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Wednesday, May 31, 2017

Good News About Mental Health in Our Schools

From Education Week's Blog
"Leadership 360"

By Jill Berkowicz and Ann Myers
May 23, 2017

"Children who are handicapped are proving every day what exciting potentials may be unlocked if we understand their problem and design interventions to address them."


J. M. Myers, M.D.* returns as a guest blogger to write this series about mental health in our schools. Here, in part one, he shares his view of the good news.

May is mental health month.

There is an intersection of mental health for children with their experience in the educational system. Now it would be easy enough to explore the issues for the 14% of children who have definable mental health diagnoses and are significantly symptomatic. Their school function is impacted at the cognitive, social, emotional, and behavioral levels.

However, I thought we might turn to educational changes that have massively impacted the mental health of children in the last 40 years, looking at one dramatically positive evolution, and one decidedly negative change. However, when addressed together in the same piece, the terrible realities of the negative may so dominate that the positive gets lost.

So, I decided to use one piece to share the positive and one piece to share the negative.

Children Benefit From 40 Years of Change

In the late 1960's and early 1970's, many developmentally and emotionally disturbed children were provided no education at all. If they were confined to an in state institution, little was offered for their education. A substantial number of children were sent to out of state residential institutions in Pennsylvania, in Massachusetts or in Alabama. Contact with their families was compromised and the engagement of families in treatment was well nigh impossible.

Nonetheless, the experiences and other realities from that time cause me to be very optimistic about America. At the same time handicapped children as a group were compromised in receiving an education, bright green shoots were popping up across America, proving what could be done.

One of my father's most satisfying experiences as a school superintendent was to observe his very skillful special education teachers engaging non-verbal autistic children in a late 1960's classroom. I observed severely multiply handicapped pre-school children being educated in Head Start classrooms in California in 1972. These accomplishments propelled what was next to come.

On November 30, 1975, President Ford signed P. L. 94-142 which mandated the education of all handicapped children. The law created mandates for districts to evaluate handicapped children and create an educational plan for them, with parental input, that would emulate as closely as possible the educational experience on non disabled students.

Was this the end of the story? By no means. Forty years of slow glacial change has ensued.

Why? Well the causes are multiple.
  • Some has been simple ignorance of what potentials existed in their students.
  • Some surely flowed from the stigma for the handicapped, especially those handicapped emotionally.
  • Some came from financial concerns that it would divert scarce resources, although the federal government was committed to augment financial support, which unfortunately never reached the level of its initial commitment.

Some came from states that believed in their omnipotent wisdom that they could pick a maximum number of children in a school district who could be designated as handicapped regardless of whether drug abuse was escalating during pregnancy or whether other environmental factors were intervening e.g. Flint leaded water impact on cognitive development.

In spite of all these obstructions, progress continued, but the rear guard action to reverse the gains continued. The most recent effort to forestall progress relied on the idea that creating a written plan would fulfill the mandates of the law regardless of whether the plan had data to support its effectiveness. These issues were still being litigated in the mid 2010's.

You might believe that educators and school officials would fully support educational plans for students with the greatest evidence supporting effectiveness. Not so. The national school superintendents association and the national school boards association actively intervened in court filings to sabotage the intent of the law.

This brings us to March 2017. The case of Enders F. vs. Douglas County School District was taken up by the United States Supreme Court and decided in March by the unanimous decision of the court handed down by Chief Justice John Roberts. It ruled that school districts must give students with disabilities a chance to make appropriately ambitious progress. Window dressing and paper plans would not suffice. Forty years of slow progress had now the final endorsement of the court.


Success

Of course this is not the end of the battle. However, the end is within sight. A landmark achievement has been won. We still have much ignorance to overcome. However, children who are handicapped are proving every day what exciting potentials may be unlocked if we understand their problem and design interventions to address them. Children are in school close to home. Services are being delivered. What a great celebration to be had in this mental health month.

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J.M. Myers, brother of Ann Myers, has spent his career working with children and families in multiple mental health and child developmental facilities in upstate New York. His previous post entitled 'Schools Need More Reliable Research' can be found here.

Ann Myers and Jill Berkowicz are the authors of The STEM Shift (2015, Corwin) a book about leading the shift into 21st century schools. Connect with Ann and Jill on Twitter or Email.

Deportation a Constant Fear for Immigrants with Disabled Children

From Kaiser Health News
via Spectrum News

By Jocelyn Wiener
May 24, 2017

Every few minutes, Abril begins to choke. Diagnosed with severe cerebral palsy and epilepsy when she was a baby, the Santa Cruz, CA 8-year-old has never spoken, walked or cleared her own throat.

Dozens of times a day, her parents, Rafael and Sonia, use a special machine to suction out saliva and phlegm from their oldest daughter’s mouth. Because choking and seizures can strike Abril anytime, a parent is always by her side.

Rafael and Sonia, both from Mexico, have lived in the United States without permission for more than a decade. But only since the recent presidential election has a question haunted them: If they are deported, what will happen to Abril?

As the Trump administration promises to deport a broader range of people, parents like Rafael and Sonia increasingly are seeking help to stay in the country so they can tend to their extremely sick children, according to interviews with doctors, lawyers and others who work with immigrants. And these professionals say they are struggling to come up with sound advice.

Rafael and Sonia know that many neighbors in their crowded mobile-home park — along with millions of other immigrants living in the country without permission — are keeping to the shadows to avoid detection by federal authorities.

But Abril depends on her parents to stay alive.


Abril, 8, sits in the living room while her parents make breakfast in the kitchen.
Her parents say dealing with Abril’s medical issues has made their family stronger.

The couple, along with other families in this story, spoke to California Healthline on the condition that their surnames be withheld, because they fear deportation. Abril and her younger sister are U.S. citizens.

Salem Magarian, pediatric director of the Santa Cruz Community Health Centers, says immigrant parents of his sickest patients are asking for letters documenting their children’s healthcare requirements. Some parents say they hope such letters will help them stay in the country if they are picked up by authorities.

“Some people are freaked out,” Magarian says. “Most people are concerned. Almost no one says, ‘It’s not a big deal.’”

One of Magarian’s patients, a toddler named Leonardo, has had multiple surgeries for serious heart defects. The boy’s mother, Karla, has been in the country without papers for 23 years, having been brought to the U.S. at age 5. Karla is terrified by the prospect of leaving her children and being sent back to Mexico, a country she doesn’t remember.

Another child suffers from a life-threatening genetic condition that leaves him unable to speak or eat, Magarian says. Richey, 8, lost his father to cancer four years ago. His mother, Sugay, has been in the country illegally for 16 years.

