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Friday, May 22, 2015

Why Childhood Anxiety Often Goes Undetected (and the Consequences)

From the Child Mind Institute

By Roy Boorady, M.D.
May 12, 2015

Kids often keep their worries hidden, or express them in ways that are hard to read.

Anxiety is a natural thing. It is normal for very young children to be afraid of the dark, or for school-age children to worry about making friends. But for some kids, normal anxiety morphs into something more serious.

A young girl might be afraid to ever leave her mother's side, even to get on the school bus, or an anxious boy may need frequent reassurance over things that happened a month ago.

Kids can develop an anxiety disorder. Eventually the disorder can start interfering with a child's friendships, life at home, and work in school. Even so, the anxiety still might not be noticeable to parents and caregivers.

For one thing, being anxious doesn't necessarily mean that you can't function—it might just make some kinds of functioning more difficult. A homework assignment that should take twenty minutes might take an hour, for example.

With anxiety, it's important to remember how internal it is. It dominates a child's thoughts, but it might not be obvious to the people around her.

It's also worth noting that in my work as a child psychiatrist I see a lot of anxious kids who are still basically happy and enjoying life. Maybe they are only struggling in certain situations, which may make their anxiety all the easier to overlook.

Outward Signs of Anxiety

When anxiety is expressed outwardly, there can be a wide range of signs, which often complicates identification.
  • Kids may have trouble sleeping or complain about stomachaches or other physical problems.
  • They may become avoidant and clingy around parents or caregivers.
  • They might also have trouble focusing in class or be very fidgety—I like to say, "Not all that moves is ADHD," even though that's often the first thing we suspect from a hyperactive or inattentive child.
  • They may have explosive outbursts that make people think they are oppositional, when their fight-or-flight mechanism is triggered.

The words we use to describe our anxiety can distract, too. People use a lot of different words to describe what they're feeling—kids might say they are self-conscious, shy, apprehensive, worried, or afraid. These words do a good job capturing what they are struggling with, but fixating too much on them can distract from the fact that anxiety is underlying factor—not some personal failure in personality.

Consequences of Untreated Anxiety

If you look at the prevalence rates of anxiety disorders, you'll see that the numbers rise as children get older. That makes sense because anxiety disorders are cognitive, so they develop as our cognitive ability develops. Separation anxiety, for instance, develops early, whereas social anxiety disorder usually develops after puberty.

A study of more than 10,000 kids, interviewed by trained professionals, shows that more than 30 percent had developed an anxiety disorder some time before they were 18.

Anxiety frequently recurs, too, and childhood anxiety is often a precursor for adult anxiety, especially for kids who don't receive treatment. The same study showed that 80 percent of kids with anxiety do not get treatment. Many adults seeking help for anxiety remember feeling anxious when they were younger, which means that they've been struggling for a long time and could have benefited from treatment as children.

Avoidance Reinforces Anxiety

Kids with untreated anxiety also begin to develop poor coping skills. A common example is avoidance—people who are very anxious will try to contain it by avoiding the thing that makes them anxious. It's a short-term solution that unfortunately reinforces their anxiety instead of acclimating them to it.

Similarly, untreated anxiety can lead to lower self-esteem, academic dysfunction and self-medication through substance abuse.

Anxiety Leads to Depression

People living with anxiety for extended periods of time are also more likely to develop depression. It isn't uncommon to meet patients who come seeking treatment for depression or depressive symptoms and it turns out that they have been dealing with lifelong anxiety as well. In cases like this people need treatment for anxiety and depression.

Fortunately, we know a lot about how to treat anxiety. It responds very well to cognitive behavior therapy, and there are medications that work, too. Getting help makes a big difference, and treatment doesn't need to be a lifelong thing—although its positive effects will be.

Wednesday, May 20, 2015

Let Kids Fidget in Class: Why It Can Be Good For Those with ADHD

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

By Anya Kamenetz
May 15, 2015

Are you a pen-clicker? A hair-twirler? A knee-bouncer? Did you ever get in trouble for fidgeting in class? Don’t hang your head in shame. All that movement may be helping you think. 

