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Wednesday, November 26, 2014

Happy Thanksgiving!

From our NESCA "Family" to Yours 

Two Years Post-Newtown: What’s Changed? What Needs to Change?

From Special Education Today
A Special Ed Law Blog from Kotin, Crabtree & Strong

By Robert K. Crabtree, Esq.
November 24, 2014

"Educate fully and with open hearts and hands; support and treat those who are severely troubled; reduce access to the means of violence against oneself or others. Can we make this happen in this fractured political culture of ours?

At this Thanksgiving time, can we at least imagine such a thing?"

The Office of the Child Advocate for the State of Connecticut has issued a report outlining major factors contributing to the murder of children at the Sandy Hook Elementary School in Newtown, Connecticut two years ago.

Although the Yale Child Study Center had evaluated the young man who committed that atrocity and recommended mental health services and special education services for him, the responses of both his mother and the special education staff at the school were found to be tragically inadequate to address the emotional issues that made him a pariah at school and resulted in his avoiding school completely.

The Council of Parent Attorneys and Advocates, Inc. (“COPAA”), a national organization with its eye on issues and initiatives that are important to our field, has used the findings in this report to advocate for additional funding for the federal mandate in IDEA. They have issued a compelling statement using the findings in this report to advocate for additional funding for the federal mandate in IDEA.

We join COPAA in urging that you let your federal legislators know how critical it is to increase funding for special education services, which include services for emotional disabilities and related services. We add to their plea a request that you let both local and national lawmakers know of your support for increased funding of ALL public education, as we attempt to understand and avoid the conditions that give rise to such desperate violence.

Along with full funding for services under IDEA should come much-expanded funding and meaningful options for children with serious mental health disorders. As many special education lawyers and advocates have also experienced, in recent years our caseloads have seen a major increase in the numbers of students afflicted with severely debilitating emotional challenges that prevent those students from being able to access an education.

The Kafkaesque maze of bureaucratic blind alleys, inconsistent and often contradictory criteria of eligibility for services, and battles between school districts and state agencies over which agency, if any, must provide the key day and often residential services and supports necessary to address the student’s needs is exhausting, incomprehensible and too often fruitless for parents who struggle, often literally, to save their children’s lives.

While underfunded government agencies battle over who, if anyone, should meet the needs of a student at risk, the student’s risk all too often becomes a tragic reality.

Exacerbating the difficulties families and their advocates face in securing meaningful services, there is an ever-decreasing supply of resources in the Commonwealth to support children in crisis, and even less to help children who need longer-term treatment. See the heartfelt plea by the Parent/Professional Advocacy League (“PPAL”) for more immediate baseline funding to make more program beds available for kids with severe mental illness, in a year when funding has disappeared far earlier than usual.

Part of the reason for declining resources, we are finding, is that recent state-level administrative decisions have led to a combining of beds available for troubled children between two previously independently supported agencies – the Department of Children and Family Services (“DCF”) and the Department of Mental Health (“DMH”) – in single group homes or other facilities.

Where resources were previously made available separately to DCF and DMH for kids in crisis – agencies whose clients’ needs and profiles are frequently incompatible to the degree that sharing residential space can be dangerous – the administrative decision to combine resources both reduces available beds and increases the risks to children already at risk. (Please note that we do applaud efforts by state agencies to work together for the good of children, but in this case we feel that the combining of beds works against the interests of children in need.)

I would add to COPAA’s and PPAL’s statements an additional plea: A society that makes the means of lethal violence so easy to acquire is making a tragic choice. As difficult as it may be to stand up to the knee-jerk absolutism and to ignore the carrots and sticks of national and local lobbyists for open access to weaponry, legislators need to find a way to stop the madness.

To me it is obvious that the imposition of intelligent restrictions on access to the means of such violence should be part of any efforts to reduce the numbers and magnitude of events like those at Newtown and Columbine.

Educate fully and with open hearts and hands; support and treat those who are severely troubled; reduce access to the means of violence against oneself or others. Can we make this happen in this fractured political culture of ours? At this Thanksgiving time, can we at least imagine such a thing?


