1 Lead-agogy: Cleaning up the mess it makes in people’s lives William D. Bessmer La Salle University EDC 503 Dr. Greer Oct 12th, 2022 2 Research Question: How do we compensate for the neurobiological effects of lead poisoning, what is the best early intervention strategy before 3rd grade? Thesis Statement Most treatments for lead toxicity, which can seriously harm a child’s health, focus on environmental remediation rather than how to treat those afflicted for the intellectual disabilities, long term educational attainment, and behavioral sequelae of lead exposure. Of note, lead toxicity imparts the symptoms of ADHD, if not the condition itself, and thus pedagogies developed for ADHD students should be applicable to the treatment of the neurological effects of lead poisoning. 3 Annotated Bibliography 1. Ahmad, F., & Liu, P. (2020). (Ascorb)ing Pb Neurotoxicity in the Developing Brain. Antioxidants (Basel, Switzerland), 9(12), 1311. https://doi.org/10.3390/antiox9121311 Ascorbic Acid (Vitamin C) supplementation can help ameliorate the long-term effects of lead toxicity in developing children’s systems by acting as a chelating agent, a molecule capable of binding lead to itself in order to facilitate its excretion from the body. This is a meta-analytical study collating the potential reasons Vitamin Can be used to treat lead exposure, a condition that is a risk factor for ADHD and autism severity in children. The analysis found that more direct research is needed to definitively demonstrate that Vitamin C is capable of chelating lead in children, though animal models and adult results all indicate the likelihood of success. Ascorbic Acid is a potential low cost solution for chelation in lead exposed children. The implications of the article indicate that a simple, low cost, neuroprotective intervention warrants further implementation. 2. Barkley, R. (2016). Managing Adhd in school: The best evidence-based methods for teachers. PESI Publishing & Media. This book was written by the world renown clinician Russel Barkley, who is a pre-eminent expert on ADHD. This book collates Barkleys research and modifies it by providing advice and statistics for how to implement evidenced based pedagogies and behavioral management techniques in the classroom. Barkley strongly believes in the effectiveness of medication to treat ADHD. Findings include: despite diagnoses being more likely in wealthier communities, 10% of a teacher’s students are likely to have ADHD, though this number is unlikely to truly capture the true number of students with the condition. Barkley asserts that “no compelling evidence indicates that social factors, such as parenting or educational environment, have been found to cause ADHD.” Barkley’s research has also ruled out diet, TV, video game and media consumption as potential causes of the condition. Barkley doesn’t mention lead toxicity. Barkly makes suggestions to breaking tasks down for students with ADHD to compensate for the executive functioning shortfalls. Evidence suggests external organizers should be provided for scholars to process more efficiently with their lapses in executive functioning. 3. Billings, S. B., & Schnepel, K. (2017). Life after lead: Effects of early interventions for children exposed to lead. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.2998982 4 This study focuses on the effects of early interventions (and their respective costs) on children exposed to lead by developing an economic framework and then importing and analyzing data from Raleigh, NC. The paper used an economic approach and focused on economic gains that focus on immediate remediation. They found that each $1 invested in children with confirmed elevated blood lead levels yields a return of nearly $1.40 based on rough (and largely conservative) estimates, based on their sample. Increases in primary and middle school educational performance among children eligible for an intervention has been observed to be statistically significant. They found that even children who test twice over the alert threshold exhibit similar outcomes as children with lower levels of exposure when remedies are applied before the onset of school. The study concludes that each dollar spent remediating lead toxicity will yield a substantial Return on Investment. 4. Evens, A., Hryhorczuk, D., Lanphear, B. P., Rankin, K. M., Lewis, D. A., Forst, L., & Rosenberg, D. (2015). The impact of low-level lead toxicity on school performance among children in the Chicago Public Schools: A population-based retrospective cohort study. Environmental Health, 14(1). https://doi.org/10.1186/s12940-015-0008-9 This study focuses on the impacts of even low levels of lead exposure on the achievement of children by linking multiple databases about lead exposure and public school testing. The study attempts adjust for variables like poverty, race, and other demographic and medical characteristics, though it was opaque on the details as to how they controlled for it. The study found that at concentrations of lead in the blood below 10 μg/dL, there are still pronounced effects. Concentration of lead above 10 μg/dL are inversely correlated to reading and math scores. Even below this threshold, failure rates are significantly different between those who are barely exposed (0-4μg/dL) and those near the threshold. They estimated that 13% of reading failure and 14.8% of math failure can be attributed to exposure to blood lead concentrations in Chicago school children. The impact of this study is in how starkly dangerous lead is to educational success. 