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The science behind supporting students after the COVID-19 outbreak

By Julie Phillips Randles
June 24, 2020
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Pamela Cantor, M.D., was more than happy to answer the call to help the New York City Department of Education whose students were in lower Manhattan the day the twin towers fell on 9/11. As a child psychiatrist, she was prepared to work with students whose night­mares about that day were interfering with their ability to function and learn in a classroom.

Instead, she discovered that it wasn’t terrorists that haunted them. Yes, 68% of New York City school children had experienced trauma sufficient enough to impair their functioning in school, but the lasting distress stemmed from growing up in poverty and facing ongoing adversity. And because she had the science to understand how the human brain works, Can­tor was able to positively affect these students’ lives.

But Cantor had another advantage, although that wasn’t the word anyone would use to describe it. Her own childhood had evolved around an ongoing trauma, and it was a therapist who showed a teenaged Cantor that she was a pearl in an oyster and not a damaged individual. This mentor supported her without wavering when she announced that she, too, was going to be a doctor despite the fact that she was an art history major and didn’t have a track record in science and math.

Backed by this kind of belief in her success, she earned a bachelor’s from Sarah Lawrence College and her M.D. from Cornell University, where she was one of five women in her class. She entered private practice in child psychiatry with a focus on trauma, and was a clinical in­structor of psychiatry at Cornell University Medical Center and an assistant professor at Yale. 

So she was the right person in the right place in 2001 to learn deeply about what children need to learn and thrive. But she was just one person. That’s why in 2002, she founded Turnaround for Children, a nonprofit that provides educators with tools and resources, grounded in science, to help turn any school into a positive force for learning and growth for all students. Since its founding, Turnaround has assisted nearly 300 schools serving tens of thousands of children.
“In my private practice, I never changed a child’s circumstances or what had hap­pened to them. What I could change was the impact it had on their lives, how they coped and ultimately surmounted adversity,” she has said previously.

That’s why Turnaround partners with school districts to equip educators to un­derstand and address the impacts of trauma and adversity, and put children on a path to learn and develop in healthy ways – a path to thrive.

“What these teachers are able to do – if they are taught the skills – is to develop trust, reduce stress and open the minds of young people to a full engagement in learning,” Cantor has said.

Cantor is also a governing partner of the Science of Learning and Development Al­liance and has shared her insights at events including the iNACOL (Aurora Institute) Symposium, Education Writers Association National Seminar, NewSchools Summit and EdSurge Fusion. In 2018, she appeared in and contributed to Edutopia’s How Learn­ing Happens project that includes videos viewed over 11 million times.

ISTE sat down with Cantor to learn more about this holistic approach to stu­dents and learning. 

What did we learn from 9/11 that can inform how we support kids after the COVID-19 outbreak?

At the time of 9/11, New York had the acute event happen at ground zero in lower Manhattan. That’s where the buildings came down, and there was an idea that all of us had then that kids who lived in the immediate proximity of ground zero were going to have the greatest impacts from this crisis. 

At the time, I was part of a group that did what is still the largest epidemiologic study on the emotional well-being of an urban school system. That study had a number of findings that really surprised us. One of the biggest surprises was learning that the most profound effects of 9/11 were not in the immediate proximity of ground zero. They were in the communities and the schools where children were living in deepest poverty.

There’s a story that illustrates the key point that I want to make both about how 9/11 is different from COVID-19, and what we can learn from 9/11 that will help us respond to the stress of COVID. 

I visited an elementary school in the South Bronx and a teacher had given their class an opportunity to do a drawing of what 9/11 meant to them. This little boy, Thomas, who was 6 years old, came up to me and showed me his drawing. In that drawing, there were two little boxes in the background that had smoke coming out. In the foreground, there were two stick-figure boys with guns pointed at each other.

