The Child Mind BlogBrainstorm

  • Optimizing Children
    July 16, 2013 Rachel Ehmke

    Spreadsheets are increasingly a part of many people's jobs, but do they need to be part of parenting, too? Amy Webb, a digital strategist (I don't know what this is) and bestselling author, thinks so. Her attitude isn't that surprising, since the book she became famous for, Data, A Love Story, is about how she harnessed data to "game" online dating sites and meet her husband. You might also remember her from her  Slate piece (an excerpt from the book) in which she came up with a (color-coded) 72-point list of qualities she deemed necessary in a future mate. People either love her or love to be horrified by her, although she might be losing people with this latest Slate story, about "data-driven parenting."

    First an explanation of what data-driven parenting means. Webb was anxious about being at "advanced maternal age" with the birth of her first child (another thing trending) so at 16 weeks she began tracking how much water she drank, how many milligrams of DHA she consumed, and how much she weighed every day of her pregnancy. After giving birth, a pediatrician told her to start measuring how much the baby was eating because she wasn't gaining enough weight. Webb expanded on this advice and began a spreadsheet that also recorded detailed descriptions of dirty diapers and her daughter's sleep habits, noting any potentially interfering factors, like air conditioning and church bells.

    They also measured how attentive the newborn was to readings from The New Yorker, Popular Mechanics, and board books they'd "received as gifts" (do we need to justify reading children's books to children?), factoring in the time of day and picture vs. word quotient. As their daughter got older, they began recording advances in vocabulary ("Dec. 10, 'ga' and 'mmm' sounds consistently") and, of course, new foods. The result is a kind of baby book on steroids, and Webb's been keeping it up for several years now.

    They use their data to inform their parenting decisions, Webb says. "It occurred to us that while our baby daughter couldn't communicate directly beyond crying, we could have a deeply intimate, beneficial conversation with her through data. We realized that we could quantify and study her in an attempt to optimize all of her development."

    Now, I don't want to get too down on this. Clearly she cares about her child and they are trying hard to be good parents. But her data collection does make me, and a lot of Internet commenters, uncomfortable. For one thing, having an "intimate, beneficial conversation" through data sounds like the kind of thing Google, Amazon, and everyone else would say to justify their constant surveillance. Shouldn't our parents, at least, be counted on to not turn us into a collection of data points? Also, at what point is she going to stop? The aloof teenage years are going to be tough on data.

    But mostly I'm disturbed because these spreadsheets seem to be less about finding a way to bond with their child and more about "optimizing" her. It's very descriptive of the kind of hyperfocus that makes parents start stressing and strategizing over the Harvard application before their kids even know how to tie a shoe. This is a woman trying to build an SAT vocabulary, not coo over pictures of a Very Hungry Caterpillar. Which isn't the worst thing. They're still bonding, whatever she's reading, and it is good for kids to hear lots of new words. But what happens when the child declines to be "optimized," as children are so wont to do?

    At least when she was using algorithms to meet her future husband, Webb had a goal with a clear end in sight. Now Webb's goal is her child's life, and that narrative is going to be a lot more complicated.

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  • Ratings Over Science: Jenny McCarthy on 'The View'
    July 16, 2013 Caroline Miller

    Science took a hit yesterday when ABC named Jenny McCarthy to be one of the co-hosts of The View. Of course, daytime talk shows court controversy, as well as telegentic blonde former models, but giving the celebrity spokesperson for the anti-vaccine movement a place at the table is a very disturbing move.

    You may dismiss the show, as many do, as silly talk, but a good deal of that talk is about politics and serious issues—not to mention serious guests who include sitting presidents and their wives. So it was fairly stunning to hear Barbara Walters, in announcing the hire, describe McCarthy this way: "Jenny brings us intelligence as well as warmth and humor. She can be serious and outrageous. She has connected with our audience and offers a fresh point of view."

    A "fresh point of view" is a shameful way to sugarcoat McCarthy's campaign against medical science and leadership of an anti-vaccine movement that endangers lives. Treating science as just one opinion among many is anything but harmless. As Time TV critic James Poniewozik puts it:

    To say that you can simply shrug off differences about medical fact as "outrageousness" or "controversy" is to feed the belief that science in general, be it vaccines or climate change or evolution, is simply subjective: you have your truth and I have mine. But we don't. The Earth didn't revolve around the sun only for Galileo.

