Monday, February 10, 2014

Heroin

Heroin is in the news again, and for good reason:  Increasingly, young people are moving from the more expensive (and difficult to obtain) prescription pain killers -- opiates like hydrocodone and oxycodone -- to less expensive and more readily available options.  Heroin -- an opioid called "horse," "smack," and other names on the street -- has also recently reached celebrity status, adding to its appeal:  the death of Philip Seymour Hoffman by heroin overdose led immediately to a flood of Ace of Spades branded heroin on the streets of New York City and elsewhere, alarming law enforcement and medical authorities.  Of course, heroin has long been associated with rock stars such as Dee Dee Ramone (Ramones), Paul Gray (Slipknot), Sid Vicious (Sex Pistols), making it attractive to kids who are fans of their music, or who want to emulate them. 


Heroin may be snorted, smoked, or injected subcutaneously (skin-popping), intramuscularly, or intravenously (mainlining).  The initial rush with use is followed by feelings of euphoria that are relatively short-lived.  Heroin dependence may be rapid and with increased use comes increased tolerance, leading the user to need more of the drug. The lethality of the drug -- which was first synthesized in 1874, and which in the past has had legitimate medical applications --  depends both upon its purity and means of use.  Heroin may be cut with other drugs such as fentanyl, enhancing or diminishing its effect. Deaths by overdose are typically caused by depressed respiration leading to anoxia (oxygen deprivation).  Use of needles carries its own risks including skin infections, hepatitis, and HIV/AIDS (the latter often due to sharing of needles, or "works").

Heroin use among children and adolescents appears to be increasing.  The New York Daily News (February 10, 2014) reports, for example,

National data from the Substance Abuse and Mental Health Services Administration shows that the number of teens dying from heroin abuse has skyrocketed. In 1999, 198 people between the ages of 15 and 24 died of a heroin overdose, compared to 510 deaths in 2009, the latest year data was taken.  More teens are seeking treatment for heroin abuse, too — the figure jumped from 4,414 to more than 21,000 (about 80 percent) between 1999 and 2009. Ninety percent of teen heroin addicts are white, according to the data.

Kids may be blind to the addictive nature of heroin or think heroin use is no big deal.  There is also evidence that parental neglect and domestic violence contribute to use.  Rejection of conventional values and anomie -- a term coined by sociologist Emile Durkheim which is analogous to social alienation -- have also been offered as explanations for heroin use.  Explanations for heroin abuse using the term "addictive personality" are fraught with difficulty, for no reliable individual characteristics have been identified.

After all is said and done:  Are we creating a nation of junkies?  Probably not, but it does seem that many youth are at increased risk for heroin dependence and the health risks associated with it.  Responsible adults need to be alert to signs that a kid has been using, and to take appropriate action if use is suspected.  Behaviors of concern (from Healing Addiction in Our Community) include:


Of course, we also need to fight for more and better treatment options for youth who use heroin and other substances.  Treatments are outlined by the National Institute on Drug Abuse (NIDA), but at the time of this writing are inadequate to meet anticipated needs. Drug Strategies, a nonprofit research agency, may prove to be a helpful resource.

Tuesday, January 21, 2014

The Common Core


The Common Core


Once again the effectiveness of the United States public educational system is being questioned, and government has answered the call by generating uniform goals for student learning and objective criteria to determine if those goals have been met.  The "common core" (Common Core State Standards Initiative) dominates discussion in education these days, and the matter has become quite divisive. On one side of the issue stand those who are concerned about the nation remaining economically competitive with other countries, and who believe our children are underachieving relative to their global peers, especially in math, science and technology. On the other side stand those -- like educational reformer Alfie Kohn -- who fear that if students are expected to learn essentially the same things, individuality will be sacrificed and instruction will become standardized and tedious.  Many teachers are concerned that their ability to run their own classrooms will be compromised and are worried they will be held accountable for student failures.

Parents are concerned there is too much testing involved in measuring instructional outcomes and too little actual teaching.  Conservatives resent the fact that the "big government" and the states have mandated common core standards, and feel that local control of education is being compromised.  More than a few believe that our educational system is working quite well and does not need "fixing."  Many people don't know what to think, or view the common core as just one other bandwagon careening through the educational system.

I believe that if fixing the public education system is the goal, then the common core misses the big picture, and will inevitably fall short of that mark.  

I also believe that if we are to truly interested in "fixing" education, we must first accomplish two goals.  

First, we must reduce the gulf between the "haves" and the "have-nots" in this country, reducing poverty and simultaneously, the gluttonous wealth that the invisible "one percent" have accumulated over recent years.  Too many children are not having their basic needs for nourishment and adequate shelter met, and as long as that is true learning will for them be a frill.

Second --  and perhaps even more importantly -- as a society we must somehow uphold the value of learning (and hence, of education) over the shallow and materialistic values that have stained the social fabric.  Children today place too much value on IPods, IPads, X-Boxes and the hottest fashions, and at the expense of educational pursuits such as reading and writing.  It strikes me that in far-flung places such as Pakistan and Iraq, children with a thirst for knowledge can and do learn . . . despite the fact that their schools lack basic things like blackboards, desks, and chairs, and that their teachers are not certified or even paid.  Those highly motivated students are the ones with whom our own children will compete as the 21st century evolves.

Most teachers think parents are doing too little to help their children succeed in school.  So, in the absence of change at the macro level, parents can do a few things to help their do well academically.  For one thing, they can limit television viewing of moronic shows and show children how books may open up new worlds to them.  They can insist that their children's time on the computer is spent learning about something -- anything -- rather than playing video games.  They can see to it that their children have a regular time for studying each afternoon or after dinner.  They can develop bedtime routines ensuring that their kids will get enough sleep.  They can attend school conferences and keep abreast of developments affecting education.