The story of Thomas’ drawing was that for him, the stress and fear were local; it was something he saw every single day, and 9/11 was very far away for him. When I saw that, as a child psychiatrist who had specialized in trauma, I was seeing something that didn’t surprise me – that stress is local. It’s some­thing that’s happening in their immediate environment. And to be helpful to children, the response needs to be equally local. 

This has huge implications for how we understand COVID-19, because COVID is something that isn’t geographically isolated. It’s everywhere. And there are very few lives in the world, let alone in the United States, that are going to be untouched by COVID. So one of the things that can help us un­derstand how to respond is looking at the mechanisms of stress. That’s the unifying principle here. The experience of the pan­demic, its uncertainty, the losses and the stress, all of these things are going to activate stress mechanisms in children that need to be responded to. And for all intents and purposes, the context of stress is local.  

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What can you tell us about how children and adults respond to stress? What does stress do to the body and the brain?  

Adversity doesn’t just happen to children. It happens inside their brains and bodies through the biologic mechanism of stress. The way that happens is because of the in­terplay of two hormonal systems – one that responds to stress, which is mediated by the hormone cortisol, and one that responds to love, which is mediated by the hormone oxytocin. 

When we experience stress – all of us are pretty familiar with that feeling, for example, when we’re preparing for a performance or a recital – we get that feeling of fight, flight, freeze, which is associated with the release of cortisol. If the stress is mild or moderate, it’s great because it’s adaptive and it helps us prepare and it makes us alert. 

But if the stress is overwhelming, cortisol can do damage to some very criti­cal structures in the brain called the limbic system that consists of three structures: the prefrontal cortex for focus; the hippocam­pus for memory; and the amygdala, which regulates our emotions. These structures are covered with receptors to cortisol, but they’re also covered with receptors to the other hormonal system, and that’s oxytocin. 

So when we experience a relationship that provides safety and trust, it triggers the release of oxytocin, and oxytocin and cortisol start to battle with each other. But oxytocin is the more powerful hormone and triggering the release of oxytocin can protect children from the damaging effects of cortisol. It can help them manage stress, and it can even promote resilience to future stress. 

Understanding these stress mechanisms is absolutely crucial to how we can support adults as well as kids in the era of COVID.

This thinking leads us to something we’re calling “the COVID paradox,” because the message in COVID that we all heard was that the way to prevent the spread of this virus was to maintain physical distance from each other. But the way we need to protect ourselves from the emotional impact of COVID is through relationships, it’s through connection. So how do we do both at the same time? This is the paradox. How do we remain physically separate, while at the same time. remaining emotionally connected? This is the most important thing we need to solve for if we want to build resilience in ourselves and our children.

How do you think the impact on children post-COVID-19 will differ from post-9/11?  

The very big difference is 9/11 was a single event. It certainly had enormous implica­tions for our political lives globally and for our sense of safety in the world, but it was still a single event.

My reading of the current medical literature is that this new virus is going to be with us for a long time. It will be better man­aged when we have a vaccine, but the best estimates for the vaccine are 12 to 18 months from now. So we have no other way to pro­tect ourselves from this particular virus than managing the disruption in our lives. That happens as a result of the requirement that we physically distance. 

At Turnaround for Children, we’ve heard various timelines for when kids will return to school. We’re also hearing that districts are advising educators to prepare for distance learning as a part of life and a part of education moving forward. So this is very different, it’s not a singular event. This is something that will be with us and something we have to manage in an ongo­ing way in the months and potentially years to come.

How resilient are children in overcoming childhood trauma? What factors make the most difference for them to be successful later in life?

This is where some of the more optimistic things come into the conversation. Although we can observe that resilience in children and adults is variable and some people ap­pear to have more than others, resilience is not a trait, it’s a set of skills, and those skills can be intentionally promoted and built in children. 

We know, for example, that if relationships protect children from the damaging effects of cortisol by promot­ing oxytocin release, that helps children recover from the acute effects of stress. It enables them to build a very key skill that’s foundational to resilience – self-regulation or being able to regulate their thoughts and behaviors. 

