Some Old-News Updates on Best Practices

Two articles you may have missed in The New York Times reiterate some important points about how to help children with two very different but very common difficulties – anxiety and disruptive behavior. 

The first article, an opinion piece written by Dr. Perri Klass, whose work and writing have been featured in a number of our blog posts (check out her other informative pieces in The Times here), reports on a meta-analysis that investigated the effectiveness of different therapies and drugs used to treat a variety of anxiety disorders in children. To read the meta-analysis on your own, see the reference at the bottom of this post. A meta-analysis is a large research undertaking that combines the results of many smaller studies to get a better idea of the big picture. This meta-analysis looked at a combined total of 7,719 patients between the ages of five and sixteen. As expected, the researchers found that exposure-based cognitive behavioral therapy (CBT) is a preferred treatment. With this type of therapy, children as young as five years old are exposed to what makes them anxious so that they can practice dealing with the triggers with support, while they simultaneously work on changing how they think about the things that make them feel bad. The researchers also found that the newer types of anti-depressants can be helpful, but they are best when used in combination with therapy (and they were found to be not as effective when used alone, as compared to the exposure-based CBT).

For those of us working in the field, this meta-analysis didn’t really tell us anything groundbreaking. It does, however, get the message out that there is an evidence-based way to help children who are suffering from the kind of anxiety that interferes with their ability to function at home and school. It also reiterates, for parents and caregivers who are seeking help, the importance of finding a therapist who focuses on this type of therapy in her or his work with anxious children.

The second Times article, from October, is another opinion piece, published in the Fixes column, and written by Suzanne Bouffard. In her column, Bouffard describes the process of Collaborative Problem Solving, a technique developed by Ross Greene, who wrote a book we love to recommend at The Yellin Center - The Explosive Child. Bouffard begins by describing the typical disciplinary methods used at many schools, even preschools, across the country. Children are typically removed from the educational environment as a disciplinary measure - they may be put in time out, forced to complete useless assignments as punishment, or even suspended from kindergarten. The main point that Bouffard makes here, and that is at the foundation of my field - school psychology - is that these exclusionary tactics may temporarily stifle unwanted behaviors, but they are also often psychologically harmful and, even more importantly, do not teach our youngest students what they should be doing instead. There’s an unfortunate persistent idea that kids behave well when they want to, but the truth is that kids behave well when they can. Taking a child who struggles with regulating her behavior and excluding her from the classroom and putting her in isolation, for example, does absolutely nothing to help her practice the skills she needs to do better next time.

Collaborative problem solving was described in one of my previous posts on this blog. Bouffard’s piece takes the philosophy behind it and puts it in a very real context, with real examples of families who have seen what a difference it can make. I highly recommend reading the article and thinking deeply about the kind of discipline your child experiences at home and at school. It offers us the opportunity to ask ourselves some potentially difficult questions about whether we’re really using what the field of psychology likes to call best practices when helping our children and our students grow into well-adjusted citizens.



Wang, Z., Whiteside, S. P., Sim, L., Farah, W., Morrow, A. S., Alsawas, M., ... & Daraz, L. (2017). Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis. Jama Pediatrics, 171(11), 1049-1056.



Photo by Michał Parzuchowski on Unsplash

Supporting Anxious Children

While collaborating with fellow teachers in different parts of the country, your blogger has noticed a common theme: anxiety in students is becoming a much more salient issue in today’s classrooms. Data supports the notation that anxious tendencies in children is on the rise; a study conducted by the National Institute of Mental Health found that 25.1 percent of kids 13-18 in the United States have been diagnosed with anxiety disorders. 

Many colleagues have shared that they feel ill equipped and under prepared to mitigate these types of social-emotional and behavioral challenges. But behavior and self-regulation aren’t the only concerns teachers or caregivers are faced with when supporting children with mental health issues. Students who are dealing with psycho-social stressors often struggle to focus on their learning and their academic performance often wanes as a result. For example, a study published in the Journal of Abnormal Child Psychology surveyed a group of 1,197 students without a diagnosed reading or math disability. The students who were diagnosed with an anxiety disorder were more likely to be in lower achieving reading and math groups.