It is also important to that we recognize the importance of the arts, for the arts enrich our lives and support academic achievement in math, science, and technology.  We should acknowledge that art, dramatics, and music add tremendous value to our lives, and require our continuing support.  We should understand that while test outcomes are important, tests cannot measure everything -- particularly creative thinking -- and so are limited.  We cannot permit uniform goals and standards of any kind to stand as obstacles to innovation.

Finally, we must hire and retain only the very best teachers, and loosen the grip of teacher unions on tenure.  We must train teachers as professionals, and expect that with much higher pay they will act as such.  (For far too long, teaching as been viewed only as a "job" with good perks, and that must change.)  Finally, I believe the time has come to question the value of having school boards that are all-too-frequently stacked with self-serving members of the community.  Local representation is important, of course, but we also need oversight by educators who are truly invested in scholastic outcomes, rather than parents who regard the board as a place to grandstand and advance their petty agendas.

I hope you agree.

  

Friday, March 29, 2013

School Shooters

It has been a long time since I've added anything to this blog, but there have certainly been some horrendous acts of school violence that deserve close attention, chief among them the carnage inflicted on innocent children by Adam Lanza in Newtown, Connecticut.  A long time ago I taught in the Newtown schools -- specifically in the high school -- so the shootings had special meaning for me.  I remember Newtown as a quiet and peaceful town, but now it is irrevocably changed.

   
Before the shootings occurred I had been looking into research regarding school shooters, only to find that there is a paucity of information about them and what makes them tick.  Perhaps the only thing we can say with assurance is that they are male.  Otherwise, common characteristics frequently appear in lists that are frustratingly general in nature and questionable in their utility.   The Federal Bureau of Investigation (1999), for example, provides no fewer than 28 characteristics of a possible school shooter, enough to confuse almost anyone trying to determine if a student may be a real threat to others.  As PBS's Frontline puts it,

A review of the [available literature] shows loose consensus around a number of warning signs for potential youth/school violence: chronic feelings of isolation or rejection, frequent angry outbursts, social withdrawal or depression, fascination with or possession of weapons, alcohol or drug dependency, history of bullying behavior, and lack of interest in school or poor school performance. Then there are items common to several lists, but not to all, like cruelty to animals and gang affiliation. And then there are some items that appear only on one or another list -- "dresses sloppily," is a "geek or nerd"; "characteristically resorts to name calling, cursing, or abusive language" -- that seem to be only marginally useful as warning signs . . . .

The lack of understanding regarding school shooters seems due to the fact that information about shooters is collected after the shooter or shooters are dead and the victims have been buried.  Then, it is typically the press that investigates the shooters, their early lives and parenting, friendships or lack of same, all with an eye to selling papers or presenting a story on the evening news.  "Psychological autopsies" are conducted by well-meaning researchers and writers of various stripe.  The water gets muddier and muddier.

Perhaps the biggest obstacle to our understanding of school shooters like Lanza is that we have little or no basis to compare them psychologically with other students.   We need to conduct comparative, psychological studies of students over time to determine how -- and why -- some turn out to become violent while others do not.  It is only through such longitudinal research grounded in potent psychological variables that we may finally determine ways we can prevent shooters from killing.  Although it is true many shooters reveal their plans to others before they murder, such information may not be taken seriously or reported to people who will take appropriate precautions.

In Lanza's case there was little or no warning.  His mother was thoughtlessly stoking his violent fantasies by providing him with firearms and ignoring the fact that her son was increasingly withdrawing from society.  One wonders if Lanza had any relationship with his father, and how mother and son related to one another.  I suppose as time goes on we will know more, but in the end there will likely be more questions than answers.

Wednesday, February 29, 2012

Another School Shooting

Well, it has happened again. This time, a young man with significant family and academic problems who had arguably been bullied went to school with a .22 handgun and shot five kids at random. As I write this, three kids are dead. Parents and family members are devastated. The community in Ohio where the shootings took place is reeling. Many are questioning how the situation could have been prevented, or if. On the day of the shootings, one student claimed to have contacted a local news station in advance of the incident, presumably to foil it. I have heard nothing more of that over the past few days, so it is difficult to know if any warning was given.

I will be writing more about violence in school in the coming days, but it is clear to me that we ignore children's mental health needs at our peril. Community mental health services are helpful, to be sure, but we must identify students in need of help before they become violent and locate highly skilled service providers in school buildings. If we do not do that, we risk even more incidents like the one we have seen. We cannot afford to remain idle.

Saturday, July 16, 2011

Problems with Special Education


In recent years I had the dubious pleasure of serving as head honcho of special education for a rural school district. I say "dubious pleasure" because while I learned a great deal, and liked my colleagues, the job was impossibly stressful and frustrating. I left the position voluntarily after I concluded that at the governmental level, the special education system is ridiculously mired in red tape. The legal system has effectively trumped the educational system when it comes to program delivery. Actual instruction of students with disabilities is at the tip of an unnecessarily bureaucratic, legislatively-driven and expensive iceberg.

Not only that, but even after several decades, special education remains the bastard child of the educational system. The shuffling of kids with disabilities into the mainstream, then back into special classes and schools, then back into the mainstream again, seems less a function of their educational needs than it does a reflection of State budgets and backroom politics. Student placements are rationalized as "good for the child" depending whether the bucks are available.