Robert Crabtree is a partner in the Special Education & Disability Rights practice group at Kotin, Crabtree & Strong, LLP in Boston, Massachusetts.

Just Released: CBHI Early Childhood Mental Health Toolkit

From the CBHI
Childhood Behavioral Health Initiative

November 25, 2014

We are excited to share the release of the Early Childhood Mental Health Toolkit from our partners at the Department of Public Health and the Boston Public Health Commission.

Available at, the Early Childhood Mental Health Toolkit: Integrating Mental Health Services into the Pediatric Medical Home is a comprehensive collection of tools and tips for incorporating early childhood mental health personnel and practices into the pediatric primary care setting.

Topics addressed include:

The model is based on a partnership between a family partner and early childhood mental health clinician. Knowing many practices may not have the capacity to create or fill these positions in the current healthcare environment, BPHC has structured the toolkit to be used by primary care practices with or without dedicated early childhood mental health staff.

We encourage you to share this resource, and other resources found on with your provider network. In the Families & Friends section are social marketing resources, including printable posters and flashcards to help engage parents and providers in conversation about social and emotional health.

A small change at the pediatrician’s office can make a large difference for a child. Integrating early childhood mental health concepts, services, and systems into the pediatric medical home helps to transform primary care, making the medical home a resource for the physical and mental health of a young child and a source of support for the entire family.

Thank you for everything you do.

Emily Sherwood, Director
Children’s Behavioral Health Interagency Initiatives

Teacher to Parents: About THAT Kid (The One Who Hits, Disrupts and Influences YOUR Kid)

From The Washington Post Education Blog
"The Answer Sheet"

By Valerie Strauss
November 14, 2014

NOTE: Amy Murray is the director of early childhood education at the Calgary French & International School in Canada. The following post, which appeared on her blog, Miss Night’s Marbles, and which I am republishing with her permission, is a powerful open letter directed to parents about THAT kid, the one other kids go home and talk about, the one who is violent, curses and gets angry in class, the one who parents worry will hurt, disrupt and perhaps influence their own children.

Murray is also the co-founder of #Kinderchat (, a twitter-based global community for educators of young children. She is a speaker and trainer on learning through play, self-regulation, behavior management, and the use of technology within the classroom.

Dear Parent:

I know. You’re worried. Every day, your child comes home with a story about THAT kid. The one who is always hitting, shoving, pinching, scratching, maybe even biting other children. The one who always has to hold my hand in the hallway. The one who has a special spot at the carpet, and sometimes sits on a chair rather than the floor. The one who had to leave the block center because blocks are not for throwing. The one who climbed over the playground fence right exactly as I was telling her to stop. The one who poured his neighbor’s milk onto the floor in a fit of anger. On purpose. While I was watching. And then, when I asked him to clean it up, emptied the ENTIRE paper towel dispenser. On purpose. While I was watching. The one who dropped the REAL ACTUAL F-word in gym class.

You’re worried that THAT child is detracting from your child’s learning experience. You’re worried that he takes up too much of my time and energy, and that your child won’t get his fair share. You’re worried that she is really going to hurt someone some day. You’re worried that “someone” might be your child. You’re worried that your child is going to start using aggression to get what she wants. You’re worried your child is going to fall behind academically because I might not notice that he is struggling to hold a pencil. I know.

Your child, this year, in this classroom, at this age, is not THAT child. Your child is not perfect, but she generally follows rules. He is able to share toys peaceably. She does not throw furniture. He raises his hand to speak. She works when it is time to work, and plays when it is time to play. He can be trusted to go straight to the bathroom and straight back again with no shenanigans. She thinks that the S-word is “stupid” and the C-word is “crap.” I know.

I know, and I am worried, too.

You see, I worry all the time. About ALL of them. I worry about your child’s pencil grip, and another child’s letter sounds, and that little tiny one’s shyness, and that other one’s chronically empty lunchbox. I worry that Gavin’s coat is not warm enough, and that Talitha’s dad yells at her for printing the letter B backwards. Most of my car rides and showers are consumed with the worrying.

