Some of the youngest learners need mental health treatment

Some of the youngest learners need mental health treatment

By Margaret Ramirez

A rare dose of treatment for preschoolers traumatized by violence

CHICAGO –– When 3-year-old Julian started throwing tantrums in preschool, his teachers were unsure how to handle him. His screaming, inconsolable crying and violent outbursts soon escalated to the point where he threw a chair at a teacher. He was subsequently kicked out of the childcare program.

His mother, Angelica Pabon, knew the reason for Julian’s anger and aggression: A few months earlier, the young boy had witnessed his father being shot to death. To recover from the traumatic experience, Julian needed a preschool capable of working through his emotional problems while supporting his academic growth.

After a referral from a social worker, Pabon enrolled Julian at Erie Neighborhood House, one of the few early childhood programs in Chicago offering educational and mental health services for young children. There, he received close attention from teachers in a therapeutic classroom to control his anger. He also attended one-on-one “play therapy” sessions with a psychologist. That was six years ago. Today, Julian’s mother says, he is a 9-year-old doing well in fourth grade at a Chicago public school.

“If I hadn’t come to this program, they would have placed Julian in special education, not because that’s where his mind is, but because of the way he was acting,” said Pabon, 28, a single mother of four who works in a hospital insurance department.

Angelica Pabon with her 3-year-old daughter, Liliana, who attends Erie Neighborhood House, a preschool program that provides academic and mental health services for young children. Her older child, Julian, received help there after witnessing the murder of his father. (Photo: Julienne Schaer)

Julian’s case illustrates a larger, more complex issue simmering inside many of the nation’s early childhood centers that serve children impacted by violence and poverty. According to a recent nationally representative survey, 13 percent of infants a year-old and younger and 44 percent of all 2- to 5-year-olds were assault victims in the prior year. Eight percent of infants and 14 percent of 2-to 5-year-olds had also witnessed violence. Other studies have had similar findings.

Most assaults on young children did not involve a weapon or result in injury, and siblings and playmates were the most common perpetrators. Still, early education experts say, any experience of violence can be traumatic. Yet few preschools have mental health professionals on staff, leaving many children in danger of falling through the cracks. Early investment would save money as well as heartache later on, experts say.

“If we put that money at the front end, we will spend less on special education classes for behavior disorder, we will spend less on adolescent substance abuse, we will spend less on gang violence, we will spend less on the juvenile criminal justice system,” said Margret Nickels, a clinical psychologist at Chicago’s Erikson Institute who is known as an authority on early childhood mental health.

In West Town, the largely Latino neighborhood where Erie’s early childhood program is located, many young children have seen violence in their homes or communities. Others show anxiety due to family hardships involving poverty, unemployment or immigration status.

On weekday mornings, mothers clutching their young children’s small hands steadily file into the Erie Community Center for drop-off. Erie Community Center is home for the early childhood program and is one of three Chicago locations managed by Erie Neighborhood House. The sprawling three-story brick building on West Superior Street houses a dozen classrooms for more than 170 children. Five classrooms serve 2- and 3-year-olds and the remainder for 3- to 5-year-olds.

To offer mental health services, the program spends $160,000 annually for a full-time psychologist and social worker who provide treatment for about 70 children each year. But Erie also relies heavily on unpaid graduate students, and officials estimate the true value of their services is more than double the current budget, which is supported by federal, state and private funds.

Erie Neighborhood House psychologist Elizabeth Yelen works at a sandbox with 5-year-old Anjel. The sandbox is used in play therapy sessions with young children to help them express thoughts and feelings. (Photo: Julienne Schaer)

Erie psychologist Elizabeth Yelen, who has treated hundreds of children in her 16-year career, said traumatized young learners who don’t get help in the early years are in danger of long-term academic difficulties that are far more expensive.

“A lot of them go to school with less information because their behavior impacts their learning,” she said. “They’re already feeling bad because they might have failed in preschool, which is hard to fathom, but it happens.”

She said children do better in school when they come out of preschool feeling safe and successful and knowing how to interact with their peers.

The long-term impact of violence on a young mind is real, experts say. And studies show that experiencing violence in early childhood can lead to lasting physical, mental and emotional harm, whether the child is a direct victim or a witness. Young children who are exposed to violence are more likely to suffer from attachment problems, anxiety and depression, leading to aggression and behavioral issues.

