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Friday, August 31, 2018

Family Income Affects Kids' Success More than Public Vs. Private School, Study Finds

From WBUR 90.9 FM Boston's "Here and Now"

By Robin Young
August 27, 2018

It's a common refrain among parents: "I wish I could send my kids to private school."

The subtext, of course, is that expensive private schools give kids a better education, which leads to better career opportunities and a more successful life. But a new study shows that the advantages of private school disappear when controlling for socioeconomic factors.

Here & Now's Robin Young speaks with Robert Pianta, dean of the Curry School of Education at the University of Virginia and one of the study's authors.

Interview Highlights

On how the study was conducted:

"We had the opportunity to be studying about 1,300 kids that were born in 1991 at 10 different locations across the country, and we followed them — actually they're still being contacted at the age of 27 in this particular study — we followed them all the way through ninth grade in high school, and during the course of that study, we tracked the kinds of schools that they were in, we asked a lot of questions of the kids and the parents, and in the high school years, we assessed the children on a wide variety of things that we care about: achievement tests, how well they're doing in school, what the teachers think of them, how motivated they are.

"And a chunk of those kids, several hundred of them, actually went to private school. And so this particular study was a way of looking at the associations between their enrollment in private schools and those outcomes at ninth grade."

"It was the family factors that carried the day in determining the children's performance in high school. It wasn't the school that they went to."
-- Robert Pianta

On the notion there are advantages to private schools, and that those advantages disappear when controlling for certain factors:

"We look at these kids when we assess them in ninth grade, and if you just simply look at private school versus public school — don't consider any other factor in the kids' history — you see huge benefits to being in private school. They're about a standard deviation of like 15 points higher on test scores, they're more motivated and the like.

"And then, as soon as you put into the equation that you're using to predict, as soon as you put in family income, those differences disappear — and they never reappear again, no matter how many other variables that you put in.

"So the idea basically being, that it's what's happening in kids' families and the kinds of conditions that they're able to purchase for their kids and the circumstances that they're able to provide for their kids over the long haul that really matter in adding up to the kinds of things that we assessed in ninth grade."

On the difference it makes when parents provided their young children with educational resources and stimulation:

"That is a very big difference. Importantly, those families continue to give those kids advantages from kindergarten all the way through ninth grade. So it is important what happens in that birth-to-5 [years old] period for sure, it sets kids up on a trajectory of success or not. Those families that give those advantages tend to also be families that will place their kids in private schools.

"Now, some low-income kids do end up in private schools for all sorts of reasons. When we looked at the low-income kids in the sample who were in private schools, we didn't see any advantage to private education there either.

"I think one of the things people miss is the stunning heterogeneity of private education. We all have this idea of what private education looks like: It's like a prep school. But private education on average is very, very heterogeneous.

"If you want to predict children's outcomes — achievement test scores, the things we care about socially — in high school, the best thing that you can use to predict that is going to be family income. Regardless of what high school you go to, the best predictor is going to be family background.

"And in this case, it's family background before the child even goes to school in kindergarten. There will be individual cases of poor kids who went to private schools that are tremendous success stories. But we make policy not on the basis of individual cases, hopefully, we make it on the basis of larger data sets and patterns of information."

On Education Secretary Betsy DeVos calling the U.S. public school system a "dead end":

"I think we're saying that, for every school that she can point out where there's a public school that's a dead end, you can probably point out a private school that's also a dead end for a kid who needs a better education. So our point here would be a policy that essentially gave families vouchers, and allowed them to go use those vouchers for tuition in any private school.

"And remember, I talked about how heterogeneous these private schools are: In any private school, that kind of policy is not likely to add much value to kids' achievement long term for the large number of kids that need help in the United States, and particularly a policy like that without oversight, that would determine what type of school a child might go to — whether it was actually a decent one or not."

On whether this is a school issue, versus one that could be addressed by helping parents and kids at home:

"Well we have lots of programs, social programs, that try to help improve parenting and provide stimulation to kids at home. And I think it's important to point out that the effects we see for schooling are small — they're not huge on average in the whole population, whether it's public or private school. There's lots of cases in which those effects are very, very positive for kids.

"And, we have lots of evidence to suggest that when you improve schools — whether it's public schools or private schools or charter schools — you do improve the outcomes for kids, and so focusing on policies that improve schools are clearly the pathway to creating better achievement outcomes for kids, particularly kids from less advantaged households."

On advice for parents concerned about what kind of school their kids attend:

"I think the parents who are struggling and really concerned about the schools that their kids are in, the best thing that they can do is get as involved as they possibly can be in the governance of that school and to use the mechanisms that are available to them to hold those public schools accountable. Many of those parents may have opportunities to look at publicly sponsored charter schools, and I think those are terrific opportunities.