But I know, you want to talk about THAT child. Because Talitha’s backward B’s are not going to give your child a black eye.

I want to talk about THAT child, too, but there are so many things I can’t tell you.

I can’t tell you that she was adopted from an orphanage at 18 months.

I can’t tell you that he is on an elimination diet for possible food allergies, and that he is therefore hungry ALL. THE. TIME.

I can’t tell you that her parents are in the middle of a horrendous divorce, and she has been staying with her grandma.

I can’t tell you that I’m starting to worry that grandma drinks…

I can’t tell you that his asthma medication makes him agitated.

I can’t tell you that her mom is a single parent, and so she (the child) is at school from the moment before-care opens, until the moment after-care closes, and then the drive between home and school takes 40 minutes, and so she (the child) is getting less sleep than most adults.

I can’ tell you that he has been a witness to domestic violence.

That’s okay, you say. You understand I can’t share personal or family information. You just want to know what I am DOING about That Child’s behaviour.

I would love to tell you. But I can’t.

I can’t tell you that she receives speech-language services, that an assessment showed a severe language delay, and that the therapist feels the aggression is linked to frustration about being unable to communicate.

I can’t tell you that I meet with his parents EVERY week, and that both of them usually cry at those meetings.

I can’t tell you that the child and I have a secret hand signal to tell me when she needs to sit by herself for a while.

I can’t tell you that he spends rest time curled in my lap because “it makes me feel better to hear your heart, Teacher.”

I can’t tell you that I have been meticulously tracking her aggressive incidents for 3 months, and that she has dropped from 5 incidents a day, to 5 incidents a week.

I can’t tell you that the school secretary has agreed that I can send him to the office to “help” when I can tell he needs a change of scenery.

I can’t tell you that I have stood up in a staff meeting and, with tears in my eyes, BEGGED my colleagues to keep an extra close eye on her, to be kind to her even when they are frustrated that she just punched someone AGAIN, and this time, RIGHT IN FRONT OF A TEACHER.

The thing is, there are SO MANY THINGS I can’t tell you about That Child. I can’t even tell you the good stuff.

I can’t tell you that his classroom job is to water the plants, and that he cried with heartbreak when one of the plants died over winter break.

I can’t tell you that she kisses her baby sister goodbye every morning, and whispers “You are my sunshine” before mom pushes the stroller away.

I can’t tell you that he knows more about thunderstorms than most meteorologists.

I can’t tell you that she often asks to help sharpen the pencils during playtime.

I can’t tell you that she strokes her best friend’s hair at rest time.

I can’t tell you that when a classmate is crying, he rushes over with his favorite stuffy from the story corner.

The thing is, dear parent, that I can only talk to you about YOUR child. So, what I can tell you is this:

If ever, at any point, YOUR child, or any of your children, becomes THAT child…

I will not share your personal family business with other parents in the classroom.

I will communicate with you frequently, clearly, and kindly.

I will make sure there are tissues nearby at all our meetings, and if you let me, I will hold your hand when you cry.

I will advocate for your child and family to receive the highest quality of specialist services, and I will cooperate with those professionals to the fullest possible extent.

I will make sure your child gets extra love and affection when she needs it most.

I will be a voice for your child in our school community.

I will, no matter what happens, continue to look for, and to find, the good, amazing, special, and wonderful things about your child.

I will remind him and YOU of those good amazing special wonderful things, over and over again.

And when another parent comes to me, with concerns about YOUR child…

I will tell them all of this, all over again.

With so much love,


Tuesday, November 25, 2014

More Transition Services from NESCA: Community-Based Skills, College Selection and Pre-College Coaching


By Kelley Challen, Ed.M, CAS
Director of Transition Services

November 24, 2014

Announcing a range of new services, and in Marilyn Weber, an important addition to our transition team...

Community-Based Skills Coaching

Community-Based Skills Coaching is a time-limited, intensive service focused on developing essential adaptive and practical independent living skills in real-life environments. This is critical for individuals needing to generalize skills taught in the classroom and/or who learn best experientially.

