Importance of school readiness (SR) for children’s mental health and later school success
What is school readiness?
Literacy and numeracy skills/academic skills, Behavior, Social-emotional, Self-regulation, Adaptive skills
How to know who is ready and when
Not age- arbitrary determiner because kids develop at different times
Behaviors/characteristics
Ability to follow routines, structure, follow rules, play with children, math skills with instruction, alphabet with instruction, identify shapes and colors, ability to dress independently, etc.
Why is school readiness important? Why should mental health providers care?
Harder as kids get older to make an impact
Children who develop competencies across domains of SR have more positive outcomes -> outcomes in community also
Children who do not develop these competences have higher levels of negative outcomes
More than 60% of FL fourth graders are not reading at grade level
28% of preschool children are at risk for emotional and behavioral problems
Early problem behaviors (externalizing) interfere with transition to grade school
attention is one of the strongest predictors of later academic achievement
Income, racial, and ethnic gaps in school readiness
What are the gaps? (income, ethnic, racial gaps)
income disparities
4/5 children from low-income homes are not proficient in reading by end of 3rd grade
Racial/Ethnic
Gaps in black, Hispanic, Native American children at low reading levels
Factors that may influence gaps
Income distribution, residential segregation, social policies like access to healthcare, preschool enrollment patterns
Some reduction of gaps in math scores, self-control, and approaches to learning- from large national study of over 20,000 children
Evidence-based strategies for promoting school readiness
What can we do?
Considerations for best practices
Pyramid of social-emotional competence in infants and young children – Response to Intervention (RTI) model
When should we start promoting children’s school readiness
Infancy, prenatal development
Social-emotional skills are developing from birth
Talk Read Sing- national campaign for parents with their babies
Importance of language nutrition for children’s early reading
CDC has free milestone checklist and resources
Talk to me baby/ Hablame bebe
Vroom
Parent Club- free parenting workshops
Early screening tools- developmental assessment
Early education
High quality early education programs- children are more likely to be successful
Need to have effective teachers to have successful classroom
How to better support early childhood teaching
Degrees, compensation, professional development activities
Implementation challenges- not ready and accessible for all schools’ settings
Hard to get parents through the door- not representative of racial and ethnic minority families
Summer Treatment Program for Pre-Kindergartners (STP-PreK)
Goals to help school-readiness across the board
Combo of preschool class and kindergarten class with academic activities and summer camp fun
Kids in groups of 12-15 children from ages 4-6
Highly trained staff- certified lead counselor and 4-5 undergraduates
4-8 weeks full day program- 360 hours of intervention (7 years of typical intervention)
Behavior Modification System- kids earning and losing points based on behavior and tracking behaviors over time- earn and lose rewards based on progress, social-emotional curriculum, academic activities including Lonigan program, recreational activities
Parent Training- parents are required to come – modified group PCIT model- parents come for 8 weeks and learn early skills and school-readiness techniques and support children social-emotional development and coaching in session of PCIT skills
Positive data- started with children head start preschools
Kids who received treatment with socio-emotional part did better so that is critical part
No difference between kids who get 8 weeks of program or 4 weeks of program
Big difference in kids who get program vs kids who just get school consultation during the year
FIU Summer Academy- same program but in Liberty City – funded by Children’s Trust
Reading Explorers- another program funded by Children’s Trust – program for rising kindergartners
Take Home messages
Important for mental health and children’s later school success
Important to reduce disparities in children’s school success
Best practices support early models and active participation by families and schools
Early high-quality education can be really effective
Early screening and intervention is key
Unique programs to address these gaps
New Directions in Understanding and Supporting Social Competence on the Autism Spectrum
Hobson quote- “the challenges of ASD stem from difficulties in action and reaction, necessary for the development of reciprocal, affectively charged interpersonal relationships with others” (1990)
Ex: When you see an old friend come off the airplane- that is a reciprocal, affectively charged interpersonal relationship
What is the mechanism of social competence?
