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Saturday, July 22, 2017

ADHD Medication Tied to Lower Risk for Alcohol, Drug Abuse in Teens and Adults

From Indiana University

July 12, 2017

The use of medication to treat attention deficient hyperactivity disorder is linked to significantly lower risk for substance use problems in adolescents and adults with ADHD, according to a study led by researchers at Indiana University.

The risk of substance use problems during periods of medication use was 35 percent lower in men and 31 percent lower in women in the study. The results, based upon nearly 3 million people with ADHD in the United States, are reported in the American Journal of Psychiatry.

"This study contributes to growing evidence that ADHD medication is linked to lower risk for many types of harmful behavior, including substance abuse," said Patrick D. Quinn, a postdoctoral researcher in the IU Bloomington College of Arts and Sciences' Department of Psychological and Brain Sciences, who led the study.

"The results also highlight the importance of careful diagnosis and compliance with treatment."

As one of the largest analyses on the risks and benefits of ADHD medication, the study drew on anonymous health care data from 146 million people with employer-based health insurance in the United States from 2005 to 2014.

Specifically, the researchers mined the data to identify people with ADHD whose records showed periods of ADHD medication use and periods without ADHD medication use -- as well as one or more visits to the emergency room due to drug or alcohol use. They then calculated the odds of the visits occurring during the person's use of ADHD medication versus the same person's non-use of ADHD medication.

"Many factors can influence who receives ADHD treatment, including socioeconomic factors, health care access, the strength of support networks and disorder severity," Quinn said. "Although no single study of real-world treatment practices can definitively show whether medication use lowers risk, studying the same people at different points in their medical history helps us control for these factors and isolate the role of medication in their behavior."

Of the nearly 3 million people with ADHD in the study's database, about 57 percent experienced periods in which they were and were not prescribed medication to treat the disorder. About 2 percent experienced an emergency room visit due to substance abuse. The median age of the study's participants was 21 for men and 28 for women.

The majority of the ADHD medicines used in the study were stimulants such as Adderall, an amphetamine, and Ritalin, or methylphenidate. A significantly smaller number used nonstimulant ADHD medication such as Strattera, or atomoxetine.

"While concerns about prescribing medications to treat ADHD that have the potential for abuse are understandable, this study provides further evidence that the use of these medications is not associated with increased risk of substance use problems in adolescence or adulthood," Quinn said. "Rather, this and other recent studies find that the risk of such problems is lower during and after periods of use of these medications."

Quinn is a member of the lab of Brian M. D'Onofrio, a professor in the Department of Psychological and Brain Sciences. Another study from this group recently reported in JAMA Psychiatry found that the use of ADHD medication was associated with lower risk of motor vehicle accidents in men and women.

D'Onofrio is also a co-author of several studies based on patient data from Sweden that found similarly lower risk for substance abuse and transport accidents in people with ADHD who used medication.

The larger number of people in the two more recent studies -- as well as the use of U.S. patients in the new analyses -- strengthens this earlier evidence.

"Together, these studies provide accumulating evidence about the possible short- and long-term benefits of ADHD medications," D'Onofrio said. "They also provide important information to medical providers who prescribe ADHD medication -- as well as to adults with the disorder and parents trying to make medical decisions for children. Overall, I think people should find these results reassuring."

Other authors on the study were Martin E. Rickert, a research scientist at IU; Kwan Hur, Robert D. Gibbons and Benjamin B. Lahey of the University of Chicago; and Zheng Chang, Arvid Sjölander, Paul Lichtenstein and Henrik Larsson of the Karolinska Institute in Sweden. Larsson is also affiliated with Örebro University in Sweden.

Journal Reference
  • Patrick D. Quinn, Zheng Chang, Kwan Hur, Robert D. Gibbons, Benjamin B. Lahey, Martin E. Rickert, Arvid Sjölander, Paul Lichtenstein, Henrik Larsson, Brian M. D’Onofrio. ADHD Medication and Substance-Related Problems. American Journal of Psychiatry, 2017; appi.ajp.2017.1 DOI: 10.1176/appi.ajp.2017.16060686

Trump Stance on Civil Rights Is 'Distressing and Dangerous,' Obama Official Says

From Education Week

By Evie Blad
July 20, 2017

Catherine Lhamon, the assistant secretary for civil rights in the Obama administration’s Department of Education, is now a prominent critic of the Trump administration’s stance on civil rights. And the criticism flows both ways.

U.S. Secretary of Education Betsy DeVos has said the office for civil rights in the Education Department, led by Lhamon, was overreaching in its approach to investigating and enforcing civil rights.

Under DeVos’ leadership, the Education Department has halted the previous administration’s practice of regularly expanding probes into individual civil rights complaints to look for larger, systemic violations. Early in her tumultuous tenure, DeVos joined Attorney General Jeff Sessions in rescinding Obama-era guidance on the rights of transgender students, and she recently said she plans to re-examine the previous administration’s guidance on sexual assault.

Lhamon is now the chair of the U.S. Commission on Civil Rights, an independent agency charged with advising Congress and the president. The commission voted in June to launch a two-year investigation into civil rights practices at several federal agencies under the Trump administration, including the Education Department.

In Lhamon’s time at the office for civil rights, the agency took a highly public role and investigated a record number of complaints.