This type of skills coaching is suitable for any student seeking experience outside the walls of a high school environment and also may be an important component for an individual taking part in a fifth year, postgraduate or gap year experience.

Individuals participate in one-on-one Community-Based Skills Coaching three hours per week for eight weeks, focused on specific individualized goals in three areas: continued learning, vocation, and community life.

Skill development may include executive functioning, interpersonal skills, self-advocacy, self-care/hygiene, meal planning and preparation, money management, shopping, travel training, engaging in volunteer and community service work, establishing healthy fitness routines, nutrition, and other skill areas critical for successful independent adult life.

Specific short-term goals are set by the client and coach in collaboration with family members prior to the first coaching session. Overall well-being and familiarity with community resources are a focus for every participant.

Moreover, our coaches will work collaboratively with agency representatives and accompany clients to meetings with them as appropriate, on behalf of eligible individuals who will be receiving ongoing support from adult human service agencies such as the Massachusetts Rehabilitation Commission (MRC) and/or the Department of Developmental Services (DDS).

Community-Based Pre-College Coaching

NESCA is pleased to offer Community-Based Pre-College Coaching packages carefully designed to help students develop concrete skills and knowledge critical for managing the transition from high school to college. Designed to meet the needs of a student intending to participate in a postsecondary two- or four-year college program, each package offers focused skill development based on the client’s current participation with their college process.

Individuals participate in Pre-College Coaching during four two-hour sessions and focus on skill development in one of the following key skill development areas:
  • College Aware – Students participating in this package learn about the variety of colleges available in postsecondary life and how college participation differs from high school. Familiarity with college resources, websites, facilities, vocabulary and schedules are key outcomes for participants.
  • College Search – Students taking part in this service develop key skills required for engaging in the college search process. Basic skills like using search engines and reviewing print resources are introduced. Additional college search strategies including making the most of a college tour, talking with disability support staff, interview skills, personal disclosure and sitting in on a class or arranging an overnight are explored and practiced.
  • College Ready – The College Ready package is designed to support critical skill development required to successfully transition to college life. Based on individual student needs, skill development in fundamental areas including organization, problem solving, campus etiquette, self-advocacy, personal money management, self-care, emotional health/wellness, leisure activities, travel skills, and phone and email etiquette may be addressed. Target skills will be selected in consultation with the student and family. While this service is similar to NESCA’s Community-Based Skills Coaching service, the process is abbreviated, focusing specifically on skill development necessary for the college environment.
  • College Accepted – After being accepted to college, students are ready to work on nuanced skills specific to being a thriving college student. Skill development focuses on a selected college program and an individual student’s needs related to that environment. Targeted skills may include practice registration, purchasing textbooks and supplies, completing necessary paperwork and meeting with college support professionals, having a roommate, learning to use campus resources and personal safety.

Each Pre-College Coaching session takes place in local community settings including at least one local college tour. For families needing support with College Selection, NESCA offers a short-term service designed to prepare a student and family to select an appropriate college environment; when appropriate, College Selection also occurs as part of Transition Planning and Consultation.

College Selection Consultation

Searching for a suitable post-secondary setting that affords opportunity for success is a difficult process for students with learning disabilities and/or autism spectrum disorders. Through short-term consultation, NESCA’s transition specialists support students (and their families) in the development of a college planning timeline, creation of college lists, learning how to explore a college online, planning college visits, researching support services and more.

Importantly, transition specialists are able to visit colleges with students to help them get the most from their experience, reality-test “fit,” and investigate beyond the official presentation. While NESCA does not provide ongoing college counseling, consultation with a transition specialist is an ideal way to start the college selection process.

How Do I Get Started?

Prior to participation in Community-Based Skills Coaching or Pre-College Coaching, a one-hour intake evaluation with parent(s), the individual, and the coach is required to determine appropriateness for the service and specific goals. The fee for the intake is $250.

Families interested in scheduling should complete the Intake Fact Sheet available on-line at In cases where an individual is not a fit for the desired service, referrals to appropriate community providers will be provided.

What is the Cost?