I admit to being cynical about this matter; but, I do believe special education as we know it will collapse under it's own weight unless certain problems are addressed. Here are some of them:

Administrators & General Education Teachers
  • The majority of school administrators and general education teachers have little or no training in special education. Many administrators view special ed students as thorns in their side, detrimental to standardized test results and as "discipline problems." Many general educators -- and particularly secondary education teachers -- resent the fact that special education students are placed in their classes. That is because they have not been properly prepared for inclusion of special education students, and because increasingly, they are being held accountable for test-outcomes.
  • Students with disabilities should never have been thrust upon general education teachers who have not been adequately prepared to deal with them, or who do not want them. Such teachers may do more damage than good to a student with disabilities. Most general education teachers require extensive, additional training if they are to work effectively with students with disabilities. Even then, close administrative supervision is necessary.
Special Education Teachers
  • It is also true that -- through no fault of their own -- most special education teachers are insufficiently trained. Special educators are unrealistically expected to be "experts" in cognitive, affective, social and physical disabilities, as well as child development and instructional technique. Many feel overwhelmed by the needs of the student population. Special education teachers are often responsible for a high number of students with disabilities, each one of whom has his/her own Individual Education Program (IEP). For these reasons, many special education teachers leave the field after only a few years.
  • Students with disabilities often have significant mental health issues, but few special education teachers have sufficient understanding of the psychology of students with disabilities. Even though most states require teachers to hold a Master's degree, even that doesn't cut it. Special education teachers need advanced training in child psychology. Mental health professionals also need to be housed in schools so they may provide direct and indirect services to students with disabilities.
Delivery of Special Education Services
  • Some educational classifications (for example, Emotional Disturbance) are so broad as to be nearly meaningless. If special education teachers are to truly meet the needs of students with disabilities, student concerns must be given greater definition. Concerns for student mental health should be given equal footing with scholastic concerns. In addition to instructional needs, attention should be given the emotional and psychological needs of students with disabilities.
  • Since the Individualized Educational Program (IEP) determines the "curriculum" a classified child receives, and since each student has his/her own IEP, it is difficult for teachers to provide coherent, group classroom instruction. Differentiated instruction is difficult to deliver, given individual student needs and the limited preparation time provided to most teachers.
  • Although most students do receive the special education services listed on their IEPs, a significant minority of kids gets many more services than they need. Those who get more than they need usually have parents who are insisting upon certain services, thinking "more is better," and threatening districts with legal action.
  • Significant funds are expended by districts trying to ward off what are often frivolous lawsuits. Unscrupulous attorneys needlessly initiate legal action against districts, knowing the districts will not waste time and money fighting them.
  • Some "student advocates" are nobly committed to their work, and perform an important service for students with special needs. But, some work for attorneys and care more about a pay check than about kids' needs. A hard-core few have an ax to grind, and are out to "get" school districts or administrators. Parents may have a hard time telling the difference. There is a need for certification of student advocates to ensure they meet standards supporting quality instruction.
  • At base, special education is legally-driven, not educationally-driven. Special education law has been drafted by attorneys, not educators. IEPs are legal documents that often bear little relationship to classroom realities. The law changes constantly, and it is humanly impossible to keep up with it.
  • Many services rendered to classified kids have no empirical basis, but are provided because (a) they have historically been available, or (b) parents want them. "Hippotherapy" (horseback riding) is but one example of such a service. Behavioral optometry or "vision therapy" is another. And, many services that have only temporary impact are provided for the same reasons: Applied Behavior Analysis (ABA), for example.
  • Even "useful" services may be provided long past the time they are effective. For example, some kids receive occupational therapy (OT) or physical therapy (PT) while making negligible progress. Special education administrators may provide such services on a student's IEP simply to keep the legal wolves away from the door.
I think we need to take a long, hard look at special education and -- as a society -- at what comprises a "disability." Everyone involved in the education of students with disabilities needs more sophisticated training. We need to wrest control of special education from the grip of lawyers and return it to educators, where it belongs, in the meantime cutting red tape. Furthermore, we need to develop more (and better) instructional and vocational programs for kids who do not benefit from traditional, academic fare. Finally -- since child mental health concerns have reached crisis proportions -- we also need to integrate mental health into schools to a far greater degree.

* * *

Wednesday, September 1, 2010

On the Misdiagnosis of ADHD


I have been avoiding writing about Attention-Deficit Hyperactivity Disorder, but I suppose the time has come to talk about it. That is because one recent study conducted at Michigan State University, and published in the Journal of Health Economics, indicates that immaturity has been mistaken for ADHD in about one million children nationwide. The results imply that nearly one in five children has been incorrectly diagnosed, and many children have been treated with stimulant medication for a disorder they do not have.

The findings may be startling to some, but not to me. I have long thought ADHD is over-diagnosed, and am reluctant to diagnose ADHD until several other factors have been ruled out. Rule-outs for ADHD include depressive disorders, anxiety disorders, psychosis, myriad neurobiological disorders, certain sleep disorders, dietary factors, poor socialization, immaturity, and differences in temperament. Some parents -- usually those who are young, stressed out, or narcissistic -- seek a diagnosis of ADHD for their own convenience, and may exaggerate problems they have with their child. Most parents are surprised to discover that I am not going to render a diagnosis of ADHD without first having interviewed them, and before I have met with their child on several occasions.

I have not been happy with the authors of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM) (currently in its fourth manifestation), because over the years they have reduced diagnosis to a formulaic process, and DSM to a cook book, diminishing the importance of clinical judgment as they have done so. One of the reasons ADHD is over-identified, I believe, is because -- thanks to DSM -- anyone who can read can "diagnose" ADHD based upon observable behaviors, overlooking the fact that the same behaviors are common to the disorders enumerated above. A diagnosis of ADHD is easy to make if one simply looks at the criteria listed in DSM, but many times that diagnosis will simply be . . . wrong.