    Even if McCarthy has been told by ABC management that the subject of vaccines is off the table, the hire gives her credibility, which can only inflame the vaccine conspiracy that she has been the voice of for years. As Alex Pareene points out on Slate:

    "Vaccine conspiracies, like so much modern cult conspiracy culture, perpetuates itself and lives on indefinitely thanks to the community-building and archiving of the Internet. With the help of some very prominent advocates, with huge audiences and a great deal of influence, it has spread far beyond the fringe."

    If you want to see what lots of other people had to say about the hire, read the comments of  some of the 2,000-plus people who have signed a petition on to urge a boycott of The View over the McCarthy hire. I'll give the last word here to one of them, Pennsylvania pediatrician Jane Longacre:

    Vaccines have saved more children's lives than any other public health intervention in history other than clean water. Don't allow ratings to take precedence over children's health!

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  • The Life and Death of 'Glee' Star Cory Monteith
    July 15, 2013 Beth Arky

    News of Glee star Cory Monteith's death over the weekend sent fans reeling. As Finn, the high school football star-turned-musical theater heartthrob, the 31-year-old actor had been a favorite, embodying the teenager who transforms from a kneejerk bully to someone who thinks for himself, making friends with those he once belittled.

    Cory Monteith

    When the show debuted in 2009, Finn was the stereotypical homophobic jock, throwing slushies into the faces of unsuspecting kids walking through the halls of McKinley High. So it was wonderful to watch him evolve into someone who cared and stood up for members of his diverse new glee club gang, including the wheelchair-bound Artie and the gay Kurt, who would eventually become his half brother. And when he fell for geeky girl Rachel (played by real-life-girlfriend-to-be Lea Michele), we fell in love with the star-crossed pair, too.

    But the successful high schooler Finn couldn't have been more different from Monteith. The Canadian actor, who was found Saturday in his Vancouver hotel room, was a high school dropout who had been battling drug addiction since he was 13. Monteith had announced in March he was entering rehab. An autopsy was to be performed today; the authorities have ruled out foul play.

    According to reports, Monteith dropped out at 16 after attending 16 schools, then worked as a Wal-Mart greeter and a school bus driver before checking into rehab at 19. As he told a Canadian talk show host in a 2011 interview, doing drugs "wasn't so much about the substances per se, it was more about not fitting in.... I hadn't found myself at all."

    Raising Drug-Free Kids: How Can the Science of Addiction Help Us?
    Featuring Nora Volkow, MD, Director, National Institute on Drug Abuse


    The actor was careful not to send the wrong message to his fans. He said he hoped his struggles with addiction would serve as an example: "I don't want kids to think it's O.K. to drop out of school and get high, and they'll be famous actors, too. But for those people who might give up: Get real about what you want and go after it."

    Monteith got real thanks to his involvement in the arts, something he credited for turning his life around, much as it did Finn's. "I think kids really need a place to go and feel like they belong," he said in a video posted on the site for Project Limelight, a Vancouver charity offering theater and arts programs to at-risk youth. "When I was a kid, I struggled a lot with who I was and where my life was going and what I was interested in. And I was fortunate to have the arts inspire me."

    Finn floundered post-graduation, leaving the Army soon after he signed up, but he found his way again when he returned to McKinley to direct the next generation of glee club members. Sadly, Monteith did not share his character's happy fate. But we like to think his example might inspire other struggling kids to find themselves through the arts, and those battling addiction or some other mental health problem to get help. 

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  • Understanding ADHD With Non-Stimulant Meds
    July 2, 2013 Harry Kimball

    Last week Dr. Jeffrey Newcorn, a child and adolescent psychiatrist and professor at Mount Sinai Medical Center, stopped by the Child Mind Institute to give a presentation on advances in ADHD medication—specifically his research on atomoxetine (brand name Strattera), a non-stimulant compound that is seeing increasing use.

    For me his most interesting point was that because stimulants are so effective at treating most cases of ADHD, the field has come to define the disorderin the criteria listed for a diagnosispartly by the targets of that treatment.