Community-Based Skills Coaching is charged at a flat rate of $3000 and includes eight three-hour coaching sessions.

Community-Based Pre-College Coaching is charged at a flat rate of $1250 and includes four two-hour coaching sessions.

For each program, progress is monitored closely and continually throughout participation and weekly overview emails are provided to the client and family.

Written program summaries are available for an additional fee.

NESCA is happy to negotiate contracts with public schools willing to participate in the cost of coaching as part of an individual education plan.

Who provides coaching at NESCA?

Marilyn Webber, Transition Specialist - NESCA is pleased to welcome Marilyn Weber, a seasoned transition advocate working with adolescents and young adults. Ms. Weber joined NESCA in Fall, 2014 in order to offer Community-Based Skills Coaching services as well as short-term consultation to families and professionals.

Ms. Weber brings decades of experience working in schools and community agencies as a job developer, job coach, work study coordinator, school to careers coordinator, transition coordinator, parent and professional trainer, and Parent Consultant. She received her advocacy training through The Federation of Children with Special Needs (FCSN), Wrightslaw and OSEP/COPAA’s SEAT program with a practicum at FCSN.

Ms. Weber was the Partnership Director for DRYVE, a youth career center funded by the Workforce Initiative Act. She is a member of Massachusetts Advocates for Children Autism Advisory Committee and Transition Coordinator Subcommittee which recently passed “An Act Relative to Students with Disabilities in Post-Secondary Education, Employment and Independent Living.” She is the proud mother of a young adult with Autism.

Sandy Storer, MSW, Transition Specialist - Social Worker and LEND Fellow Sandy Storer, MSW provides community-based pre-college coaching and college selection services at NESCA. In her 2008-2009 LEND (Leadership Education in Neurodevelopmental and Related Disabilities) Fellowship at the Eunice Kennedy Shriver Center of the University of Mass. Medical School, Ms. Storer conducted an in-depth investigation of the issues that impact students with Asperger’s Syndrome in the transition to post-secondary education, and beyond.

Ms. Storer holds degrees from Northwestern and Boston Universities, and received additional, intensive training in family systems therapy and family therapy at The Family Institute of Cambridge. She has practiced privately as a counselor, coach and consultant for middle and high-school students with Asperger's Syndrome, autism, non-verbal learning disability and related disorders, and has extensive experience in public and private school settings, including 12 years as school social worker at Clarke Middle School in Lexington, MA, where she specialized in helping students with autism spectrum and related disorders.

She also worked in Disability Support Services at Northeastern University, and taught family therapy at MetroWest Mental Health Association, Framingham, MA, where she treated families and individual clients.

Kelley Challen, Ed.M., CAS, Director of Transition Services - Community-Based Skills Coaching and Pre-College Coaching at NESCA are overseen by Kelley Challen, Ed.M., CAS, Director of Transition Services. Ms. Challen received her Master's Degree and Certificate of Advanced Graduate Study in Risk and Prevention Counseling from the Harvard University Graduate School of Education. Initially trained as a school guidance counselor, she completed her practicum work at Boston Latin School focusing on competitive college counseling. She began facilitating social, life, and career skill development programs for transition-aged youth in 2004.

Prior to joining NESCA, Ms. Challen founded an array of programs for teens and young adults at MGH Aspire, and spent time as Program Director of the Northeast Arc's Spotlight Program, where she often collaborated with schools to develop in-district social skill and transition programming. She is also co-author of the chapter "Technologies to Support Interventions for Social-Emotional Intelligence, Self-Awareness, Personal Style, and Self-Regulation" for the book Technology Tools for Students with Autism.

While Ms. Challen has special expertise in working with students with Asperger's Syndrome and related profiles, she provides transition assessment, consultation, planning, and programming support for individuals with a wide range of learning and developmental needs.

Monday, November 24, 2014

Parent Dilemma: When A Kid’s Concussion Lingers On

From WBUR 90.9 FM's Blog "CommonHealth"

By Carey Goldberg
November 21, 2014

When Eli Davis was 15, his ski popped off in the middle of a steep, bumpy slope and he went suddenly airborne, then landed hard, the back of his head slamming down against unyielding ice. That was his first concussion.