This conversation has been edited for length and clarity.

Much recent public debate has centered on the Education Department’s decision to focus on individual civil rights complaints and to end a practice of exploring related data to look for larger, more systemic issues. DeVos said in a letter to U.S. Sen. Patty Murray, D-Wash., that the office for civil rights “had descended into a pattern of overreaching, of setting out to punish and embarrass institutions rather than work with them to correct civil rights violations.”

What’s your response to this criticism, and why did you consider this systemic approach important?

Catherine Lhamon
I think the only way to do effective civil rights enforcement, which is OCR’s congressional charge, is to use the expertise of the staff related to civil rights ... as well as the kinds of fact patterns that can come up to evaluate whether civil rights have been violated.

The statutory and regulatory charge for the office for civil rights is to act whenever the office has information that civil rights may have been violated. Typically, if the office received a complaint or otherwise opens an investigation into a particular issue, the office is examining whether there was particular animus toward a single student or a lack of information about civil rights law as it applies to a class of students.

We saw it over and over again. If one student had not had, for example, a manifestation determination [a required assessment schools do before disciplining a student with disabilities to determine if that student’s misbehavior stems from their disability] ...typically that was because the school didn’t know that it should conduct such an [assessment]. It means that it had not only not done it for that student, but it had [also] not done it for the whole class of students like that student at that school.

If you get a correction only for the one student who knew to complain to OCR, you are failing to satisfy Congress’ charge to protect civil rights for all students.

A conservative critic recently criticized the systemic approach. He pointed out some cases for which you ended up finding that there wasn’t something worth penalizing the school for the individual complaint but you uncovered something in systemic data, like racially disparate rates of suspensions. He argued that maybe that was inappropriate. If the individual complaint is resolved without you taking any action, then why should you take action on broader issues?

I think that is an astounding criticism in its historicity and its failure to understand the reason for having federal civil rights enforcement.

It is a good thing every time the office can identify lack of violation of civil rights, and that is worth celebrating. It is also the case that the office employs close to 600 staff who have singular expertise with respect to civil rights and who follow the updates in the law, changes in statute, changes in court interpretations, and the wide variety of fact patterns that can take place for students in school.

It really is an unbelievable trove of resources for schools about how to make sure that every student is respected as a learner in school...

It is astonishing to me to hear from people that when there are violations of the law, OCR should turn away from that because that particular student didn’t think to come to OCR and ask for relief. That is not the structure the Congress set up 60 years ago, and it is not the structure any of us would want for a child we love in school.

Another one of DeVos’ criticisms of the approach of more automatic triggering of systemic reviews is that it slows down resolution for the original, individual complainants.

I find it laughable. The [Trump administration’s] budget proposal for the office for civil rights requires such an astounding staff loss that the staff are projected to carry 42 cases per person under that budget proposal.

If anyone were concerned about slowing down resolution—which we were in the Obama administration—the thing to do is to ask for more dollar resources for the staff to be able to speed up the work, not to ask for the staff to carry an untenable caseload.

That is, again, an absolute red herring to suggest there is real concern about speed. The reality is that I’m sick every day about knowing how long students have had to wait for justice.

The staff when I was there were working as hard as they could to secure as much justice as they could every single day. The way to achieve that is not to put blinders on the staff’s eyes and to turn away from justice issues that are evident to us. The way to achieve that is to do the work [in a] fair and comprehensive [way].

That means tracking down the facts, going where the facts lead you, and hearing from people who have a variety of perspectives about the particular issues under investigation to make sure that you are achieving a just and comprehensive result.

Some conservative policy watchers have criticized headlines that say that DeVos is rolling back education civil rights. They say she is actually returning to norms that existed before the Obama administration, which took a more aggressive approach. You had record-high investigations in part because of a more public posture from the agency.

Is this just the kind of policy shift we’d see with a transition in the White House? Would you have had these kinds of concerns about previous GOP administrations or previous administrations in general?

I had real concern, for example, about the way the Reagan administration approached civil rights enforcement. Until now, that was for me the low point in U.S. history for federal civil rights attention and enforcement. I worry that we are now at a nadir that drops below the Reagan administration.

I certainly don’t think that the posture of this administration—in what it has said and the actions it has taken to date—is consistent with the traditional ebbs and flows of administration change. The particular hostility to civil rights enforcement and a callous and astonishing lack of knowledge about the civil rights minimums—that are bipartisan and long-standing in this country—amaze me.

To be concrete about that, just two days ago, the secretary of education gave a speech in which she said that she directed the office for civil rights to return to improved [Individuals with Disabilities Education Act] enforcement, but the office for civil rights does not enforce the IDEA.

So, that core lack of knowledge about the jurisdictional charge for the jewel of civil rights within the Department of Education is distressing and dangerous and is unprecedented in the existence of the Department of Education. So I don’t think what we are witnessing today is just the shift in administration. I think what we are witnessing today is dangerous on a level that we have not yet seen as a country.

The Obama administration issued a lot of guidance. That included some of the big ones that get a lot of attention, like the 2014 guidance on disparate impact and school discipline, transgender students, bullying, and Title IX.