Allowing kids with ADHD to move around in class
may help them collect their thoughts. (LA Johnson/NPR)

A new study suggests that for children with attention disorders, hyperactive movements meant better performance on a task that requires concentration. The researchers gave a small group of boys, ages 8 to 12, a sequence of random letters and numbers. Their job: Repeat back the numbers in order, plus the last letter in the bunch. All the while, the kids were sitting in a swiveling chair.

For the subjects diagnosed with attention deficit hyperactivity disorder, or ADHD, moving and spinning in the chair were correlated with better performance. For typically developing kids, however, it was the opposite: The more they moved, the worse they did on the task.

Dustin Sarver at the University of Mississippi Medical Center is the lead author of this study. ADHD is his field, and he has a theory as to why fidgeting helps these kids.

“We think that part of the reason is that when they’re moving more they’re increasing their alertness.”

That’s right — increasing. The prevailing scientific theory on attention disorders holds that they are caused by chronic underarousal of the brain. That’s why stimulants are prescribed as treatment. Sarver believes that slight physical movements “wake up” the nervous system in much the same way that Ritalin does, thus improving cognitive performance.

However, he explains, alertness occurs on a “rainbow curve.” You want to maintain a “Goldilocks” level of alertness — not too much, not too little. That’s why moving around didn’t help the typically developing kids; it might even have distracted them.



Lots of popular classroom-management advice focuses on controlling students’ postures and movements, on the theory that sitting still is synonymous with thinking well. For example, Doug Lemov’s “Teach Like A Champion” model, used in many charter schools, uses the acronym SLANT, for “Sit up, Listen, Ask and answer questions, Nod, Track the speaker.”
This is one small study, not meant to provide conclusive evidence one way or another. But in his role as an ADHD researcher, Sarver often finds himself in conversation with teachers who ask him for his opinion.

Sarver tells them that it may make more sense to grant kids with ADHD some leeway — not to get out of their desk constantly or distract other students, but to move around as they need to.

“When I tell a kid, ‘Sit down, don’t move, stop tapping, stop bouncing,’ the kids are spending all their mental energy concentrating on that rule. And that doesn’t allow them to concentrate on what we’re asking them to do, which is their homework.”

Monday, May 18, 2015

Some Young Children With Autism Lose Label, but Retain Learning Challenges

From Education Week's Blog "Early Years"

By Christina Samuels
April 29, 2015

A small percentage of children who had been diagnosed with autism spectrum disorder as toddlers no longer showed symptoms of the disorder four years later, but most continued to have emotional or learning disorders, according to a study that was presented at a recent meeting of researchers in child health.

The findings came from a study of 569 children in New York between 2003 and 2013. They had all been diagnosed with autism spectrum disorder through an early-intervention program around age 2 1/2. But 38 children—about 7%—showed no further signs of autism as young children when they were 6 years old.

Those 38 children did have normal cognitive function, but many, about 68 percent, also had learning disabilities. Nearly half had attention deficit hyperactivity disorder, and a quarter had disabilities such as anxiety, obsessive compulsive disorder, or selective mutism.

Only three of the 38 had no other diagnoses. Nearly 75 percent of the children required academic supports, such as a small classroom or a resource room setting, according to the findings.

The findings were presented Sunday at the Pediatric Academic Societies meeting in San Diego. The research was led by Dr. Lisa Shulman, a developmental pediatrician and a specialist in early identification and treatment of autism, based at the Albert Einstein College of Medicine at Yeshiva University in New York.

"When an early ASD diagnosis resolves, there are often other learning and emotional/behavioral diagnoses that remain," said Dr. Shulman, in an interview with AAP News, a news magazine published by the American Academy of Pediatrics.

"Understanding the full range of possible positive outcomes in this scenario is important information for parents, clinicians, and the educational system."

Diagnosing Autism Spectrum Disorder Early

You may wonder how clinicians are able to diagnose autism accurately very young children. Dr. Shulman and the Albert Einstein College of Medicine created this video of baby and toddler milestones that offers a good primer on social behavior and language development parents should expect from their children at different ages. What makes this video particularly useful is that it features real children as well.

