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https://www.ncdhhs.gov/about/department-initiatives/early-childhood/why-early-childhood-matters#:~:text=A%20child's%20early%20years%20can,long%2Dlasting%2C%20detrimental%20impact.

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A child's early years can have lifelong physical, social, and emotional impacts. While positive experiences and environments can set up a young child on a stronger life-long path, traumatic experiences or environments during those formative years can have long-lasting, detrimental impact.

Early childhood experiences from birth to age 8 affect the development of the brain's architecture, which provides the foundation for all future learning, behavior and health. A strong foundation helps children develop the skills they need to become well-functioning adults.

In particular, the time between birth and age 3 is a period of rapid brain development when billions of connections between individual neurons are established. Mechanisms and interventions to support that development must be available beginning at birth.

The experiences children have early in life play a crucial role in the development of the brain. Exposure to positive factors, especially stable and responsive relationships with parents and other adults, and safe and supportive environments promote positive development.

When brain development in infants and young children is fully supported, they are more likely to reach milestones critical to future individual and community success. These include:

Third-grade reading proficiency

High school graduation and postsecondary education

Gainful employment

Lifetime physical and mental health and well-being

Avoidance of substance use disorder and crime

On Feb. 27, North Carolina welcomed Dr. Jack Shonkoff as the keynote speaker for the NC Early Childhood Summit. Shonkoff is a leading scholar on early child health and development and the director of the Harvard Center on the Developing Child.

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A child's early years can have lifelong physical, social, and emotional impacts. While positive experiences and environments can set up a young child on a

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8930564/#:~:text=For%20example%2C%20when%20adults%20verbally,1998)%2C%20children%20persist%20longer.

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Julia A. Leonard, 1, 2,* David M. Lydon-Staley, 3, 4, ⁵ Sophie D. S. Sharp, ¹ Hunter Z. Liu, ¹ Anne T. Park, ¹ Danielle S. Bassett, 4, 5, 6, 7, 8, 9, ¹⁰ Angela L. Duckworth, ¹ and Allyson P. Mackey ¹

Abstract

Children's behavior changes from day to day, but the factors that contribute to its variability are understudied. We developed a novel repeated measures paradigm to study children's persistence by capitalizing on a task that children complete every day: toothbrushing (N = 81; 48% female; 36-47 months; 80% white, 14% Multiracial, 10% Hispanic, 2% Asian, 1% Black; 1195 observations collected between January 2019 and March 2020). Children brushed longer on days when their parents used more praise ( d = 0.23) and less instruction ( d = −0.22). Sensitivity to mood, sleep, and parent stress varied across children, suggesting that identifying the factors that shape an individual child's persistence could lead to personalized interventions.

Keywords: Motivation, intensive repeated measures, persistence, early childhood, intraindividual, parenting

To become healthy and successful adults, children need to persist on tasks that are not always easy or fun, like studying, exercising, or brushing one's teeth ( Duckworth et al., 2007; Mischel et al., 1989). Children's ability to persist develops gradually ( Oeri & Roebers, 2020; Saudino et al., 1996; Zhou et al., 2007). Toddlers are notoriously strong-willed and easily distracted; yet just a few years later, they are expected to persist through challenging tasks like learning to read. Development is not always linear: children have good days when they easily persist through tasks, and bad days when they struggle to complete tasks they could do easily the day before. Understanding the psychosocial and physiological factors that shape within-child variability in young children's persistence is critical for developing personalized interventions to help children be the best versions of themselves.

In the present study, we measured fluctuations in three-year-olds' persistence by capitalizing on an ecologically-valid daily task that three-year-olds are just learning to do on their own: brushing their teeth. Toothbrushing is the ideal task because it is a daily behavior that parents want to support, and requires persisting on a task that is not especially fun, but is necessary for the development of a healthy habit. Toothbrushing is also not cognitively challenging, so individual differences in brushing are unlikely to be related to IQ. In other words, variation in toothbrushing persistence is not likely to be driven by variation in perceived difficulty or interest, as might occur if we studied daily puzzle completion. Furthermore, toothbrushing is also an activity done by children all over the world, making this paradigm potentially useful in many cultures.

What might influence whether a child brushes longer on a given day? When children decide whether or not to persist, they consider information about expected utilities (cost and rewards), which is often communicated via adults' behavior ( Bandura 1977; Leonard et al., 2017; Leonard et al., 2020; Leonard et al., 2021; Lucca & Sommerville, 2018; Lucca et al., 2019; Lucca et al., 2020). For example, infants and preschoolers pay attention to adults' actions and outcomes and rationally try harder after watching adults' efforts lead to success rather than failure (Leonard et al., 2020; Lucca et al., 2019). Children also listen to adults' explicit messages about effort: 18-month-olds put in more effort on a gear-stacking task if their parents praise their effort, rather than their abilities ( Lucca et al., 2019). However, to date no study has looked at how adult behavior varies from day to day, and in turn influences day-to-day fluctuations in children's persistence. Furthermore, most of the work on children's rational learning ignores how physiological states influence behavior, presumably because it is difficult to study children when they are not in a good mood or able to concentrate. Here, we used a novel repeated measures paradigm to investigate four major factors that we predicted would fluctuate from day to day, could be reported with high ecological validity, and based on prior literature, could impact how long children would brush their teeth: parent talk, parent stress, child mood, and child sleep.

A great deal of work has looked at the relationship between adult talk and children's persistence across children. Longitudinal studies have shown a correlation between positive, autonomy-supporting parenting and children's persistence ( Deater-Deckard et al., 2006; Frodi et al., 1985; Kelley et al., 2000; Prendergast & MacPhee, 2018). More specifically, longitudinal and cross-sectional studies find that parent praise for effort, rather than ability is correlated with children's persistence ( Gunderson et al., 2013; Lucca et al., 2019). Experimental work has shown a causal impact of specific adult talk. For example, when adults verbally reinforce children's on-task behavior, children try harder (Krantz & Scratch, 1979; Van Hecke & Tracy, 1987). Further, when adults praise children's effort over their ability in laboratory tasks ( Cimpian et al., 2007; Mueller & Dweck, 1998), children persist longer. When adults directly instruct children on what to do, it can help children learn explicit information (e.g., learning vocabulary; Dickinson et al., 2019; Klahr & Nigam, 2004), but can hurt their learning in exploratory learning contexts (e.g., finding a non-obvious function of a toy; Yu et al., 2018; Willard et al., 2019). There is some limited evidence that parent talk fluctuates from day to day, with downstream consequences on child behavior. For example, on days when parents are stressed, they report being less encouraging of their 8-12-year-old's engagement in physical activity ( Dunton et al., 2019). However, no study has directly measured fluctuations in parent behavior and their preschooler's behavior over time. Thus, it is unknown whether or how fluctuations in parent behavior shape fluctuations in children's persistence. On the one hand, impacts of parenting may be cumulative, with day-to-day variability having little influence on children's behavior. On the other hand, children may dynamically adjust their behavior, and persist longer, in response to parent behaviors in a given moment.

Children's moods also impact their behavior. Experimentally inducing a pleasant or excited mood in preschoolers leads to greater task persistence ( Masters & Santrock, 1976; Ridgeway & Waters, 1987). Children's mood may affect persistence both through internal and social mechanisms: positive mood induction causes preschoolers to set more ambitious goals ( Hom & Arbuckle, 1988) and to be more compliant with their parents' requests to complete an effortful task ( Lay et al., 1989). Parents can help regulate their children's emotions through modeling emotion regulation themselves and displaying positive affect ( Morris et al., 2017). However, it is unclear whether day-to-day fluctuations in child mood relate to daily fluctuations in persistence, or how variations in parent affect and behaviors relate to variations in child mood.

Children's broader physiological states may also impact their persistence on a given day ( Bandura, 1977). Work in adults suggests that sleep directly impacts persistence. After one night of sleep loss, adults rate tasks as more effortful ( Drummond et al., 2005; Hockey et al., 1998) and prefer lower effort over higher effort tasks, even at the cost of rewards ( Engle-Friedman et al., 2003; Libedinsky et al., 2013). Sleep deprivation alters the neural circuits involved with reward valuation, emotional control, and cognitive control, all of which play key roles in effort-based decision making and persistence ( Chee & Chuah, 2007; Gujar et al., 2011; Massar et al., 2019; Yoo et al., 2007). Although the link between sleep and persistence has not yet been studied in children, sleep does impact related behaviors. Toddlers who skip their nap are less able to self-regulate during a challenging task ( Miller et al., 2014). Preschoolers with more variable sleep duration are rated by their teachers as adjusting more poorly to preschool ( Bates et al., 2002). In school-aged children and adolescents, sleep is related to mood ( Könen et al., 2016), working memory ( Könen et al., 2015), and performance on standardized tests the next day ( Cusick et al., 2018). Young children might be especially vulnerable to the negative consequences of sleep on behavior, as their brains are undergoing rapid large-scale development ( Cao et al., 2020; Dewald et al., 2010).

Taken together, prior work points to variation in parents' behavior and stress, as well as children's mood and sleep, as potential influences on fluctuations in children's persistence. To understand how fluctuations in these factors relate to fluctuations in persistence, it is important to measure all variables with high temporal sampling. Technological advances, including the widespread availability of mobile phones, have made daily measurement more feasible. Ecological momentary assessment (EMA) designs collect intensive repeated measures data in everyday settings, as participants go about their daily lives ( Shiffman et al., 2008). EMA has been used in preschoolers to explore fluctuations in self-regulation via parent report ( Ludwig et al., 2016; Ludwig & Rauch, 2018) and in toddlers to show how children's physical and social context influence their diet and exercise ( Campbell et al., 2018; Hager et al., 2017), but none have directly measured young children's motivational or cognitive processes.

In the current study, parents submitted videos of nightly toothbrushing over 16 days, capturing both children's persistence and parent talk. We focused on evening brushing, rather than morning brushing, because we did not want to interrupt or delay morning routines. Parents also completed daily surveys about their stress, and about child mood and sleep. We examined how fluctuations in parent talk and stress, and child mood and sleep, separately impacted fluctuations in brushing time. We ran separate models testing how each individual factor related to brushing because this approach is directly applicable to targeted interventions focused on specific factors. We predicted that children would brush more when their parents used more praise, and that parents would use less positive talk when they were stressed. We predicted children would brush longer if they were in a better mood, and after they had slept and napped well.

We also explored whether children differed in their sensitivity to psychosocial and physiological influences ( Boyce & Ellis, 2005; Ellis & Boyce, 2008), and whether their broader social context (socioeconomic status and parent stress over the last month), influenced their sensitivity. This approach allowed us to explore individual differences in children's sensitivity to parenting, mood, and sleep, a critical step towards the creation of personalized interventions. Part of the data for this study was collected prior to the onset of the COVID-19 pandemic, allowing us to ask questions pertaining to how parent behavior, and its relation to child behavior, differed before and after a stressful global event. Finally, we tested whether parents had insight into which factors were most important for their own child's fluctuations in persistence.

Materials and Methods

This study was exploratory. The Institutional Review Board at The University of Pennsylvania approved this study. Parents provided informed, electronic consent for their child's participation.

Participants

Families were recruited through partnerships with local preschools and through social media. Overall, 90 families enrolled in the study with the goal of 85 usable participants which would allow us to detect an r of .3 with power of .8 in across-participant correlations. One family was excluded for prenatal drug exposure, three families were excluded for sending in unusable or no video data; four families dropped out of the study; and one child was excluded for outlying brushing times ( M = 135.94 sec per night, > 3 SD from sample mean; though results remain similar when this child is included; see SM Table 1). The final sample consisted of eighty-one three-year-olds ( M age = 40.84 months, range 36 - 47 months).

The racial and ethnic makeup of the sample was as follows: 80% white, 14% Multiracial, 10% Hispanic or Latinx, 2% Asian, 1% Black, and 1% preferred not to answer. Parents were asked to report their child's gender and were provided four options: female, male, other, and prefer not to answer. Forty-eight percent of parents reported that their child's gender was female, and the rest reported that their child's gender was male. All data were collected in the United States of America. Ninety-four percent of families were from Pennsylvania ( n = 57), and New Jersey ( n = 19). The remaining families were from Delaware ( n = 2), Massachusetts ( n = 1), Maryland ( n = 1), and Florida ( n = 1). The average parental education ranged from 12 to 20 years ( M = 16.98, SD = 1.75). The annual family income ranged from $14K to $200K ( M = $125K, SD = $50K). Data were collected in two waves: January - June 2019 ( n = 24), and March - May 2020 (during the COVID-19 pandemic, n = 57). The two waves matched on age ( t(79) = 0.09, p = .93), gender ( Χ ²(1, n = 81) = 0.90, p = .34), and parent education ( t(79) = 0.70, p = .49). The annual family income was slightly higher in the second wave ( t(75) = 2.02, p = .05; wave one M = 107K, wave two M = 133K). To account for possible differences between waves, the study start date was included as a covariate of no interest in multilevel models.

Procedure

Interested parents filled out a screening questionnaire and were contacted if they had a three-year-old and their child passed the following inclusion criteria: no neurological or psychiatric diagnosis, not born prematurely, speaks English, and tries brushing their own teeth at night. Parents also were required to speak and read English fluently and to have access to a video recording device. Eligible participants were contacted via email with instructions on how to sign up and consent to the study online via REDCap. The online consent was followed by baseline questionnaires ($10 compensation; detailed below). After the surveys, participants were sent instructions on how to participate in the 16-day daily text message portion of the study (see SM Figure 1). We collected data over 16 days to ensure that we had at least 5-8 usable days per child (see analysis plan) without over-burdening families. Participants were sent text message links to surveys in the morning at 8 am (with a reminder 2 hours later if they did not respond) and in the evening at 8:30 pm (with a reminder 1.5 hours later if they did not respond). Participants were compensated $2 per day for completed surveys and an $8 bonus for completing all 16 days. The number of daily evening survey days completed by participants ranged from 7 to 16, with 73% completing all 16 days ( M = 15.33, SD = 1.63; n = 2 for 7 days; n = 1 for 11 days; n = 3 for 13 days; n = 6 for 14 days; n = 10 for 15 days; n = 59 for 16 days), and the number of completed morning survey days ranged from 11-15, with 85% completing all 15 days ( M = 14.74, SD = 0.72; n = 1 for 11 days; n = 1 for 12 days; n = 4 for 13 days; n = 6 for 14 days; n = 69 for 15 days).

Parents reported their total annual income and education level, as well as the education level of their partner if applicable (99% of parents reported the education level of their partner; education level was averaged if available for both parents; one variable was used if the other was not available). Parent average education and income were normalized and averaged to create a composite measure of socioeconomic status (SES; Bradley & Corwyn, 2002). Parents filled out the 10-item Perceived Stress Scale (PSS; Cohen & Williamson, 1988) which indexes parents' feelings of stress in the last month. The 10 items were summed to create the total PSS score.

Daily Measures

Persistence.

Parents sent in a video of their child brushing their teeth every night as part of the evening survey (see Figure 1 and SM Table 2 for details on daily measure administration). Parents were instructed to start recording the video before the toothbrush was in their child's mouth and to stop recording when they took the toothbrush back from the child (see SM Figure 1 for exact instructions). Parents were instructed to let their child brush by themselves for as long as they could before the parent stepped in to finish the job (77% of participating families said that having their child brush first before brushing for them was in line with their normal brushing routine). Persistence was operationalized as the amount of time the child spent brushing their teeth. Using Vcode, two coders (blind to hypotheses) coded all videos for the amount of time that the child spent brushing their teeth (see SM for exact coding scheme). A third coder arbitrated discrepancies over 10 seconds for time brushing between the two coders. Coder scores were highly correlated ( r = 0.99, p < .001). Time brushing from the two coders was averaged for analyses. If children did not brush their teeth for a night, resulting in no video, parents were instructed to let us know. Children were given a "0" if they did not brush at all even after the parent tried to initiate the activity (e.g., "My son refused to brush his own teeth tonight", n = 6 nights) and were marked as missing data if the parent wasn't able to record (e.g., child was at a sleepover).

Parent talk.

All video data were transcribed. One coder coded parent speech from video and the second coder coded parent speech from transcription, and used the video if the context or tone of the transcribed speech was unclear. Agreement between coders was 99%: of 9391 utterances, the coders disagreed on 30. A third coder arbitrated these disagreements. We coded praise into three different categories based on Gunderson et al. (2013): "process praise" (e.g., "good job"), "person praise" (e.g., "good girl"), and "other praise" (e.g., "very good", "nice"). The majority of praise was classified as "other praise" (462 instances) and "process praise" (349 instances). There were few instances of "person praise" (e.g., "good girl"; 32 instances). However, we did not have the power to analyze the effect of specific types of praise on brushing, so focused our analyses on total praise (the total of all three types of praise). We coded distraction (e.g., singing, reading a book, invoking pretend play) based on prior work showing that self-distancing promotes children's persistence (White et al., 2017), however distraction was used so infrequently (442 occurrences in 30/82 parents) that we did not have the power to analyze it within or across children. We coded utterances such as "Brush the backs!" and "keep brushing" as instruction (note that the majority of these utterances were general phrases to keep the child on-task like "keep going" and "brush"; see https://osf.io/8njht/ for full transcript). We coded any off-topic or uncategorizable comments (e.g., "How is it going?") as other speech, however we did not have strong hypotheses as to how this heterogeneous speech category would relate to brushing, so we did not analyze it.

Out of 9,145 total utterances from parents, 9% were praise, 5% were distraction, 50% were instruction, and 36% were other. The full coding scheme is shown in SM Table 3. We constructed a measure of total talk for each subject on each night as the count of total parent utterances per night. To explore the relationship between specific types of parent talk and children's persistence, we created measures of percent praise and percent instruction as the amount of each category of talk divided by total talk per person per night. Parent talk measures were positively and significantly correlated (see SM Table 4).

One family was excluded from parent talk analyses due to poor audio quality in videos. Nights when someone besides the parent was supervising the brushing were excluded ( n = 4 nights). Children whose parents never used praise or instruction were excluded from multilevel models with those variables, as they could not provide information on how fluctuations in that type of parent talk were associated with fluctuations in brushing behavior ( n = 17 for praise; n = 1 for instruction). Children whose parents never used praise did not differ from children whose parents did use praise on SES, gender, parent perceived stress, or parent average stress (all p s > .6).

Parent stress.

Parents reported on their stress in the evening survey. They were asked "What is your stress level right now?" They could answer on a 0 (not stressed at all) to 10 (extremely stressed) scale (increments of 1). We measured parent stress with one item to lower parent demands and reduce dropout. We also asked about parent mood, but fluctuations in parent mood were too closely related to fluctuations in parent stress to have separable effects on parent or child behavior ( b = −0.50, p < .0001; see SM Fig. 2). Hence, we focused our analyses on parent stress based on previous work linking lower parent stress to positive parenting behaviors ( Dunton et al., 2019).

Child mood.

Parents reported on their child's mood in the evening survey. They were asked "What is your child's mood right now?" and could answer on a 0 (extremely bad) to 10 (extremely good) scale. We measured child mood with one item to minimize demands on parents and reduce dropout.

Sleep duration.

We chose to use parent report of child sleep since this measure is accurate, and more inexpensive and feasible for three-year-olds (who often take off wearable electronic trackers) compared to continuous sleep tracking methods like actigraphy ( Iwasaki et al., 2010). Parents reported on the time their child went to bed in the evening survey and the time their child woke up in the morning survey, as well as how many times and the total duration that their child was up during the night. Parents also reported whether their child took a nap that day (on the same day as toothbrushing) and the length of the nap. We calculated children's sleep based on their bedtime and wake up time, subtracting any time they were awake at night, and adding in the nap of the current day.

To reduce the possibility that parents would infer our hypotheses, we also asked questions about how much children ate for dinner.

Post-study parent predictions of child behavioral fluctuations

At the end of the 16-day study, parents responded to the following question by text message: "Which of the following variables (pick as many as apply) do you think related to your child's day-to-day variance in how long they brushed their teeth each night? How much I encouraged them, how much sleep they got the night before, my mood, their mood, my stress, the time of day that they brushed, how much they ate for dinner, or other." Parent prediction data were available for 64 participants because it was first collected midway through the first wave of the study.

Analysis Plan

Fluctuations in brushing time, parent talk, parent stress, child mood, and child sleep.

First, we computed an intraclass correlation (ICC) to identify the proportion of between-person and within-person variance in daily brushing time. We analyzed the intensive repeated measures data (7-16 days nested in 81 participants) using multilevel models that were parameterized to separate within-person and between-person associations by splitting predictors into time-invariant (between-person) and time-varying (within-person) components ( Bolger & Laurenceau, 2013). There were no significant relationships between the number of evening surveys completed and the key variables: average child sleep ( r(79) = 0.10, p = 0.37), mood ( r(79) = 0.15, p = .17), parent stress ( r(79) = −0.10, p = .36), percent praise ( r(78) = −0.07, p = .54), percent instruction ( r(78) = 0.19, p = .09), or brushing ( r(79) = −0.10, p = .38).

Models were fit using the nlme package in R (Pinheiro et al., 2018) using maximum likelihood estimation. Statistical significance was evaluated at p = .05. Children were included in multilevel models if they had at least 5 data points for the two variables of interest, following guidelines from Bolger and Laurenceau (2013). Time-invariant person-level variables for usual percent praise, percent instruction, parent stress, child mood, child sleep, and brushing were calculated as the arithmetic mean across each individual's repeated measures. Time-varying, day-level variables were calculated for percent praise, percent instruction, parent stress, child mood, child sleep, and brushing as deviations from those person-specific means. In these models we controlled for day of study (0-15) and study start date (day 0 - day 483, to control for any differences associated with the timing of participation relative to the COVID-19 pandemic).

We constructed a multilevel model (Level 1) of percent parent praise and brushing as:

where TimeBrushing it is the time spent brushing for child i on day t; β 0i indicates the expected time brushing on a typical day with an average percent of praise; β 1i indicates differences in time brushing associated with changes in day's praise; β 2i indicates differences in time brushing as the study progressed to control for time as a third variable ( Bolger & Laurenceau, 2013); e it are day-specific residuals that were allowed to be autocorrelated (AR1).

Person-specific intercepts and associations (from the Level 1 model) were specified (at Level 2) as:

where the ys are sample-level parameters and the us are residual between-person differences that may be correlated, but are uncorrelated with e it. The parameter y 01 indicates how usual praise was associated with the usual time spent brushing. The parameter y 02 indicates how study start date (within each wave, there were multiple study start dates) was associated with the usual time spent brushing. Effect sizes were computed for multilevel models using 'lme.dscore' from the EMAtools package in R (Kleiman, 2017).

We constructed four more models by replacing parent percent praise with parent percent instruction, parent stress, child mood, and sleep to see how these factors also influenced day-to-day fluctuations in children's time brushing, as well as their usual time spent brushing. To examine how predictor variables related to each other, we ran separate models predicting each variable (percent praise, percent instruction, parent stress, child mood, child sleep) from the other variables. Results were false discovery rate (FDR; Yekutieli & Benjamini, 1999) corrected at p < .05 for multiple comparisons for the p-values predicting within-child relationships across the five models (i.e., we FDR-adjusted the five p-values for multiple comparisons).

Estimates from Level 2 in the multilevel model were used to explore how average brushing relates to average parent percent praise, parent percent instruction, parent stress, child mood, and sleep controlling for within-subject effects, start date, and day of study. Results were FDR-corrected for multiple comparisons at p < .05 for the five p-values predicting across-child relationships across predictor models.

Between-subject relationships with demographics and daily measures.

We ran individual correlations relating child age, gender, SES, and parent perceived stress to average brushing time, percent praise, percent instruction, parent stress, child mood, and sleep, as well as variability in each of these measures. We calculated variability as the coefficient of variation (standard deviation across days divided by mean across days; a unit-free variable) (e.g., Levitt et al., 2004; Lydon-Staley et al., 2020). We chose this approach so as not to rely solely on standard deviation, because standard deviation is often related to the mean ( Baird et al., 2006; van Geert & van Dijk, 2002). Results were FDR-corrected at p < .05 for multiple comparisons separately for models relating averages and variability.

Individual differences in sensitivity.

Individual differences in sensitivity to predictor variables were explored in children for whom data were available for 8 or more nights ( n = 61 for parent percent praise, n = 77 for parent percent instruction and sleep, n = 78 for parent stress and child mood). Participants with fewer than 8 data points to contribute to a given model were excluded from these analyses because they lacked sufficient data to give a reliable individual estimate (Jenkins & Guintana-Ascencio, 2020). Children whose parents exclusively used one type of talk were also excluded from models looking at percent of praise or instruction due to lack of variance ( n = 1 for percent instruction).

We estimated each individual's sensitivity to each of the five predictor variables (percent praise, percent instruction, parent stress, child mood, and child sleep) by extracting standardized β's from person-specific linear models predicting brushing time with each of the predictor variables separately, controlling for the day of the study. We examined whether sensitivity to each factor was related to sensitivity to other factors and demographic variables (results are FDR-corrected at p < .05 for multiple comparisons).

Parent predictions of child behavioral fluctuations.

We first calculated the percent of parents who endorsed each of the key predictor variables (encouragement, parent stress, child mood, and sleep) as influential on their child's brushing. We asked parents about encouragement generally rather than specific types of encouragement (e.g., praise) because we thought parents would find this general prompt more interpretable. To test whether parents' guesses were accurate, we compared the absolute value of the standardized β of the guessed predictor variable with brushing between children whose parents said the guessed predictor mattered versus those whose parents said the guessed predictor did not matter. We allowed for effects to be both positive and negative because the direction was not stated in the question, i.e., parents could believe that they need to encourage their children more when their children are brushing less well. Analyses were restricted to children who had enough data for sensitivity analyses (see above), and whose parents responded to the question about predicted sensitivity ( n = 48 for encouragement analyses with praise, n = 62 for parent stress, child mood, and child sleep).

Impact of COVID-19.

To test whether the onset of the COVID-19 pandemic systematically impacted our data, we compared the average and coefficient of variation of brushing time, child sleep, child mood, parent mood, and parent talk variables between the first and second collection data collection waves (data collected in wave two was collected at the beginning of the March 2020 lockdown in the Philadelphia region, where the majority of our data was collected). We also tested for interactions in the multilevel models to determine whether the relationship between predictor variables and day-to-day brushing differed by study enrollment date (which linearly controls for the impact of COVID-19, which we predicted might differ across time). Finally, we tested whether parent self-report of stress at the onset of the study (on the PSS) differed before and after the onset of COVID-19.

Results

Within-child variability in brushing

Brushing time varied substantially within and across children (Intraindividual mean = 28.39 sec, range = 4.55 - 74.07 sec, SD = 13.56 sec; intraindividual coefficient of variation mean = 0.51, range = 0.19 - 1.12, SD = 0.21; see SM Table 5 for variability in predictor variables). Fifty-nine percent of toothbrushing time variance was attributable to within-person variation and 41% was attributable to between-person variation. Brushing time significantly decreased across days of the study (see Table 1 ), potentially due to the novelty of being filmed while brushing the first few nights. Multilevel model results indicate that children brushed longer on nights when parents used a higher percent of praise ( b = 17.83, FDR-corrected p = .008; Figure 2a ). On nights when parents used a higher percent of instruction, children brushed less ( b = −6.61, FDR-corrected p = .008; Figure 2b ).

Children brushed longer when they were in a better mood, but this result did not survive FDR correction ( b = 0.64, p = .03, FDR-corrected p = .11; Figure 2c ). There was a non-significant positive relationship between sleep and brushing time: children brushed slightly, but not significantly, longer when they slept more the night (and day, if they napped) before they brushed ( b = 0.85, p = .08, Figure 2d ). Within-child variation in brushing time was not significantly predicted by parent stress ( b = −0.40, p = .12, Figure 2e ).

Within-child variability in relationships among predictor variables

Multilevel models revealed that fluctuations in parent stress were related to fluctuations in child mood: parents were less stressed when children were in a better mood ( b = −0.32, p < .001, FDR-corrected p < .001; see SM Table 6), and vice versa ( b = −0.33, p < .001, FDR-corrected p < .001). Variability in child sleep was related to variability in child mood: when children slept more, they were in a better mood ( b = 0.24, p < .001, FDR-corrected p = .002). Variability in child sleep was also related to variability in parent stress: when children slept more, their parents were less stressed ( b = −0.15, p = .02, FDR-corrected p = .21).

Contrary to our prediction, fluctuations in parent stress were not related to fluctuations in the percentages of parent praise or instruction ( SM Table 6). Furthermore, fluctuations in child sleep and mood were not related to fluctuations in the percentages of parent praise or instruction. As expected, because we were looking at percentages of total talk, parent talk types traded off against each other: on nights when instruction made up a greater percent of what parents said, they used a lower percent of praise ( b = −0.18, p < .001, FDR-corrected p < .001), and on nights when praise made up a greater percent of what parents said, they used a lower percent of instruction ( b = −0.55, p < .001, FDR-corrected p < .001).

Between-child relationships among brushing, predictor variables, and demographics

Across children, average percent parent instruction was negatively associated with average brushing time, but this result did not survive FDR correction ( Table 1 , MLM: b = −16.13, p = .04, FDR-corrected p = .36). Average child mood was positively, but not significantly, associated with average brushing time ( Table 1 , MLM: b = 2.98, p = .06, FDR-corrected p = .36). Average brushing time did not relate to child age, gender, parent average perceived stress, or SES (see SM Table 7).

Variability in brushing time (coefficient of variation) was negatively related to SES: children from lower SES backgrounds had more variable brushing times ( r(79) = −0.43, FDR-corrected p = .01; SM Table 8). Parents who indicated higher perceived stress at the beginning of the study had higher stress ( r(79) = 0.51, FDR corrected p < .001) and lower variability in parent stress throughout the study ( r(79) = −0.38, FDR corrected p = .04). No other relationships among demographics and EMA measure averages and variability were significant after FDR correction ( SM Tables 7 and 8).

Individual differences in brushing sensitivity to predictor variables

Sensitivity to mood was negatively related to sensitivity to parent stress: children who brushed more when they were in a good mood brushed less when their parents were stressed ( Table 2 , r(76) = −0.45, p < .001, FDR-corrected p = .002). Children who brushed more when their parent used a greater percent of praise, brushed less when their parent used a greater percent of instruction ( Table 2 , r(58) = −0.53, p < .001, FDR-corrected p = .002). All other relationships between sensitivity to fluctuations in predictor variables and demographics did not survive FDR correction for multiple comparisons (see Table 2 ; SM Table 9 for outlier analyses - results do not change).

Table 2.

1

2

3

4

5

6

7

8

6. Mood sensitivity

−0.10

−0.01

−0.02

−0.25*

0.21

7. Parent stress sensitivity

0.04

0.02

0.10

−0.08

−0.12

−0.45**

8. % Praise sensitivity

−0.21

−0.02

−0.05

−0.01

0.01

−0.12

0.26*

9. % Instruction sensitivity

−0.01

−0.01

−0.06

−0.14

−0.12

0.22

−0.26*

−0.53**

Parent predictions of child brushing sensitivity

In order from most commonly endorsed to least commonly endorsed, parents thought the following factors impacted their children's brushing: child mood (92%), parent encouragement (65%), parent stress (50%), child sleep (18%). However, for the parents who thought that their child's mood mattered for brushing, their child's sensitivity to mood (absolute value of β) was not higher than for children whose parents did not think their child mood mattered ( t(60) = −0.63, p = .55). The same was true for parent encouragement (percent praise: t(48) = −1.59, p = .12), and parent stress ( t(60) = 1.10, p = .28). Parents who thought that child sleep did not matter for brushing actually had children on average for whom sleep did matter for brushing ( t(60) = 2.74, p = .01).

Impact of COVID-19

Some data were collected before the pandemic ( n = 24, January - June 2019), and some were collected during the early stages of the COVID-19 pandemic ( n = 57, March - May 2020). Parent perceived stress (reported via a questionnaire at the beginning of the study) was higher during the pandemic ( t(79) = 2.55, p = .01), but parent average daily stress did not differ between pre-COVID and COVID epochs ( t(79) = 1.17, p = .25). Praise and instruction percentages did not differ between pre-COVID and COVID epochs (percent praise: t(78) = −1.01, p = .32; percent instruction: t(78) = 0.34, p = .73) and the relationship between parent talk measures and brushing did not change by epoch (see SM Table 10). Children's average sleep, mood, and brushing time did not differ by study start date (sleep: t(79) = 1.51, p = .14, mood: t(79) = −0.06, p = .95, brushing time: t(79) = −0.87, p = .39), nor did associations among sleep, mood, stress, and toothbrushing (see SM Table 10).

Robustness to analytical decisions

Due to the exploratory nature of this study, we checked whether our main results were robust to analytical decisions. We ran one model to test whether percent praise, percent instruction, and child mood uniquely predicted fluctuations in persistence above and beyond other factors. In this model, which included 62 children with data on all variables, within-child variation in percent praise positively predicted brushing (percent praise: b = 13.92, p = .009; see SM Table 11). Mood also positively predicted brushing ( b = 0.93, p = .02). The relationship between percent instruction and within-child brushing was close, but not significant ( b = −5.05, p = .056).