    "Our criteria are really strongly built to things that stimulants make better," Newcorn said. "So there is a real premium on efficiency of processing, getting tasks completed, finding boring things interestingthe things that stimulants do better." But as a clinician and researcher, Newcorn sees two problems here. For one, there are many more dimensions to the disorder—as he puts it, "all the things about ADHD that we'd like to track better that aren't part of our criteria." Andrelatedly, as he demonstratedthough most people with ADHD respond to stimulants, many don't. How to help them, he said, begins with understanding how they are different.

    Newcorn's rationale for pursuing atomoxetine emerged from a widely known clinical fact: there are two classes of stimulants, and if one doesn't work well for a young person with ADHD, chances are the other class will. About 80% of patients will respond to either methylphenidate or amphetamine. Are those other 20% just out of luck? Not if you broaden your idea of what "response" is, and understand that the two classes of stimulants, though similar, work differently in the brain. Why can't something else work?

    "It makes sense to look at atomoxetine," he said, which targets some of the same neurotransmitters as stimulantsbut in a very different way and in different parts of the brain, as Newcorn illustrated with imaging studies. Its effects are also different, he postulated, serving more to "drive mental effort" and "increase" the signal as opposed to stimulants, which "decrease noise." And it can help people who have been labeled non-responders to treatment.

    The upshot here is that all cases of ADHD aren't the sameand that Newcorn is blazing a trail into a future of personalized medicine. There is no place and no need anymore for a "one size fits all approach" to ADHD treatment, he said. Instead of settling on averageson the sunny but still wanting 80% response rate for stimulantswe can and should figure out "which drug is best for which patients." Or, as he put it, "our goal is not to treat partial responders with something that doesn't work too well." And by thinking about ADHD in a more catholic way, we find that the tools to achieve a better goal may be in front of us.

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  • Mental Health Shot Down With Gun Control
    July 2, 2013 Caroline Miller

    Back in the winter, when Congress was considering (however briefly) legislation reining in gun sales, some mental health measures were attached to the bill under discussion. The logic was that both initiatives were responses to the shootings at Sandy Hook Elementary School—measures designed to help keep children safer.

    While the gun control proposals on the table—extending background checks to sales at gun shows, or limiting the size of magazines for semi-automatic weapons—proved too controversial to get serious traction in the Senate, let alone the House, the mental health measures had widespread bipartisan support.

    So it's ironic that the defeat of gun control took the mental health bills off the agenda too.

    "When we had the bill on the gun debate last month, I think the only amendment, that passed was the one on mental health," Senator Roy Blunt of Missouri told a reporter at Missourinet last month, noting that the mental health provision cleared the Senate 95 to 2.

    The measure he was referring to is called the Mental Health First Aid Act of 2013, and it authorizes the launch of a demonstration program to support mental health first aid trainings nationwide on how to identify, understand, and respond to the signs of mental illnesses. It was introduced by Mark Begich (D-Alaska) and Kelly Ayotte (R-N.H.), and had eight other cosponsors from both parties, including Sen. Blunt.

    That's a bill that would have been especially meaningful for kids struggling with psychiatric issues, since it would support training for adults who work with young people—teachers, scout leaders, church leaders, etc.—to help them identify, understand, and respond to the signs of psychiatric problems.

    There are a number of other bills that were also proposed in the wake of Sandy Hook that also claimed bipartisan support, including one that would boost funding for local mental health centers. We have to wonder why interest in these bills disappeared as soon as gun control was declared dead—and we'd like to see them resuscitated.

    Whenever gun violence erupts, mental health initiatives are touted as the one thing everyone can agree on—supporters of the NRA and the Gabby Giffords and Brady campaigns alike. But for members of Congress they seem to gain traction only as an alternative to gun measures. We'd like to see that across-the-aisle support amount to more than a way for politicians to appear to be proactive in the wake of tragedy.

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  • Amy Winehouse and Bulimia
    June 25, 2013 Rachel Ehmke

    We thought we knew the Amy Winehouse story. The gossip press, obsessed with her self-destructive rampages, documented every boozy blowout and run-in with the law until she was a caricature of a celebrity in a downward spiral. That Winehouse was bulimic since her teenage years was less well known, although I remember seeing lots of "Scary Skinny!" style captions under paparazzi photos of the singer walking around Camden in her trademark ballet flats, often looking intoxicated.