“I try not to go anywhere,” Sugay says. “If I go anywhere, I’m very afraid … I know this is not my country, I know this is not my place, but I’ve never done anything bad and I have a special baby who needs his mother.”

Such fears are reinforced by news accounts. The Salt Lake Tribune recently reported that the single mother and sole caretaker of an 18-year-old with cerebral palsy and epilepsy was deported to Colombia.

In another case, an Ohio mother of four children — including one with a history of seizures — was deported to Mexico. A spokesman for U.S. Immigration and Customs Enforcement (ICE) told The Guardian that the woman’s case had been reviewed several times by the courts.

Rafael spends time with his daughters at their home in Santa Cruz, California.
Fear of deportation has limited the family’s time outdoors.

“For parents who are ordered removed, it is their decision whether or not to relocate their children with them,” the spokesman said.

Immigration officials say they continue, as under the previous administration, to target for deportation people who have committed crimes — but they also say the new administration has changed policies to no longer support the practice of selective enforcement.

“Basically, there’s no exempted class for arrest,” says James Schwab, spokesman for the ICE field office in San Francisco.

Jessica Vaughan, director of policy studies at the Center for Immigration Studies, a pro-enforcement think tank that favors reduced immigration, says she sees plenty of benefits to enforcing immigration laws more rigorously — particularly increasing access to low-wage jobs for U.S. citizens and legal residents.

But she also says she “absolutely” believes exceptions should — and will — be made in cases where deporting parents would cause “undue hardship” for a young U.S. citizen.

“That’s why Congress created these forms of relief,” she says. “I think most Americans would support that.”

A Precarious Existence

Abril’s father, Rafael, arrived in Santa Cruz from Mexico as a teenager 19 years ago. His brothers are U.S. citizens and his mother is a legal permanent resident. In March 2001, before his 21st birthday, Rafael’s mother applied for a green card for him. He said he’s still waiting for the application to be processed.

After he’d been in California for nearly a decade, he fell in love with Sonia, who had arrived in the U.S. in 2006. She became pregnant. Everything seemed normal until she was 35 weeks along and stopped feeling the baby move. After an emergency cesarean section, Abril was rushed to Lucile Packard Children’s Hospital Stanford.

Magarian began caring for Abril when she came home at 6 weeks old. Given Abril’s serious brain damage and severe cerebral palsy, Magarian didn’t expect her to make it past six months.

Abril was in the hospital constantly at first. Her parents found great solace in their faith as they struggled to accept their new reality.

Over time, they learned the intricacies of caring for their daughter: how to suction her mouth, what to do if her gastrointestinal feeding tube gets blocked or she has a seizure, which of her grunts are normal and which require a call to 911.

Mostly because of her parents’ unwavering attention, Abril’s condition has stabilized over the years, Magarian says. Still, her health remains precarious, and she remains vulnerable to seizures and pneumonia. Many children in Abril’s situation end up hospitalized repeatedly, he says.

Sonia holds her younger daughter, Camila, while an occupational therapist
massages Abril. Sonia says caring for Abril is a 24-hour job and she
is able to take a break when the therapist visits.

Even so, until recently, Rafael and Sonia had begun to feel they were living something of a normal life. Sonia watched their daughters. Rafael rode the bus each day to his job as a cook. A special-education teacher from the local school district came to the trailer twice a week to work with Abril.

Rafael and Sonia worried less about deportation during the Obama administration, which prioritized the removal of immigrants with criminal records. Donald Trump’s promises of a border wall and mass deportations made them nervous.

Their fear grew after helicopter flyovers in mid-February signaled federal immigration raids in Santa Cruz County.

Soon after, Rafael and Sonia hired an attorney to help them become legal residents.

Some advocates say they worry that desperate families with chronically ill or developmentally disabled children are unwittingly putting themselves at greater risk of deportation by seeking legal help.

Often the applicants get turned down, triggering deportation proceedings.

In the best-case scenario, a judge will cancel the parent’s removal because of the hardship it would cause for a medically dependent child. But judges don’t always do this. Barbara Pinto, a senior staff attorney at El Centro Legal de la Raza in Oakland, California, says more families have been asking her organization about this legal channel. She recommends against it.

“It’s seen as very irresponsible and unethical” for attorneys to suggest such a risky process, she says.

A Daunting Responsibility

Rafael and Sonia know they’re taking a risk. But they don’t know what else to do.

These days, they rarely venture out of their trailer. No more trips to the park. No more weekend strolls at the shopping mall.

In case they get picked up by immigration authorities, they have been writing down the details of Abril’s care. But those details could fill a book, they say, and they don’t even know who’d be willing to take her.

Her uncles feel so uncomfortable with her serious health problems they don’t visit anymore. Rafael’s mother is too frail to lift her 53-pound granddaughter. Certainly someone could care for Abril’s healthy younger sister. But Abril?

“Nobody wants that big a responsibility,” Sonia says.

They think their best option might be a couple whom they barely know, whose own disabled child passed away. If that doesn’t work out, Abril could end up in foster care.

Rafael and Sonia say they wouldn’t be able to get the same financial support for Abril’s care in Mexico. Medi-Cal and California Children’s Services pay for the expensive equipment and medication that keep Abril alive — but only here in the U.S. Together, Abril’s three seizure medications cost about $5,000 a month, an amount they say they cannot possibly afford on their own.

“If we go to Mexico and we have to bring her,” Sonia says, “it is certain she will not live much time.”

Priscila Rodríguez, associate director of Disability Rights International, says Sonia’s concerns are valid. Her organization has documented the condition of people with disabilities in Mexico, finding they often are segregated from society and abused.

Rafael and Sonia aren’t certain how much their daughter understands; her developmental delays are profound.

But, over time, they have learned to love things about her that other people don’t see: the peaceful expression that crosses her face when they hold her. The smile that started appearing much more often after her little sister was born. Her apparent affinity — shared with little girls the world over — for Anna and Elsa in the Disney movie “Frozen.”

Sonia smooths Abril’s hair and places her daughter gently on a bed made up with “Frozen” sheets.

“She gives us love how she can,” she says.

This story originally appeared on Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. It has been slightly modified to reflect Spectrum’s style.

Tuesday, May 30, 2017

Brain Images Reveal Roots of Kids' Increasing Cognitive Control

From Cell Press
via ScienceDaily

May 25, 2017

As children age into adolescence and on into young adulthood, they show dramatic improvements in their ability to control impulses, stay organized, and make decisions. Those "executive functions" of the brain are key factors in determining outcomes, including educational success, drug use, and psychiatric illness.


A rendering of diffusion tractography, which was used to reconstruct the
anatomical pathways in each participant's brain. Credit: Baum et al.