Exposure to violence can also lead to various health problems and make children more likely to be involved in the juvenile justice system. Even community violence that children do not directly witness has been shown to hurt their ability to pay attention as well as their cognitive performance.

According to experts, treating such children requires close collaboration between teachers, social workers and parents.

In the case of Julian, whose last name is being withheld for his protection, the boy was showing a range of intense emotions, from anger and aggression to profound sadness and neediness. He was literally breaking down, Yelen said. The beginning of his treatment, and in some ways the key to his later success, started with a simple act: A teacher held him.

“The teacher who was in that classroom at the time held him a lot,” Yelen said. “He needed to be held. He needed to be nurtured. And that’s what we were doing.”

For children like Julian who have witnessed murder, “how much scarier can it get?” she continued. “They are completely flooded with anxiety. A lot of our job is helping them to feel safe. And if you feel safe, you can learn.”

Ana Perez and her daughter Angelina, who received services at Erie Neighborhood House in Chicago with psychologist Elizabeth Yelen (right). (Photo: Julienne Schaer)

Julian’s mother also received guidance at Erie on how to work through Julian’s emotional problems at home. Pabon recalled how after his father’s death, her son would constantly ask questions. Before therapy, the young mother would become exasperated and tell him to “stop asking questions.”

“He would always ask, ‘What are we going to do?’ and it’s because he’s afraid, he’s scared, he doesn’t know what’s going to happen,” she said. “So now I know that I have to explain everything: ‘First, we’re going to do this, then we’re going to do that.’”

Although Julian no longer receives services at Erie, two of his younger siblings, 5-year-old Anjel and 3-year-old Liliana, are currently enrolled there.

Nickels said there is a growing need for psychologists and social workers at preschools to support teachers in working with children’s emotional needs.

In response, the Erikson Institute’s Center for Children and Families last year opened a neighborhood-based therapy office in the Austin neighborhood, an underserved Chicago community with a high rate of violence. Nickels, the center’s director, said several of the first children who came for therapy were 3-year-olds who had been expelled from preschool or childcare centers by teachers with no knowledge of how to handle traumatized children.

While the link between trauma and brain development has been well documented, Nickels said she still encounters ignorance on the topic from childcare workers, preschool teachers and even principals who wrongly believe that young children don’t understand what is happening and are not impacted.

“Shouting, watching your parent get hit, these are emotional and physiological experiences that even infants perceive and trigger intense stress reactions,” Nickels said.

“These intense stress reactions are carried by brain chemistry that have, in turn, a very damaging impact on brain development. The substances that are being released during stress responses can either halt or reverse important brain developmental processes. It can literally destroy very vital connections that are formed as the brain develops during those first few years of life.”

Early recognition and treatment of emotional problems in young children would likely decrease disciplinary action and reduce the number of children misdiagnosed as special education students, she said: “If we understand that this kind of exposure to stress literally disables children in many ways that are needed for school success…then we understand why they’re not listening. It’s because they can’t. They’re not aggressive because they’re just bad. It’s because they don’t know what else to do. So it becomes an issue of, ‘What do we need to teach them?’ rather than, ‘Why are they doing this to us?’”

Angie Perez, 5, attended Erie Neighborhood House in Chicago for preschool and received therapy to help her handle a troubling home situation. (Photo: Julienne Schaer)

Inside Erie Neighborhood House’s early childhood program, the preschool classrooms appear like most others at first glance, with children stacking blocks and coloring art projects. However, the program is different in several important ways. In addition to a lead teacher, each classroom has three psychology graduate students who assist in assessing each child’s emotional needs. This fall, Erie has a total of 11 psychology graduate students who will likely carry 10 cases each.

During naptime, teachers meet with Yelen and her psychology students to develop plans for emotional growth through play therapy and academic growth in the classroom.

On the building’s lower level, children who need individual attention participate in weekly play therapy sessions with Yelen or one of the graduate students. The cheery therapy rooms are painted in bright colors and stocked with toys, a sand and water play table, and a poster with photos and drawings illustrating various emotions including happy, worried, surprised and sad.

Of the 174 children enrolled at Erie, about 70 receive either play therapy services or psychological evaluations.

Children guide Erie’s process of play therapy and choose what to play, paint, color or say in a 60-minute session. Music is used when appropriate. Therapists observe and interact according to a child’s individual needs. But the overriding goal is to help children feel a sense of safety by developing a therapeutic relationship, Yelen said.