"On balance, there aren't enough good schools for kids — whether those are public schools or private schools or charter schools. And we need parents to advocate for better schools."

Full-Day Kindergarten is Great for Kids, So Why Isn’t It Required?

From The Hechinger Report

By Lillian Mongeau
August 15, 2018

The academic gains of kids who attend full-day kindergarten are well-documented, but most states pay only for half-day kindergarten and don’t require students to attend it.

Full-day kindergarten students Januel Soto and Guijermo Rodriguez work on
drawing pictures as part of a writing workshop project at Dr. Norman W. Crisp
Elementary School in Nashua, New Hampshire. Photo: Lillian Mongeau

NASHUA, N.H. — “Fact or opinion?” teacher Patricia Lemoine asked her kindergartners on a blustery April morning: “Ms. Lemoine has a rug in her classroom.”

“Fact!” shouted her 5- and 6-year-old students, who sat on the rug in question. Whether or not it’s the best rug in the whole school, they ceded, was a matter of opinion.

Lemoine, who teaches at Dr. Norman W. Crisp Elementary School in the small city of Nashua, New Hampshire, nodded. A fact, she told her students, is “true, true, true, and we can prove it.”

It’s also a fact — true, true, true, and we can prove it — that full-day kindergarten classes like Lemoine’s help kids do better in early elementary school, researchers say. But state policy has been slow to catch up with this point.

Only 14 states and Washington, D.C., require districts to offer full-day kindergarten, according to kindergarten policy data collected by the Education Commission of the States, a national think tank.

And, even though most states require school districts to offer at least half-day kindergarten, only 17 states and the District of Columbia mandate that children attend it. Of those, two offer a waiver to children who are assessed as ready to start first grade.

Early learning advocates and politicians have spent a lot of time in the past five years talking about preschool. Former President Barack Obama made preschool a key part of his education agenda during his eight years in office. Spending on state-funded preschool programs for 4-year-olds has risen in both red and blue states, especially since 2008.

But for the benefits of preschool to be sustained, experts argue, children must continue to receive a high-quality early elementary education. Full-day kindergarten, which has been shown to boost academic gains for students well into elementary school, could be critical.

“The opportunity for full-day K should be available for all,” said Harris Cooper, a professor of psychology and neuroscience at Duke University. Cooper is the lead author of a 2010 review of all the research examining the impact of full-day kindergarten, which found that children who attended for a full day had better academic outcomes the following year, more self-confidence, and were better at playing with others.

In the 36 states that don’t require schools to offer full-day kindergarten, many districts have gone ahead with it anyway, using a combination of federal funding, available state dollars and parent-paid tuition to cover the cost of the approximately 540 extra hours of instruction time each school year.

Related: Why is it so hard to stop suspending kindergartners?

New Hampshire is the latest state to approve legislation to fund full-day kindergarten in districts that want it. However, districts here are not required to offer kindergarten at all, nor are children mandated to attend it. The new funding doesn’t kick in until 2019, but many New Hampshire school leaders aren’t waiting until then to offer full-day programs.

In Nashua, full-day kindergarten has long been provided in schools that serve a majority low-income population, but 2017-18 is the first school year full-day has been available at all 12 district elementary schools.

“It feels good to be able to offer parents what they’ve been asking for for years,” said Kelley Paradis, principal of Main Dunstable Elementary School in Nashua. Paradis, whose school offered full-day kindergarten for the first time in the 2017-18 school year, said that by April 2018, every class for the 2018-19 school year was full and the school already had a waiting list.

During the summer of 2017, Paradis said, she and Main Dunstable’s three kindergarten teachers focused on the logistics of doubling their students’ time in school. How would the kids behave in the new classroom? How would they find the bathrooms? Where would the kindergartners sit at lunch? How would teachers handle dismissing kindergartners at the same time as all the older kids?

But those things all fell into place with some extra planning and “what we learned about were the unanticipated social-emotional benefits,” Paradis said.

“The best thing has been being able to teach every subject every day.”
-- Wendy Lundquist, kindergarten teacher

Simple things like socializing during lunch and participating in “specialty classes” like art and music have made the kindergartners more comfortable in their building and with each other, the school’s teachers said.

Friendships have blossomed, kids have received more individual attention each day and the academic gains at this middle-class school have been significant, they said.