We also ran multilevel models including one participant with outlying brushing time ( M = 135.94 sec per night, > 3 SD from sample mean) and found that percent praise still positively related to brushing and percent instruction still negatively related to brushing (percent praise: b = 12.60, p = .02, FDR-corrected p = .09; percent direct instruction: b = −6.84, p = .004, FDR-corrected p = .05; see SM Table 1).

We focused on parent daily stress instead of mood because they were so highly correlated, but when we averaged the two measures of parent affect together to predict within-child variations in brushing, results were still null ( b = −0.01, p = .98; see SM Table 12). Finally, all coded and deidentified data are publicly available on the OSF ( https://osf.io/bdp78/) and identified video data is available upon request for other researchers to explore different coding techniques and run follow-up analyses.

Discussion

Young children's persistence fluctuated substantially from day to day. Within children, variation in persistence was related to variation in parent talk: Children's time spent brushing their teeth was positively correlated with parent praise and negatively correlated with parent instruction. These results were robust to various analytical decisions. Fluctuations in child mood were also associated with fluctuations in brushing, but this effect was weaker and more variable across children. Fluctuations in parent stress and child sleep were not related to children's persistence, but were related to child mood. Some children were more sensitive to fluctuations in predictor variables than others: children who were sensitive to variability in parent stress were also sensitive to variability in their own mood, and children who were sensitive to variability in parent praise were also sensitive to variability in parent instruction. Parents were not able to accurately predict which variables shaped brushing in their own children, but their guesses were consistent with the overall importance of parent encouragement and child mood.

Our work is the first to show that fluctuations in parent praise relate to fluctuations in child persistence within a family, providing better evidence than between-family studies that parent praise relates to children's behavior, and does not just reflect broader positive aspects of a child's environment. Why might praise impact children's behavior in the moment? Drawing upon a utility framework of effort-based decision making ( Inzlicht et al., 2018; Kurzban et al., 2013), parent praise might be a reward for effortful action in a given moment. However, the data is still correlational, and it is also possible that better child persistence elicits more positive feedback from parents. Untangling cause and effect is especially difficult given the current paradigm's reliance on two cumulative, co-occurring measures. Intervention studies to induce more praise from parents are necessary to determine whether praise causally impacts persistence in naturalistic contexts the way it does in laboratory experiments ( Cimpian et al., 2007; Mueller & Dweck, 1998; Yu et al., 2018).

Parent instruction, on the other hand, may not be an effective strategy to help children brush, or parents may use instruction more when a child is off-task. Instruction may also reduce the time children spend brushing because they are able to brush more efficiently. However, it is difficult to assess the quality of brushing from video data alone. Furthermore, we chose time spent brushing as the dependent measure because it is what most dentists recommend tracking, rather than efficiency, which is harder to measure. It could also be the case that instruction is more helpful in circumstances that require a high level of skill, like when children are trying to learn piano.

There was a positive relationship between children's mood and brushing time, but this result was weak and variable across children. Past work has found a causal impact of positive mood on persistence in four-year-old children ( Masters & Santrock, 1976; Ridgeway & Waters, 1987), suggesting that having a positive mood may lead to longer brushing on a given day. Positive mood might increase children's persistence through multiple mechanisms, including increasing children's willingness to comply with parent requests ( Lay et al., 1989), decreasing the subjective cost of errors ( Pourtois et al., 2017), increasing self-efficacy ( Hom & Arbuckle, 1988), or changing interactions with parents. Here, we observed that fluctuations in mood were also related to fluctuations in parent stress. This relationship is almost certainly bidirectional: children's moods may deteriorate when their parents are stressed, and parents may feel more stressed when their children are in a bad mood. Mood and persistence may also reflect similar underlying physiological processes like fatigue. Experiments that induce positive mood in children, possibly through fun parent-child games prior to brushing, are necessary to test whether positive mood causes more brushing.

Our results show the advantages of measuring experiences within rather than just across children. None of the variables that we measured significantly predicted individual differences in average brushing time. Thus, it is not the case that parents who on average use more praise and less instruction have children who on average brush more. Measuring individual variation in brushing also revealed that more variable brushing time was associated with lower SES, suggesting that repeated measures may be even more important for characterizing behaviors for children in low-SES environments.

There were large individual differences in which factors were most predictive of brushing. For every predictor, some children showed positive effects, and others showed negative effects. Some children were sensitive to affective states, brushing more when they were in a better mood and less when their parents were stressed. We did not find an effect of SES on sensitivity to any of the factors, but the SES range was narrow, with only 4 families reporting incomes less than $62,500 per year. Larger and more diverse samples are needed to determine what makes some children sensitive to sleep, some sensitive to parent talk, and others sensitive to affective states. It is also possible that more than two weeks of data are necessary to precisely detect an individual child's sensitivity.

At the end of the study, parents were asked which factors influenced their own child's brushing. The majority of parents chose parent encouragement and mood, consistent with the within-child effects observed in the study. However, parents were not accurate in guessing which factors were most important for their own child. It is possible that parents answered this question based on their impressions of the quality of their child's brushing or their skill level, rather than the fine-grained brushing time that we measured here. These results point to the potential benefit of providing parents with individualized information about the causes of variability in their children's behavior.

Data collected before and during the pandemic suggest that the factors that proximally shape variability in children's persistence are fairly consistent regardless of broader global contexts and schedule disruptions. It is possible parents have been able to provide a buffer for their children against stressors in the world, even if they internalize the stress themselves, at least in the few minutes that we observed in this fairly affluent sample at the very beginning of the pandemic. Whether these results hold as the pandemic has stretched on remains an open question.

A major contribution of this work is the development of a new task to measure fluctuations in persistence. We chose to study fluctuations in persistence in an ecological domain in which parents want children to persist: brushing their teeth. Toothbrushing has no immediate pay-off and is not especially intrinsically motivating, reflecting a feature shared by many tasks that require persistence in both children and adults, like cleaning one's room and getting dressed. However, we do not know how the factors that shape persistence here will generalize to other tasks that require persistence. We intentionally chose a task that was not likely to be sensitive to individual differences in cognitive ability, so traditional models of effort might be less relevant for predicting behavior. Future work should test whether findings reported here translate to children's daily fluctuations on a wider range of tasks that require persistence, including those with both more immediate and delayed rewards. Notably, this daily video framework can be extended to study fluctuations in persistence in other domains that are more cognitively challenging or rewarding, like completing difficult homework or practicing a musical instrument, as suggested in Muenks, Wigfield, and Eccles (2018).

This study has a number of limitations. First, although toothbrushing is an ecologically valid task, its psychometric properties are not yet known and it may involve skills related to persistence, like executive function, conscientiousness, and compliance. Second, our sample is skewed towards higher-income families within a Western, Educated, Industrialized, Rich, and Democratic (WEIRD) cultural context, and thus we cannot address how our findings might differ in other contexts. Third, although we were able to measure persistence and parent talk objectively with video data, we relied on parent report for measures of child sleep, parent stress, and child mood. Parent report of child mood could be biased by their observation of a child's behavior during brushing. Parent report of both their stress and child mood may have artificially inflated the relationship between the two. Questions were brief to limit parent time commitment and reduce drop out, but they were limited in the amount of detail they provided. Many other unmeasured features of children's environments may also impact their persistence (e.g., exercise; Ludwig & Rauch, 2018). Fourth, we did not collect data on the quality of children's sleep. Although parent report of young children's sleep has been shown to be comparable to more intensive measures like actigraphy ( Iwasaki et al., 2010), the use of actigraphy may help with precision for data on factors like nighttime waking ( Lam et al., 2011). Furthermore, parents whose children attended childcare may have reported on naps without direct observation on some days. Fifth, we focused on evening brushing, but some relationships between predictor variables and persistence may be stronger during morning brushing (e.g., the relationship with sleep). Thus, future studies should probe time of day effects. Sixth, parents may have modified their own behavior due to being observed, potentially lowering the ecological validity of their parenting practices. Seventh, we do not know if our results will generalize beyond the pandemic, but comparisons with pre-pandemic data suggest that major differences are unlikely. Eighth, we were underpowered to run interactions, which require substantially larger sample size (e.g., Heo & Leon, 2010), or more complex time lagged analyses, which may require more time points per child. Future research with larger samples, and/or more occasions of sampling, should probe whether predictor variables interact in meaningful ways to impact fluctuations in brushing (e.g., are children more responsive to social input after a good night sleep?). Finally, this study was exploratory in nature and positive results merit replication in an independent sample.

A major strength of this work was that daily video data gave us a window into children's lives by capturing their naturalistic persistence and interactions with their parents. Our methods allowed us to go beyond measuring children's behavior solely via parent report, or with a snapshot measure in the lab that may be sensitive to unmeasured fluctuations in children's attention and motivation. This approach has implications for developmental science broadly. Measuring behavior every day will lead to a better estimate of average behavior, as well as estimates of variability in behavior, particularly in young children who may be difficult to study in laboratory settings. These measures may be, for example, more related to brain structure and function than performance on a snapshot measure in the lab. Intensive repeated measures will also be helpful for testing computational models of cognitive development. Clinically, daily at-home videos of child behavior can go beyond parent report to track variation in symptoms like inattention, hyperactivity, defiance, and oppositional behaviors and to understand the factors that contribute to variability. By capturing naturalistic family dynamics, this method can be helpful for understanding susceptibility and resilience to adversity.

In sum, we found that children's persistence fluctuates from day to day and is shaped by parent behavior. Our results inform both old and new theoretical models of persistence. We add nuance to Bandura's theory (1977) that verbal persuasion impacts persistence by specifically showing that praise, but not instruction, is associated with greater persistence. Our work replicates prior work in the praise literature showing that adult praise motivates children ( Brummelman & Dweck, 2020; Cimpian, et al., 2007; Gunderson et al., 2013, 2018; Lucca et al., 2019; Mueller & Dweck, 1998). We add to this literature by characterizing naturalistic parent praise over multiple days: parent praise during the daily task of toothbrushing mostly consisted of generic praise and process praise (e.g., "nice!" and "great job!"), with few instances of person praise (e.g., "good girl"). Furthermore, we show that the quantity of parent praise positively relates to individual children's persistence across days, building on empirical and theoretical work suggesting that general praise is helpful on tasks focused on continued commitment towards a goal ( Eskreis-Winkler & Fishbach, 2020). Beyond verbal and social input, we show that children's own physiological states may matter more for some children more than others. We also expand on modern theories of children as utility maximizers (Lucca et al., 2020) by suggesting that the costs and rewards of effortful actions may fluctuate from day to day depending on social feedback and physiological states.

Our work provides a path towards identifying the specific factors that impact individual children's persistence to design targeted interventions, some of which parents may not find obvious. For children who are most sensitive to parent stress, we can recommend interventions to enhance parent emotion regulation ( England-Mason & Gonzalez, 2020). For children who are most sensitive to sleep, interventions that target sleep hygiene might be more effective ( Wilson et al., 2014). Group-level interventions that enhance children's motivation and cognition have been frustratingly elusive ( Bailey et al., 2020; Diamond & Ling, 2016), and individualization may be the key to better efficacy.

Acknowledgements

We thank Yoojin Hahn and Greer Bizzell-Hatcher for help coding the data and Ava Cruz for help with graphic design. We thank Sophie Bridgers for critical feedback.

Funding

This research was supported by a Jacobs Foundation Early Career Research Fellowship to A.P.M., NIDA (1R34DA050297-010) to A.P.M, a University of Pennsylvania MindCORE Postdoctoral Fellowship to J.A.L., and NIDA (K01DA047417) to D.M.L.

Footnotes

Competing interests

The authors declare no competing interests

Data and code availability

All data, materials, and preregistrations are available on the Open Science Framework: https://osf.io/vr2du/

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Daily fluctuations in young children's persistence

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Children's behavior changes from day to day, but the factors that contribute to its variability are understudied. We developed a novel repeated measures paradigm to study children's persistence by capitalizing on a task that children complete ...

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Principles of Child Development and Learning and Implications That Inform Practice

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NAEYC’s guidelines and recommendations for developmentally appropriate practice are based on the following nine principles and their implications for early childhood education professional practice.

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Developmentally appropriate practice: Knowing about child development and learning

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It is important teachers understand children’s development.

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Kenneth R. Ginsburg, and the Committee on Communications, and the Committee on Psychosocial Aspects of Child and Family Health; The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds. Pediatrics January 2007; 119 (1): 182-191. 10.1542/peds.2006-2697

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# data[].attributes.attachment_link.title
The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds

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Play is essential to development because it contributes to the cognitive, physical, social, and emotional well-being of children and youth. Play also offers an ideal opportunity for parents to engage fully with their children. Despite the benefits derived from play for both children and parents, time for free play has been markedly reduced for some children.

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Stress may be a response to a negative change in a child's life. In small amounts, stress can be good. But, excessive stress can affect the way a child thinks, acts, and feels.

Children learn how to respond to stress as they grow and develop. Many stressful events that an adult can manage will cause stress in a child. As a result, even small changes can impact a child's feelings of safety and security.

Pain, injury, illness, and other changes are stressors for children. Stressors may include:

Worrying about schoolwork or grades

Juggling responsibilities, such as school and work or sports

Problems with friends, bullying, or peer group pressures

Changing schools, moving, or dealing with housing problems or homelessness

Having negative thoughts about themselves

Going through body changes, in both boys and girls

Seeing parents go through a divorce or separation

Money problems in the family

Living in an unsafe home or neighborhood

SIGNS OF UNRESOLVED STRESS IN CHILDREN

Children may not recognize that they are stressed. New or worsening symptoms may lead parents to suspect an increased stress level is present.

Physical symptoms can include:

Decreased appetite, other changes in eating habits

Headache

New or recurrent bedwetting

Nightmares

Sleep disturbances

Upset stomach or vague stomach pain

Other physical symptoms with no physical illness

Emotional or behavioral symptoms may include:

Anxiety, worry

Not able to relax

New or recurring fears (fear of the dark, fear of being alone, fear of strangers)

Clinging, unwilling to let you out of sight

Anger, crying, whining

Not able to control emotions

Aggressive or stubborn behavior

Going back to behaviors present at a younger age

Doesn't want to participate in family or school activities

HOW PARENTS CAN HELP

Parents can help children respond to stress in healthy ways. Following are some tips:

Provide a safe, secure, and dependable home.

Family routines can be comforting. Having a family dinner or movie night can help relieve or prevent stress.

Be a role model. The child looks to you as a model for healthy behavior. Do your best to keep your own stress under control and manage it in healthy ways.

Be careful about which television programs, books, and games that young children watch, read, and play. News broadcasts and violent shows or games can produce fears and anxiety.

Keep your child informed of anticipated changes such as in jobs or moving.

Spend calm, relaxed time with your children.

Learn to listen. Listen to your child without being critical or trying to solve the problem right away. Instead work with your child to help them understand and solve what is upsetting to them.

Build your child's feelings of self-worth. Use encouragement and affection. Use rewards, not punishment. Try to involve your child in activities where they can succeed.

Allow the child opportunities to make choices and have some control in their life. The more your child feels they have control over a situation, the better their response to stress will be.

Encourage physical activity.

Recognize signs of unresolved stress in your child.

Seek help or advice from a health care provider, counselor, or therapist when signs of stress do not decrease or disappear.

WHEN TO CALL THE DOCTOR

Talk to your child's provider if your child:

Is becoming withdrawn, more unhappy, or depressed

Is having problems in school or interacting with friends or family

Is unable to control their behavior or anger

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Stress in childhood: MedlinePlus Medical Encyclopedia

# data[].attributes.attachment_link.description
Stress may be a response to a negative change in a child's life. In small amounts, stress can be good. But, excessive stress can affect the way a child thinks, acts, and feels. Children learn how to respond to stress as they grow and develop.

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Young people experience stress from a variety of sources. Some stress can be positive, but too much stress is overwhelming. Tuning into emotional or behavioral cues is important in identifying potential problems.

Cite this

American Psychological Association. (2019, September 5). Identifying signs of stress in your children and teens. https://www.apa.org/topics/stress/children

Young people, like adults, experience stress. It can come from a variety of sources including doing well in school, making and sustaining friendships, or managing perceived expectations from their parents, teachers, or coaches. Some stress can be positive in that it provides the energy to tackle a big test, presentation, or sports event.

Too much stress, however, can create unnecessary hardship and challenge. Adults can sometimes be unaware when their children or teens are experiencing overwhelming feelings of stress. Tuning into emotional or behavioral cues is important in identifying potential problems and working with your young person to provide guidance and support to successfully work through difficult times.

Here are some tips from APA on ways to recognize possible signs of stress.

Watch for negative changes in behavior

Youth of all ages, but especially younger children, may find it difficult to recognize and verbalize when they are experiencing stress.

For children, stress can manifest itself through changes in behavior. Common changes can include acting irritable or moody, withdrawing from activities that used to give them pleasure, routinely expressing worries, complaining more than usual about school, crying, displaying surprising fearful reactions, clinging to a parent or teacher, sleeping too much or too little, or eating too much or too little.

With teens, while spending more time with and confiding in peers is a normal part of growing up, significantly avoiding parents, abandoning long-time friendships for a new set of peers, or expressing excessive hostility toward family members, may indicate that the teen is experiencing significant stress. While negative behavior is not always linked to excessive stress, negative changes in behavior are almost always a clear indication that something is wrong. Adults will want to pay attention to these behaviors and determine an appropriate response or intervention.

Understand that "feeling sick" may be caused by stress

Stress can also appear in physical symptoms such as stomach aches and headaches. If a child makes excessive trips to the school nurse or complains of frequent stomachaches or headaches (when they have been given a clean bill of health by their physician), or if these complaints increase in certain situations (e.g., before a big test) that child may be experiencing significant stress.

Be aware of how your child or teen interacts with others

Sometimes a child or teen may seem like his or her usual self at home but be acting out in unusual ways in other settings. It is important for parents to network with one another so that they can come to know how the child or teen is doing in the world around them. In addition to communicating with other parents, being in contact with teachers, school administrators, and leaders of extracurricular activities can help parents tap into their child or teen's thoughts, feelings, and behaviors, and be aware of any sources of concern.

Listen and translate

Because children are often not familiar with the word stress and its meaning, they may express feelings of distress through other words such as "worried," "confused," "annoyed," and "angry." Children and teens may also express feelings of stress by saying negative things about themselves, others, or the world around them (e.g. "No one likes me," "I'm stupid," "Nothing is fun."). It is important for parents to listen for these words and statements and try to figure out why your child or teen is saying them and whether they seem to indicate a source or sources of stress.

Seek support

Parents, children, and teens do not need to tackle overwhelming stress on their own. If a parent is concerned that his or her child or teen is experiencing significant symptoms of stress on a regular basis, including, but not limited to those described above, it can be helpful to work with a licensed mental health professional, such as a psychologist. Psychologists have special training to help people identify problems and develop effective strategies to resolve overwhelming feelings of stress.

Special thanks to psychologists Mary Alvord, PhD, and David J. Palmiter, Jr., PhD, ABPP, for their assistance and expertise.

The full text of articles from APA Help Center may be reproduced and distributed for noncommercial purposes with credit given to the American Psychological Association. Any electronic reproductions must link to the original article on the APA Help Center. Any exceptions to this, including excerpting, paraphrasing or reproduction in a commercial work, must be presented in writing to the APA. Images from the APA Help Center may not be reproduced.

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From time to time, our favorite little people can find themselves up against big emotions. Whether it's a squabble with a sibling or not being allowed to have a cookie before dinner, frustration and anger can bubble to the surface, and chances are it won't be at the time or place of your choosing.

And while these situations might be unpleasant for you, imagine how difficult it is for someone who doesn't know how to handle them. When tempers begin to flare, breathing exercises are one of the most effective calming strategies for kids who are dealing with difficult emotions.

Anyone who has ever tried it can tell you there's a lot of power in a deep cleansing breath. For kids, deep breathing is a great way to get them to focus on something else in the moment rather than "the thing" (or things) that are making them sad, mad, or frustrated. Moreover, breathing calms children by physically slowing them down. To practice deep breathing, they must stop whatever they are doing to complete the exercise.

Some of the documented benefits of deep breathing include:

Breathing exercises for kids

When it comes to deep breathing exercises for kids, the key is to make these exercises fun and easy to remember when things feel topsy-turvy. The following breathing exercises use imagery that appeals to children, and language they will have no trouble understanding.

Remember that when you introduce these mindful breathing exercises to your kids, be sure to do so outside of an emotionally charged situation. Instead, introduce these breathing exercises during calm moments when your child will be receptive to the information and willing to practice them along with you. Preparing them ahead of time will leave them better equipped to handle situations when they arise - even when you're not around.

Smelling Flowers

Tell your little one to imagine they are smelling a flower, breathing in deeply through the nose and out through the mouth. Smelling flowers is one of the easiest breathing exercises to master, and a good starting point for your child.

The Bunny Breath

Just like a little bunny in the garden, encourage your child to take three quick sniffs in through the nose, and one long exhale out through the mouth.

Blow Out Candle

Have your child blow out the candles on a make-believe birthday cake, drawing a deep breath in through the mouth, and blowing it out strong through the mouth as well.

The Snake Breath

Tell your child to pretend he/she is a snake and hiss, inhaling deeply through the nose and blowing out through the mouth with a soft and low hissing sound.

Blowing Bubbles

Remind your child how softly they need to blow to get a nice big bubble. Encourage them to take a deep breath in and blow it out soft and long.

Smell The Flower And Blow Out The Candle

Have your child pretend that he/she has a flower in one hand and a candle in the other. The first step is smelling the flower, taking a deep breath in through the nose, and filling the lungs with air. Next, have your child exhale and blow out the candle in the other hand.

BumbleBee Breath

Have your child sit comfortably and inhale through their nose, keeping their mouth closed. Next, with their mouth still closed, have them make a humming or buzzing noise (like a bumblebee) as they exhale. Your child can also cup their hands around their ears to amplify the buzzing sound.

Deep Belly Breath

Have your child place one hand on their belly and one hand on their chest. Let them take a deep breath in for four counts and then exhale slowly (through their nose) for four counts. Remind them to pay attention to the rise and fall of their chest and belly as they complete the exercise.

Tumble Dryer

Have your child sit cross-legged and get comfortable. Have them point their index fingers toward each other in front of their mouth. After your child inhales deeply through the nose, have them exhale through their mouth and swirl their fingers around as they do so (like a tumble dryer). The fun part of this is the swishy noise they'll hear as they exhale.

Dragon Fire Breaths

Have your child interlace their fingers under their chin, and as they inhale, have them raise their elbows as high as they can around their neck and face. On the exhale, have them lower their elbows back down.

Hot Air Balloon Breath

For the hot air balloon breath, have your child sit comfortably and cup their hands around their mouth. Have them inhale deeply, and on the exhale (through their mouth), prompt them to expand their hands outward, as if they are blowing up a giant hot air balloon.

Shoulder Roll Breath

Shoulder roll breaths are a great breathing exercise for kids. They have the added benefit of releasing tight muscles and tension. Have your child sit comfortably. As they take a deep breath in, encourage them to roll their shoulders up toward their ears. Have them drop their shoulders back down on the exhale.

If none of the techniques above hold your child's attention, this short, guided breathing exercise with Pipsi from Moshi may be able to help.

Deep breathing exercises can help kids to reset, self-regulate, and respond to stress in a healthier way. But it's important for parents to remember that mindful breathing isn't necessarily intuitive, particularly in moments of frustration. Often when your child is angry, frustrated, or anything but calm, you'll have to remind them to breathe deeply.

When you do so remember the following:

Get down to their level

Getting down to your child's eye level signals to them they have your full attention. When you get down to your child's level, make eye contact, and speak softly. Your message is more likely to be heard and received.

Find a quiet space

If a meltdown happens in the middle of a playground or a birthday party, the stimulation from your child's surroundings won't be conducive to returning them to a state of calm. Do your best to remove your child from the situation. Find a quiet space to talk to your child and do some mindful breathing.

The good thing about these breathing exercises for kids is that they don't cost a thing, and they can be used anywhere at any time. While these breathing techniques are effective for calming your child in anxious moments, they're also effective for getting your child to settle down before bedtime.

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12 Fun and Easy Deep Breathing Exercises For Kids

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The key to deep breathing for kids is to make the exercises fun and easy to remember. These breathing exercises are perfect for all ages.

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For kids in the hospital, physical needs are often, and understandably, top of mind for families. It's extremely encouraging to watch a child heal on the outside. But child life specialists at Lurie Children's know it's equally as important to prioritize emotional and mental healing so that children feel safe to fully experience what they're going through. While it's common for parents and caregivers to want to shield children from certain reactions or emotions, experts remind us that there is no such thing as a good feeling or a bad feeling - there are just feelings - and creating emotionally safe spaces for children is far more beneficial in eliminating trauma and stress than diverting them away from their reality.

The Association of Child Life Professionals ( ACLP) defines emotional safety as "an intentional, interdisciplinary practice to promote resiliency, healing and trust for pediatric patients and their families during medical experiences." Lurie Children's Certified Child Life Specialist Rebecca Mitsos and her team of clinically trained and licensed clinicians focus on how a child's emotional reaction impacts what they're experiencing in the healthcare setting. They use their expertise in child development and trauma-informed care to assess, support and advocate for a child and family's psychosocial needs and to teach kids lifelong coping skills. This can include but is not limited to developmental play, procedural support, trauma intervention and bereavement/grief support.

Below Mitsos shares how to identify an emotional emergency and empowers families to establish emotional safety on their own. While the child life profession focuses on children in the hospital, she notes this strategy is available to and recommended for people of all ages, in any environment where it's needed.

Signs of an emotional emergency

Crying

Yelling

Tantrum

Stonewalling (ignoring)

Whining

Antagonizing a sibling, parent, or friend

Eating disorder behaviors and/or changes in typical eating patterns

Substance use and abuse

Self-harming behaviors

"While some may recognize these as challenging behaviors, they are often stemming from a place of big feelings - frustration, anger, sadness, etc.," says Mitsos.

How to respond to an emotional emergency

"As child life specialists, we are often the first responders to the emotional and behavioral needs of patients and families, but the listen, protect, connect strategy we apply is useful for all families to help foster a safe space for emotions during vulnerable moments," says Mitsos.

1. Listen

Encourage the child to express and name exactly what they're feeling. It's important to offer validation versus dismissing or negating the expressed feelings. You cannot fix someone's feelings, but you can make them feel safe, heard, and supported. To do this, try saying things like "I hear you," "that would make me feel sad, too," or "I understand this is difficult and you are feeling a lot of big feelings."

Avoid things like "don't be scared," "be tough," or "it'll be fine." These types of statements have the potential to make your child feel overlooked or even guilty or shameful for feeling a certain way. Simply listening to kids is the first step.

2. Protect

Once you know what a child is feeling, you can determine how to respond to what they've shared, i.e., "what can I do to help you?" Work with the child to validate their experience and identify what they might need from you by simply asking them "I know this is difficult and you are feeling sad, how can I help?"

This cues to them that their feelings are protected, their value is acknowledged, and their safety is prioritized. Every emotional emergency is unique, but in the moment they may need anything from physical space, taking a walk or a change of scenery to crying, listening to music, taking a nap, or watching a movie. These are all sound coping strategies and can be helpful for a child experiencing an emotional emergency.

3. Connect

By listening to and protecting a child's feelings and emotional reactions, you create an opportunity for deeper and authentic connection. Your interactions and experiences will be much more productive if both parties feel heard and understood and the child ultimately understands that feelings are meant to be felt, not fixed.

Planning ahead

The same way your family might have a fire escape plan, it's smart to think about what your child may need before an emotional emergency is triggered. Mitsos and her team recommend using these prompts to prepare:

Have them think about a time they felt worried, scared, confused, or overwhelmed

Identify what helped them when they felt this way, whether it was certain people or things/activities

Acknowledge what was more harmful than helpful in the moment

"It's important to think about feelings as part of the body," says Mitsos. "To take care of a child's eyes you'd take them to an eye doctor or get them glasses; to take care of their ears you'd get hearing tests done or get them a hearing aid. Their feelings are just as worthy of taking good care of."

Learn more about the Child Life team at Lurie Children's.

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Tools for Emotional Safety from a Certified Child Life Specialist

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For kids in the hospital, physical needs are often, and understandably, top of mind for families. It's extremely encouraging to watch a child heal on the outside. But child life specialists at Lurie Children's know it's equally as important to prioritize emotional and mental healing so that children feel safe to fully experience what they're going through.

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At a glance

Emotional intelligence is the ability to be smart about emotions.

It can help kids with learning and thinking differences manage their challenges.

There are things you can do to develop your child's emotional intelligence.

Consider this scenario: Samuel is struggling with his math homework. Instead of yelling and giving up, he tells his mom how frustrated he is and asks for help. Or this one: Samuel's friend gets some upsetting news and cancels their plans to hang out. Samuel understands why his friend doesn't feel like socializing and makes other plans.

These responses might not seem like a big deal. But they're signs of an important set of skills that make up what's known as "emotional intelligence" (EI). This type of intelligence isn't measured by IQ tests. Yet it's crucial to helping us work through challenges and respond to situations successfully. It also helps us make positive connections with the people around us.

Emotional intelligence can be especially helpful to kids with learning and thinking differences. At the same time, certain learning and thinking differences make it harder for some kids to develop it. Learn more about EI and how you can help your child build this key ability.

What emotional intelligence is

EI is the ability to be smart about feelings - our own and other people's. It involves being able to notice, understand and act on emotions in an effective way.

The concept of EI has been around for decades. It was made popular by the 1995 book, Emotional Intelligence: Why It Can Matter More Than IQ. The author, psychologist Daniel Goleman, described EI has having five basic parts.

1. Self-awareness: When people know what they're feeling at a particular time and understand how their moods affect others.

2. Self-regulation: When people can control how they respond to their emotions. They consider possible consequences before acting on impulse.

3. Motivation: When people can accomplish goals in spite of negative or distracting feelings they may be having.

4. Empathy: When people can understand how others feel.

5. Social skills: When people can manage relationships. They know what kind of behaviors get a positive response from others.

Why EI is important for kids with learning and thinking differences

Think about the challenges Samuel might face every day. Tasks that are easy for his peers may be difficult for him. He may study hard but get poor grades anyway. He may feel embarrassed about his learning differences and afraid to ask for help.

One of the key roles of EI is shaping how we respond to challenges. Is Samuel has learning and thinking differences, EI can be like a GPS that can help him navigate his way around obstacles and toward success. It allows him to size up situations, put them in perspective, and come up with ways to work through them.

The five factors that make up EI come together to help Samuel achieve the best outcome. Here's how that might play out when he's struggling with that math homework:

He realizes he's getting frustrated.

He quickly considers the outcome of yelling or throwing his book on the floor.

He comes up with a better way to respond - explain how he's feeling.

He wants to try again, despite being frustrated, because he understands what he'll gain in the long run.

He asks his mom for help.

She pushes a little too hard, but he understands it's because she really cares and wants to help him find success.

He says he needs to go at a slower pace and would like to try doing it again by himself.

The next day, he waits until after class and tells his teacher he's having trouble understanding.

Without emotional intelligence, the outcome would likely be different. Here's how the scenario might play out:

He throws his pencil down in frustration the minute he gets stuck on a problem.

He yells at his mom when she come in to help, thinking she's just there to nag him.

He storms out of the room and never comes back to try again. He doesn't see any point in it.

In math class the next day, he tells the kid sitting next to him that the assignment was stupid.

When the teacher asks the students to hand in their work, he says he didn't do it. He doesn't tell her after class that he was having trouble with it and ask for help.

Why some kids struggle with EI

Many kids with learning and thinking differences don't have any trouble with emotional intelligence. Some have particularly high EI, in fact. But trouble with EI can sometimes be an early sign that a child has a learning or thinking difference.

Kids with ADHD might miss social cues because they're not paying close enough attention to pick up on them. Kids with an auditory processing disorder might misinterpret what others are saying to them. And kids with nonverbal learning disabilities might not pick up on social cues at all.

On the flip side, it's not uncommon for people with dyslexia to show very high EI. Some researchers think this may be due to their brain's natural ability to think in the "big picture."

How you can help your child

The good news about EI is that it isn't set - with help and practice your child can develop it over time. That's true even for kids who are weak in this area due to learning and thinking differences. It just might take them longer to get there.

Many school districts offer social and emotional learning (SEL) programs that teach kids to be aware of emotions and act on them effectively.

There are things you can do at home, too:

Talk about challenges. Ask kids how they feel when they're struggling with something. Put a name to the emotions: sad, angry, overwhelmed, etc. Then ask why they're feeling the emotion they just named.

Work on strategies. Brainstorm ways kids might have done something differently to get a different outcome. Controlling emotions in order to think of solutions is a big part of EI.

Help others. Have kids join you in taking care of people in need as a way to build empathy. You can join a volunteer effort, or just bring them along when you take food to a sick neighbor.

Key takeaways

Some kids with learning and thinking differences have trouble with emotional intelligence.

Schools may offer social and emotional learning (SEL) programs to help build EI in kids.

Talking about challenges and feelings helps build emotional intelligence.

About the author

About the author

Peg Rosen writes for digital and print, including

Reviewed by

Reviewed by

Donna Volpitta, EdD is the founder of Pathways to Empower. Her work draws on the latest research in neuroscience, psychology, and education.