Some, including DeVos, have criticized your “Dear Colleague” letters, calling them “administrative fiats” and saying that you essentially created a new policy while bypassing the formal review process. How do you respond to that? Do you believe that there is any instance in which you should have collected more public input or in which collecting more public input might have made people more receptive to that guidance?

My first response is that the criticism is pure and utter nonsense. The United States Supreme Court has ruled unanimously in just the last few years that the issuance of guidance that is not legally binding is well within the purview of administrative agencies, and it is absolutely appropriate to share information about how those agencies do their work.

For purposes of the office for civil rights, the goal of that guidance is to share information with schools about how they can satisfy student civil rights. It is a way of avoiding a “gotcha” moment through enforcement and sharing information with the school.

In addition, there is nothing new or unusual about issuing guidance without notice and comment. It is very consistent across administrations. One concrete example is the George W. Bush administration in 2005 issued clarification of Title IX’s application to intercollegiate athletics without notice and public comment... .

Whether it would have been useful for the Obama administration to have heard more viewpoints—I don’t think it would have been because we heard from lots of people, lots of criticism over all of the various issues that we were addressing.

The sexual-violence guidance that we issued, the White House task force to protect students from sexual violence held 27 listening sessions in the first 90 days of that task force, and those listening sessions involved college and university presidents, administrators, general councils, Greek organizations, student-survivor advocates, conduct administrators, and the whole gamut of people involved in the issue—and they expressed a wide variety of views in very public settings.

OCR’s practice over years has been to hear from people on all sides of issues before issuing the guidance documents.

The Obama administration’s OCR put a great emphasis on sharing information online—including a list of colleges that sought Title IX exemptions and agreements between OCR and schools to resolve civil rights complaints—and you also made the civil rights data collection more open and usable so that people could more easily search it. How did this level of transparency advance your policy goals?

I think it is critically important for everyone involved to know what their rights are and to know what their obligations to other people are.

Sharing that level of transparency meant that more students are more safe because people who wanted to satisfy the law had access to knowing what they needed to do; ... people who wanted to know whether they had a right to something or not had access to information so that they could advocate for themselves without having to wait for someone else to come in. We saw substantially more compliance because of more information about how to comply.

We saw between the 2011-12 and the 2013-14 data collections an almost 20 percent drop in rates of suspension in schools around the country. That is extraordinary progress in a very short period of time that followed real sunlight on an issue that has bedeviled schools since the very first desegregation agreements that OCR began enforcing when OCR opened as an office following the 1964 Civil Rights Act.

There is a set of persistent and ugly challenges for students in schools that has lasted too long, and to be able to see that kind of incredible transformation in such a short period cements, to me, the value of transparency and information sharing.

Do your concerns about the current administration’s approach extend to that transparency?

It is very hard to know. So far, the administration hasn’t modified the transparency as much as many worried that they might. As I mentioned in the budget proposal for OCR, I see a plan to continue the civil rights data collection in what appears to be a transparent and universal way and that I think is very comforting. I hope that plan continues. So far, this administration has continued to share information on the website about resolution agreements secured and about schools under investigation.

There have been some blips in willingness to share information through [the Freedom of Information Act], and some websites have come down that I’m hoping will come back up, but it is a little early to know whether that transparency will continue or not. I certainly think that level of transparency is critical to meaningful civil rights satisfaction.

After the Trump administration rescinded the transgender-student guidance, you were at a protest outside the White House with Gavin Grimm [a transgender student who sued his Virginia school district for access to the boy’s restroom]. I know that you and clearly others in the administration felt very strongly about this issue.

Why did the Education Department and the Justice Department wait until 2016 to issue the guidance? Do you ever wish you had acted sooner?

The department before I started had begun investigating rights of transgender students in schools, and that was because so many administrators, educators, and families had asked questions about those rights. As you probably know, the office issued together with the Department of Justice the first resolution related to transgender students in 2013, before I came.

Following that and several others, those investigations helped OCR to see the scope and variety of the kinds of facts that needed answers in both K-12 institutions as well as institutions of higher education.

So OCR, together with the Department of Justice, was using the time to investigate those kinds of facts and also universities and colleges and school districts and states’ view of the appropriate ways to address those facts consistent with the law. Then OCR and DOJ also went through the interagency-review process to make sure that all relevant agencies were comfortable with the particular answer. That process is long.

We issued the guidance as soon as we could following what is a responsible and detailed investigation of both law and facts.

When the Trump administration rescinded the transgender guidance, one of its concerns was that you had issued it without seeking public input.

It is amazing to me. It could not be further from the truth. I and my colleagues at the Department of Education and the Department of Justice filed briefs in the Supreme Court and the [U.S. Court of Appeals for the 4th Circuit, in Richmond, Va.] detailing the lengths that we went through to analyze and hear ... people’s views on this topic.

You had to feel that night standing there outside the White House with Gavin that tension between being careful and deliberate and also the urgency for this individual student, right? [Grimm later graduated from high school before his complaint was resolved.]

I felt that that night and I felt that every day when I was at the office for civil rights, and I feel that every day now.

The reality is that civil rights issues are issues that people feel strongly about regardless of the issue. They are issues that affect who a person is in his or her core every time. You don’t want to get it wrong. You don’t want to start down the wrong path and you want to be careful and be sure that you are comprehensive enough. That worry is present every day of doing civil rights work.

