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Interview with Pediatric Disorders Series Editors Paul McCabe and Steven Shaw

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Dan Florell:  Welcome to NASP Dialogues, the dialogue podcasts focused on events and issues in school psychology. I'm Dan Florell, the NASP webmaster and moderator of our current dialogue. Today we are discussing the book "Current Topics and Interventions for Educators." Today we have Steve Shaw and Paul McCabe with us. Paul, why don't you tell us a little bit about yourself?

Paul McCabe:  Well, thank you for having me here. I am an associate professor at Brooklyn College, which is part of the University of New York. My background is‑‑ I am both a clinical and a school psychologist, so I have experience in school settings as well as in hospital psychiatric types of settings. The research that I have done has focused on pediatric issues as it affects kids and their ability to be successful in schools, also early childhood development. That played a role in how we developed this project.

Dan:  Thanks. Steve?

Steve Shaw:  I am assistant professor at McGill University in the school psychology program. Before that, I was a practitioner for eleven years. Most of that time was spent as lead school psychologist in a hospital setting. Much of my research comes from experiences working with children with genetic issues, as well as I was always temporarily "on loan" to the Oncology department; so working with children with cancer as well. Those experiences really led to taking on medical issues as an important area of research.

Dan:  Well, it's good to have you both here. What we are going to talk about is your new three book series that's co‑published by NASP and Corwin Press. Entitled "Current Topics and Interventions for Educators" is the umbrella term and then the three volumes. The first one we have is Pediatric Disorders. The second one Genetic and Acquired Disorders, and then the third, Psychiatric Disorders. I think when a lot of our members start getting to hear multiple volumes they have visions of Best Practices and its all encompassing nature. So I need to ask there is this book or series of books an encyclopedia of medical issues?

Steve:  No. It really isn't. The Encyclopedia of Medical Issues would be bigger than Best Practices. I really didn't want to work that hard. I don't know about Paul... [laughter]

Steve:  But, really what it is, I think it’s more pointed. It's more to the point of "What are the current issues that are giving school psychologists problems?" That are most relevant? That are most current right now? These are the medical issues that everyone is thinking about. That's what we wanted it to be. We wanted current and timely, as well as not covering the five hundred chapters that would be necessary for it to be an encyclopedic issue. We wanted to cover the most important issues.

Paul:  Yeah. Just about what Steve said ‑‑ most encyclopedias will have a real breadth. They cover almost every disorder, different types of diseases, genetic issues, and so on. But, you are limited to typically a half a page or a one page sort of a summation of that disorder. Those certainly have a place, and they are helpful in terms of looking up a topic of interest. We wanted to really have depth. We wanted to go into a specific disease or disorder, really study what's happened in terms of research there, and to give practitioners a real scholarly update.

What we know and don't know. That's important. Especially the don't know. So they know how to, then, move forward at that point. I think that is a real strength of this volume.

Dan:  Paul, could you tell me when you decided to make that switch from maybe an encyclopedia to narrowing it down? Obviously, there is going to be some challenges there in what to include and what not to include. How did this project evolve over time to it's current state of the three book format?

Paul:  These books originated from a feature that's in the Communiqué. The NASP Communiqué called Pediatric School Psychology, which has been ongoing for roughly five years‑‑ give or take. What we have tried to do in that column is we have tried to talk about current pediatric issues that practitioners are facing. Again, to do a real thorough scholarly review of what's going on related to that topic, and then to then to wrap up those pieces talking about what can school psychologists do. We always wrap up with implications for school psychologists. What can they do right now in their schools for kids who are having some of these difficulties?

From that series we developed this book project. Really what we wanted to do was take those kinds of topics ‑‑ again, making sure that they were really current, really relevant ‑‑ and giving it that real scholarly treatment like we did for the Communiqué articles.

In terms of picking the topics, often we started with just seeing what's going on with the news. For instance, one of the chapters is on steroid use in adolescents and I was one of the co‑authors of that. That started when I was actually watching the congressional hearings on adolescents who were using steroids.

There were a few incidents of adolescents who had attempted suicide, and unfortunately several who had committed suicide after stopping steroid use. So, Congress was investigating this and trying to find out "What do we know about steroids?"