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Emotional Intelligence in Children | LD, ADHD and Emotional Skills

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Emotional intelligence is the ability to be smart about emotions. It can help kids with learning and thinking differences manage their challenges. There are things you can do to develop your child's emotional intelligence. Consider this scenario: Samuel is struggling with his math homework.

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S A M P L E
This form may be adapted to use with preteen or teenage participants in
your program. You may wish to make the language less formal or the
vocabulary less sophisticated, depending on the developmental stage of the
young people in your programs. You might also wish to add or subtract
components to the code. You may find you get more "buy in" if the
participants are part of the development process. If you use a "contract"
such as this, you must be willing to enforce the consequences if the code is
broken, or otherwise the "contract" has no meaning for the participants.
Including youth and staff together in one code strengthens the notion that
rules are part of life that both youth and adults have to follow.
Code of Conduct

[Name of Nonprofit] is a youth-serving, community-based organization
dedicated to providing [description of mission or services]. Participation
in the organization's programs is subject to the observance of the
organization's rules and procedures. The activities outlined below are
strictly prohibited. Any participant or staff member who violates this
Code is subject to discipline, up to and including removal from the program.

Abusive language towards a staff member, volunteer or another
participant.

Possession or use of alcoholic beverages
or illegal drugs on [Name of Nonprofit]'s property or reporting to the
program while under the influence of drugs or alcohol.

Bringing onto [Name of Nonprofit]'s property dangerous or unauthorized
materials such as explosives, firearms, weapons or other similar items.

Discourtesy or rudeness to a fellow participant, staff member or
volunteer.

Verbal, physical or visual harassment of another participant, staff
member or volunteer.

Actual or threatened violence toward any individual or group.

Conduct endangering the life, safety, health or well-being of others.

Failure to follow any agency policy or procedure.

Bullying or taking unfair advantage of any participant.

Failing to cooperate with an adult
supervisor/leader/mentor.

I have read and I understand the [Name of Nonprofit]'s Code of Conduct. I
agree to abide by the rules described above and understand that I may be
removed as a participant if I violate any of these rules.

Signature __________________________________________

Date _______________

Witness ___________________________________________

Date _______________

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Youth Program Sample Code of Conduct - Nonprofit Risk Management Center

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S A M P L E This form may be adapted to use with preteen or teenage participants in your program. You may wish to make the language less formal or the vocabulary less sophisticated, depending on the developmental stage of the young people in your programs. You might also wish to add or subtract ...

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FAQS | ADDITIONAL RESOURCES

The skills are the same as those taught in evidence-based cognitive-behavioral therapy, and focus on healthy ways to deal with stressful situations.

With practice, these skills can help children and youth recognize how their feelings are influenced by what they think and what they do. The skills can be useful in dealing with COVID-related challenges and other everyday stressors now and as they grow into adulthood.

In addition to COVID-related stresses, some children and youth are experiencing stress or trauma related to other issues. Current or historic events such as systemic racism or discrimination based on race, ethnicity, sexual orientation, gender identity, socioeconomic status, religion, or cultural background can have significant impact on emotional wellbeing. Even though these tools cannot address factors like discrimination, the skills may help children cope in difficult times and difficult situations they cannot control.

Children and youth who are feeling serious anxiety or depression likely need more than what these tools can provide. If symptoms are more severe or long lasting, consider seeking out additional help. Our Additional Resources page has some options for finding more information or connecting with a mental health provider.

The Board on Children, Youth, and Families expresses its thanks to the Centers for Disease Control and Prevention for its critical support for this project.

BCYF also thanks the Robert Wood Johnson Foundation and the Jacobs Foundation for their critical support of the leadership activities of BCYF. This project was made possible by the contributions of scientific experts, Spanish-speaking volunteers who assisted with translation, and family advocates who provided input throughout the project process.

Frequently Asked Questions

1. Why and how were these tools developed?

Why? Many children and teens struggle with feelings of stress, anxiety, and depression, particularly during the pandemic. These tools were created to promote the mental and emotional wellbeing of children and youth - during the COVID-19 crisis and beyond.

How? The National Academies of Sciences, Engineering, and Medicine (NASEM) made this project possible with funding from the Centers for Disease Control and Prevention (CDC). NASEM brought together a group of experts to develop ways to help children and youth with difficulties they face every day. Together with experts at ICF, they created tools, based on cognitive behavioral therapy (CBT), to help reduce stress, anxiety, and depression. The tools are meant for children and youth directly, and for parents to help children and youth with stress, anxiety, and depression. Teachers and other caregivers may also be able to use these resources.

More information about this project and the group of experts is available on the project webpage: https://www.nationalacademies.org/our-work/promoting-emotional-well-being-and-resilience.

2. What are stress, anxiety, and depression? ¹

Stress is a normal reaction to everyday pressures. Pressures may come from outside a person's body (something that happens to you) or from the inside a person's body (something you are feeling). Some stress can be helpful, like giving a person a boost of energy and feeling of urgency to study for a test. But having too much stress at once or having a lot of stress for a long time without enough breaks, can make life hard and cause problems with thinking and with doing day-today activities. When children or teens feel stressed, they may:

Sweat

Have a dry mouth

Feel short of breath

Have trouble sleeping

Fidget

Have a stomachache or headache

Feel tense in the body

Find it hard to think and finish tasks

Anxiety is an emotion of fear or worry about things that might happen in the future, or fear or worry about one's safety, or the safety of others.Many children and teens have fears or worries, but some have so many fears and worries that they interfere with school, home, or play activities. When children or teens feel anxious, their muscles may tense, and their breathing and heartbeat may become more rapid. They might also have stomachaches, other body aches or pains, feel tired all the time, or have trouble sleeping. They might have upsetting thoughts that are hard to control. Sometimes, anxiety can make a child or teen irritable or angry. Some anxious children and teens keep their worries to themselves, or might not even be aware of them, and, thus, the symptoms can be missed. Examples of different types of anxiety that can cause difficulties with daily life include

Being very afraid when away from parents (separation anxiety)

Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias)

Being very afraid of school and other places where there are people (social anxiety)

Being very worried about the future and about bad things happening (general anxiety)

Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

Depression. Occasionally being sad or feeling hopeless is a part of every child and teen's life. However, some children and teens feel sad or uninterested in things that they used to enjoy, or feel helpless or hopeless in situations they are able to change. When someone experiences depression, their eating and sleeping habits may change, they may feel tired and lack motivation to do things that they typically enjoy, feel bad about themselves, feel more irritable, and they might pull away from their friends and family. They might also have stomachaches or headaches. They might have trouble sleeping or may sleep too much.Some children and teens may not talk about their helpless and hopeless thoughts, and may not appear sad. Depression might also cause a child or teen to make trouble or act unmotivated, causing others not to notice that the child is depressed or to incorrectly label the child as a troublemaker or lazy. Examples of behaviors often seen in children and teens with depression include

Feeling sad, hopeless, or irritable a lot of the time

Not wanting to do or enjoy doing fun things

Showing changes in eating patterns - eating a lot more or a lot less than usual

Showing changes in sleep patterns - sleeping a lot more or a lot less than normal

Showing changes in energy - being tired and sluggish or tense and restless a lot of the time

Having a hard time paying attention

Feeling worthless, useless, or guilty

Showing self-injury and self-destructive behavior

Managing Symptoms. Although experiencing feelings of stress, anxiety, or depression may be difficult, it's important to remember that these feelings can change, and there are tools that can help children and teens learn to manage feelings and help them cope.
Coping with these feelings can increase confidence and bring a greater sense of control. But sometimes children and teens can't cope with these feelings on their own. When that happens, it is important to get help.

1. https://dictionary.apa.org/

3. What are some causes of stress?

Stress can be caused by a many things. Sometimes the cause is a specific situation that might be very difficult like...

Having to do a difficult task,

Feeling left out or lonely, or

Feeling embarrassed in a social situation.

When stress is caused by events like this, the uncomfortable feelings can go away after the event is over. Many people also experience stress that lasts a long time without a break like...

Living in a neighborhood where they don't feel safe

Having a parent who is sick and does not get better

Feeling systemic racism or oppression at school

Thoughts, feelings, and behaviors can be difficult to manage when stressful factors like these feel outside of a person's control. Cognitive behavioral therapy skills can help a person focus on what they can control.

4. What is cognitive behavioral therapy (CBT)?

Cognitive behavioral therapy (CBT) works by helping a person notice how their thoughts affect how they feel and behave. CBT helps them turn unhelpful thoughts around to more helpful thoughts so they feel better. Experts tell us that CBT is the gold standard of therapy for children, teens, and adults who are experiencing stress, anxiety, and depression.

The word "cognitive" refers to what we think, and the word "behavioral" to what we do. CBT can help children and teens...

"Catch" thoughts that are not helpful, "check" them, and "change" them to feel better.

Learn to notice and do the things that help them feel better.

Learn helpful skills like deep belly breathing and mindfulness.

CBT won't be able to fix all the things that make someone feel stressed, anxious, or depressed, but it can help them cope with those feelings and feel better.

These tools don't teach every part of CBT, only some of the most tested and easy-to-use skills. Although these tools can't take the place of a mental health provider, they can help children and teens learn how to better cope with everyday stress and anxiety.

NOTE: It takes time to learn a new habit, usually 30 to 60 days, so it's important for children and teens to keep practicing these skills regularly. They will not only benefit today, but will build resilience and help manage future stress throughout life's journey.

5. What kinds of skills are included in these tools?

The CBT skills we teach here can help children and teens deal with stress, anxiety, and depression, and can provide parents, teachers, and other caregivers with tools to help children and teens learn new ways of coping. Here are some of the CBT skills we cover in these tools:

Deep belly breathing involves slowing down breathing as a strategy to stay calm and relax. This skill is taught in the Belly Breathing or Deep Breathing scenarios.

Mindfulness is all about learning how to stay fully in the present moment and being aware of one's thoughts and feelings without feeling bad about them. This skill is taught in the Calming Your Mind scenarios.

Doing activitiesthat make children and teens feel better - even when they feel down, that can help reduce stress, and give them more energy. This skill is taught in the Doing Fun Activities or Increasing Favorite Activities scenarios.

Catching, checking, and changing your thoughts means learning to "catch" thoughts that are not helpful, "check" them, and "change" them to feel better. When we are feeling stressed, anxious, or depressed, we often fall into thinking traps, or patterns of unhelpful thoughts that are based on incomplete information. Here are a couple of the most common thinking traps that are addressed in these tools:

Labeling is when someone attaches a negative description to themselves. For example, when someone makes a mistake, they might say "I'm such a failure," rather than recognizing that making mistakes is normal. Learning how to get out of this thinking trap is taught in the Catch, Check, and Change Your Thoughts - Part 1 scenarios.

All-or-nothing thinking often involves the use of absolute terms, such as never or always. For example, if someone tries out for a basketball team and don't make it, they might think, "I'll never be a basketball player!" In reality, when they focus on their feeling of failure, they might not remember that they can try out for a different team or practice and try again next year. Learning how to get out of this thinking trap is taught in the Catch, Check, and Change Your Thoughts - Part 2 scenarios.

There are other thinking traps too. Examples include "self-blame," or thinking things are always their own fault even when those things are outside of their control; "mind reading," or thinking that they know other people are thinking negatively about them; "should statements" or telling themselves they should or must do something that they might not be able to do; and "catastrophic thinking," or focusing on the worst possible outcomes of something.

6. Why are the pronouns "they," "them," or "theirs" used to refer to a single person in these tools?

The language we use to describe people and experiences is important. It signifies how we express ourselves and how other people see us. Many times, in English or Spanish, we use different forms of nouns, pronouns, or adjectives that are based on assumptions about a person's gender. Many people may not view this as a problem. But, for some people, assumptions about gender are not accurate, and can be harmful. Gender inclusive language is used throughout the modules to ensure that all children and teens can connect to our scenarios. They, them, and theirs are pronouns frequently used to refer to a single person when we are not aware of the person's gender, and/or when a person does not identify as a boy/man or a girl/woman. For example, if a person notices that someone left an item in a classroom but the person does not know who it belongs to, the person might say "Oh no, someone left their water bottle" using "their" as a gender neutral pronoun. In Spanish, gender inclusive language is sometimes created using an -e, rather than a feminine -a or a masculine -o.

7. Where should I go if I need additional resources or help?

If you or your child or teen are in need of immediate support, the Lifeline network is available 24/7 across the United States. You can call (800) 273-8255 or text 741741.

If you are looking to find a provider who can support you or your child's mental health, you can visit the Substance Abuse and Mental Health Services Administration and Mental Health America treatment locators. Cognitive behavioral therapists can be found on the Association for Behavioral and Cognitive Therapies website. The American Psychological Association also has a resource page dedicated to COVID-19.

To learn more about the COVID-19 pandemic, visit the websites for the CDC or the NIH.

For additional help, visit our Resources page.

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Emotional Wellbeing in Children and Youth

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FAQS | ADDITIONAL RESOURCES With practice, these skills can help children and youth recognize how their feelings are influenced by what they think and what they do. The skills can be useful in dealing with COVID-related challenges and other everyday stressors now and as they grow into adulthood.

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Your Healthiest Self
How you feel can affect your ability to carry out everyday activities, your relationships, and your overall mental health. How you react to your experiences and feelings can change over time. Emotional wellness is the ability to successfully handle life's stresses and adapt to change and difficult times. Flip each card below for checklists on how to improve your health in each area. Click on the images to read articles about each topic. You can also print the checklists separately or all together to share with others or as a reminder to yourself.
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6 strategies for improving your emotional health

Want to learn more?

NIH scientists study how physical illness, mental health conditions, caregiving, sleep, and stress impact your emotional health and well-being. Read more resources from the NIH institutes advancing research in these areas.
More resources about emotional wellness "

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Find out how to successfully handle life's stresses and adapt to change and difficult times.

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What Works Brief No. 21

The What Works Brief is a continuing series of easy-to-read, "how to" information packets on a variety early learning practices. Program managers and in-service providers may find this resource useful in meeting professional development needs. This brief discusses children's emotional literacy and illustrates practical intervention strategies for early childhood settings and home environments.

This What Works Brief is fromthe Center on the Social and Emotional Foundations for Early Learning.

Introduction

The following brief includes examples and vignettes that illustrate how practical strategies might be used in a variety of early childhood settings and home environments.
Four-year-old Gregory is an avid block builder. At free play, he has busied himself with an elaborate construction of a zoo. To complete his masterpiece, he needs an elusive Y-shaped block. As he searches the room in vain for the last, crucial piece, his initial calm hunt becomes more hurried and disorganized. He begins to yell and disrupt other children's play. Gregory sees that his classmate Malik has the piece he wants. Gregory aggressively approaches Malik, who looks frightened. His teacher approaches in the nick of time and asks, "What's the matter?" Gregory screams that Malik has his block and then swiftly turns away to go after the piece. Gregory's teacher stops him from grabbing the block, whereupon Gregory launches into a major tantrum. The tantrum persists even though his teacher repeatedly tells him to "calm down." Keisha is 4 years old and loves to play at the computer. The computer area is her first choice at center time, just about every day. Today, Keisha is getting nervous because her teacher has called upon most of the boys and girls to decide where they would like to play first and Keisha notices that there is just one space left at the computers. She starts to bounce a little with her hand extended in the air and tries her best not to call out to the teacher, "Me next!" When Keisha finally gets called on to make her choice, she sees that the computer area is full. Keisha crosses her arms across her chest and frowns. Her teacher asks, "Keisha, what is the matter?" Keisha says, "I wanted to play on the computer." Her teacher replies, "Hmmm... they look full." Keisha replies, "Yeah, I'm frustrated and a little mad." Her teacher responds, "You feel frustrated and a little mad, huh? Well, that is a problem." Keisha begins to take some deep breaths and then proclaims, "I will go play at the block corner until Bahta is done. Can you come tell me when he is finished?" Her teacher replies, "I am so proud of you for staying so calm and figuring out a solution to your problem. Why don't you ask Bahta to let you know when it is your turn?" Keisha smiles at the suggestion and skips off to make the request of Bahta.
Fostering Emotional Literacy in Young Children: Labeling Emotions

Emotional literacy is the ability to identify, understand, and respond to emotions in oneself and others in a healthy manner. Children who have a strong foundation in emotional literacy tolerate frustration better, get into fewer fights, and engage in less self-destructive behavior than children who do not have a strong foundation. These children are also healthier, less lonely, less impulsive, more focused, and they have greater academic achievement. The focus of this What Works Brief is on building an emotional vocabulary. The development of a feeling word vocabulary is considered to be of critical importance in a child's emotional development because it makes it possible for children to better understand their emotional experiences. The ability to name a feeling allows children to discuss and reflect with others about their personal experience of the world. The larger a child's emotional vocabulary, the finer discriminations they can make between feelings and the better they can communicate with others about their feelings.

Children who are able to label their emotions are on their way to becoming emotionally competent. In the above two scenarios, great variation can be noted in the children's skills in labeling emotions. Gregory is unable to label his feeling of frustration, and at the same time, he is unable to read his peer's frightened expression and calm himself down. Keisha, on the other hand, is able to correctly identify her feelings, control her impulses to yell out, regulate her disappointment in a healthy way, and solve an interpersonal problem with some support from her teacher.

What Accounts for Variations in Children's Abilities to Label Emotions?

The ability to label emotions is a developmental skill that is not present at birth-it must be learned. And just as there is wide variation in the point at which children start to demonstrate appropriate use of books, begin writing, and recognize letters, some children's ability to identify, understand, and label their emotions develops at a slower rate than others.

Three variables can underlie a child's growing ability to label emotions: (1) the child's temperament and developmental status, (2) parental socialization and environmental support, and (3) the teacher and child care providers' emphasis on emotional literacy. Indeed, differences in the way adults talk to and teach children about feelings and problem solving are related to children's abilities to label emotions.

What Can Adults Do?

Adults can play a major role in children's ability to identify, understand, and express emotions in a healthy way. The following strategies are key in fostering emotional literacy in young children:

Express Your Own Feelings. One way to help children learn to label their emotions is to have healthy emotional expression modeled for them by the adults in their lives. For example, a teacher who knocked over all the glitter can say, "Oh boy, is that frustrating. Oh well, I'd better take a deep breath and figure out how to clean it up." Or a parent who just got word that she got a promotion at work can say, "Wow! I am so excited about this! I feel proud of myself for working so hard." Parents, teachers, and child care providers can make a point to talk out loud about their feelings as they experience them throughout the day.

Label Children's Feelings. As adults provide feeling names for children's emotional expressions, a child's feeling vocabulary grows. Throughout the day, adults can attend to children's emotional moments and label feelings for the children. For example, as a child runs for a swing, another child reaches it and gets on. The first child begins to frown. The teacher approaches her and says, "You look a little disappointed about that swing." Or a boy's grandmother surprises him by picking him up at childcare. The boy screams, "Grandma!" and runs up to hug her. The child care provider says, "Oh boy, you look so happy and surprised that your grandma is here!" As children's feeling vocabulary develops, their ability to correctly identify feelings in themselves and others also progresses.

Play Games, Sing Songs, and Read Stories with New Feeling Words. Adults can enhance children's feeling vocabularies by introducing games, songs, and storybooks featuring new feeling words. Teachers and other caregivers can adapt songs such as "If you're happy and you know it" with verses such as "If you're frustrated and you know it, take a breath"; "If you're disappointed and you know it, tell a friend"; or "If you're proud and you know it, say 'I did it!'" The following are some examples of games young children can play.

Adults can cut out pictures that represent various feeling faces and place them in a container that is passed around the circle as music plays. When the music stops, the child holding the container can select a picture designating an emotion and identify it, show how they look when they feel that way, or describe a time when he or she felt that way. To extend this fun activity, give the children handheld mirrors that they can use to look at their own feeling faces.

Children can look through magazines to find various feeling faces. They can cut them out and make a feeling face collage. Adults can help the children label the different feeling faces.

Children and adults can play "feeling face charades" by freezing a certain emotional expression and then letting others guess what the feeling is. To extend this activity, ask the children to think of a time that they felt that way.

In the mornings, have children "check in" by selecting a feeling face that best represents their morning mood. At the end of the day, have children select again, and then talk about why their feeling changed or stayed the same.

Finally, the teacher can put feeling face pictures around the room. Children can be given child-size magnifying glasses and told to walk around looking for different feeling faces.When they find one, they can label it and tell about a time they felt that way. With a little creativity, teachers and other caregivers can play, adapt, or develop new games, songs, and stories to teach feeling words.
Gregory's teacher, Miss Antoinette, realized that Gregory and some of his classmates needed help to develop skills in labeling emotions. She started making a conscious effort to label her feelings, as well as the feelings of children in her class throughout the day-every day. She encouraged the other adults in the room to do the same. She also planned at least one feeling game, song, or story a day to introduce new and more complex feeling words. She also taught the children some strategies for regulating their emotions such as taking deep breaths, relaxing their muscles, and thinking of "happy places." When she saw Gregory get upset, she would move into ask him how he was feeling and help him use some of the strategies for calming down. Over time, Miss Antoinette noticed a significant difference in Gregory and his peers' behavior. The children would tell each other how they felt instead of fighting and would help each other when in distress. Miss Antoinette noticed that the children no longer needed her to intervene to solve problems as often-but instead would solve them on their own. She noticed that even for children like Keisha, who had a strong foundation in labeling emotions, positive changes were occurring. Miss Antoinette felt a sense of calm in her room and was happy that she would be sending her children onto kindergarten with a strong foundation in emotional literacy.
Who Are the Children Who Have Participated in This Intervention?

The children who have participated in research on emotional literacy include preschoolers who exhibit a range of disabilities including ADHD, oppositional defiant disorder, conduct disorder, speech and language delays, challenging behavior, and deafness and hard of hearing. Studies have included preschoolers from low-income families. The importance of keeping in mind the cultural backgrounds and beliefs of the children and families in a teacher's care cannot be overstated when teaching young children to identify, understand, and respond to emotions.

Where Do I Find More Information on Implementing This Practice?

Practical information on helping children develop emotional literacy can be found in journals such as Young Children and Young Exceptional Children. See the following resources for ideas on how to teach young children to identify, understand, and express emotions in a healthy way:

Joseph, G. E., & Strain, P. S. (2003). Enhancing emotional vocabulary in young children. Young Exceptional Children, 6(4), 18-26.

Joseph, G. E., & Strain, P. S. (2003). Helping young children control anger and handle disappointment. Young Exceptional Children,7(1), 21-29.

Kusché, C. A., & Greenberg, M. T. (1994) The PATHS curriculum. Seattle, WA: Developmental Research and Programs.

Shure, M. B. (2000). I can problem solve: An interpersonal cognitive problem-solving program. Champaign, IL: Research Press.

Webster-Stratton, C. (1990). The teachers and children videotape series: Dina dinosaur school. Seattle, WA: The Incredible Years.

Webster-Stratton, C. (1999). How to promote children's social and emotional competence. London: Paul Chapman.

What is the Scientific Basis for This Practice?

For those wishing to explore this topic further, the following researchers have documented the effects of enhancing emotional literacy in early childhood settings:

Denham, S. A., & Burton, R. (1996). A social-emotional intervention for at-risk 4-year-olds. Journal of School Psychology, 34(3),225-245.

Domitrovich, C. E., Cortes, R., & Greenberg, M. T. (2002, June). Preschool PATHS: Promoting social and emotional competence in young children. Paper presented at the 6th National Head Start Research Conference, Washington, DC.

Greenberg, M. T., & Kusché, C. A. (1998). Preventive interventions for school-age deaf children: The PATHS curriculum. Journal of Deaf Studies and Deaf Education, 3(1), 49-63.

Moore, B., & Beland, K. (1992). Evaluation of Second Step, preschool-kindergarten: A violence prevention curriculum kit. Summary report. Seattle, WA: Committee for Children.

Webster-Stratton, C., & Hammond, M. (1997). Treating children with early-onset conduct problems: A comparison of child and parent training interventions. Journal of Consulting and Clinical Psychology, 65(1), 93-109.

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Fostering Emotional Literacy in Young Children: Labeling Emotions | ECLKC

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The What Works Brief is a continuing series of easy-to-read, "how to" information packets on a variety early learning practices. Program managers and in-service providers may find this resource useful in meeting professional development needs.

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New to paperback is last year's Unlocking the Power of Emotions to Help Our Kids, Ourselves, and Our Society Thrive by Marc Brackett, PhD, founder and director of the Yale Center for Emotional Intelligence.

On his website, Brackett notes that emotions influence the following:

Attention, memory, and learning

Decision making

Creativity

Mental and physical wellbeing

Ability to form and maintain positive relationships

Academic and workplace performance

The architect of the RULER approach to social and emotional learning in schools across the country, Brackett believes emotional intelligence is as important as academic intelligence. And, "Think about it: how many of us had a comprehensive emotion education?" asks Bracket ( Maria Shriver website).

RULER stands for the five skills of emotional intelligence: Recognizing, Understanding, Labeling, Expressing, and Regulating emotions. And it's not just for kids; it's for all of us.

Tara Well, PhD explains RULER in a Psychology Today post. Excerpts are featured below:

Recognizing emotions in oneself and others. This is not just in the things we think, feel, and say, but our facial expressions, body language, vocal tones, and other nonverbal signals...

Understanding the causes and consequences of emotion...helps us make better predictions about our own thoughts and more informed choices about our behaviors.

Labeling emotions with precise words...People with a more developed feelings vocabulary can differentiate among related emotions such as pleased, happy, elated, and ecstatic. Labeling emotions accurately increases self-awareness, helps us to communicate emotion more effectively, and reduce misunderstandings in social interactions.

Expressing emotions, taking context and culture into consideration. By expressing our feelings in accordance with cultural norms and social contexts, we can inform and invite empathy from listeners...

R egulating emotions effectively to achieve goals and well-being...(I)nvolves monitoring, tempering, and modifying emotional reactions in helpful ways, in order to reach personal and professional goals...

Selected Quotes from Permission to Feel: My message for everyone is the same: that if we can learn to identify, express, and harness our feelings, even the most challenging ones, we can use those emotions to help us create positive, satisfying lives. Most of us are unaware of how important vocabulary is to emotion skills. As we've seen, using many different words implies valuable distinctions-that we're not always simply angry but are sometimes annoyed, irritated, frustrated, disgusted, aggravated, and so on. If we can't discern the difference, it suggests that we can't understand it either. It's the difference between a rich emotional life and an impoverished one. Your child will inherit the one you provide. In one study, sixth graders who went five days without glancing at a smartphone or other digital screen were better at reading emotions than their peers from the same school who continued to spend hours each day looking at their phones, tablets, computers, and so on. Emotionally intelligent individuals had an intuitive understanding of one of the central conclusions of happiness research: Well-being depends less on objective events than on how those events are perceived, dealt with, and shared with others. ...(T)he necessary skills: The first step is to recognize what we're feeling. The second step is to understand what we've discovered-what we're feeling and why. The next step is to properly label our emotions, meaning not just to call ourselves "happy" or "sad" but to dig deeper and identify the nuances and intricacies of what we feel. The fourth step is to express our feelings, to ourselves first and then, when right, to others. The final step is to regulate-as we've said, not to suppress or ignore our emotions but to use them wisely to achieve desired goals.

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"Permission to Feel": Marc Brackett's RULER Approach - Minding Therapy

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New to paperback is last year's Unlocking the Power of Emotions to Help Our Kids, Ourselves, and Our Society Thrive by Marc Brackett , PhD, founder and director of the Yale Center for Emotional Intelligence.

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The National Child Traumatic Stress Network

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Children whose families and homes do not provide consistent safety, comfort, and protection may develop ways of coping that allow them to survive and function day to day. For instance, they may be overly sensitive to the moods of others, always watching to figure out what the adults around them are feeling and how they will behave. They may withhold their own emotions from others, never letting them see when they are afraid, sad, or angry. These kinds of learned adaptations make sense when physical and/or emotional threats are ever-present. As a child grows up and encounters situations and relationships that are safe, these adaptations are no longer helpful, and may in fact be counterproductive and interfere with the capacity to live, love, and be loved.

Complex trauma can affect children in a multitude of ways. Here are some common effects.

Attachment and Relationships

The importance of a child's close relationship with a caregiver cannot be overestimated. Through relationships with important attachment figures, children learn to trust others, regulate their emotions, and interact with the world; they develop a sense of the world as safe or unsafe, and come to understand their own value as individuals. When those relationships are unstable or unpredictable, children learn that they cannot rely on others to help them. When primary caregivers exploit and abuse a child, the child learns that he or she is bad and the world is a terrible place.

The majority of abused or neglected children have difficulty developing a strong healthy attachment to a caregiver. Children who do not have healthy attachments have been shown to be more vulnerable to stress. They have trouble controlling and expressing emotions, and may react violently or inappropriately to situations. Our ability to develop healthy, supportive relationships with friends and significant others depends on our having first developed those kinds of relationships in our families. A child with a complex trauma history may have problems in romantic relationships, in friendships, and with authority figures, such as teachers or police officers.

Physical Health: Body and Brain

From infancy through adolescence, the body's biology develops. Normal biological function is partly determined by environment. When a child grows up afraid or under constant or extreme stress, the immune system and body's stress response systems may not develop normally. Later on, when the child or adult is exposed to even ordinary levels of stress, these systems may automatically respond as if the individual is under extreme stress. For example, an individual may experience significant physiological reactivity such as rapid breathing or heart pounding, or may "shut down" entirely when presented with stressful situations. These responses, while adaptive when faced with a significant threat, are out of proportion in the context of normal stress and are often perceived by others as "overreacting" or as unresponsive or detached.

Stress in an environment can impair the development of the brain and nervous system. An absence of mental stimulation in neglectful environments may limit the brain from developing to its full potential. Children with complex trauma histories may develop chronic or recurrent physical complaints, such as headaches or stomachaches. Adults with histories of trauma in childhood have been shown to have more chronic physical conditions and problems. They may engage in risky behaviors that compound these conditions (e.g., smoking, substance use, and diet and exercise habits that lead to obesity).

Complexly traumatized youth frequently suffer from body dysregulation, meaning they over-respond or under-respond to sensory stimuli. For example, they may be hypersensitive to sounds, smells, touch or light, or they may suffer from anesthesia and analgesia, in which they are unaware of pain, touch, or internal physical sensations. As a result, they may injure themselves without feeling pain, suffer from physical problems without being aware of them, or, the converse - they may complain of chronic pain in various body areas for which no physical cause can be found.

Emotional Responses

Children who have experienced complex trauma often have difficulty identifying, expressing, and managing emotions, and may have limited language for feeling states. They often internalize and/or externalize stress reactions and as a result may experience significant depression, anxiety, or anger. Their emotional responses may be unpredictable or explosive. A child may react to a reminder of a traumatic event with trembling, anger, sadness, or avoidance. For a child with a complex trauma history, reminders of various traumatic events may be everywhere in the environment. Such a child may react often, react powerfully, and have difficulty calming down when upset. Since the traumas are often of an interpersonal nature, even mildly stressful interactions with others may serve as trauma reminders and trigger intense emotional responses. Having learned that the world is a dangerous place where even loved ones can't be trusted to protect you, children are often vigilant and guarded in their interactions with others and are more likely to perceive situations as stressful or dangerous. While this defensive posture is protective when an individual is under attack, it becomes problematic in situations that do not warrant such intense reactions. Alternately, many children also learn to "tune out" (emotional numbing) to threats in their environment, making them vulnerable to revictimization.

Difficulty managing emotions is pervasive and occurs in the absence of relationships as well. Having never learned how to calm themselves down once they are upset, many of these children become easily overwhelmed. For example, in school they may become so frustrated that they give up on even small tasks that present a challenge. Children who have experienced early and intense traumatic events also have an increased likelihood of being fearful all the time and in many situations. They are more likely to experience depression as well.

Dissociation

Dissociation is often seen in children with histories of complex trauma. When children encounter an overwhelming and terrifying experience, they may dissociate, or mentally separate themselves from the experience. They may perceive themselves as detached from their bodies, on the ceiling, or somewhere else in the room watching what is happening to their bodies. They may feel as if they are in a dream or some altered state that is not quite real or as if the experience is happening to someone else. Or they may lose all memories or sense of the experiences having happened to them, resulting in gaps in time or even gaps in their personal history. At its extreme, a child may cut off or lose touch with various aspects of the self.

Although children may not be able to purposely dissociate, once they have learned to dissociate as a defense mechanism they may automatically dissociate during other stressful situations or when faced with trauma reminders. Dissociation can affect a child's ability to be fully present in activities of daily life and can significantly fracture a child's sense of time and continuity. As a result, it can have adverse effects on learning, classroom behavior, and social interactions. It is not always evident to others that a child is dissociating and at times it may appear as if the child is simply "spacing out," daydreaming, or not paying attention.

Behavior

A child with a complex trauma history may be easily triggered or "set off" and is more likely to react very intensely. The child may struggle with self-regulation (i.e., knowing how to calm down) and may lack impulse control or the ability to think through consequences before acting. As a result, complexly traumatized children may behave in ways that appear unpredictable, oppositional, volatile, and extreme. A child who feels powerless or who grew up fearing an abusive authority figure may react defensively and aggressively in response to perceived blame or attack, or alternately, may at times be overcontrolled, rigid, and unusually compliant with adults. If a child dissociates often, this will also affect behavior. Such a child may seem "spacey", detached, distant, or out of touch with reality. Complexly traumatized children are more likely to engage in high-risk behaviors, such as self-harm, unsafe sexual practices, and excessive risk-taking such as operating a vehicle at high speeds. They may also engage in illegal activities, such as alcohol and substance use, assaulting others, stealing, running away, and/or prostitution, thereby making it more likely that they will enter the juvenile justice system.