What’s the mechanism of social competence
Ex: mechanism of headaches- we know the mechanism and can act on it with aspirin
Social skills mechanisms (have long been hypothesized but not as frequently tested)
Social knowledge
Training in social knowledge is the core of many social skills interventions for ASD
Training social rules should kelp kids with ASD
But little research has tested the question of do kids with ASD have social knowledge and does it matter
In research- doing poorly on the social knowledge measure shows low social knowledge and doing not poorly on social knowledge measure would make it seem like they have friends
These measures are not hard to administer but haven’t been until 10 years ago
Insight/self-awareness
Social motivation (this is the hot term right now in ASD)
Hard to measure
Not great ecological validity
Social information processing
Have trouble processing info in real time- have trouble with having the interaction in time even if have the skills to
Social creativity
Flexibility- coming up with novel solutions to social problems
Measurable
French psychologist has a measure for this
Social Skills Mechanisms & Findings
Social Skills Mechanisms and Findings
Social knowledge
Asked kids and teens with ASD and typically-developing how they would approach someone
Are those who do better more prosocial?
No independent relationship to outcomes (TOM, classroom, etc!
Knowing what to do does not appear to be enough for doing it
Kids with ASD were just as good at knowing the rules but wider variation within the ASD rules
Insight/Self-awareness
Asked kids about their own social abilities and asked their parents and teachers
Kittens think they’re lions
Kids report being average compared to their peers but teachers and parents are rating the kids at least a standard deviation lower than average
This difference correlates with
Less depression
Less hostile view of others and in social scenarios
Parents report less self-efficacy
How to explain this:
Positive illusory bias – tendency for kids with ADHD to overrate their own ability relative to how others rate them
Self-protective hypothesis- notion that many of these kids are aware of the difference between themselves and others so they inflate their ratings as a way to protect their sense of self
Clinical implications- correcting their misperceptions might have deleterious effects so better to focus on giving them other skills/strengths they do have and help to build confidence around that instead
Social motivation
Measured in studies looking at kids’ ability to persist in interacting with peers when things not going so well
Kids had less efficient neural emotion processing
Fewer ASD symptoms
Better parent and self-report social skills
Poorer on tasks identifying emotions in faces (less emotion recognition)
How to explain this
Kids who are active but odd- really motivated to tell you about something but not understanding your responses of sitting and nodding head while they’re spitting off info
More poor quality or low-level interaction
Kids with high social motivation and low social knowledge tend to do more poorly when trying to interact with peers- missing opportunity
Social information processing
Electrode system of research that he does and shows processing of facial information
This is uniquely different in kids with ASD and the facial processing is delayed
Better emotion recognition if faster processing
Social Creativity
Take-home
Social knowledge not as important as we thought
Awareness and motivation important but complicated
Interventions, Current Evidence & Conclusions
Interventions
Research- that interventions help some but not in schools but from self-report- kids report that they have benefit from interventions (but this may have to do with social knowledge effects and not social performance effects- knowing vs doing) and found effects entirely attributable to social knowledge
So are the interventions training knowledge or performance?
Strengths of teaching social knowledge- good for teaching social knowledge but limits of deficits in application
Strengths of performance based – targeting activities, social reinforcement, practice (inside-out approach)
Example- clapping at same time as someone else based on eye contact
First study in adolescent ASD to show maintenance effects
Replicated in independent sample
Good effects on social knowledge without directly teaching
RCTS:
Community-based RCT effects on kids making friends compared to a knowledge training program- both groups showed improvement in friendship
SDARI group at higher rate after a single session but knowledge training catches up
Key point: not advocating one thing is better than another- but there are differences in mechanisms and we need to attend to these differences to better target our interventions
Knowledge and performance training can help but differently
Conclusions
Know and performance represent distinct groups
Social creativity info processing may matter more
Social skills interventions are not all created equal
May better match kids to interventions based on better understanding of social mechanisms
Should We Give Psychoactive Medication to America’s Children or Teach Their Parents and Teachers Better Child Management Skills: A Decade of Research on Comparing, Combining, and Sequencing Interventions for Childhood ADHD
Presenter:William E. Pelham, Jr. Ph.D., Director of the Center for Children and Families; Distinguished University Professor, Florida International University
Most common diagnosis of children and most common referral for many things- health care professionals, kids with IEPs, child mental health facilities, etc
Diagnosis has been around since 60s with different names
ADHD Core Symptoms- same over 60 years
Inattention, Impulsivity, Hyperactivity
Most kids get diagnosed as having both I and H/I
Must meet symptom criteria, create impairment in daily life functioning, symptoms in two or more settings, etc.