Friday, July 21, 2017

Autism Research Needs a Dose of Social Science

From Spectrum News

By Sue Fletcher-Watson
July 18, 2017

Scientists are increasingly recognizing a moral imperative to collaborate with the communities they study, and the practical benefits that result.

Autism researchers are joining this movement, partnering with people on the spectrum and their families to better address their priorities.

But scientists aren’t always equipped to tackle these priorities. For instance, many societal issues that are important to autistic people, such as obtaining support as a parent, fall outside of my expertise as a psychologist.

Most of the funding for autism research in the United Kingdom supports work in the category of ‘biology, brain and cognition or causes.’ In the United States, funding is slightly more evenly distributed, but researchers investigating ‘treatments and services’ still earn a minority of grant money.

In both countries, funding directed at societal issues is miniscule. This is not simply because this type of research has lower costs; the distribution of published papers across these disciplines is also uneven.

It doesn’t have to be this way. Autism research doesn’t have to mean science. It doesn’t have to include p-values and normal distributions, nor Bayesian models and latent variables. In fact, we are increasingly facing the limitations of these methods in terms of understanding the heterogeneity of autism.

With that in mind, we can invite experts from other disciplines, such as law, history, political science and the arts, into the fold. They have the potential to make extensive contributions to the lives of autistic people.

Divergent Disciplines

In a Twitter chat during the International Meeting for Autism Research in May, some participants noted the lack of representation from the social sciences, arts and humanities in autism research. The organizers don’t deliberately block experts from these disciplines from participating in the conference.

For example, the 2015 keynote by Roy Richard Grinker provided an anthropological perspective on the construct of ‘autism.’ And a sprinkling of studies from beyond the usual trinity of biology, medicine and psychology mark a fascinating departure from the meeting’s scientific focus each year.

But we need more of this mix, especially at a time when what it means to be ‘autistic’ is so hotly debated. It is challenging to honor the neurodiversity and autistic rights agenda while recognizing the difficulties that many people on the spectrum face. We need to consider a wide range of opinions if we want to achieve this balance.

Steve Silberman, author of Neurotribes,” and others draw parallels between the autistic rights movement and the gay rights movement. In 2013, the American Psychiatric Association appointed its first openly gay president — an extraordinary move considering that just 40 years ago, homosexuality was still listed as a psychiatric disorder in the “Diagnostic and Statistical Manual of Mental Disorders.”

Can we expect the same for autism a few decades from now? A comparative, historical analysis of the autistic rights movement against the backdrop of other civil rights movements would provide a fascinating context for the status of autism.

It would also be constructive to identify the limits of these comparisons. Are there fundamental differences in how we might conceptualize and pursue these rights? When rights are won, how and when will they be translated into services and opportunities?

Sociologists might investigate the related subject of intersectionality and autism. For example, how does autism interact with other potential sources of discrimination, such as race, sexuality, gender and religious belief?

Social Studies

The experience of autistic people as citizens is also a valuable subject for research. In June, the U.K. held a general election. The hashtag #cripthevote was highly visible. People used the tag to highlight barriers to voting for people with disabilities, and to discuss the impact of different political manifestos on the community.

Understanding political engagement among people on the spectrum is crucial to helping them achieve autonomous participation in society. Political scientists could examine whether campaign materials are suitable for the autistic community, and explore other barriers to voting.

There is widespread interest in understanding the needs and experiences of autistic people as they age. Many parents worry about what will happen to their children when they themselves are gone. What legal and financial-planning mechanisms could help parents to make provisions for their adult children? And what happens when autistic people lose mental or physical capacity as they age, due to dementia or ill health? Are the legal frameworks for our aging population enough, or should there be special considerations?

Finally, although a lack of creativity is considered a sign of autism in some diagnostic tools, the many autistic artists undermine this notion. An art historian could analyze the contributions of these artists and the ways in which their autism influenced the creative process. This would enrich and expand our understanding of the autistic experience.

Some of these projects in sociology, law, politics, history and art require significant investment and research over time. They would particularly benefit from leadership by scholars who are themselves autistic. But scientists can address some of these issues on a smaller scale.

For instance, starting in September, I’ll be supervising a graduate student in music who is exploring the best way to teach music to autistic children. (And in writing this piece, I consulted with autistic people.)

It seems likely that the biomedical scientific community will continue to represent the establishment in autism research. But we should take every opportunity to draw in our colleagues from other disciplines to deliver research that can help us provide better support to the autistic community and their allies.

Sue Fletcher-Watson
is chancellor’s fellow in developmental psychology at the University of Edinburgh in Scotland.

Disability Services Remain In Peril Under Revised Health Bill

From DisabilityScoop

By Michelle Diament
July 14, 2017

Senate Majority Leader Mitch McConnell, R-Ky., released a new version of a
bill to repeal and replace the Affordable Care Act, which retains plans to
fundamentally alter Medicaid. (Carlos Barria/Reuters)

Despite a nod to the vulnerability of home and community-based services under a Republican health care plan in the U.S. Senate, disability advocates say a new version of the proposal does little to quell fears.

Tucked inside the latest version of the Senate bill, unveiled Thursday, is a proposal for a new waiver that states could apply to “for the purpose of continuing and/or improving home and community-based services.”

