Frank Porter Graham Child Development Institute The University of North Carolina at Chapel Hill earlydevelopments Winter 2015 | Vol. 16, No. 1

Healthwinter 2015 | early developments 1 the health issue

Introduction rom dieting to immunology to mindfulness, in this issue of Early Developments we tell the stories F behind some of FPG’s groundbreaking research and outreach on physical, social, emotional, and mental health. Because health is tied closely to child development and later outcomes, FPG’s research and service on multiple fronts continue to enhance the lives of children and families in many ways—in some cases, still bringing health benefits decades later.

Our Health issue is the latest edition of Early Developments to address a major area of emphasis at FPG. In 2010, FPG developed a comprehensive five-year Strategic Plan to guide our projects and collaborations. Since then, we have dedicated issues of Early Developments to our major areas of emphasis from the Strategic Plan:

Developmental Disabilities (as the Autism issue) http://fpg.unc.edu/resources/early-developments-vol-13-no-1

Public Policy & Evaluation http://fpg.unc.edu/resources/early-developments-vol-14-no-1

Professional Development, Technical Assistance, and Implementation Science http://fpg.unc.edu/resources/early-developments-vol-14-no-2

International Initiative http://fpg.unc.edu/resources/early-developments-vol-15-no-1

And later this year FPG will publish a special issue dedicated to Diversity.

To access more issues, please visit our archive of Early Developments: http://fpg.unc.edu/resources/early-developments-archive 10,000 copies of Early Developments were printed at a cost of $xxxx or $.xx each.

2 early developments | winter 2015 FPG. Advancing knowledge. Enhancing lives. early developments Buildingcontents Bridges shows teachers, children and families how literacy resolves conflict and other social-emotional issue-New Resources 21 Winter 2015 | Vol. 16, No. 1

ISSN 1536-4739

Editors 2 Introduction Pam Winton and Dave Shaw From dieting to immunology to mindfulness, in this issue of Writer Early Developments we tell the stories behind some of FPG’s Dave Shaw groundbreaking research and service on physical, social, emotional, and mental health. Designer and Layout Editor Maxine Mills

Co-editors 4 Physical Health: Stephanie Ridley, Jay Diet, Exercise, and More Hargrove, and Emily Simmons FPG joins the war on childhood obesity and provides consultation for new health projects—and the most famous study on early education Photographers and care reveals significant health benefits 30 years later. Don Trull and Zach Pope

9 Social Health: Children and Youth with Autism Spectrum Disorder Never before has FPG directed such a comprehensive array of www.fpg.unc.edu initiatives to help children and young adults with autism spectrum disorder. UNC’s Frank Porter Graham Child Development Institute publishes Early Developments. FPG is one of the nation’s oldest multidisciplinary 14 Mental and Emotional Health centers devoted to the study of children and families. Our mission As the practice of medicine evolves to accommodate many interrelated is to cultivate and share knowledge components of health, FPG continues to look at how mental and that enhances child development emotional health are nested within a constellation of factors that and family well-being. influence outcomes. To subscribe or to change your address contact Jay Hargrove CB #8185, UNC-CH 21 News Chapel Hill, NC 27599-8185 FPG experts serve on the North Carolina Early Childhood Advisory [email protected] Council, and last year the 20th National Health Equity Research Webcast aired for thousands of viewers nationwide. Periodicals postage paid at Chapel Hill, NC

10,000 copies of Early Developments were printed at a cost of $xxxx or $.xx each.

winter 2015 | early developments 3 his past year, FPG’s research and service have addressed many aspects of the physical health of children and their families. Below are stories and snapshots of FPG’s latest research, resources, and projects on physical health. As First Lady Michelle Obama’s Let’s Move! initiative aims to solve the problem of obesity within a generation, our first story shows how FPG stands Tamong those at the forefront of this battle. Our second story reveals how the most famous study on early education and care is leading scientists to ask a new question: is it possible that high-quality early care in and of itself can bring a lifetime of physical health benefits? FPG scientists also have conducted studies and supported projects on lowering children’s Body Mass Index and understanding the relationships between childhood stressors and immune outcomes, as well as providing consultation for important new health programs.

Physical Health Diet, Exercise, and More

4 early developments | winter 2015 Overcoming outside and play, and even at recess, “When teachers directed the activities, preschoolers actually are fairly inactive.” activity levels increased in all six Childhood Obesity “Clearly, it’s important to get children classrooms,” she said. “And moderate PG investigator Allison De Marco up and keep them moving,” said to vigorous activity increased in five of often plays a crucial role in FPG director Samuel L. Odom. He six.” F projects designed to help children and his colleagues wanted to create a Whether through “Tip Toe Through exercise. De Marco helped develop an program that would include children Puddles” or “Lily Pad Walk,” she added, innovative physical activities guide, for even younger than the 3 to 5-year-olds results show why child care teachers instance, to help North Carolina fight that other physical activity programs must take the lead to promote high childhood obesity, and new research previously tried to target. levels of physical activities for their