Cognition: Thinking and Learning

Children with complex trauma histories may have problems thinking clearly, reasoning, or problem solving. They may be unable to plan ahead, anticipate the future, and act accordingly. When children grow up under conditions of constant threat, all their internal resources go toward survival. When their bodies and minds have learned to be in chronic stress response mode, they may have trouble thinking a problem through calmly and considering multiple alternatives. They may find it hard to acquire new skills or take in new information. They may struggle with sustaining attention or curiosity or be distracted by reactions to trauma reminders. They may show deficits in language development and abstract reasoning skills. Many children who have experienced complex trauma have learning difficulties that may require support in the academic environment.

Self-Concept and Future Orientation

Children learn their self-worth from the reactions of others, particularly those closest to them. Caregivers have the greatest influence on a child's sense of self-worth and value. Abuse and neglect make a child feel worthless and despondent. A child who is abused will often blame him- or herself. It may feel safer to blame oneself than to recognize the parent as unreliable and dangerous. Shame, guilt, low self-esteem, and a poor self-image are common among children with complex trauma histories.

To plan for the future with a sense of hope and purpose, a child needs to value him- or herself. To plan for the future requires a sense of hope, control, and the ability to see one's own actions as having meaning and value. Children surrounded by violence in their homes and communities learn from an early age that they cannot trust, the world is not safe, and that they are powerless to change their circumstances. Beliefs about themselves, others, and the world diminish their sense of competency. Their negative expectations interfere with positive problem-solving, and foreclose on opportunities to make a difference in their own lives. A complexly traumatized child may view himself as powerless, "damaged," and may perceive the world as a meaningless place in which planning and positive action is futile. They have trouble feeling hopeful. Having learned to operate in "survival mode," the child lives from moment-to-moment without pausing to think about, plan for, or even dream about a future.

Long-Term Health Consequences

Traumatic experiences in childhood have been linked to increased medical conditions throughout the individuals' lives. The Adverse Childhood Experiences (ACE) Study is a longitudinal study that explores the long-lasting impact of childhood trauma into adulthood. The ACE Study includes over 17,000 participants ranging in age from 19 to 90. Researchers gathered medical histories over time while also collecting data on the subjects' childhood exposure to abuse, violence, and impaired caregivers. Results indicated that nearly 64% of participants experienced at least one exposure, and of those, 69% reported two or more incidents of childhood trauma. Results demonstrated the connection between childhood trauma exposure, high-risk behaviors (e.g., smoking, unprotected sex), chronic illness such as heart disease and cancer, and early death.

Economic Impact

The cumulative economic and social burden of complex trauma in childhood is extremely high. Based upon data from a variety of sources, a conservative annual cost of child abuse and neglect is an estimated $103.8 billion, or $284.3 million per day (in 2007 values). This number includes both direct costs-about $70.7 billion-which include the immediate needs of maltreated children (hospitalization, mental health care, child welfare systems, and law enforcement) and also indirect costs-about $33.1 billion-which are the secondary or long-term effects of child abuse and neglect (special education, juvenile delinquency, mental health and health care, adult criminal justice system, and lost productivity to society).

A recent study examining confirmed cases of child maltreatment in the United States found the estimated total lifetime costs associated with child maltreatment over a 12-month period to be $124 billion. In the 1,740 fatal cases of child maltreatment, the estimated cost per case was $1.3 million, including medical expenses and productivity loss. For the 579,000 non-fatal cases, the estimated average lifetime cost per victim of child maltreatment was $210,012, which includes costs relating to health care throughout the lifespan, productivity losses, child welfare, criminal justice, and special education. Costs for these nonfatal cases of child maltreatment are comparable to other high-cost health conditions (i.e., $159,846 for stroke victims and $181,000 to $253,000 for those with Type 2 diabetes).

In addition to these costs are the "intangible losses" of pain, sorrow, and reduced quality of life to victims and their families. Such immeasurable losses may be the most significant cost of child maltreatment.

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Children whose families and homes do not provide consistent safety, comfort, and protection may develop ways of coping that allow them to survive and function day to day.

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Fast Facts

At least 1 in 7 children have experienced child abuse and/or neglect in the past year, and this is likely an underestimate. In 2019, 1,840 children died of abuse and neglect in the United States.

Each day, more than 1,000 youth are treated in emergency departments for physical assault-related injuries.

In 2019, about 1 in 5 high school students reported being bullied on school property in the last year.

8% of high school students had been in a physical fight on school property one or more times during the 12 months before the survey.

Each day, about 14 youth die from homicide, and more than 1,300 are treated in emergency departments for violence-related injuries.
It's important to recognize the signs of traumatic stress and its short- and long-term impact.
The signs of traumatic stress may be different in each child. Young children may react differently than older children.

Preschool Children

Fear being separated from their parent/caregiver

Cry or scream a lot

Eat poorly or lose weight

Have nightmares

Elementary School Children

Become anxious or fearful

Feel guilt or shame

Have a hard time concentrating

Have difficulty sleeping

Middle and High School Children

Feel depressed or alone

Develop eating disorders or self-harming behaviors

Begin abusing alcohol or drugs

Become involved in risky sexual behavior

The Body's Alarm System

Everyone has an alarm system in their body that is designed to keep them safe from harm. When activated, this tool prepares the body to fight or run away. The alarm can be activated at any perceived sign of trouble and leave kids feeling scared, angry, irritable, or even withdrawn.

Healthy Steps Kids Can Take to Respond to the Alarm

Recognize what activates the alarm and how their body reacts

Decide whether there is real trouble and seek help from a trusted adult

Practice deep breathing and other relaxation methods

Impact of Trauma

The impact of child traumatic stress can last well beyond childhood. In fact, research has shown that child trauma survivors may experience:

Learning problems, including lower grades and more suspensions and expulsions

Increased use of health and mental health services

Increase involvement with the child welfare and juvenile justice systems

Long-term health problems (e.g., diabetes and heart disease)

Trauma is a risk factor for nearly all behavioral health and substance use disorders.
There is hope. Children can and do recover from traumatic events, and you can play an important role in their recovery.
A critical part of children's recovery is having a supportive caregiving system, access to effective treatments, and service systems that are trauma informed.

Get Help Now
SAMHSA Behavioral Health Treatment Services Locator The National Child Traumatic Stress Network: Get Help Now Healthcare Toolbox: Basics of Trauma-Informed Care
Not all children experience child traumatic stress after experiencing a traumatic event. With support, many children are able to recover and thrive.

As a caring adult and/or family member, you play an important role.

Remember To:

Assure the child that he or she is safe.

Explain that he or she is not responsible. Children often blame themselves for events that are completely out of their control.

Be patient. Some children will recover quickly while others recover more slowly. Reassure them that they do not need to feel guilty or bad about any feelings or thoughts.

Seek the help of a trained professional. When needed, a mental health professional trained in evidence-based trauma treatment can help children and families cope and move toward recovery. Ask your pediatrician, family physician, school counselor, or clergy member for a referral.

Visit the following websites for more information:

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Recognize the signs of child traumatic stress and the impact that trauma may have on children. The infographic developed by SAMHSA's National Child Traumatic Stress Initiative (NCSTI) provides information on the prevalence and impact of traumatic events on children, and what actions can be taken to support children who experience traumatic events.

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A Kid's Book About Trauma by Megan Bartlett

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A Kid's Book About Trauma by Megan Bartlett

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Quick Take Help kids better understand trauma and the importance of movement and relationships in healing from trauma. For Ages 5+ What’s Inside This book will help kids understand what trauma truly means, how it affects our minds and bodies, and how movement and relationships can help us on our paths to healing. Becau

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Healing Days: A Guide for Kids Who Have... book by Susan Farber Straus

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Buy a cheap copy of Healing Days: A Guide for Kids Who Have... book by Susan Farber Straus. 2013 Gelett Burgess Children's Book Award: Mind, Body and SpiritHealing Days is a sensitive and reassuring story intended for children who have experienced trauma... Free Shipping on all orders over $15.

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Somebody Cares: A Guide for Kids Who... book by Susan Farber Straus

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Buy a cheap copy of Somebody Cares: A Guide for Kids Who... book by Susan Farber Straus. 1st place, Picture Books ages 6 & older, 2016 Purple Dragonfly Award This is a book for children who have experienced parental neglect and have been taking care of... Free Shipping on all orders over $15.

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When Bad Things Happen: A Guide to Help... book by R.W. Alley

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Buy a cheap copy of When Bad Things Happen: A Guide to Help... book by R.W. Alley. This new book in the Elf-help series from Abbey Press helps parents deal with their children's fears and sadness, showing adults how to restore a child's trust that... Free Shipping on all orders over $15.

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Far Apart Close in Heart by Becky Birtha

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Far Apart Close in Heart by Becky Birtha

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diversity crime family separation departure law jail prison justice social emotional family parents embarrassment embarrass shame feelings loss anger distance

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Far Apart Close In Heart Pb | The Book Vine

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Far Apart, Close in Heart: Being a Family When a Loved One Is Incarcerated (PB) This title illustrates a range of situations children may experience with moms or dads behind bars and reassures them they are not alone. Includes tips for speaking with kids about an incarcerated loved one and suggestions to help them cope.

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Variety of Trauma Informed Teaching Books

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Variety of Trauma Informed Teaching Books

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31 Trauma-Informed Teaching Books plus one box of 48 Conversation Cards

Conversation starters

They help give language to both adults and children on difficult subjects.

They let the reader know they are not alone.

This list is intended to be helpful to directors, teachers, and parents.

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31 Trauma Informed Teaching Books | The Book Vine

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31 Trauma-Informed Teaching Books plus one box of 48 Conversation Cards Conversation starters They help give language to both adults and children on difficult subjects. They let the reader know they are not alone. This list is intended to be helpful to directors, teachers, and parents.

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Psychosocial problems in traumatized refugee families: overview of risks and some recommendations for support services - Child and Adolescent Psychiatry and Mental Health

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This article is an abridged version of a report by an advisory council to the German government on the psychosocial problems facing refugee families from war zones who have settled in Germany. It omits the detailed information contained in the report about matters that are specific to the German health system and asylum laws, and includes just those insights and strategies that may be applicable to assisting refugees in other host countries as well. The focus is on understanding the developmental risks faced by refugee children when they or family members are suffering from trauma-related psychological disorders, and on identifying measures that can be taken to address these risks. The following recommendations are made: recognizing the high level of psychosocial problems present in these families, providing family–friendly living accommodations, teaching positive parenting skills, initiating culture-sensitive interventions, establishing training programs to support those who work with refugees, expanding the availability of trained interpreters, facilitating access to education and health care, and identifying intervention requirements through screening and other measures.

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Abstract

Trauma is prevalent among children and adolescents, with youth of color generally reporting greater exposure compared to White youth. One factor that may account for this difference is racial stress, which can manifest into trauma symptoms. Although racial stress and trauma (RST) significantly impacts youth of color, most of the research to date has focused on adult populations. In addition, little attention has been given to the impact of the ecological context in how youth encounter and cope with RST. As such, we propose the Developmental and Ecological Model of Youth Racial Trauma (DEMYth-RT), a conceptual model of how racial stressors manifest to influence the trauma symptomatology of children and adolescents of color. Within developmental periods, we explore how individual, family, and community processes influence youth's symptoms and coping. We also discuss challenges to identifying racial trauma in young populations according to clinician limitations and the post-traumatic stress disorder framework within the diagnostic and statistical manual of mental disorders-fifth edition (DSM-5). The article concludes with implications on applying DEMYth-RT in clinical and research settings to address RST for youth of color.

Keywords: Racial trauma, Racial stress, Children and adolescents, Ethnic minority, Ecological contexts

Substantial research has documented the profound effects of stressful life events and traumatic experiences on the psychological health and well-being of children and adolescents (e.g., Pine and Cohen 2002; Yule 2001). While many incidents of childhood trauma go unreported, statistics show that more than one in four children experience a traumatic stressor before adulthood (e.g., Costello et al. 2002). The prevalence of trauma exposure is higher among children and adolescents of color compared to their White counterparts, with many studies indicating that African American and Latinx youth often report the highest exposure (e.g., Buka et al. 2001; Hatch and Dohrenwend 2007; Hussey et al. 2006). Evidence also suggests that post-traumatic stress disorder (PTSD) is prevalent among youth and young adults of color (e.g., Abram et al. 2004; Pole et al. 2008; Roberts et al. 2011). One factor that may explain higher rates of trauma exposure for youth is racial trauma, dangerous or frightening race-based events, stressors, or discrimination. Although racial trauma is similar to PTSD, and can lead to a PTSD diagnosis, it is distinct due to ongoing collective and individual injuries from exposure and re-exposure to racial stress, which can collectively become traumatic ( Comas-Díaz et al. 2019). Racial trauma is likely underreported due to clinician lack of awareness, clinician bias and discomfort surrounding racial topics, and the narrow and exclusive scope of the diagnostic and statistical manual of mental disorders-fifth edition (DSM-5) PTSD criteria (e.g., Bryant-Davis and Ocampo 2006; Comas-Díaz 2016; Williams et al. 2018b).

Despite theoretical models ( Carter 2007; Helms et al. 2012; Williams et al. 2018b) and empirical research ( Carter 2007; Kaholokula 2016; Williams et al. 2018a) evidence documenting the consequences of racial trauma for adults, there is little research on children and adolescents' racial trauma across developmental periods. In addition, given the importance of families and communities to the psychosocial development of children and adolescents, little consideration has been given to the influence of these ecologies in youth's experience of, and coping with, racial trauma. Thus, in this article, we will begin by defining constructs and discussing the impact of racial stress and trauma (RST) on youth of color during three broad developmental periods (i.e., preschool/elementary, middle school, and high school). Furthermore, we will take an ecological approach to understand how RST impacts the child, family, and community and how these systems are integral to coping with RST. We bridge these gaps by introducing the Developmental and Ecological Model of Youth Racial Trauma (DEMYth-RT) and conclude with clinical and research recommendations to move the field forward.

Race and Racism Defined

Research literature has contended with the concept of race throughout time and disciplines (see Betancourt and López 1993). While one singular definition does not exist, it is important to understand the major arguments underlying race. At the center of the argument is the notion that because race is not a biological construct, it should not be proposed as a categorization in scientific research. Race scholars, however, note that the ramifications of perceived race are real, thus, categorizations are useful in codifying the systemic outcomes in relation to different groups ( Smedley and Smedley 2005). Still some argue that races are biologically distinct and outcomes associated with the categorization lend themselves to hereditary and hierarchical findings ( Plomin 2018). Within this conceptual paper, we agree with a definition posited by Helms et al. (2005) in that race is indeed real, but as a sociopolitical categorization that has been used to differentiate groups via phenotypical characteristics for hierarchical stratification ( Helms et al. 2005). Of greatest importance to the discussion, however, is that there is a lack of biological evidence supporting inherent distinctions between racial groups. As such, evidence that appears to support group differences along racial lines is a function of sociodemography, or the interaction between groups and physical conditions ( Williams and Jackson 2005). Along with other scholars, we propose that youth of color are members of both a racial group, the social construct which is acknowledged within the United States, and an ethnic group, people with a shared nationality, culture, language and/or religion (e.g., Cooper et al. 2005). Given that RST can be based on race (e.g., Black, White, Asian) and/or ethnicity (e.g., West Indian, Dominican, Japanese), we use racial-ethnic to be comprehensive.

Racial discrimination, or differential treatment toward individuals of a given race, may be particularly debilitating for members of stigmatized racial groups ( Salter et al. 2018). Racism is the system by which racial discrimination thrives within the United States, and the system has typically benefited European Americans while harming members of other racial groups, including African, Latinx, Asian, and Native American Indians (ALANAs; LaVeist 1994). Although substantial literature exists regarding racial discrimination and wellness outcomes in adult populations (e.g., depression, anxiety, sleeplessness, hypertension, cardiovascular disease; Berger and Sarnyai 2015), Pachter and Garcia Coll (2009) illuminated the paucity of research focused on children. The majority of child-based studies exploring racial discrimination are focused on African American populations, in which upward of 90% experience racial discrimination as early as 8 years old (e.g., Pachter and Garcia Coll 2009; Priest et al. 2013). Compared to research on African American youth, there is less literature on racial discriminatory experiences of other ALANA youth, even with a growing Latinx and Asian American demography ( Priest et al. 2013). As such, two things remain relatively overlooked regarding ALANA youth and racial discrimination: (1) how RST experiences may manifest across the lifespan for ALANA youth and (2) how the individual, family, and community systems influence youth's exposure to, stress from, and coping response to RST.

Trauma During Childhood and Adolescence

Stressful life events and traumatic experiences can have a detrimental and lasting impact on the psychological health and well-being of children and adolescents ( Arseneault et al. 2011; Copeland et al. 2007; Greeson et al. 2011). A traumatic event is a dangerous, frightening, or violent incident that involves actual or threatened death or a threat to the bodily integrity of self or others ( American Psychiatric Association 2013, p. 271). For children, witnessing a traumatic event that threatens the safety or life of a loved one could be just as traumatic as a direct interpersonal incident given that children's sense of security depends on the perceived safety of significant others in their lives. Experiencing a traumatic event can initiate lasting physical, physiological, emotional, psychological, or social effects that impact youth's daily functioning and well-being ( Substance Abuse and Mental Health Services Administration [SAMHSA], 2014). One of the most commonly diagnosed trauma disorders is PTSD, which is a disabling condition that impacts cognitions, behaviors, and affect ( Kessler et al. 1995; Yule 2001). Those diagnosed with PTSD engage in avoidance of situations, people, or reminders of their traumatic experience to lessen anxiety and distress. Children who have experienced traumatization and who may have a formal diagnosis of PTSD, or a similar trauma or stressor related disorder, often have co-occurring psychological sequelae ( Copeland et al. 2007). Although there is burgeoning literature on childhood trauma, a significant amount of research on PTSD is adult-based, which may not directly apply to children and adolescents ( Copeland et al. 2007).

Among community samples of children and adolescents, more than two-thirds of youth report experiencing at least one traumatic event by the age of 16 (e.g., Copeland et al. 2007; Costello et al. 2002). Although several studies indicate that a significant number of youth experience trauma, the prevalence is still underreported given that children and adolescents may be less likely to recognize trauma or report the trauma to safe adults. Furthermore, the estimates of exposure to trauma varies by racial-ethnic differences. ALANA groups report exposure to more traumatic events compared to their White counterparts (e.g., Buka et al. 2001; Hatch and Dohrenwend 2007), likely due in part to experiences of racism broadly ( Jernigan and Daniel 2011; Williams et al. 2018b). Correspondingly, children and adolescents of color report more encounters with racial discrimination than White youth ( Fisher et al. 2000; Romero and Roberts 1998; Seaton et al. 2008), contributing to differential experiences of racial stress and trauma. Trauma may be more disabling for youth of color who contend with traumatic experiences that may be overlooked (e.g., racism), thereby posing a threat to children's physical integrity and psychological health.

Oversight of Racial Trauma

Despite evidence that individuals of color can be traumatized by historical, interpersonal, or vicarious encounters with racial discrimination within their communities, experiences with racial trauma may be misperceived, dismissed, or unacknowledged by clinicians ( Bryant-Davis 2007; Carter 2007; Helms et al. 2012). Overlooked experiences of RST may include humiliating and shaming events, threats of harm and injury, and witnessing racial discrimination toward other ALANA people ( Comas-Díaz et al. 2019). Significant evidence documents that different forms of racial stress are associated with physiological problems (e.g., Huynh 2012), substance use (e.g., Gibbons et al. 2004), conduct problems ( Brody et al. 2006), and negative psychological symptoms (e.g., Assari et al. 2017), including trauma symptoms (e.g., Flores et al. 2010; Lewis et al. 2018) among youth and young adults of color. Of note, recent studies indicate that exposure to violence on electronic devices including the television and internet are linked with trauma symptoms and other psychological sequelae ( Bernstein et al. 2007; Bor et al. 2018; Naeem et al. 2012; Tynes et al. 2012). This is particularly relevant to youth who report frequent use of technological devices and engagement on social media, including media coverage and discussion about racially stressful and traumatic incidents ( Anyiwo under review; Quintana and McKown 2008). These events include, but are not limited to, viewing the unarmed killing of Black and Brown children by police on television or the Internet ( Bor et al. 2018; Thomas and Blackmon 2015), witnessing the persistent use of racial epithets or racial teasing on social media ( Tynes et al. 2015), and hearing about efforts to hurt or murder those from one's racial background. Indeed, youth of color have reported negative psychosocial outcomes in response to vicarious racial stress (e.g., TV exposure, online encounters; Douglass et al. 2016), and Quintana and McKown (2008) note that vicarious exposure to racial discrimination may cause trauma symptoms and affect psychological adjustment.

Clinicians' oversight, biases, and discomfort talking about issues of race can limit their initial ability to recognize whether children and adolescents' experiences with RST warrant treatment or a PTSD diagnosis ( Franklin et al. 2006; Pinderhughes 1989). Oversight of RST can impact the clinician's ability to properly assess and diagnose the traumatic experience and lead to inappropriate treatment decisions. Clinician bias and discomfort discussing racial topics may also impact rapport and treatment outcomes ( Pieterse 2018; Sue et al. 2010). Racial trauma may be unacknowledged due to a perception that it is "subjective" or unmeasurable, rendering the question whether racial events could in fact be traumatic ( Bryant-Davis and Ocampo 2006; Carter 2007). However, similar to other traumas, an individual's perception of whether an incident was traumatic is a critical element of treatment ( Bryant-Davis 2007; Carter 2007; Helms et al. 2012). Clinicians' lack of awareness on these issues and limited understanding of how racial trauma is applicable to the definition of PTSD may lead a misunderstanding of the etiology of trauma, invalidation of trauma, and cause some to erroneously believe that racial trauma is a "myth."

Understanding Racial Trauma Within a DSM-5 Framework

Racial trauma can fit the definition of PTSD as defined by the DSM-5 when it involves a Criterion A event, such as a racially motivated assault. The DSM-5 also recognizes that reoccurring exposure to mildly traumatic incidents with enough frequency can contribute to PTSD as well, and this often the case with racial trauma ( Williams et al. 2018b). However, as some scholars have previously noted, what is considered a Criterion A event is subjective and narrow (e.g., Holmes et al. 2016), and so one can suffer from racial trauma with or without the occurrence of such an event as defined by the DMS-5. Furthermore, research findings indicate that covert discrimination may be equally or even more distressing than overt discrimination ( O'Keefe et al. 2015; Sue et al. 2007; Williams et al. 2018c). Covert discrimination can result in anxiety as people of color attempt to ascertain whether an unpleasant interpersonal experience was based on race and whether perpetrators are trustworthy or dangerous. Much like sexual harassment, where smaller, ongoing distressing experiences can culminate into traumatization ( Larsen and Fitzgerald 2011; Palmieri and Fitzgerald 2005), ongoing racially discriminatory events can have a cumulative effect which may increase hypervigilance, avoidance, and contribute to PTSD symptoms or the development of a PTSD diagnosis ( Williams et al. 2018b). Trauma-related symptoms such as anxiety, depression, and negative future outlook may be linked to experiences of covert discrimination, and subtle mistreatment in the form of microaggressions, which can be associated with trauma symptomology in young adults ( Nadal et al. 2014; Williams et al. 2018c). Although several symptoms associated with PTSD may be evident in RST, others such as avoidance of dominant groups or cognitive distortions about safety based on race, may be challenging to identify. RST may also be challenging to address in racial environments in which children do not make the decision on where to live or attend school.

While not all racial traumas will lead to PTSD, for those who have historical and genetic vulnerabilities, racial events may have increased potential to lead to PTSD ( Williams et al. 2018b; Gone et al. 2019). Historical and cultural trauma can be passed on to subsequent generations through both social and epigenetic mechanisms (e.g., Bierer et al. 2014; Kira 2010), and since traumatization is cumulative, prior traumas and racial oppression also increase risk of PTSD. These vulnerabilities result in a baseline of stress that is exacerbated by ongoing experiences of racial maltreatment (i.e., overt and/or covert racism). Following a triggering experience of racism, which likely includes a perceived threat to safety, life, or personhood, the individual experiences emotions associated with the traumatic event (e.g., fear, disbelief, anger). Subsequently, and possibly after having their experience invalidated and having no perceived safe space to process the encounter, the individual begins to experience the typical symptoms of PTSD (e.g., re-experiencing the event, avoiding trauma reminders, worsening cognitions and mood, altering arousal and hypervigilance for an extended period), causing significant distress or impairment that is not accurately explained or treated. Further, due to the marginalized status of the victim, avenues for professional help may be limited, thus maintaining or worsening traumatization. Collectively, these symptoms involve interpersonal experiences of racism and could result in an individual meeting full criteria for PTSD due to racial trauma.

Applying a Racial Trauma Diagnosis to Youth

In the same way, youth of different ages display differential trauma symptoms in response to traumatic experiences (e.g., Center for Substance Abuse Treatment 2014; Green et al. 1991), we propose that the experiences, interpretations, and resulting symptoms and behaviors of racial trauma may be different for children and adolescents, compared to adults, based on developmental stage. Although specific to racial discrimination, the Brown and Bigler (2005) developmental model of children's perceptions of racial discrimination suggests that cognitive abilities, situational factors and individual differences, influence how youth perceive and make meaning of racially stressful situations. Applied to racial trauma, as youth develop cognitive skills and learn their social position within the world, their understanding and coping behaviors in response to racially traumatic situations are likely to shift.

The American Psychological Association Presidential Task Force on Traumatic Stress Disorder and Trauma in Children and Adolescents (2009) and the National Traumatic Stress Network ( NCTSN 2017) both have acknowledged the potential stressful impact of racial discrimination for children and adolescents, but as previously noted, there is limited literature on racial trauma within childhood and adolescence. Sanders-Phillips (2009) highlighted that racial discrimination is a chronic form of violence and trauma that can influence child outcomes, exacerbate the effects of other forms of violence (e.g., community violence, domestic), and dampen parental and communal support. Although specific to African American children, to our knowledge, Jernigan and Daniel (2011) is the only other article that begins to conceptualize racial trauma for children to date. The scholars highlight the importance of the school context in experiencing and processing racial trauma, which is important given that youth's encounters with and social support to manage racial stress come from multiple ecological contexts. As indicated by Helms et al. (2012), "Individual trauma and treatment need to be understood within the context of family, community, religion, culture, and sensitive to the sociopolitical history of racism in the community in which the traumatic event occurred" (p. 71). As such, the family and community contexts should also be considered in understanding racial trauma for ALANA children and adolescents.

The Developmental and Ecological Model of Youth Racial Trauma

RST is a concerning and persistent problem for children and adolescents that can threaten physical safety, impede psychological integrity, and lead to a traumatic response (e.g., Jernigan and Daniel 2011; NCTSN 2017). The Developmental and Ecological Model of Youth Racial Trauma (DEMYth-RT), proposed here, highlights that the lack of awareness and acknowledgement of RST may lead some to believe that racial trauma is a "myth", or widely held, but false idea. DEMYth-RT acknowledges the reality of racial trauma and the consequential psychological symptoms of ALANA youth. Within developmental periods, the model provides an ecological framework for how RST can impact family and community systems that the child is embedded within, with attention to how these systems are integral to youth's interpretation and management of RST. In addition, the model illuminates how prevention and intervention approaches may interrupt the transmission of trauma from in vivo experiences and vicarious processes to youth's psychological expression and well-being ( Fig. 1 ).

Racial Trauma for Preschool and Elementary Children

Childhood (e.g., aged 3-5 years [preschool-kindergarten] and aged 6-11 years [elementary school]) is a critical time for physical, cognitive, language, and socioemotional development. According to the DSM-5, children 6 years of age and under may have different reactions to traumatic experiences compared to older children (e.g., bed wetting, loss or regression in developmentally appropriate functioning and behavior, numbing response) because of their limited ability to verbalize their feelings about threatening and dangerous events ( Scheeringa et al. 2001; Three 2005). Yet, young children can be affected by stressful and traumatic experiences that threaten the safety and well-being of themselves or their caregivers ( Yasik 2005). The impact of racial trauma may be particularly challenging for small children, who have the ability to recognize racial differences from as early as 3 months ( Liu et al. 2011; Sangrigoli and De Schonen 2004), but lack the cognitive understanding and language to report and process racial discrimination. Given that preschool and elementary school age children implicitly assign positive and negative attributions to individuals based on race ( Baron and Banaji 2006; Clark and Clark 1950; Spencer and Markstrom-Adams 1990), children can develop a racially targeted view of the world in which they begin to understand that skin color can be a threat to safety and security for themselves and their caregivers. Therefore, direct or vicarious experiences with RST may elicit trauma symptoms, fear, helplessness, and worry about the bodily integrity of themselves and their caregivers based on race.

In understanding how RST influences the family context for all children beginning in childhood, it is important to first acknowledge that historical trauma (e.g., slavery, genocide, mass-incarceration; SAMHSA 2014) affects genetics (e.g., Walters et al. 2011), impacts parenting behaviors ( Heart 1999), and has implications for the family system ( Danieli 1998; Degruy-Leary 1994; Wardi 1992). Historical trauma is defined as the "cumulative emotional and psychological wounding across generations and over the lifespan emanating from massive group trauma experiences" ( Brave Heart 2003, p. 7), and must be accounted for with consideration to younger children and family dynamics. Beyond the consequences of historical trauma, parents must contend with their own encounters with racial stress, which are associated with a myriad of physical and mental health consequences ( Geronimus 1996; Giscombé and Lobel 2005; Williams and Mohammed 2009). Parents' racial stress concurrently impacts aspects of the family system, such as communication ( Wardi 1992), parenting behaviors ( Anderson et al. 2015), and parental problem solving (e.g., Brave Heart and DeBruyn 1998). In addition, racial trauma can influence caregivers' emotional availability and cause cognitive pre-occupation, which may prevent them from protecting their children from RST ( Lewis et al. 2018). Given that attachment to caregivers and family is important for the management of stressors ( Smith and Carlson 1997), young children who perceive a lack of protection from caregivers may feel increasingly overwhelmed by the intensity of physical and emotional responses to racially traumatic experiences.

Daycares, neighborhoods, and schools are common contexts in which young children can experience RST. First, the loss of infants and children from racially traumatic incidents (e.g., racially motivated killings) can have profound consequences on communities including psychological pain, communal morale, human capacity (e.g., future leaders), and the ability to safeguard one's culture and language ( Evans-Campbell 2008). These experiences could lead to communal trauma responses, such as weakened social structures, social malaise, and traumatic grief ( Evans-Campbell 2008). Such experiences may amplify the effect of a child's direct or vicarious encounters with racial trauma within the community. In addition, children of color may begin to experience racism within the community from peers and this behavior is unlikely to be disguised or even recognized as wrong. Previous studies show that by the age of 6, White children can exhibit anti-Black bias, and younger children openly admit their bias ( Baron and Banaji 2006). Further, some teachers express bias against children of color in a variety of ways (e.g., increased surveillance, discipline, and expulsions) that leave children of color recognizing differential treatment and preference attributed to race ( Gilliam et al. 2016). Thus, children of color may be encountering regular experiences of unaddressed RST within their community from a very early age. However, it is also important to acknowledge that committed schools and teachers can play a role in intentionally combating RST for young children ( NCTSN 2017). For example, school staff can promote racial pride, increase awareness and acknowledgement of race, and reduce the consequences of RST by creating a safe and empowering environment for students.

Elementary School Age Child Case Example

Recent immigrant children have a high prevalence of experiencing trauma ( Jaycox et al. 2002), and some youth are refugees who fled their country of origin due to racially traumatic circumstances, such as fear of persecution due to race ( United Nations High Commissioner for Refugees 2001). To illustrate, Laura is a 5-year-old girl from Central America and lives with her relatives who migrated to the United States (US). Laura's mother paid an acquaintance to transport her daughter on the journey to the US because her mother was worried about the pervasive gang violence targeting people of her ethnic group, who were considered "lower class" and were typically of a darker skin tone. As a result, her mother was worried for Laura's safety as well as her own. Laura's mother provided little warning about the journey because she was nervous, fearful, and did not know how to explain the unexpected move in a way she thought her daughter may understand. The separation was particularly hard because Laura and her mother had a strong attachment.

Laura witnessed traumatic events (e.g., death of others) along the way, and although she made it to her destination safely, she had a difficult time adjusting to the new environment. In addition, in her new school, children teased Laura for her "broken English," dark skin, and ethnic facial features. At home, Laura was frequently reminded of her journey because of constant exposure to the news highlighting that people from her home country were being killed and detained. Her family often talked about the news and discussed concern about Laura's mother making the journey to join them in the United States. Laura displayed a decreased appetite, heightened reaction to strangers, and was fearful of leaving the house. She had difficulty sleeping, often having nightmares of ethnically motivated violence (i.e., violence targeted at specific ethnic groups) that she witnessed at home and of the images she saw on television. Laura often interpreted what she saw on television literally without fully grasping the concept of images and videos being repeatedly replayed on television; as such, she kept thinking that the events on television were happening several times a day to people who looked like her and her mother. Laura's family attributed her mood and odd behaviors to Laura missing her mother and to her difficult journey, and they believed that she would "snap out of it," Although they were often concerned about her behavior, they did not want to take her to the doctor or a mental health professional out of fear that she would be deported because of her legal status. The family remained silent and hoped that Laura would begin "acting like a normal child" after more time passed.