Avery Geddes, 6, is served a fruit snack for dessert during lunch at Main
Dunstable Elementary School in Nashua, New Hampshire. The social benefits
of eating lunch at school have been a huge unexpected benefit of full-day
kindergarten said principal, Kelley Paradis. Photo: Lillian Mongeau

“The best thing has been being able to teach every subject every day,” said Wendy Lundquist, who has taught kindergarten for 19 years. During previous school years, she said, she was only able to get to science or social studies on any given day, not both.

“My kids who are struggling are doing better,” said Mary Plouffe, who began teaching 15 years ago. They have extra hours to practice and more teacher support, they are “more motivated” and are improving more quickly, Plouffe said. “We should have done this years ago.”

Related: Cramming for kindergarten

In a bit of a twist for an initiative usually vaunted for its ability to boost reading and math scores, Nashua teachers said they were pleased to be spending much of the extra time offered in their full-day programs on the things kindergarten used to be famous for: art, free play and recess, among other not-strictly-academic activities.

It’s unclear if this anecdotal finding is part of a trend. Research from 2016 indicates that children spent a smaller percentage of their kindergarten day on activities like art, music and theater in 2010 than they did in 1998, according to a study led by Daphna Bassok of the University of Virginia and published in AERA Open, a peer-reviewed education research journal. The pattern of how kids spent their days held true for both full-day and half-day programs, according to the report.

After a morning filled with reading picture books, learning sight words, practicing addition, making weather graphs, counting backwards and singing songs, a class of Main Dunstable kindergartners stood in a circle in the school’s music room. They grasped each other’s hands and raised them high, making a series of spaces for a classmate to weave in and out of as they sang: “Bluebird, bluebird, in and out my window!”

When they switched to the next verse, the “bluebird” traded spots with another classmate and the dance continued.

“It’s fun,” said Hadassa Aguiar, 6, when asked what she liked about kindergarten. “I like play time every day. I know everybody. I can read a whole entire book.”

Since children from low-income families are more likely to be unprepared to do well in school when they show up on the first day of kindergarten, time to catch up to their peers is important. The extra time is also important for children who speak a language other than English at home and for students with learning disabilities.

“What full-day kindergarten does is push up the starting point,” says Cooper, the Duke professor. That means children who enter kindergarten behind the curve can potentially make enough progress to start first grade on par with wealthier classmates, he explains.

One of the benefits of a full day of school, Main Dunstable Elementary School
principal Kelley Paradis said, is that kindergartners now get to participate in
the New Hampshire school’s specialized classes, like the music class
pictured here. Photo: Lillian Mongeau/The Hechinger Report

The first-grade teachers at Dr. Norman Crisp Elementary in Nashua are used to getting students who have spent a year in full-day kindergarten. They love it. And they can tell immediately when one of their students hasn’t been in kindergarten at all.

“By the end of the first day, I realize, ‘Oh, I have six who have not been to kindergarten,’” said Shauna DeRosa, who has taught for eight years.

“If they’re coming out of kindergarten, even if they’re struggling, they’ve had some support,” said Kendra Raymond, who has taught for 10 years. It’s a big help to their progress in first grade that students arrive in her classroom already connected to reading specialists or special education staff, she said.

New Hampshire had considered paying for full-day kindergarten in the past. The most recent failed effort lost on a party-line vote in 2015, with Republicans voting against. Then, in the months before he was elected in 2016, Republican Governor Chris Sununu came out in favor of full-day kindergarten and, within the year, had signed a law to cover the new cost with money from the state’s lottery system.

14 — Number of states that require districts to offer full-day kindergarten.

In 2019, New Hampshire will provide interested districts with about $2,900 per full-day kindergartner, more than is offered for half-day kindergartners, but just two thirds of what is offered for first- through 12th-grade students. By 2020, the state will raise kindergarten funding to match that provided to the higher grades.

The full amount is still just about a third of the per pupil cost for a year of education, according to reporting from Jason Moon of New Hampshire Public Radio. The rest comes from local taxes.

Related: Rethinking grade levels and school design for personalized learning

Leianny Menendez, 6, and Zariya Rodgers, 5, play a card game meant
to help them improve their understanding of more and less towards the end
of their full day of kindergarten at Dr. Norman W. Crisp Elementary School in
Nashua, New Hampshire. Photo: Lillian Mongeau/The Hechinger Report

Before the new law was signed, a smaller percentage of kids attended full-day kindergarten in New Hampshire than in almost any other state, reported Moon, who has followed the issue carefully since the measure was first introduced in the state legislature.

In March, Moon called several districts that weren’t offering full-day kindergarten and found that the new funding from the state would not sway them to start offering it.