has shown that when teachers direct “Child care programs can be excellent children. these physical activities, young children avenues for increasing children’s “It was fun to see how creative they Diet, Exercise, and More become more active and less sedentary. physical activity,” Odom said. “We could be when working from our “In the past twenty years, childhood designed our guide especially for instructions, adapting and enhancing obesity rates have skyrocketed,” said De children birth to age 5 in these settings.” the activities for their own kids,” she Marco. “And for the first time in over a De Marco, FPG investigator Susan A. said. “Teachers are more comfortable century, children’s life expectancies are Zeisel, and Odom—with support from providing activities they know are safe declining because of increased numbers the Blue Cross Blue Shield of North and developmentally appropriate.” of overweight kids.” Carolina Foundation—developed a guide Be Active Kids is making the physical De Marco said these statistics are for the foundation’s Be Active Kids activity guide available at no cost especially alarming because research program. The guide contains dozens to child care teachers around North has long shown that being overweight of age-appropriate activities, such Carolina and beyond, offering sample during childhood is associated with as catching bubbles and pretending activities online (http://beactivekids.org/ health issues later in life. Obesity, to be storks, complete with teacher pdf/BAKSample.pdf). coupled with a lack of physical activity, instructions. In addition, teachers can “Teachers want to promote healthier can lead to coronary heart disease, incorporate other aspects of learning child outcomes,” De Marco said. “Our hypertension, Type II diabetes, and into the activities. work with Be Active Kids shows just other chronic diseases. After training lead child care how important teachers are to that “About one-third of overweight teachers and their assistants, the FPG process.” preschoolers and one-half of overweight team provided materials—including While the news about the Be Active school-age children remain overweight balls, chalk, scarves, beanbags, and Kids program was promising in North as adults,” she explained. hula hoops—and asked teachers to Carolina, far from the program De She also noted that studies have incorporate activities like “Jump for the Marco’s research was revealing a shown how physical activities can Sky” and “Inchworm Wiggle” into their different story in kindergartens in reduce the chances of developing lesson plans. De Marco, Zeisel, and China. Collaborating with Bi Ying Hu, obesity and chronic diseases, while Odom then conducted a study of the Kejian Li, and Yuewen Chen on a study positively influencing other areas of program’s effectiveness in both indoor published last year in the International development. Childhood physical and outdoor environments for children Journal of Early Childhood, De Marco activity is related to better health, from six NC classrooms. looked at 174 classrooms from 91 higher test scores, and fewer behavioral De Marco said the Be Active Kids kindergartens in the Zhejiang Province. problems. guide works to increase activity and According to the study, children had “But preschoolers engage in mostly to decrease sedentary behaviors, and “inadequate opportunity for outdoor sedentary activities,” said De Marco. results are most striking when teachers play, including free play, as well as low “Surprisingly, children don’t just run head the activities. level of physical activity.”

winter 2015 | early developments 5 The research team also determined that the quality of outdoor play differed significantly across locations in urban and non-urban areas. For practitioners, they recommended increasing opportunities to use “a wide range of outdoor activities and to improve teachers’ professional competencies in organizing quality outdoor activities for children.” For policymakers in Zhejiang Province, they emphasized supporting the quality of outdoor environments so that children’s play could enhance early childhood development and learning. Currently, De Marco heads FPG’s project to evaluate Shape NC, an initiative that assists communities and child care programs across North Carolina in promoting healthy eating and physical activity among the state’s youngest children. By analyzing secondary data and conducting new interviews, focus groups, and web- based surveys, her team will determine Shape NC’s effectiveness.

High-Quality Early Education—and Its Health Benefits 30 Years Later hile FPG continues to conduct Project from birth until age 5 were through the project were healthier research and outreach designed enjoying better physical health in their now—significant measures also indicated W to directly enhance the physical mid-30s than peers who did not attend that better health is ahead for them. well-being of children and their families, the childcare-based program. “To our knowledge, this is the first last year a groundbreaking study The findings appeared in Science and time that actual biomarkers, as opposed of FPG’s most famous project also were the result of FPG’s collaboration to self-reports of illnesses, have been determined that experiencing a high- with scientists from the University compared for adult individuals who quality early care and education setting College London and the University of took part in a randomized study of early in and of itself can bring health benefits Chicago, where Nobel laureate James J. childhood education,” said Frances that last for decades. Heckman spearheaded an intricate Campbell, FPG senior scientist and With substantial implications for statistical analysis of data from the principal investigator of the Abecedarian health care and prevention policy, FPG Abecedarian Project. Not only did FPG Project’s follow-up studies. scientists found that children who and Heckman’s team determine that “This study breaks new ground in received high-quality early care and people who had received high-quality demonstrating the emergence of the education in FPG’s seminal Abecedarian early care and education in the 1970s relationship between education and

6 early developments | winter 2015 Frances Campbell, FPG senior scientist and principal investigator of the Abecedarian Project

both obesity and hypertension, and none exhibited the cluster of conditions known as “metabolic syndrome,” which is associated with greater risk of heart disease, stroke, and diabetes. From the start, the Abecedarian Project represented a revolutionary approach to early childhood education by providing care from early infancy and exposing children to a high- quality center for five years, instead of the shorter durations typical of other programs. Children in the treated group benefited from stable early childhood environments, which included on-site health care and nutritious meals. They also attended full days, five days a week, year round, and they learned under the health,” added Craig Ramey, the original principal “Abecedarian Approach,” an innovative curriculum investigator on the project, who now serves as that began in infancy. a professor of pediatrics and a distinguished “It is of particular significance that an early research scholar at Virginia Tech. “It broadens our educational intervention produced long-term understanding of the power of high-quality early health effects,” said FPG senior scientist emeritus experience to change lives for the better.” Joseph Sparling, who co-created the Abecedarian The study determined that people who received Approach. Sparling noted the importance of early care with the Abecedarian Project had the curriculum’s educational content and five- lower rates of pre-hypertension in their mid-30s year duration, which he and colleagues are now than those in the control group. They also had adapting and applying in Canada, Mexico, China, a significantly lower risk of experiencing total and Australia. coronary heart disease (CHD)—defined as both “Good health is the bedrock upon which other stable and unstable angina, myocardial infarction, lifetime accomplishments rest, and without it, or CHD death—within the next 10 years. other gains are compromised,” Campbell said. Compared to the control group, males treated in “Investing in early childhood programs has been the Abecedarian Project had lower incidences of shown to pay off in ways we did not anticipate hypertension in their mid-30s. In addition, treated forty years ago when the Abecedarian study was men less frequently exhibited combinations of founded.” s