5. Jakubowski, M. (2011). Low-level environmental lead exposure and intellectual impairment in children — The current concepts of risk assessment. International Journal of Occupational Medicine and Environmental Health, 24(1), 1-7. https://doi.org/10.2478/s13382-011-0009-z Review paper of the effects of lead on intellectual abilities of children. It finds through its meta-analysis that there is no safe level of lead consumption. Every 10 μg/l of lead in the blood leads to an IQ score decrease of 1 point. That 1 point in IQ comes with a commensurate 4.5% increase in the risk of failure to graduate high school. Each point of IQ increases worker productivity by 1.76%-2.38%. The developing brain is more 5 vulnerable to the neurotoxicity of lead than the mature brain. In children, an elevated blood lead (B-Pb) causes concentration-dependent reduction in Intelligence Quotient (IQ) score and reduced cognitive functions up to at least seven years of age. There is some evidence that this subsequently leads to a reduced adult brain grey matter volume, particularly the pre-frontal cortex, the seat of executive control. Elementary school students have demonstrated a 15% reduction on end of year testing in reading and mathematics. They postulate that exposure levels measured in 10 μg/l units can be used for risk analysis and decision making. 6. Love, H. R., & Beneke, M. R. (2021). Pursuing justice-driven inclusive education research: Disability critical race theory (discrit) in early childhood. Topics in Early Childhood Special Education, 41(1), 31–44. https://doi.org/10.1177/0271121421990833 A qualitative study that ruminates over how the application of DisCrit to inform the education system. They posit that young children are at risk of exclusion based on their disability. They focus on early intervention as and are critical of the occupational frameworks that require significant conformity of the disabled. They disambiguate ableism and racism and consider how these biases negatively affect children. Considering the fact that lead poison exposure is a socio-economic and race based geographically designed issue, it makes sense to look at disability critical race theory intersection, though I find that the mechanistic effects of environmental racism are unacknowledged here. The paper suggests that implicit and explicit bias training is crucial for those working at the intersection of race and disability. They suggest that adequate supports and variations in seating arrangements are vital elements for pedagogy of these children, and considering the impulse control issues of lead poisoning, perhaps fewer demands that students be seated all period is a solution. 7. Lovett, M. W., Frijters, J. C., Wolf, M., Steinbach, K. A., Sevcik, R. A., & Morris, R. D. (2017). Early intervention for children at risk for reading disabilities: The impact of grade at intervention and individual differences on intervention outcomes. Journal of Educational Psychology, 109(7), 889–914. https://doi.org/10.1037/edu0000181 This study combined two well known reading intervention programs (PHAST and RAVE-0) to create a “Triple Focus Intervention” modality that was tested in three cities for 236 students. A second round of longitudinal analysis was conducted to ascertain relationships between the timing of intervention. They found that timing of early intervention for reading problems in the primary grades is vital. Triple-Focus intervention was associated with benefits for struggling readers across 1st, 2nd, and 3rd grades, on all reading and reading-related outcomes. Early intervention in 1st and 2nd 6 grade nearly doubled the gains compared to children receiving an intervention in 3rd grade. It was found that IQ modulated how effective the intervention was, with higher IQs seeing larger gains for early interventions. The study is hampered by low sample size and nonconformity between the literature and reading programs offered by the various schools used in the study. The IQ to effectiveness of early intervention relationship demonstrates that treating lead toxicity may not be as easy to remediate 8. McDermott, C. L., Seidlitz, J., Nadig, A., Liu, S., Clasen, L. S., Blumenthal, J. D., Reardon, P. K., Lalonde, F., Greenstein, D., Patel, R., Chakravarty, M. M., Lerch, J. P., & Raznahan, A. (2018). Longitudinally mapping childhood socioeconomic status associations with cortical and subcortical morphology. The Journal of Neuroscience, 39(8), 1365–1373. https://doi.org/10.1523/jneurosci.1808-18.2018 1,243 longitudinal MRI brain scans were analyzed to ascertain the morphological differences in the brain due to the effects of Socio Economic Status (SES), cross referenced against IQ tests administered to the clients. Up to 20 points of IQ are lost simply due to the effects of low SES. This change in IQ is manifested by brain morphological changes. Meta-analyses of functional imaging data indicate that cortical correlates of SES are centered on brain systems serving sensorimotor functions, language, memory, and emotional processing. Higher SES is associated with areal expansion of lateral prefrontal, anterior cingulate, lateral temporal, and superior parietal cortices. Cortical Surface area seems to be the connection between IQ and SES. The study used an outdated standard for SES which made it less refined than would be preferred, and the SES spectrum was not demonstrative of the US population at large. There was some postcolonial opinionating in the discussion about being surprised at the effects of SES in a sample that drew heavily from the United States, as if the adversity of the poor in other nations was of measurable greater magnitude. In regards to lead, how much of this structural difference of the brain is experiential vs. environmental? 