Self-regulation is the prerequisite, the building block, for resilience. If we’re able – in the ways in which we set up our homes or ultimately set up our classrooms – to promote relationships, to establish order and routines, we’ll help build resilience in kids. 

In fact, Turnaround for Children has captured that message in what we call the three R’s: relationships, routines and resil­ience. And all of them can be built. 

For children who have been socially isolated for health or other reasons, what risk does that introduce to their development and how can we help them thrive in spite of it?

To answer this, we need to start with the principle that all children are malleable. Their brains are malleable, their bodies are really malleable and even their genetics are malleable. 

What we know as the most powerful driver of development for children is the context – the experience, environments and relationships that kids are in. So when kids are in an environment that’s constrained, whether they’re a child that has to be pro­tected because they have a serious illness or they have to be protected from COVID, the question is what are the essentials that need to be in any environment to drive the posi­tive developmental needs they have? 

They need relationships and trust more than any other single thing. And they need to have routines and things that happen in a regular, recurring way because routines help children begin to be able to focus and even catch up on things like learning. We also need those kinds of relationships and routines to build resilience. 

When children don’t have that, whatever the cause, a kind of dysregulated, chaotic, emotional state happens. In those states, children can’t focus their attention, they’re easily triggered in terms of their behavior and they’re at enormous risk for mental health issues like depression and anxiety disorders. 

So we have a choice in the way we construct environments around whether we want to push toward protective factors, which is what our three R’s are all about, or whether we’re going to continue to expose kids to risk factors in which they’re think­ing, emotions and behavior are going to be dysregulated.

What do we often overlook when considering learning and development in children and youth?

It’s interesting because those of us who are glass-half-full people in a moment like this tend to see a convergence of important ideas in a very positive and healthy direction. We would have said before the pandemic that schools that put relationships at the center of learning are going to activate the healthiest parts of a child’s limbic system, meaning their ability to focus, concentrate, remember, control their behavior and man­age their emotions. 

We need all of those things for a child to learn, whether it’s basic learning or to develop those wonderful higher-order skills like perseverance and self-direction, all of which depend on having these foundational regulatory skills. 

Even without the pandemic, our organization has been a thought leader on the science of learning and development, trying to move our education systems away from delivering content or filling kids up with academic content as a way of defin­ing learning, and instead moving toward a system that actually develops the learner in holistic ways. 

If you have that as your goal – that every learner should have higher-order thinking skills,  problem-solving and mastery of content areas – then we’re talking about designing a very different system, and rela­tionships are primary in that system. 

It’s not a coincidence that the very same system I’m talking about that’s the ideal for the 21st century is also a system that would help many more children manage the stress­ful contexts of their lives, which are abso­lutely going to interfere with their learning apparatus. 

If educators right now are thinking, how do we prevent learning loss, how do we have kids catch up on their mathematics, all of those kinds of things, if children’s brains are not open and receptive, it’s not going to work. We have to prioritize well-being and wellness. We have to prioritize relationships. And then we’ll have a cognitive apparatus that’s working.

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You talk a lot about the idea that context matters in learning. What do you mean by context and how can educators influence the context to maximize learning?

By context I mean the environments, relationships and experiences in a child’s life. It could be at home, it could be in a classroom.

Context has a series of concentric circles, but it certainly starts with a child’s primary attachment – a parent or grandparent – and moves out from there. All of these people and experiences are the drivers of develop­ment. This is a core finding of the science of learning and development that’s 180 degrees from what people believed at the beginning of the 20th century. 

Back then, people believed in genes, and the genes were the determinant of skills and talents and outcomes for children. It’s the opposite today. We know that nurture drives nature and that the opportunity we have, whether it’s at home or at school, is to be the drivers of development, of learning, of resilience – of all of those important and positive things for kids.