Now, researchers reporting in Current Biology on May 25 have mapped the changes in the network organization of the brain that underlie those improvements in executive function.

The study reveals that the maturing brain becomes increasingly segregated into distinct network modules for greater efficiency. Indeed, the new evidence shows that the degree to which executive function improves in a person with age depends on the degree to which that well-defined modular network structure emerges.

"We were surprised to find that the developmental refinement of structural brain networks involved increased modular segregation and global integration, since highly modular systems have the potential to become fragmented," says Ted Satterthwaite, an assistant professor of Psychiatry in the Perelman School of Medicine at the University of Pennsylvania.

"This increasingly modular yet globally integrated network topology may maximize communication efficiency while minimizing wiring costs in the brain."

The findings suggest that modular brain architecture is critical for the development of complex cognition and behavior. They could also lead to the identification of biomarkers of abnormal brain development that could predict a person's risk for psychosis and major mood disorders, the researchers say.

Satterthwaite and his colleagues set out to define the normal development of structural network modules and its relationship to executive functioning. They capitalized upon a large sample of 882 youths between the ages of 8 and 22 who completed diffusion imaging as part of the Philadelphia Neurodevelopmental Cohort, a community-based study of brain development that includes rich neuroimaging and cognitive data.


As expected, executive function improved markedly in study participants with age. An analysis of the brain images revealed an increasingly specialized and modular structure that was nonetheless fully integrated.

"The development of modular network architecture did not result in the brain becoming fragmented," explains the study's first author Graham Baum (@graham_baum), a Ph.D. candidate in the Perelman School of Medicine at the University of Pennsylvania. "In fact, the overall network communication capacity actually increased, due to strengthening of specific 'hub' connections between modules. These results show that as kids grow up, their brain becomes more segregated into specialized units, but also more integrated as a whole."

The researchers suggest that a globally integrated network architecture may be critical for supporting specialized processing and reducing interference between brain systems. At the same time, the increase in global integration may allow those specialized parts to work together in a coordinated fashion.

The researchers also found a relationship between the emergence of that modular structure and a person's performance on tests of executive function.

The researchers say they are now combining structural and functional imaging techniques to examine how structural brain networks constrain and shape functional brain networks and activation patterns. They will also investigate whether information about brain networks can predict the emergence of psychiatric disorders in children years later.

Journal Reference
  • Baum et al. Modular Segregation of Structural Brain Networks Supports the Development of Executive Function in Youth. Current Biology, 2017 DOI: 10.1016/j.cub.2017.04.051

Trump Budget Would Abandon Public Education for Private Choice

From The Conversation
via the Education Law Prof Blog

By Derek Black
May 24, 2107



The Trump administration has announced its plan to transform education funding as we know it. The new budget proposal takes aim at a host of elementary, secondary and higher education programs that serve needy students, redirecting those funds toward K-12 school choice in the form of vouchers, tax credits and charter schools.

Public schools that enroll a large percentage of low-income students stand to lose significant chunks of their budget, as well as a number of specialized federal programs for their students. At the same time, the Trump budget will incentivize families to leave not only these schools, but public schools in general.

As a scholar of education law and policy, I note that my recent research on state voucher and charter programs shows that the loss of both money and core constituents proposed by this new budget could throw public education into a downward spiral.


The Proposed Changes in Federal Funding

Through Title I of the Elementary and Secondary Education Act, the federal government currently sends US$16 billion a year to public schools to provide extra resources for low-income students. While Title I is the single largest federal grant, the federal government spends more than twice that amount through a multitude of other programs.

School systems like those in Miami, Milwaukee, Houston, San Antonio and Detroit get anywhere from 15 to 25 percent of their funding from the federal government.

The new budget proposes about $4 billion in cuts to programs like literacy for students with disabilities and limited English proficiency, class-size reduction, and after-school and summer programs.

The Trump administration promises the money is not really gone; it’s just coming back under different policies. The administration plans to add $1 billion to Title I, but the additional money comes with a big catch: States must spend that money on school choice. To access the new money, states and districts would have to adopt student enrollment policies that allow families to choose their own schools and take public money with them.

This would fundamentally change the way states have funded schools and assigned students for the past century. While choice policies have significantly grown in recent years, the vast majority of districts continue to assign students to a public school based on where they live. If families choose to leave the district to attend another school (i.e., a charter school), local school funds remain with the district. A substantial chunk, if not all, of state and federal dollars typically stay with the district as well.

Trump’s proposal would have all of the local, state and federal dollars follow the child, regardless of the school the student attends. Choice advocates argue that this gets the government out of the driver’s seat and brings market forces to bear on public schools. Competition, they reason, will improve public schools and, thus, benefit everyone.

The Threat to Low-Income Schools

Studies have shown that while decreased student enrollment does reduce some public school costs, other costs remain fixed. School buses drive the same routes. Air conditioners run just as much. And, quite often, the school still needs the same number of teachers. When states fail to account for these realities, they can drive school districts into bankruptcy.

Under Trump’s proposal, when a student enrolls in a charter school, that student will take not only federal funding with them, but all of the state and local funding that previously supported the local school. This would effectively reduce the funding for the local school without reducing its costs.

The effect on high-poverty districts could be catastrophic. On average, school districts serving predominantly low-income students already receive significantly less state and local funding than others. In Nevada, for instance, predominantly middle-income schools spend $10,400 per pupil, whereas schools serving just a moderate number of low-income students spend only $6,100 per pupil. Taking more money away from needy schools would likely widen these gaps.

States, of course, can stick with the traditional rules for spending federal Title I money, but if they want additional money from Trump, they have to agree to his choice proposal. History has shown that states are typically willing to do anything to get new federal education money, even when it’s a bad idea.

In 2009, Secretary Arne Duncan offered even less money for states to adopt controversial teacher evaluation systems and the Common Core. While those policies imploded within a few years, more than 40 states were initially quick to take the deal.

The Threat to Public Schools in General

The administration plans to go beyond the education budget alone. Although it is holding back the details for now, the administration is close to proposing an entire new tax scheme to fund private education. This new program would give individuals and businesses tax credits for “donating” to organizations that pay for students’ tuition at private schools.

In the past, states have experimented with traditional school voucher programs, which are typically limited to small numbers of low-income students. The new tax credit system, by contrast, could be used by states to fund wealthier students – and could be opened up to enrollment at religious schools as well.

As a result, enrollment in these programs has risen dramatically in comparison to traditional vouchers. In states like Florida and Indiana, the size of these programs quadrupled in just a few years.

A Wolf in School Choice Clothing

On the surface, these policies are just about moving money around – freeing up traditional public school funding to spur growth in charter and private schools. Below the surface, however, I believe the new budget undermines confidence in public education.