A few months later, at soccer camp, he was defending the goal when a breakaway player took a shot from just five feet away and it rocketed right into his face. He finished the game, but he remembers thinking, “Oh…That was not a normal hit.” Another concussion, a worse one.

So far, so familiar. Efforts to expand awareness about the risks of concussion have exploded in the last few years, changing youth sports that had long been more cavalier about hits to the head. Coaches and parents take courses on identifying and treating concussion. Most know to err on the side of caution with head injuries — “When in doubt, sit ‘em out” — and watch for the telltale symptoms that may follow, from dizziness to headache to brain fog.

What fewer know, however, is that while most concussions clear within several days or weeks, a small minority of cases last much longer — like Eli’s.

“He looked at the two of us and said, ‘I don’t care about soccer. I care about the rest of my life.'”
– Al Davis, about his son, Eli

For months after the soccer injury, he suffered a mild headache that would not subside; grogginess and fatigue; sensitivity to light and noise; an inability to think hard that made learning impossible. He found himself stuck on the couch at home, feeling ever more “cabin sick,” when he wanted desperately to be back at school and on the soccer field.

“You can only watch so many seasons of ‘Lost,’ ” he says.

Dr. Neal McGrath, a neuropsychologist and nationally known expert on concussion, estimates very roughly that perhaps 10 to 15 percent of kids with concussions have “longer, tougher recoveries,” often when they’ve accumulated too many concussions, or their injuries have come too close together. That probably amounts to thousands of American children living through prolonged concussion recoveries each year, he says.

Now, Eli’s parents, Robin Friedman and Al Davis of Brookline, Massachusetts, are creating an online venue where those kids and their families can connect, learn from each other and from authorities like Dr. McGrath, and gain support for the long haul they may face.

Professional Web and video content creators who specialize in patient education sites, Friedman and Davis are in the midst of shooting videos like the one above and the others in this post for a site they’ll call Connect2Concussion. They’re trying to fill a void they found as parents groping their own way through post-concussion recovery and all the dilemmas it entails.

Though Eli is thriving now as a sophomore at the University of Massachusetts, his parents still vividly remember how frightening and confusing his condition was in high school. They were worried at first by each day of school Eli had to miss, Friedman says, then scared by how long his symptoms lasted.

“We just didn’t get it,” she says. “With a broken bone or a sprain, you can take an X-ray and you can see it’s healed, and then you know what to do,” she says. “With concussion, they just send you home. It could really be two days or it could be two years, and everything in between, because every child is different, every injury is different and every recovery is different.”

“It gets crazy,” Davis adds, “because every day that goes by, it’s like sand going through an hourglass. You have no idea. You don’t know if he’s going to be OK on Friday, next Monday or two months from now. And what we’ve learned subsequently is that two months from now is actually a reality for people. A year from now is a reality for people. Or it could be three days and everything is good to go.”

Concussion is very manageable, McGrath emphasizes. “But there are do’s and don’ts, if you will, many involving regulation of physical and cognitive activity, that people should understand, going into recovery. And when symptoms are ignored or mismanaged, there’s the risk that the person in recovery can feel stuck, or actually have symptoms become more intense.”

Eli was prescribed the standard treatment: rest, particularly “cognitive rest,” which his parents learned meant he should limit or avoid activities like texting, computer work, even reading. Cognitive rest is the universally accepted recommendation for the first stage of recovery, McGrath says. But it can be very challenging in practice.

“You can’t take a teenager and put them in a dark room or suspend them in animation until they get better.”
– Al Davis

“You can’t take a teenager and put them in a dark room or suspend them in animation until they get better,” Davis says. The situation calls for the art of compromise often familiar to parents of teens, he says: “You have to say, ‘Maybe your friends can come over tonight for a couple of hours.’ or ‘You can watch “Lost” but just don’t get too involved in it!’ You have to find a way to mediate the recovery.”