Despite his support for offering full-day kindergarten as a matter public policy, Cooper said attending six hours of school may not be appropriate for some 5-year-olds.

“Parents and educators should consider characteristics of the child in addition to potential effects on achievement,” he said. “That they’re ready cognitively doesn’t necessarily mean they’re ready emotionally.”

Back in Lemoine’s kindergarten classroom, it was 2 p.m. and school had been in session for nearly six hours. Justin Pichardo-Morban, 6, was painting “things about spring” with some well-used watercolors. Jaliyah Carrion, 5, was sitting next to him drawing trees. Jeraliz Rosario, 5, was “drawing spring” too.

All three children looked happy and energetic as they added bright greens and yellows to their sopping wet paintings. In fact, no one in the room, not the kids playing the math-based card game, or the ones building cities out of Legos, looked tired.

If anything, said Leianny Menendez, 6, kindergarten might be just a bit too easy. “I like it,” she said, “but I wish I could be in fourth grade so I could learn even harder things.”

This story about kindergarten was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education.

Thursday, August 30, 2018

7 Things Special Education Teachers Want Parents to Know

From Popsugar

By Murphy Moroney
August 28, 2018

Having a child with special needs often leaves parents with oodles of questions when it comes to their education. Does my kid need an IEP? Should I schedule regular meetings with his or her teacher? Am I doing enough to help my child in the classroom? For concerned parents, getting to the bottom of all their pressing questions can quite frankly be exhausting.

We did some of the heavy lifting for moms and dads who are navigating the school system by asking special needs educators the things they want parents to know. And unsurprisingly, their answers are beyond enlightening.

Scroll through to see exactly what experienced educators from around the US have to say about their profession, and grab a notebook to take some notes along the way!

Related: 8 Back-to-School Tips For Parents of Kids With Special Needs

1.) They're constantly monitoring their students' progress.

"There are so many rewarding parts of my job! In the state of South Carolina where I teach, I'm required to take a lot of progress monitoring data. What that means is that I'm constantly collecting intel on my students. That being said, I get to watch them grow.

"Sometimes it can take a lot of work to see results, but the best part is when you see a student who has been struggling notice their own progress. When they start to see their own growth in the classroom, that's the best part for me. I love watching them get excited about learning." — Jackie Viotto, South Carolina

2.) They want to see your kid succeed more than anything.

"Many of these kids have convinced themselves that they are incapable of learning because it takes them so much more time than others. I show them they are perfectly capable if they trust me and try. The fear of failure is often too great for kids to even put much effort into trying." — Keren Albiston, New York

3.) There are many, many reasons a child might need an IEP.

"Students can get IEPs or 504s for a variety of reasons, such as commonly associated learning disabilities, like ADHD and dyslexia. Children can also get them for severe medical ailments you think a teacher should be aware of, like severe allergies.

I think that when people realize that reasons for having a IEP/504 are so diverse, the stigma that having an IEP makes you 'dumb or different' will be far less common." — Katie Simon, New York

4.) Just because children are in a special needs classroom doesn't mean they're not smart.

"Students often think they're in my classroom because they're not smart. That's not the case at all! I always tell them it's because they learn differently and that's the truth. Most of the students I serve either have a learning disability or another health impairment (like ADHD) that impacts how they're performing academically. There's usually a difference between where their IQ is and where they're achieving on paper.

"Many of my students have average to above average intelligence, but are performing below where they should be. My goal is to try to catch them up." — JV

5.) Having a mix of voices on your kid's team is a good thing.

"There are multiple people on an IEP team for a reason. Each person brings a unique perspective to contribute to the success of a child. Those opinions may differ, but that doesn't mean that person isn't also thinking about what's best for the child.

"Don't go into every IEP meeting with guns blazing ready to fight the school. Groups of contentious adults aren't ever going to be able to implement a plan that's best for your child."— KA

6.) Teachers truly want you to advocate for your child.

"I tell all my parents to never be afraid to advocate for your child. Sometimes I feel like parents sit in IEP meetings and look lost. I wish that parents would remember they have a say when it  comes to how their child is served in the school setting.

"The psychologist, the speech therapist, or whoever is in the meeting with you aren't trying to talk at you, we're trying to convey what the student needs. Please don't be afraid to ask questions! We'd love to explain more things to you." — JV

7.) Special needs educators are drowning in paperwork.