However, the waiver proposal, which would allow states to receive full federal funding for home and community-based services, is limited in scope. It would be available as a four-year demonstration project for just a handful of states and overall funding for the initiative would be capped at $8 billion total.

The provision is aimed at assuaging concerns over sweeping changes to the Medicaid program that are a hallmark of the legislation Senate leaders have been working for weeks to push through. But disability advocates say it does nothing to make up for billions in cuts to a decades-old program that people with disabilities rely on in order to live independently.

The Republican plan seeks to fundamentally alter Medicaid by instituting first-ever caps on federal spending for the program. Currently, Medicaid operates as an entitlement, with the federal government providing matching grants to help states cover the cost of providing services for anyone who meets eligibility requirements.

Under the Republican bill, however, the federal government would provide a fixed amount for each beneficiary regardless of the true cost of care, leaving states to make up any difference.

The nonpartisan Congressional Budget Office estimated last month that the plan would lead to $772 billion less in federal dollars for Medicaid by 2026, with cuts continuing for decades. A new estimate from the budget office factoring the latest changes to the bill is expected early next week.

Advocates have warned that reduced federal support would lead states to take cost-cutting measures, seriously threatening services for people with developmental disabilities who depend on Medicaid for everything from traditional health care services to supports that enable them to live and work in the community.

In particular, advocates say that home and community-based services, which are considered optional under current Medicaid policy, would likely be the first to go if states choose to trim services in light of diminished federal funding.

The newly-added provision creating the waiver program is “laughably inadequate” to address such concerns, said Julia Bascom, executive director of the Autistic Self Advocacy Network.

“It’s limited to a few states and would impact a tiny fraction of people with disabilities in need,” Bascom said.

Even states that benefit from the proposed waiver would only stand to gain for a few years, according to Alison Barkoff, director of advocacy at the Center for Public Representation. Meanwhile, she said “it does nothing to address the likely reduction, elimination and growing wait lists for optional HCBS programs that will occur in every other state across the country.”

All the while, Barkoff noted the Senate plan calls for an end to the Community First Choice Option, a Medicaid program created under the Affordable Care Act that offers states extra federal dollars for home and community-based services if they meet certain criteria.

The proposed waiver, Barkoff indicated, “does not even make up for the loss of that single HCBS program.”

Thursday, July 20, 2017

Student Trauma is Real. But Connection Can Heal.

From Education Week's Blog
"Teacher-Leader Voices"

By Gary G. Abud, Jr.
July 11, 2017

Connection is a powerful human experience,
and it can help to reverse the impact of childhood trauma.

Can...can you...can you hear me now?

As humans, we are hard-wired for connection with each other. When we face challenging life situations, we often seek out and lean on others. Relationships are our human cell phone signals. In The Power of the Other, Dr. Henry Cloud compares our strong desire to develop meaningful relationships to how a cell phone constantly seeks connection in order to function.

Like a phone after powering up, people begin to seek connection as soon as they enter the world, and they never stop.

There are many factors that can interfere with connectivity; and if our signal gets disrupted, we relocate until a good connection can be restored. When we establish a strong connection with others, we want to maintain it, but we don't always have a 4G LTE network of relationships. Just as dead zones can disrupt cell signals, there are myriad factors, including trauma, that can disrupt our personal connections with others and limit our functioning.

The Reality of Trauma

Traumatic events, such as war, death, or violence can have a serious influence on one's health, stress, and anxiety; for kids, this is especially true, as they lack the social and emotional skills to deal with the impact of trauma. Trauma can even cause physical pain, including when a traumatic event is non-physical.

In recent years, the Center for Disease Control and Prevention has helped to expand what qualifies as trauma to include more social and emotional events, such as poverty, divorce, and food insecurity.

When kids are exposed to Adverse Childhood Experiences (ACEs) like abuse, neglect, or household dysfunction earlier in life, there is a larger risk for negative impacts on learning, health, and wellbeing in later years. That is because both emotional and social pain as well as physical pain are neurological.

Pain is more than a metaphor, as UCLA Neuroscientist Matthew Lieberman found in his research. Social separation in infants causes pain and triggers a physical response. Acetaminophen has been shown to alleviate the pain of a broken heart just like it can ameliorate back pain.

Years after a traumatic event, one is more likely to remember the pain associated with a lost loved one than the pain of a broken arm. And, like Cloud, Liberman also acknowledges that connection with others is among our greatest human needs.

Trauma, ACEs, Empathy and Learning

ACEs have more than an emotional impact on children, they change the brain, affecting memory, cognition, and learning capacity. Some children born during the Great Recession have been found to have deficiencies in nutrients that are key to cognitive development and mental health—such as folate, choline, and omega-3 fatty acids—as a result of poverty, food insecurity, and parents' inability to purchase costlier whole foods.

Stanford psychologist Hilit Kletter points out that this might lead kids to act out, exhibit big emotions, or struggle with impulsivity in school, which gets them in trouble or is mistaken for ADHD.

For many who experienced financial struggles and other ACEs in the past decade, there was a high level of shame. The shame associated with social and emotional pain breaks down connection with others and isolates us from each other.