Comorbidities with other disorders- learning, language, CD, ODD, etc.
Domains of functional impairment in children
Relationships with parents and adults, relationships with other kids- peers and siblings, academic achievement, behavioral functioning in school (may be related to comorbid learning difficulties not hyperactivity in school), family functioning at home, leisure activities
Role of functional impairment in treatment
Should be targeting peer relationships (teaching skills to the kids), parenting and family variables (teaching skills to parents), and academic achievement (teaching skills to teachers for classroom management)
Goal of treatment is to minimize impairment in daily life functioning and maximize adaptive functioning that will facilitate skill development (to what extent does medication do that?)
Why is it important to treat ADHD in childhood?
People think this is childhood disorder and kids outgrow it but not true- maybe not as hyperactive or fidgety but still have the core deficits over lifetime
Prognosis:
Many longitudinal studies of kids through their 20s
Kids can still have difficulties as they move throughout 20s and into 30s (lit hasn’t gone past 30s)
One study looking at financial independence at age 30 – whether or not financial independent of parents- and answer is no- 70% of the ADHD children at age 30 are living with parents or don’t have a job at age 30 (compared to control group of 10% of 30 year olds living with parents or without a job)
Giving medication and not teaching functional skills may be the reasons for this
Youth ADHD Treatment
What is effective treatment for ADHD kids in childhood?
Evidence-based short-term treatments
Behavioral modification
CNS Stimulant medication
Combined behavioral and stimulant
Most of recommendations are for combined approaches
Psychoactive medicine business is booming so there is more medication use than behavioral or combined
6-8% of kids in the US are taking medications for ADHD (1/5 of those taking 2+ medications)
Stimulants for ADHD are prescribed more often than antibiotics for elementary age kids
Skyrocketed increase in use of medication over last 20 years – in early 90s- kids with ADHD were treated with Ritalin- one pill lasted four hours—then other companies made new drugs that lasted longer: Adderall and Concerta
Guidelines on treatments and sequencing
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), the biggest ADHD organization, says simultaneous usage of medications and behavioral intervention therapy
American Academy of Child and Adolescent Psychiatry (AACAP) says medications first and then to not add behavioral until the 5th approach
American Academy of Pediatrics (AAP) is in the middle- says either/or or the combo preferably- this is the biggest influential guideline
Centers for Disease Control and Prevention (CDC) says behavioral treatment for young kids
Society of Developmental and Behavioral Pediatricians (SDBP) came out on Fr- first set of guidelines that says that psychosocial treatments are necessary and should be foundation of treatment for ADHD and then later says medication could be a supplement
Bill: "Behavioral Therapy" (BT) has lower risks (side effects) and equivalent efficacy so BT should routinely be the first line of ADHD treatment
One pill of Ritalin costs $8- aka $3,000/year- this could be a lot of psychosocial treatment
Components of effective comprehensive treatment
Parent training, school interventions, peer-focused interventions
Benefits of short-term behavioral treatments
Teaching skills to parents, teaching skills to teachers, teaching skills to kids with peers
Lots of evidence that these approaches work
Benefits of pharmacological treatments
Behave better in classroom and at home- this removed incentive of parents and teachers to do behavioral treatments
Limitation of pharmacological intervention
Medications rarely normalize their function
Acute, immediate effects that go away when medication wears off so very limited and have to continue to medicate the child with no residual benefit
Poor compliance in long-term use
High school kids do not want to take their medication – they don’t think they have any problems and they don’t like the side effects
Uniform lack of evidence for beneficial long-term effects
Single biggest problem with relying on medications for treatment