That's just one example of a very current topic that was important. Practitioners wanted to know more, so we decided to investigate that. That really, I think, characterizes the whole series. These are all topics I think that people are going to find are very relevant, and important in their everyday practice.

Dan:  I was going to say I think we find some of the initial indicators anyway, here at the convention, that your books seem to have sold out actually. I guess the relevance and also the thirst for knowledge in regards to a lot of these disorders seems to be fairly high, if that's any indicator. Steve, what would be the intended audience for those books? Paul talked a little bit about practitioners. Could you elaborate on that?

Steve:  Right. Even though we are at NASP, at the NASP conference for school psychologists, we see the audience as being even broader than that. School teachers, therapists, counselors, administrators, ‑‑ all would be an excellent audience for this book. These individuals are asked to work with children, work with classrooms, or to develop policy that has an awful lot to do with medical issues. Yet, rarely do they have any training involved at all. We wanted to get that balance between something that was readable and accessible, and practical, yet also became a lot more in depth.

It was a lot more scholarly than, for example, a WebMD search, or a Google search or something like that ‑‑ which is what most of us really do. This was an opportunity to put everything in one place. To review the literature in a scholarly fashion, yet make it accessible and actionable. We see everyone from school nurses, to school teachers, to psychologists really being an audience for this.

Dan:  Paul, what are the goals for these books in addition to the wide range of intended audience which sounds like most school professionals? What would you like to have come out from these books?

Paul:  I think we have, really, several goals. I think we really wanted to facilitate the information on these topics, on these disorders, to practitioners, to all sorts of school professionals in a way that it would make their jobs a little bit easier. If they had to do some investigation of a particular disorder, that they could flip to that chapter and get a real good sense of what's going on with this disorder in a way that they know that the research is critical, it's scholarly, it's up‑to‑date. It also gives them practical tips of things that can be done in the classroom.

We have handouts in each chapter that can be reproduced and distributed to parents, or teachers may want to take a look at the hand‑outs themselves; so get the information out to the audience that could really use that information. It's really about disseminating information among a number of people in schools.

I'd also like people in schools to think about how pediatric issues, disorders, interplay with academics, interplay with social and emotional development and behavior. We often don't think about some of the biological aspects of these things. We sort of see what's happening in front of us.

A child, for instance, is having a behavior problem. Well, it could be due to a blood sugar difficulty they are having at that point. We often don't think of that right away. We might get to that later on, and so I think these books, hopefully, will have people start thinking, perhaps, a little bit more broadly at how there are biologically‑based aspects to a number of behaviors in schools.

Dan:  Obviously, that has implications for how we intervene, if you know the biological basis that maybe some of this erratic behavior is low blood sugar than having a candy bar may be the intervention, which behaviorally you would never come up with. Give him a candy bar, unless it's a token, and it's very infrequently done. Just this vision of some child with a pile of candy bars at the end of the day. [laughter]

Often, that's not what we teach the very first reaction, or something to think about when we do see some of these aberrent behaviors but rather to follow more the structured behavioral set. It sounds like a very unique aspect and perspective to bring to these problems that we sometimes have missing when we're doing some of this analysis. So, in addition to that, Steve, can you mention about what other information readers are going to get from these books?

Steve:  Sure. Not only to have, like we mentioned, the in‑depth information hand‑outs for parents and hand‑outs for teachers, but I think what's really exciting about this information is with any current topic ‑‑ there's controversy. We try to present it as best we can in a scholarly fashion, the controversy and what the evidence is. There are things that we don't know, for example. Paul mentioned that knowing what's unknown in the field is extremely important, but sometimes there's controversy.

There's both sides. There's multiple issues. We try to give those multiple issues; to give professionals as much information as they can. We do appreciate that that's frustrating because sometimes you just want to know what the answer is. If the current literature doesn't really have a consensus for one way of working with things or another way, we present the controversy.

One of the things we have in there is discussion questions to help even foster further discussion on the controversy because this isn't a field that just has dry facts. This is evolving, and the way that schools respond to evolving knowledge of medical issues is going to have a dramatic effect on what schools do.