winter 2015 | early developments 7 In Brief More on Physical Health

These snapshots provide a quick look at more S tress Exposure and Immune Outcomes of FPG’s research, resources, and outreach on in Children Physical Health. FPG fellow Lynne Vernon-Feagans heads a new project that will examine the associations How to Lower Children’s Body Mass Index between and among economic adversity, FPG’s Pan Yi (statistician), Nina E. Forestieri parent-child interactions and relationships, (researcher), and Jonathan B. Kotch (fellow) and children’s immunological functioning in collaborated with scientists from several middle childhood. The project will use existing universities on a study that revealed the data from the Family Life Project, as well as effectiveness of the Nutrition and Physical new data, from families living in poor, rural Activity Self Assessment for Child Care communities. intervention. Nurse childcare health http://fpg.unc.edu/projects/stress-exposure-and- consultants delivered the intervention, and the immune-outcomes-children researchers concluded it increased provider knowledge, improved center policies, and Evaluating Smart Start’s Child Care lowered BMI for enrollees in child care centers. Health Consultant Project http://fpg.unc.edu/resources/nutrition-and-physical- activity-randomized-control-trial-child-care-centers- Smart Start’s Race to the Top–Early Learning improves-knowl Challenge Child Care Health Consultant Project utilizes health professionals to Flame Retardants in Breast Milk? provide consultation through site visits and by telephone, promoting healthy and safe A new study from FPG senior scientist environments in child care settings in North Barbara Goldman and a team of researchers Carolina. The project is designed to increase says yes: some flame retardants do appear in the percentage of children with high needs breast milk and may affect young children. who participate in ongoing health care as Polybrominated diphenyl ethers are in the part of a schedule of well child health visits, environment, household dust, and humans— as well as to increase the percentage who are and are known for their detrimental effects on up-to-date in a schedule of well-child care and neurodevelopment in animals. developmental screenings. http://fpg.unc.edu/resources/brominated-flame- http://fpg.unc.edu/projects/evaluation-smart-starts- retardants-breast-milk-and-behavioural-and-cognitive- race-top-early-learning-challenge-child-care-health- development-36-month consultant-proj

R esources Housed at FPG’s Early Childhood Technical Assistance Center The ECTA Center posts resources and links to a vast array of materials on numerous subjects, including a new report that summarizes research on what children need for a healthy start, as well as the positive effects of nurturing relationships, safe and secure environments, access to nutrition, health- promoting behaviors, and enriching early learning experiences. The report also provides policy and practice recommendations for supporting children’s lifelong health. http://ectacenter.org/topics/effective/effective.asp

8 early developments | winter 2015 SOCIAL Health

rye Children and Youth F

y of Jeff with Autism s

Courte Spectrum Disorder ever before has FPG directed such a comprehensive “We developed our approach from research in several array of initiatives to help improve the social fields,” said Odom, CSESA’s principal investigator. “Because health of children and young adults with autism of the complex educational needs of many students with ASD, spectrum disorder (ASD). Toddlers to high school it was important to develop a comprehensive program for students are benefiting from research, programs, high schools.” andN resources that support their families, providers and In several high schools, CSESA focuses on understanding educators, school administrators, and policymakers. emotions, developing friendships, and social problem-solving. What follows here are two stories and many short glimpses Early results at a high school in the Raleigh-Durham, North of FPG’s commitment to meeting the needs and supporting Carolina, area show that student groups designed to bring the strengths of children and youth with ASD. together adolescents with and without ASD have helped them engage with one another more often. Hope After High School “Even a simple hallway ‘hello’ between students with autism and their peers is more likely now,” said Kara Hume, n innovative program from FPG and six partner CSESA’s project director and co-principal investigator. universities is preparing students with autism for life CSESA also addresses literacy skills, which can be limited in A after high school. many students with ASD. At Myers Park High School (MPHS) “Public high schools may be one of the last best hopes for in Charlotte, N.C., the program helped with Christopher adolescents with autism—and for their families,” said FPG Stickell’s inclusion in an English class. director Samuel L. Odom. “Many of these students will face “Not only did my son have access to a wider world than unemployment and few social ties after school ends.” his self-contained classroom, but the students in the English While teachers and other professionals in the schools work class had some of their pre-conceived notions about autism hard to achieve beneficial results for students with ASD, shattered,” said Lois Stickell. “Many were surprised when positive outcomes remain elusive, given the scarcity of spe- Chris read aloud a passage from Julius Caesar.” cific programs for these students available in high schools. “We help develop basic high school survival skills,” Hume To fill this gap, Odom and other scientists formed the Center said, adding that another cornerstone of the program is its on Secondary Education for Students with Autism Spectrum emphasis on promoting responsibility, independence, and Disorder (CSESA). self-management.

winter 2015 | early developments 9 According to Odom, projects that they will be administering the many teens with ASD program on their own within 2 ½ years. continue to live with their “CSESA will expand to 60 more schools over parents after high school. the next 3 years,” he added. “We hope a lot more “Not surprisingly, parents students with autism spectrum disorder will be worry about the future as able to leave high school better prepared for the they anticipate their child’s challenges they’ll face.” transition out of the public schools,” he said. Visit: http://csesa.fpg.unc.edu/