"There is so much paperwork to complete for special education. We are told to have aids and assistants help the students so we can complete paperwork or I have to get a sub to write all day. It seems like as a teacher, my time should be spent teaching." — KA

Socioeconomic Inequalities Often Land Students of Color in Special Ed, Study Says

From Education Dive

By Jessica Campisi
August 23, 2018

Dive Brief
  • The study, which was published in the journal Sociological Quarterly, found that racial minorities are less likely than their white peers to be labeled as having a learning disability.
  • A student’s socioeconomic status is a predominant factor in predicting academic achievement, and academic achievement is often used to diagnose learning disabilities, with students also often incorrectly classified as having a disability because of language barriers and immigration history, the study says.

Dive Insight

The study’s findings reveal a broad problem: Calling a lack of achievement — which is often based on socioeconomic status — a disability doesn’t address the achievement gap and the issues behind it.

Dara Shifrer, the study’s lead author and a sociology professor at Portland State, made this point in a university news release, saying instead of enrolling minorities in special ed, we need to look at the inequalities that exist in society.

Minority students, including those who are African-American or Hispanic, often face economic, health or educational disadvantages, the American Psychological Association says. They’re more likely to be in poverty, have poor access to health care, or face psychological distress.

On top of that, discrimination and marginalization can make it even harder for these students to improve their socioeconomic statuses, the APA notes. And in certain schools, where the environment looks more like a prison than a classroom and harsh disciplinary policies are given out for small infractions like violating dress code, predominantly minority students are often funneled into the school-to-prison pipeline as a result.

Solving the problem, or taking the first steps to address it, needs to go farther than a label. More funding for early childhood education programs and greater transparency from teachers, Shifrer said, will get support for the students who need it the most.

But there’s a lot more that can be added to the list of items to change, like re-evaluating the system that’s getting students jail time instead of class time, or giving minority students someone who looks like them to look up to.

Recommended Reading

Wednesday, August 29, 2018

'Concussion Doctor' Says Kids Shouldn't Play These Sports Until They're 18

From the TODAY Show

By A. Pawlowski
August 24, 2018

You wouldn’t let your child drink a glass of cognac or smoke a cigarette, so why would you send him out on a football field to risk brain damage?

It’s a question Dr. Bennet Omalu — a forensic pathologist whose discovery of chronic traumatic encephalopathy (CTE) was portrayed in the Will Smith film “Concussion” — wants parents to consider as students head back to school.

He warns that children who play football, hockey and lacrosse could face a lifetime of health consequences and details his findings in his book, Truth Doesn't Have a Side: My Alarming Discovery about the Danger of Contact Sports.”

“We need to develop more brain-friendly, healthier types of sports,” Omalu told TODAY. “We have elevated sports to the level of a religion. We’re in denial of the truth.”

What do you want parents to know about contact sports?

Omalu: Knowing what we know today, there is no reason whatsoever that any child under the age of 18 should play the high-impact, high-contact sports.

The big six are: American football, ice hockey, mixed martial arts, boxing, wrestling and rugby. Blows to the head are intrinsic to the game. That truth could be inconvenient, painful and difficult, but we should not deny it.

What’s your view on lacrosse and soccer?

Omalu: Lacrosse has one of the highest concussion rates across all sports. It’s a very dangerous sport — people need to know that. I also don’t think kids younger than 18 should play it.

As far as soccer, there should not be any heading below the age of 18. Soccer is a high-dexterity, high visual-spatial coordination sport. You need very high levels of brain functioning to play it and children have not attained that level of brain development.

Soccer as it’s played today should be played by only children who are above the age of 12-14. Children younger than that should play a modified form of soccer, whereby there’s less contact. Maybe we make the balls bigger and lighter so that there’s less accidental injury.

Which sports are safe for kids?

Omalu: The non-contact sports: swimming, track and field, volleyball, basketball, table tennis, lawn tennis, badminton — there are so many of them. There is still a risk of accidental injury. You have to play safe.

You’ve said letting kids play football is the “definition of child abuse?” How so?

Omalu: I take classes in child abuse recognition every few years in order to maintain my license to practice as a physician. The fundamental definition of child abuse is the intentional exposure of a child to the risk of injury. That injury does not have to occur.

We wouldn’t give a child a cigarette to smoke because a cigarette is potentially harmful. But we would put on a helmet on the head of a child and send him out on a field to play a game whereby he sustains repeated blows to his head, to suffer sub-concussions and concussions.

Which is more dangerous: a cigarette or a concussion of the brain? A concussion of the brain, of course. If that is not the definition of child abuse, what is it?

When people hear the statement “Omalu says playing football is child abuse,” they become emotional. But when you remove the emotionality, it’s a very objective statement. I’ve not met any parent who disagrees. Some parents will say, “Don’t put it like that; that makes me feel bad.”

What are the health consequences if a child suffers a concussion?

