Internat'l Transp. Corp., 904 F.Supp. 922, 929-30 (E.D.Wis. 1995); Pritchard v. Southern Company Services, 1995 WL 338662, 4 AD Cases 465, 473 (N.D.Ala. 1995); Lussier v. Runyon, 1994 WL 129776, 3 AD Cases 223, 231 (D.Me. 1994); Scharff v. Frank, 791 F.Supp. 182, 187 (S.D.Oh. 1991) ("stereotypical treatment").

[7] Robert L. Burgdorf Jr., The Legal Rights of Handicapped Persons: Cases, Materials, and Text 8 (1980).

[8] Louis Harris & Assocs., The ICD Survey of Disabled Americans: Bringing Disabled Americans into the Mainstream 55 (1986).

[9] Id. at 46, Table 19.

[10] Paul Steven Miller, The Impact of Assisted Suicide on Persons with Disabilities -- Is It A Right Without Freedom?, Issues in Law & Medicine 9:47, 54 (1993).

[11] Evan J. Kemp Jr., "Could You Please Die Now?: Disabled People Like Me Have Good Reason to Fear the Push for Assisted Suicide," The Washington Post C1 (Jan. 5, 1997).

[12] In re Quinlan, 355 A.2d 647 (N.J. 1976).

Study: Mistreatment for Tots with ADHD

From Smart Kids with LD



April 13, 2015

Guidelines from The American Academy of Pediatrics call for use of behavioral therapy first rather than medication for pre-school age children with ADHD. Yet nearly half of all preschoolers (46.6%) diagnosed with the disorder take medication alone or do so in conjunction with behavioral therapy.

Those stunning findings, published this week in the Journal of Pediatrics, are from the first National Survey of Children with Special Health Care Needs using data gathered from 2009-2010. The research included 6.4 million children ages 4-17 years old with an ADHD diagnosis.

Key Findings

According to an article in The Washington Post, “The first national survey of children with attention deficit/hyperactivity disorder shows that nearly half of pre-schoolers are on medication for the condition, and more than a fifth were receiving neither of the recommended therapies.”

Other results from the study of preschool children with ADHD include the following:

  • 53.2% of preschool-age children have used behavioral therapy in the previous year;
  • 21.4% did not receive either behavioral therapy or medication.

Although the study does not provide explanations for the findings, Steven Cuffe, chairman of the Department of Psychiatry at the University of Florida College of Medicine, theorized that “there may be an issue with availability of behavioral treatments for pre-schoolers….That [number receiving behavioral therapy] should be higher.”

In addition, the study found that a substantial number of preschoolers (15.3%) were taking dietary supplements for the disorder. This despite the fact that there are no proven dietary treatments for ADHD, notes Steven Cuffe.

Sunday, April 26, 2015

Beyond Education Wars

From The New York Times

By Nicholas Kristof 
April 23, 2015

For the last dozen years, waves of idealistic Americans have campaigned to reform and improve K-12 education.

Armies of college graduates joined Teach for America. Zillionaires invested in charter schools. Liberals and conservatives, holding their noses and agreeing on nothing else, cooperated to proclaim education the civil rights issue of our time.

Yet I wonder if the education reform movement hasn’t peaked.

The zillionaires are bruised. The idealists are dispirited. The number of young people applying for Teach for America, after 15 years of growth, has dropped for the last two years. The Common Core curriculum is now an orphan, with politicians vigorously denying paternity.

K-12 education is an exhausted, bloodsoaked battlefield. It’s Agincourt, the day after. So a suggestion: Refocus some reformist passions on early childhood.

I say that for three reasons. First, there is mounting evidence that early childhood is a crucial period when the brain is most malleable, when interventions are most cost-effective for at-risk kids.

Researchers are finding that poverty can harm the brains of small children, perhaps because their brains are subjected to excessive cortisol (a stress hormone) and exposed less to conversation and reading. One study just published in Nature Neuroscience found that children in low-income families had a brain surface area on average 6 percent smaller than that of children in high-income families.

“Neuroscience tells us we’re missing a critical, time-sensitive opportunity to help the most disadvantaged kids,” notes Dr. Jack Shonkoff, an early childhood expert at the Harvard Graduate School of Education.

Growing evidence suggests what does work to break the poverty cycle: Start early in life, and coach parents to stimulate their children. Randomized controlled trials, the gold standard of evidence, have shown this with programs like Nurse-Family Partnership, Reach Out and Read, and high-quality preschool. These kinds of interventions typically produce cognitive gains that last a few years and then fade — but, more important, also produce better life outcomes, such as less crime, fewer teenage pregnancies, higher high school graduation rates, and higher incomes.

The second reason to focus on early interventions is that the low-hanging fruit has already been picked in the K-12 world. Charter schools like KIPP showed that even in high-poverty environments, students can excel. In New York City, which under Michael Bloomberg became a center for education reform, high school graduation rates rose to 66 percent in 2013 from 47 percent in 2005.

I support education reform. Yet the brawls have left everyone battered and bloodied, from reformers to teachers unions. I’m not advising surrender. Education inequity is America’s original sin. A majority of American children in public schools are eligible for free or reduced price lunches, and they often get second-rate teachers in second-rate schools — even as privileged kids get superb teachers. This perpetuates class and racial inequity and arises in part from a failed system of local school financing.

But fixing K-12 education will be a long slog, so let’s redirect some energy to children aged 0 to 5 (including prenatal interventions, such as discouraging alcohol and drug use among pregnant women).

That leads to my third reason: Early education is where we have the greatest chance of progress because it’s not politically polarized. New York City liberals have embraced preschool, but so have Oklahoma conservatives. Teacher unions will flinch at some of what I say, but they have been great advocates for early education. Congress can’t agree on much, but Republicans and Democrats just approved new funding for home visitation for low-income toddlers.

My perspective is shaped by what I’ve seen. Helping teenagers and adults is tough when they’ve dropped out of school, had babies, joined gangs, compiled arrest records or self-medicated.

But in Oklahoma, I once met two little girls, ages 3 and 4, whose great-grandmother had her first child at 13, whose grandmother had her first at 15, whose mom had her first at 13 and now has four children by three fathers. These two little girls will break that cycle, I’m betting, because they (along with the relative caring for them) are getting help from an outstanding early childhood program called Educare. Those two little girls have a shot at opportunity.

Even within early education, there will be battles. Some advocates emphasize the first three years of life, while others focus on 4-year-olds. Some seek to target the most at-risk children, while others emphasize universal programs.

But early childhood is not a toxic space, the way K-12 education is now. So let’s redeploy some of our education passions, on all sides, to an area where we may be able to find common ground: providing a foundation for young children aged 0 to 5.