Alithea Morrison, second from right, sits next to her preschool teacher, Kathy Boisvert, as she and her classmates sing during class at Millville Elementary School in Millville, Mass. The class is one of more than 100 school sites for the Learning Experiences Alternative Program, which immerses children with autism spectrum disorders in classes with typically developing children trained in ways to communicate and work with them.
—Gretchen Ertl for Education Week

Saturday, May 16, 2015

Why Emotional Learning May Be as Important as the ABCs

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

By Maanvi Singh, NPR
January 2, 2015

Thomas O’Donnell reads about Twiggle the Turtle to his
kindergartners at Matthew Henson Elementary School
in Baltimore. (Elissa Nadworny/NPR)

Thomas O’Donnell’s kindergarten kids are all hopped up to read about Twiggle the anthropomorphic turtle.

“Who can tell me why Twiggle here is sad,” O’Donnell asks his class at Matthew Henson Elementary School in Baltimore.

“Because he doesn’t have no friends,” a student pipes up.

And how do people look when they’re sad?

“They look down!” the whole class screams out.

Yeah, Twiggle is lonely. But, eventually, he befriends a hedgehog, a duck and a dog. And along the way, he learns how to play, help and share.

These are crucial skills we all need to learn, even in preschool and kindergarten. And common sense — along with a growing body of research — shows that mastering social skills early on can help people stay out of trouble all the way into their adult lives.

So shouldn’t schools teach kids about emotions and conflict negotiation in the same way they teach math and reading? The creators of Twiggle the Turtle say the answer is yes.


Emotional Intelligence 101

Twiggle is part of a program called Promoting Alternative Thinking Strategies, or PATHS. It’s designed to help young kids recognize and express emotions.

Matthew Henson Elementary is one of about 1,500 schools around the country using this program, which was first developed in the 1980s.

Every week, students get two 15- to 20-minute lessons on themes like self-control and treating others with respect. Especially for the youngest kids — in kindergarten and first grade — Twiggle often serves as their guide.

O’Donnell says his students are really taking to the lessons. They’re trained, for example, to “do the Turtle” when they’re upset. “That’s when they stop and cocoon themselves. They wrap their arms around themselves and they say what the problem is,” he explains.

O’Donnell’s kids do the turtle all the time — in the hallway and during class.

Right before class starts, for example, one little girl tells her friend, “I don’t like when you touch my hair, because it makes me sad.”

“Sorry!” her friend responds.

While most kids will eventually figure out such strategies on their own, or with help from their parents, O’Donnell says, the lessons help them learn more quickly.

And for some, especially those with troubled home lives, Twiggle is their first and only introduction to healthy self-expression, he says. “Some of them don’t have words to express how they feel before this.”

The Long Game

We previously reported on a national study comparing PATHS and other, similar programs showing positive effects in preschool. They are based on research showing that kids who act up a lot in school and at home — even very young kids — are more likely to have mental health problems and commit crimes years later as adults.

So Kenneth Dodge, a psychologist at Duke University, asked, “Could we do something about that to prevent those problems from actually occurring?” And he has dedicated his career to answering that question.

He and his colleagues launched the FastTrack Project to see if they could change students’ life trajectory by teaching them what researchers like to call social-emotional intelligence.

Back in 1991, they screened 5-year-olds at schools around the country for behavior problems. After interviewing teachers and parents, the researchers identified 900 children who seemed to be most at risk for developing problems later on.

Half of these kids went through school as usual — though they had access to free counseling or tutoring. The rest got PATHS lessons, as well as counseling and tutoring, and their parents received training as well — all the way up until the students graduated from high school.

By age 25, those who were enrolled in the special program not only had done better in school, but they also had lower rates of arrests and fewer mental health and substance abuse issues.

The results of this decades-long study were published in September in the American Journal of Psychiatry.

The findings prove, Dodge says, “In the same way that we can teach reading literacy, we can teach social and emotional literacy.”

Cost Versus Benefit

PATHS and FastTrack aren’t the only programs of their kind. A social-emotional learning program called RULER, developed at Yale University, has shown promising results, as well. And every year, the Chicago-based Collaborative for Academic, Social and Emotional Learning rates the top evidence-based emotional intelligence programs around the country.