We have written before about self-regulation strategies and teaching children mindfulness; some of these ideas and tools may be effective interventions for helping students cope with anxiety and behavioral difficulties. However, another excellent resource is an informative book written by Dr. Nancy Rappaport and Jessica Minahan titled The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students. The Behavior Code provides strategies to determine causes and patterns of behavior in order to effectively de-escalate challenging situations. The book is also a treasure trove of worksheets and practical resources.

In their book, the authors emphasize that misbehavior is a symptom of an underlying cause and is a form of communication that serves a function and has a pattern to it. They explain that a displayed maladaptive behavior is often the symptom of underdeveloped skills, such as weak executive functioning, poor self-regulation, or immature social skills. The behavior is often the child’s attempt at solving a problem the best way they know how. Children will continue to engage in the problematic behavior due to the function it serves in getting them a desired result. For example, whining may get the teacher’s attention. Often, when teachers systematically evaluate behavior they will discover a pattern to what triggers or causes the behavior and what function it is serving. Knowing the cause, function, and pattern to challenging behavior is the first step towards helping build effective, personalized, interventions in order to support the child

The authors also provide some tangible tips for working with anxious students:

• It is common for teachers or caregivers to publicly praise positive behavior. However, children with anxiety don’t always want any extra attention from peers, which can make this strategy ineffective. Private or non-verbal praise is often better for students with anxious tendencies.

• Students with anxiety often enter into negative thinking cycles. Vague or non-specific praise is easy for them to dismiss. The authors suggest using fact-based praise with specific examples of how the student has done. 

• There are new biofeedback tools that can turn calming down into a game for students. One such tool is EmWave, which gives students a black and white picture that will slowly fill with color as the device monitors the child’s heart rate and the student begins to calm.

Learn Mindfulness with Sitting Still Like a Frog by Eline Snel

Like that awful song your teenager has been playing on repeat all summer, the mindfulness trend is hot right now. Unlike that song, however, mindfulness is a trend we hope will stick around. Mindfulness can help improve attention and emotional resilience by simply encouraging people to be aware of what is happening around and inside them. Often it has been linked to meditation or yoga, but mindfulness can be taught in the context of everyday activities, too. Results of research exploring the effects of mindfulness suggests that it’s a very promising technique; children who learn mindfulness are able to sustain attention longer, resist impulses, self-soothe, and effectively control anxiety. In fact, in a recent blog post, we noted research that found that using mindfulness techniques has proven effective to reduce stress and depression and to improve parenting skills in parents of children with developmental disabilities.

For parents who think their children could benefit from mindfulness, Sitting Still Like a Frog by Eline Snel is an excellent resource. Snel, founder of the Academy for Mindful Teaching in the Netherlands, has worked to develop meditation and mindfulness training programs for more than twenty-five years. Her book is a user-friendly and effective tool that helps families use mindfulness and reap its benefits. The exercises in it are basic enough for children as young as five but nuanced enough to use with kids into their middle school years.

The book contains exercises for families to try together and explanatory passages aimed at adults that parents will find insightful and intriguing. In addition to the text, the book comes with an audio CD that leads listeners through more activities that promote calm and focus. Those suspicious that the book will smack of strange, new-age ideas will be pleasantly surprised by its down-to-earth tone and common-sense advice. To give you a sense of the program, here’s a short excerpt from the first track on the audio CD:

“A frog sits very still but is always aware of what is going on around it. It jumps, stops, and sits really still, being aware of everything around it. It only moves when it really has to, like when it’s hungry. It doesn’t waste energy doing things it doesn’t have to do. It’s aware of all the commotion going on around it, but it doesn’t react.”

Cultivating this awareness is a big part of Snel’s mindfulness training. In addition to learning to be attentive to their surroundings, kids are encouraged to turn the lens inward to find out what they’re thinking, feeling, and doing with their minds and bodies. Many children have difficulty understanding the escalation of their own impulses or feelings and aren’t sure how to control them, so providing kids with tools for this purpose can be enormously comforting. Parents can give staying power to the book’s worthy lessons by helping kids remember to use what they’ve learned when they’re presented with challenging situations.