North Carolina offers a cautionary tale. A few years ago, North Carolina slashed its traditional education budget by 20 percent, while doubling its expenditures on charter schools. Since then, North Carolina’s public schools have fallen from being among the finest in the nation to some of the worst.

Policies like these misunderstand why we have public education in the first place. Our government institutions have long funded public schools because they produce benefits for society as a whole: productive citizens, social values, shared experiences and an effective workforce. Individuals surely benefit, but the pursuit of these societal goals is the reason that our states provide education.

Trump’s effort to reshape school financing reflects a vision of education that is not public at all. This new vision is all about individuals, ignoring what may happen to our societal values, public schools and the neediest students who will be left behind.

This article was originally published on The Conversation. Read the original article.

Monday, May 29, 2017

National School Lunch Program Threatened: Students Need Healthy, Nutritious Food

From The Heller School for Social Policy and Management
via HuffPost

By Jessica Hoffman, Juliana Cohen, Lindsay Rosenfeld, and Edward Alan Miller
May 18, 2017


The National School Lunch Program, administered by the United States Department of Agriculture (USDA), provides a critical source of nutrition for over 31 million children in the United States every day. Children living in poverty depend on these meals as a main food source.

During the Obama administration, lawmakers passed the Healthy Hunger Free Kids Act in 2010 in an effort to curb this country’s obesity epidemic and to maximize children’s learning and development. The Act directed the USDA to improve the nutritional content of school meals. Specific changes included increasing the amount of fruits, vegetables, and whole grains, and decreasing sodium and milk fat.

These healthier school meal standards had strong support from parents. They also had strong support from the military, which views children’s health as a matter of national security. This is in the face of recruitment challenges stemming from the high proportion of young adults who are too obese to serve.

Even so, the Trump administration recently announced that it would allow the USDA to roll back several of the regulations associated with these provisions due to concerns about food waste. This is despite the breadth of scientific evidence that supports the benefits of healthier school meals.

Several years ago, one of us (Juliana Cohen) responded to concerns expressed in the media about making school meals healthier by conducting a rigorous study of the nutritional changes adopted under the Healthy Hunger Free Kids Act and its impact on the amount of food children actually ate and threw away.

The study, published in the American Journal of Preventive Medicine in 2014, measured the foods selected and eaten by over 1,000 elementary and middle school children before and after the school meal regulations changed.

The study showed that when healthier standards were put into place, children actually selected more fruit in their lunches while their selection of vegetables and entrées did not change. Most importantly, once the standards were in effect, children ate more of the entrées, fruits and vegetables, resulting in less waste – not more.

Food waste is indeed an issue, but it is not new to school meals. The healthier standards set forth in 2010 did not create this problem and rolling back the standards will not fix it. The real issue is the extraordinary challenge of preparing healthy, appetizing foods for thousands of children a day on a very small budget.

School cafeterias receive on average $2.93 for each lunch from the USDA or from students paying out of pocket, but after accounting for cafeteria operating expenses only about half of this money actually goes towards food.

So what are the solutions to address food waste in schools? Polices that are backed by evidence.

First, providing students with sufficient time to eat their meals (which should be at least 20 minutes of seated time), as well as offering recess before lunch in elementary schools, can be cost-free solutions. Second, the USDA can draw on existing programs to increase schools’ access to the highest quality and quantity of produce, grains, and proteins as a cost-effective way to offer better-tasting options for students. Lastly, the USDA can offer additional culinary training and support to help cafeteria staff prepare whole grain items and other more challenging foods using methods that enhance flavor without extra salt.

Many other countries have achieved the goal of healthy, palatable school meals with resounding success. There is no reason that the United States as the wealthiest nation in the world should not join their ranks.

The benefits of nutritious school meals cannot be overstated: healthier, more alert students who are ready to learn, and who develop healthy eating habits early in life, experience reduced prevalence of chronic disease and disability, lower medical costs, and improved worker productivity.

We should not weaken the school lunch standards further. Instead, we should truly make school lunches great by providing schools with the resources they need to offer the healthiest, best tasting foods possible. Investing in the health and development of our youngest citizens is one of the most important investments we can make as a country.

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This post is authored by a research team for the NOURISH project (Nutrition Opportunities to Understand Reforms Involving Student Health). Jessica Hoffman is an associate professor at the Bouvé College of Health Sciences at Northeastern University. Juliana Cohen is an assistant professor at Merrimack College and the Harvard T.H. Chan School of Public Health. Lindsay Rosenfeld is a scientist and lecturer at the Institute for Child, Youth and Family Policy at the Heller School for Social Policy and Management at Brandeis University. Edward Alan Miller is a professor at the McCormack Graduate School of Policy and Global Studies at the University of Massachusetts Boston.

Kids Don’t Need to Follow Politics to Feel Anxious

From The Conversation
via Fatherly


By Barbara Milrod
May 22, 2017

“Lucy,” a shy, intelligent six-year-old, missed three days of school because she had stomachaches. The symptoms started the day after Lucy witnessed a loud argument while waiting for the bus with her babysitter. A “scary man” shouted at people waiting: “Watch out, you’re all going to be deported now!”

Lucy didn’t know what “deported” meant, but she knew it was very bad. People told the man to leave and shouted insults at him that Lucy didn’t understand. The man finally left, shaking his fist and threatening “police action.” Lucy held her babysitter’s hand, looked up and noticed tears in her sitter’s eyes. Lucy’s stomach started to rumble.

Sadly, cases like Lucy’s are becoming increasingly common.

I’m a child and adolescent psychiatrist and psychoanalyst with expertise in anxiety disorders. Since November’s election and the general political upheaval that accompanied it, medical professionals across the country have observed an uptick in agitation and anxiety among our young patients.

What do we know about how anxiety develops in children? And what can parents do to reduce it?


Kids Take on the Grown-Ups’ Anxiety

Strong emotions are contagious – particularly anxiety. And while anxiety spreads easily among us all, children are the most vulnerable. Elementary school children lack a fully developed ability to solve problems on their own, making it difficult for them to separate other people’s worries (especially adults’) from their own frightening fantasies.

Unfortunately, although kids tend to take on their parents’ worries, it can be hard for parents to control anxiety – even in normal times. But these are not normal times: Politicians, the media and ordinary citizens on both sides are hurling heated rhetoric across the aisle, all of which is fueling anxiety.

When upset enough, people can start to think and behave in less rational, more primitive ways. Mental health professionals call this “regression”: when people go from adult, rational behavior to a more emotionally charged, less reasoned way of thinking and acting.

These days, I’ve personally observed this sort of overly emotional, regressive behavior more and more frequently – often in public places, like on the subway, where people seem more ready than in recent memory to dispense insults.