Brene Brown's model of interpersonal connection spans a continuum, ranging from empathy (most connected) to shame (least connected). According to her shame-resilience curriculum, vulnerability is the key to helping us connect, which in turn yields empathy, and can overcome the destructive impact of shame.

So, understanding and empathy from a caring adult can help contextualize symptoms of trauma as maladaptive behaviors, not misconduct.

In order for students to be receptive to new learning, there needs to be a supportive ecosystem around social and emotional development in schools, which includes awareness among educators, a trauma-informed MTSS, and a school-wide social emotional learning curriculum taught by teachers, like the Second Step Program.

Researcher Chuck Saufler explains that this type of network of structure and support to kids, founded on authentic, trusting connections, changes the brain in a positive way. It decreases the stress response in the body, removing cognitive inhibitors, and creates a climate of relaxed alertness in the brain, leading to better learning.

Students who have strong connections in school perform better, because relationships are central to learning and development, since they create a sense of doing school with, rather than doing school to, kids. That's why forming strong connections with students between educators and the classroom environment, is crucial. This yields relational literacy among students, too, and it all begins with adults who develop understanding and empathy for the students in the context of trauma.

Connection is the First Step

During a time when many students have experienced some form of trauma, even a single nurturing personal connection can work to reverse the negative aspects of trauma for a child. According to a recent report by the National Network of State Teachers of the Year, this is because that personal connection engenders in students a sense of belonging at school, especially students in poverty.

Moreover, the report notes that teachers play a key role in fostering social and emotional competencies and skills in students through strong positive relationships.

In Poor Students, Rich Teaching, Eric Jensen describes the belief of teachers in their own ability to bring about powerful change in the classroom and overcome the impact of poverty on students as the "Relational Mindset."

He cites that relationships, in particular for students from unstable homes, influence classroom engagement, allow low-income students to perform equal to higher-income peers, and can help build resilience to protect students from the effects of early-life trauma.

A Relational Mindset requires teachers to adopt a more psychological perspective on student behavior, says Jensen, but that mindset shift can start with changing our words and beliefs, according to the Continua Group. Our personal beliefs and values inform our thoughts, words, and actions.

So, to adopt a belief that behavior skills (including social-emotional ones) are as important to academic success as reading and math, we should adjust our language around student behavior from an "I can't believe the student did this!" view to "why did the student do this?"

This will lead us to build relationships, maintain them, and work to repair them when connections are disrupted, eventually a relational mindset will help students develop relational literacy themselves. And this would have an impact on how we build our Multi-Tiered Systems of Support (MTSS) and Response to Intervention (RTI) systems to not only help some students, but to support all students.

To make sure every kid succeeds, RTI expert Mike Mattos says we must treat behavior like we do reading and math. Just as we don't punish kids for struggling to read—and instead give them the targeted reading support they deserve—we should not just punish students for struggling with social, emotional, or behavioral skills.

From a trauma-informed perspective, we should realize kids need interventions, coaching, and support to develop social-emotional skills, not punitive measures.

Because teachers play an important role in students' social-emotional skill development through relationships, one way they can work to enhance those connections in the classroom is by building on the ways children learn from each other in a social context. Teachers can make sure there are ample opportunities for student-to-student discussion, collaboration, and feedback in the learning environment within students zones of proximal development.

Better communication will yield stronger relationships and better connections, working to undo the harmful effects of trauma.

Restorative Practices

Restorative Practices are flexible and responsive approaches to establishing, developing, and restoring relationships that enable people to develop a shared sense of community in an increasingly disconnected world. Restorative Practices empower students to resolve conflicts on their own and in small groups, and it's a growing approach around the country to building community and addressing student behavior issues in schools.

One way to better test scores and less discipline problems in schools is to adopt restorative practices. And what educators wouldn't want that, especially when approximately 5% of students represent 50% of all disruptive behaviors in schools? In classrooms or schools, the intent is to first make relationships with students, then maintain them, and (when things go wrong) repair the harm to those relationships. This happens through one-on-one, small, and large group interactions, bringing students together with adults to dialogue and discuss issues or questions with one another.

Restorative Practices have three main goals:
  • Developing competency to increase the pro-social skills of students, help them realize when they have harmed others, and address underlying factors that lead youth to engage in maladaptive behaviors.
  • Ensuring safety by directing students to recognize the need to keep the school community safe through strategies that build relationships and empower them to take responsibility for the well-being of one another.
  • Sharing accountability through providing opportunities for wrongdoers to be accountable to those they have harmed, and enabling them to repair the harm they caused to the extent possible, not just serving a punishment for the offense, which often leaves the victim out of it.

According to the International Institute for Restorative Practices (IIRP), a fundamental tenet of the Restorative Practices philosophy for schools is that students are happier, more cooperative, and more successful when educators do things with them, rather than to them or for them. Restorative Practices revolves around safety of all, meeting the needs of each individual, and focusing on the harm done to others through words and actions.

Brain research on stress, motivation, learning, and memory supports the use of restorative practices in schools. These practices have the aim of fostering strong connections between students and others in schools, and then using that as the basis for addressing issues that come up in the school setting. It is not a single strategy, set of talk moves, or group of activities; it is a philosophy of interpersonal connection between students and adults in schools that can support social-emotional development in students and learning in schools.