Racial Trauma for Middle School Age Children

As children develop into early and middle adolescence (e.g., 12-14), they are often beginning or continuing to contend with the self in relation to group identities (e.g., Tajfel and Turner 1986). In addition to rapid physical growth, which, for some populations (e.g., Black boys), may contribute to exaggerated stereotyping (e.g., Goff et al. 2014), there are cognitive and psychological changes associated with the exploration of an autonomous identity. Increased cognitive maturity helps in the development of ALANA youth's racial-ethnic identity ( Quintana 2007), however, it may also reveal the ways in which RST impact the child as a member of their racial group. Youth may consciously or unconsciously internalize RST, which may lead to negative attributions about how they view their own racial group (i.e., private regard) and how they perceive others view their racial group (i.e., public regard) (e.g., see Sellers et al. 2006). School age ALANA children may exhibit a variety of reactions to trauma, particularly racial trauma ( NCTSN 2008; Sanders-Phillips 2009). Although youth may have the cognitive ability to perceive differential treatment based on race, school age youth may not connect the experiences with their mood (e.g., trauma symptoms), behavior, and self-image. Of note, youth who have directly or vicariously experienced trauma may become preoccupied about their own safety or the safety of peers and family members ( Greenwald 2014). Trauma experiences, including RST, may lead to distractibility and problems in school that could easily be misinterpreted by adults as attention deficit hyperactivity disorder (ADHD), phobias, or other anxiety disorders (e.g., Thompson and Massat 2005).

Regarding the family, school age ALANA adolescents and their caregivers often begin or adjust the content and frequency of racial socialization (i.e., communication regarding racial behaviors and attitudes; Coll and Pachter 2002; Hughes and Chen 1999; Hughes et al. 2006), during this stage of heightened racial awareness. For example, as youth move out of childhood, parents generally begin to have more conversations with their children about preparing for racial bias ( Hughes and Chen 1999). Coping with RST is an additional task for families of color that extends beyond general coping socialization strategies (e.g., Anderson et al. 2018). Such a task may be seen as burdensome by some, given that parents must often contend with, reflect on, and resolve their own experiences with racial discrimination ( Anderson and Stevenson 2019). Parents' racial discrimination may influence the socialization messages parents convey to their children ( Saleem et al. 2016) and could foster feelings of parental incompetency in assisting in the resolution of their adolescents' racial stressors. Of note, new immigrant families may struggle in appropriately adjusting their racial socialization within a new context.

In addition, youth are often shaped by other socializing agents within their community during this developmental stage. Of greatest salience is social media, in which younger adolescents are beginning their foray ( O'Keeffe and Clarke-Pearson 2011). Research has demonstrated the harm of online discrimination for youth ( Tynes et al. 2015), which further questions whether the PTSD Criterion A components are inclusive of these "virtual world" (i.e., online) experiences. The racialized lens of bullying or harassment activities may be contributing to a more complex psychological injury or trauma. In the "physical world" (i.e., lived) community settings, the toll of RST may be exacerbated after the community contends with a loss of a young adolescent at the hands of law enforcement, for example, Tamir Rice-a 12-year-old boy with a toy gun, and Jason Pero-a 14-year-old boy shot on a reservation. While active forms of protest may be a way to cope with immediate calls for justice (e.g., Anyiwo et al. 2018; Hope and Jagers 2014), some youth may feel unmotivated, numb, or hopeless immediately following a tragic loss.

Middle School Age Child Case Example

The appropriation and misrepresentation of Native American Indian populations at schools and sporting events can precipitate RST for these youth (see Baca 2004; Friedman 2013). To illustrate, Jason is a 11-year-old Native American Indian boy who attends Savage Warrior middle school, which is predominantly White. At school, Jason often feels isolated as one of the few students of Native American Indian descent. His isolation becomes even more apparent during school-pep rallies and sporting events when the "Native American mascot" comes out waving a tomahawk and making a reverberating noise that seems to unite his peers in school spirit, but trigger physiological symptoms (e.g., sweating, heart-racing) for him. Jason is particularly triggered by such events given that he is the victim of online racial teasing and bullying. Jason often feels that both he and his culture are misunderstood and devalued. School is an unwelcoming and often hostile racial environment as Jason hears racial epithets and experiences racially targeted bullying. These situations elicit trauma symptoms (e.g., hypervigilance, depressive symptoms, nightmares) and decrease his focus in class. Jason believes that the portrayal of his culture is disrespectful and offensive, but he developed symptoms of internalized racism as evident through his self-critical thoughts, feelings of shame regarding his racial-ethnic identity, and anger that his physical features make it difficult to blend into the mainstream culture.

Racial Trauma for High School Age Youth

For high school-aged youth (i.e., 15-18 years), adolescence is marked by increased physical, social, and cognitive changes (e.g., Piaget et al. 1958; Steinberg and Morris 2001). During this developmental period, youth develop formal operational thought, deductive reasoning, and problem-solving skills. For ALANA youth, these changes coalesce with increased understanding of advanced forms of racism (e.g., institutional racism), exposure to racial discrimination, and ability to make meaning of racial encounters ( Brown and Bigler 2005). Increased social comparison and sensitivity to others' evaluations are also characteristic of adolescence ( Krayer et al. 2007). As such, the experience of RST during this sensitive period could impact youth's severity of trauma symptoms, sense of self, hope, and ability to heal from these incidents ( Heard-Garris et al. 2018; Jernigan and Daniel 2011). Adolescents' trauma symptoms may manifest similarly to adults, but could also include unique features such as rebellion, social withdrawal, increase in risky activities, delinquency, and other action-oriented responses to trauma ( Hamblen 2001). Teens may also engage in different coping strategies and help-seeking behaviors ( Chapman and Mullis 2000; Copeland and Hess 1995; Rickwood et al. 2005) to manage racial trauma. For example, some youth may cope with racial trauma by dissociating or compartmentalizing; however, if trauma symptoms go unaddressed during adolescence, youth may develop secondary symptoms. Similar to the literature on complex trauma, or experiences with multiple traumatic events ( Cloitre et al. 2009; Cook et al. 2017, 2003), the accumulation of stressful racial encounters may prolong PTSD symptoms and sequelae, thus increase vulnerability to subsequent traumatic exposure and symptoms in later adolescence and adulthood.

Familial relationships for adolescent youth can be fraught with increasing tension over autonomy and cohesion ( Steinberg 1990). Although peers play an increasing and often much larger role for youth during adolescence, ALANA youth may find it challenging to gain support regarding RST solely from same-age peers. Just as parents adjust their parenting strategies based on their child's age and needs ( Minuchin 1985), ALANA parents must adjust how they engage in mature conversations with their teenagers ( Steinberg and Silk 2002) related to safety and racial discrimination ( Coll and Pachter 2002; McAdoo 2002). For example, parents may provide more personal and historical explanations and discuss complex forms of racism (e.g., institutional), which can influence youth's outcomes ( Saleem and Lambert 2015), while also acknowledging the reality of adolescents' desire for individuation and social interactions. Parents must contend with the reality that their children may face more discriminatory experiences outside of their supervision. Given that parents are worried about youth's increase in risky behaviors during adolescence ( Steinberg and Silk 2002), they may also worry about the contexts that youth of color find themselves in, particularly in relation to authority and race. Such conflict may prove challenging in helping older adolescents from a parental standpoint, however, older siblings, extended family, and natural mentors within the community may assist to fill this gap ( Stanton-Salazar 1997).

The community (e.g., neighborhood, school) in which adolescents live has significant implications for the exposure and experience of RST. Given the increased autonomy of adolescents, youth may be more likely to directly witness or experience RST within their community, and for some youth, they may repeatedly witness incidents, even in spaces designed to be safe such as youth recreation centers or school ( Jernigan and Daniel 2011). Given that adolescents have the cognitive capacity to recognize racial discrimination and the potentially damaging consequences for their lives and health, some youth may experience hypervigilance and frequent worry about RST within their community. This may be particularly true for teenagers who are more likely to have unsupervised use of electronic devices and exposure to social media content, including hate crimes and the killing of ALANA teens. Two examples are Jordan Edwards-a 15-year-old boy shot in the back of the head by a police officer-and Trayvon Martin-a 17-year-old boy shot by a neighborhood watch community member. While some adolescents may be proactive in pushing back against racially targeted violence within their community (e.g., protests, vigils, activism), attempts could lead to reoccurring RST exposure due to punitive law enforcement or community responses. Of note, aspects of the neighborhood such as social cohesion, may influence how youth manage racial stress by protecting against the effects of racial discrimination on youth's depressive symptoms ( Saleem et al. 2018).

High School Age Adolescent Case Example

Stereotypes ( Pitner et al. 2003; Steele 1997) and the concept of "model-minority" can exacerbate feelings of RST throughout adolescence and into adulthood ( Awad et al. 2019; Qin et al. 2008). As an example, Lee's parents immigrated to the United States prior to Lee's birth; his father immigrated from China and his mother from Palestine. Lee was raised with a tricultural identity (i.e., Chinese, Palestinian, American) due to his parents' cultural socialization. Lee wanted to explore his passion of music production, but his parents encouraged him to remain focused on the advancement of his educational pursuits because they both immigrated for better educational opportunities as medical doctors. In high school, Lee was called upon frequently by teachers and asked for academic help from his peers, even though he did not perceive himself as academically gifted. The pressure of the "model-minority" stereotype caused significant stress and worry for Lee. In addition, the negative depiction of Palestine in the media contributed to an uncomfortable racial climate at school. He experienced frequent microaggressions and discrimination from peers, including questions such as "Why does your mother wear that wrap on her head?" and "Do you think your family knows any terrorists?" One day during class, Lee was sent to the principal's office by a teacher for wearing a shirt representing Palestine. Lee was asked to change because it made others uncomfortable. Due to the racial climate and the stress that Lee was put under to perform by classmates, teachers, and parents, he began avoiding school, dissociating, having nightmares about being racially targeted, and experiencing worry and hypervigilance about his performance and race. These symptoms were misinterpreted as anxiety by teachers, who recommended a mental health consultation. Yet, Lee's family was against the idea due to cultural mistrust and the minimization of Lee's difficulties, which prevented him from accessing treatment. In Lee's senior year, he continued feeling isolated from his peers and experienced frequent worries about being pulled over and arrested because of his race, given the number of videos online showing racial policing of Palestinians. He received no intervention for his stress and trauma-laden symptomatology, which had a significant impact on his academic engagement and achievement.

Prevention and Intervention Through Future Research and Clinical Practice

Attention to the important issue of RST is emerging within the research literature. Although empirical studies and accompanying measures still focus primarily on adult experiences (e.g., Carter 2007), scholars are calling for greater focus on youth experiences (e.g., Anderson and Stevenson 2019; Jernigan and Daniel 2011; Jones and Neblett 2016; Svetaz et al. 2018). In particular, Wade et al.'s (2014) exploration of adverse childhood experiences (ACEs) in urban populations led to the theoretical expansion of ACEs to include items on discrimination, more fully conceptualizing the experiences of ALANA youth. There remains the need for investigators to examine whether the type of racial trauma and resulting symptoms differ for children of different racial-ethnic backgrounds. It is also necessary for researchers to examine racial trauma for children and adolescents to clarify the prevalence and effects of this psychological stressor on youth. For example, at the time this paper was written, scholars do not have an extensive understanding of how the racial criminalization and hostility along with the family separation at the United States and Mexico border will impact families immigrating to the United States ( Dreby 2015). Appropriate data on RST for these families could bring to light the idea that such a separation is traumatic not only because families were forcefully divided, but also because of the conditions of detainment facilities and political and ethnic-racial motives behind such policies. As such, research utilizing language-specific interviews will be vital in capturing the totality of experiences faced by these youth and their families, particularly with regard to their race, immigration status, and the current geopolitical environment.

Arguably, one of the most important clinical questions regarding the treatment of any presenting problem is how to conceptualize and treat symptomatology in different racial-ethnic groups. While some scholars argue for cultural adaptation to existing universal interventions ( Bernal and Domenech Rodríguez 2012), others argue the need for targeted interventions created with cultural specificity of the stressor ( Pieterse 2018). Still others consider a focus on ethnicity and race within universal interventions to promote positive psychosocial outcomes with diverse youth (e.g., Umaña-Taylor et al. 2018). Although programming approaches for ALANA populations differs, what is less known is in what capacity the topics of race and racism are effectively managed across health care and community settings. The literature indicates this is an area of challenge for many clinicians ( Owen et al. 2014; Sue et al. 2010). While scholarship may contend with the notion of clinician's cultural competence, few studies have conceptualized racial trauma as a focus of this practice with clients (e.g., Pieterse 2018). Interventions which consider how parents can address the RST experienced by children have emerged in recent years ( Coard et al. 2004). For example, engaging, managing, and bonding through race [EMBRace] ( Anderson et al. 2018), specifically focuses on African American clients and utilizes racial socialization as a tool for children and families to collectively confront the RST presented in sessions. In relation, various clinical settings (e.g., primary care and pediatric wellness visits) have started considering how to integrate such racial socialization techniques in family visits to both address and start the healing process for ALANA families (e.g., Heard-Garris et al. 2018), but clinical application and implementation is still in early stages. In addition, school-based recommendations have been made for educators by students' varying developmental stages by the NCTSN, Justice Consortium, Schools Committee, and Culture Consortium (2017). Finally, more holistic measurement and assessment of urban and/or ALANA youth ACEs, including discrimination, can make for more accurate treatment options from clinical providers (e.g., Wade et al. 2014).

Conclusions

Given the limited research focus on understanding of RST for children and adolescents, we offer a framework for unpacking how RST can influence children and adolescents' trauma symptoms with consideration of ecological and developmental contexts. As acknowledged within the literature on racial trauma within adult populations, a discrete racially traumatic incident, or the cumulative effect of several racially stressful incidents, may trigger symptoms consistent with PTSD ( Jernigan and Daniel 2011; Quintana and McKown 2008; Williams et al. 2018b). Yet the field has lacked a thorough conceptualization of racial trauma for children and adolescents of color. Given that youth's understanding of trauma and the resulting symptoms may differ based on age ( Center for Substance Abuse Treatment 2014; Green et al. 1991), we propose that the experiences, interpretations, symptoms, and behaviors of racial trauma will be different for youth at different developmental stages. In addition, consistent with the stress and coping literature, the family and community systems that a child is within can influence how youth interpret and manage racial trauma. Through the DEMYth-RT, we introduce a model for acknowledging the existence and resulting psychological symptoms of racial trauma for ALANA youth with developmental and contextual considerations. The goal of the model is to stimulate future work and contribute to knowledge that is critical in healing for ALANA children and adolescents. The recognition and treatment of racial trauma during childhood and adolescence has the potential to change one's trajectory of well-being and help to close racial disparity gaps in health and education in adulthood. Addressing RST can benefit individuals (e.g., health), communities (e.g., productive citizens and community members), and the greater society (e.g., cost-saving, general culture of health and well-being for all). The prevention and intervention of such important health and wellness indicators starts first with acknowledging that RST is not a myth, but is indeed a reality for ALANA youth.

Footnotes

Conflict of interest The authors declare that they have no conflicts of interest.

Ethical Approval This article does not contain any studies with human participants or animals performed by any of the authors.

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Addressing the "Myth" of Racial Trauma: Developmental and Ecological Considerations for Youth of Color

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Trauma is prevalent among children and adolescents, with youth of color generally reporting greater exposure compared to White youth. One factor that may account for this difference is racial stress, which can manifest into trauma symptoms. Although racial ...

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Sadly, more than 800 children aged one to nine die each year in the UK. One in eight of these deaths are caused by accidents. Last year, over 45,000 under-fives were admitted to hospitals across England, Scotland and Wales as a result of accidents, and almost three quarters of these accidents happened at home.

During the first five years of a child's life, they develop at a faster rate than at any other time in their lives. The quality of a child's early experiences is crucial for healthy brain development. Keeping children safe, both emotionally and physically, is an important factor in this.

A safe environment for children is one where any potential risks to them are minimised. It is an environment which promotes their physical and emotional well-being and ensures that their needs are met. Creating a safe environment for children is an ongoing process that requires constant monitoring and adaptation to their changing needs and abilities as they progress and develop.

Although accidents are preventable, they are still the leading cause of death, ill health and disability for children in the UK. There is also a strong link between deprivation and the risk of death throughout childhood.

There are some key things that should be considered when thinking about creating a safe environment for children.
These include:

Childproofing the area - this helps to prevent accidents and injuries and can include things like securing drawers and cabinets, putting in window guards or locks, and ensuring any electrical outlets are safe.

Ensuring physical safety - this includes ensuring that the physical environment is free from hazards. This includes poisonous or toxic substances or sharp appliances. This can be achieved by ensuring anything hazardous is out of reach of children and ensuring the use of safety gates and appropriate locks wherever possible.

Ensuring a clean environment - regularly clean and disinfect the environment to prevent the spread of germs and reduce the risk of illness. This is particularly important in areas where children play, eat and sleep.

Ensuring there are adequate safety devices - this includes fire detectors and carbon monoxide detectors and that the environment is free from mould or damp.

Transporting children safely - this includes using age-appropriate car seats and safety belts and following all other transport safety advice.

Being prepared for accidents and emergencies - this includes having a first aid kit with all of the necessary medicine and other equipment to hand, including taking these with you on holidays and day trips. It also involves knowing where the nearest hospital or medical centre is.

Adequate adult supervision - this is not only important for their physical safety but also for their emotional well-being. If you are caring for a child, you should be knowledgeable about child safety and you should be present and attentive while they are in your care.

Establishing rules and boundaries - set clear rules and expectations. Teach children what is safe and what is not. For example, they should understand the importance of not touching electrical outlets or playing with sharp objects. This does not replace adult supervision as children are curious and will always attempt to push boundaries; however, teaching children what is not safe and providing appropriate adult supervision is key.

Educating children about how to have safe interactions with others - this will involve role-modelling safe play to babies and young children. With older children once they have language, conversations can begin about safe adults, what is appropriate/inappropriate and body autonomy. It is important to reassure your child that they can come to you with any problem, that you are there to help them and that they will always be believed. It is important to teach children how to say no if they feel uncomfortable or unsafe. Teaching children about having safe interactions with their peers is also important, in terms of safe play and how to manage conflict.

Teaching children about emergency procedures - this includes educating your child about emergency procedures, such as calling 999 in case of an emergency or having an emergency exit plan in case of a fire.

Internet safety - this includes not allowing children to have access to the internet or smartphones/tablets until they are old enough to understand some of the safety issues.

In order to safeguard children whilst in education, all staff, volunteers and governors are expected to comply with the requirements of the current Department for Education guidance, Keeping Children Safe in Education, which is reviewed and updated annually.

It is vital that the classroom is a safe space for children. Arranging the classroom environment so that it is a safe space is one important way to promote safety.
Some ideas to promote a safe learning environment in schools are:

Labelled boxes and storage units help to keep the area tidy - these will help to prevent clutter from building up and prevent tripping hazards.

Easy to reach, low, open shelving to prevent toys and other equipment from falling on children.

Providing children with activities that are stimulating so as to avoid them becoming too physically active indoors.

Clearly defined areas of interest and scheduled times for groups of children to access the areas will help to prevent running and collisions.

It is important to also consider the condition of the materials which the children have access to.
This includes ensuring that:

There are no missing or broken parts.

The sizes of the individual pieces are not too small which can be a choking hazard for small children.

There is no rust or peeling paint on the equipment or inside the room.

There are no loose nuts or bolts.

There are no sharp edges, rough surfaces or splinters in wooden furniture or equipment.

There are no visible cracks in the equipment.

All points of electricity are safe and childproofed.

Furniture or large play equipment is stable.

In a classroom, it is not only the indoor space that needs to be kept safe, but also any outdoor space needs to be safe for children to explore and needs to be free from hazards. This is particularly important if the space is a shared community space or if any other people have access to it.
The outdoor space should be monitored and checked for:

Debris - which can include glass, cigarette ends, litter, or building supplies.

Animal excrement.

Surfaces that may be too hot or cold for children to touch safely.

Natural objects that could cause harm. This includes sharp rocks, stumps, roots or branches.

Water, ice or snow that may pose a risk of accidents.

Any exposed power lines or utility equipment.

Any unsafe insects - which could include anthills, beehives or wasp nests.

Any holes or ditches in the floor or uneven ground.

Any other foreign material.

It is important to inspect both the indoor and outdoor areas every day before the children arrive.

When the children are on site, constant and appropriate levels of supervision, depending on their age and abilities, is the best way to ensure that safety levels are continuously monitored. It is important to continuously monitor the environment throughout the day and make any changes to the environment where this is necessary. While a safe environment is important, the most important thing in ensuring safety is adequate supervision, especially for young children.
It is important throughout the day that:

Any spillages are cleared up immediately.

Good hygiene of the room and the children is maintained.

The area is tidied up after each activity before moving on to a new one.

Certain areas are set out for different activities to avoid any accidents with materials/equipment.

All schools must appoint someone within the school to ensure that the health and safety responsibilities of the school are being met, and that risk management is being continually assessed and updated. Risk assessments are necessary as they demonstrate that the school is taking action to meet the statutory requirements for health and safety. For further reading about how to create a risk assessment in schools, please see our knowledge base.

Creating a safe environment for your children at home is essential for their development and well-being. Creating a physically safe environment where they can play and explore, free from hazards, is a key part of ensuring a safe environment for children at home.

A safe environment at home also includes children having a home free from abuse and neglect, ensuring appropriate boundaries and supervision, and creating a home where children feel loved, valued and respected.
It is important to create a home environment that:

Is calm and free from excessive conflict.

Models healthy, loving, respectful adult relationships.

Has loving boundaries. Children need boundaries and these need to be implemented in a loving, respectful way. Children do not need consequences or punishments for their behaviour.

Ensures that they feel loved and cared for no matter what. This means providing love and affection consistently and never withdrawing this as a way to set boundaries.

Ensures that they know they can come to you with a problem and you will help them and not punish them for making a mistake.

Models the behaviour you would like to see from your children.>

Is consistent with rules and boundaries that are important to keep you all safe, while not being rigid in your approach. This means that there is room for flexibility if this meets the needs of your child.

Fosters open conversations with your child about body autonomy and sex and relationships, appropriate to their age. This means that they will feel able to talk to you and ask any questions they may have without feeling any shame or embarrassment.

Encourages discussions about online safety with your child, which is vital in this digital age. This also includes not allowing your child to have access to social media until they are able to understand some of the risks associated with it and being cautious about unsupervised internet use.

Encourages open conversations with your child about their mental health and well-being. It is important to show children that experiencing difficult emotions is normal so that it is more likely they will come to you if they ever experience any anxiety or depression.

Apart from at home, school or a nursery provider, there are other environments that should be safe for children. These are usually places that are set up to accommodate children and have all of the necessary safety checks in place.
Some examples of these include:

Public parks and playgrounds - these should be designed in a way that they are safe for children to access. However, this does not mean that they are always safe places as they are not usually staffed or checked regularly. This means that there could be hazards, for example glass or other dangerous materials on the floor. As they are open to the public, as with anywhere, there could be other people there who are unsafe. Your child should always be supervised appropriately, according to their age, when attending a public park or playground.

Libraries - these are usually safe and supportive places for children. Children can enjoy the different books on offer and some libraries offer reading groups for children to attend or story time sessions. You can find your nearest library here.

Community centres - often organising specific activities for children, community centres are usually a safe place for children where they can engage in sports, art classes, music classes, or other activities designed for children. These classes are run by adults who will have had to undergo the necessary checks to work with children. Community centres are usually a positive and inclusive environment where children are able to explore and have fun in a safe environment.

Play centres and sports centres - these centres are required to have the necessary safety checks in place, enabling them to cater to children and families.

A safe environment is vital for a child's physical and emotional health and development. Development is how children grow physically and emotionally and learn to communicate, think and socialise. In the early years, a child's main way of learning and developing is through play and interactions with their parent or main attachment figure.

Positive experiences including warm, loving and responsive relationships in the first five years of life are crucial for child development. Ensuring their safety, both emotional and physical, is an important part of this process. For further reading about the child development stages, please see our knowledge base.
There are a number of reasons that children need a safe environment in order to thrive, including:

To protect their physical safety in order to reduce the risk of accidents and injuries.

To promote their social development. A safe environment allows children the opportunity to develop important social skills.

To promote their cognitive development. A safe environment is crucial for brain development in children.

To promote their capacity to learn and achieve academic success. When children feel safe and secure, they are more likely to thrive in a learning environment.

To protect their emotional well-being. A safe environment provides children with emotional security and stability, ensuring that their emotional well-being is prioritised.

To nurture confidence and self-esteem. When children feel safe and protected by safe adults, this enhances their confidence in exploring the world around them and promotes their self-esteem.

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All about Safe Environments for Children

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A safe environment is vital for a child's development. A safe environment for children is one where any risks to them are minimised.

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Everyday Struggle: Switching Codes for Survival | Harold Wallace III | TEDxPittsburgStateUniversity

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Both Not Half: How language shapes identity | Jassa Ahluwalia | TEDxChandigarh

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Ellevation: EL Program Management Tools for K-12

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Intelligence Tests to Better Identify Gifted and Talented ELs

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5 Strategies for Teaching Academic Language to ELs

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Academic language is not just a challenge for English learners (ELs) in our classrooms - it is something that all students may struggle with. Indeed, math instruction is filled with vocabulary that many students won’t be exposed to outside of the lesson. Especially ELs. Think about the academic lang…

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When we offer activities to children in early education settings, we want them to be not only entertaining but to have clear learning outcomes. It's much more beneficial for children and helps us to meet the NQS (National Quality Standards) .

In this article, I'll list language and literacy activities to do with your preschoolers. They all are fun for children and easy to organise for teachers. These activities are an excellent start for introducing young minds to letters and setting the stage for further learning.

1. Treasure Hunt

Use a tray, or a toy box and throw a bunch of toys in it. Close your eyes and go on a "treasure hunt." You can do this activity in a sandpit. Bury toys in the sand and then go on a treasure hunt. As you and the children take turns pulling toys out of the box, encourage them to create a story from what they find. Story telling is an important skill for oral language development.

2. Crocodile circle

Picture a bin with a crocodile face on top, filled with letters and surprise cards. Children pass the crocodile around the circle singing "Crocodile, crocodile down by lake, I'm going to reach right in and see what ( letter) you ate". The child holding the crocodile then pulls a letter and calls it out. Extra surprise cards can let you repeat a turn, reverse directions or anything else you want to include.

3. Letter matching archaeology game

The perfect accompaniment to a dinosaur-themed unit, this activity allows children to practice letter recognition while playing archaeologist. Drop a few magnetic letters onto a cookie sheet, writing the letters you chose on a piece of paper for the children to use as a key. Cover the letters in flour and give the kids a brush to carefully 'search the site' for hidden letters. When they find one, they must match it to their paper key before continuing the hunt.

Save this list for your future reference ⇓

4. Storytelling

Picture books are great to use for storytelling. And storytelling is a fantastic activity for children to learn how to construct their message, to learn new vocabulary, to sharpen memory and to improve listening skills. Simply encourage children to describe what they see. It might be especially funny experience if children take turns page after page.

5. Lotto with pictures

This game can be played with 2-4 players. Each player should choose a board and find the tiles that match his or her board. Turn those tiles over and mix them up. The first player should draw a picture tile from the pile. If the picture matches the player's board, the player keeps the tile and puts it on his board. If it does not match, the player puts it back into the pile. The next player gets a turn.

The game is continued in this way until one player has found all six of his or her tiles and wins the game. Should I mention that while children draw their tiles, encourage them to talk about objects they see.

6. Mini alphabet sensory bins

Tape the letter on the front of each box, or let the kids guess the letter as they examine the objects. Either way, these sensory bins transform a fun, hands-on play activity into a literacy lesson.

7. Snowball throw alphabet game

Paper, tape and ping-pong balls are all you need for this game of 'snowball' throwing. Tape a bunch of letters to a wall, call out the sounds and have the children throw the snowball at the letter represented. As an added bonus, kids get to work on their coordination as well as their alphabet.

Build castles, houses, farms. Once your masterpiece is built, create stories out of your play with animals and people.

9. Bringing books to life

Read a story/rhyme together and discuss which characters you each want to be. Consider the props you might want to bring to this story alive. You might create caves and homes with blankets and cushions - you may even like to close the blinds and use a torch to create a spooky atmosphere. Put some enthusiasm into your storytelling or rhyme and discuss what is happening within the story. There are so many stories and rhymes that can be acted out, such as:

We're going on a Bear hunt - by Michael Rosen and Helen Oxenbury

A Summery Saturday Morning - by Margaret Mahy
The Three Billy Goats Gruff Five Little Speckled Frogs
10. What Goes Together Game

Say a noun, such as 'flower'. Next, have the child say or write three to five words that tell about the word. For example, for flower they might say: pretty, blue, tiny, tall, or smelly.

11. Shaving cream writing

For this activity you'll need baking paper and non-menthol aerosol shaving cream

Lay out paper flat on a table. Children spray a large pile of shaving cream on the area. Have them spread out the cream and practice their writing skills.

This activity will be very helpful with fine motor skills - also visual and tactical learners will benefit. The more senses you use, the more you learn. Do this activity to practise letters, writing words, writing cursive, numbers, and doing addition.

12. Outdoor Drawing Activity

Invite children to pair up and sit back to back so they can each see a different part of the grounds. Have children spend 2-5 minutes carefully drawing what they see, in silence. Then give them a few minutes to share their drawings and tell their partners about two or three things they saw.
Which literacy activities you love doing in your classroom? Share with us in the comments below. Let's Grow this list for our future reference!

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12 Language and literacy activities for preschoolers

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A great list of fun language and literacy activities for preschoolers, including printable worksheet | EduTribe - community of early childhood educators in Australia

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Language and Literacy games for Middle School

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Language and Literacy games for Middle School

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15 Fun Literacy Games for Students

Literacy skills are fundamental in learning how to communicate effectively. Reading opens the world to students so they know more and can grasp complex concepts.

The process can be challenging for some kids, but incorporating fun literacy games in the classroom setting can help. Using games when educating kids can build their confidence and motivate them to take risks.

Read on to learn about other benefits of teaching with literacy games. This article also provides age-appropriate games for each developmental stage.

Benefits of Teaching with Literacy Games

Teaching with literacy games is a fun way to engage students and make learning enjoyable. Literacy games can help students develop an understanding of the English language and improve their reading, writing, speaking, and comprehension skills. By playing literacy games in the classroom, students can be exposed to various new words, learn how to spell, and practice their handwriting.

There are many benefits of teaching with literacy games, including:

Greater Motivation

Children are more motivated to learn when they're having fun. They are more attentive and willing to pay attention to what's happening in the classroom. Students also show more enthusiasm, participate in class, and are more engaged.

Comprehension and Language Development

Understanding is as important as learning to read. This ensures readers can interpret what they've read. They should be able to answer questions based on the content. It's a fundamental skill that helps in other areas, including math.

Playing games also helps with language development by building vocabulary and reinforcing phonics.

Collaborative Learning

Playing facilitates interaction and sharing of ideas. In some cases, teams often have to strategize to succeed. By using each other's strengths while playing, students can learn from one another. This can also help them grasp concepts faster.

Identifies Student Challenges

Playing games in a classroom setting, especially ones involving reading card games, can help teachers identify student challenges. This can include learning challenges or difficulties with vision or hearing. Children tend to be uninhibited while playing. They're usually focused on achieving successful results, making it easier for teachers to recognize students' issues with reading.

The 5 Best Literacy Games for Kindergarteners

Early childhood is the most critical development stage. Reading to an infant can enhance their social and reading skills. Participating in a preschool reading game can build students' critical thinking and problem-solving skills and improve their reading capabilities. These skills can be further boosted when they play any of the following games:

Alphabet Woods helps to reinforce learning the alphabet in a fun way. Playing their cards alphabetically allows students to grow trees for the forest animals. Each card played will enable students to collect a forest animal. The goal of the game is to collect the most animals.

In this game that fosters lower and uppercase letter recognition and alphabet sequencing, players take turns drawing a letter token from the bag and identifying its match to determine where on one of the five alphabet boards it should be placed. When a player places the last letter token and a board is complete, they collect a Rooby token. The player with the most Rooby tokens at the end of the game wins!

This game uses special dice with symbols. You want to look out for the sheep and the clovers. Revealing either of these determines if a player gets to move sheep across the game board or collects a clover tile. Players can use the words on their clover tiles to create sentences to earn points. It doesn't matter if the sentences are silly as long as you win points. The player with the highest number of points wins.