So what’s the catch? Why don’t all schools offer emotional intelligence lessons?

Well, it’s expensive.

The full, intensive FastTrack program costs around $50,000 per student, over a 10-year period. Schools can also pick and choose elements of the program.

For example, the short PATHS lessons about Twiggle at Matthew Henson Elementary cost less — about $600 per classroom to start, plus an additional $100 a year to keep it running.

It’s pricey, but it does cost less per child than juvenile detention or rehab programs later on, according to Dodge. As a society, we spend a lot on remedial services — programs like PATHS are preventive, he says. “This is something that in the long run will save dollars.”

At Clark K-8 School in Cleveland, fifth-grader Tommy DeJesus Jr. says he thinks it’s been worthwhile.

DeJesus has been exposed to the PATHS curriculum since he was in kindergarten, and he says he continues to use the social skills he learned from good old Twiggle.

The other day, for example, DeJesus says, he was quick to step in when he saw that a friend was being teased. “They were making fun of his shoes and how he dressed. I said, ‘Just because you have shoes and he doesn’t, that doesn’t give you the right to bully him,’ ” he says.

And the cool thing was, they listened.

Friday, May 15, 2015

Gifted Children’s Challenges with Learning and Attention Issues

From Understood

By Peg Rosen
May 14, 2015

At a Glance: Children can be gifted and also have learning and attention issues. Many of them go through school without being identified as having special talents or needs. You can help your child get more support.

“Your child is gifted and needs special education?”

Many parents are all too familiar with this kind of comment. You may hear it from friends. From family. Even from some teachers and doctors.

Yet there are lots of people who have exceptional ability in some academic areas and significant learning difficulties in other areas. Educators use a special name to describe students who qualify for gifted programs as well as special education services. These children are referred to as “twice-exceptional” learners. Some organizations estimate that there are hundreds of thousands of twice-exceptional learners in U.S. schools.
  • Consider Tessa: She’s a bright, insightful and enthusiastic fourth grader who is reading at a 12th-grade level. At the same time, she can’t pass her spelling tests, and writing is a huge struggle.
  • Consider Jamie: At 16, he knows everything about the Civil War, writes beautifully, and can talk endlessly about politics. Yet he needs a calculator to help him with even the most basic math. And he couldn’t tie his shoes until he was in seventh grade.
  • Consider Steven Spielberg: He’s one of the most successful filmmakers of all time, but reading has been a lifelong struggle for him because he has dyslexia.

Twice-Exceptional and Easily Overlooked

Some groups estimate that there are hundreds of thousands of twice-exceptional learners in U.S. schools. But there are no hard numbers because so many of these students are never formally identified as being gifted, having a disability or both.

Twice-exceptional children tend to fall into one of three categories. These categories help explain why students often go through school without the services and stimulation they need:
  • Students whose giftedness masks their learning and attention issues. These kids score high on tests for giftedness but may not do well in gifted programs. These students use their exceptional abilities to try to compensate for their weaknesses. But as they get older, they may be labeled as “underachievers” or “lazy” as they fall behind their gifted peers.
  • Students whose learning and attention issues mask their giftedness. Learning and attention issues can affect performance on IQ tests and other assessments for giftedness. For example, since many of these tests require language skills, kids with language-based challenges may not perform well. These kids may be placed in special education classes, where they become bored and possibly act out because they aren’t being challenged enough. Some of these children are identified, wrongly, as having emotional problems.
  • Students whose learning and attention issues and giftedness mask each other.These kids may appear to have average ability because their strengths and weaknesses “cancel each other out.” Consequently, these students may not qualify for gifted programs or for special education programs.

Identifying Twice-Exceptional Students

Federal law protects students with disabilities. School districts are required to look for children with disabilities and provide special education to those who qualify for it. Gifted education is a different animal.

There is no federal requirement for gifted education. Decisions about gifted programming are made at the state and local level. Few states specify what these services should be and which talents should be nurtured. This is often left up to individual school districts. And funding for gifted services can vary greatly from district to district.

Identifying twice-exceptional students tends to be a low priority. Often it takes a proactive parent to push for testing for both giftedness and learning and attention issues. But sometimes teachers are the first to raise the possibility.

