How Children Succeed (Book Review Pedcast)

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How Children Succeed


How Children Succeed

by Paul Tough

Houghton Mifflin Harcourt:

I hope you are having a good day. I am your host, Dr. Paul Smolen also known as Doc Smo. Thank you for joining me today for another installment of, the pediatric blog where we talk about everything kid, from diapers to the diploma, from the bassinette to the board room, from the swaddle to the sware, we talk about it here. With the help of one of my superb intern, Angela Solis, today we are going to continue with my book review series.

A friend of mine from college recently sent me a book he thought might interest me. He knows me well. I was immediately intrigued by the title: How Children Succeed, by Paul Tough, a journalist with expertise in education and poverty. After reading the first chapter where he introduced me to the recent research about how crucial early brain development is in children under 2 years of age is, I decided that parents who follow the blog should hear about this research. The author introduced me to the concept of the ACE (Adverse Childhood Events) score which is a way psychologists measure the amount of “stress”, both physical and psychological that a child endures in their early childhood.  Mr. Tough admits that measuring a child’s ACE score is not easily obtained but, does seem to measure something important. According to Mr. Tough’s many experts believe that the higher the ACE score a child has in the first 3 years of life, the poorer his or her educational outcome is likely to be. He claims further that research supports the concept that this “toxic stress” a child experiences changes the way these children react to the world for the rest of their life. Experts believe that high ACE scores tends to create children with short attention spans, less curiosity and confidence to explore their world. Fascinating! These observations seem to explain a lot of what we see in children. To me it appears that factors outside the classroom seem to determine their success or failure far more than the quality of the teaching they experience.

Unfortunately, after this initial enlightening chapter, I did not find the other information and commentary as interesting. The rest of this long book explores, in great detail I might add, the following themes:

-how character traits such as determination, grit, and self regulation, and curiosity affect success
-how different school systems have tried to implement character education programs
-what mental strategies successful students have learned to implement when faced with trials
-what programs are in place currently trying to help disadvantaged children
-future paths for educational reform

As you can see from the extensive list of topics covered in this book, my hope of finding a great parenting book capable of giving parents insight into factors that might point their children in the direction of success did not materialize. Based on the jacket summary, this seems like a revolutionary book that holds the key to make your own child successful beyond the academic skills emphasized in a traditional classroom. Do not be fooled. This is not a parenting book with solutions of how to instill character traits in your child, or how to mitigate the long-term effects of painful emotional situations. This is investigative journalism in which Tough immersed himself into various educational cultures, from the south side of Chicago to the elite Riverdale neighborhood in the Bronx. He scoured scholarly journals and interviewed experts in the fields of education, neuroscience, and child psychology. There is no doubt that this book is thoroughly researched and well-written for he is able to keep a narrative tone throughout the book, while stringing together study after study to validate his points. This book, therefore, is aimed at individuals specifically interested in education policy or political science majors destined to annotate it for class in the hopes of one day emerging from DC as the next Michelle Rhee. If you have the time, the book certainly opens your eyes to the current education policy trends, but be prepared for what begins as an informative piece on the influence of character strengths on children’s success to turn suddenly political within two chapters. We think this is a very informative book for educators, policy wonks, school administrators, psychologists, and anyone interested in social policy… but not for parents looking for useful parenting information. We give it two and a half out of five Doc Smo stars.

Again, I would like to thank my more than capable intern, Angela Solis, who helped in the writing of this pedcast book review. Both she and I would love to hear your comments at or on Facebook or iTunes. This is Dr. Paul Smolen, hoping your children have an overwhelming need, to go ahead and succeed. Until next time.

From the Desk of DocSmo-Exercise and “Your Little People”

I find very little useful, practical knowledge in most of my pediatric journal reading, but an article in the February 2012 journal, Pediatrics, caught my eye as different.  The authors of this article decided to study how much physical activity children are getting in daycare centers.  Seventy five percent of children are in group care settings in the United States; fifty six percent of these are in daycare centers.  The study observed thirty-six daycare centers in Cincinnati, Ohio.  The results of this study shocked me.  In these daycare centers, only two and one half percent of a child’s day is spent being active–by my calculations, this translates to, on average, about 37 minutes in the average ten hour day.

The authors did in-depth interviews with the care givers in these centers and found three main barriers to physical activity for these children:

1. Safety Concerns–Licensing laws limit the types of play equipment permitted; moreover, weather concerns—particularly fear of lightening and severe weather—limit outdoor time.

2. Academic Knowledge–Pressure from parents to prepare their children for kindergarten results in reduced unstructured and play time.