As a child psychiatrist, I’m concerned when I see emotionally charged language routinely expressed in public discourse, often in the form of intolerance toward those with differing political beliefs or divergent racial/ethnic/sexual orientation backgrounds.

Times of emotional upheaval (and the regressive behavior that accompanies it) can effectively terrorize children, causing them to become traumatized, highly anxious or have difficulty sleeping, eating or focusing in school.

Developmental Factors in Processing Anxiety

Before third or fourth grade, children haven’t yet formed the rational, organized thought processes that developmental psychologist Jean Piaget called “concrete operations.” Before reaching this stage of cognitive development, children don’t rely on cause and effect. Rather, magical (nonrational) explanations predominate.

Noises in the middle of the night are as likely to come from monsters as heating pipes. The school bus is as likely to appear because they blinked and wished it as because it has a schedule. Conflicts unambiguously feature “good guys” and “bad guys.”

Anxious fantasies can feel as real as the everyday world. For Lucy, who experienced her worries as physical symptoms (stomachaches and even vomiting the next time she got on the bus), it required patience and attention to translate her symptoms back to language so she could feel more in control.

In general, adults rely on a routine ability to read their own emotions and those of others. These skills are newly developed in young children and can collapse in scary situations or in the face of parental upheaval. When children become anxious enough, this collapse can spiral into an impaired ability to understand the world and a growing sense of isolation.


What Can Parents Do?

How can parents navigate this flood tide of personal and community upset and raise relatively healthy kids? Parents always have a hard job, but I’ve seen the aggressive political climate complicate the ever-daunting task of raising children. Parents want to remain truthful to children to underscore trust, while also gauging what children can tolerate hearing without becoming overwhelmed. This can get more difficult when parents feel overwhelmed themselves.

Parents should reflect and reinforce their own values. Lucy’s parents couldn’t pretend that her bus stop incident didn’t happen, didn’t matter or wasn’t frightening. They needed to acknowledge how frightened she felt, while reassuring her that school had not become dangerous.

What parents tell children is important, but how parents act is also a crucial guide for kids. In today’s political climate, it’s more important than ever for parents to be good role models. That means that values like kindness, patience, respect for others, taking turns and sharing should be developed early and demonstrated often.

Listening to others is crucial, even when we’re angry. Bullying, violence and name-calling are behaviors that parents should take care not to model for their children. (One survey of 2,000 K-12 teachers suggested an increase in school bullying during the 2016 election.)

Parents’ roles are more important now than ever. How parents respond in these challenging times can shape a child’s ability to grow normally or become traumatized. How they channel anxiety and rage makes a difference.

Furthermore, the significant impact parents have on their children’s mental health and well-being may, in turn, be crucial to maintaining a rational society. In my view, this is the small, partial contribution that parents can make to this country’s current upheaval.

This article was originally published on The Conversation. Read the original article by Barbara Milrod, Professor of Psychiatry, Medical College, Cornell University.

Sunday, May 28, 2017

Is Mindfulness Meditation Good for Kids? Here’s What the Science Actually Says.

From Vox

By Brian Resnick
May 22, 2017

Meditation is meant to help students deal with stress. But the hype may be outpacing the evidence.




First period, 8:45 am, a circle of high school students sits so quietly that all you can hear is the whirl of computer fans.

Today’s lesson: attention to breathing.

“Just notice your breath,” says the instructor, Satyani McPherson, “where it manifests in the body and the abdomen. ... And whatever is appearing, just allow it to be there.”

A student walks in late, and the door slams. No one moves. Eyes are closed. Fourteen chests rise and fall.

*****

The juniors and seniors in this international baccalaureate class at Eastern Senior High School in Washington, DC, are stressed out. I asked Raven Wright, a senior, to list all the things she has deal with in a given day. Be on time. Homework. Applications. Scholarship essays. Two jobs: Chipotle and Macy’s. Mentoring a younger student. Driving lessons. Exhausting.

Once a week for a semester, as part of their IB philosophy class Theory of Knowledge, Wright and her classmates take a break from classwork to meditate. Eastern is one of hundreds of K-12 schools — many of them in urban areas, attended mainly by minority students who qualify for free school lunch — in the US participating in an unconventional, informal experiment in training students to become more focused and less reactive.

Anecdotally, the students at Eastern love it. “Mindfulness is gonna stay with me for the rest of my life,” A’layza Mitchel, a student who struggles with the autoimmune disease lupus, says. “Especially with the fact of me being a lupus patient and always having to hear news about how it is going to affect me.” With mindfulness, she says she “can just take a moment” to process feelings.

Teachers and administrators at schools like Eastern have welcomed it too. They see mindfulness as a powerful new skill to offer students, not just to manage stress but also to keep them from acting out.

The companies and foundations largely responsible for introducing mindfulness programing into schools tout its psychological benefits — such as reduced stress and increased attention. And they say the evidence for mindfulness is based on decades of scientific research.

But research quality is not the same as quantity. And considering that more and more US schools are embracing it, I decided to take a look through the literature: What does the science actually say about mindfulness in kids?

I read more than a dozen studies — including systematic meta-reviews, which account for thousands of other papers — analyzing the best available research on mindfulness (in both students and adults) and talked to researchers and advocates involved in the work. I asked these experts what questions and concerns parents should have when they hear mindfulness is coming to their schools. (Scroll down for those questions.)

The short of it: The relatively few studies we have on mindfulness in schools suggest a generally positive effect on decreasing anxiety and increasing cognitive performance. But the hype around mindfulness also seems to be outpacing the science, especially when it comes to teaching these practices to children.


Mindfulness Brings Awareness to Thoughts, Sensations and Emotions

Mindfulness is about noticing. Noticing your breathing. Noticing how your emotions manifest in your body. “The essence of mindfulness is just tolerating experiencing sensations that come into your body, other than trying to get [them] to stop immediately,” Jeff Bostic, a child and adolescent psychiatrist at Georgetown University, says.

“The one fundamental concept that’s shared by all the branches [of mindfulness practice] is the awareness that you accept sensations ... and that you can make sense of what triggered them.”

You can think of mindfulness as state of mind, an ability, and a practice. It can be traced all the way back to the early teachings of Buddhism (though it’s not exclusive to Buddhism). And it has an immediate intuitive appeal in a world that’s more distracting and fast-moving than ever before.

Mindfulness is now taught in hospitals and Silicon Valley corporate seminars, and is popular on the TED circuit. More than 14 million people have downloaded the Headspace app for its simple 10-minute meditation exercises. There’s an entire academic journal, Mindfulness, devoted to its study.