Some people feel like we ask way too much of our teachers. They are educators, coaches, counselors, cheerleaders, disciplinarians, foster parents, etc. If we want to care for the whole child, how can we do it in a way that doesn’t overburden teachers?

I do think we ask teachers to do too much, but I think that’s because we continue to add and we don’t subtract. Not everything we ask teachers to do is equally important. When we think about whole child design, we think about five elements. 

The physical and emotional safety in the environment; a culture of belonging; integrated supports; being intentional in building skills and mindsets; and rich, rigor­ous instructional experiences. 

One of the really interesting things we had the chance to work on was that series of videos produced by Edutopia, featuring Linda Darling-Hammond, professor of education emeritus at the Stanford Gradu­ate School of Education. Edutopia looked at classrooms in different schools across the country. These were not high-tech class­rooms, but what was so interesting was the ways in which teachers integrated the ele­ments I mentioned. 

We tried to highlight this in the videos by pointing out that teachers were forming relationships with their kids; there were lots of prompts around the classroom to scaffold learning for kids. They had children working together to solve problems. And in the process, children were building skills like self-regulation, executive function and growth mindset. 

The message here is that we were looking at teachers who were having a much more productive and satisfying day and students were having fun learning.
I believe we have to move to whole child design, but we have to do it in ways that integrate across practices and have teachers do the things that only teachers can do. One of those right at the top is the relationships they form with kids.

How can technology be used to enhance a child’s well-being?

The feature of technology that would change the game for kids is whether children are active in their use of it or if they’re passive recipients of content. If they’re passive recipients of content, I would say that’s actively harmful to kids, and particularly vulnerable kids, because vulnerable kids need intentional skill-building, particularly around self-regulation, executive function and growth mindset. 

There are a couple of things I can imagine that would be most important as far as enhancing a child’s well-being. One is that the actual way in which content is delivered is tied directly to skill-building.

But in order to build a skill, you have to practice. So, just like learning anything else, a child has to be active.  

You can’t learn the piano by listening to the piano. You have to learn the piano by playing the piano, and playing certain things over and over and over again. Building on this metaphor for a moment, if your teacher is listening to you play the piano and giv­ing you feedback, that’s the third leg of this incredible stool. Because something we now know is that one of the key ingredients to great teaching is great feedback – children continuously getting feedback about what they’re doing. 

Sometimes adaptive technologies can learn about students and give that informa­tion in real time to teachers. So there’s a loop of sharing knowledge, students actively engaging with it and creating information for teachers about how students learn so teach­ers get real-time feedback they can then use to help children. You know if a student’s do­ing well in a particular area that’s a virtuous cycle, and I think technology could play a very virtuous role in it.

What could an educator start doing tomorrow to better apply the science of learning and development in their practice?

The science of learning and development operates from the principle of the malleabil­ity of the brain and the ability of the brain to change as a result of the environments, experiences and relationships that children have. So if we were going to play by those rules, we would want a teacher to open that brain to learning – and that means children feeling physically and emotionally safe and connected. That’s number one. Number two is understanding that all learning is variable; it’s as variable as the brains we have, and no two children learn in exactly the same way.

So teachers have to be able to differentiate how each child learns, and using technology is an enormous boost to being able to do that. 

Then, teachers have to respond to kids in differentiated ways. So, a child that’s shut down because of stress is not going to learn more, just because they’re given more to learn. A teacher has to recognize that they’re going to need to do something to reduce the stress level in order for learning to start again. 

Another key feature here is that challenge grows the brain. I think that some folks, when I put the focus on relationships, perceive what I’m saying as being soft. What I’m actually saying, to use another metaphor, is that an athlete needs to prepare to run the toughest race. So if you prepare by doing all of the things we’ve been talking about and then face a challenge, it’s a very good thing for the brain. 

Then you really don’t just follow your assumptions about what children are ca­pable of. You give them challenges so that they discover what they’re capable of.

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(Photo by Brian Hatton)