3. Budgetary Constraints–Tight budgets mean that expensive play equipment is just not affordable.


         The authors draw some interesting conclusions from their data.  Children in daycare centers are probably not getting enough exercise on a daily basis, certainly not what experts recommend  (Experts at the National Association for Sport and Physical Education recommend one and one half hours a day for toddlers and two hours for preschoolers).  The study authors suggest that the lack of exercise in daycares is contributing to the obesity epidemic in the United States.  Finally, they think that lawmakers, daycare operators, and parents need to find a new balance between exercise, safety concerns and academics offered to our children in daycare.  My guess is that parents, armed with the knowledge that these researchers uncovered, could solve this problem very quickly.  Parents, let’s get started.

Smo Notes:


2. Copeland et. al., Pediatrics Volume 129, Number 2,February 2012

“Sit Down and Listen”: ADD News 2011 (Pedcast)

In November of 2011, the Academy of Pediatrics experts revised their guidelines for pediatricians when it comes to the management of children with ADD.  In this edition of, Dr Smolen introduces parents to the new changes when it comes to helping children with ADD along with some of his own insights and opinions.  Informed parents will certainly want to listen.



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Lunchroom Lowdown- Attention Deficit Disorder (Article)

My partners are really smart people with a lot of experience under their collective belts. I pay a lot of attention when they speak, because I always learn from their wise insights. Such was the case the other day in the lunchroom, when the subject of practical ADD management tips came up. One of our doctors has a child with ADD, so she is speaking from more than doctoring experience, which gave the conversation a whole new perspective. Here are the highlights:

Things are not always what they appear: Dr. Kimberly Riley recalled stories of children whose main problem was not attention span but learning disabilities. She has noticed that after their learning problem had been identified and helped, the impulsiveness and inattention faded away. They didn’t have ADD, simply a learning disability that had not been recognized. Dr. Riley also pointed out that if a child has severe learning difficulties, genetic testing may aid in looking for recognized genetic problems that impair learning. Conversely, Dr. Downing has noticed that in her experience, many of the children that present mood problems like anxiety, depression, or oppositional behavior really have ADD as a core feature dominating these children’s personality. Both the mood problem and the ADD issue need to be addressed for the child to get maximum benefit.

Sleep problems usually seem to accompany the ADD personality
: all of the doctors agreed that many children who are diagnosed with ADD have innate sleep difficulties. Certainly, the medications that are used to treat ADD can cause sleep problems on their own, but this is not the root cause. Dr. Plonk has noticed that initiation of sleep can be very difficult for these children, going all the way back to infancy. He believes that this problem has a neurological basis. Drs. Plonk, Riley, Moorman, and Downing all recommend 1-3 mgs. of Melatonin about 30 minutes before bedtime to help children get to sleep; they feel that this OTC hormone is both safe and effective. They also have found that a homeopathic product called Calms Forte can be effective in children with ADD. Both of these products have unfortunately not been tested by the FDA for safety or effectiveness since they are non prescription products. Keep in mind, however, that both parents and doctors are fans of melatonin so I think you can be confident giving it a try.

Beware of the easy fixes
: My colleagues believe that ADD is a neurologically based “chronic” disorder. Chronic means just that, chronic. They have noticed that as children mature, they almost always improve in their ability to concentrate and to avoid distractions but often don’t catch up with their age-matched peers until adolescence or beyond. For those who need help, the combination of behavioral therapy, attention to learning problems and associated mood problems, and possibly medication seems to get the best results. The doctors were pretty unanimous declaring that dietary supplements (except fish oil), strict dietary restriction of sugar, gluten and preservatives along with other assorted therapies seem to have limited effectiveness. As you will hear in the Pedcast featuring Dr. Kilbane, other physicians strongly disagree with that contention.

Let’s not forget there is a kid with feelings behind that diagnosis of ADD: Drs. Plonk, Riley, Downing, and Moorman became very animated and forceful when the subject of a child’s self image and self esteem came up. They all strongly feel there is a need to speak directly and honestly to children who have this diagnosis, reminding them that they are not “bad kids” and that to a large degree, they can’t help this impulsive behavior and lack of attentiveness. Dr Downing even noted that one of her patients declared to his mother just after this conversation, “You owe me, Mom” (an apology I presume). Understanding that the ADD behavior pattern is not anyone’s fault can be a huge relief to many families. As Dr. Downing points out, guilt is a strong emotion, and doctors can be very useful in mitigating some of this emotional baggage.

Conclusions of the doctors: My partners feel that the best approach to helping a child with an ADD diagnosis includes: having their learning problem and mood difficulties addressed, managing sleep problems if they exist, making sure that the school they attend provides appropriate accommodations to help the child with behavior and learning, initiating good behavioral management strategies at school and home, and most of all treating the child and his/her family with the respect and patience they deserve. That is the Lunchroom Lowdown for this week.


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