We like to keep that discussion going and use these books as, really, just grist to get a discussion. Once they're a discussion happening, then we can work towards developing better educational practices, better involved medical aspects, better policies that involve medical components as well. We'd like our book to really be out there, and the information can really drive a lot of discussions in this rapidly evolving field.

Dan:  Paul, as Steve were mentioning earlier, before the publishing of your books in regards to the real focus of school population and how these medical problems maybe impact, most people are getting their information from the Internet. How does the Internet really affect how educators and parents get information about pediatric issues?

Paul:  It could be quite mixed, really, the quality of information you are going to find on the Internet. I usually actually start with the Internet just to see what's out there, to see what kind of hits I get when I pull up a topic. I'm curious just to see what's the first thing that I'm going to run into. Even if you choose something that's a little more scholarly focused, like Google Scholar, it will lead you toward more of the refereed studies. but not always. Sometimes you still end up on sites that are not exactly what I think are of top notch, research‑based websites.

Yet, that's where a lot of educators may turn, just like I am. Also, I think that's where a lot of parents turn, just like I am, just because the Internet is so easy to use and there is some good information out there. I'm not trying to say that the Internet is not a good thing.

What we wanted to provide in these books was something significantly more than what you're going to find with the Internet. It's a real scholarly review of what is out there and has been published, and as Steve mentioned, what we know and what we really don't know in the literature. That's often what you don't get on the websites.

I'll just give you an example. One of our chapters talks about some of the myths associated with immunization. There's been some beliefs and it's been promoted on certain websites of not particular high quality that if you don't give your child this immunization it could, perhaps, prevent a certain disorder from developing.

The literature base is pretty clear on this that there's really no relationship. If you were a parent, and you happened to just do a Google search and you found those websites, you may decide not to immunize your child ‑‑ which can cause all sorts of problems both for your child and your family, but also significant public health concerns. Now we are talking about the promulgation of diseases, perhaps, within that community. We think that this book can add significantly to what one might find in the Internet.

Dan:  So, the books really come in and provide the grunt work for the parents that, maybe, see a thousand websites come up on a particular topic that they're trying to look at ‑‑ not being able, maybe not being knowledgeable enough about the area to really be able to sift through a lot of that. Then come up with not only "which side I should land on," or "what, in general, is the two sides real pertinent information," and sounds like those books really do provide that shortcut way for parents and educators to get up to speed and not have to access the Google kind of information.

Steve, are books about medical issues relevant to modern school psychology? I mean there is obviously been a lot of emphasis on RTI, the inclusive practices ,and a lot of the behavioral approaches to a practice. Yet, medical seems to be not really mentioned in all of those things.

Steve:  And I don't see those as ‑‑ I may be alone on this ‑‑ but I don't really see those as two things that can't exist together. The emphasis on response to intervention in this whole way of thinking is certainly been on ecological factors and environmental factors and to greatly deal to the exclusion of medical and biological factors. I think that the example of the behavior caused by some level of hypoglycemia. Those are kinds of issues that we always need to consider and I really see it as exactly like "you do not make a diagnosis of learning disability until you have vision and hearing screening," which is a basic.

We need to think the same way about behavior and other learning problems that we need to rule out the possible, at least the reasonably possible medical conditions, before we start moving 100 percent into an ecological factor.

This is something we can do, and I think what happens is most often people who study Response to Intervention tend to be pure behaviorists, and completely ignore the medical factor. On the other hand, people who tend to be more medically focused and more neuropsychological in nature often ignore the ecological factors. Often you have these two worlds working almost in silos that never collaborate, never communicate.

If we could get them together, we find that both sides could add a lot to the other. But right now, unfortunately, when the researcher does neuropsychology, that is the niche they stay in. When somebody does response to intervention, they tend not to be knowledgeable of medical issues. We would like this book to serve a small purpose to bridge that gap because certainly both can share a lot.

Theoretical purity is nice, in some circles, but when you are in real practice, there are clear needs. We are very happy that many practitioners see that need and I'd like to see more researchers involved on that ‑‑ working on that nexus or that collaboration of where response to intervention and some of the medical, genetic, neuropsychological factors ‑‑ where they come together. There are some opportunities for those things to work for them together. Hopefully this book will help contribute to some of that.