The diagnosis of ADHD is a subjective one even if done correctly, and that has also led to misdiagnosis. It is all too easy to see what one wants to see. Adults who are otherwise well-intentioned -- but have little patience for the hi-jinx of children -- are likely more prone to think a child has ADHD than those who are more accommodating. Although there are numerous checklists that purportedly compare the behavior of a child with that of his or her peers, they are also susceptible to bias on the part of a parent, teacher or professional. The phrase, "Perception is reality" has all too often held sway when it comes to diagnosis of ADHD.

Finally, and although it may make me unpopular with some practitioners, I should mention the fact that ADHD is big business. The Center for Disease Control and Prevention estimates that the social cost of ADHD ranges between 36 and 52 billion dollars per year. Some practitioners not only diagnose ADHD, but also run treatment groups and derive a significant portion of their income from children and youth so diagnosed.

Now, having made remarks about the misdiagnosis of ADHD, I can say that when properly diagnosed, medical and psychological treatment for those with the disorder can be life-changing. I have seen kids who were totally "off the wall" and failing in school make dramatic gains in behavior and scholastic achievement once they were treated, and know adults who have been able to improve their relationships and vocational situations when helped. There are times when ADHD should be the primary diagnosis for a given individual . . . but, probably not as many times as has been true in the past.

Tuesday, August 24, 2010

Bullies & Bullying, Part Two


Shortly after I finished writing the first part of Bullies & Bullying, a 15 year old girl named Phoebe Prince, originally from Ireland, and living in Northhampton, Massachusetts, hung herself. Her suicide followed incessant bullying inside and outside of school. Phoebe herself asked school personnel for help. Her parents also contacted school authorities on at least two occasions about their daughter's predicament. Little or nothing nothing was done about it.

A few weeks later, a second suicide took the life of an 11 year old boy who had been taunted by peers for supposedly being "gay." The child hung himself using an extension cord. Again, the school district was implicated for having done nothing, despite the fact the boy's mother had filed several complaints with the district for inaction.

Although the schools may not have legal responsibility for stopping bullying behavior, they certainly have the moral and ethical responsibility to do so. But, when they are unresponsive to student and parent pleas for intervention, or when bullying programs are clearly ineffectual, how is one to proceed? Although many do so, why should a child have to transfer from one school to another to avoid being a victim? Or, should a child continue to suffer at the hands of other students due to the failure of adults to provide a safe and secure environment at school?

I think not.

In my private practice, I have found that many children and youth strive to do what teachers and administrators tell them to do with respect to bullies. Most kids are told to simply ignore bullies: Good policy when it comes to verbal abuse, perhaps, but ignoring someone who is pushing you, or tripping you, or hitting you . . . that's damn tough! But, many kids do try to ignore physically aggressive peers, with the result that they get victimized again, and again, and again. The continuing victimization only feeds feelings of helplessness and hopelessness, the cornerstones of depression.

In the first part of Bullies & Bullying, I suggested that school personnel may do little or nothing to help kids who are being harassed and victimized by their peers, this despite the fact that many districts have zero tolerance policies and bullying programs to prevent student aggression. But, zero tolerance policies are of little utility, for they often target the student who is victimized as well as the student who is the bully. Children who fall prey to bullies may be unfairly disciplined for having done nothing!

As a psychologist there is little I can do to promote change in the many schools and school districts my young clients attend, but I have developed a somewhat controversial way of helping students cope with bullies and bullying. It consists of "going by the book," and if that fails, falling back on the "law of the jungle," a phrase I use that harks back to Evan Hunter's book, Blackboard Jungle, and the movie classic of the same name.

Playing it By the Book

When a child reports that he is being bullied by another child or children, and if it is a continuing problem --and assuming he has done nothing to provoke aggression -- I first recommend he (1) report it to his teacher. If the bullying continues, or the teacher fails to respond, or if after teacher intervention the bullying continues, the next step is to (2) report it to administration, typically the assistant principal. If the bullying still continues, or if the administrator fails to respond, the next step is to (3) involve parents if that has not already occurred. The parents should then request a conference with teacher(s), guidance counselor(s), and administrator(s) in attendance to see if the matter can finally be resolved.

Most of the time -- but not always -- involvement of parents puts school personnel on high alert, and the bully soon feels the heat and ceases his or her aggressive behavior. That is especially true if the parents are influential in the community or otherwise have pull. In some cases, however, school personnel continue to look the other way, or worse, find fault with the student who is being victimized. It also happens that things get better for the victimized child for a time, then fall back into their previous pattern.

The Law of the Jungle

If reporting bullying to teachers and administrators falls on deaf ears, and if parental involvement with school administration fails, and only in the case that no weapons are involved, the time has then come for the child who is being victimized by a bully (or bullies) to take the matter into his or her own hands. The Law of the Jungle comes into play. The child must stand up to the bully, and be ready to fight back.

Preparations are necessary.

First, the parents of the child must be informed that because no civilized remedy seems possible, a more aggressive approach to bullying -- "taking a stand" -- must be considered. Although the potential legal consequences for taking a stand are likely small, these should be discussed with parents. In my experience, most adults readily endorse a more aggressive approach. That is especially true of fathers when it comes to sons.

Second, the child and parents must accept the real possibility that the child may be injured in an altercation. Most children are pleased to have adult permission to take a stand, and many are fearless.

Third, the child must understand that if a fight occurs in school, he or she may receive disciplinary sanctions. This usually involves a brief suspension. Again, most are accepting of this, particularly when parents signal their acceptance.