Omalu: Many papers have shown that all it takes for your child to suffer brain damage is just one concussion. But before your son suffers a concussion, there must have been hundreds if not thousands of sub-concussions. The damage is permanent because the brain does not have any ability to regenerate itself.

There were two papers that came out of Sweden, one in 2014 and another in 2016. Researchers identified 1.1 million children and they followed them for 41 years. They found out that if a child suffers just one concussion that brings him to the hospital, that child is more likely to die before the age of 42, especially through violent means; he has a two to four times increased risk of committing suicide as an adult; and is about two to four times more likely to suffer a major psychiatric illness as an adult, including major depression.

He is more likely to have diminished intelligence and is more likely to be less gainfully employed as an adult. He is more likely to become a drug addict or alcoholic; and is more likely to engage in violent or criminal behavior.

What about playing these high-contact sports when you’re over 18?

Omalu: Your brain becomes fully developed at about 18-25. I would be the first to defend your right to do whatever you want as an adult as long as it doesn’t pose a threat to the life of another person. That doesn't mean it's safe.

Children have not reached the age of consent. We are having fewer children so our children are becoming more precious. My son is almost 8 years old and he'll be the first to tell you that football is not good for your brain.

Shedding Light on Developmental Blind Spots

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

By Lisa Shulman, M.D.
August 17, 2018

One day, when I was speaking to a medical student shadowing me in my developmental pediatrics practice at the Rose F. Kennedy Children’s Evaluation and Rehabilitation Center, where I specialize in the early identification of autism, I commented that I often spend my days contending with blind spots. “How so?” he asked.

I started with a definition:

Blind Spot
  • An area that is not able to be seen, either due to its location outside the field of vision or due to some physical obstruction or a defect in one’s vision. Often used to describe the areas around a car that cannot be seen with the rearview or side mirrors.
  • By extension, an area of knowledge or understanding that you do not have or do not pay attention to.

The second definition was to be our focus I explained—the blind spots resulting from either a lack of knowledge about development, or from something being seen so frequently that on a certain level, it becomes invisible.

I elaborated that I see the fallout from blind spots in parents, healthcare providers and educational systems. They can interfere with or delay a child receiving an early diagnosis of autism and therefore being offered appropriate services that can lead to the best outcome for the child.

I’ve recently been named the New York State Act Early Ambassador by the U.S. Centers for Disease Control and Prevention. In that role, I am charged with working to support parents and systems in the early identification of children with autism and other developmental disabilities so they can get the help they need.

“Learn the Signs. Act Early.” is designed with blind spots in mind.

Its strategy for early identification of autism and other developmental disabilities is to cast a wide net of responsibility, encouraging developmental monitoring of young children by everyone who has contact with them and providing educational and free materials to make that a reality.

These monitors include parents, healthcare providers and early educators, all of whom can identify when a child’s development has gone off course.

In taking this student through my day, I helped him identify those blind spots. Here are a few of the children we saw.

Parental Blind Spots

A parent can have a blind spot about something amiss with a child’s development or behavior. It can be the result of a “That’s just the way he is” mind-set, or it can stem from a lack of knowledge about child development—or from outright denial.

Often, it’s an observation by someone else that opens a parent’s eyes.

The mother of the first child we saw, “Damian,” reported that she hadn’t been concerned that her 2½-year-old wasn’t talking until another child at the park asked her son to play and the mother had to explain that Damian was big for his age and not yet able to speak.

The other child appeared incredulous. The mom went home and Googled “age of talking” and realized that by now her son should be speaking in phrases and having conversations. Before the encounter at the park, she hadn’t been concerned.

Next came “Jordan,” who was referred by his physician for not speaking at 24 months. Jordan could have been diagnosed with autism during the time it took for him to walk from the waiting area to my office. His mom was not really concerned, though, because she reported that he had started speaking since the referral. She had almost canceled the appointment. Hmm….

Jordan dumped out toys from a bin and scattered and mouthed them. He did not engage in pretend play with a toy truck and did not imitate my actions with the toys. I heard no language. A large part of a developmental evaluation of a young child involves getting a detailed history from the parents about what the child can do at home.

I asked the appropriate questions. “How many times do you need to call his name to get his attention?” “Once,” the mother said. “Is he able to point to body parts or get his shoes on request from another room? “Yes,” she responded.

The little boy in front of me seemed incapable of any of these tasks, so I asked the mom to please ask him to do each of these things.

His mother was unable to get Jordan’s attention. She offered reasons: he was tired, he was distracted by the toys, he was stubborn. When I asked about his recent language burst, the mom reported that he had started to say sentences from his favorite YouTube video recently.