Dan:  The situation you are describing, of course, is that classic nature/nurture that has been around for the last 150 years or so, and the debates and who is holding sway, one way or the other, as the pendulum swings back and forth. Of course, most of the research indicating that they are so tightly intermingled and a lot of research that I've read intermingled so much that they almost totally blur together after a while. Being able to have that may be a small approach in pushing the two together, I think, is a real benefit of this particular book. Now, we were talking about the schools, we were talking about medical issues ‑‑ Steve, what roles are schools playing in this healthcare system? Or if they are not playing a role, what role could they play?

Steve:  I see schools playing a larger and larger role every day. We have so many children without any type of formal health insurance or inadequate health insurance. We have many children uninsured, but all children go to school. It is the common ground where we can find children, identify issues. We see a lot of things such as full service schools where they actually have physicians working in schools, although that is not particularly common and I am not sure that is necessarily a viable solution to a lot of medical problems, but it is an opportunity to access all kids.

Just that, right there, becomes the basis from which to create some type of universal health approach. Now, funding for that is an issue, but usually when we have some type of vaccination program, quite often those are done through schools. That's the first place where community health services, they work through schools. That has become the community center.

I think as we are slightly switching the US view on health care from being something that is private, private and personal matter, to becoming more of a community concern. I think that as that change happens, we will see schools become even more involved in health care.

These are other issues that can happen. In fact, I'm from Montreal, in Canada , where we do have a different type of health care system, in which community centers including schools are not just important parts, but are really the first and primary action point from which medical concerns happen.

Now, not only that, but healthcare ‑‑ as it is evolving ‑‑ schools may play a larger role but even in the way health care is setup now, schools can play a large prevention role. We see a lot of work actually lead by a school psychologist on obesity prevention. We see a lot of things on working to prevent mental health problems and working on appropriate dietary interventions. Many other aspects of preventative programming that schools are really taking a lead on.

That is what is happening right now but in terms of actual, medical ‑‑ not just preventative but secondary preventative activities working with children at risk. We are going to see that more and more and more in schools. I don't know which way the health care situation will go in the US , but I think no matter where it is, we'll find schools playing a larger role. Already, there is a pretty large role for schools.

Dan:  I think one of the things that you all have alluded to and talked about, somewhat specifically, are the controversial topics. The ones that are making headlines, and that your books do attempt to address those. You are not shying away and saying, "Oh, it is too controversial. We are not going to bring it up." Paul, in addition to trying to address some of these controversial topics, can you give me some more examples of ‑‑ in addition to, say, the steroid one that you focused on -- of other topics that your books cover?

Paul:  Sure. In fact, I mentioned before the controversial topic of immunizations and disorders, so that was one example. We have a chapter on dietary modification as a possible treatment for autism. That's a good example of a chapter where ‑‑ that's one that I co‑wrote ‑‑ where we really kind of concluded that the research just isn't there yet. It is not to say that dietary modification may not work for some kids, and there's certainly some parents out there that really believe that it is helpful. The research hasn't quite caught up with that belief yet. We really want to let school psychologists know where was that topic, at least in terms of empirical status.

We have other interesting chapters. We have one on mood disorders, specifically looking at depression and bipolar disorder. It's long been a belief that kids who have mood disorders, especially bipolar, tend to be more creative, especially during the manic swings. Does the research hold that up? Is it true?

Then, of course, there's a controversy associated with that. If you have a child who is in a manic phase, but is incredibly creative at that time, are there ethical concerns about prolonging treatment or delaying treatment, delaying administration of medications for the sake of perhaps enhancing creativity?

Or perhaps the child ‑‑ and I've worked with some kids who want to delay taking medications because they know they're in a really good place right now in terms of creativity. So we talk about that.

We've got chapters that look at the issues of medications that are used in children and adolescents. This actually comes up in a number of chapters that we really have a system where we're using psychopharmacological medications with children that really do not have a research base to back them up. There are so few medications that are approved for especially younger children. There are a number that are approved for adolescents, but not for younger children.

We talk a little bit about that, and some of the pros and cons of prescribing off‑label. As well as some practices where we see perhaps parents, and perhaps even medical professionals, who are prescribing multiple medications to treat a variety of psychiatric symptoms, perhaps medical symptoms.