Erie preschool teacher Angelic Santos who has taught young children for 10 years, said the collaboration between teachers and psychologists is crucial to connect educational and emotional goals.

“For a child to be able to focus and learn and understand, they need to be settled emotionally,” she said. “If they are worried about all the other stresses that they have, whether it’s domestic violence or not having enough food at home, if they don’t learn how to cope, they are going to be too distracted. By addressing all those issues, we can help them to focus and even find solace in education and going to school.”

Though much attention focuses on traumatized children who display anger and aggression, others show more subtle behavioral changes that translate into a quiet cry for help.

Two years ago, Ana Perez recalled how a domestic violence incident caused her then-3-year-old daughter, Angie to change dramatically from playful and outgoing to detached and withdrawn.

Angie became a perfectionist, so obsessed with clothes and her appearance that she would cry if she didn’t like how she looked. Yelen said it is common for kids to manifest their internal struggles with a fixation on external appearance.

After two years of therapy at Erie along with family therapy, Angie, now 5 and in kindergarten, has gained self-confidence and become more engaged and excited about school, said Perez, 38, a petite, soft-spoken, mother of four working as an office assistant for a furniture company.

In play therapy, at Erie, “they’re able to be free in what they want to say because Mom is not there,” Perez said. “Now, Angie is very blunt, and I think that’s because of therapy. And I love that because I’m not scared that she’s holding something in.”

Over-testing our kids is not the answer — it’s the problem

Over-testing our kids is not the answer — it’s the problem

by Anya Kamenetz

In the era of No Child Left Behind and Common Core,
we’ve forgotten about the learning and development that matter

“I’m writing a book about school testing.”

 “Thank goodness. It’s about time.”

That’s the conversation I’ve been having again and again recently. As an education writer for the past twelve years and as a parent talking to other parents, I’ve seen how high-stakes standardized tests are stunting children’s spirits, adding stress to family life, demoralizing teachers, undermining schools, paralyzing the education debate, and gutting our country’s future competitiveness.

The way much of school is organized around these tests makes little sense for young humans developmentally. Nor does it square with what the world needs.

My husband edited together a two-minute time-lapse video of our daughter learning, over several months, to walk: standing up on wobbly legs, waving her hands with a “Woop!” crashing back down on her rear end, toddling a few steps into our outstretched arms, and, finally, crossing a room. It’s pretty irresistible, if I do say so myself.

Parenting my daughter in the first years of her life has been a master class on human development. She is so driven to explore her environment and to express herself, to communicate with, please, and sometimes resist the people around her. She doesn’t just walk—she walks toward something. She doesn’t just speak—she speaks to someone. Mental, physical, emotional, and social milestones are all intertwined.

In the first year or four, children are hardly ever bored, unless they’re hemmed in by “Nos.” They stay in the proverbial state of flow, right on the edge of their abilities. Provided they get the emotional refueling they need to feel secure, they are always reaching for the next milestone, stumbling, teetering, and getting up again.

All the experts are constantly reminding parents that infants develop on their own timetables. The overall trajectory of growth and progress is more important than any particular snapshot in time. Furthermore, early learning is as much about creative expression and social engagement as it is about parroting any memorized patterns, like letters or numbers. Good preschools are little Paris salons—full of art, music, movement, rivalries, friendships, love, and, above all, imagination. They are also highly concerned with the practical matters of life, such as the use of forks, buttons, faucets. Folding laundry and washing dishes can be just as absorbing for toddlers as reading books and singing songs.

Yet just a few years later, when kids enter school, we start to limit our consideration of learning and development to a single hand-eye-brain circuit, forgetting the rest of the body, mind, and soul. It’s math and reading skills, history and science facts that kids are tested and graded on. Emotional, social, moral, spiritual, creative, and physical development all become marginal, extracurricular, or remedial pursuits. And we suddenly expect children to start developing skills on a predetermined timetable, one that is now basically legislated on a federal level. This is what is called rigor and high expectations. But it’s woefully out of date.

Still, as a parent, I have to admit that if you give my daughter a test—any test—I want her to score off the charts. Tests seductively promise to reveal the essential, hidden nature of identity and destiny. Everyone wants to see good numbers.

This is a book about reconciling that dilemma. If you can’t manage what you don’t measure, as the business maxim goes, how do we measure the right things so we can manage the right things? How do we preserve space for individual exploration while also asking our children to hit a high score? Is there any way to channel the collective thirst for metrics and data into efforts that actually make our schools and our communities healthier and our children more successful?