Mindfulness can be very beneficial to children with attention difficulties and anxiety. But it can also help frazzled adults manage stress and feel more balanced. So, by sharing the lessons from Sitting Still Like a Frog with your kids, you may be doing yourself a favor, too.

Ten Signs: When To Seek Help for Difficulty In School

How can a parent know if the time is right to seek help for difficulty in school? The honest answer is that every child (and every situation) is different, but if you are having significant or persistent concerns about a student, no matter their age, academic level, or context, we strongly recommend speaking with a qualified professional to ensure that your child is receiving the appropriate support he or she may need to excel in their educational pursuits. Sometimes, it can be important to seek help from professionals working independently of your child's school if you have concerns that the school is not meeting your child's needs, and especially if faculty and administrators do not share your level of concern.

The Yellin Center has compiled a list of ten signs parents and educators should be on the lookout for in students who are experiencing some difficulty in their day to day school or home lives. If more than a handful of these statements are accurate depictions of a student in your life, Dr. Yellin recommends you seek out professional care.

Ten Signs: When To Seek Help for Difficulty In School

1. Stomach aches, headaches or other symptoms of minor illness that occur consistently on Sunday nights, Monday mornings, or when working on projects or preparing for school
2. Feeling stressed or generally anxious
3. Homework and school projects taking much longer than expected on a regular basis
4. Not reading for pleasure, and not feeling joyful about learning or new experiences, generally
5. Diminished self-esteem
6. Low motivation
7. Grades and test scores are not reflecting effort (especially), or knowledge
8. Evidence of strong verbal skills paired with poor writing
9. Knowing subject material one week but completely forgetting it in the following week
10. Seemingly performing well in school, but completely "falling apart" -- emotionally, academically, or otherwise -- at soon as at home

-Jeremy Koren

Coping with Test Anxiety: Worriers Versus Warriors

Most of us have been there: butterflies in the stomach, clammy hands that tremble, difficulty breathing. Test anxiety is all too familiar to most of us. A recent article in The New York Times by Po Bronson and Ashley Merryman (also authors of Top Dog: The Science of Winning and Losing) explores why some kids (Warriors) seem to approach exams with cavalier nonchalance while others (Worriers) are seized with paralyzing stress. Of course, human behavior is influenced by a multitude of factors, but there’s also a compelling genetic explanation for this phenomenon. When a person experiences stress, the prefrontal cortex of his/her brain is flooded with the chemical dopamine. Because our brains work best when dopamine levels are controlled, the gene responsible for clearing that dopamine, a gene called the COMT gene, sets to work to restore balance. COMT, however, comes in two varieties. The first clears the dopamine slowly. The second clears it rapidly. Those who have the rapid removal version of COMT, Warriors, tend to perform better under stress. Worriers on the other hand, whose brains seem to become saturated with dopamine, often experience a drop in performance.

Here’s the part that makes this seem particularly unfair to Worriers: A slow-acting COMT gene is typically associated with higher cognitive and executive function skills. So students with higher cognitive abilities who sit down to a test are at a larger disadvantage than their less academically able classmates. The Times articles notes that a study in Taiwan demonstrated that students with higher IQs coupled with the slow-removal gene under-performed their fast-acting COMT-endowed counterparts on a high-stakes national exam.

This seems like bad news for Worriers, but, happily, there is hope. Studies of stress indicate that, like much else in life, the spin we put on a situation has an enormous impact on the way we deal with it. According to the authors, both amateur and professional athletes have been found to experience the same levels of stress before competition. The difference? The amateurs view stress as a derailing force while the professionals view it as an energizing one. The article notes that a study at Harvard put this principle to the test in an academic setting. Before taking a practice test, some students were given a statement explaining to them that stress actually improved test performance. Not only did that group out-perform the control group on the practice test, but they attained higher scores again when they took the actual GRE weeks later.