There are spiritual, philosophical, and cultural dimensions to this movement, for sure. But researchers from fields ranging from neuroscience to psychiatry have been fascinated by it too. According to Bostic, mindfulness attenuates the more evolutionarily primitive areas of our brains — the amygdala, the brain stem, etc. — the areas that provoke us to fight, be frightened, or flee, and turn up activation in our frontal lobes, the reasoning center.

Mindfulness is thought to have wide-ranging effects, from lessening depressive symptoms to reducing anxiety and helping to deal with chronic pain and trauma. There are studies that find mindfulness reduces the levels of the stress hormone cortisol. Neuroimaging studies have shown increases of brain matter density in regions linked to learning and memory (though we can’t always assume more brain matter equals better). And some behavioral studies find increases in working memory and decreases in mind wandering.

What’s less well understood is how effective it is as an intervention — in other words, if you want to use it to change mental health or behavior.

Mindfulness in Schools is a Grassroots Movement

In the 1970s, Jon Kabat-Zinn, a molecular biologist at University of Massachusetts and practitioner of Zen Buddhist mediation, began developing a mindfulness program for adults in clinical settings. He called it mindfulness-based stress reduction (MBSR), and designed an eight-week course to teach participants how to deal with the pain and stress of chronic illness that’s still very popular today.

Throughout the ’80s and ’90s, mindfulness continued to grow as a complement to traditional medicine and pain management. And it started to make its way into schools “in ad hoc, idiosyncratic ways,” says Oren J. Sofer, senior program manager at Mindful Schools, which provides mindfulness training instruction for educators. There’s still no formal, national accreditation for mindfulness instruction in schools. But it's become a bit more centralized.

Today mindfulness enters schools through several routes. There are regional-based nonprofits like Minds Incorporated in the DC area that offer mindfulness instruction (sometimes free of charge) to local schools. There are national organizations such as Mindful Schools, which has trained around 14,000 educators and professionals who work with youth in mindfulness instruction (the starter course costs $125). And it’s being written into textbooks from publishers like Scholastic.

Some schools are even trying it as an alternative approach to discipline.

At Robert Coleman Elementary in Baltimore, students are sent to a “Mindful Moment” room in lieu of traditional detention. When students enter the room — decked out with tie-dye tablecloths and purple beanbags — staff from a nonprofit called the Holistic Life Foundation ask students to explain what happened. Then they practice breathing or yoga with the students — though sometimes they just play a game. School officials have told reporters the mindful moment room has helped reduce the number of suspensions.

The Evidence for Mindfulness in Adults is Limited but Promising

Mindfulness clearly has attracted a lot of buzz. “We’re almost getting to the point now where the efficacy is taking for granted,” said Timothy Caulfield, who studies health and public policy at the University of Alberta and is skeptical of the research.

So to really know if mindfulness training works — for kids, for adults, for anyone — we need to zoom out a bit and look at the sum of the research we have.

When researchers want to evaluate an intervention like mindfulness, here are the main questions they ask:

1) Does days or weeks of mindfulness instruction lead to any reductions in psychological stress?

2) Is mindfulness any more effective than other stress reduction therapies?

3) Does it work in the school setting?

4) If it does work, why?

5) Is the research high quality, well controlled, and free of bias?

Let’s start with the first question.

In 2014, JAMA Internal Medicine published an exhaustive systematic review on mindfulness studies that looked at measures of psychological stress and well-being. In all, the studies included 3,500 adult participants. The analysis included studies that used mindfulness-based stress reduction, transcendental mediation, or mantra-based techniques, and tracked participants on a variety of outcomes — like anxiety, depression, and stress scores.

The results of the JAMA meta-review were generally positive. These programs seem to slightly move the needle on anxiety and depressive symptoms to a degree “comparable with what would be expected from the use of an antidepressant in a primary care population,” the study concluded.

But here’s a caveat: The analysis found that mindfulness was no more effective than other wellness interventions like exercise, muscle relaxation, or cognitive behavioral therapy.

This is a glass-half-empty or half-full type of finding. On one hand, it could mean mindfulness training is as effective as these other treatments. On the other hand, “it doesn’t show that it’s magical,” said Caulfield.

Overall, at this point in time, the quantity and quality of evidence on mindfulness practices is pretty weak. The JAMA study authors started out with a huge stack of 18,000-plus citations on mindfulness in the literature. But only 47 of those studies had a methodology strong enough to be included in the trial.

“The modest benefit found in the study ... begs the question of why, in the absence of strong scientifically vetted evidence, meditation in particularly and complementary measures in general have become so popular, especially among the influential and well educated,” Allan Goroll, a professor of medicine at Harvard, wrote in a commentary published alongside the JAMA paper.

But Designing Studies for Testing Mindfulness is Also Really Hard

So if you want to see the effectiveness of mediation, you’d compare people who received instruction for a few weeks with those who did not. Right? The problem is that you can’t have the control group do nothing. What if the benefit of being in a mindfulness program is derived from spending time in a classroom setting? Or just paying attention to an instructor?

These variables are really hard to control for, but researchers try by having the control groups engage in some other activity — like educational programming, which takes the same amount of time and relative level of engagement. Other studies use active controls, where participants do exercise, undergo massage, or do some other type of therapy where there’s an expectation of getting better.

But even with these controls, it’s still hard to control for people’s expectations. It’s not like a clinical drug trial where the control and experimental groups are taking an identical-looking pill. In these studies, people know what group they’ve been sorted into. It could be that people who get sorted into mindfulness groups expect greater improvements and are then likely to tell their evaluators they improved. (These studies largely rely on participant self-reports in their data collection.)

"If it being presented as a worldview, or almost as a philosophy, that's one thing. But the problem is that it is increasingly being framed as an intervention."

“There's nothing wrong with placebo effects except that they often aren't enduring,” says James Coyne, emeritus professor of psychology in psychiatry at the University of Pennsylvania (and a vociferous critic of psychological research methods).

The mindfulness literature also suffers from other methodological limitations. Studies vary greatly in the populations of their subject pools — the JAMA review included studies on alcoholics, asthma sufferers, and people who have a constant ringing in their ears — as well as in the dosage of the treatment (how long and how often participants train), and in the type and quality of the instructions. Which makes it hard to understand if mindfulness gains in one group will generalize to another. There are a lot of variables at play.

A recent PLOS One study found evidence that the whole field of mindfulness studies suffers from publication bias — that is, a tendency for only positive results to be reported, leaving contradictory evidence collecting dust in researchers’ file drawers.

The PLOS authors — McGill University psychologists — did a systematic review of the literature, finding 124 randomized controlled studies on mindfulness. Ninety percent of the studies showed positive results, which is a lot higher than you’d expect given the small sample sizes used in the mindfulness studies. (The percentage of positive results should, according to their calculations, be closer to 65 percent.)