It was unclear where his mother’s blind spots came from (lack of knowledge? denial?), but I knew we would need to get on the same page so we could take the necessary first steps toward addressing his condition.

System Blind Spots

We then saw 3-year-old “Melody,” who had been diagnosed with autism through the New York City Early Intervention program program and received a set of autism-specific interventions. She was now aging out of that program, and her mother had Melody evaluated by the school district so services could be put in place in a preschool setting.

The mother came to see me after the results of that evaluation indicated that Melody did not qualify for any therapeutic services.

Melody came enthusiastically into the office without greeting me and expertly completed a shape puzzle, labeling the shapes—octagon, pentagon and oval—as she replaced them. She knew her letters, too. While her mother agreed that Melody was bright, she pointed out that the little girl still could not have a conversation and did not play with other children.

Indeed, Melody had clear signs of autism, as well as cognitive strengths. In this case, the system had a blind spot for signs of autism in a child with normal cognition.

A Pediatrician’s Blind Spot

It is not unusual for me to get a call from an experienced pediatrician who tells me he or she is seeing a 2½-year-old or a 3-year-old who is severely autistic but was never referred for early intervention. I can hear and sense the pain in that doctor’s voice that one of our own had a blind spot for an obvious case of autism.

“Ethan” presented a milder version of such a case. Almost 4, he had been referred for evaluation of hyperactivity. In the waiting area, he had been playing happily on an iPad at his mother’s side. When I called his name, his mom took away the iPad and Ethan proceeded to have a severe tantrum, kicking and screaming on the floor.

On entering my room, Ethan went under my desk, where he turned off my computer. He had no interest in the toys and made little eye contact. I couldn’t get his attention by calling his name; he followed no commands. Other than screams of “No,” I heard no language from Ethan.

When his mom took Ethan out to change his diaper, the student said the child did indeed seem very hyperactive. “Would it surprise you,” I asked, “if I said that he was also severely autistic?” The student said “Yes.” He had spotted the hyperactivity, but because he had seen Ethan make eye contact a few times he didn’t even consider the possibility of autism.

When the mom came back with Ethan, I attempted to get him involved in doing puzzles, drawing, looking at pictures and talking about what he saw—but nothing held his attention. He was spinning my chair, turning the lights on and off and doing his own thing regardless of my requests or offerings.

In explaining my concerns to Ethan’s mother, I noted that Ethan was very active, but also very self-directed. It was hard to get his attention and direct it. He would need to learn to pay attention to others in order to learn from the teacher and make friends. His mother asked if I thought he could have autism.

By the end of our day, my lesson for the student was that you can be a loving parent or a caring physician or a diligent early educator and still have a blind spot for the early signs of autism.

Understanding those blind spots and working with programs such as Learn the Signs. Act Early. directed toward families, healthcare providers and early educators is the best way to help children with autism and other developmental disabilities receive an early diagnosis and the best outcome.

Remember: Learn the Signs and Act Early. Don’t wait and see.

Lisa Shulman, M.D. is a neurodevelopmental pediatrician and associate professor of pediatrics at Albert Einstein College of Medicine. She is also director of Infant and Toddler Services and the RELATE program at Montefiore's Children's Evaluation and Rehabilitation Center.

Tuesday, August 28, 2018

First Biomarker Evidence of DDT-Autism Link

From Columbia University's Mailman School of Public Health

August 16, 2018

A study of more than 1 million pregnancies in Finland reports that elevated levels of a metabolite of the banned insecticide DDT in the blood of pregnant women are linked to increased risk for autism in the offspring.

DDT and autism link: DDT persists in the food chain because its breakdown
occurs very slowly, as long as several decades, resulting in continuing exposure
to populations. These chemicals are transferred across the placenta.

The study is the first to connect an insecticide with risk for autism using maternal biomarkers of exposure.

An international research team led by investigators at Columbia University's Mailman School of Public Health and the Department of Psychiatry published these results in the American Journal of Psychiatry.

The study, conducted in collaboration with investigators at the University of Turku and the National Institute of Health and Welfare in Finland, is the first to connect an insecticide with risk for autism using maternal biomarkers of exposure.

Researchers identified 778 cases of childhood autism among offspring born from 1987 to 2005 to women enrolled in the Finnish Maternity Cohort, representing 98 percent of pregnant women in Finland. They matched these mother-child pairs with control offspring of mothers and offspring without autism.

Maternal blood taken during early pregnancy was analyzed for DDE, a metabolite of DDT, and PCBs, another class of environmental pollutants.