Kara Hume and “CSESA has provided opportunities for greater “Tried and True” Strategies Samuel L. Odom collaboration and relationship building with for Children with Autism the families who have attended ‘Transitioning Together’ sessions,” said Phyllis Alston, an ast year, the National Professional exceptional children teacher at MPHS. Each week, Development Center on Autism Spectrum CSESA staff and school district personnel lead L Disorders released its much-anticipated these discussion groups with families. update on evidence-based practices for “We became aware of resources available that children and youth with autism. FPG scientists without CSESA we may not have been made aware spearheaded the project, screening 29,000 articles of,” said Faith Hamilton, whose teenager will be about ASD to locate the soundest research on attending Central Piedmont Community College interventions for children from birth to age 22. in the fall to study photography. “My son gained “More children than ever are being diagnosed confidence and his grades improved this year.” with autism,” said FPG director Samuel L. Odom, According to Odom, built into the CSESA who co-headed the new review. “We’re catching program’s design are features that help to install it them earlier, with better tools, and these children quickly and successfully, such as “autism teams,” need the right services.” which spearhead efforts within the schools. The “Some interventions may seem cutting-edge, program also uses coaching to provide feedback on but we don’t yet know if they have any drawbacks new practices as teachers implement them. or trade-offs,” said FPG investigator Connie Wong, Although most complex programs may take who co-headed the new review of research. “Our 5 to 7 years to put into place, Odom said schools report only includes what’s tried and true.” in North Carolina and five other states began Kristine Ganley and Karen Berlin, training and using CSESA’s approach within weeks, and he technical assistance providers at George Mason

10 early developments | winter 2015 Samuel L. Odom speaks internationally on evidence-based practices for children with ASD

University, heavily rely on the NPDC’s in its 2008 review. After considering reports on evidence-based practices to more studies this time, scientists also help people seeking professional devel- renamed and broadened one category, opment. “We don’t provide training on “technology-aided instruction,” and practices not included on it,” said Berlin. added five more, including “exercise” According to Ganley and Berlin, before and “structured play groups.” have helped her to advocate for her the NPDC published its comprehensive “Expanding the list offers more tools sons’ services. reviews of research, interventions for to educators and service providers,” “Knowledge is power,” Smith said. children with autism were much more said Ganley. “This improves outcomes “Knowing what works has given us the controversial. “Internet searches for children with ASD.” upper hand in acquiring appropriate returned as many different approaches Not only does the NPDC’s report therapy and tools.” as authors behind them, and mastery provide guidance for professionals, it According to Smith, video modeling, of any practice was rare,” said Ganley. also is an essential tool for families. a longtime evidence-based practice “If there was no reliable report on “Parents often pay for interventions that from the NPDC’s list, helped her boys evidence-based practices, intervention have no evidence behind them, but this learn how to blow a feather. Develop- would be based upon myths,” added report will allow them to make the best ment of this key motor skill is often Berlin. choices,” said Odom. associated with the ability to speak. Applying more stringent criteria, the For Allison Smith, the Pawtucket, “They couldn’t learn how to blow a NPDC’s new report drops one evidence- R.I., mother of identical twin 4-year-old feather until they watched their older based practice from the 24 identified boys with autism, the NPDC reports brother doing it on video,” she said,

winter 2015 | early developments 11 even though therapists had been work- and then try them took a lot of guess Read FPG’s report on evidence-based ing face-to-face with the boys on the work out of the process,” said Smith. “If practices for children and youth task for months. “But it only took a few there was no review of evidence-based with ASD: viewings of the short clip before the practices, a lot of children would be http://autismpdc.fpg.unc.edu/sites/autismpdc. twins got it.” without the interventions and services fpg.unc.edu/files/2014-EBP-Report.pdf “Being able to research the practices that are most appropriate for them.” s

In Brief More on Children and Youth with Autism Spectrum Disorder The following short descriptions of Evaluating Parent-Mediated http://fpg.unc.edu/resources/classroom- research, resources, and projects Interventions for Toddlers with ASD practice-inventory-psychometric-evaluation- rating-scale-intervention-practices-c provide glimpses at more of the broad Many novel scientific challenges and diverse work at FPG on behalf of confront rigorous research evaluating children and youth with ASD. the effectiveness of programs for Improving Social-Communication and Engagement of Elementary toddlers with ASD. Students with ASD R esources on ASD through FPG’s http://fpg.unc.edu/resources/ Professional Development Center designing-studies-evaluate-parent- Social-communication is a key area of (The PDC@FPG) mediated-interventions-toddlers-autism- need for children with ASD, and this spectrumdisorder In addition to intensive workshops on new FPG project is studying the first- Using the Autism Program Environment time application in elementary schools Rating Scale with Proficiency, the PDC@ Joint Attention Mediated Learning of an intervention designed for public FPG delivers free online instruction on Intervention for Children with ASD preschools. such topics as the early identification and their Families http://fpg.unc.edu/projects/improving- social-communication-and-engagement- of ASD. This study looks at parent-child engagement during toddlers’ play elementary-students-autism-spectrum- http://pdc.fpg.unc.edu/ disorders sessions within their homes. http://fpg.unc.edu/projects/joint-attention- Family Adaptation to Fragile X N ew Implications for How Syndrome (FXS) mediated-learning-intervention-toddlers- autism-spectrum-disorders-and-their Activities May Be Categorized for With former FPG director Don Bailey, Children with Autism FPG senior scientist Debra Skinner Concurrent Validity of Autism A new study suggests that child has helped lead research at the Fragile Symptom Severity Measures characteristics and maternal education X Syndrome Research Center, which affect the frequency of specific activities Several screening and diagnostic focuses on family adaptation to FXS—a of children with autism. genetic condition that causes a range measures for preschool-aged children include an assessment of symptom http://fpg.unc.edu/resources/activity- of developmental problems than can participation-among-children-autism- severity, and this study determined three include features of autism spectrum spectrum-disorder disorder. such measures to be reliable and valid. http://fpg.unc.edu/projects/family- http://fpg.unc.edu/resources/brief-report- A Pioneering Curriculum for adaptation-fragile-x-syndrome concurrent-validity-autism-symptom-severity- measures Teachers of Students with ASD To help meet students’ needs and Recognition for FPG’s Study on appreciate their strengths, FPG designed Autism Treatments N ew Implications for Use of The Classroom Practice Inventory ready-made, flexible resources for An annual list of scientific studies school districts to support professional The Classroom Practice Inventory that represent significant progress has development for teachers. named FPG’s groundbreaking research (CPI) was developed as a tool to provide descriptive information about http://fpg.unc.edu/news/pioneering- comparing the TEACCH and LEAP curriculum-supports-teachers-students-autism models as one of the field’s top 20 the practices used to address the developmental needs of children with advances. ASD, and new findings from its use in http://fpg.unc.edu/news/fpg-study-autism- preschools indicated the CPI produced treatments-makes-list-top-advances reliable and valid assessments.