The authors also took a look at mindfulness studies whose methods were registered before the trials began. (Preregistration is now seen as a research best practice, as it limits researchers’ ability to skew conclusions after the data comes in.) They found 21 registered trials, but only eight of these locked-in study designs yielded publishable results. That suggests that many studies that go unregistered and do not find positive results are simply forgotten.

“I’m not against mindfulness,” Brett Thombs, an author of the study, told Nature. “I think that we need to have honestly and completely reported evidence to figure out for whom it works and how much.”

(A note: Mindfulness research is hardly the only field of psychological study that suffers from publication bias. Researchers throughout social and biomedical sciences are amid a revolution to demand more rigorous data collection procedures.)

The students of Eastern High School practice mindfulness meditation.

What Does the Research on the Benefits of Mindfulness for Kids Say?

Okay. The JAMA analysis only covered research on adult subjects. What about research on kids? It seemed from my time at Eastern High School that the kids were benefiting from the instruction, at least anecdotally.

Yarnetta Leonard, 17, an Eastern student, says the mindfulness class is helping her manage sad and angry feelings. After the woman who was raising her in southern Virginia died, Leonard was forced to move to DC to live with her biological mother. “Coming here, being in a space where I can just think instead of retaliate and be mad and be sad — I can think of my actions and do better for myself,” she says.

High schools like Eastern — where the kids are mostly of color and qualify for free school lunch — are commonly targeted for mindfulness interventions. And increasingly, there’s high-quality research on whether mindfulness programs can help.

Over the past few years, Erica Sibinga, pediatrician who was one of the co-authors on the JAMA study, and her colleagues at Johns Hopkins, have been conducting well-controlled trials of using mindfulness in some of Baltimore’s poorest public schools, which would have a lot to gain from a program that reliably reduces stress.

That’s because the chronic stress of growing up poor puts kids at a disadvantage for long-term well-being. It’s thought that chronic stress — from poverty, from violence, from lack of good nutrition — activates cellular pathways that make our bodies more prone to inflammation and less able to fight off infections.

Some studies suggest people who grow up poor are even more susceptible to the common cold later in life. “If we’re able to provide youth with tools that may reduce the negative impact of trauma that may potentially have long lasting effects,” Sibinga says.

She and her colleagues recently conducted a randomized clinical trial with 300 fifth- to eighth-graders in two Baltimore city schools. Half the students got mindfulness instruction for 12 weeks. The other half got 12 weeks of health education, and were the study’s controls. Sibinga and her colleagues tried hard to match the instructors for both the health class and the mindfulness class in terms of engagement and skill level. They tried to make the health class engaging and exciting.

Here, mindfulness seemed to move the needle. “On depression, [students] moved from the borderline concerning levels to the normal level,” Sibinga explains. “Does that mean each kid in the intervention group has moved? No, it doesn’t. But the average has moved.” The study found similar improvements in anxiety levels, self-hostility, coping, and post-traumatic symptoms.

Again, that’s only one study. I only found two recent systematic reviews on the use of mindfulness and meditation practices in schools. Like the JAMA study with adults, they generally find positive results, but note methodological flaws in the literature.

A 2014 review published in Frontiers in Psychology found, across 24 studies (11 which had not been published in peer-reviewed journals), that mindfulness improved measures of cognitive performance but had less of an impact on stress and coping.

“What we see from the data, people who suffer, whether they are kids or whether they are adults, they profit the most,” say Harald Walach, a psychologist who studies complementary medicine in Germany and who was co-author of that review. “They are at a low point, and from the low point it is always going upward. If you have kids with real emotional problems, you would likely see a larger effect than if you have normal kids who are doing well at school and have a good family background.”


A second 2014 meta-analysis — published in Education Psychological Review — looked at 15 studies of school meditation programs (which included transcendental mediation as well as mindfulness), and found “school based meditation is beneficial in the majority of cases,” but “the majority of effects of mediation upon student outcomes are small.”

Because mindfulness sessions are composed of a grab bag of activities — concentrating on breathing, concentrating on sounds, group discussions of the mind-body connection — it’s hard to know what, exactly, the mechanism for these positive changes is, and if that mechanism is unique to mindfulness.

“What is not answered is whether the true contribution is the mindfulness practice itself,” Walach says. The effect could be from just taking time out from the normal classroom schedule, or taking part in a group activity, or being taught by an inspired teacher. “Or do you need all of that together — that, we don’t know, because it hasn’t been studied very well,” he says.

And that’s one of the biggest criticism of mindfulness that I kept encountering in reporting: It’s all kind of vague. Mindfulness — a collection of disparate concentration activities — targets broad regions in the brain and broadly helps people on a number of things.

“It may look like it’s all over the place ,” Sibinga admits. “But it may be what’s changing is upstream of all of those things.” By upstream, she’s talking about overall systemic changes in the brain or in patterns of thinking. The uncertainties don’t scare her away from the research. “We know our whole body and brain and mind function together,” she says. But we don’t know exactly how. “I’m fascinating by that question. It makes me think we need to explore it further.”

She hopes more schools that are inviting in mindfulness training will also invite in those from the research community to study it.

Mindfulness is Basically Harmless, but It’s Not for All Kids

Nothing is for everyone. The same goes for mindfulness.

Though the researchers and studies I consulted agree that it’s basically harmless, I asked Sibinga, the pediatrician, if there are any cases where kids shouldn’t be involved with mindfulness programs. The cases are rare, but she says schizophrenics and people suffering from other thought disorders are not advised to seek out mindfulness training, as it may not be helpful to be “mindful” about thoughts or delusions that don’t have any basis in reality.

The other contraindication is for people who have suffered a severe recent trauma. “Their ability to compartmentalize and wall that [trauma] off is closely related to their ability to cope,” she says. Mindfulness can be an invitation to tear down those mental walls too soon. (And that’s why it’s important, she says, for mindfulness instructors and students to be well trained, and to look out for these vulnerable youth.)

Researchers have also been looking into potential negative effects of mindfulness. One 2015 study in Psychological Science found that 15 minutes of mindfulness instruction made study participants (college undergrads) more susceptible to forming false memories.

In the case of this study, the participants were shown a list of words like “garbage, waste, can, refuse, and sewage.” Participants who did mindfulness training were more likely to misremember reading the word “trash,” which is similar to those words but didn’t actually appear on the list.

Why? The authors guess when you turn your thoughts inward during meditation, you may be more likely to mix up reality with imaginative assumptions. “Mindfulness meditation appears to reduce reality-monitoring accuracy,” the authors of the paper concluded.