A roll of the die moves players' pawns around the gameboard, where they can land on word cards or challenge spaces. All players can try to identify the matching synonym or antonym on their bingo boards when anyone lands on a word card. Once identified, they cover the corresponding square with a token. After landing on a challenge square, the player can choose any open square on their bingo board and place a token in the space. The objective of this bingo-style game is to fill a row or column with four tokens to win.

This is similar to some of the kid book games that provides an excellent outlet for kids to hone their storytelling skills. On each player's turn, they move Pickles along the gameboard and draw a card to tell the story. Players who tell the story correctly receive the card. After that, each player tells the story from the beginning and adds one sentence based on the card content they've drawn. The player who collects the most cards wins when Pickles reaches the castle.

The 5 Best Literacy Games for Elementary Students

Here are some fun literacy games for kids in the five to ten age group. They include reading board games for elementary students and fun reading games for elementary school.

You can use teams or individual students to play this game. Each takes a turn, chooses a descriptive word, then draws a picture based on the word. The other players try to guess the picture before time runs out. Each point is awarded to the artist and guesser if they're correct. The first team or player that reaches 15 points wins.

The category card determines the specific category and number of matching letters a player needs to spell the word. The letters can be used in any order based on quick thinking and speed. The fastest player collects the card used in each round. The winner is the player with the most cards at the end of the game.

Players choose the category from a stack of cards. They write four answers based on the category, each starting with a letter on the letter cards. Players then reveal their answers and will receive points for each letter completed before the time runs out. The highest-scoring player wins.

Spell as many four-letter words as you can using the two letters shown on the card that has been turned over. Place one letter tile from each correctly spelled word onto a corresponding letter space. Cover all the letter spaces on your slide board first to win!

Players read aloud the script they've created to the other players, who vote on the best story. Players earn points along the way, and the one with the most wins. It's one of a few reading intervention games encouraging students to read aloud. This can alert you to any reading challenges your students might be having.

The 5 Best Literacy Games for Middle School Students

Here are a few literacy games for middle school students you can introduce to your class. They may not include reading games middle school students might expect, but these still test their comprehension skills.

It's a great way to reinforce your students' knowledge of Shakespeare. Players must determine which answers are accurate by placing their pawns next to them. Players are awarded a shilling for every correct answer.

The player who starts chooses a letter on one of their cards and says a word beginning with that letter. The second player must quickly play their card and say words associated with the word given by the previous player. The first player to play all their cards wins.

You can bid a letter during each round. This allows the player to add a word to an existing chain. The goal is to use all your letters before the other players.

Players collect tiles as they go, follow the directions, and move around the gameboard accordingly. They can use the letter tiles to build as many words as possible. The player with the best words, wins.

Players use the letter cards they've been dealt to create words or add letters to existing words in the play area. Each letter used earns points. The player with the most points at the end of the game wins.

Learning Through Play with SimplyFun

Reading is a fundamental skill that opens the doorway to other areas of education. Fun literacy games can help make reading more manageable. Finding ones suitable for your student's developmental stage and age is easy with .

We have various fun literacy games for every age range that help in math and English. Browse through all of them to find the best game for your young learner!

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Fun Literacy Games: An Engaging Way to Learn

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Boost reading skills with fun literacy games! Engage kids and make learning enjoyable with our interactive, educational games.

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Supporting Your Child’s Literacy Development at Home

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Your Springfield-Greene County Library card gives you access to all the resources and services of the Springfield-Greene County Library.

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Explore language and literacy. Discover how language is the ability to both use and understand spoken words or signs. Literacy is about using and understanding written words, or other symbols, to communicate.

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https://scied.ucar.edu/art-science

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Explore STEAM education resources developed at the UCAR Center for Science Education and visit the Art-Science Gallery at the NCAR Mesa Lab visitor center in Boulder, Colorado to see exhibits that connect atmospheric science with visual art.

Art-Science Classroom Activities

The Art of Clouds (grades 4-12) Students use a cloud identification guide to identify clouds in landscape paintings, then make their own art to identify cloud types.

Whirling, Swirling Air Pollution (grades 6-9) This storytelling activity builds literacy skills while giving a sense of the many ways in which daily activities contribute to air pollution.

Drawing Clouds Inside the Lines (grades 3-6) In this classroom activity, students investigate how clouds change over time by making repeat observations of a section of sky and then representing their data graphically.

The Colors of the Seasons (grades K-4) In this Elementary GLOBE activity, students will understand how colors in nature relate to their local environment and to seasonal changes within that environment. Students will practice observational and recording skills, make comprehensive comparisons, and will form a hypothesis based on the information they have assembled throughout the school year.

Art-Science Learning Resources

Presentations

The Art of Clouds: A collection of slides featuring Western landscape paintings with identifiable clouds.

Art and Science, An Intersection: NCAR Ignite presentation by Lisa Gardiner to tell the story of how air pollution made its way into landscape art during the Industrial Revolution

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Explore STEAM education resources developed at the UCAR Center for Science Education and visit the Art-Science Gallery at the NCAR Mesa Lab visitor center in Boulder, Colorado to see exhibits that connect atmospheric science with visual art.

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STEAM Art Activities that Put the "A" in STEAM

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One of the most forgotten things is art. It's so easy to focus on science or math, and then at the end of the day, you've done nothing else! If you are looking for a really fun STEAM activity for your kids, you can't go wrong with something creative like these STEAM art activities!

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Putting the 'E' in STEM for the Littlest Learners

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Watch 3-year-olds at play and you'll see them building. On the beach, it's a sandcastle encircled by a moat. In the classroom, it's a towering edifice constructed of cardboard or blocks. "They're natural engineers with an inclination to design the world around them," said Christine M.

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How to Teach an Engaging Simple Machines Unit - Teaching Muse

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Everything we think, say, and do is processed through our own cultural backgrounds. But because culture is absorbed and passed down from generation to generation rather than explicitly taught, we're seldom aware of it.

Culture shapes not only our values and beliefs, but also our gender roles, family structures, languages, dress, food, etiquette, approaches to disabilities, child-rearing practices, and even our expectations for children's behavior. In this way, culture creates diversity.

Cultural diversity and teachers

For teachers, it is essential to see and understand your own culture in order to see and understand how the cultures of children and their families influence children's behavior. Only then can you give every child a fair chance to succeed.

Think about your own upbringing. How did your family's expectations affect what you did? Were your parents, siblings, and other relatives close or distant? Were they strict, lenient, or somewhere in between? Were your school's expectations any different? All of this, and more, plays a part in how you view the behavior of the children you teach.

These ideas lie at the heart of NAEYC's position statement Advancing Equity in Early Childhood Education. Its guiding principles include

Recognizing that "self-awareness, humility, respect, and a willingness to learn are key to becoming a teacher who equitably and effectively supports all children and families"

Developing a strong understanding of culture and diversity

Understanding that "families are the primary context for children's development and learning"

One major takeaway from the position statement is that early childhood educators must support consistently warm and caring relationships between families and their children, respect families' languages and cultures, and incorporate those languages and cultures into the curriculum, their teaching practices, and the learning environment.

Cultural diversity and young children

Children bring their own set of culturally based expectations, skills, talents, abilities, and values with them into the classroom. And they begin to develop their self-concept (at least in part) from how others see them. To form positive self-concepts, children must honor and respect their own families and cultures and have others honor and respect these key facets of their identities too. If the classroom doesn't reflect and validate their families and cultures, children may feel invisible, unimportant, incompetent, and ashamed of who they are.

Many people, including educators, have long believed it is better to act colorblind and/or "cultureblind"-that is, to not acknowledge color or culture. But research has shown that this artificial blindness keeps us from recognizing, acknowledging, and appreciating important differences. Worse, it may lead to unintentional bias toward or disrespect for those who are different from us.

We know now that acknowledgments of color and culture are essential for legitimizing differences. Color and culture make each one of us special and enable us to offer unique gifts and opportunities to groups we are part of. At the same time, color and culture help children learn about each other and the world. In short, color and culture enrich classrooms.

To appreciate what each child can contribute to the class, teachers need to learn about each family's cultural values. Helping children to see themselves in your pedagogy, curriculum, environment, and materials enables them (and their families) to feel welcomed and valued.

Take a look around your classroom.

Does the artwork on the walls accurately reflect the children's lives, or are the walls covered with store-bought, stereotypical images?
Why not have the children create their own posters with their own artwork, things from home, and photos families can supply?

Are labels (and other child-focused texts) repeated in each child's home language, or are they in English only?
Why not forge connections and support children's learning by asking family members to help children use their home languages throughout the room?

It's important to see cultural and linguistic differences as resources, not as deficits. As NAEYC's equity position statement puts it, "Children's learning is facilitated when teaching practices, curricula, and learning environments build on children's strengths and are developmentally, culturally, and linguistically appropriate for each child."

The difference between equitable and equal

Equal is not the same as equitable. Every child in your group has different needs, skills, interests, and abilities. Equal would mean giving all children the same activities, materials, and books. Equitable means ensuring that you consider each child's strengths, context, and needs and provide all children with the opportunities that will support them in reaching their potential.

It's crucial to recognize the inequities that children and their families face-in school and out. The position statement reminds us that "dominant social biases are rooted in the social, political, and economic structures of the United States. Powerful messages-conveyed through the media, symbols, attitudes, and actions-continue to reflect and promote both explicit and implicit bias." For example, research conducted by Yale University professor Walter Gilliam clearly shows that young African American boys are subject to higher rates of suspension and expulsion than their White European American peers.

How cultural diversity shapes behavior

Your culture and the children's cultures aren't the only cultures at work in your classroom. Every school and early childhood education program has a culture too. The cultures of most American schools are based on White European American values. As the makeup of the US population becomes more diverse, there is more cultural dissonance-which impacts children's behavior.

White European American culture has an individual orientation that teaches children to function independently, stand out, talk about themselves, and view property as personal. In contrast, many other cultures value interdependence, fitting in, helping others and being helped, being modest, and sharing property. In fact, some languages have no words for I, me, or mine.

Children who find themselves in an unfamiliar environment-such as a classroom that reflects a culture different from their home culture-are likely to feel confused, isolated, alienated, conflicted, and less competent because what they've learned so far in their home culture simply doesn't apply. They may not understand the rules, or they may be unable to communicate their needs in the school's language.

Rethinking challenging behavior

Because your responses to children's conflicts and challenging behavior are culture bound, it is all too easy to misinterpret children's words or actions. The next time a child seems defiant, ask yourself, Is that behavior culturally influenced? Could I be misunderstanding the child's words or actions?

For example, White European Americans tend to use implicit commands, such as, "Johnny, can you please put the blocks away?" Children raised in the White European American culture understand that they are being told to put away the blocks. But children raised in the African American culture may interpret this utterance differently. In their culture, adult commands are usually explicit: "DuShane, put away the blocks." To African American children, an implicit command in the form of a question may seem to offer a choice about how to behave.

Culture also defines personal space, including how much space feels appropriate in the block area, at circle/meeting time, and in the dramatic play area. In some cultures, children feel comfortable playing close to one another; in others, the same space may feel claustrophobic and lead children to hit or shove a playmate who seems too near. Similarly, you may stand too close or too far away, depending on children's cultures. For example, if Cadence doesn't pay attention to your request to keep the sand in the sandbox, you may be too far away to connect with her.

In White European American culture, teachers expect children to sit still and maintain eye contact to show that they're paying attention. But in other cultures, children might show their interest by joining in; they may learn through hearing or telling a story, watching others, or using trial and error. If they don't understand the lesson, they might have a hard time paying attention. Or they may be paying attention in a different way.

Culture counts

There are many rewards for teachers who take culture into account. You can form authentic, caring relationships with children and families; build connections between what children already know and what they need to know; select activities, materials, and instructional strategies that honor children's cultures and life experiences; and teach children the skills they need to succeed in a global society.

From the Pages of Young Children: Research on How Culture Affects Learning

For more examples of how culture affects learning, check out " Diverse Children, Uniform Standards: Using Early Learning and Development Standards in Multicultural Classrooms" in the November 2019 issue of Young Children. The authors, Jeanne L. Reid, Catherine Scott-Little, and Sharon Lynn Kagan, provide several examples of culturally influenced differences in how children pay attention, approach learning, seek guidance, and express their knowledge and skills. They also offer tips to help teachers address standards for early learning that are not sensitive to these cultural differences.

This article supports the following NAEYC Early Learning Program Accreditation standards and topic areas

STANDARDS 7: FAMILIES; 1: RELATIONSHIPS

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Valuing Diversity: Developing a Deeper Understanding of All Young Children's Behavior

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For teachers, it is essential to see and understand your own culture in order to see and understand how the cultures of children and their families influence children's behavior.

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A new study finds that children show bias at a surprisingly young age. But teachers have ways to address this and create a welcoming classroom.

We know that teens and adults can demonstrate social bias toward people from cultures different from their own. But what about young children? Do they show bias toward peers based on identity groups? Researchers at Northwestern University sought to provide more insight into this issue in a new study with 4- and 5-year-olds.

Using an implicit bias test commonly given to adults, researchers found that the children rated images of black boys less favorably than images of white boys and girls, with images of black girls falling in the middle.

Young children are "astute observers of the social world," and this can have pernicious effects on how they perceive race and gender, according to Danielle Perszyk, a psychologist at Northwestern University, and her colleagues. The majority of children in the study-both black and white-had a "strong and consistent pro-white bias."

To explore how young children may show racial and gender bias, the researchers conducted two experiments to examine whether preschool children are aware of and demonstrate bias toward other children based on both race and gender. The researchers looked at young children's implicit and explicit biases toward four groups: black males, black females, white males, and white females.

In the first experiment, the children were divided into two groups, and each group was shown the same order of four images: a prime image-one that might cause them to have a positive or negative reaction to a subsequent image; a blank screen; a neutral image (a Chinese character); and a gray screen.

Each group had different prime images. One group saw positive and negative images (e.g., a cute puppy and a snarling puppy). The other group was shown smiling faces of black and white girls and boys. In both groups, after the gray screen appeared, the children were asked to indicate if the Chinese character they had seen was "nice looking" or "not nice looking."

In the second experiment, a different group of children completed the same procedure, but the prime images of black and white boys and girls had neutral expressions rather than smiles. Participants were asked to rate how much they liked each boy's and girl's face on a 6-point scale, with 1 being "really don't like" and 6 being "really like."

Results from the first experiment showed that children responded more positively to the Chinese character when it followed white faces rather than black faces. They also responded more positively when it followed female faces as opposed to male ones. The Chinese character had the least positive responses when it followed images of black boys.

The second experiment found a similar impact of race on children's feelings toward the neutral image, but there was no difference in response based on the gender of the face in the images. Results from the children's responses in both experiments revealed that black boys were rated less positively than black girls, white girls, and white boys.

These findings show that children begin to show bias from an early age. Not only do they absorb the stereotypes they see, but they also become "increasingly attuned to social category labels, social status, and the biases exhibited by family members," explain Perszyk and her colleagues.

Addressing Social Bias in the Classroom

In recognition of this research, it's valuable for educators to be mindful and to implement strategies in their classrooms that recognize young children's social biases. Here are four relatively simple strategies they can start with.

1. Be aware that children-possibly at an earlier age than expected-may demonstrate bias and preference in their interactions: Preschoolers are not immune to bias and may treat each other differently based on race, ethnicity, or gender.

2. Determine how you want to address situations when bias is occurring: Rather than ignore situations in which children demonstrate bias, educators can use these situations as inspirations for story selection, activities, and projects. For instance, a child may project hierarchies of power in their play by attempting to dominate materials or controlling how play occurs. In response, an educator can work with them to resolve the issue, which could involve listening to the children's experiences and offering suggestions for sharing.

If children feel uncomfortable discussing a situation in which they felt rejected by their peers, educators can have them show what happened or how they're feeling through the use of persona dolls. These dolls have a name, a background, and other traits, and they can help children become more comfortable discussing feelings-they sharing their experiences through the dolls.

Educators can invite parents or community members to the classroom to share their experiences in antiracist activities, or use books as a way of introducing the history of racial and ethnic relations. Resources such as EmbraceRace and Lee & Low Books' blog can used to generate dialogue with children.

3. Be mindful of the social environment you're nurturing: Children use adults-including educators-as reference points for how to react to others. Understanding one's own preferences and biases is helpful in determining whether social bias toward certain groups is being perpetuated in classrooms. These biases and preferences may be influencing children's interactions with peers in their classroom as well as educators' selection of the activities, projects, books, and images they present in the classroom.

Educators can become more aware of their own biases by dialoguing with other educators and sharing their stories related to their own cultural identity. These conversations can be kicked off by having educators share a family cultural artifact or family ritual and explain the reasons for its significance.

4. Understand that addressing bias is a process: Even if an educator would like to immediately change the circumstances in their classrooms, progress may be gradual. Just as it may take educators time to realize their biases and work through them, young children will not change their patterns of thinking immediately.

Educators are in a unique position to potentially see children's social biases unfold as they play and work with peers, so they have a valuable opportunity to help children work through their biases and explore historical and everyday experiences of people from a variety of cultural groups. These explorations may encourage the children to create a welcoming environment in which all students can learn.

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Bias Starts as Early as Preschool, but Can Be Unlearned

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A new study finds that children show bias at a surprisingly young age. But teachers have ways to address this and create a welcoming classroom.

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University of San Diego - Professional & Continuing Education

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Educators today are working in an increasingly diverse world, which translates to an equally diverse classroom. Just look at the statistics: the 2020 U.S. Census found that the population of all minorities in the United States increased from 2010, and the multiracial population specifically grew 276% over a 10-year period. When you consider a previous Census Bureau report that forecasted that half of all U.S. students in public schools would be minority students by 2020, it becomes clear why culturally responsive teaching is becoming increasingly important.

However, knowing how to implement a culturally relevant pedagogy isn't inherently easy, and requires a balancing act on the part of you, the educator. To help you start to introduce these concepts and tactics into your classroom, here is a breakdown of culturally responsive teaching and 10 examples of CRT being implemented in schools.

What is Culturally Responsive Teaching?

According to Edutopia, culturally responsive teaching "attempts to bridge the gap between teacher and student by helping the teacher understand the cultural nuances that may cause a relationship to break down - which ultimately causes student achievement to break down as well."

When put into practice, teachers can develop culturally responsive pedagogies which are "student-centered approaches to teaching in which the students' unique cultural strengths are identified and nurtured to promote student achievement and a sense of well-being about the student's cultural place in the world."

Why Use Culturally Responsive Teaching?

There are numerous studies that point to the benefits of culturally responsive teaching (CRT). CRT has been shown to increase student engagement, cultivate critical thinking and problem solving skills, and ultimately improve a students' sense of belonging in the classroom. For educators, culturally responsive pedagogy has been critical for improving their ability to reach students, especially in the time of remote teaching and COVID-19. Reports show that teachers who use this teaching style are better able to respond to student needs, and is an effective way to combat educational inequities that have been exacerbated by the COVID-19 pandemic.

From an overall educational perspective, the biggest benefits of culturally relevant teaching include:

Teachers and students are more actively contributing to the classroom environment and culture.

Students get to learn from more interactive, collaborative and culturally conscious activities.

This teaching style helps foster a sense of belonging for students of all backgrounds.

It has been proven to improve brain processing and student engagement.

10 Examples of Culturally Responsive Teaching in the Classroom

There is no one way to implement elements of culturally responsive teaching into your classroom. There are countless different tactics to try that align with your style - here are 10 of the most common:

1. Learn About Your Students: Kick the school year off with exercises that help you get to know your students. Distribute surveys or questionnaires that allow your students to share a bit more about their backgrounds, and their learning styles. With these responses you can go into the year with a complete picture of your classroom makeup.

2. Interview Students: This is a more personal approach to getting to know your students better. Face-to-face communication will help create an open dialogue between you and your pupils, and will encourage them to open up about things like their hobbies, favorite subjects and their preferred in-class exercises.

3. Integrate Relevant World Issues: There are many different ways to do this. Consider implementing a current events roundup into your morning meetings or classroom routine. You can also use culturally relevant terms in word problems that relate back to student interests and cultures.

4. Leverage the Power of Story: Many cultures have oral traditions, myths and stories that are passed down through the generations. These stories can be used as teaching tools about manners, morality and more. Use your students' diverse cultural stories to teach valuable lessons to your classroom, while also sharing some unique history of other groups.

5. Gamify Lessons: Gaming is hugely popular amongst school-aged children. Consider "gamifying" your lessons - popular tactics include offering reward badges or setting standards for new "levels" students can move up to for certain projects or proficiencies.

6. Use Media that Positively Depict a Range of Cultures: Find age-appropriate media outlets from different cultures and languages to use in your curriculum. These outlets can be used to teach a differing perspective on a current or historical event.

7. Encourage Students to Propose Ideas for Projects: Turning the tables and letting students propose ideas for projects is a great way to let students play to their strengths and get creative. Encourage them to use their cultural heritages or backgrounds as an inspiration, and support them in taking projects from concept to completion.

8. Experiment with Peer Teaching: It is suggested that teachers try allowing students to participate in peer-to-peer teaching. In this exercise, students are able to use their own vocabulary and cultural references to teach each other about a topic or subject.

9. Encourage Students to Leverage Cultural Capital: Empower your students that come from varying backgrounds to use their voices and speak about their diverse backgrounds. For example, if you teach an English class that includes ESL students, try to find ways to include them in lessons and allow them to share experiences they have had.

10. Involve Parents by Using Take-Home Letters: Open the door to parent participation at the start of the school year, when starting a new unit or trying an education tool for the first time. Parents can provide cultural context and support, and will appreciate being kept in the loop regarding their child's education.

How to Implement Culturally Responsive Teaching in the Classroom

There isn't a step-by-step process that every teacher must follow to introduce culturally relevant teaching into their classroom. Instead, here are some elements of a culturally inclusive classroom, and some choices you can make to begin this exciting process:

Gather demographic information on students such as background, languages spoken, etc.

Identify students' assets and their cultural capital.

Create a welcoming classroom environment and develop authentic, caring relationships with your students.

Examine the curriculum to identify where you can tie in cultural elements.

Explore CRT resources to deepen your own understanding of the concept.

Share your own background and experiences with students to open lines of communication.

Encourage students to talk in pairs or small groups before sharing their own experiences with the whole class.

Learn about your students' traditions, holidays and family or other cultural activities, and try incorporating some of these traditions or activities into classroom activities.

Choose media, like stories or poems or video, that reflects the culture of the students so they can relate to the topic or characters, and teach their classmates about their heritage.

How Does Culturally Responsive Teaching Apply to Parents & Families?

Students' parents and guardians can be one of your most valuable resources when it comes to building a culturally relevant pedagogy. Because they are your students' resource when it comes to learning about their own cultural backgrounds. As such, you should be sure to engage with families from the beginning, inviting parents and guardians into the classroom community. They can share books from their native cultures or country, or participate as a guest speaker to tell their own stories. This helps them actively participate in their child's learning and share a bit about what makes them unique.

Resources for Culturally Responsive Teaching

Some easily accessible CRT resources available to teachers include:
Mathematica Education Northwest ChangeKidsLives Inclusive Schools Network Culturally Responsive
Professional Development for Culturally Responsive Teaching

There are a number of introductory resources available online for educators interested in culturally responsive teaching. However, these articles and eBooks provide a surface-level overview of CRT. While this information is hugely valuable, for educators who seek to have a more comprehensive understanding of this practice, there are other options.

Consider the Teaching for Diversity, Equity and Inclusivity in the Classroom Series offered by the University of San Diego. This program is available through the school's Division of Professional and Continuing Education, meaning each course in this series is available completely online. Through the Diversity, Equity and Inclusivity program, learners will learn how to celebrate diversity, and also strategize how to promote inclusivity, equity and anti-racism in the classroom. To learn more about this program, please contact us.

FAQs

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University of San Diego - Professional & Continuing Education

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Culturally Responsive Teaching Guide (+10 Examples) - University of San Diego - Professional & Continuing Education

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Culturally Responsive Teaching Guide (+10 Examples). Advance your career with professional and continuing education from the University of San Diego.

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Culturally Responsive Practices in Early Childhood

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Culturally Responsive Practices in Early Childhood

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In a world where early childhood education classrooms are increasingly becoming more multicultural, culturally responsive teaching is necessary for educators to help children connect with the content. In addition, educators need to learn teaching strategies that match how children understand and interact with the world.

Culturally responsive teaching gives children access to a welcoming and engaging learning environment, making them feel safe, seen, and understood. Children also perform better academically, leading to more successful learning outcomes.

Read on to discover what culturally responsive teaching is, why it's important, and how to become a culturally responsive educator.

What is culturally responsive teaching?

Culturally responsive teaching is an education approach that connects children's cultures, experiences, and languages to what they learn in the classroom to improve educational outcomes. Culturally responsive teaching encourages children to use familiar ways of thinking, speaking, and analyzing to learn new ideas. In the mid-1990s, educational theorist Gloria Ladson-Billings introduced this education approach. Other education scholars, like Geneva Gay, have since done more research on the subject. Gay defines culturally responsive teaching as "using the cultural knowledge, prior experiences, frames of reference and performance styles of ethnically diverse students to make learning encounters more relevant to and effective for them."

There are several fundamental principles for culturally responsive teaching, which include:

Having high expectations for all children

Engaging children's knowledge, practices, experiences, and perspectives

Building a bridge between home and school practices

Identifying and leveraging children's strengths

Critically questioning traditional education practices, content, and assessments

Preschool is typically where children have their first education experiences outside the home, so it's essential that the instruction be flexible, include their cultures, and uphold their identities.

Educators shouldn't take it for granted that children have experience with particular communication strategies or equipment, like toys. For example, children may be dual language learners or have limited access to toys and manipulatives. In addition, the cultural difference between home and preschool practices may affect children's learning and make them anxious and unhappy. Culturally responsive teaching will create an inclusive environment that will make children feel safe and learn better.

Why is culturally responsive teaching important?

Traditional education isn't realistic for children in diverse classrooms and communities. Here's why integrating culturally responsive teaching in the classroom is essential.

It strengthens children's identity

Culturally responsive teaching strengthens children's sense of identity and belonging. It helps them feel empowered and valued and builds trust that enhances their relationship with the teacher.

It raises expectations for all children

When teachers focus on children's strengths rather than their weaknesses, it helps them create child-centered instruction. This is especially beneficial for children from underrepresented groups whose strengths are typically underestimated.

It helps teachers meet children's needs

Because of unconscious bias from some teachers, some children's needs may go undetected, or the teachers might mislabel certain children. Focusing on children's assets helps teachers attend to each child's specific needs.

It builds cultural awareness and critical thinking

Culturally responsive teaching helps teachers and children understand and appreciate different perspectives and build empathy for others. Encouraging children to ask questions about other cultures and behaviors develops critical thinking skills.

How to be a culturally responsive teacher

Culturally responsive teaching isn't just about recognizing children's cultures; it's about building a bridge between their experiences and the educational content. Let's discuss some ideas on how to be a culturally responsive teacher.

Self-reflection and assessment

Are you aware of your unconscious or implicit biases? Over the years, your culture and experiences have affected how you think, behave, and act. It's essential to recognize how your culture has influenced your attitudes and how that may affect children's learning. For example, you might believe that quiet or introverted children don't understand the lesson because their participation is limited. Or, if you grew up in a two-parent home, your ideas of family will leave some children out. This could cause children from broken homes or single-parent families to feel like they don't belong or there's something wrong with their family. Recognizing your biases will help you make more informed decisions when teaching children.

Get to know the children

Beyond the children's personalities, find out more about the children. Get to know where they come from and where they currently live, and find out how they usually do certain things. The best way to do this is by being in a one-on-one setting with each child, as some children might be shy at first about speaking up in the classroom. Casually ask them about their likes, dislikes, and activities they do at home. If a new child has recently immigrated from another country, ask them questions like, "What games did you play at school?" If they can, let them teach you and the class. If they can't articulate their experiences or culture, research online and have conversations with them based on what you discover. Also, show genuine interest in their understanding of the educational content to put them at ease.

Adapt the learning to fit children's cultures

Children engage more and learn more effectively when the content is within the context of their experiences. For example, what kind of illustrations are you giving the children in the lessons? Do they represent different cultures? What activities get all the children excited? Are there activities that don't benefit all children? Recognize how your content may be biased. Assess your current lesson plans and modify the instruction, considering the children's backgrounds and readiness levels. Invite the children to speak to the class about their experiences. Make the learning interactive and include educational games, storytelling, visuals, and songs.

Create a judgment-free environment

Encourage the children to value each other's experiences and differences. If a child has questions about another's behavior, encourage them to ask questions. Guide the conversation toward learning and not criticizing to help them understand the world around them. This will help your children to feel more comfortable sharing their experiences in class. And it will help them become critical thinkers and look at situations with an unbiased opinion.

Culturally responsive teaching strategies

Let's discuss a few culturally responsive strategies you can employ in the classroom:

Consider your classroom setup

What books are in your classroom library? Do they represent different families? Do they include diverse races? Do the posters on your classroom walls depict various cultures? Small changes can create an inclusive classroom environment for all children.

Call on each child individually

Some children might be shy or uncomfortable speaking up in the classroom voluntarily. Calling on children who don't raise their hands familiarizes them with speaking in front of others. Encourage them to share their personal views when a subject requires it. This practice keeps them engaged and builds their confidence.

Share content in various ways

Offering various means of representation is a universal design for learning (UDL) principle. Children respond differently to different types of content due to learning needs, preferences, or culture. Set up various learning stations, each with a unique teaching method. While teaching a specific concept, have the children rotate between listening to you teach, playing a game, or creating artwork.

Use stories

Stories deepen children's learning and help them understand the world better. In every culture, stories play a role in teaching values, manners, and self-regulation skills. Additionally, children remember content better when they can process a coherent narrative.

Build relationships with children and their families

Parents and families play a crucial role in children's learning; involving them is a core part of culturally responsive teaching, which promotes inclusive learning. Communicate with children's families when starting a new lesson series, so families can offer support at home and build on what their children are learning during the day. For new children, ask the families questions about their traditions, what language they use at home, and how they prefer to communicate. Learn the basics of their languages and invite them to participate in school activities.

Examples of culturally responsive teaching

Culturally responsive teaching promotes values of diversity, equity, and inclusion and prevents children from developing biases. The following are a few examples you can start using if you haven't done so already.

Reading books that contain images of diverse types of families, including single-parent families, two-parent families, guardians, and families of different races

Greeting each child as they come into class in the way they are most comfortable with, for example, a high-five, a handshake, a hug, a wave, or a fist pump

Playing and dancing to songs in different languages

Saying "good morning" to the children in various languages represented in the classroom

Teaching the children how to say "hello" and "goodbye" in another language

Facilitating a "show and tell" where children stand in front of the class and speak about activities they enjoy or food they love to eat

Making a photo collage corner of the children and their respective families

Hosting an event where each child comes with a favorite or traditional dish they'd like to share with the class

Celebrating different traditions and holidays from around the world

Putting up a world map to learn about other countries

This isn't a complete list, and remember your application of these strategies will depend on the different cultures and experiences of the children in your classroom.

Connecting culture to content

Culturally responsive teaching draws from children's individual cultures and experiences and integrates them into classroom learning. Understanding the unique backgrounds of your children and their families will help you create a positive learning environment where children can make connections between their lives and the educational content they receive.

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What Is Culturally Responsive Teaching in Early Childhood Education?

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Learn what culturally responsive teaching is, why it's important, and what strategies and examples you can use in an early childhood education classroom.

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Culturally Responsive Teaching in Older Children

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Culturally Responsive Teaching in Older Children

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Know

What do you think of when you hear the word 'culture'? How do you define it? You may think of several things, including the culture of a group of people (an office or neighborhood), or you may think of the culture that you associate with your family, race, and ethnicity. Culture can be defined in many ways, but at the heart of it, you will find a shared set of values, beliefs, habits, customs, and practices. Researcher, Donna Y, Ford defines culture in this way:

Culture is the accumulation of beliefs, attitudes, values, habits, customs, and traditions shared by a group of people. These beliefs, attitudes, habits, etc., are learned and acquired. Culture serves as a frame of reference through which individuals and groups view, interpret, and respond to the world. No one is born with a culture. Culture is learned/acquired.

Culturally responsive teaching is a term that was created by researcher, Geneva Gay. The term evolved from culturally relevant teaching, which is a philosophy and way of teaching focused on three main components: student learning, cultural competence; and critical consciousness (Ladson-Billings, 1995). Culturally responsive teaching is centered on several different components, including:

A strong understanding of cultural diversity.

A culturally relevant curriculum.

High expectations for every child, especially students of color.

An appreciation for different styles of communication.

The use of multicultural instruction - teaching styles and pedagogy.

Donna Y. Ford encourages educators to consider culturally responsive education to be grounded in equity. She also asks you to think about the term 'responsive', which means to address a need. Therefore, culturally responsive teaching uses the knowledge, customs, perspectives, and experiences of racially and ethnically diverse students to create better instructional opportunities. As Gay (2018) reminds us "virtually every student can do something well" (p. 1). Therefore, teachers are encouraged to learn to identify, celebrate, and connect students' potential and skills with their teaching strategies. Think about how difficult it might be to teach or care for a child that you don't know. While this may sound like a strange concept, too often this exact scenario happens when educators limit their knowledge about a child to who they are in the context of their program, ignoring all the other parts of the child's identity and experiences. While Ladson-Billings's and Gay's models include different components, their ideas are similar. Instead of looking at children of color from a deficit perspective, both models seek to focus on the assets that children of color possess, and then incorporate their knowledge and experiences into instructional practices and curriculum development and materials (e.g., books, videos, crayons, dolls, toys, and so on).