Implementing Restorative Practices at your school requires training and coaching of staff and students, progress monitoring of the practices themselves and student interactions, and debriefing about the implementation process along the way.

But because Restorative Practices emphasize the values of empathy, respect, honesty, acceptance, responsibility, and accountability, it is especially promising as a schoolwide means of supporting students social-emotional learning in a trauma-informed way.

It provides ways to effectively address behavior and other school issues, offers a supportive environment that can improve learning, and ensures student wellbeing by allowing for the reparation of harm. Restorative Practices are not about enforcing rules; the focus is on repairing harm done to others, fulfilling a need not met, and ensuring the safety of all. They can be incorporated into MTSS or a Positive Behavior Intervention and Supports (PBIS) system.

At their core, Restorative Practices require the formation of strong connections and the building of relationships. From there, harm to relationships can be repaired and connection can be restored. Because of our strong desire to connect with others, as people we do not typically want to harm those with whom we have a relationship.

Changes of behavior do not come from a punishment anyway, they come from a change of heart. That happens when three factors are present in addressing behavior: the impact of one's actions on others are made known, the possibilities of alternate actions are shown, and the opportunity to repair the harm done is given. After all, you cannot restore a relationship with, or repair harm to, someone with whom you have no relationship in the first place.

And in a school, with kids and adults who are longing to connect with others against a backdrop of trauma, our hearts' desire should not be for punishment, it should be for for the connective power of empathy, teaching, and forgiveness. Forgiveness doesn't excuse behavior; forgiveness prevents behavior from stepping on your heart.

Through the healing power of connection, and by installing restorative practices at a school or in a classroom, educators have the potential to positively influence school climate and strengthen social connections between students and staff. Restorative Practices can enhance the climate of a classroom and school much better than extrinsic rewards or threats of punishment ever could, because they empower students.

This philosophy and pedagogy meets the vital need to help students develop social-emotional skills, support interpersonal relationships, and be non-confrontational with even the most challenging students.

In the end, Restorative Practices prioritize relationship building and mutual understanding over finger-pointing and retribution. With the primary 'rule' being "do no harm," Restorative Practices becomes a tool to fight against the negative impact of poverty and the harmful effects of trauma. Through the power of connection, it teaches students how to become the people we want them to be, and does not just expect them to do so on their own.

Seven Ways to Make & Maintain Connections

For any educator to connect with their students is a given, but it isn't always easy to do, especially once the school year gets busy. But because it is so crucially important to build connections with kids, even those not in your classroom, the work must be made a priority.

Here are seven activities that can be used with students or adults in the classroom or school setting. These can help to make connections, but also maintain them as well. This is especially important for the use of Restorative Practices later on to repair relationships. But it should not just be about the connections with kids.

Remember that building connection and community with the adults in the building is key too, as it will set the tone for doing the same with students.

Many of these activities are great ways to get the school year started, too:
  • Community Building Circles —using Restorative Practices circle format to get to know one another in the classroom, discuss topics, and have shared experiences;
  • Team Building Activities—Teampedia has a variety of easy and quick team-building activities for both small and large groups;
  • One and Done—in the first 30 days of the school year, demonstrate a single act of empathy (e.g., doing a favor) for a different student each day;
  • Two by Ten—Identify one or two students who need a connection early on in the year. For 10 consecutive days, invest two minutes each day with them to talk about anything but school;
  • Three in Thirty—Ask enough questions to discover three things about every student in the first 30 days of the year;
  • Me Bag—Have each student, and teacher, fill a bag with two to three items that represent who you are, and then provide an opportunity to share what everyone packed in their bag with each other.

A Personal Connection

My favorite class in high school, also taught by my favorite teacher, was AP English. Despite struggling as a reader throughout school, due to a visual impairment, I loved literature. For me, reading was a private means to a very public end. I looked forward to what came as a result of reading: the opportunity to dialogue about a text with others in class. Even when I found reading to be tiresome or difficult, I persisted, because I loved discussing literature, especially poetry.

Nearly 400 years ago, English poet John Donne famously declared, "no man is an island." Like Cloud referred to cell phones, Donne was speaking of connection in the island metaphor. To this day, I can vividly recall discussing Donne's poem in 11th grade. Because of the social context of the class, AP English developed in me a sense of belonging, a growth mindset, and the grit necessary to succeed against the setback of having a degenerative eye disease.

Now, I realize that my affinity toward English class likely had less to do with the literary content and more to do with the personal connection I felt in the classroom.

Gary G. Abud, Jr. is an educational consultant, speaker, and writer. Previously, he served as an elementary school principal, taught high school science and technology, and worked as an instructional coach for PreK-12 schools.

In 2014, he was selected as the Michigan Teacher of the Year and consults with educators, schools, and organizations on topics of curriculum, instruction, assessment, and technology. He resides near Detroit, Mich. with his wife and fellow educator Janice, and their preschool daughter Laina. Connect with Gary on Twitter @mr_abud.

Possible Early Diagnosis of Autism Spectrum Disorder

From UT Southwestern Medical Center
via ScienceDaily

June 29, 2017

Measuring a set of proteins in the blood may enable earlier diagnosis of autism spectrum disorder (ASD), according to a study from the Peter O'Donnell Jr. Brain Institute at UT Southwestern Medical Center.