Some early tip-offs that your child could be a twice-exceptional learner:
  • Extraordinary talent in a particular area, such as math, drawing, verbal communication or music;
  • A significant gap between your child’s performance in school and his performance on aptitude tests;

There isn’t a simple, one-test way of identifying twice-exceptional children. Ask your child’s school how it evaluates kids for giftedness and learning and attention issues. The process will likely include assessing your child’s strengths and weaknesses as well as observing him in class and other settings.

It may be helpful for you and the teachers to keep records of what your child excels in and struggles with. Be on the lookout for “disconnects” between how hard he’s studying and what kinds of grades he’s making.

Social and Emotional Challenges

Giftedness can add to the social and emotional challenges that often come along with learning and attention issues.

Some challenges that twice-exceptional learners may face:
  • Frustration: This is especially common among kids whose talents and learning issues have gone unnoticed or only partially addressed. These students may have high aspirations and resent the often-low expectations that others have for them. They may crave independence and struggle to accept that they need support for their learning and attention issues.Like many gifted students, twice-exceptional learners may be striving for perfection. Nearly all the students who participated in one study of giftedness and learning disabilities reported that they “could not make their brain, body or both do what they wanted to do.” No wonder these kids are frustrated!
  • Low self-esteem: Without the right supports, children with learning and attention issues may lose confidence in their abilities or stop trying because they start to believe that failure is inevitable. This kind of negative thinking can add to the risk of depression.
  • Social isolation: Twice-exceptional kids often feel like they don’t fit into one world or another. They may not have the social skills to be comfortable with the students in their gifted classes. They may also have trouble relating to students in their remedial classes. This can lead twice-exceptional learners to wonder, “Where do I belong?” These children often find it easier to relate to adults than to kids their age.

How to Help Your Child

With the right supports and encouragement, twice-exceptional learners can flourish. (Just ask Steven Spielberg!)

Here’s what you can do to help your child:
  • Talk to the school. If you suspect your child may be twice exceptional, request a meeting with the school’s special education coordinator. Discuss your concerns, and ask about types of tests.
  • Ask to stay in the gifted program. If your child has been identified as gifted but is not doing well in that program, request that he be assessed for learning and attention issues before any decisions are made about removing him from the program.
  • Make the most of your child’s IEP. If the school determines that your child is twice exceptional, use the annual goals in his Individualized Education Program (IEP) to address his weaknesses and nurture his gifts. Be prepared to brainstorm—and to be persistent!
  • Find other twice-exceptional kids. Encourage your child to spend time with children who have similar interests and abilities. This can help him celebrate his strengths and feel less isolated. You may be able to connect with twice-exceptional families through Understood’s parent community.
  • Empower your child. Help him understand what his gifts and weaknesses are. Reassure him that he can get support in the areas where he struggles. But resist the urge to rush in and rescue him every time he gets frustrated. It’s better to help him learn to cope with his mixed abilities.

By partnering with your child’s teachers, you can help your child develop his talents and achieve his full potential. Learn more about how to be an effective advocate for your child at school. Explore Parenting Coach for strategies on how to handle frustration and other everyday challenges.

With your love and support, your child can move ahead and make the most of his gifts.

Key Takeaways
  • Gifted children with undiagnosed learning and attention issues may appear to be “underachievers” or “lazy.”
  • Twice-exceptional children are often at risk for social and emotional challenges.
  • Your child’s IEP can address his weaknesses and nurture his strengths.


Peg Rosen has written for numerous digital and print outlets, including ParentCenter, WebMD, Parents, Good Housekeeping,More, Fitness and Martha Stewart. More by this author

Wednesday, May 13, 2015

Free Talk Thursday, May 14th in Holliston: Transition Planning - What Comes after High School for Children with Special Needs?

From the Holliston SEPAC

May 12, 2015

Please join the Holliston SEPAC at a workshop to learn about:
  • Laws and regulations relating to transition planning;
  • Key areas to assess and methodologies;
  • Strategies for including assessment information in Transition Plans and IEPs.

This talk is free and open to the public.

