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The National Academies of Sciences, Engineering and Medicine
Board on Children Youth and  Families
Division of Behavioral and Social Sciences and Education

BCYF Projects in Development

 

Study on Abusive Head Trauma in Infants and Young Children


Background and Need

Abusive Head Trauma (AHT), which includes, but is not limited to, what is known as "shaken baby syndrome (SBS)," is a serious, often fatal traumatic brain injury caused by forceful shaking, impact, or both. Symptoms include breathing problems, bleeding in the eyes, seizure, paralysis, and coma. Each year, almost 2,000 infants and young children are diagnosed at US hospitals with non-fatal AHT and it is estimated that another 150 sustain fatal inflicted head injuries. While the scientific community confirms the medical validity of the existence of AHT, there is debate about aspects of the diagnosis and the underlying causes. This is particularly true regarding the effect of shaking (as opposed to contact with a hard surface) and is particularly relevant to legal proceedings in which a medical diagnosis has also functioned as proof of both underlying cause and intent of the accused.

The identification of an infant with possible AHT presents many challenges to front line physicians: an accurate history of potential trauma is rarely available, the child is incapable of providing a verbal history, there is no single test to determine the accuracy of the diagnosis, and characteristics of the etiology of AHT overlap with, but may be distinguishable from, those of accidental injury and different developmental disorders. Further uncertainty is generated because the mechanisms of response to injury in the developing infant brain are only partially understood, although it is recognized that the infant's unique biochemical and physiologic makeup render the immature nervous system more vulnerable to trauma-induced injury.

Although physicians in multiple subspecialties view AHT as a cause of both significant neurologic morbidity and infant and child mortality, there is ongoing internal debate within the scientific community regarding the pathogenesis, diagnosis, and characteristic features of AHT. Systematic reviews highlighting the injuries associated with AHT and those arguing against its diagnosis have been published. Some have been criticized for improper methodology and bias. Another issue that has emerged is the use of biomechanical modeling techniques to quantify the contribution of physical shaking to AHT. Clinicians and researchers acknowledge that although biomechanical models can improve the understanding of kinematics during shaking, thresholds for infant neuropathological injury remain unclear, and a biofidelic model of the infant body has yet to be developed. The civil and criminal justice systems are typically involved in cases of abuse. Thus, scientific discussion related to AHT often occurs during the course of legal proceedings in the courtroom. However, general acceptance in the form of Frye or Daubert standards regarding the admissibility of scientific evidence have not always been applied to the case of AHT. This becomes particularly problematic when medical diagnoses of AHT are used as the basis for determination of intent to harm and/or murder. Indeed, physicians are limited in their ability to determine manner of death and whether the source of trauma was in fact intentional abuse.
This requires inferences about intent and knowledge of other evidence linking individuals to the time and place of death. Determination of manner of death by the same person making a causal diagnosis can lead to contextual bias, violating the task irrelevant information guideline promoted by the National Commission on Forensic Science. In the case of AHT, manner of death and inferences of intent are inextricably tied to diagnosis of the mechanism ('abusive', 'shaken'), which further cloud the issue. Additional topics debated in the court system include: the validity and criteria of diagnoses of AHT, the pathophysiology and etiology of subdural and retinal hemorrhage in infants, the contribution of birth trauma to later neurological collapse, the clinical presentation and timing of injury in abused infants, and the validity of alternative diagnoses to account for evidence of traumatic brain injury. This debate makes it difficult for judges and jurors who are tasked with adjudicating critical issues of intent and motive, and actors in the legal system are in need of clarity on best practices for handling and reviewing evidence in cases of diagnosed AHT. The medical community is also in need of clarity on appropriate evaluation for patients admitted with suspected abusive injuries. There is thus an immediate need for an objective review of the available evidence, informed of the high-stakes ramifications in the courtroom, to assist medical, legal, and social services professionals.

For further information on this study in development, please contact Natacha Blain, Board Director, at nblain@nas.edu.
 