Components of Culturally Responsive Teaching

Below, you will find descriptions for the five key components included in culturally responsive teaching:

1. A strong understanding of cultural diversity that recognizes the different cultural values and customs of various races and ethnicities, their traditions and impact on society, and then connects that knowledge to the support and instruction provided by the teacher.

2. Curriculum that is culturally relevant. Teachers should provide multiple perspectives instead of only one perspective. Materials, including images displayed on walls and bulletin boards, should reflect a wide range of diversity. Issues involving race, gender, ethnicity and class should be placed in context for children and youth. Topics and materials are of interest to minoritized children, such as multicultural literature,

3. Expectations are high to support the success of every child while still respecting and validating their cultural identities. This component is a reminder that every child deserves to succeed and should be supported to reach their full potential. As educators, we cannot allow some children to succeed, while allowing other children to fail, and remain OK with these outcomes.

4. An appreciation for different styles of communication with the understanding that different cultures interact in different ways. For example, many communities of color have an active style of communication where an individual may begin speaking before someone else is finished. This may feel more conversational and less formal in these cultures but to someone outside of this community this manner of communication may appear rude or inappropriate and a child may be told to be quiet or wait until the other person is finished before talking. This could cause the child to stop engaging in the discussion due to the mismatch between their culture and the expectation of an educator.

5. The use of multicultural curricular and instructional examples can be used by staff members to connect prior knowledge and cultural experiences to new information.

It's important to note that while culturally responsive teaching is meant to make learning more relevant and effective for ethnically diverse students (Gay, 2018), all children benefit from culturally responsive teaching. Educational opportunities are often designed with middle class, White children in mind even though the populations of many programs do not fit this profile. White children from lower socioeconomic classes often have very different experiences than their wealthier White peers despite being from the same racial group. It is also important to remember that all White children do not have the same ethnic background or experiences. Culturally responsive teaching can incorporate ethnicity into the curriculum to help children recognize the diversity that exists within their own race and appreciate and celebrate the diversity found among other races and ethnicities. Culturally responsive teachers should look beyond racial identity and consider the other aspects of culture children and youth carry with them, including age, gender, religion, sexual orientation, social class, and the geographic location of their home (rural, urban or suburban). Educators can find ways to affirm all of these aspects of a child's identity by connecting them to the activities and experiences in the classroom.

Culturally Responsive Teaching in Practice

Certain aspects of culturally responsive teaching will sound familiar since it includes elements of anti-bias and anti-racist teaching. Programs that practice culturally responsive teaching include a wide array of books that feature images and characters that represent various ages, genders, races, and ethnicities. A culturally responsive program will include a variety of books about diversity and will not be limited to one type of diversity, such as gender, race or ethnicity, since all aspects of diversity are important and must be affirmed in culturally responsive teaching.

Culturally responsive teaching shares multiple perspectives of historical and current information rather than a single story of a group of people. For example, when discussing the enslavement of African Americans, narratives told from the perspective of those who were enslaved should be shared, and narratives about the ways that the enslaved resisted and found ways to survive should also be included to provide a better understanding of that period. When children and youth learn about Indigenous people, they should learn that many of the struggles that existed for them in the past are still present, including the fight for their land and the fight for their human rights. Children and youth should also learn about the rich and beautiful culture of the Indigenous people. While some individuals still believe that children are too young to talk about race, culturally responsive teaching would provide insight into the critical role that young children played in the Civil Rights Movement and the important role that women played in the movement in terms of organizing, strategizing and leading groups of people to demand their civil rights. Too often, these narratives are left out of the larger story, but culturally responsive teaching seeks to correct these wrongs by shining a light on voices that are often overlooked or purposefully omitted.

In culturally responsive teaching, children are encouraged and given opportunities to draw from their prior knowledge and experiences and connect it to what they are learning. This validates the knowledge that children and youth may learn at home or outside of schools and programs and it allows them to make connections between their learning. Another important aspect of culturally responsive teaching is critical consciousness. Critically conscious children are given the tools to examine, critique, and analyze inequities in society. For example, rather than having youth simply read historical documents like the Pledge of Allegiance or the Declaration of Independence, culturally responsive teaching encourages them to carefully decipher the meaning behind the text and question whether the liberties that these documents talk about were truly meant for everyone and to consider what these historical texts mean in today's context. Donna Y. Ford often shares the story of a teacher who was reading the inscription of the Statue of Liberty to third-grade children. One child whose family were undocumented immigrants was troubled and confused. "Teacher," he asked, "why do some people want my family to go back to Mexico and build a fence'? She was unprepared for this question; had never considered how her students might feel based on their experiences and social media. How would you respond to this question? Would you have anticipated this child's legitimate question and concern? Would you have already addressed it in your lesson plan?

Culturally responsive teaching considers how the routines and expectations of a program may not be supportive of all children and youth and works to change/remove inequities. For example, many programs may have rules around communication and encourage children to wait their turn before speaking. Culturally responsive teaching, instead, looks for ways to incorporate the cultural practices found in many communities of color where an overlap in communication is supported. This is known as 'call and response'. With this awareness, children would not be seen as rude or inappropriate for talking at the same time as someone else. While this may seem like a small adjustment, oftentimes, children of color may be disciplined for a communication style that feels normal to them but is considered inappropriate or wrong in their school or program. This more accurately reflects the ways that schools and programs often do not match the cultural norms that children and youth are accustomed to at home.

It is important to note that most classrooms and programs reflect the culture, language, experiences, and norms of White children overall, but especially those who are higher income. What is often described as "best practice" and "developmentally appropriate" typically aligns with cultural frameworks derived from Eurocentric perspectives (Iruka et al., 2020, p. 60). As a result, many programs do not recognize or acknowledge the cultural clashes that occur between home and school. For example, some cultures focus on the collaborative effort and achievement of the group, as opposed to the effort and achievement of one person/students, which, to repeat, is primarily the focus in programs and schools. These two examples and many others can be difficult concepts and behaviors for students to navigate, especially younger children, and can lead to challenging behaviors and frustration. This is important to keep in mind when working with children from racial and ethnically diverse backgrounds.

The Opposite of Culturally Responsive Teaching

Some educators believe that they are practicing culturally responsive teaching when they are not. If programs are engaging in "Culture Week," "Culture Month," or hosting potlucks to get a glimpse into various cultures, they are not truly practicing culturally responsive teaching. Many refer to this practice as 'tourism'. James A. Banks, the founder of a multicultural curricular infusion model, calls this the 'contributions approach', which is the lowest level of integrating multicultural content into the program and often promotes and reinforces stereotypes about people of color. Quick and shallow attempts to engage in culturally responsive teaching are not effective and do not represent the correct and desired way to teach. Adding a few diverse books to a bookshelf does not represent culturally responsive teaching, which Banks labels as the 'additive approach/level". It is temporary and disconnected from other aspects of what is explored in the overall curriculum. The various elements of culturally responsive teaching require more than a surface level effort to affirm the rich identities and heritage of children and youth.

Equally important, programs that ignore societal inequities or discuss them from a single perspective are not teaching in a culturally responsive manner. Programs that talk about culturally responsive teaching but continue to look at children of color as problems to be solved, individuals who need saving, or troublemakers that they must tolerate, are not teaching in a culturally responsive manner. Ford considers this to be 'culturally assaultive' and others refer to it as 'curricular violence'. Therefore, the development of a critical awareness is so important and essential in this work because it will allow educators, children, and youth to connect current inequities to historical information and see how all the "deficits" that children of color supposedly have were created to marginalize them indefinitely. These deficit-oriented perspectives are intentional and allow the myth of a racial hierarchy to remain in place.

Culturally responsive teaching, like anti-bias teaching, must not appear in your curriculum for a part of the year and then disappear. Some identities should not make a guest appearance in your program, while other identities have a starring role during the year. Culturally responsive teaching is about affirming the lived experiences and prior knowledge of children and youth, and it allows them to draw from their customs and culture to make connections to their learning. Research has shown that when teachers and educators teach in culturally responsive ways, children and youth are more engaged and feel validated. This seems logical since it allows their experiences to be affirmed and it recognizes their knowledge. Rather than always being positioned as the learner trying to make connections to distant worlds, facts, and identities that do not resemble your own or anyone that you know, culturally responsive teaching makes it clear that children of color have experiences that must be included in curricula and in how it is taught. Again, culturally responsive teaching should not be an add-on to your lessons or something that appears as an afterthought in your planning. It should be central to your lessons and centered in your planning to achieve the goal of affirming the experiences, knowledge, and customs of children and youth of color. Gay reminds us, "The highest-quality educational programs and practices can never be accomplished if some ethnic groups and their contributions to the development of U.S. history, life, and culture are ignored or demeaned" (Gay, 2018, p. 21).

Creating Culturally Relevant Activities

When something is relevant, it has meaning, significance, and a purpose in your life or context. Before you begin the work of designing or adapting activities to be culturally responsive, you should first look at your current practices, content, and materials. You can do this in several ways. One way to get a better understanding of your current practice is to have the Training & Curriculum Specialist observe you several times throughout the week and provide you with feedback on how your practices align with the components of culturally responsive teaching. You can also record yourself engaging in several planned activities to see what practices you have in place that may align with culturally responsive teaching and what you can improve upon or eliminate. While reviewing your video recordings, keep the components of culturally responsive teaching nearby, so you can see which aspects are already in place and which ones you need to add to future activities and experiences. In time, this work will not require as much thinking and effort, as you will begin to find that it becomes more natural for you to center these elements in your practice. However, in the beginning, you will need to be very intentional about your planning and engage in careful reviews to see where the evidence of culturally responsive teaching exists or is missing. Be mindful of the degree to which your learning environment is equitable and inviting (Ford, 2015a, 2015b).

To ensure that you are not overlooking critical information as you review the recordings, it is important to have a colleague, coach, or someone who is familiar with the cultures in your program review the recordings as well. While reviewing, look to see how often you interact with children representing different genders, ages, racial and ethnic backgrounds, and income levels and social classes. Notice if your interactions with each group look the same or different and examine the reasons behind your choices. Also pay close attention to how you interpret nonverbal communication. Do you pay attention to this type of communication, or is it ignored, and why? As you begin to design more culturally responsive activities, remember that children can provide (in)valuable insight to help with your planning. Partnering with families can also provide insight into topics to adopt and explore. While you may not have all of the answers early on, it's important to remember that answers are not as important as the questions that the children and youth will ask about you, their peers, and the world around them. Let their questions and observations encourage and guide you.

One example of a culturally responsive activity that could be included in your curriculum plans is an "All About Me" activity. This activity typically includes information about a child, such as their name, birthday, family members, favorite color, favorite food, songs or type of music they like, things they enjoy doing at the program and things they enjoy doing at home or outside of your program. "All About Me" projects can be a great way to build community and allow children to show pride in themselves. Just like a neighborhood study can be explored through culturally responsive teaching, a culturally responsive "All About Me" project could include information about the story behind a child's name, or an opportunity for families to share how their child's name was chosen. Families can be given an option to send a video or audio recording to share this information or they can write the information down so you can make "All About Me" books for each child. An "All About Me" project can also include information about the child's race and ethnicity, languages they speak at home, family traditions, special foods and what makes them special and other information that is important to the child and family. It is important to note that all families may not have access to some or all of this information. For example, if a child in your program has been adopted, the child's parents may not be able to provide some or all of this information. Educators can have a conversation with their program directors and colleagues to brainstorm ideas to adjust their "All About Me" activity to ensure that it is inclusive for all of the children in the program.

Another project that could be designed with culturally responsive teaching in mind is a neighborhood study. Similar to an "All About Me" project, this would need to be adapted based on the age of the children so that it is developmentally appropriate. Neighborhood studies often center on community helpers such as the roles of firefighters and police officers (and school resource officers). While it is true that these individuals are community helpers, it's important to recognize that not all communities see police officers as people/professionals they trust and would turn to for help with a problem or when in a crisis. While the majority of White, middle- and upper-class families may not have to think twice about calling the police for help, many racially and ethnically marginalized communities must weigh the consequences of calling the police. For them, a routine call for assistance could turn and has turned deadly. For many communities of color, when interactions with the police turn deadly, they are forced to endure additional harm when the legacy of their loved one is misrepresented and/or demonized in the media. Before the public has a chance to know anything meaningful about an individual, a media campaign is often orchestrated to erase signs of their humanity which can lead to recurring trauma for families as they are grieving the loss of their loved one. All of these factors, and others, impact the decisions of people of color when calling the police.

In some Black and Latine communities where individuals have a lower socioeconomic status, in addition to some immigrant communities, many people would not call the police for help due to the brutality and surveillance that many communities of color find themselves in. That can also extend to school resource officers. Large spotlights that shine bright lights into housing projects, common practices of stopping and frisking children, teenagers, and adults because they look "suspicious," and continual images on television and online of police officers killing unarmed Black people has created deep tensions between these communities and the police. A culturally responsive lesson would consider these tensions and think of different helpers to highlight or find a way to include police officers in the study, but also include lessons that examine the long history of tensions between minoritized communities and police officers. The important historical context that provides insight into how we have arrived at the point where we find ourselves should not be discounted or ignored. As educators, we want to protect rather than further traumatize children of color.

See

It is important that child and youth professionals understand how culturally responsive teaching can lead to better learning outcomes for all children. Listen Iheoma U. Iruka, Research Professor at the University of North Carolina at Chapel Hill and the Founding Director of the Equity Research Action Coalition at Frank Porter Graham Child Development Institute, and other experts in the field discuss how to embed these practices in authentic and meaningful ways.

Culturally Responsive Teaching in Practice Video not available

Experts discuss ways to ensure culturally responsive practices are a central part of your program.

A culturally responsive program should include a variety of books about diversity. When choosing materials and activities for your program, consider how diversity is represented within them. Listen as a literacy specialist shares ways to ensure the books you provide are supportive of all children and families.

Culturally Responsive Materials Video not available

Reflect on the ways diversity is represented in books and other materials.

Do

As you reflect on both culturally relevant and culturally responsive teaching, is there evidence of them in the curriculum of your program and how are they evident - in some, most, or all lesson plans and materials? Regardless of your response, it is possible for all content areas to be taught in culturally relevant and responsive ways. Math, language arts, science, music, art, literacy, physical education, and history can all be taught using a cultural lens. Additionally, developmental skills such as social-emotional, cognitive, and linguistic skills can be supported in a similar way. Below are steps to take as you create and/or review culturally responsive experiences and activities. Remember to work in collaboration with staff members and other individuals from minoritized backgrounds and refer to the components of culturally responsive teaching when planning lessons.

Examine your curriculum and identify which cultures are present and which ones are missing.

Examine your program to determine which cultures are present and which cultures you might want to include in your curriculum to expose children and youth to different groups of people.

Review the expectations of your program, including communication styles and how children are nurtured to succeed. How inviting is your classroom and program?

Analyze the perspectives shared in your program. Are you unintentionally creating stereotypes of groups of people by sharing a narrow and one-dimensional view of who they are as culturally different individuals and groups?

Examine who you position as experts. Who are the people that children and youth are learning about from books, materials, videos, or visits? Why have they been selected? Does this provide a full understanding of a group of people, or does this limit the view that your children and youth are forming under your care?

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Culturally Responsive Teaching in Practice

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What do you think of when you hear the word 'culture'? How do you define it? You may think of several things, including the culture of a group of people (an office or neighborhood), or you may think of the culture that you associate with your family, race, and ethnicity.

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Centers for Disease Control and Prevention

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CDC's National Center on Birth Defects and Developmental Disabilities has information on certain birth defects, disabilities, mental, emotional, and developmental disorders, and blood disorders that affect children. Click on the following links to learn more:

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CDC's National Center on Birth Defects and Developmental Disabilities has information on certain birth defects, disabilities, mental, emotional, and developmental disorders, and blood disorders that a

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Another one: https://accessiblecampus.ca/tools-resources/educators-tool-kit/teaching-tips/teaching-students-with-physical-disabilities/

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Working with children who have physical disabilities requires thoughtful planning for child care providers. Children with physical disabilities need different types and amounts of assistance and support in order to participate fully in their child care program. Child care providers who are including a child with a physical disability need to get input from the parents, professionals working with the child, and the child himself or herself. That input can help the child care provider make specific plans to accommodate the child in the child care program.

Helping Children Be Independent

Children with physical disabilities are children first. Like all children, they need opportunities to make choices and do things for themselves, within the limits of their ability. Resist the temptation to do everything for the child. Provide appropriate help, but encourage children to try to do things themselves. This may mean that tasks and chores could take a little more time. Remember that doing things independently helps children build self-confidence and independence. Provide encouragement and patience, and help the other children do the same.

Specific Ways Child Care Providers Can Support Children with Physical Disabilities

Here are some specific ways child care providers can support the learning of children who have physical disabilities.
Make it easy to move around in play areas.

Use heavy, stable furniture and equipment that cannot be easily knocked over.

Remove rugs that can be tripped over, or tape them down.

Arrange furniture and equipment with a wide aisle so children can move around more freely.

Provide a safe place for walkers, crutches, wheelchairs, or canes so other children do not trip over them.

Work with parents to find comfortable ways for a child to sit. A corner with two walls for support, a chair with a seat belt, or a wheelchair with a large tray across the arms are three possibilities that may help children with certain physical disabilities participate more fully in child care activities.

Make objects more steady. For example, secure paper, mixing bowls or wood blocks to the table or floor so they remain in place as the child paints, draws, stirs or hammers.

Adapt learning activities.

Provide tools that children with motor disabilities can use for grasping, holding, transferring and releasing.

Be sure objects are age-appropriate. For example, a bean bag made from dinosaur fabric is much more appropriate for a 5-year-old than a rattle or a baby toy.

Provide materials of different textures - such as play dough, fabric swatches, ribbon, corrugated cardboard and sandpaper - to stimulate the sense of touch.

Be sure activity areas are well-lighted. Add lamps if needed.

Plan activities to encourage all children to move all body parts. Work with parents and specialists to choose special exercises for the child, and encourage the whole class to do some of them as part of a large group activity.

Add tabs to books for turning pages.

Place tape on crayons and markers to make them easier to grip.

Secure paint brushes into a glove, or provide paint brushes with large knobs on the ends.

Consider buying scissors that open automatically when squeezed, or scissors that do not require children to use finger holes.

Provide spray bottles to practice the squeezing motion needed to use scissors.

Keep items contained. Roll a ball inside a hula hoop placed on the floor. Play with blocks on a cookie sheet or the lid of a cardboard box.

Teach classmates how to help a child with a physical disability.

Playmates are usually eager to assist children with disabilities, but may take over and provide too much help. Applaud and encourage helping behaviors, but also teach children to encourage their classmate to do as much as possible on his own.

Teach children how to offer help respectfully. Encourage them to ask if the child wants help first, and to take "no" as an answer.

Encourage children to find creative ways to include a child with a physical disability in their play activities. For example, moving blocks to a table might make it easier for a child in a wheelchair to participate.

For More Information

For more information on supporting children with physical disabilities in a child care program, check out the eXtension Alliance for Better Child Care section on Child Care for Children with Special Needs, or take a look at the following articles:

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Specific Ideas for Child Care Providers to Help Children with Physical Disabilities

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Working with children who have physical disabilities requires thoughtful planning for child care providers. Children with physical disabilities need different types and amounts of assistance and support in order to participate fully in their child care program.

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Another one: https://ldaamerica.org/info/successful-strategies-for-teaching-students-with-learning-disabilities/

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Another one: https://blog.kaplanco.com/ii/autism

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How to help your child communicate

Don't

try not to ask your child lots of questions

try not to have a conversation in a noisy or crowded place

try not to say things that could have more than 1 meaning, such as "pull your socks up" or "break a leg"

Dealing with anxiety

Anxiety affects a lot of autistic children and adults. It can be caused by not being able to make sense of things going on around them, and feeling misunderstood or unaccepted by people who are not autistic.

Try to find out why your child's feeling anxious.

It might be because of:

a change in routine - it might help to prepare your child for any change, such as a change of class at school

difficulty identifying, understanding or managing their feelings

a noisy or brightly coloured place - it might help to take your child to a calmer place, such as another room

If your child is often anxious, ask your GP about therapy, such as cognitive behavioural therapy (CBT), which may help.

Search The National Autistic Society's directory for counsellors experienced in helping people with autism and read more about managing anxiety from The National Autistic Society.

Helping with your child's behaviour

Some autistic children have behaviours such as:

stimming - a kind of repetitive behaviour (such as flapping their hands or flicking their fingers)

meltdowns - a complete loss of control caused by being totally overwhelmed

If your child has these behaviours, read our advice about how to help your child's behaviour.

Eating difficulties

Many children are "fussy eaters".

Autistic children may:

only want to eat foods of a certain colour or texture

not eat enough or eat too much

eat things which are not food (called pica)

have problems with coughing or choking while eating

be constipated, so they feel full even when they have not eaten much food

It may help to keep a food diary, including what, where and when your child eats. This can help you notice any common issues your child has.

Speak to a GP or your autism team about any problems your child's having with eating.
The National Autistic Society has more about how to help with eating problems
Problems sleeping

Many autistic children find it hard to get to sleep, or wake up several times during the night.

This may be because of:

anxiety

sensitivity to the light from smartphones or tablets

problems with the sleep hormone melatonin

issues such as hyperactivity or a health condition that affects sleep

You can help your child by:

keeping a sleep diary of how your child sleeps to help you notice any common issues

following the same bedtime routine

making sure their bedroom is dark and quiet

letting them wear ear plugs if it helps

talking to a GP about how to manage health conditions that make sleep difficult, such as a food sensitivity or breathing problem

If these tips do not help, talk to your autism team about creating a sleep plan to help your child's sleep behaviour.

If your child's sleep does not get better, a GP might refer you to a paediatrician or child psychiatrist with experience of autism who can prescribe a medicine called melatonin to help your child sleep.

Staying healthy

It's important that your child has regular check-ups with the:

dentist

optician

doctors treating any other conditions your child has

Children over 14 who also have a learning disability are entitled to an annual health check.

Do not be afraid to let staff know what they can do to make it easier to go for check-ups.
Find out more ways to stay healthy from the National Autistic Society
Friendships and socialising

Some autistic children find it hard to make friends.

There are some things you can do to help:

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How to help your autistic child with day-to-day life

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try not to ask your child lots of questions try not to have a conversation in a noisy or crowded place try not to say things that could have more than 1 meaning, such as "pull your socks up" or "break a leg" Anxiety affects a lot of autistic children and adults.

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I am still very much up in the air about what kind of path I would like to follow. I am studying youth development and dance at MSU and would like to get my masters in either OT or AT in order to work with children and teens in a dance therapy setting. I will be using this intention for this tab.

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Can J Occup Ther. 2021 Jun; 88(2): 117-130.

Language: English | French

Abstract

Background.

Professionalism has been given different definitions over time. These are, commonly theoretical and difficult to operationalize.

Purpose.

This study aimed to provide an operational definition of the concept of professionalism in occupational therapy.

Method.

Based on a concept analysis design, a meta-narrative review was conducted to extract information from 30 occupational therapy manuscripts.

Findings.

Professionalism is a complex competence defined by the manifestation of distinct attitudes and behaviours that support excellence in the occupational therapy practice. In addition, professionalism is forged and evolves according to personal and environmental characteristics. The manifestation of professionalism can lead to positive consequences for occupational therapists, clients, and the discipline, notably contributing to a positive and strong professional identity. Moreover, professionalism is also subject to cultural influences, which leads to variations in its development, manifestations, and consequences.

Implications.

This study offers a contemporary operational definition of professionalism and levers to promote its development and maintenance.

Keywords: Professional attitudes, Professional behaviours, Professional identity, Professional reasoning, Professional values

Keywords: Attitudes professionnelles, comportements professionnels, identité professionnelle, raisonnement professionnel, valeurs professionnelles

Résumé

Contexte de recherche.

Le professionnalisme a fait l'objet de différentes définitions au fil du temps. Ces définitions ont souvent été théoriques et difficiles à opérationnaliser.

Objectif.

Cette étude visait à fournir une définition opérationnelle du concept du professionnalisme en ergothérapie.

Méthodologie.

Selon un devis d'analyse de concept, une recension métanarrative des écrits scientifiques a été réalisée afin d'extraire les informations pertinentes de 30 manuscrits.

Résultats.

Le professionnalisme est une compétence complexe, définie par la manifestation d'attitudes et de comportements qui favorisent l'excellence dans la pratique de l'ergothérapie. De plus, le professionnalisme se forge et évolue selon des caractéristiques personnelles et environnementales. La manifestation de professionnalisme peut avoir des conséquences positives pour les ergothérapeutes, les clients et la discipline, en contribuant notamment à l'acquisition d'une identité professionnelle positive et forte. Le professionnalisme est également sujet à des influences culturelles, ce qui entraîne des variations dans son développement, ses manifestations et ses conséquences.

Implications.

Cette étude fournit une définition opérationnelle contemporaine du professionnalisme et des leviers qui permettent de favoriser son développement et son maintien.

Background

Dictionaries propose several definitions of professionalism. For instance, the Merriam-Webster Dictionary defines professionalism as "the conduct, aims, or qualities that characterize or mark a profession or a professional person" ( Merriam-Webster, 2019; online). For the Cambridge Dictionary, professionalism is "the combination of all the qualities that are connected with trained and skilled people" ( Cambridge Dictionary, 2019; on line). These definitions are generic, somewhat circular, poorly informative for health professionals, and difficult to operationalize in the context of occupational therapists.

To improve the rigour of the definitions, some authors suggested the need for a profession-specific understanding of professionalism ( Aguilar et al., 2012; Bryden et al., 2010). In fact, a review of the medical and allied health literature indicated that professionalism relies on the application of the values of the profession and the demonstration of professional behaviours and attitudes ( Aguilar et al., 2011). These values, behaviours, and attitudes may differ between professions, leading to different conceptualizations of professionalism. For instance, in the field of nursing, professionalism is defined as having six components: (a) acting in the patients' interests, (b) having high standards of competence and knowledge, (c) demonstrating high ethical standards, (d) showing humanism, (e) practicing social responsibility, and (f) demonstrating sensitivity to people's cultures and beliefs ( Yoder, 2017). Physicians describe professionalism as the moral, cognitive, and collegial aspects of practice ( Tobin & Truskett, 2020). Examples of how professionalism manifests is putting patients first, managing conflicts of interest, disclosing errors, self-regulating, and advocating ( Tobin & Truskett, 2020). The difference between how professions conceptualize professionalism is of importance because studies have shown that professionalism is part of the process of developing a professional identity. For instance, authors have suggested that values, which are central components of professionalism, impact how people perceive their identity as professionals ( Drolet & Désormeaux-Moreau, 2016). Positive effects of having a strong professional identity were shown regarding professionals' well-being and satisfaction ( Skorikov & Vondracek, 2011), as well as retention of individuals within the profession ( Ashby et al., 2016). Furthermore, studies have shown that a vague professional identity may have negative collective consequences for a profession, such as weak quality of services offered to the population ( Drolet & Désormeaux-Moreau, 2014, 2016). Thus, it is important to explicitly define what professionalism is for occupational therapists to favour a strong and specific professional identity.

Occupational therapists showed interest in the concept of professionalism during the past 65 years. In fact, a content analysis of the Eleanor Clarke Slagle Lectures, published from 1955 to 1985 in the American Journal of Occupational Therapy, suggested that professionalism was one of the most discussed subjects during those years ( DeBeer, 1987). From a historical understanding of professionalism in occupational therapy, it appears that the first definitions mainly considered observable behaviours, such as continuing education or self-evaluation ( Parham, 1987). A few years later, other works suggested that this behavioural definition of professionalism was superficial and did not consider the intrinsic motivation of occupational therapists to show professionalism. The authors then suggested that professionalism should be defined as a combination of extrinsic and intrinsic manifestations, and should also consider values such as altruism ( Kanny, 1993) or integrity ( Peloquin, 2007). DeIuliis (2017), in a recent occupational therapy book, stated, "Professionalism can be described as the attributes, characteristics, or behaviours that are not explicitly part of the profession's core of knowledge and technical skills but are nevertheless required for success in the profession" (p. xv). This definition is aligned with the task-oriented paradigm of professionalism construction, which is based on a list of selected characteristics that are expected to be applied by professionals ( Colley et al., 2007). This paradigm allows occupational therapy students and new graduates to understand professionalism because of the concrete expectations it proposes ( Reiter et al., 2018). However, experienced occupational therapists may find it superficial because they have a more profound understanding of professionalism as they have had opportunities to internalize it ( Robinson et al., 2012). Task-oriented definitions are also mainly prescriptive and do not consider that professionalism may manifest itself in different ways, which have been evoked in the sociological evolution of professionalism in occupational therapy ( Breines, 1988; Remmel-McKay, 1975).

Recognizing professionalism in the practice of occupational therapists by identifying its manifestations, notably by identifying its attributes, is crucial. Furthermore, understanding the antecedents to favour for professionalism to take place is essential to support the development of professionalism amongst occupational therapy students or to promote its maintenance amongst clinicians. Finally, questioning the outcomes of professionalism in occupational therapy is critical.

Given these gaps in the current state of knowledge, the question of "What is professionalism in occupational therapy?" remains partially answered. As the understanding of professionalism appears to be commonly assumed rather than clearly explained ( Bryden et al., 2010; van Mook et al., 2009), conducting a study to provide an operational definition of professionalism in occupational therapy (i.e., exposing clear attributes, antecedents, and consequences of the concept) is vital, thereby providing resources to promote its manifestation in day-to-day practices and allowing the construction of a strong professional identity.

Thus, this study aimed to provide an operational definition of the concept of professionalism in occupational therapy.

Method

Design

A concept analysis research design was used to conduct this study ( Walker & Avant, 2011). This design was chosen because it goes further than a linguistic exercise; it is part of a theoretical construction approach. It enables clarifying ambiguous, overused, or unexplored concepts to obtain an operational definition underlining specific characteristics, such as attributes, antecedents, and consequences. The Walker and Avant (2011) concept analysis method is a recognized application in health of the method developed by Wilson (1963) in education. This design highlights the relations amongst the characteristics defining a concept. It has been described in the occupational therapy literature ( Tremblay-Boudreault et al., 2014) and applied to various concepts such as preventive behaviours at work ( Lecours & Therriault, 2017), quality of life ( Levasseur et al., 2006), and social participation ( Lariviere, 2008).

Procedure and Analysis

A systematic five-step approach was used to collect relevant documents about the attributes, antecedents, and consequences of professionalism in occupational therapy.

1. Identify the research question

The question should be broad and open in including as many relevant documents as possible, and the core concept must be specified. The target question for this study was the following: What is professionalism in occupational therapy?

2. Select relevant documents

To investigate how professionalism in occupational therapy is defined, a meta-narrative review was conducted ( Wong et al., 2013). This type of literature review was chosen because it allows the interpretation of the meaning of terms, which is compatible with the concept analysis design. Furthermore, meta-narrative reviews propose a systematic method that offers the flexibility required to include diverse types of documents ( Wong et al., 2013). Initially, distinct combinations of keywords related to the research question and aligned with our knowledge of the literature about professionalism were proposed to search for documents from the relevant scientific databases ( Table 1 ). The keywords and search strategies were developed by two researchers and validated by a librarian with accurate knowledge of occupational therapy literature. The reference lists of the selected documents were also examined manually to ensure literature saturation. Moreover, the gray literature was explored to include theses, professional papers, institutional documents, and textbooks. To do so, a search in Google with the same keywords as those used for the scientific databases was performed. The following inclusion criteria were used to select relevant documents: (a) documents concerning occupational therapy and (b) documents addressing the concept of professionalism (i.e., documents proposing a definition of professionalism or a description of attributes, antecedents, or consequences). Documents addressing values, attitudes, or behaviours adopted by occupational therapists, without making links with professionalism, were excluded. For feasibility reasons, only documents written in French or English were selected, and no limit regarding publication dates was imposed.

Table 1

Keywords

Databases and Search Engines

'occupational therap*', professionalism, 'professional value*', 'professional attitude*', 'professional behaviour*'

Academic Search Complete, CINAHL, Medline, Eric, PubMed, PsycINFO, Cochrane library, OTseeker and Google

3. Study the selection

Primarily, the selected documents were integrated into the Endnote X9 reference management software. After the elimination of duplicates, two researchers checked for the relevance of all documents based on the title, abstract, and keywords. When ambiguity was present, the document was read entirely to determine its inclusion in the study. Regular peer-debriefing meetings amongst the researchers took place to rule on the inclusion or rejection of the documents ( Padgett, 2017). This regular communication amongst researchers heightened their reflexivity and guarded against the undue influence of any one's perspective.