Reduction in growth and adult height if taken medications all childhood (MTA study)- on average children were an inch shorter than they would have been otherwise
Lack of information about long-term safety (e.g. later substance use)
His neurologist friend says we have no idea what effects these medications have on the brain and safety
Study on classroom rule violations- many more violations with placebo than kids with medication- showed that medication was helpful but only brought ADHD kids halfway between placebo kids and typically developing kids so shows that medications didn’t get that them close to typical kids
Big problem with compliance to medication
Research & Conclusions
Research in the last 20 years
Important to combine treatments
How you combine the treatments is very important (study from 2017 on sequencing of medications vs BT)
Kids who started with BT were better than if they started with medications (on classroom rule violations)- for second randomization- the groups that went from BT to BT still did the best and the worst group went from medications to BT
Parents who got medications first and then were assigned to BT next never went to parent training- so starting with medications messes up parents’ motivation to go to parent training
Take-home points
Sequence matters!- start with psycho-social approach with parents and teachers
Most widely used treatment of medication has negative effects and bad effects if given before other treatments
There are more teens in South Florida vaping than in the Nation
People are significantly more likely to keep using if they used as a teen
Teens are especially vulnerable to using nicotine later in life
Vaping associated with illness and death
September of last year but outdated because now so many more illnesses and death
Lung injury and deaths
Majority male, 15% < 18-year-olds and majority 35 years and older
Majority of lung illnesses reported for people using this for THC and current research suggests related to vitamin E acetate
What are e-cigarettes?
Electronic nicotine delivery systems; Variety of sizes
How do they work?
Power source and heating element and tank/cartridge
Device, e-liquid, nicotine concentrations
1 Juul pod= same amount of nicotine as 1 pack of cigarettes (20 cigarettes)
Are e-cigarettes less harmful than regular cigarettes?
Yes but only because regular cigarettes are SO harmful
Still has nicotine and is an addictive substance
Smoking regular and then transitioning to e-cigarettes?
Yes, it can be helpful but people don’t usually stop using regular cigarettes altogether so it does not fix the problem
Health Effects
Vaping increases risk of regular cigarette smoking
PG and VG are food grade products so we don’t know long-term effects but they are allowed to be inhaled
Unintended injuries
Defective batteries – could explode in face
Nicotine poisoning by accidental ingestion- pediatric exposure can be lethal at high levels of nicotine concentration from kid drinking e-liquid bottle but these are currently outlawed
Second-hand and third-hard exposure
Non-users exposed
Third-hand: residue remaining on surfaces absorbed from skin (like oil on phone from hands when smoking with phone)
Dr. Matthew Sutherland: Cognitive Neurological Proof
Brain development and nicotine
The prefrontal cortex (PFC) (impulse control and decision-making) and striatum (motivation, reward) are different for teens and adults
Brain regions develop at different rates and into mid-20s
PFC develops more slowly than other parts and continues to develop into mid-20s and then reaches full maturation and levels off
Striatum develops more quickly and reaches full maturation and levels off
These 2 brain systems-> risky decisions
Teens make more risky decisions when they’re with their peers
Example: study with driving simulation where participant decides whether to stop at yellow light or run light or wait until green light and this was done alone and then with peers and with peers, adolescents made way more risky decisions
Teen brain and behavior sensitive to social pressures
Vaping behavior of family and friends lead to higher risk of e-cigarette use
Teen brains are sensitive to nicotine’s addictive effects
Addiction can happen quickly
We need to define addiction
Can define as report addictive symptoms within one to two days of smoking first cigarettes
Addiction can happen at low levels of nicotine use – i.e withdrawal symptoms before even smoking two cigarettes a day