Exploring the Opportunity Gap for Young Children from Birth to Age Eight

Background and Need

For nearly 20 years, American schools have been under increasing pressure to measure student achievement as a means of holding schools accountable for the quality of public education available to children. For many young children (birth to age eight) in the United States, unequal opportunity—both in and out of school—from the time they are born can have long-lasting impact on future academic outcomes and opportunities in life. Although achievement and opportunity appear to be related, they are not one in the same. The opportunity gap refers to the potential causes—societal conditions that preclude equal access to high-quality educational opportunities—while the achievement gap refers to the effect—subgroups of children who demonstrate lower performance than others and subgroups of children who do not achieve at a recognized level of performance.

More needs to be understood about what constitutes the opportunity gap and its relationship with the achievement gap and how these concepts should be defined and measured. Our understanding of the trajectory of opportunity across the birth to eight continuum requires greater attention and analysis, as well as the long-term effects of the opportunity gap on young children's learning and development across domains. This focus will enable us to better understand the intertwined relationship of the opportunity gap and the achievement gap. Demographic characteristics (e.g., race/ethnicity, gender, socioeconomic status, language learner status, child's age, geographic location) are associated with experiences of institutional racism and discrimination, and more needs to be understood about certain subgroups of children who may be differentially affected by the absence of specific opportunities, or whether this has a negative impact on young children across racial, ethnic, socioeconomic, and linguistic designations. Studies looking at contextual factors that impact academic outcomes have addressed many challenges facing children. For example:
• Disparities by income in terms of cognitive skills, health, and behavior have been found as early as eighteen months of age.
• African-American and Hispanic/Latino children enter kindergarten 7 to 12 months behind their peers in reading and 9 to 10 months behind in mathematics, on average.
• Higher-income parents are more likely to have paid parental leave benefits at work, are more able to take unpaid leave to spend time with their newborn children, and are more likely to invest in their children's education, including enrolling their children in early care and education programs.
• Children from families with higher incomes are substantially ahead on measures of reading and mathematics school readiness and measures of social and emotional development, such as teacher-reported self-control, attention, and peer relationships.
• Programs such as Head Start and Early Head Start, while targeted to low-income families, are underfunded and do not serve all children who are eligible to receive services.
• National levels of teacher quality in the United States are similar to international peer countries, yet the gap in access to qualified teachers (i.e., those who have earned a specialized degree, teacher certification, and have at least 3 years of experience) in the United States between students of high and low socioeconomic status is among the largest in the world.
• Children who live in neighborhoods with high concentrations of families who are economically disadvantaged are more likely to attend under-resourced schools, to have less-experienced teachers, and be bullied by peers.
• Children living in rural areas go on to take advanced mathematics once they reach secondary school at a significantly lower rate than their urban peers and are less likely to go on to attend college.
• Integrated learning environments with students from across the socioeconomic spectrum have been shown to be beneficial for all children, including those from disadvantaged households.

School systems across the country must continue, of course, to measure the academic outcomes of students and ensure that they are learning. At the same time, overall outcomes for children might be improved by efforts to keep opportunity gaps from becoming achievement gaps (e.g., addressing school factors such as institutional racism, culturally relevant curricula, and disciplinary policies). Since many factors begin to influence the trajectory of at-risk children before they even reach school age, closing the opportunity gap may require a deeper and integrated examination of family and community factors, such as family and community engagement, parent/caregiver academic achievement, health of parents and/or child(ren), and cultural norms.

For further information on this study in development, please contact Natacha Blain, Board Director, at nblain@nas.edu.


 
Policies to Reduce Intergenerational Child Poverty

Background and Need

Some 13 million U.S. children—17 percent of all children– currently live in families with incomes below the federal poverty line. Nearly 40 percent of children will live in poverty at some point during their childhood. Poor children are more likely than their more affluent peers to struggle in school, to suffer neglect or maltreatment, to have behavioral problems, and to experience problems in their physical and emotional health and development. These challenges and disadvantages pose long-term developmental consequences as these children grow into adulthood. The intergenerational transmission of poverty is thus perpetuated, as poor parents have poor children, who are more likely to become poor adults themselves.