Fourth, the child must be instructed to wait for provocation, then confront the bully verbally. Physical force should be used only if the child is threatened directly. (Some bullies will back down once a child confronts them verbally, but most will not).

Fifth, the child should be shown how to block and throw a punch, especially a jab. A jab has the greatest chance of landing successfully.

Finally -- and this is most important -- the child should be told that he or she need not win a fight in order to succeed in thwarting a bully. Most bullies are cowards, and will soon find another victim who will not fight back. Taking a stand is more important than being a fighter.

Now, I understand many psychologists and educators will find fault with what is clearly politically incorrect guidance on my part. The reality is that the Law of the Jungle often holds sway in schools and certainly in neighborhoods, however, and that is particularly true when adults have abdicated their responsibility to enforce sanctions.

I would welcome any feedback to what is a somewhat controversial position.

Tuesday, March 9, 2010

Bullies & Bullying, Part One

Many of the kids I see in my private practice are boys, and a healthy percentage of those are middle school students in grades six, seven and eight. More than a few of them are tormented by bullies, and do little or nothing to "invite" bullying. The kids I see are simply trying to keep their heads above water academically while negotiating the perils of puberty. Most are short in stature, or overweight, or both. Most are neither athletic nor troublemakers. Many -- but by no means all -- have poor self-esteem made worse by bullying. All of them are suffering.

The school districts they attend have zero tolerance rules in place, meaning that the administrators have developed unthinkingly even-handed-- and sometimes harsh -- ways of dealing with student fights and aggression. In literally all districts, unless the instigator of a fight can be identified, all students involved in a fight are given identical discipline, usually (but not always) in-school or out-of-school suspension (ISS or OSS). All students are advised to report aggressive peers to teachers or administrators before matters get out of hand or a fight erupts. This would be a sensible policy if it worked, but the kids I see say to a person that it does not work, and most have lost faith in the policy and the adults who are empowered to enforce it.

All of the boys who have been the victims of bullies tell me they have informed responsible adults they are being targeted, but that the adults so informed do little or nothing to prevent bullying from happening again. Only today, one boy told me he told the Assistant Principal in his school several times he was being pushed and hit by another student, and that the Assistant Principal spoke to the offending student, then let him go . . . to push and hit the targeted student yet again. Another boy told me that when he reported a bully, the administrator told him that he "must have done something" to provoke the other child. Yet another boy was effectively abandoned by his district with the recommendation he enroll in a private school, which he then did. Blaming the victim allows some school personnel use to avoid the problem of bullying altogether, presumably relying upon kids to determine the pecking order or reasoning "boys will be boys."

Now, it is certainly possible that the boys I have seen are lying to me, and that in fact, they are doing something to provoke the bullies involved . . . but I sincerely doubt that. It may also be true that in some respects the boys I see act or look like "victims," but even if so the abuse they suffer lacks justification. In my mind, to say that some kids deserve to be bullied -- because they look or act a certain way -- upholds a standard of brutality that we should not tolerate in our society, much less in our schools. It is roughly analogous to the warped belief that because a women dresses provocatively, or acts flirtatiously, she deserves to be sexually harassed or assaulted.

Please do not think me naive: Having been a teacher and a school administrator, I am well aware of the difficulties posed by monitoring student behavior. But, it is also true that many teachers and administrators ignore the problem of bullying, or assume bullying programs and character education will win the day. Adults must step up to the plate and intervene swiftly to stop bullies from acting aggressively. It is also true that application of zero tolerance rules misses the point, for the bully and the bullied are given similar discipline for dissimilar behaviors. Fairness goes out the window in the quest for equal treatment of students . . . more on that later!

Tuesday, June 23, 2009

Cutters & Cutting


A cutter is a person, usually an adolescent and most often a female, who cuts herself in what is typically a private ritual. Razor blades, knives, compass points, shards of glass, or any sharp implement may be used in a self-injurious, but rarely lethal, manner.

Cutters usually do not want to commit suicide. Many talk about cutting as providing relief from emotional "pressure" they feel. Most try to hide scabs and scars left by this self-injurious behavior, and some will go to great lengths to avoid detection. Many feel guilty about their behavior. Cutters may target any part of the body for self-injury, but arms, legs, and torso are perhaps most common. In some cases, cutting is accomplished as part of a ritual, and may be associated with a certain song, incantation, or object that has special meaning to the cutter. A few cutters openly seek attention, and may even post photographs online or elsewhere. Cutting has been associated with depressive disorders, post traumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, and Borderline Personality Disorder (BPD).

It is difficult for most people to understand why a child might want to cut herself, or how drawing of blood might relieve feelings of stress or pressure, but cutters do derive certain gratification from the behavior. Sadie, a 15 year old girl who has cut her thighs with an Exact-O knife for nearly a year, put it this way:

When my father yells at me, I just can't take it sometimes . . . . So I go up to my room, lock the door, turn on my IPod real loud, then get my gear from my closet, take down my pants and find a place I haven't cut. It's . . . somehow, it feels good to cut, not too deep . . . and it's important to get it all in a straight line, so I have parallel lines, maybe two inches . . . and I use tissues to blot the cuts or sometime just let them scab up . . . .
The website http://www.selfinjury.com/ has posted graphic representing different motivations youth have for engaging in cutting behavior. Some youth cut to relieve the great stress they feel in their home, school, or peer group environments. The behavior is triggered by a particularly stressful life event, and leads -- paradoxically -- to a feeling of relief. Other youth feel alienated, detached, or isolated, and engage in cutting to feel "real" or alive, in the way that a tired person might throw cold water on his face to wake up. In fact, some therapists persuade cutters to use ice cubes rather than sharp implements on their skin.