12 early developments | winter 2015 FPG fellow Brian Boyd competence and peer relationships of Equipping Youth with ASD for students on the autism spectrum. Adulthood http://fpg.unc.edu/sites/fpg.unc. An emphasis on promoting “rigor, edu/files/resources/snapshots/FPG_ relevance, and relationships” within a Snapshot75_2014.pdf comprehensive transition framework for students with ASD is important for Introducing Students with High improving in-school and post-school Functioning Autism to Peer Social outcomes. Networks http://fpg.unc.edu/sites/fpg.unc. This FPG study examines the effects edu/files/resources/snapshots/FPG_ N ew Guide for Teachers Facing of peer social networks on social Snapshot77_2014.pdf the Spike in the Rate of ASD interactions, frequency of victimization, Diagnoses and friendship development for high TV Journalist Dwayne Ballen’s Scientists at FPG and the Organization school students with High Functioning Keynote at the 2014 Inclusion for Autism Research have released Autism (HFA) or Asperger’s Syndrome. Institute a multimedia manual that provides http://fpg.unc.edu/projects/introducing- When journalist Dwayne Ballen strategies for secondary school teachers students-high-functioning-autism-peer-social- delivered his keynote address at FPG’s networks whose classrooms now include National Early Childhood Inclusion students with ASD. Institute, the former network sports An Action Plan for High Schools: http://fpg.unc.edu/news/researchers-help- anchor spoke about how his son Julian’s teachers-facing-spike-student-autism-rate Voices from Key Stakeholders inclusion was especially important, Four critical issues have emerged, each because high-functioning autism meant S trategies for Teaching Common of which research has identified as Julian knew he was different. Core to Teens with Autism essential to address in order to promote http://fpg.unc.edu/news/tv-journalist-dwayne- optimal outcomes for students with ASD. High school students with autism ballen-deliver-keynote-inclusion-institute can learn under Common Core State http://fpg.unc.edu/projects/introducing- students-high-functioning-autism-peer-social- Standards, boosting their prospects for N ew Case Studies on Evidence- networks college and employment. Based Practices for High Schoolers with ASD http://fpg.unc.edu/news/strategies-teaching- The Roles and Needs of Families common-core-teens-autism-show-promise FPG’s Center on Secondary Education of Adolescents with ASD for Students with Autism Spectrum Quick Advances through Video Supporting transition-age students Disorder developed these case studies Instruction for Teens with Autism with ASD and their families requires on visual supports, self-management, a better understanding of the unique Difficulty with social situations hinders and prompting to support the learning roles and needs of families, as well as the relationships, schoolwork, and of service providers working with high implementing practices that can best mental health of teens with autism, and school students with autism. ensure family involvement and enhance often these students struggle with http://csesa.fpg.unc.edu/high-school-case- post-secondary outcomes. studies complicated interactions in high school. Scientists from FPG and Michigan State http://fpg.unc.edu/resources/snapshot-76 Evidence-Based Practices for University say that iPads and video- Saudi Children and Youth based instruction may change all Keys to Independence after Working with professionals from that—and save schools money. High School the Centre for Autism Research in http://fpg.unc.edu/news/video-instruction- Research shows that independence is Riyadh, Saudi Arabia, FPG is helping brings-quick-advances-teens-autism the biggest indicator of which students to establish and promote high quality with autism spectrum disorder are programs and evidence-based practices Promoting Social Competence likely to live on their own, have a job, for learners with ASD and their families. and Peer Relationships for and participate in their communities http://fpg.unc.edu/projects/promoting- Adolescents with ASD after high school. use-evidence-based-practices-children-and- This two-page research snapshot http://fpg.unc.edu/news/superior-visual- youth-autism-spectrum-disorders-and-the examines numerous avenues that offer thinking-may-be-key-independence-high- schoolers-autism promise for strengthening the social

winter 2015 | early developments 13 s the practice of medicine evolves to accommodate many interrelated components of health, FPG continues to study how mental and emotional health are nested within a constellation of factors that influence outcomes. mental AThis work is highly varied, as evidenced by the two stories we spotlight here. The first story looks at the power of and mindfulness to overcome physical and emotional effects of childhood adversity. The second looks at the needs of students with one of the most common mental health disorders—in emotional particular, at the supports enabling low achieving students with attention deficit/hyperactivity disorder (ADHD) to enhance Health their chances for academic success.