As documented in the National Academy’s 2019 report A Roadmap to Reduce Child Poverty, the harmful effects of living in poverty on children’s health and development, educational progress, economic prospects, and general welfare persist into adulthood. Children who experience poverty are more likely to become unmarried parents before age 20 and to experience poverty as adults. They are at increased risk of criminal involvement and diminished prospects for future college attendance, employment, and earnings. Despite the resilience some children display, these disadvantages are often perpetuated across generations and reflect stark racial and ethnic disparities. Poor children tend to lack the supports and resources—including a two-parent family, consistently employed parents, high-quality schools, and other forms of social and economic capital—that could help them escape poverty as adults.

Broader social, economic, and demographic factors play a role in determining which families and individuals will be poor. Poor children are often part of families and communities that struggle with multiple social and economic disadvantages, such as insufficient or substandard housing, high rates of unemployment, high rates of crime and substance use, family trauma and mental or emotional problems, food insecurity, and inadequate access to affordable, high-quality early childhood care and education. These circumstances serve to entrench poverty within families and communities and perpetuate racial disparities in poverty rates from one generation to the next.

For further information on this study in development, please contact Natacha Blain, Board Director, at nblain@nas.edu.
 



Workshop on the Use of Technology in Education


Background and Need

Since the 1970's, technology has played a role in US classrooms. Long viewed as a powerful tool that could bolster learning both directly and as an adjunct to teacher-directed lessons, computers--and now other informational technologies--have become pervasive. In 1984, there was 1 computer per 125 students in the US; in 1998 there was 1 per 7 students; and in 2008 (the last year that data are available) it was 1 per 3. These data are but a small part of the picture since they do not include home computer use or, for that matter, smart phones which are, for all intents and purposes, pocket computers that are virtually ubiquitous by the time students start high school. The potential value of information technology as a learning aid cannot be overlooked or underestimated. Even beyond any direct and measurable educational benefits, computer literacy and fluency are essential life skills in today's highly technology-reliant society. Still there are potential downsides to the widespread use of technology. Problematic internet use is rising among children and adolescents and many teachers report that digital devices in the classroom are distracting as students often multi-task by mixing education with entertainment. Equally notable, is some emerging research that suggests that note taking with paper and pencil is more effective in retaining information than note taking on a laptop and that screen use can lead to deficits in social cognition.

This reliance on technology is occurring at a time when educational outcomes in the US compare unfavorably to other industrialized countries. In a global context, US high school students consistently rank below average in math and close to average for science and reading. The salient question then is what role can information technologies play in improving educational outcomes? Or more important, how can we maximally leverage the benefits they offer while ensuring that the risks are minimized? These questions are of great interest to parents, teachers, school boards, and of course, policy makers. They also have considerable financial implications as the federal government spends as much as $4 billion annually to subsidize telecommunication services in schools, and federal, state, and local governments spend more than $13.2 billion to directly purchase educational technologies.

The scientific landscape of ICT and learning is as vast as it is complex. It spans multiple platforms, multiple age ranges, multiple educational milieu, and multiple socio-economic backgrounds. It also involves many different disciplines including psychology, economics, pediatrics, and education, to name a few. Moreover, there are varied vested interests in promoting or opposing the use of ICT in classrooms including teachers' unions and advocacy groups, parent organizations, educational software developers, and computer manufacturers. Given this array of stakeholders and researchers, it is not surprising that the hundreds of studies conducted over many years and in many different settings have reached conflicting conclusions. The proposed workshop will identify some of the key issues and contradictions in the research and explore the state of the evidence related to use of technology.

The workshop will inform the development of a subsequent NASEM consensus study that will explore the evidence-base in depth and provide clear and actionable recommendations for schools, teachers, parents, and policymakers.

For further information on this workshop in development, please contact Natacha Blain, Board Director, at nblain@nas.edu.


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