(It’s unclear how practically significant misremembering one word on a list is for classroom instruction. Perhaps if students are daydreaming, Brent Wilson, the UC San Diego psychological researcher who led the study, says, they’ll have trouble telling if a thought “came from the daydream or the teacher.”)

And then, finally, some people just don’t enjoy introspection, especially when it comes to negative emotions. “It is not uncommon for participants in mindfulness interventions to report various unpleasant reactions, such as agitation, anxiety, discomfort, or confusion, during formal mindfulness training exercises,” a 2016 review of the state of the field reported.

(Though dealing with tough emotions is a core feature of the therapy, not a bug.)
Conclusion: should every school have a mindfulness program?

The state of the evidence here is frustrating. Overall, there’s evidence that suggests mindfulness has a positive effect for kids on anxiety and cognitive measures. But the research isn’t clear on why, whom it’s most beneficial for (a recent small study found mindfulness training may work better in women), or whether the effect is specific to mindfulness instruction.

“There's a lot we still have to learn about what we're doing,” Tish Jennings, a professor of education at the University of Virginia, says. She’s generally in favor of mindfulness, and has used it with teachers to help them cope with the stress of their demanding jobs. But she cautions that there’s still a lot we don’t know.

Such as: How long do the effects last? And in what populations? What’s developmentally appropriate for kids of different ages? What types of meditations are more effective than others?

“Often those of us who are developing these programs, we combine a lot of these [meditation] activities, because we're not exactly sure which one is going to work for what person,” she says. “Because the other thing we don't know is [whether] some people might benefit more from one kind of activity than another.”

Mindfulness is an interesting — and experimental — approach to providing kids with a way to reduce stress. But it’s not a home run.

“It’s okay to keep an open mind about this stuff; we just need to be really careful not to hype the potential benefits associate with it,” Caulfield says. “It would be great if something as simple and straightforward as mindfulness really did have all these incredible benefits, but we’re not there yet.” When it comes to programs touting mental health benefits for youth, he says, we should demand a high bar of evidence.

Oren J. Sofer, the senior program manager at Mindful Schools, disagrees with skeptics’ thinking that it’s too soon to bring mindfulness meditation into schools. “You can overstate the research and make claims that haven’t been validated, but saying that it’s ‘experimental’ I believe is understating the research,” he says.

“I think it’s important to research this stuff, but at the same time, I think it’s important to have common sense. Do we as adults and educators in society have a responsibility to teach children to be self-aware? You don’t need a research study answer that question.”

Throughout my conversations, I had a lingering question: Does mindfulness need to have a scientifically approved psychological benefit for it to be useful or interesting for students?

It’s not just a psychological technique. It’s a philosophy: a way of approaching life. At Eastern High School, teacher Rebecca Milner welcomed it into her classroom because it complemented the curricula — she teaches Eastern philosophy in her course. A little stress reduction is an added benefit.

We don’t demand humanities instruction have double-blind placebo strength evidence before teachers assign students to read Hamlet. Teachers assign Hamlet because it’s a great piece of literature that invites students to think about the characters, history, and the English language. Hamlet is taught because it is interesting to think about Hamlet.

Mindfulness could be something similar: a toolset for a new, interesting way of thinking about the body, mind, and our emotions.

“If it is being presented as a worldview, or almost as a philosophy or an approach to relaxing, that’s one thing,” Caulfield says. “But the problem is that it is increasingly being framed as an intervention. If they’re making claims about specific clinical benefits, I do think we need research to support it. Or present it as experimental or possibly beneficial.”

But here’s the thing: Mindfulness instructors also like to avoid telling students about the religious and philosophical roots of these practices. And so they lean on the science in their pitches. “We deal with [the religious issues] by being transparent and bringing in the science,” says Bruce Gill, executive director of Minds Inc., the D.C. nonprofit that provided the mindfulness programming for Eastern High School.

(To the organization’s credit, the website does caution that “much research is still to be done.” And Gill was sure to point out “the bulk of formal research has been done with adults.”)

Should these open questions prevent further research efforts in schools? No. Not at all. If mindfulness is truly useful in reducing stress in children and adolescents, we should know that. There needs to be more high-quality research like Sibinga’s to better understand how this affects kids. (There’s a large randomized controlled study underway in 76 UK schools involving around 6,000 students, which should help.)

Questions Parents Should Ask About Mindfulness Programs at Schools

So parents should be mindful and ask some questions when mindfulness training comes to their school district. The experts I talked to suggested a few:
  • Is mindfulness instruction replacing another, potentially more valuable, activity or resource? For instance, we know physical fitness is critical to mental and physical well-being. Are mindfulness programs taking time out of fitness? Or math instruction? Or reading? There’s only so much time in the school day.
  • How much does the program cost? Where is the budget coming from?
  • How much training do the instructors have? Teaching mindfulness to yuppie adults is different than teaching it to urban youth. Are the instructors used to the classroom setting?
  • Do the instructors practice mindfulness in their own lives? (Sofer says this makes a huge difference in instruction quality.)
  • Are the instructors using a mindfulness practice with a strong evidence base like mindfulness-based stress reduction (MBSR)?
  • Have the practices been fully secularized? Will the students learn about Buddhist origins of the techniques? (This might be more of a sticking point for some parents more than others.)
  • Is there a quiet space for the training? Distractions will make it a waste of time.
  • Is it being used to control behavior or to reduce anxiety?


At the very least, Sibinga says, this research “is a recognition is that children really need balance in their school day, and the notion of teaching for the test and trying to cram full the day with only academic work is limited.”

If the benefit of mindfulness is simply taking time out of a busy school day, and just remembering to breathe, that’s not such a bad thing.

Further Reading
  • The 2014 JAMA Internal Medicine systematic meta-analysis reviewed more than 18,000 study citations on mindfulness as a method to improve stress and well-being. It found a generally positive effect and concluded that mindfulness mediation was about equally effective as other relaxation therapies such as exercise and massage.
  • This 2016 review of the evidence on mindfulness interventions is pretty easy to read (i.e., free of academic jargon). Like the JAMA review, Carnegie Mellon psychologist J. David Creswell finds an overall beneficial effect for adults dealing with mental health issues. “Some of the strongest and most reliable [randomized control trial] evidence indicates that mindfulness interventions ... improve the management of chronic pain, reduce depression relapse rates in at-risk individuals, and improve substance abuse outcomes,” he writes. But he worries: “Mindfulness interventions are being integrated into schools and the workplace in the absence of a corpus of high-quality well-controlled RCT [randomized control trial] studies.”
  • Dr. Sibinga and a co-author outline the case for using mindfulness meditation to reduce the effects of childhood stress and trauma.