The modern era of high-stakes standardized testing kicked into gear at the turn of the twenty-first century, with federal No Child Left Behind legislation mandating annual math and reading tests for public school children beginning in third grade. It has not been a golden age. Standardized testing has risen from troubling beginnings to become a $2 billion industry controlled by a handful of companies and backed by some of the world’s wealthiest men and women.

The near-universally despised bubble tests are now being used to decide the fates of not only individual students but also their teachers, schools, districts, and entire state education systems—even though these tests have little validity when applied this way.

Attaching high stakes to the outcomes of individual tests is an error that economists call “Goodhart’s law” and psychologists call “Campbell’s Law.” This has been stated most simply as: “When a measure becomes a target, it ceases to be a good measure.”

If you give people a single number to hit, they will work toward that number to the detriment of all other dimensions of success. The more you turn up the pressure to hit that number, the worse the distortion and corruption gets.

A recent example of Goodhart’s law is the 2008 case of thousands of pounds of Chinese infant formula and milk powder adulterated with toxic melamine. Why would you add something like this to food in the first place? Melamine is a nitrogen-based industrial compound. Dairy products are tested for their protein content to ensure good nutritional quality. But most tests of the level of protein in food actually just check for the element nitrogen, as protein is the only wholesome source of nitrogen in food. So adding melamine powder to a food raises its apparent nutritional value. The food inspectors asked for a simple number—How much nitrogen is in this?—in place of a more complicated value—Is this a healthy food? And they got what they asked for.

In a 1976 paper, multidisciplinary social scientist Donald Campbell cited educational testing as a case of Goodhart’s law. “Achievement tests may well be valuable indicators of general school achievement under conditions of normal teaching aimed at general competence,” he wrote. “But when test scores become the goal of the teaching process, they both lose their value as indicators of educational status and distort the educational process in undesirable ways.”

That undesirable distortion is exactly what is happening today.

The stakes for the state tests currently given annually in public schools are enormous. They determine eligibility for grade promotion and graduation. This shuts out large numbers of minorities, the poor, English language learners, and the learning disabled. They double as performance metrics for teachers, who are being denied tenure and even fired based on their students’ scores. Schools that fail to meet test score targets are sanctioned, lose their leadership, or close; districts and states must give the tests and follow the rules or else lose billions of dollars in federal education aid.

These are only the most obvious, direct effects of testing. The indirect effects of judging our schools with these numbers ripple outward through society.

The Two-Income Trap was a best-selling book cowritten by Elizabeth Warren, now a senator from Massachusetts, with her daughter, Amelia Warren Tyagi. It was published four years before the mortgage crisis.

As Jill Lepore summarized in the New Yorker: “With two wage earners and low down payments, middle-class families took on bigger mortgages and contributed to an increase in the cost of housing, especially when families with children paid a premium for property in school districts with high test scores”—test scores that were newly available in the early 2000s thanks to No Child Left Behind and published in many districts.

The feedback loop is closed when rising real estate values result in higher property taxes, meaning even more money flows to the schools that post the best scores.

In the book Warren advocates a universal public voucher system to neutralize the unequal effects of local property taxes on school funding, a position she’s since revised.

Of course there were many factors that contributed to the so-called Great Recession, but a lot of them, like this one, seem to trace back to an overreliance on numbers at the expense of good sense and heedless of the broader social implications.

In any case, the high-stakes madness is going to get worse before it gets better.

In 2015 the phase-in of the Common Core State Standards in forty-two states brings with it new, more difficult, and longer mandatory tests to nearly every classroom in the nation, up to five times a year. Scores are projected to drop sharply—the “Common Core Cliff”— and even more kids, teachers, and schools will be labeled failures as a result.


The test obsession is making public schools, where nine out of ten American children are enrolled, into unhappy places. Benchmark, practice, field, and diagnostic exams are raising the total number of standardized tests up to thirty-three per year in some districts. Physical education, art, foreign languages, and other vital subjects are going on the block in favor of more drilling on core tested subjects. In one Florida high school a student reported that her brand-new computer lab was in use 124 days out of the 180-day school year for testing and test prep.

Like so many other Gen X and Gen Y parents, I’m committed to sending my daughter to a public school, both because private school would be a financial stretch for our family and because I have a strong personal belief in public schools as the building block of democracy. But I can’t ignore what I’ve been hearing.