14 early developments | winter 2015 The content of FPG’s work also encompasses of scientists from FPG, Temple University, Child depression, substance abuse, prejudice, Trends, and the Rockefeller University conducted relationships, and much more, addressing and the groundbreaking study—the first to examine unlocking the critical roles mental and emotional relationships between childhood adversity, health play in child and adult lives. mindfulness, and adult health. Robert Whitaker, professor of public health and Be Well to Teach Well pediatrics at Temple University, said the findings are especially important because adults who ith significant implications for early were abused or neglected as children typically childhood education, new research experience poorer health. W reveals that a mindful disposition is “Previous research has shown that childhood associated with alleviating lasting physical and traumas worsen adult health through changes in emotional effects of childhood adversity. A team how the body responds to stress,” said Whitaker,

winter 2015 | early developments 15 who led the new study. He added that some people might adopt poor health behaviors, like smoking, to cope with stress. As a visiting scholar at FPG, Whitaker collaborated with FPG scientist Kathleen Gallagher on the study, which surveyed 2,160 adults working for Head Start, the nation’s present moment. Nobody, however, had explored largest federally-funded early childhood education whether mindfulness in adulthood could offset the program. According to Gallagher, one of the effects of adverse childhood experiences. study’s most striking features is its focus on Head Whitaker’s team surveyed 66 Head Start Start teachers and staff, who are responsible for programs across Pennsylvania, asking staff if teaching and caring for some of America’s most they experienced emotional, physical, or sexual vulnerable children. abuse as children or if they were exposed to other “It’s essential for adults working with young adversities such as household violence, substance children to be well—physically and emotionally,” abuse, or mental illness. He also asked about their said Gallagher. “Better health enables better current health, as well as their mindfulness—their relationships with children, and research has tendency in daily life to notice what happens as long demonstrated that good relationships are it happens and to be aware and accepting of their crucial for children’s learning and social-emotional thoughts and feelings. development.” “Nearly one-fourth of our Head Start Whitaker explained that when adults provide respondents reported three or more types of services to children who are experiencing trauma, adverse childhood experiences,” said Whitaker, it can reactivate in adults an unhealthy stress adding that almost 30 percent reported having response to their own childhood adversity. “This three or more stress-related health conditions, can potentially worsen the health and functioning such as depression, headache, or back pain. of these adult caregivers,” he said. However, the risk of having multiple health According to Whitaker, studies have shown the conditions was nearly 50 percent lower among health benefits of learning to be more mindful— respondents with the highest level of mindfulness focusing on and accepting your reactions to the compared to those with the lowest levels, even for

16 early developments | winter 2015 FPG’s new associate director of research, Desiree W. Murray

Academic Support in High School for Low Performers with ADHD hile the message from Be Well to Teach Well is clear—that W healthy teachers can make better teachers—schools also must be able to match their programs and services to their students to best meet those children’s needs. New research on high school students with attention- those with multiple types of childhood being and classroom interactions. deficit/ hyperactivity disorder (ADHD) adversity. In addition, regardless of the “In-person training on mindfulness provides critical clues about how amount of childhood adversity, Head practices is difficult to implement on a schools can do this for an important Start workers who were more mindful large scale and very costly,” Gallagher subset of the student population. also reported significantly better health said, explaining how the upcoming Be The study revealed that high school behaviors (like getting enough sleep) Well to Teach Well differs from other students with ADHD are using an and better functioning, including fewer programs. “But by providing online unexpectedly high rate of services for days when they felt unwell mentally or training and ongoing coaching, we their age group, yet many low achievers physically. plan to help many more teachers to with ADHD are not getting the “Our results suggest that mindfulness be well—and to develop the healthy academic supports they need. Scientists may provide some resilience against relationships that are so important for from FPG and several other universities the poor adult health outcomes that positive child outcomes.” published the findings in School Mental often result from childhood trauma,” “We need more research on delivering Health after examining data from the Whitaker said. “Mindfulness training mindfulness training to teachers,” said Multi-Modal Treatment Outcome Study may help adults, including those with a Whitaker. “But there’s reason to believe for ADHD (MTA), a large, nationally- history of childhood trauma, to improve a program for teachers like Be Well representative sample of students their own well-being—and to be more to Teach Well will help teachers and diagnosed with ADHD. effective with children.” children in their classrooms flourish.” According to the National Institute of The findings compelled Whitaker and Mental Health, ADHD remains “one of Gallagher to begin developing Be Well Read the full study: the most common childhood disorders to Teach Well, an online professional http://fpg.unc.edu/resources/adverse- and can continue through adolescence development program designed to help childhood-experiences-dispositional- mindfulness-and-adult-health and adulthood.” In addition to Head Start teachers improve their well- experiencing hyperactivity, people with

winter 2015 | early developments 17 ADHD have trouble focusing, paying attention, evidence behind them. “One of the most common and controlling their behavior. supports we found, for instance, was allowing Desiree W. Murray, FPG scientist and lead students to have extended time on tests—but author of the study, said previous studies have there’s no clear evidence this helps improve demonstrated that children with ADHD often have performance among students with ADHD.” difficulty completing work and performing at the The new findings enabled Murray’s team to level of their actual academic ability. make recommendations for high school support “Prior research has shown that students with staff serving students with ADHD. ADHD score 10-30 points lower than their peers “Using more evidence-based strategies could help on achievement tests, and 30 percent repeat a reduce the performance gap between students with grade,” explained Murray. “High school students and without ADHD,” she said. “These include with ADHD take lower level classes and fail more teaching self-advocacy, self-management strategies, courses than their peers.” and specific study and organizational skills.” According to Murray, high school students with Murray said that she and her team are generally ADHD also are up to eight times more likely to encouraged by the “unexpectedly high rate of drop out. services” for high school students with ADHD in Murray said the clear need for effective their study’s sample. However, if schools focused educational interventions for adolescent students more on services backed by research, these with ADHD led her and her team to examine students would be more likely to benefit. outcomes for these students, while looking at the “Evidence-based practices can help improve high school services they use. long-term outcomes for high school students with Her study found additional evidence revealing ADHD,” said Murray. “Providing effective services that students with ADHD function significantly may contribute to increased graduation rates and worse than their peers on academic measures. successful transitions to adult life.” Teachers rated high school students with ADHD as Currently, Murray serves as FPG’s new more aggressive and less academically successful, associate director of research, as well as and these students’ test scores and grade point principal investigator on a new FPG project that averages were lower than their peers’. is developing a semester-long health education Using survey data provided by school staff, curriculum for high schoolers to improve their Murray’s team determined that slightly more than health beliefs and behaviors and to enhance their half of all high school students with a history academic success. of ADHD receive some type of formal school She also holds workshops at the PDC@FPG services, six times as much as students without (http://pdc.fpg.unc.edu) for professionals who ADHD in the study sample. plan to train teachers in the evidence-based Most of the services and accommodations Incredible Years Teacher Classroom Management for students with ADHD targeted academic Program. The program not only strengthens performance through Individualized Educational teachers’ management skills in classrooms with Plans (IEPs) as part of special education programs. 3-8 year-olds, it also promotes children’s social, Only half of these students received behavioral emotional, and academic competence, as well supports or were taught learning strategies. as reducing classroom aggression and lessening “Although school procedures for identifying disruptive behaviors. Additionally, the curriculum academic impairment in this population appear to be helps teachers effectively collaborate with parents working for the most part, our results also suggest to support their school involvement, promoting that 20 to 30 percent of students with academic consistency between home and school. Teachers impairment and ADHD have fallen through the even report decreased stress levels after attending cracks,” Murray said. “There is a need for greater the training. s or more effective academic supports for a substan- tial minority of the students in our sample.” Read about Desiree Murray’s projects Murray said that only about one-fourth of the and resources: interventions reported in the school survey have http://fpg.unc.edu/profiles/desiree-w-murray