Successful treatment of cutting typically involves more than dealing with the specific behavior, however, for that does not resolve underlying problems. The successful therapist must help the youth who is cutting identify stressful life situations and to develop strategies for eliminating or reducing them. The reasons for a youth feeling alienated or detached from her environment must also be explored. The youth must be encouraged to access and express difficult emotions, many of which may cause her to relive painful experiences. In some cases, and especially when abusive situations are present, a youth must be removed from her dysfunctional home environment. Collaboration between therapist and youth -- a therapeutic alliance -- is essential.

Teachers and parents often suspect a youth is cutting, or see the evidence directly. Cutting should not be ignored, or regarded as a "stage," because it signals that a child is in trouble. Rather, the youth should be addressed privately, non-judgmentally, and calmly. The adult should communicate concern to the youth, and suggest that the youth seek treatment. Teachers may also want to tell parents in confidence if they suspect their son or daughter is cutting, and offer to find help through the guidance department, school psychologist, or social social worker.

Monday, July 28, 2008

Acting Out, Part Eleven: Gang Culture


The phenomenon of youth gangs is not new, of course, but the behavior of youth in gangs has become appreciably more violent over the years. Gone are the days of switchblades and zip guns. Weapons of choice now include Smith & Wesson .38 revolvers, machetes, and assault weapons, including AK-47's. Gangs such as the Crips, Bloods, Latin Kings, MS-13, and others are responsible for much violence, some of which has found its way out of urban centers and into suburban -- and even rural -- environments.

Especially in urban areas, schools have had to take steps to contain youth gangs. Although it is slightly dated, a report from the Office of Juvenile Justice and Deliquency Prevention (2000) draws a clear connection between the presence of gangs in schools and students' violent behavior, possession of deadly weapons, and involvement with drugs. Alarmingly, over one third of youth over age 12 describe the presence of at least one gang in their school.

Despite the obvious connection between gang culture and violence, gang membership remains the stuff of romance, though not in the way West Side Story portrayed the antagonism between the Sharks and the Jets. Today, gang culture is romanticized through popular music, particularly gangsta rap. Of course, the culture of gangs includes norms for dress, demeanor, and behavior that hold appeal for many youth. The appeal cuts across lines of race and sex, and to a great extent, socio-economic status. The clear association between gang culture and drugs means that youth who are attracted to gangs are also susceptible to drug abuse.

Although youth gangs pose clear danger to peers and adults in authority, only a small percentage of students are bonafide members of gangs, and it is probably the influence of gang culture that is of greatest concern. Gang culture attracts youth for reasons that reflect basic human needs, and so are readily understandable. These include:
  • A need to be wanted and accepted . . . to belong
  • Support, structure, and values
  • The desire to be acknowledged and respected; to have status
  • Excitement and "fun"
  • A need for power and influence
White and Mason (2006) state that gang culture provides youth with a social identity. They state:
Groups of young people band together for social, cultural and familial reasons. They also do so for protection. Youth group formation, which in some cases may include the evolution of the group into a gang, is thus often intertwined with violence or the threat of violence in the lives of young people. Over time, group identification becomes central to individual social identity, and the fate of the collective is inseparable from the security and social belonging of the individual.
It is easy for whites to blame the appeal of gangsta lifestyle on aspects of Black society, but truthfully, the appeal of gang life has little to do with color. Gangs -- and the youth who comprise them -- come in all colors. Kids attracted to the gangsta lifestyle are typically alienated from traditional institutions (including school), are depressed and unmotivated, and have parents who have failed to forge meaningful relationships with them. Some of the kids are significantly impaired in their capacity to form meaningful bonds with others (see Acting Out, Part Nine: Empty Kids), but most are simply followers looking for a home.

Only this afternoon I was talking with a 17 year old youth who has adopted the behavior, dress and mannerisms of gang culture. He told me he and his friends get together to write and record hip-hop lyrics. He told me that the songs he writes authentically depict his personal history, which includes paternal abandonment and a mother addicted to crack. He also told me one of his buddies cries when his music is sung or recorded. When that happens, he said, both he and his friends comfort the boy. Their group is a family, albeit a fragile one.

The way schools are set up now, the number of children and youth needing genuine, caring relationships far outstrips our capacity to deliver the goods: the financial resources and trained personnel just aren't there. And no, special education does not help: Sorry, but no services are provided kids who are socially maladjusted! Only a few lucky kids will find teachers and counselors who have time and energy to meet their needs for affection and adult guidance. If we are to avoid a future society like that in Kubrick's A Clockwork Orange,* change must come, and schools are the logical place to start.

Comprehensive approaches have been shown to be effective when cities or communities are faced with significant gang violence. Operation Ceasefire in its various manifestations has reduced homicides among youth. The Department of Health & Human Services in its evaluation of school-based programs notes that several are effective, including the PATHs Program and others.
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* Warning: This link takes you to an extremely graphic and troubling scene of home invasion by a youth gang set sometime in the future. As I write this, similar home invasions by youth, and particularly Asian youth, are happening with greater frequency.


Saturday, June 14, 2008

Acting Out, Part Ten: Needs & Attention



Attention

A ten year old boy is in the school cafeteria, stuffing down French fries as if he hasn’t eaten in a week. Ketchup dribbles down his chin and onto the table. “Ben, stop that!” chides the aide assigned to his table. Mrs. McGovern, Ben’s teacher, looks up from her lunch. “Oh, that’s typical . . . He’s just looking for attention.” The aide – thinking that he should ignore this behavior – turns away. Ben looks perplexed. He grabs four more fries and crams them in his mouth.