The research found that the levels of two proteins previously identified as potential markers for ASD could help scientists accurately diagnose the disorder in approximately 75 percent of the children studied. When the two proteins are measured together, the diagnostic accuracy increased to 82 percent.

The study published in the Journal of Neuroinflammation is among several recent and ongoing efforts to improve early diagnosis of ASD by shifting focus to biological measurements instead of behavioral symptoms.

Progress in this area could lead to earlier intervention and help limit the effects of the disorder, said Dr. Dwight German, study senior author and Professor of Psychiatry at UT Southwestern.

"ASD is a very heterogeneous disorder, and if we can identify biomarkers for even a subgroup of ASD patients, then that would be extremely helpful not only for early diagnosis but also for the development of therapeutics," said Dr. German, whose latest research builds upon an ASD finding published last year in Scientific Reports.

ASD affects approximately 1 in 68 children in the U.S. The neurodevelopmental disorder is characterized by social interaction and communication challenges, and restricted and repetitive patterns of behavior.

Most cases are not diagnosed until about age 4, when communication and social disabilities become apparent. However, recent research offers hope that detection may be possible by age 1 by measuring brain growth.

Journal Reference
  • Sarika Singh, Umar Yazdani, Bharathi Gadad, Sayed Zaman, Linda S. Hynan, Nichole Roatch, Claire Schutte, C. Nathan Marti, Laura Hewitson, Dwight C. German. Serum thyroid-stimulating hormone and interleukin-8 levels in boys with autism spectrum disorder. Journal of Neuroinflammation, 2017; 14 (1) DOI: 10.1186/s12974-017-0888-4

Wednesday, July 19, 2017

'Dirt Is Good': Why Kids Need Exposure To Germs

From NPR's Health Blog "Shots"

By Lulu Garcia-Navarro
July 16, 2017

Jack Gilbert, co-author of the book "Dirt Is Good," says kids should be
encouraged to get dirty, play with animals and eat colorful vegetables.

As a new parent, Jack Gilbert got a lot of different advice on how to properly look after his child: when to give him antibiotics or how often he should sterilize his pacifier, for example.
After the birth of his second child, Gilbert, a scientist who studies microbial ecosystems at the University of Chicago, decided to find out what's actually known about the risks involved when modern-day children come in contact with germs.

"It turned out that most of the exposures were actually beneficial," Gilbert says. "So that dirty pacifier that fell on the floor — if you just stick it in your mouth and lick it, and then pop it back in little Tommy's mouth, it's actually going to stimulate their immune system. Their immune system's going to become stronger because of it."

Gilbert is now the co-author of a new book called Dirt is Good: The Advantage of Germs for Your Child's Developing Immune System. Presented in a Q&A format, the book seeks to answer many of the questions Gilbert has fielded from parents over the years.

This interview has been edited for length and clarity.

The Advantage of Germs for Your
Child'sDeveloping Immune System
Hardcover, 250 pages
Interview Highlights

What are some things that parents get wrong?

Some of the main things are over-sterilizing their environment, keeping their children from ever getting dirty. So going out into the backyard and playing in the mud, and then as soon as they're filthy, bringing them in and sterilizing their hands with antiseptic wipes, and then making sure that none of the dirt gets near their faces.

Also, keeping them away from animals. The dogs and cats, sure, but also, other animals. It's fine to wash their hands if there's a cold or a flu virus around, but if they're interacting with a dog, and the dog licks their face, that's not a bad thing. In fact that could be extremely beneficial for the child's health.

What about hand sanitizer? Good or bad?

Usually bad. Hot, soapy water is fine. Even mildly warm, soapy water is fine, and it's probably less damaging to the child's overall health.

How about the five-second rule? The idea that if something falls on the ground and is there for under five seconds, it's clean.

The five-second rule doesn't exist. It takes milliseconds for microbes to attach themselves to a sticky piece of jammy toast, for example. But it makes no difference. Unless you dropped it in an area where you think they could be a high risk of extremely dangerous pathogens, which in every modern American home is virtually impossible, then there's no risk to your child.

Wash a pacifier or lick it if it falls on the ground?

Lick it. A study of over 300,000 children showed that parents who licked the pacifier and put it back in — their kids developed less allergies, less asthma, less eczema. Overall, their health was stronger and more robust.

Are things like allergies an unintended consequence of trying to protect our kids too much?

Absolutely. In the past, we would have eaten a lot more fermented foods, which contain bacteria. We would have allowed our children to be exposed to animals and plants and soil on a much more regular basis. Now we live indoors. We sterilize our surfaces. Their immune systems then become hyper-sensitized.

You have these little soldier cells in your body called neutrophils, and when they spend too long going around looking for something to do, they become grumpy and pro-inflammatory. And so when they finally see something that's foreign, like a piece of pollen, they become explosively inflammatory. They go crazy. That's what triggers asthma and eczema and often times, food allergies.

Give us some advice. What should I allow my child to do?

Oftentimes, it's hard to get your kid to eat a healthy diet. I would strongly try to encourage the consumption of more colorful vegetables, more leafy vegetables, a diet more rich in fiber as well as reducing the sugar intake. But just generally, allow your kid to experience the world. As long as they're properly vaccinated, there's no threat, and they will actually get a stronger, more beneficial exposure.