Nicotine changes the brain -can impact working memory, attention, and increase depression/anxiety
Nicotine releases large amounts of the neurotransmitter dopamine in the brain
Dopamine- big role of reinforcement (reward and motivation) in the striatum and working memory and self-control in the PFC
The brain responds after being exposed to nicotine by reducing dopamine
As the brain changes, the person “needs” nicotine to keep brain functioning stable and avoid withdrawal
Lead to changes in reward processing- i.e. Hitting winning shot doesn’t feel as good
High stats of teens vaping
Important risk factors- older age, male, White (including Hispanic), lower grades
Risk perception- e-cigarettes are lowest perceived risk of all drugs, including alcohol
They go into school and educate- 37 community outreach educational events – school personnel, parents, students
Dr. Elisa Trucco's Breakout
Engaging Teens in Conversations about VapingConsiderations when talking to teens about vaping
Have facts ready to answer questions- even if you don’t feel comfortable or know all of the facts
Don’t do scare tactics- makes them want to try it
Avoid criticism
Encourage open dialogue
Suggest that teens talk to trusted adults (e.g. soccer coach they are close with)
Active listening
Consider whether teens are experimenting or using heavily (and may want to stop)
Regular user: consider how much of a problem vaping poses for them and whether they can and how that change can impact them
Experimenting: consider reasons leading to experimentation or plans for starting use and factors that will likely increase risk (use among fam/friends, etc.)
Start with consider a behavior you want to change (VERY Motivational Interviewing (MI) RELATED)
Then tell them if they did that behavior at work, they’d be fired, and the person will be very fearful and stressed
Change process- generally we are in a state of ambivalence (desire, self-efficacy, urgency, commitment)
5 basic principles for changing behavior
1. Expressing empathy
Supportive companion and knowledgeable component (not using scare tactics)
2. Develop discrepancy
Highlight where they want to change
3. Avoid argumentation
This can evoke resistance and defensiveness
4. Roll with resistance
Solutions are usually evoked by the client so you can guide them to that point
5. Supporting self-efficacy
Believe that you can perform the behavior- people who don’t feel like they have the self-efficacy don’t want to engage in that behavior
So show them the things that they are doing that shows self-efficacy (by just being here you are promoting your recovery)
Build motivation for change
Elicit self-motivational statements
Ask why they like it and what’s the other side and what the worries are about vaping
Affirming the client
Tell client you respect them for coming to meet with you and that they are working towards stopping using
Change talk and sustain talk
Ambivalent teens often change between the two
Change-> mowing towards changing the behavior
Sustain-> status quo
Goals is for your teen to increase change and decrease sustain talk
Types of change talk- DARN CATS and how to increase change talk- OARS
Showed two videos-
one of ineffective athletic director and player- she was very dismissive and didn’t use any change talk or try to elicit any change talk from him
other with effective athletic director and player – she waited for awhile to let him speak and then reflected and summarized what he was saying then role play with teen and therapist
ACE project – Antecedents and Consequences of Electronic Nicotine Delivery Systems
Dr. Matthew Sutherland's Breakout
Group presentations for students with Miami-Dade County Public Schools (MDCPS)
learned about the need in community for vaping-related programming – educational and interventional components
started from workshop with Trust Counselors – now do many different events and use discussion-based things like Kahoots questions and then discussion and interactive games to highlight misconceptions
Many resources available on e-cigarettes (e.g. NIDA for teens, CDC, educational programs)
Outline of his talk to different audiences
Games- can game, aerosol game, cliffhanger game
An Introduction to Sociodramatic Affective-Relational Intervention (SDARI)
Presenter:William E. Pelham, Jr. Ph.D., Director of the Center for Children and Families; Distinguished University Professor, Florida International University