This balancing challenge is the kind of area where the website in the works can really help, McGrath says. Visitors will hear stories about “the person who tried to do too much. You hear about the person who balanced it well. You hear about the person who maybe even went too far in the direction of rest and withdrawal from normal activities.”

“You hear extreme stories about people thinking, ‘If I have a concussion, I have to go home, I have to stay in a dark room until all symptoms are gone. I can’t even look at my phone or a TV, as if it’s Superman and Kryptonite. And nothing could be further from the truth. In fact, if you put someone in those extreme circumstances — particularly an adolescent, for whom it’s extremely important to stay connected to their peers — you often get a lot of other difficulties you didn’t count on.”

Perhaps the hardest dilemma for parents of a child recovering from a concussion is deciding when it’s safe enough to return to the sports arena.

Eli had dreamed of playing on the high school’s varsity soccer team his whole young life, Friedman says, and insisted on trying out soon after his goalkeeping injury. He made the junior varsity team, but within weeks, she says, he confessed to her that he just wasn’t feeling well enough to play.

She faced the decision: “If I pull him off the team, he’s done. If I don’t, I’m jeopardizing everything: his academics, his possible recovery.” She hopes the Connect2Concussion project will help empower other parents as they make such decisions about what’s best for their children, she says. As for her, she told Eli he was off the team.

“You are staying home,” she said, “and you’re going to recover.”

Davis confesses that he was a bit slower to let go of soccer for Eli; he knew quitting the team would hurt Eli in the coaches’ eyes. But his son helped him along, he says: “At some point, he looked at the two of us and said, ‘I don’t care about soccer. I care about the rest of my life.’ ”

Eli was lucky in that his school, Brookline High School, already had a program to help returning students with medical or emotional problems who can’t handle the full onslaught of a big, hard-driving high school. It offers them a safe and quiet retreat at school, staffed by social workers.

But as Friedman and Davis have been gathering interviews, they’ve heard that not all school systems are as accommodating. In the video above, one mother whose daughter is still recovering describes the resistance she ran into at school.

McGrath and his staff focus some of their efforts on “educating the educators,” he says, helping them strike the delicate balance needed with long-term concussion recovery.

“The anxiety around keeping up in school can get very high, very fast.”
– Dr. Neal McGrath

High school teachers tend to be skilled at holding students to high expectations; but “suddenly, when you have a student with a concussion, we’re asking them to shift gears and expect less of the student for a time — even though he or she may look perfectly healthy — and recognize that too much normal academic activity for some recovering students may cause a real increase in their symptoms.”

It’s not an easy adjustment for students, either, if they’re highly motivated. “The anxiety around keeping up in school can get very high, very fast,” McGrath says. “And that’s where we want the message to the student to be, ‘Look, you can only push so hard right now. We’re going to readjust expectations for you on a temporary basis. We’re going to go at your pace, allow your concussion recovery to happen, and once it does, we’ll get back to all the normal expectations.’ ”

Students may need to hear that again and again, he says.

Through Eli’s high school years, Davis and Friedman became experts on that message, and learned volumes about concussions and recoveries in general. Willy nilly, they became “go to” experts on concussions in their community.

But they’re not in any way trying to replace the individual medical advice of a physician, they say. What they’re creating is called “peer-to-peer education,” which can have a special power all its own — but they filter it through McGrath’s expertise. Also involved in the project is Brookline recreation director Lisa Paradis, who is active in concussion programs nationally.

The team particularly hopes the site will help teens recovering from concussion share with each other. To help build connections, Eli is doing the tweeting and Facebooking.

So how is he doing now?

“I’m normal — I think,” he says. “I haven’t felt any symptoms in a while, not at all.”

And, not to try too hard to make lemonade, but did he learn any valuable lessons from his concussion saga?

“Yes, I learned patience, definitely,” he says. And “I learned how to look at the big picture…”

Saturday, November 22, 2014

School Stimulant Use as 'Socioeconomic Advantage'? Study Suggests It Could Be.

From the Education Week Blog
"Inside School Research"

By Sarah D. Sparks
October 20, 2014

Whether your child's drug use is a path to jail or an edge for college may depend in part on your family income.