Part of managing test anxiety, then, is a matter of philosophy. The other comes with good, old-fashioned practice. The authors advocate “training, preparation, and repetition” as the best way to prepare Worriers for a stressful event. Here are some of our ideas for combating test anxiety, whether you’re coaching a student in your life, or yourself:

• Allow the student to verbalize what she is feeling and help her by giving her the right language if she struggles. If talking it out is too hard, ask her to write about her thoughts. 

• Help the student to understand that stress is not only normal but potentially beneficial. Share with him the story about stress experienced by amateur and professional athletes. Talk about viewing stress as a positive phenomenon. 

• Physical relaxation can sometimes trigger mental clarity. Help students learn self-coaching language, or teach them to tense, then relax, various muscle groups. Some students may feel better if they have the chance to engage in physical activity before a test, like doing some yoga poses or going for a jog. 

• Familiarity with test-day factors can be enormously helpful in combating stress. Help your student take practice tests, ideally under the same conditions in which she will face the real thing (i.e. setting, time constraints, etc.) If all that isn’t possible, visit the test site, review the testing procedures with your student using the verbatim instructions if you can find them, etc. 

• Scholastic competitions (the math team, spelling bees, etc.) can serve as what the authors call “inoculation” for Worriers. Encourage your student to participate in such activities.

Photo: CC by Justin D. Miller

A Week to Focus on ADHD

A coalition of national organizations, including CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) and the Attention Deficit Disorder Association (ADDA), have declared this to be ADHD Awareness Week, and we thought that this would be a good time to look at the facts about ADHD to help parents, educators, and students better understand this condition.

The CDC notes that ADHD is one of the most commonly diagnosed behavioral disorders of childhood, with 9.5 % of children being diagnosed with ADHD at some point. Boys are two to three times more likely to be diagnosed with ADHD than are girls. Some of that difference may stem from the fact that there is more than one kind of ADHD; the National Institutes of Mental Health notes that there are three different types of ADHD:

• Predominantly hyperactive-impulsive
• Predominantly inattentive
• Combined hyperactive-impulsive and inattentive

A girl who seems to daydream in class may not be as likely to be diagnosed as a boy who can't sit still and is disruptive, but both students may have ADHD and may need treatment and strategies to get the most out of what is going on in their classrooms.

Research is clear that ADHD has a real, brain-based cause and also has a genetic component. It is not caused by parenting styles or food allergies, although environmental toxins may be a factor in its occurrence. Co-morbidities, conditions that are often diagnosed in individuals with ADHD, include anxiety, depression, and learning disabilities. 

While diagnosis of ADHD is generally made by looking at the how many symptoms occur in various settings -- such as both at home and at school -- it is important to take a nuanced look at what is going in an individual before deciding on a diagnosis and before determining the appropriate treatment. For example, a student who is struggling to process what is going on in his classroom because of a language disability may appear to be inattentive, when the difficulty is actually a learning problem, not ADHD. Only by addressing the language processing difficulty will this student be able to attend properly in his classroom. 

What about treatment? This needs to be an individualized decision, especially for children. There are many medications that can be effective in helping with ADHD symptoms, and the National Institutes of Mental Health has a good explanation of what these are. But these medications can have side effects and parents may want to consider behavioral strategies before they decide whether medication is the best choice for their child. It is crucial that parents work with a physician with experience with these medications to make the right decision for their child.

Related articles from The Yellin Center Blog about ADHD

Mental Health Issues on College Campuses

 

An excellent program, held earlier this week at Fordham University School of Law (also sponsored by the New York State Bar Association), focused on legal and practical issues raised by college students with mental illness. 

These students include those who first show symptoms of emotional difficulties while dealing with the academic or social pressures of college, as well as a growing number of students with long-standing mental illness -- mild or more serious -- who are now enrolling in colleges across the country. The consensus among the program speakers was that the number of these students is growing because of such factors as more effective medication that can mitigate the impact of mental illness and the impact of the Americans with Disabilities Act and related statutes, which have required colleges to make reasonable accommodations for students with all kinds of disabilities.