    Her eating disorder wasn't a secret, but it just didn't get the same attention that her drug use did, at least until now. This week her brother, Alex Winehouse, told the press that he blames bulimia for her death, not substance abuse. In an interview with the Observer he said, "She suffered from bulimia very badly. That's not, like, a revelation—you knew just by looking at her... She would have died eventually, the way she was going, but what really killed her was the bulimia."

    I think hearing this comes as a shock to people because it deviates from the meteoric-rise-and-fall-of-a-celebrity story that we've internalized. Winehouse may have died at 27—putting her in the romanticized 27 Club of other musicians like Jim Morrison, Janis Joplin, and Kurt Cobain, who died tragically at that age—but her demons were around years before she got famous. It's a good reminder that substance abuse and addiction often don't come out of thin air. People who develop problems with substances often struggle with something else first—untreated depression, trauma, eating disorders—that don't get resolved so they begin self-medicating.

    Alex Winehouse's interview is also welcome because bulimia tends to be a very private thing that individuals and families struggle with quietly. Hearing people talk publically about it—and how dangerous it can be—is important. "We all knew she was doing it but it's almost impossible [to tackle], especially if you're not talking about it," her brother said. The Winehouse family has formed a foundation focused on drug and alcohol abuse and also recently donated money to Beat, an eating disorder charity.  Alex told The Guardian "We had to support eating disorder charities because no one talks about it."

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  • ADHD and Substance Abuse: Are Meds Really to Blame?
    June 24, 2013 Nancy Konigsberg

    This is a guest post by Nancy Konigsberg, an occupational therapist and applied behavioral analysis therapist who has a son with ADHD.

    Every time I see an article debating the benefit and/or consequences of giving children stimulant medication for ADHD I take notice. When I read recently that that researchers found a link between ADHD and substance abuse, but no link between medication specifically and substance abuse, I wanted to know why, and why people were speculating that the use of stimulant medications might contribute to substance abuse.

    This matters to me personally because my son has ADHD and he takes stimulant medication. But I am also a pediatric O.T. and I recently completed a post-graduate program in Applied Behavior Analysis. What my professional experience and education have taught me is that a disorder does not define behavior. The principle of behavior analysis is that behavior has a function—a child acts in order to get something tangible, or get attention, or to escape something, for instance. Behavior is either strengthened or diminished by the history of reinforcement. Whatever consequence immediately follows a behavior reinforces (negatively or positively) that behavior. If a child is having a tantrum and the parent says "I will give you a treat if you stop tantrumming" and the child stops and gets the treat, the tantrum was just reinforced. That is, the child understands that having a tantrum results in getting a treat.

    Until my son was in first grade, when he started on stimulant medication, I would get calls and complaints about his behavior on almost a daily basis. He was thrown out of programs and demoted. It's not that he was badly behaved per se. It was just that he couldn't sit still, he couldn't follow directions and that he had a hard time adjusting to a group environment. Almost the minute he started the meds, his life started to change. He could listen and attend and interact appropriately with his peers.  This allowed him to do well academically. And it wasn't just in academics that he started to excel. He was named "outstanding music student of the year" and "most improved swimmer" on the swim team. Prior to taking the medication he had difficulties with motor skills. It seems that the medication allowed him to process information much better. Slowing him down allowed him to learn. And when he learned, he started to succeed. When he succeeded he got rewarded with commendations, trophies and good grades. The reinforcement of recognition and praise keeps my son on track. 

    This makes me wonder about the link between ADHD and substance abuse: whether those kids who have ADHD and don't get positive feedback turn to drugs because of their history of reinforcement. When children aren't behaving appropriately or aren't doing well in school they usually hear criticism instead of praise. If all they ever hear is "Why can't you do better?" or "Why did you get detention?" or "Why can't you do anything right?" they develop poor self-esteem. They don't get feedback that will keep them on a good path. Their history of reinforcement is one of negativity. Ultimately, they seek approval from peers or escape or just a means to feel good. They achieve this with substances such as drugs and alcohol. 