Parents are sending kids to public schools with high test scores and great reputations, only to come up against an unyielding rigidity that I trace directly back to The Tests. In poorer districts, teaching to the test is even more likely to replace the other activities that students desperately need.

The charter schools that are supposed to provide educational choice are captive to data-driven decision making that results in even more test score obsession to please lawmakers and private donors with good-looking figures.

I’ve heard from parents whose kindergartner was shy at first, so she got placed in the slow reading group. Or everything was fine until third grade, the first testing year, and then their son started getting stomachaches every night. Or their twins, who were reading grade levels ahead of the rest of the class, wanted to bring in their own books, and the teacher said no. Or their daughter is a great reader who overthinks the answers on multiple-choice questions. Or their son loves math but is frustrated by the long word problems with written explanations used to satisfy the Common Core State Standards.

Whatever subject the kid hates the most, “targeted interventions” on that subject grow to take over all of school. Instead of customizing learning to each student, standardization dictates one best way. In the end it seems pretty much everyone gets left out.


Here’s what’s so insidious about this test creep. It’s something I didn’t realize before I had my daughter: it’s not just the child who takes the tests. I can tell you all day that I want my kid to be a natural learner, immersed in her passions, following her bliss, unfolding like a flower just at her own pace, but don’t I know the exact day, week, and month when she said her first word? Don’t my husband and I keep a Google doc tally of all of her milestones? Don’t we use the G word—genius—unironically, several times a day, to label a child who’s barely potty trained?

Rationally, I know how crazy this obsession with metrics and data is, how counterproductive. I could talk to you all day about developmental variations and multiple intelligences and student-driven learning. But I think it’s a natural human instinct, brought to excess by the anxious times we live in, that just wants my daughter to be the winner, even when I know winning is beside the point, even when I know it would be good for her to lose sometimes. I know I’m not the only parent out there with these tiger tendencies. And I know this tension has got to be resolved somehow if we are to move forward.

As the mother of a preschooler, my highest priority is to protect her innate resilience, curiosity, and joy. One huge threat to that is sixteen years of high-stakes, high-pressure, highly regimented schooling and testing. I wrote this book to give you and me the tools to build a shield.

The Test is a tour of our test-obsessed culture. Part 1 is “The Problem.” We’ll look at the troubling history of standardized testing and the mystery of human intelligence: What is it, exactly, and does it really exist? Then we’ll continue into the Cold War birth of today’s testing mania and the toll it is taking across our education system.

The second half of the book is “The Solutions.” I visit the schools, labs, and other sites where educators and innovators are moving beyond the limitations and distortions of today’s high-stakes standardized tests. What if evaluation and feedback could be an integral, joyful part of the learning process? What if the data schools collect actually served our communities? This book has a positive vision for accountability that really works.

In the last chapter I’ll give you an actionable set of strategies borrowed from fields like games, neuroscience, social psychology, and ancient philosophy to help children do as well as they can on tests and, more important, to use the experience of test taking to do better in life.

I use a simple acronym, TEST, to remember these win-win strategies.

Manage the Test: Realize what the tests are for and how they work, and come up with a strategy to take them well.

Manage Emotions and Energy: Emotional intelligence and the mind-body connection can be cultivated for optimal performance in school and in life.

Manage Self-Motivation: Successful children set their own goalposts instead of abiding by external marks. Motivation and effort matter most. For these the child has to take the lead.

Manage your Tone: Instead of focusing on preparing your child, focus on your own attitude and the messages you’re sending as a parent.


While we subject our offspring to endless measurement, what is really being tested? It’s our values as parents—the kind of kids we want to raise and the kind of society we want to have. The testing obsession is damaging our education system. It is damaging our children. But our society is locked into a testing arms race. The parents who have the most time, energy, and resources are afraid to stop playing the testing game for fear their children will be left behind. The schools that serve the children with the fewest resources are even more determined to push them toward standardized test performances that can somehow make up for everything else they lack.

Some parents will read this book and decide not to subject their kids to any more tests. Some will find ways to make the testing experience better. Some, I hope, will be inspired to work toward a collective solution. Whatever you choose, as parents we can—we must—transform our families’ relationships to these tests.

How do we keep our own parental anxieties in check to build corresponding resilience and calm in our children?

How do we let our children be who they are while also motivating them to be the best they can be?

How do we build a world where every child is challenged to achieve her own personal best?

The answer is not multiple choice.