In a residential treatment facility across the state, a group of counselors is discussing Erikka, an adolescent girl. The previous night she took a paper clip to her arm until the blood came. In the morning she was taken to the hospital for a tetanus shot. “The nurse said she did it for attention,” one of the counselors reports. The other counselors nod knowingly.

Each day -- in schools, on playgrounds, in homes and in residential care – many behaviors that troubled children and youth show are described as attention-seeking. Oftentimes, labeling of behavior as attention-seeking serves as an “explanation” for the behavior. Books and articles discuss attention as if it is an end in itself. Sometimes it seems that nearly all social behavior may be regarded as attention-seeking!

Are people -- even children -- truly that simple? I think not.

The failure to understand the complexity of children’s behavior causes some adults to ignore what they perceive as youthful efforts to gain attention. Although certain literature indicates that ignoring inappropriate behavior is one of the best ways to deal with it (Alberto & Troutman, 1999; Madsen, Becker & Thomas, 1968; Sulzer-Azaroff & Mayer, 1991), this is an appropriate management technique only some of the time (Redl & Wineman, 1952). Many times, ignoring inappropriate behavior is counter-therapeutic, even dangerous. Ignoring behavior may cause it to increase in frequency, severity or duration. We need sophisticated ways of understanding the behavior of children if we are to intervene in a ways that are helpful and meaningful.

The Relationship of Human Needs to Behavior

Approaches to child behavior involving understanding of motivation are more useful than simplistic explanations invoking attention-seeking. Assuming children understand what is expected of their behavior, caregivers must also strive to help children and youth understand the forces that drive their maladaptive actions. It is only through development of such self-understanding that troubled children and youth may make real progress in school and other treatment settings. Helping children and youth understand the basic needs that drive behavior enables them to identify those needs and ultimately, to meet them appropriately. Of course, helping kids understand their behavior takes time and some psychological sophistication on the part of the adult.

Several writers have attributed human behavior to basic needs that are universal. Some time ago White (1959), for example, posited that human beings “naturally” strive to attain competence. Needs for achievement, influence, and social affiliation have also been held to underlie human behavior (Atkinson, 1981; McClelland, 1961). The Circle of Courage popularized by Brendtro, Brokenleg and VanBokern (1990) suggests common needs for belonging, mastery, independence and generosity. Maslow (1968) described five needs that are common to all people: (1) physiological, (2) safety and security, (3) love and belongingness, (4) self-esteem, (5) self-actualization. He furthermore linked deprivation of needs to maladaptive behaviors such as those characteristic of obsessive-compulsive disorder.

All of these perspectives hold that human needs are primary determinants of behavior. A hungry person seeks food. The frightened toddler seeks the security provided by a parent. The adolescent strives to belong to a clique, to achieve in school or in sports. The adult attempts to develop expertise, to make a contribution to society. A need once gratified generally loses its motivating force. If the need goes unmet, however, it may have an adverse affect upon behavior, and perhaps become a point of fixation for the individual.

When one takes the position that human needs drive behavior, the inappropriate actions of troubled children and youth described as attention-seeking may be re-conceptualized as need-seeking. This perspective has several advantages for children and their caregivers, for it supports an positive stance towards education and treatment. Chief among the advantages are the following:

  • Need-seeking implies that children and youth have been deprived of the basic material for building productive relationships. Attention-seeking implies that behavior is intentional, purposive, and possibly malicious.
  • Need-seeking invites empathy, for behavior is regarded as reflecting unmet biological, social, or individual predispositions. Attention-seeking invites neglect or punishment, for inappropriate behavior is seen as volitional.
  • Need-seeking suggest that human behavior is complex, and that if appropriate measures are taken it may be changed in a predictable manner. Attention-seeking implies that if behavior is simply ignored it will “go away.”

Drawing connections between specific child behaviors and the needs they reflect is challenging. The caregiver must take a sincere interest in the child, and establish and test hypotheses about his or her behavior through observation and experience. Assessment of behavior through techniques such as the conflict cycle or Life Space Crisis Intervention (LSCI; see Long, Wood & Fecser, 2001) may prove helpful. At least some knowledge of one or more theories of motivation (see above) is essential.

I believe it is because we have reduced many child behaviors to "attention-getting" that we see more children with significantly troubling behavior. When we really try to understand the motivations for maladaptive behavior we will see change for the better.


References

Alberto, P.A., & Troutman, A.C. (1999). Applied behavior analysis for teachers (5th ed.). New Jersey: Merrill.

Atkinson, J. W. (1981). Thematic apperceptive measurement of motivation in 1950 and 1980. In G. d'Ydewalle & W. Lens (Eds.), Cognition in human motivation and learning (pp.159-198).
Hillsdale, NJ: Erlbaum.

Brendtro, L. K., Brokenleg, M., & Van Bockern, S.
(1990). Reclaiming youth at risk: Our hope for the future. Bloomington, IN: National Education Service.
Long, N. J., Wood, M. M., & Fecser, F. A. (2001). Life space crisis intervention, 2nd ed.
Austin: Pro-Ed.

Madsen, C. H., Becker, W. C., & Thomas, D. R. (1968). Rules, praise, and ignoring: Elements of elementary classroom control. Journal of Applied behavior Analysis, 1, 139-150.


Maslow, A. H. (1968). Toward a Psychology of Being, D.
Princeton: Van Nostrand.

McClelland, D. (1961). The achieving society.
Princeton: Van Nostrand.

Redl, F., & Wineman, D. (1952). Controls from within: Techniques for the treatment of the aggressive child.
New York: Free Press.