    The study linking ADHD and substance abuse itself offers evidence for this hypothesis. The researchers noted that children with comorbid ADHD and ODD/CD (oppositional defiant disorder/conduct disorder) may be much more at risk than those with just ADHD. They observed that the ODD/CD might be the problem rather than the ADHD. They also noted that there is evidence that parental maltreatment is more likely to independently predict substance abuse problems than childhood ADHD. The point here is that the history of reinforcement might be the most relevant factor in contributing to future substance abuse.

    Why do I bring all of this up? It is easy to form misconceptions when we hear that children with ADHD are three times more likely to develop substance use problems than typical children. And it is easy to shy away from trying stimulant meds when you hear that they may be related to addiction.  But the ADHD or stimulants might not have a causal relationship with substance use. It may well be that it is the history of reinforcement for a child which is much more predictive of future behavior. 

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  • Noticing Bullies Inside the Family, Too
    June 18, 2013 Rachel Ehmke

    We think of bullying as something that happens in the schoolyard or, increasingly, online. But what about bullying that happens at home?

    A new study in Pediatrics claims that kids bullied by siblings experience negative mental health effects, much like any other kind of bullying. But another more subtle point the authors are making is that children even can be bullied by siblings.

    We tend to downplay it when siblings get aggressive, which makes sibling bullying "under-recognized and under-estimated," says Corinna Jenkins Tucker, PhD, lead author of the study. Which makes sense. We think of sibling fights as a common, innocuous thing, and they often are. I grew up with an older brother who sometimes kicked soccer balls at my head, for example. But even when he was picking on me, I knew that he basically liked and even respected me, which makes all the difference in these interactions. For children who are actually being victimized, it's a different story.

    One of the reasons we're disturbed by Internet bullying is because we know how far-reaching it is. In 2013 you're never far away from the Internet, which means kids are never far away from their aggressors-they follow you home on your phone and your computer. Similarly, getting bullied by a sibling is another serious violation of the sanctuary that home is supposed to represent. Imagine needing to share a bunk bed with your tormentor.

    So, if parents take anything away from this Pediatrics study, maybe it should be a renewed sense of awareness. It's good for siblings to be rambunctious and competitive, but the sustained, victimizing bullying techniques from the playground shouldn't fly there, so they definitely have no place at home. The ability to empathize is important, and it's one that we need our kids to exercise wherever they are.

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  • Paris Jackson: The Wrong Thing to Say to a Teenager Who Is Suicidal
    June 11, 2013 Caroline Miller

    We were distressed to read about Paris Jackson's hospitalization last week after what is being officially called a suicide attempt. The daughter of an extraordinarily talented and self-destructive father, we can imagine that Paris might be in a very precarious situation emotionally. But she is also a 15-year-old girl not unlike the thousands of other 15-year-old girls from the most ordinary families in the world who make suicide attempts every year. Teenage girls experience very volatile emotions, and they lack the skills and experience to put them in perspective—a risky combination.

    In Paris's case, fortunately, her suicidal behavior didn't result in her death. But it did result in an outpouring of the worst possible responses from gossip sites pretending to be news outlets. Coverage at TMZ, for instance, reads like a list of what not to do when a teenager expresses suicidal feelings or behavior. (The ellipses, by the way, are theirs.)

    Law enforcement sources familiar with the situation tell TMZ ... based on the information the L.A. County Sheriff's Dept. has gathered ... "She wanted attention."  One source involved in the case tells us ... her call to a suicide hotline is compelling evidence "she wanted to be saved."  The source added, "It makes no sense if you really want to die to call a hotline, where the person on the other end will get an ambulance over to your house.

    You couldn't invent a worse message to send to other vulnerable teenagers: that we trivialize your pain and desperation, that we don't take your actions seriously, and that calling a hotline means that you aren't truly suffering. Unbelievable.

    Just as bad was the endless speculation about what prompted her action, from being bullied at school to being upset over having to testify in the wrongful death lawsuit involving her father to being told she couldn't go to a Marilyn Manson concert. And then Marilyn Manson got into the act in a concert Thursday, dedicating a song to Paris, and miming cutting himself with a huge knife.