18 early developments | winter 2015 In Brief More on Mental and Emotional Health

From prenatal drug exposure to http://fpg.unc.edu/resources/symptoms- Racial Discrimination and How teacher-student relationships, the depression-and-their-management-among- Mothers Talk to Young Children following examples also show low-income-african-american-and-white- mothe New research finds that mothers’ how FPG’s focus on mental and perceptions of racism are a emotional health supports children, significant predictor of how they families, providers, administrators, N ew Resources for the Children’s Bureau interacted with their young children and policymakers. during a picture-book session. Not only do these resources from http://fpg.unc.edu/resources/racial- How Low-Income Mothers FPG’s National Implementation discrimination-correlate-african-american- Manage Depression Research Network contribute to mothers-emotion-talk-young-children child welfare, they also advance This look at the rural South finds the field of implementation and that most mothers reported having S trategies and Concerns of evaluation through an extensive depressive symptoms currently or in Successful Young African report, a brief offering key concepts the past. The women reported the American Men for lay readers, and a compelling and primary causes to be relationships, The route to early success for complementary infographic. financial issues, and parenting African American men requires stresses; their strategies for managing http://fpg.unc.edu/resources/pii- adept navigation of conscious and approach-building-implementation-and- symptoms of depression varied evaluation-capacity-child-welfare unconscious racism, as well as by race. capitalizing on available community and family supports, according to

fwinter 2015 | early developments 19 a new report from FPG’s Research, year, and, in particular, watching Fighting Parents and Children’s Policy, and Practice Alliance for video exemplars was associated with DifficultyR egulating Emotion Supporting Excellence in Black growth in emotionally supportive Exposure to greater levels of inter- Children. behaviors—but not in classroom parental conflict, more chaos in the http://fpg.unc.edu/news/successful- organization behaviors. household, and more time in poverty young-african-american-men-voice- http://fpg.unc.edu/resources/dose- are key contributors to young strategies-and-concerns-white-house- response-relations-between-preschool- children’s ability to recognize and summits teachers-exposure-components- modulate negative emotion. professional-develo http://fpg.unc.edu/resources/poverty- Supporting Young Children household-chaos-and-interparental- Who Experienced Prenatal Drug Child Care Instability and the aggression-predict-childrens-ability- Exposure Social-Emotional Adjustment of recognize-a This short article offers information Children in Prekindergarten for early intervention professionals Changes in child care may disrupt T he Stabilizing Influence of about the growing challenges of children’s emerging relationships Success Coaches illicit substance abuse and provides and impede social-emotional In Catawba County, North Carolina, resources to assist anyone who is development, especially when science and “Success Coaches” are supporting young children who have changes occur during infancy and helping to keep parents and kids been prenatally exposed. toddlerhood. This study of children together, and Hickory resident Kelley http://fpg.unc.edu/resources/resources- from rural, low-wealth families Walker is only half-joking when she within-reason-resources-supporting-young- examined child provider instability says her Success Coach saved her children-who-have-been-prenatally-expos before age 3 and determined it sanity. was negatively associated with http://fpg.unc.edu/news/science-and- Improving Child Addiction and teacher ratings of children’s social success-coaches-keep-families-together Mental Health Outcomes adjustment at prekindergarten. FPG is working with Canada’s Centre http://fpg.unc.edu/resources/child- Preventing High-Risk Behaviors for Addiction and Mental Health care-instability-6-36-months-and-social- and Achieving Socially adjustment-children-prekindergarten (CAMH) to improve outcomes Significant Outcomes for children and youth. CAMH’s This white paper from FPG’s Conflict Levels in Teacher Provincial System Support Program National Implementation Research is intended to create and build the Relationships with Boys and African Americans Network concludes that where implementation capacity of regional physical health is concerned, people Boys and African American and local implementation teams, and are beginning to understand that kindergartners experience increasing FPG is helping CAMH to develop healthier lifestyles lead to longer, conflict with their teachers as the the infrastructure for sustaining and healthier and happier lives. However, school year progresses, regardless of scaling up interventions in children’s the same progress has not extended the teacher’s ethnicity. mental health and addiction. to mental, emotional, behavioral, or http://fpg.unc.edu/news/fpg-works- http://fpg.unc.edu/news/conflict- social health—and evidence-based increases-teacher-relationships-boys-and- improve-child-addiction-and-mental-health- solutions to improve well-being in outcomes-canada african-americans these areas hold great potential. http://fpg.unc.edu/sites/fpg.unc. Increasing the Quality of Risk Factors and their Impact on edu/files/resources/other-resources/ Preschool Teachers’ Interactions Parenting Fishbein_Payes_Aldridge-2013_December- with Children Parenting deteriorates when rural Preventing-high-risk-behaviors-and- achieving-socially-sig-outcomes-for-child- A new study released this year families face a number of risk factors families.pdf examined the impact of an effective at once—and, as a result, children’s coaching model. Teachers exposed intellectual, emotional, and social to a greater number of cycles of development suffers. coaching showed more improvement http://fpg.unc.edu/news/mounting- in classroom interactions over the challenges-undermine-parenting