The investigators found the odds of autism with intellectual disability in offspring were increased by greater than twofold for the mother's DDE levels in the top quartile. For the overall sample of autism cases, the odds were nearly one-third higher among offspring exposed to elevated maternal DDE levels.

The findings persisted after adjusting for several confounding factors such as maternal age and psychiatric history. There was no association between maternal PCBs and autism.

While DDT and PCBs were widely banned in many nations over 30 years ago, including the U.S. and Finland, they persist in the food chain because their breakdown occurs very slowly, as long as several decades, resulting in continuing exposure to populations. These chemicals are transferred across the placenta in concentrations greater than those seen in the mother's blood.

"We think of these chemicals in the past tense, relegated to a long-gone era of dangerous 20th Century toxins," says lead author Alan S. Brown, M.D., MPH, professor of Epidemiology at Columbia University's Mailman School of Public Health and of Psychiatry at Columbia University Medical Center.

"Unfortunately, they are still present in the environment and are in our blood and tissues. In pregnant women, they are passed along to the developing fetus. Along with genetic and other environmental factors, our findings suggest that prenatal exposure to the DDT toxin may be a trigger for autism."

The researchers offer two reasons for their observation that maternal exposure to DDE was related to autism while maternal PCB exposure was not. First, maternal DDE is associated with low birthweight, a well-replicated risk factor for autism.

In contrast, maternal PCB exposure has not been related to low birthweight. Second, they point to androgen receptor binding, a process key to neurodevelopment. A study in rats found DDE inhibits androgen receptor binding, an outcome also seen in a rat model of autism. In contrast, PCBs increase androgen receptor transcription.

Journal Reference
  • Alan S. Brown et al. Association of Maternal Insecticide Levels With Autism in Offspring From a National Birth Cohort. American Journal of Psychiatry, 2018 DOI: 10.1176/appi.ajp.2018.17101129

ADHD Meds: Risk of Abuse?

From Smart Kids with LD

By Alan Wachtel, M.D.
August 20, 2018

Question: I’ve heard that putting kids with ADHD on prescription stimulants raises their risk for becoming illicit drug users. True?
-- Evelyn G., St. Paul, MN

Dr. Wachtel: When prescription stimulants are taken orally and in the approved dose and manner, they are not addictive. In fact, those who do not take medication for their ADHD have a significantly higher risk of substance abuse than those who do.

Prescription stimulants (such as Adderall; Ritalin; Vyvance; Concerta; and Focalin) are categorized as Schedule II drugs: controlled substances that are legal but are considered dangerous because of their potential for abuse and dependence and the traumatic impact they can have on those who abuse them.

All stimulants are different from each other with respect to impact, potential side effects, potency, duration, and how they work. As with all drugs, stimulants have potential side effects, such as weight gain, decreased appetite, wakefulness and talkativeness, even when taken properly.

Some people experience symptoms similar to those of withdrawal when they discontinue the use of stimulants all at once, instead of gradually.

These discontinuation symptoms – depression, anxiety, fatigue, insomnia, irritability, headaches or mental “fog” – are not specific to stimulants, however; many people experience comparable “withdrawal trauma” when they stop taking medications that treat depression and anxiety, as well as chronic muscle, bone or diabetic nerve pain.

Misuse and Abuse

The misuse of stimulants is another story altogether. Taking stimulants without a prescription; with someone else’s prescription; in a manner or dose other than that prescribed; mixed with other drugs, such as alcohol, cocaine or marijuana; or just to feel euphoric can lead to substance use disorder and addiction.

For example, when snorted, smoked or injected, stimulants cause an increased and rapid high, which has little to do with the improved alertness, energy, attention and productivity they are prescribed for.

Stimulant misuse can also have serious medical consequences, such as heart, nerve or stomach complications, and can lead to psychosis, anger and paranoia. Continued misuse and abuse can lead to addiction and long-term side effects.

While taking stimulants will not turn your child into a drug addict, it is not a silver bullet of protection, shielding him from abusing drugs.

A Harvard research study has shown, however, that only 25% of those taking prescription medications for their ADHD had a history of substance abuse, compared with 75% of those who were not being medicated.

It is likely that those who were untreated for their ADHD were struggling in and out of school, felt powerless, and turned to drugs to self-medicate.

On the other hand, because those who were receiving appropriate drugs for their ADHD were more tuned into their bodies and felt successful and good about themselves, they did not abuse their prescriptions or turn to illicit stimulants to help make them feel better.

Dr. Wachtel is a psychiatrist and noted expert in the treatment of ADHD. He is the author of The Attention Deficit Answer Book: The Best Medications and Parenting Strategies for Your Child.