Sulzer-Azaroff, B., & Mayer, G.R. (1991). Behavior analysis for lasting change. Fort Worth, TX: Harcourt Brace College Publishers.

White, R. (1959). Motivation reconsidered: The concept of competence. Psychological Review, 66, 297-333.

Thursday, May 22, 2008

Acting Out, Part Nine: Freddy



When I was in my early twenties I took a job teaching secondary students with learning, emotional and behavioral disorders. I was told mine would be a "new" classroom, and in fact it was: a tiny, converted storage room with no closet space, and with a minuscule window in one corner. It would take me until Christmas -- and after many promises -- to get a chalk board. The fact that the room had absolutely no sound proofing led me to dub it the "echo chamber," and explained why at the end of each day I had a headache. Imagine how it helped my students!

I didn't know it at the time, but my students were some of the most difficult kids in the high school. Most were with me all day, still others were assigned to my room when another teacher had prep periods or lunch. My supervisor was a school psychologist whose office was located in the administration building across town, and who never left her office except to eat, which apparently she did in quantity. The high school principal was a glad-hand who was all style, no substance. He was at his best hitting on young, female teachers.

Freddy was one of the tenth graders in my 6:1:1 class. A good-looking boy with wavy hair and glasses, for reasons initially unclear to me he was classified with emotional disturbance. He was also one of my stronger students academically, capable of doing work at the 5th or 6th grade level. I learned that his mother died when Freddy was quite young, and that his father was an alcoholic who was verbally (and probably physically) abusive of his only child. I felt sorry for this boy who was less than ten years younger than I.

All went fairly well during the first few weeks of school. Freddy and the other students performed according to expectations, complaining at most any work they were expected to complete, but doing it anyhow. The kids assigned to my classroom were soon reluctant to enter it, however, and would wait until the corridors cleared before doing so. They grumbled about being assigned to the "retard room." They also started calling themselves Sweathogs, after a popular television show, Welcome Back , Kotter. Having the romantic fantasy that I might also be a "Kotter," I attempted to persuade my students it was "okay" to be in a special education class. My idealism was met with skepticism. Freddy led the charge.

Freddy had friends who were not special education students, and as the school year progressed his unhappiness about being a sweathog became more and more obvious. He insulted his classmates with disabilities, nearly all of whom lacked the skills to counter his verbal abuse; he actively avoided coming to class, and when he did attend refused to complete his work and disrupted it. He was noncompliant with my reasonable requests probably half the time, and the other students were taking notice, and following suit. There was no possibility of segregating Freddy, for the room was too small. Lack of administrative support meant that sending him out of the room proved nothing. He always came bouncing back. I was on my own.

Remembering a minor work of classic fiction I had read, The Blackboard Jungle (1954), and studying the tenets of psychoeducation, I decided I would forge a relationship with Freddy. So, I found ways for him to gain prestige through "acceptable" channels, and used planned ignoring of Freddy's maladaptive classroom behavior when that was feasible. Those strategies would have worked in the majority of cases, I now believe; but what I didn't understand then -- and comprehended only years later -- is that Freddy's relationship with his father was so dysfunctional that he could not extend trust to me. His personality development had been severely compromised through poor parenting, and as classroom authority I was caught up in Freddy's negative transference reaction. The closer I tried to get to Freddy, the more he would push me away, and the nastier he became.

I soon became defensive, caught up in the conflict cycle Drs. Nick Long and Frank Fecser describe so well. At times I took the initiative to "out tough" Freddy. Other times, I tried to appease him. Basically . . . It wasn't pretty.

Winter break gave me brief respite from the anxiety I was now suffering, but when school came back into session things were worse than they had been before. Freddy and his father had come to blows on Christmas day, and Freddy had run away from home. He was living with friends, drinking, smoking marijuana and had some run-ins with police. I was beginning to understand just how troubled Freddy really was.

I had little control over Freddy in school. He became verbally abusive of me, calling me "Chrystal Balls," babbling nonsense, refusing to do his work and continuously challenging my authority. He seemed to have singled me out, and I felt utterly helpless dealing with him. The school administrators gave me little support and my two special education colleagues were living their own hell. My previous desire to develop a relationship with the boy gave way to despair. I prayed Freddy would be absent from school, and celebrated when he failed to report. I really wondered if I was cut out for special education, or for teaching. I tried not to bring my troubles home, but that proved increasingly difficult. I was really stressed out.

My involvement with Freddy did not end well. Towards the end of the school year he was transferred to an older -- and more experienced -- female teacher's class. His behavior stabilized in the new environment and I was left to ponder what I did "wrong." My ego had taken a severe beating, and scars remain.

I have thought about Freddy over the years and now think I was overly zealous in trying to "relate" to him. I believe that due to my age, he saw me as an equal but also -- given his troubled relationship with his father -- as an authority figure who was not to be trusted. I also think I assumed that because I wanted to develop a positive relationship with Freddy, he would want to do likewise. My naivete, or perhaps narcissism, got in the way. In some ways, I empowered Freddy, and he readily took advantage of that. Maybe I forgot that Richard Dadier's attempt to win over a troubled student in The Blackboard Jungle fell flat.

I learned early on that working with troubled and troubling kids is not easy. It is analogous to piloting a submarine through a minefield or perhaps, flying an airplane into the eye of a hurricane. You might survive a few false moves, but more than that and you are lost. Relationship remains critical, far more so than any prescribed procedure for behavior management, but relationship cannot be rushed. Support from colleagues is essential. An empathic stance combined with patient understanding that trust cannot be manufactured generally brings durable results.

It would be nice if teaching ED/BD kids was like Welcome Back, Kotter. Sometimes it is, but more often it is not.