4. Extract and chart data

Data on the selected documents were classified according to an adaptation of an extraction grid developed for concept analysis in occupational therapy ( Tremblay-Boudreault et al., 2014). The extraction grid included considerable descriptive information about the study (e.g., authors and country), methodological information (e.g., participants and study design), and results (e.g., attributes, antecedents, and consequences of professionalism). This grid was used by two researchers to extract information from five documents. Subsequently, a peer-debriefing meeting took place amongst researchers to modify or adjust the grid as needed. The modified grid was used to extract the information of three other documents before being modified again to improve its validity. These validation steps allowed the researchers to obtain the final version of the grid, which was used to extract the information of all selected documents. Following this systematic research process, a total of 30 reviewed documents 1 were included in the analyses, as shown in the flowchart presented in Figure 1 . The information of 12 documents out of 30 (40%) was extracted by two researchers to ensure scientific rigour.

5. Analyze the data

The data were examined using the template analysis as an analytical strategy. Template analysis is a form of thematic analysis that is compatible with several qualitative research designs ( Crabtree & Miller, 1992). Template analysis has also been found useful in analyzing information from the literature ( Crabtree & Miller, 1992). Given that this study aimed to build new knowledge based on the literature, the template analysis was a relevant strategy to achieve the research aim.

Template construction strategy

Initially, a reading of the entire corpus (i.e., data gathered in the extraction grid) was undertaken to obtain a sense of the whole. Several other readings were then conducted to ensure a sense of the immersion of the researchers into the data corpus. The initial coding then started, and the descriptive codes were used and assigned to meaning units (single ideas) found during the data corpus review. The aim of the study was kept in focus to ensure the relevance of the proposed coding. In doing so, the codes were intended to help define the attributes, antecedents, and consequences of professionalism in occupational therapy. The next step consisted of proposing categories and themes. The codes (micro level) were grouped into categories (meso level) and broader themes (macro level). Based on the concept analysis design, three a priori themes (i.e., a: attributes, b: antecedents, and c: consequences) were used to group emerging codes into categories and themes from which a general structure was generated. This step enabled the researchers to propose links amongst the retained codes, categories, and themes. Multiple rounds of applying the extraction grid data to the general structure made the fine-tuning of the analytical process possible.

The analyses were conducted by two researchers. Other members of the research team periodically checked the meaning units identified, codes assigned, and structure produced throughout the analytical process.

Ethics

Institutional ethics approval was not required for the secondary analysis of already published data.

Findings

Description of the Selected Documents

Although there were no restrictions on publication dates, the selected documents were mostly recent. More than 60% had been published in the last 10 years. Three documents were written in French, with the others all being in English. Half of the selected documents were scientific articles, institutional documents, and opinion articles. A textbook was also selected. Diverse types of occupational-therapy-related participants including clinicians, students, educators, or trainee supervisors were represented in the documents. The participants most often came from North America, but some studies included participants from other continents such as Europe, Oceania, Africa, and Asia. Table 2 describes the characteristics of the selected documents.

Table 2

Number of Documents (%)

Date of publication

2011 and after

19 (63.4%)

2000-2010

7 (23.3%)

Before 1999

4 (13.3%)

Publication language

English

27 (90.0%)

French

3 (10.0%)

Types of documents

Scientific articles

17 (56.7%)

Institutional documents

4 (13.3%)

Opinion articles

8 (26.7%)

Textbooks

1 (3.3%)

Types of participants*

Occupational therapists: Clinicians

7 (17.9%)

Occupational therapy students

7 (17.9%)

Occupational therapists: Classroom educators

4 (10.3%)

Occupational therapy assistants

2 (5.1%)

Occupational therapists: Placement educators

2 (5.1%)

Occupational therapists: Trainee supervisors

1 (2.6%)

Not applicable/not specified

16 (41.1%)

Continent of the origin of the participants

America

9 (30.0%)

Europe

2 (6.7%)

Africa

1 (3.3%)

Asia

1 (3.3%)

Oceania

1 (3.3%)

Not applicable/not specified

16 (53.4%)

Operational Definition of Professionalism in Occupational Therapy

The findings from our concept analysis led to the following operational definition of professionalism in occupational therapy:

Professionalism in occupational therapy refers to the development of an individual as an occupational therapist serving the public in a distinct way. It is developed within a professional system and organizational context, and emerges from certain individual characteristics such as reflexivity, values, and training/experience. Professionalism is characterized by personal (e.g., being confident), relational (e.g., being devoted), and occupational (e.g., being organized) attitudes and distinctive behaviours such as projecting an appropriate image, managing with diligence, working in teams, communicating properly, and reasoning to address clinical issues. Professionalism in turn leads to ethical behaviour, and satisfied practitioners who are able to advocate for recipients of their services. As a result, clients are satisfied because they receive competent and client-centred services from the practitioners. The professionals in the discipline become good leaders, and the profession increases its credibility and develops a strong, positive identity. The proposed definition also recognizes the ubiquitous cultural influences that generate differences in the development, manifestations, and consequences of professionalism.

For illustration of the aforementioned operational definition of professionalism, please see Figure 2

Figure 2 shows the specific characteristics defining professionalism, and exposes the relation between its antecedents, attributes, and consequences. The figure also highlights the constant cultural influences impacting the process of development, manifestations, and consequences of professionalism in occupational therapy.

Description of Attributes, Antecedents, and Consequences of Professionalism

The analysis of the selected documents allowed us to describe with precision and specificity the attributes, antecedents, and consequences comprising the proposed operational definition of professionalism in occupational therapy.

Attributes

Attributes are characteristics that enable the recognition of the concept in reality ( Walker & Avant, 2011). Following the exhaustive literature review, the attributes of the concept of professionalism in occupational therapy are attitudes and behaviours, as described in Table 3 .

Table 3

Attitudes

Personal

Positive

Patient

Confident

Mature

Motivated

Relational

Weighted

Humble

Attentive

Devoted

Nice

Declarative

Occupational

Creative

Reliable

Flexible

Organised

Involved

Responsible

Persevering

Behaviours

Projecting an appropriate image

Managing with diligence

Time

Resources

Working in teams

Collaborating

Cooperating

Communicating properly

Verbal

Non-verbal

Written

Reasoning

Adopting critical thinking

Exercising clinical judgment

Attitudes, which are manifestations of soft skills of a person (i.e., personality traits that enable a person to interact with the environment; Schulz, 2008), are divided into three types regarding professionalism in occupational therapy: (a) personal, (b) relational, and (c) occupational. Our analysis led to the identification of five personal attitudes that a professional occupational therapist may manifest, which are being positive, patient, confident, mature, and motivated. For instance, Kasar and Muscari (2000) 2 suggested that having a positive attitude about the role of occupational therapists is a manifestation of professionalism. For other authors, professionalism implies an occupational therapist who undertakes projects and takes initiatives with motivation ( Campbell et al., 2015; Kasar & Muscari, 2000; Mason & Mathieson, 2018). Relational attitudes include being weighted, humble, attentive, devoted, nice, and declarative. DeIuliis (2017) demonstrated that professional occupational therapists must be weighted in their relationships; they must have "the ability to self-regulate or maintain emotional stability" (p. xxxi). Professionalism also implies that occupational therapists show an attentive attitude while communicating with clients ( Mason & Mathieson, 2018) and colleagues ( Campbell et al., 2015), and in other circumstances as well, such as attending a conference ( Randolph, 2003). Concerning attitudes that are occupation-centred, we identified seven attributes of professionalism, which are being creative, reliable, flexible, organized, involved, responsible, and persevering. According to several authors, professionalism requires occupational therapists to have a "creative approach to health" ( Adam et al., 2013, p. 80) by improvising and thinking outside the box ( Campbell et al., 2015) or by using creativity to solve problems (Aguilar et al., 2013). Another example of an occupation-centred attitude is flexibility. In other words, occupational therapists must be "adaptive to different contexts" ( Burford et al., 2014, p. 367) such as patients' situations, physical environments, or specificities of the clinical demand.

Behaviours, which are observable actions of individuals, were divided into five categories. The first behaviour that was identified is projecting an appropriate image. Studies have suggested that adequate dressing and grooming ( Bossers et al., 1999) "inspire trust and confidence" ( Burford et al., 2014, p. 369) and is a sign of professionalism. The second behaviour that was found to be an attribute of professionalism is managing with diligence. For instance, authors suggested that properly managing time ( Adam et al., 2013; Campbell et al., 2015; Glennon & Van Oss, 2010; Kasar & Muscari, 2000; Randolph, 2003; Sullivan & Thiessen, 2015) or managing resources in an efficient manner ( Bossers et al., 1999; Royal College of Occupational Therapists, 2017) are manifestations of professionalism for occupational therapists. Working in teams was the third behaviour that formed part of the attributes of professionalism. For Glennon et al. (2010), this behaviour is important to grow as a professional because "working collaboratively [allows one] to maximize one's own learning experiences" (p. 14). The fourth behaviour defining professionalism in occupational therapy was communicating properly, verbally, non-verbally, and in writing. For instance, Campbell et al. (2015) suggested that communicating with an "appropriate language level with clients" (p. 5) is a manifestation of this attribute. Finally, reasoning was the last behaviour that formed part of the attributes of professionalism in occupational therapy. This behaviour implies adopting critical thinking and exercising clinical judgment. For example, Kasar and Muscari (2000) reported the importance of "analyzing, synthesizing, and interpreting information" (p. 44) as part of professional behaviours. Another example has been found in the manuscript of Parham (1987), in which she reported the importance for occupational therapists to "critique [their] own clinical thinking. Develop an awareness of how [they] are naming and framing clinical problems" (p. 560).

Antecedents

Antecedents are events, characteristics, and incidents that must be in place before the occurrence of the concept ( Walker & Avant, 2011). Our literature review suggested that antecedents related to the person and environment are required for professionalism to take place, as shown in Table 4 .

Table 4

Person

Reflexivity

Introspection

Analytical skills

Recognition of one's limits

Values

Shared with other allied health professionals-

Empathy

Integrity

Health

Altruism

Opening

Respect

Honesty

Human rights

Sense of duty

Specific to occupational therapy-Occupational values

Enablement

Occupational engagement

Occupational balance

Occupational participation

Occupational performance

Occupational signification

Occupational justice

Training and experience

Education and professional development

Work experience

Environment

Professional system

Regulations and laws

Codes of ethics

Policies and procedures

Organizational context

Expectations of the organization

Organizational functioning

Concerning person-related antecedents, our analysis revealed that reflexivity is important in the development of professionalism. According to the authors, reflexivity includes the capacity of introspection ( Aguilar et al., 2012; Bossers et al., 1999; Sullivan & Thiessen, 2015), analytical skills ( Campbell et al., 2015; Drolet & Désormeaux-Moreau, 2016; Mackey, 2014), and recognition of one's limits ( Hordichuk et al., 2015; Randolph, 2003; Robinson et al., 2012). Another person-related antecedent concerns values. Our concept analysis allowed one to understand that both values shared with other allied health professionals and occupational therapy-specific values are required for professionalism to occur. For instance, authors have suggested that having a "strong sense of empathy" ( DeIuliis, 2017, p. xxix), "respect for people's language, culture and views" (Aguilar et al., 2013, p. 211), and "honesty [...] by being transparent and authentic" (Drolet & Desormeaux-Moreau, 2015, p. 279) are shared values among allied health professionals that are antecedents to professionalism. Our analysis also proposed that individuals must develop specific occupational values such as enablement, including valorizing clients' self-determination; and believing in clients' potential ( Aguilar et al., 2012, 2013; CAOT, 2012; Dillon, 2002; Mason & Mathieson, 2018; Nortje & De Jongh, 2017; Université Laval, 2019), occupational engagement, occupational balance, occupational participation, occupational performance, occupational signification ( Aguilar et al., 2012, 2013; Hordichuk et al., 2015; Légis Québec, 2018), and occupational justice, including advocating for occupational opportunities and occupational rights ( Aguilar et al., 2012; Burford et al., 2014; Hordichuk et al., 2015; Kasar & Muscari, 2000; Légis Québec, 2018; Nortje & De Jongh, 2017; Robinson et al., 2012). Finally, training and experience should also be considered person-related antecedents of professionalism in occupational therapy. For instance, the literature suggests that professional occupational therapists are "qualified by education, training, and/or experience to practice capably and safely in [their] chosen role" ( Royal College of Occupational Therapists, 2017, p. 14). For students or new graduates, fieldwork experience would be of importance for development of professionalism ( Glennon & Van Oss, 2010), notably because it allows one to understand roles and responsibilities, and to apprehend how to manage knowledge in concrete situations ( Bossers et al., 1999; Robinson et al., 2012). Furthermore, education, professional development, and work experience have an influence on the development of professionalism. For instance, Nortje and De Jongh (2017) suggested that continuous professional development training is an important factor in maintaining professionalism for clinicians.

Environmental antecedents concern the professional system and the organizational context in which occupational therapists evolve. The professional system, with its regulations and laws ( Bossers et al., 1999; Burford et al., 2014; CAOT, 2012; DeIuliis, 2017; Nortje & De Jongh, 2017; Sullivan & Thiessen, 2015; Université Laval, 2019), codes of ethics ( Bull, 2007; Randolph, 2003; Robinson et al., 2012), policies, and procedures ( Burford et al., 2014; Campbell et al., 2015; Mason & Mathieson, 2018; Robinson et al., 2012) has an influence on how professionalism develops and takes place on a daily basis. The organizational context with expectations of organizations and organizational functioning was also an antecedent of professionalism. For instance, Robinson et al. (2012) revealed that how workplace communicates expectations to professionals has an impact on the development and manifestation of professionalism. Concurrently, Adam et al. (2013) have highlighted that "organizational issues" (p. 82) impact professionalism of occupational therapists.

Consequences

After the identification of the concept, examining the consequences of the occurrence of the concept is possible. Our concept analysis revealed that professionalism has tangible consequences to the professionals, service recipients, and the profession at large as shown in Table 5 .

Table 5

For the occupational therapists

Ethical practice

Personal satisfaction

Advocacy skills

For the clients

Competent services

Client-centred practice

For the profession of occupational therapy

Leadership

Credibility

Development

For the occupational therapists themselves, professionalism may lead to ethical practice. For Drolet and Désormeaux-Moreau (2015), the internalization of professionalism components that are values may help occupational therapists "to facilitate the resolution of ethical challenges posed by professional practice" (p. 282). Personal satisfaction ( Weppler, 1973) and development of advocacy skills ( Aguilar et al., 2012, 2013; Bossers et al., 1999; Glennon & Van Oss, 2010; Sullivan & Thiessen, 2015) were also consequences of professionalism for occupational therapists. For clients, professionalism in occupational therapy tends to ensure that they receive competent and client-centred services. The authors reported that being professional lead occupational therapists to be "clinically competent" ( Campbell et al., 2015, p. 5; Nortje & De Jongh, 2017, p. 42;). For Glennon and Van Oss (2010), adopting professional attitudes and behaviours may "improve client-centred interventions" (p. 13). Finally, for the profession of occupational therapy, the occurrence of professionalism may lead to increased leadership in the profession. In fact, leadership is an important consequence of professionalism as the authors stated that it enables occupational therapists to develop leadership roles ( Bossers et al., 1999) in their workplace ( Aguilar et al., 2012), but also more globally in the healthcare system (Aguilar et al., 2013). Another consequence of professionalism is better credibility of the profession for the population. This idea was found in several manuscripts, including one of Remmel-McKay (1975) published in the 1970 s stating that professionalism in occupational therapy "has encouraged greater assumption of authority and greater inputs into the total health industry" (p. 108). Finally, the last consequence of professionalism we identified was related to the ongoing development of occupational therapy (Aguilar et al., 2013; Bossers et al., 1999; Dillon, 2002; Royal College of Occupational Therapists, 2017; Sullivan & Thiessen, 2015), contributing to a strong and unique professional identity.

In addition to the attributes, antecedents, and consequences of professionalism discussed earlier, our analysis also revealed that culture has an influence on professionalism. The analysis allowed one to understand that culture impacts on the antecedents, attributes, and consequences of professionalism. The literature proposes that different cultural aspects may influence professionalism such as the societal ( Wood, 2004), individual ( Davys et al., 2006; Wood, 2004), generational ( Reiter et al., 2018), or organizational ( Burford et al., 2014) aspects of culture. As an example, Reiter et al. (2018) have suggested differences in how occupational therapists of "various generations interpret and display [professional] behaviours" (p. 3). Another example concerning the individual aspect of culture was provided by Davys et al. (2006) as they explained how personal presentation and appearance of occupational therapists may differ. They explained that personal presentation is a way of expressing one's identity. Burford et al. (2014) have explained how organizational culture influences professionalism of occupational therapists. For instance, support (or a lack of) from superiors or peers may enhance or inhibit the manifestation of professionalism. Therefore, the influence of culture may lead to variations in the development, manifestations, and consequences of professionalism.

Discussion

Based on the data extraction of 30 documents from the literature in occupational therapy, this concept analysis proposed a definition of professionalism in occupational therapy. The identification of attributes, antecedents, and consequences suggest concrete levers to identify, develop, or implement professionalism in the practice of occupational therapists.

Professionalism as a Developmental Process: The Importance of Antecedents

This study was innovative as previous reflections and studies on professionalism have mainly focused on attributes, showing less interest in antecedents or consequences. This different understanding of professionalism, focusing on the variables upstream of the manifestation of the concept, may have led to the proposal of a distinct definition, especially concerning the values and parameters of the professional system. In fact, other authors have suggested that these characteristics define professionalism as part of its attributes ( Aguilar et al., 2012, 2013; Bossers et al., 1999; Bull, 2007; CAOT, 2012; Hordichuk et al., 2015; Kasar & Muscari, 2000; Mason & Mathieson, 2018; Sullivan & Thiessen, 2015). However, our concept analysis allowed one to understand that the values and parameters of the professional system are antecedents of professionalism, just as reflexivity, training, experience, and organizational context. In fact, the values and parameters of the professional system are not manifestations of professionalism; they do not allow for recognition.

Values are abstract axiological or evaluative constructs that are not perceptible in real life ( Drolet, 2014). However, they influence professional practices in the sense that occupational therapists must first adhere to values, such as empathy or occupational justice, to show professionalism through its attitudes and behaviours. This reflection suggests that values are more likely to be antecedents than attributes of professionalism. This important idea reinforces the place that must be given to the transmission of professional values, especially those specific to occupational therapy, to support the development of professionalism amongst students and early career occupational therapists.

In the same way, parameters of the professional system, such as the code of ethics or the regulations and laws, must be well defined before occupational therapists can implement these in professional practice. These elements are also considered as antecedents of professionalism, not as attributes, because they influence the adoption of behaviours and attitudes by occupational therapists. In fact, by being aware of the socially organized sanctions that condemn and punish professional misconduct, occupational therapists may regulate their actions to show professionalism.

This precision concerning antecedents of the concept is in line with the idea of a developmental understanding of professionalism ( Reiter et al., 2018; Robinson et al., 2012; Sullivan & Thiessen, 2015); some prerequisites must first be acquired and must influence the possibilities of occupational therapists to develop and implement professionalism in their practice.

Professionalism: A Definition Halfway Between the Two Paradigms

Based on the two paradigms of professionalism construction suggested by Colley et al. (2007), our definition includes task-oriented and person-oriented components. In relation to the task-oriented paradigm, the proposed definition includes a list of values, attitudes, or behaviours that were described as being part of what professionalism in occupational therapy is. These should not be considered as requirements, but as levers to be managed. In a developmental understanding of professionalism, these levers may help students and new graduates to understand, in a tangible manner, how to display professionalism ( Reiter et al., 2018). Our results also suggested that professionalism is a complex competence, going further than the application of expectations. This implies the interaction of personal, environmental, and occupational variables and it requires a reflexive practice from occupational therapists. In fact, occupational therapists must first develop reflexivity and show introspection and analytical skills in order to be able to recognize their limits. These antecedents enable occupational therapists to demonstrate behaviours related to reasoning, such as adopting critical thinking and exercising clinical judgment. The manifestation of these attributes of professionalism may contribute to ethical practice. The reflexive practice is then part of professionalism in its antecedents, attributes, and consequences. This important characteristic of professionalism is crucial to support occupational therapists' decision-making processes in complex situations, leading to a fair professional practice ( Fulford, 2004). Reflexive practice is also related to the ability of occupational therapists to manage conflictual situations and take thoughtful and meaningful professional actions ( Kinsella, 2001). This converges with the person-oriented paradigm of the professionalism construction. This more in-depth part of our definition may appeal to experienced occupational therapists who have an intrinsic experience of professionalism.

Moreover, our definition is not constructed to be prescriptive. Figure 2 proposes categories of antecedents, attributes, and consequences without prescribing specific ways to manifest them. Tables 3 ​ to ​to5 5 propose concrete examples of these characteristics based on the literature. However, our understanding of the evolution of the concept suggests the importance of not being prescriptive and allowing room for variations in ways to express professionalism ( Remmel-McKay, 1975; Wood, 2004). A non-prescriptive definition of professionalism respects and promotes professional autonomy and the reflective practice of occupational therapists. Cultural influences (e.g., individual, societal, generational, and organizational) that constantly impact the antecedents, attributes, and consequences of professionalism also justify the need to accept variants, dynamism, flexibility, and adaptivity in the development, manifestation, and outcome of professionalism. These cultural influences impacting on how occupational therapists manifest professionalism are in line with previous findings, notably those of Freeman et al. (2009) and Drolet et al. (2020) stating that organizational culture, with its bureaucratic rules and management practices, influences how occupational therapists fulfil their professional obligations.

Professionalism: Based on Shared and Specific Characteristics

Another interesting finding of this study is the idea that some characteristics of professionalism are shared between allied health professions, as others are specific to occupational therapy. In line with other authors suggesting the importance of a profession-specific definition of professionalism ( Aguilar et al., 2012; Bryden et al., 2010), we identified values that are unique to occupational therapists. Our analysis of the literature allows one to understand that values of enablement, occupational balance, occupational engagement, occupational participation, occupational performance, occupational signification, and occupational justice are antecedents of professionalism that are specific to occupational therapists. Previous works stated that occupational therapists consider occupation a profession-specific value ( Aguilar et al., 2012). Although occupation is deeply rooted in the identity of occupational therapists ( Townsend et al., 2013), we cannot consider occupation as a value as it is a concrete descriptive concept and fails to fulfil the requirements of the definition of a value ( Drolet, 2014). A valued concept should not automatically be considered a value. We have privileged the inclusion of seven occupational values that are abstract concepts that meet contemporary definitions of values ( Drolet, 2013). This conceptual clarification is important for building fair and accurate theories ( Hammell, 2009; Phelan, 2011). As theories guide our practices and influence the development of our professional identity ( Turner & Knight, 2015), there is a need for a reflection on those professionalism features that are unique to our profession and to deepen those specificities that enrich the complexity and value of occupational therapy.

Why Acting with Professionalism? The Importance of Consequences

Finally, an important contribution of this study for the advancement of knowledge is the identification of the consequences of professionalism. As professionalism was mainly assumed and barely explained ( Bryden et al., 2010; van Mook et al., 2009), few authors have examined the consequences of professional practice in occupational therapy. In addition to the adoption of ethical practice, the feeling of personal satisfaction, and the development of advocacy skills for occupational therapists, professionalism contributes to ensuring competent services and a client-centred approach, a fundamental prerequisite for occupational therapists ( Townsend et al., 2013). Professionalism is also a means of assuming leadership, attaining credibility, and advancing as a profession. As these consequences are mainly positive for occupational therapists, clients, and the profession, putting in place the antecedents of professionalism and working on the implementation of its attributes are important, thereby leading to the occurrence of these consequences. This process may contribute to the development of a strong and unique professional identity in occupational therapy, responding to the call for a profession-specific definition of professionalism.

Strengths and Limitations

This study proposed a holistic understanding of professionalism, including the definition and identification of links between antecedents, attributes, and consequences. These concrete characteristics offer levers to identify, develop, and implement professionalism in the practice of occupational therapists. The rigorous methodology was presented thoroughly, allowing for replication. However, consistent with the concept analysis design, quality assessment and grading of selected documents were not performed. In addition, it should be recognized that other methods of concept analysis do exist and that maybe the use of another method would have led to different results. Finally, the definition of professionalism proposed is as of today. Consequently, as concepts evolve over time, it is possible that this definition becomes obsolete.

Conclusion

In this study, we proposed an operational definition of the concept of professionalism in occupational therapy, highlighting its antecedents, attributes, consequences, and the constant influence of culture. The results of this study provide an informative, non-prescriptive, and operational definition of professionalism in occupational therapy that is suitable for all occupational therapists, regardless of their age, geographic location, and place of practice. The results obtained suggest concrete implications. For occupational therapists in practice, targets to achieve as part of the professional practice's continuous development process are now available. Notably, specific attitudes and behaviours to adopt are highlighted. For educational settings, antecedents to promote the development of professionalism amongst students are well defined, such as values to be shared with them. For employing organizations, the organizational context features that enable occupational therapists to manifest professionalism are known. For professional associations, knowledge of the consequences of professionalism proposes strong arguments to advocate supporting the development of this primordial competence in occupational therapy. The next research step will be to determine how culture influences the development, manifestations, and consequences of professionalism. As this is a relevant finding from this study, pursuing our understanding of the influence of culture on professionalism in occupational therapy is crucial.

Key Messages

This article proposes levers to promote the development and maintenance of the concept of professionalism for researchers, practicing occupational therapists, educational settings, and professional associations.

This theoretical work proposes an operational definition of professionalism that suits novice and experienced occupational therapists.

Culture influences the development and manifestation of professionalism in occupational therapy; culture should be considered in any further research about professionalism.

Acknowledgements

The authors thanks Karine L'Écuyer, research assistant, for her help with the literature search.

Author Biographies

Alexandra Lecours is an assistant professor in the Rehabilitation Department at Laval University and a regular researcher at the Center for Interdisciplinary Research in Rehabilitation and Social Integration. Her research interests focus mainly on occupational health, safety and well-being. She is also interested in professional development.

Nancy Baril is a clinical professor in the Department of Occupational Therapy at the Université du Québec à Trois-Rivières (UQTR). She is a fieldwork supervisor and teaches health promotion and occupational therapy with children and teenagers.

Marie-Josée Drolet is a full professor in the Department of Occupational Therapy at the Université du Québec à Trois-Rivières (UQTR). She teaches ethics and conducts research in this field.

Notes

1. The list of selected documents for conducting the concept analysis is shown in Appendix 1.

2. To lighten the text, extracts from the selected documents are shown to illustrate the results. The full list of references supporting each of the identified characteristics of professionalism can be obtained by contacting the first author.

Footnotes

Funding: This study was supported by a grant from the Fonds pour la recherche clinique of the Université du Québec à Trois-Rivières.

ORCID iD: Alexandra Lecours https://orcid.org/0000-0002-4485-7829

References

Adam K., Peters S., Chipchase L. (2013). Knowledge, skills and professional behaviours required by occupational therapist and physiotherapist beginning practitioners in work-related practice: A systematic review. Australian Occupational Therapy Journal, 60, 76-84. 10.1111/1440-1630.12006 [[ PubMed] [ CrossRef] Google Scholar]

Drolet M.-J., Désormeaux-Moreau M. (2014). Les valeurs des ergothérapeutes: résultats quantitatifs d'une étude exploratoire. Bioéthique Online, 3, 21. [ Google Scholar]

Fulford K. (2004). Chapter 14. Facts/values. Ten principles of values-based medicine. In Philosophy Canada (Vol. 57, pp. 113-122). Oxford Press University. [ Google Scholar]

Richard C., Colvez A., Blanchard N. (2012). État des lieux de l'ergothérapie et du métier d'ergothérapeute en France. Analyse des représentations socioprofessionnelles des ergothérapeutes et réflexions pour l'avenir du métier. ErgOthérapies(48), 37-46. [ Google Scholar]

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Articles from Canadian Journal of Occupational Therapy. Revue Canadienne D'Ergotherapie are provided here courtesy of SAGE Publications

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What is Professionalism in Occupational Therapy? A Concept Analysis: Qu'est-ce que le professionnalisme en ergothérapie? Analyse de ce concept

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Professionalism has been given different definitions over time. These are, commonly theoretical and difficult to operationalize.This study aimed to provide an operational definition of the concept of professionalism in occupational therapy.Based on a ...

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AOTA 2020 Occupational Therapy Code of Ethics

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Preamble. The 2020 Occupational Therapy Code of Ethics (the Code) of the American Occupational Therapy Association (AOTA) is designed to reflect the dynamic nature of the occupational therapy profession, the evolving health care environment, and emerging technologies that can present potential ethic…

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Kindling a Fire: All Play and No Fun: The Professionalism of Youth Sports

One of my favorite memories of growing up in Indian Hill is playing pickup basketball or little league baseball at Stephan Field with my friends. It usually wasn't terribly well organized or well played, but we had a lot of fun, strengthened our relationships, and maybe even improved our skills.

These days, though, if you see a child playing sports, it's more likely that the kids will be playing their fifth game of the weekend at a club tournament with dozens of adults tracking their every move. And it's more likely than ever that the children will be feeling the pressure to specialize in a single sport at an early age.

One result of this cultural shift is that today's athletes are quite simply better than they used to be. Access to more regular and sophisticated training has significantly improved the skill level of the average young athlete. With apologies to Eric Fischer, Max Comisar, and the rest of my legendary fifth-grade Indian Hill baseball team, I don't think we'd measure up to the fifth graders of today.

But I do worry that something important has been lost in the increasing professionalization of youth sports. In our zeal to train our kids to be the best athletes, we are risking more frequent injuries, causing more pervasive burnout, and making many kids feel left out of the joy of sports. As is true in other areas where hyper-intensive parenting prevails, this new philosophy towards youth sports can cause unintended harm in its quest to develop the perfect resume for teenagers.

For example, multiple studies have shown that increased specialization and year-round play lead to more injuries. In one study, researchers found that teens who spend more hours practicing a sport per week than their age (i.e., a 12-year-old practicing for 13 hours or more) were 70% more likely to sustain an overuse injury. Another study found that practicing a sport for eight months or more per year made an athlete three times more likely to sustain an overuse injury.

Interestingly, some research even indicates that early specialization in a sport leads to greater physical inactivity as an adult. This counterintuitive result is likely due to burnout, which is another known risk of overly intensive training at young ages. Over 70% of youth sports participants quit organized athletics by the time they are 13 years old. Plenty of top players are victims of the pressure and stress to succeed at young ages and end up quitting the game they once loved. In some studies, early specialization is the best predictor of an early exit from organized sports.

At some level, the focus parents place on their children's athletic development is understandable. Every parent wants their child to succeed and to discover the unquestionable benefits that come from participating in sports. And it can be difficult to resist the lure of specialized training when so many of a child's peers may be signing up for club and travel teams. Additionally, a number of parents are hoping that athletics can lead to college scholarships or preferred admission, especially given how intensely competitive college admissions are today.

But in this respect, intensive youth sports training can often be fool's gold. First, there is mixed evidence suggesting that intensive, specialized training leads to more college scholarship opportunities. In one study, 88% of college athletes played multiple sports growing up, and the vast majority did not specialize before age 13. At higher levels, this also proves true: every year, the overwhelming majority of NFL first-round draft picks were multi-sport athletes in high school.

And even if scholarship opportunities are on the table, they can amount to less than they seem. Families often spend tens of thousands of dollars and thousands of hours on club and travel sports teams, only to realize later that the scholarship dollars available from colleges are rather modest. For example, a Division I baseball team has only 11.7 scholarships to allocate among 27 players, which means even some of the best players only receive a few thousand dollars of scholarship support. Families hoping that there is a pot of gold at the end of the travel baseball rainbow are often disappointed.

Finally, this outcome-focused approach to youth athletics can sometimes ignore the best interests of the kids. Children today need more free, unstructured play away from adults to develop their own self-efficacy and resilience. Hyper-intensive youth sports provides the opposite setting by constantly supervising children and instilling a transactional approach to play.

As the father of two boys, I struggle with this dilemma every day. But while I can't unwind the $19 billion youth sports industry overnight, I do have two suggestions:

1. If your child is an athlete, expose them to multiple sports. There's nothing wrong with joining a club team or training hard at a chosen sport. But make sure that an athlete gets experience engaging in multiple sports. At Country Day, we still require all Middle School students to play three sports so that they take new risks, develop new skills, and make new friends. Sometimes they learn they have untapped potential or unknown interests in a sport they may not have considered. Other times, they simply train their bodies in different ways from the year-round effort they're already engaged in. I'm proud that some of our top athletes in high school - including Division I college signees - are key contributors to multiple varsity sports at CCDS.

2. Make sure that the child is as invested in the team as the adults. Youth sports should be about children, not grownups. Take regular stock of why a child is participating in a sport, and ensure it's based on their intrinsic desires, not some potential future reward advocated by an adult. There's nothing wrong with pushing your kids to play a sport - in fact, I believe there is immense value in athletics - but check in to see if the "why" still makes sense for parent and player alike.

Whether your child is a star athlete or a benchwarmer like me, I hope they get to experience some of the pure joy of sports that I remember so fondly from my days at Stephan Field. With the right approach, every kid can be a winner.

"Kindling a Fire" is a column submitted regularly to Indian Hill Living by Head of School Rob Zimmerman '98. This ran in the December 2023 edition of the publication.

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Kindling a Fire: All Play and No Fun: The Professionalism of Youth Sports

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I do worry that something important has been lost in the increasing professionalization of youth sports. In our zeal to train our kids to be the best athletes, we are risking more frequent injuries, causing more pervasive burnout, and making many kids feel left out of the joy of sports.