There was a good deal of discussion during the program of the problems caused when college administrators and mental health counselors fail to take action or share information about students in crisis because they believe that doing so will violate federal law, specifically FERPA, the Family Educational Rights and Privacy Act. All of the speakers - who included attorneys, mental health professionals, and college administrators (and a number of individuals who serve in more than one of these roles) -- were clear that they would rather deal with a lawsuit claiming that they breached a student's confidentiality under FERPA than face one in the aftermath of a tragedy. "There is no FERPA police force," one attorney stated. In addition, as we have noted before in this blog, there are numerous exceptions to FERPA, including when disclosure of information is necessary to protect the health of the student or other individuals.

Parents and students need to keep in mind that despite news reports when violence or suicide occurs at a college, a college campus is actually a very safe place. As Victor Schwartz, M.D., a psychiatrist who is Dean of Students at Yeshiva University in New York noted, the level of violence on campuses is lower than that in the communities in which they are located, and the rate of suicide among college students is one half that of students in the same age group who are not enrolled in college.

Attorneys Deborah Scalise, Melinda Saran (Vice Dean at SUNY
 Buffalo Law School), and Carolyn Wolf discuss ethical issues

Most mental health issues that face college students do not reach the serious levels of possible violence or suicide. For high school students who have a history of depression, anxiety, or mood regulation issues it is important to investigate the resources available at any college you are considering. What mental health services do they have on campus? How and when are students referred to community mental health providers? Will you be able to have prescriptions for medication filled near campus? And all students and parents should be aware that college can be a stressful time for young people and should learn about the kinds services a prospective school offers to support the mental health of its students.

Test-Taking Tips From The Experts

Because of the nature of memory, we often tell students that the best way to study for a test is to take practice tests. Research indicates that rereading study material, the method preferred by most people, is less effective than taking practice tests for two reasons: First, our brains have difficulty distinguishing between material with which we are familiar and material which we truly understand. Students may stop studying too early because they recall seeing information before, only to realize during the test that they didn’t actually understand it. Second, answering practice questions gives the brain practice at retrieving information from long-term memory, the process a student undergoes during actual testing. Students who have the opportunity to rehearse “finding” answers are more prepared to do this quickly and easily on test day.

An article in The Wall Street Journal from earlier this week covers this principle and offers other testing tips derived from a number of studies on learning. For example, nearly everybody knows that eating a nutritious breakfast on test day is important, but a recent experiment demonstrated that consumption of a nutritious diet should start a week before the test date for optimum results. The article also discusses how to balance sleeping and studying, and offers tips to help combat test anxiety. 

Students gearing up for the first round of mid-terms can access the full article here.

Photo used under Creative Commons by Steven S.

Anxiety and Gender Issues in Math Education

A survey of studies looking at math anxiety and how it relates to math learning appeared in a recent issue of Education Week. The article built on information from the Learning and the Brain Conference held in Chicago in early May of this year where Sian L. Beilock, a professor of psychology from the University of Chicago, was a featured speaker. Dr. Beilock and her colleagues look at how emotions, such as anxiety, affect complex cognitive skills, such as solving mathematical problems.

Like so much of learning, math anxiety has several different aspects. One is the social acceptability of math difficulties, since many people will readily confess to "being terrible at math" but would not make the same kind of admission about another academic skill, such as reading. There are also gender issues, with female elementary school students being more likely to have difficulties with math if their female teachers have some anxiety about math themselves. This is particularly important because the vast majority of elementary school teachers are female; of note, this finding does not apply to male students.

Other findings noted in the Education Week article include documented changes in the prefrontal cortex of the brain (which controls active working memory, a key function for math calculations) when students are faced with even such minor anxiety provoking stimuli as a picture of a frowning face. Math anxiety can also diminish a student's number sense, a part of sequencing, making the anxious student less likely to be able to quickly determine which of two numbers is larger.

As groups such as the STEM Education Coalition work to raise awareness about "the critical role that STEM  education [science, technology, engineering, and mathematics] plays in enabling the U.S. to remain the economic and technological leader of the global marketplace of the 21st century," it is important to be aware of such barriers to math competence and enjoyment as anxiety and gender issues so that more students, boys and girls, can enjoy and succeed in math and related fields.