A new study in the American Sociological Review finds that middle and high school students from wealthier backgrounds are more likely than students in poverty to "selectively use stimulants only during the academic year," and they are most likely to do so in states with the most stringent academic accountability.

The use of prescription stimulants in response to academic pressure may be "a new pathway through which medical interventions may act as a resource for families of higher socioeconomic status to transmit educational advantages to their children, either intentionally or unwittingly," conclude the study's authors, Marissa D. King of the Yale School of Management, Jennifer Jennings of New York University, and Jason M. Fletcher of the University of Wisconsin-Madison.

While scientists have found no silver-bullet "smart drug," a wide array of different chemicals can be "nootropic," enhancing cognition by easing stress responses in challenging situations or boosting mental acuity after late-night study sessions.

As I reported back in 2012, the use of stimulants like methylphenidate (the active ingredient in Ritalin) and modafinil (often known by the brand name Provigil) under legal but so-called "off-label" precriptions has been on the rise. Some students may use them to get high, but many others are using them to gain an academic edge—be it real or imagined.

The study authors noted that those stimulants have been found to improve note-taking, quiz and test performance, homework completion, and even social skills among students with attention-deficit disorders—but also noted some evidence that stimulants can improve memory and learning in those without attention deficits.

That's where socioeconomic status and family responses to academic pressures start to play a role.

King, Jennings, and Fletcher analyzed the nearly 4 million patients ages 20 and younger who filled more than 15.7 million stimulant prescriptions from Sept. 1, 2007 to August 31, 2008. They also tracked low- and high-income students who were served by the same doctor, and cross-referenced the patients' home states and the intensity of their academic accountability systems.

The researchers found that while elementary school students typically fill prescriptions for stimulants like Ritalin year round, in middle and high school, students are 30 percent more likely to have a prescription filled during the school year than in summer.

"The mismatch between children's academic and social behaviors and the schooling environment is a strong driver of stimulant prescriptions," they found. The rate at which prescriptions were filled even suggested that students were taking the medicines during the school week but not neccessarily on weekends or holidays.

Moreover, the gap varied by students' family income. Teenagers from higher socioeconomic backgrounds—defined as those who used private insurance—were 36 percent more likely to fill a stimulant prescription in the school year than in the summer, while low-income students— those using public Medicaid or state Children's Health Insurance programs—were only 13 percent more likely to use stimulants in the academic year than in the summer.

While some doctors do allow "drug holidays," some studies have found that parents often move students on and off of medication frequently and without first consulting a doctor. Moreover, the American Academy of Pediatrics notes,

"These breaks may speak to a desire of parents or children to minimize the use of stimulants, but there is no reliable evidence indicating that the breaks are helpful or necessary from a medical point of view."

Those gaps remained even when high- and low-income students were served by the same doctor, and they got worse in states with high academic accountability, as defined by the Education Week Research Center's 2008 Quality Counts report.

Not 'For Fun'

These are prescription drugs, and the long-term impact of their use on children and teenagers, whose brains are still undergoing major changes, is nowhere near known. But doing drugs to do better in school, as opposed to using them for recreational purposes, doesn't get tracked in the same way, and doesn't seem to trigger the same alarm among even groups that generally oppose adolescent drug use.

For example, the most recent survey on adolescent drug use by the National Center on Addiction and Substance Abuse at Columbia University has an entire chapter devoted to academic performance and drugs, but it focuses on statistics on how students who have lower grades in school are more likely to drink alcohol or smoke tobacco or marijuana.

As might be expected, when asked for "the most important problem facing people your age—that is, the thing which concerns you the most," the most common answer, given by a quarter of the respondents, was drug, alcohol or tobacco use—but, when asked for their biggest personal source of stress: 56 percent said "academics/doing well in school," another 3 percent said "balancing school and other activities," and 1 percent said "getting into college."

But all of the questions related to prescription-drug use clarify to students that they are talking about drugs used without a prescription, specifically to "get high." They were not asked about their or their friends' or peers' use of stimulants to perform better academically.