    Marilyn Manson isn't exactly a role model for probity, but even for him this lapse in judgment is shocking. For a very thoughtful description of what it's like to feel suicidal I recommend an interview last week with comedian and actor Stephen Fry, who admits that he made a suicide attempt last year that would have been fatal but for a producer who found him unconscious in his hotel room.

    "You may say, 'How can anybody who's got it all be so stupid as to want to end it all?' " Frye said in the interview. "That's the point, there is no 'why?' That's not the right question. There is no reason. If there was reason for it, you could reason someone out of it."

    Fry, who is on the record about having bipolar disorder, said he often feels suicidal. "Sometimes it's the expression I imagine on my mother and father's face—both of whom are alive and happy—that stops me," he said. "But there are other occasions when I can't stop myself, or at least I feel I can't."

    We hope that the caring adults around Paris Jackson will make sure that whatever pain led her to this act gets serious attention, as well as the love and support she deserves. 

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  • School Cuts Suspensions by Asking Kids What's Bothering Them
    June 11, 2013 Beth Arky

    In the 1967 classic To Sir, With Love, Sidney Poitier plays an innovative teacher who helps some tough East London kids succeed both in school and at home by taking a personal interest in their lives.

    Fast-forward some 50 years and this type of positive approach remains the exception, not the rule. Middle and high schools are doling out suspensions at ever-higher rates; according to two recent reports, 2 million students were suspended during the 2009 school year, and boys of color and children with disabilities were suspended at much higher rates.

    So it's encouraging to learn about Lincoln High School in Walla Walla, Washington, which is bucking the trend with policies that keep kids in school and enjoying great success doing so. How great? Suspensions have dropped a whopping 85 percent. Given that Lincoln is an alternative school that takes on at-risk students whose behaviors have gotten them kicked out of other settings, its success rate is that much more remarkable.

    So how does it work? Let's say a student behaves negatively—maybe he hurls curses at a teacher. The go-to consequence in this time of increasing "zero-tolerance" is suspension; according to a 2011 report by the National Education Policy Center, 95 percent of kids are kicked out of school not for weapons or drugs but for categories including "disruptive behavior" and "other," which includes being "defiant"—a vague, highly subjective term—cell phone use, dress code violations, displays of affection.

    But this is not the case at Lincoln High; instead, teachers and administrators act quickly to stem escalation and try to find out what's going on in the student's life that might be causing him to act out. So principal Jim Sporleder might ask a student, "Wow. Are you OK? This doesn't sound like you. What's going on?" He gets even more specific: "You really looked stressed. On a scale of 1-10, where are you with your anger?"

    Sporleder did his about-face after he learned the theories of John Medina, the best-selling author of Brain Rules. Medina writes, "Severe and chronic trauma (such as living with an alcoholic parent, or watching in terror as your mom gets beat up) causes toxic stress in kids. Toxic stress damages kid's brains. When trauma launches kids into flight, fight or fright mode, they cannot learn. It is physiologically impossible."

    "It sounds simple," Sporleder says about the new approach. "Just by asking kids what's going on with them, they just started talking. It made a believer out of me right away."

    This is not about giving kids a pass. There are still consequences, just not punishment, which many consider less effective as a way to shape behavior. Instead, Lincoln uses ISS—in-school suspension, "a quiet, comforting room where the student can talk about anything with the attending teacher, catch up on his homework, or just sit and think about how maybe he could do things differently next time." Sporleder and his staff also give kids the tools to recognize their reaction to stress and how to self-regulate their response to it.

    The approach is in stark contrast with traditional suspensions, which don't work well for kids who are already at-risk. "Studies show that one suspension triples the likelihood of a juvenile justice contact within that year," California Chief Justice Tani Cantil-Sakauye told the California Legislature last spring. "And that one suspension doubles the likelihood of repeating the grade." Meanwhile, according to the NEPC report, "research shows being suspended even once in ninth grade is associated with a 32 percent risk for dropping out, double that for those receiving no suspensions." 

    Given the cost to students, parents, and society at large when kids aren't encouraged to stay in school, Lincoln High offers an important lesson: When students are treated as individuals, when teachers and administrators take time to find out what's behind their behavior, what's happening in their lives that's affecting them in school, the results can be stunning. 

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