9. Pew Charitable Trust. (2017). 10 policies to prevent and respond to childhood lead exposure [white paper]. Retrieved October 12, 2022, from https://www.pewtrusts.org/-/media/assets/2017/08/hip_childhood_lead_poisoning _report.pdf This white paper is an academic analysis of the best policies to address childhood lead exposure. It was found that by keeping blood lead levels of children born in 2018 at zero would generate $84 billion in benefits. Providing targeted evidence-based academic and behavioral interventions to the roughly 1.8 million children with a history of lead exposure could increase their lifetime family incomes and likelihood of graduating from high school and college. It will decrease their potential for teen parenthood and criminal conviction. They report that Black children are at highest risk 7 of lead poisoning, followed by Hispanic children. Possible remediation strategies for the neurocognitive effects of lead toxicity include using PATHS (Promoting Alternative Thinking Strategies) which fosters emotional and social competencies through the development and strengthening of skills in emotional literacy, positive peer relations, and problem solving. This intervention was found to improve cognitive concentration and reduce aggressive and antisocial behavior for 1st-3rd grade children, as well as improve academic skills of students, as they were 60-70% more likely to attain proficiency in reading and math, respectively. This sets up a strong foundation to compare the Triple focus intervention to PATHS to perhaps grow a hybrid program to treat lead’s neurotoxic effects on grades. The suggestions on addressing lead are all conjecture, but well researched. 10. Schatz, N. K., Fabiano, G. A., Raiker, J. S., Hayes, T. B., & Pelham, W. E., Jr. (2021). Twenty-year trends in elementary teachers’ beliefs about best practices for students with ADHD. School Psychology, 36(4), 203–213. https://doi.org/10.1037/spq0000442 This study focused on the changing opinions of educators in regards to their opinions and beliefs about ADHD best practices. Teachers responded to a questionnaire about their interactions with students with ADHD as well as their beliefs about best practices for these students. This study is qualitative in nature, but does synthesize some trends. Teachers generally agreed that behavioral classroom management, medications, and the combination of the two are effective treatments for students with ADHD. The success of any implementation of any ADHD supports requires teacher buy-in. Does this environmental cause of the ADHD symptoms therefore build compassion to develop that buy in? Paired with the implicit bias training and seating arrangement variation suggested by Love and Benekee, and the focus on early intervention of the other papers above, a holistic approach to treating the symptoms of lead exposure to children in early grade levels can potentially be developed. 8 Summary Lead affects the brain. Even at low doses, IQ points are lost when exposed. The best and most re-iterated remediation strategies are relegated to cleaning the exposure site and medically treating the child. There is little as far as instruction as to how to further clean up the effects of lead exposure, but this bibliography shows a path forward. 1. Lead is an environmental toxin spread by automobiles, water, soil contamination, and paint chips. Lead is constrained by geography, and that geography is typically the poorest regions of an aging urban center. 2. Lead affects the IQ and development of children exposed to it. 3. The effect of IQ loss from lead exposure and Socio Economic Level is difficult to ascertain, but it appears to be mediated by reduced surface area of the brain, and thus, lead’s ability to lead to diminished brain volume thus affects the IQ, as volume and surface area are related in 3 dimensional objects. 4. Treatment for exposure to lead includes cleaning or abating the exposure source and medically treating the child with chelating molecules. 5. Vitamin C supplementation and proper nutrition have been demonstrated to help lend resilience to those exposed to lead as vitamin C is a chelating biomolecule that can cross the blood brain barrier, and thus should be present in all lunches for kids in certain neighborhoods. 6. Lead results in behavioral functioning similar to ADHD and may be a risk factor for autism spectrum behaviors. 7. Therefore, evidence based pedagogy that is effective for ADHD will be effective for the treatment of the educational sequelae of exposure. 8. Early interventions for special needs children need not be adapted too much in order to accommodate those afflicted with lead toxicity. 9. Considering the race and class issues, implicit and explicit bias training is vital.