20 early developments | winter 2015 news NC Governor Appoints Council to Ensure “Healthy, Happy” Children

orth Carolina Governor Pat federal Race to the Top-Early Learning McCrory has appointed 23 Challenge Grant (RTT-ELC). N new members to the North “North Carolina has exciting Carolina Early Childhood Advisory opportunities to strengthen our early Council (ECAC). According to the Office childhood system through this grant,” of the Governor, the council’s charge and private sectors, and the council is said the ECAC’s Mary Ruth Coleman, is to develop a shared vision for young committed to building on this,” she said. FPG senior scientist emerita. children and a comprehensive system Odom said that findings from FPG’s of family strengthening services. After the ECAC’s first meeting in Abecedarian Project have shaped policy early fall of 2013, Coleman praised its “The quality of care during early decisions around the country and have comprehensive approach and noted childhood can often determine the resulted in more public investments in its members include a wide range of level of success a person achieves programs for young children, which the researchers, educators, and health care later in life,” said Governor McCrory state’s Race to the Top–Early Learning professionals, as well as state senator in a statement after authorizing the Challenge (RTT-ELC) grant exemplifies. Ron Rabin and state representative council. “The state of North Carolina He added that FPG now spearheads Justin Burr. Joining Coleman from FPG is committed to giving parents every work in the grant’s “Transformation are the Brookings Institution’s Ron tool they need to make sure all of North Zone”: four rural, high-need counties Haskins, who serves on FPG’s executive Carolina’s children start life healthy, in North Carolina that are receiving leadership board, and Dick Clifford, happy and eager to learn.” focused programs and services. senior scientist emeritus. FPG director Samuel L. Odom said Odom also noted the contributions of “With major reductions in funds for research supports the Governor’s Kelly Maxwell, a member of the current services during the recession, this is a statement about the long-term benefits RTT-ELC grant management team, critical time to make sure investments of quality early care. in bringing such significant funding are made wisely as we seek to ensure to North Carolina. Maxwell was FPG’s “FPG’s Abecedarian Project provided that North Carolina has an enlightened associate director at the time of the comprehensive high-quality care and citizenry and a competent workforce,” state’s grant application and served as education for children birth to age 5, said Clifford. “At the same time, we have its lead writer. and decades later they’re still reaping to ensure that these young children the benefits,” Odom said. “Other FPG have the chance to have a happy and “With Governor McCrory’s support, studies have shown that even a single productive childhood.” funding from Race to the Top, and the year of pre-k can help children while Early Childhood Advisory Council’s Coleman said the ECAC would provide in the program and for several grades expertise, North Carolina now has the innovative and practical advice afterward.” the opportunity to make significant the state needs to strengthen its early strides forward in enhancing the lives The ECAC’s responsibilities include childhood system. “North Carolina of children and families in our state,” advising on the $70 million award that has been a leader in early childhood, Odom said. s North Carolina received through the with strong collaboration across public

winter 2015 | early developments 21

FPG Co-Sponsors 2014 National Health Equity Research Webcast

ast May, the 20th National Health Equity Research Webcast aired for thousands L of viewers. This webcast, hosted on UNC’s campus by FPG and several other co- sponsors, is an annual interactive, live-streamed symposium that explores the intersection of health, policy, and diversity through expert panel discussions and a question-and-answer session.

The topic was the School to Prison Pipeline. Nationally-known speakers included Anthony A. Peguero, assistant professor of sociology and research affiliate of the Center for Peace Studies and Violence Prevention at Virginia Tech; Thalia González, assistant professor of politics at Occidental College; and Gary Flowers, CEO of Gary Flowers and Associates.

Christopher Hill, director of the Education and Law Project at the North Carolina Justice Center, moderated the question-and-answer session with the studio audience and remote viewers.

The UNC School of Education hosted a preliminary screening of the short documentary NC School to Prison Pipeline the day before, addressing the impact of stringent suspensions and incarceration on the youth of North Carolina. After the screening, Durham Assistant District Attorney Shamika Rhinehart moderated a town hall meeting.

The National Health Equity Research Webcast More news about FPG: http://fpg.unc.edu/news charges no admission and requires no viewing http://fpg.unc.edu/news/in-the-news-archive fee. Broadcasts are available here: Media coverage of FPG: http://sph.unc.edu/webcast/sph-webcasts/?webcast_ More resources from FPG: http://fpg.unc.edu/resources id=2014-06-03_wc2000sp2014&seg=all

22 early developments | winter 2015 new resources

winter 2015 | early developments 23 early developments Nonprofit Organization Frank Porter Graham U.S. Postage Child Development Institute PAID CB 8185, UNC-CH Permit No. 177 Chapel Hill, NC 27599-8185 Chapel Hill, NC

ISSN 1536-4739 Change Service Visit us online Requested www.fpg.unc.edu FirSt ClaSS U.S. Postage PAID Permit No. 177 Chapel Hill, NC

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24 early developments | winter 2015