When:   7:00 - 9:00pm Thursday, May 14, 2015

Where: Holliston High Room 303
                   370 Hollis Street, Holliston, MA

NOTE: This talk has been moved from the library to Room 303After entering through the main high school entrance, take the first hallway on the right, after the library. Prior to the stairs, take the left down the hallway. Room 303 is the first classroom on your right, after the back wing hallway.

Speakers: Kelley Challen, Ed.M., CAS
                        Director of Transition Services, NESCA

                        Meg Camire
                        Director of Student Services, Holliston


NESCA Transition Services

Transition is the process, ideally beginning at age 14 if not sooner and extending through high school graduation and beyond, by which an adolescent or young adult masters the life skills necessary to function independently in post-secondary school or the workplace.

NESCA offers complete transition assessment (including testing and community-based observation), consultation, planning, coaching and college selection services, coordinated by Kelley Challen, Ed.M., CAS. Other members of NESCA's transition team include Jason McCormick, Psy.D., Sandy Storer, MSW and Marilyn Weber. Learn more HERE!

Students Report Host of Academic Issues when Recovering from Concussions

From Education Week's Blog
"Schooled in Sports" 

By Bryan Toporek
May 11, 2015

While recovering from the symptoms of a concussion, a vast majority of students reported having one or more issues that impaired their academic work, including headaches, problems paying attention, and difficulty studying or understanding material, according to a new study published online in the journal Pediatrics.

The study's authors examined 349 students between the ages of 5 and 18 who sustained a concussion and underwent an initial evaluation within 28 days of the injury. Parents of all 349 students reported their children's postconcussion symptoms, and 239 of the students did the same.

Clinicians divided the children into two groups: those who had recovered from their concussions, based on a lack of symptoms and no impairments on neurocognitive testing, and those who had not yet recovered from their concussions, based on elevated symptoms or impaired performance on neurocognitive tests.

Among the 109 students who had fully recovered from their concussions by the time of the study, just five reported having headaches interfere with their academic work, eight reported having problems paying attention, and 11 said they were feeling too tired. Of the 240 who had not yet recovered from their concussions, however, 121 had headaches interfering with their work, 106 had problems paying attention, and 95 felt too tired.

Likewise, a far greater number of students who had not yet recovered reported having to spend more time on homework, difficulty understanding material and studying, and difficulty taking class notes.

In total, 88 percent of the group still recovering from a concussion reported at least one school problem related to their concussion symptoms, such as headaches, fatigue, or concentration problems. In addition, 77 percent reported having some form of diminished academic skills, such as problems taking notes or studying.

Among the fully recovered group, just 38 percent had symptom-interfering problems and 44% had a diminished academic skill.

The fully recovered students reported consistent interfering symptoms and diminished academic skills across all age groups. The still-recovering group reported consistent interfering symptoms as well, but their diminished academic skills varied by age level. High school students in the latter group reported a greater number of academic-skill problems than middle and elementary school students.

A significantly smaller percentage of students in the fully recovered group reported having trouble with one or more classes compared to their peers still dealing with concussion symptoms, and the same was true in the parents' reports, too. In particular, math proved problematic for students still recovering from a concussion: 114 such students reported having trouble with that subject, more than any other class. (Language arts, science, and social studies followed, in that order.)

The study's authors did find a positive correlation between symptom severity and the total number of school problems reported by students and parents.

"The range of reported postinjury school problems suggests the need to provide actively symptomatic students with targeted supports during the postinjury recovery period," the authors conclude.

The American Academy of Pediatrics made a similar recommendation in a 2013 clinical report, saying schools should create a multi-disciplinary team to ease a student-athlete's transition back to the classroom after he or she sustains a concussion.

"We know that children who've had a concussion may have trouble learning new material and remembering what they've learned, and returning to academics may worsen concussion symptoms," said Dr. Mark Halstead, a lead author of the AAP's report, at the time.

A handful of states have already begun taking matters into their own hands. The Illinois Senate recently approved a bill that would require schools to create a concussion oversight team responsible for establishing both a return-to-play and a return-to-learn protocol. Both Virginia and Nebraska implemented similar return-to-learn requirements for student-athletes last year.