That can cause all sorts of situations where we have kids in schools who have symptoms that could be related to the disease or disorder that they're suffering, but it may also be side effects from the medications. This becomes very complicated for teachers to try to figure out what's going on and sort of where to target their intervention.

We also talk quite a bit about genetic and biological bases of disorders such as autism. Such as some of the chromosomal disorders you'll find out there in children. We talk about the biology of shyness, and that shyness is not just a behavior that may evolve from the environment, but really has biological mediation to it.

In that case, how do we work with kids who are really predisposed to be shy and to perhaps help them to build the skills to move beyond that but also help them to accept who they are. That's just an example of some of the topics and some of the controversies we get into.

Dan:  Now a lot of this that we've talked about is almost a reference book, to some degree, where you have certain chapters, and more than likely, most practitioners are probably going to turn to that chapter and read. You've also alluded to some other issues. And I don't know if the books necessarily cover this, it may not have been in the scope, but things like collaborating with medical professionals about these issues. How do you broach this within a school setting?

Almost like "here's the information" and you have a very good source of information. Are there any chapters that address how we use that information to integrate it within that school or medical setting? Or is that something that maybe other resources can be used in cooperation with these particular books that you've got out now?

Steve:  Well, that's actually something we do have, a chapter on school collaboration with medical professionals. The whole theme of this, even though there are many different aspects of it, the entire theme is we wanted to make all of the information here do two things at once. One is be scholarly, and the other is being practical. Those are two things we often think of as separate, but this is a book that really tries to bring them together. Nothing can be practical unless we have some systems level approach of "How can you apply this information? How can you make it work?" It's great to have the information, but sometimes just the study of how to introduce medical issues into a school setting is, in and of itself, a very scholarly and difficult thing to do.

We have a chapter on that, and we really want all of the chapters to at least have some component of "How is this practical? How does this effect teaching? How does this affect learning? How does this effect behavior?" and "What can we do about it?"

Although we do have a chapter on collaboration, we also try to make all of the chapters have some component on "How can you use this information?" Because if we don't have some aspect of how this information can be practical and usable, I don't think we've succeeded, so we really wanted to focus on that a lot.

Dan:  I think that goes along with what Paul was talking about in that Google search ‑‑ where in the Google search are you going to get that next level of information? You can find information about the disorder. You may be able to find how behaviors or abreactions may occur, but not on how to integrate those findings in so that you can really utilize that and intervene in a more successful manner. I think that sounds like another real benefit of the book and the approach that you all took. Is there any last little points that you'd like to make [for] the listeners who are still considering buying your book series here on medical issues?

Paul:  I think I would just say I know this topic sometimes can be a little overwhelming or perhaps intimidating for some people. And I just want folks to know that I think these chapters, if we've succeeded, have brought this material to a level that, again as we mentioned, is scholarly yet very accessible. I think the chapters including the background literature review that we do is really readable and we give you a sense of where the scholarship is at right now. What we know and what we don't know and kind of wrapping that up.

Then we follow that up with some bullet points of what are the major findings from the research. Sometimes that's great for someone who's really busy to just quickly flip to that and see what do we know, very quickly.

Then following that we have educational implications. So we've taken that research and we've said, "All right, now how does this apply to the schools?" And again, you get some great bullet points on what can schools do, what can classroom teachers do right away with this issue.

Then as we mentioned before, we've got materials that can be distributed to teachers, to parents, to kind of further this idea. We also have discussion questions that Steve mentioned before that really get people to kind of think and talk. It's not just questions that review the material that's in the chapter, but it's getting everyone to think a little bit more broadly about this topic. Especially some of these ethical concerns that may come up, just some practice considerations, and so on.

So I think hopefully if we've succeeded in this we've really been able to take some pretty dense material and we've made it accessible for school practitioners.

Dan:  Great. Well I'd like to thank you both for coming in today to talk about your new series book on "Current Topics and Interventions for Educators." That was Steve Shaw and Paul McCabe, and I'd like to thank you again. That's going to conclude this Dialogues podcast. Please tune in again for future Dialogues podcasts available on the NASP website.