Lead exposure in very young children and the resulting brain damage remain devastating long-term problems in New Jersey and around the country. That’s one of the reasons experts say teachers and school nurses, as well as parents, must become better educated and work more closely with doctors and health officials to help reduce the impact on affected kids.
The state has recently stepped up efforts to prevent lead exposure from happening in the first place. Following the scandal of lead-contaminated drinking water supplies in Flint, MI, and the discovery of unsafe levels in dozens of Newark schools, the state last month announced $10 million in grants to remove lead-based paint in homes and a public relations campaign aimed at emphasizing the importance of screening children for exposure.
But to help the many thousands of children who have already been exposed or will be in the coming years, superintendents, regular and special-education teachers, nurses, and school psychologists must learn how the heavy metal affects young bodies, which of their students are affected, and how to advocate for them, according to attendees at a conference on lead exposure held at Princeton University last week.
Educators must also learn how to provide the children with the specialized assistance they need to overcome learning delays and behavioral problems that lead can cause, the speakers said.
As things currently stand, not all children are tested for lead; schools typically aren’t aware which children have been exposed; many people don’t realize lead causes brain damage; and few children undergo detailed neuropsychological testing to determine how the poisoning is affecting them and the best strategies for remedying those deficits.
“We don’t have the financial resources to have neuropsychologists available in school systems. If you don’t do neuropsychological testing, any intervention you do is a shot in the dark. You’re wasting your time, and you’re wasting that child,” said Ted Lidsky, a neuropsychologist and expert on lead poisoning. “We’re basically failing children on every level. There’s a Jewish term called ‘shonda.’ It means a total disgrace. This is a disgrace.”
More than 3,000 children in New Jersey tested with elevated lead levels last year, mostly poor, minority kids in older cities, and the actual number of those exposed is probably higher. While the state requires testing at age 1 and 2, only 26 percent of children under age 6 in the state are tested annually, said Peter Chen, an attorney with Advocates for Children of New Jersey (ACNJ).
A small number of children have very high lead levels, but 19 percent of those tested have a blood lead level (BLL) of at least 3 micrograms per deciliter of blood, enough to merit an evaluation and possibly educational interventions, Chen said. The state this year adopted the Center for Disease Control’s 5-microgram standard for the BLL that triggers case management services for affected children, down from its previous 10-microgram standard.
Lead exposure can cause a host of long-lasting problems, including deficits in speech, language, hearing, memory, visual-spatial skills, attention, social behavior, and motor skills. Studies show that people with lead-damaged brains do worse in school and commit more crimes. The national cost of special education, reduced earnings and taxes, and crime due to lead exposure is estimated to run to hundreds of billions of dollars.
A number of interventions are available to help children who have been exposed to lead, such as a method called Fast Mapping that helps kids with autism and other conditions learn vocabulary, said Vicki Sudhalter, a psychologist and former teacher in New York. She demonstrated the technique, which involves showing children a group of images they know — for example, of a rabbit, a cat, and a turtle — and then gradually adding new images for which they are taught the words.
Assistive technologies like iPad apps can help children with fine motor deficits learn to speak correctly and have the advantage of capturing their attention, giving immediate feedback, slowing down kids’ behavior, and tracking their performance, she said. Children who have difficulty controlling their emotional arousal levels may benefit from educational programs that can teach them to monitor themselves before they become upset or violent. Teachers can use techniques such as talking more slowly or stepping away from students to calm down classrooms, Sudhalter said.
Most importantly, by understanding that lead exposure is affecting a child, parents and teachers can avoid making the child think that he or she is simply incapable of learning and doomed to failure in life, she said. Sudhalter said she has had students who have dropped out of school because they expected to do poorly.
“Unfortunately, what happens is that, as the effects of lead poisoning become apparent to the parent, the child begins to hear he or she is being bad, or she’s being disobedient, or she can’t do things. Very early on that becomes a major part of the child’s identity,” Sudhalter said. “Once you get the kid at 16, or even 12, or even 10, it’s very difficult to break that type, to break through that and say, ‘No, you can do it.’”
Conference speakers noted that a number of programs are available to help lead-exposed children. For example, universal preschool programs such as Head Start and New Jersey’s Abbott preschools in 31 low-income districts benefit poor children generally, and in the case of Head Start also include health services.
In addition, the federal Individuals with Disabilities Act (IDEA) includes provisions that can help lead-exposed children, including pre-school-age kids. The law’s Child Find mandate identifies children with histories of lead exposure, the Part C program helps pay for state programs serving infants and toddlers with developmental delays, and an early intervention program allows funds to be spent helping children who are not in special education but still need additional supports. IDEA also helps states pay for special education.
Connecting children with IDEA-funded programs can be tricky, though. For example, Child Find requires states to identify children who are eligible for help, but it’s unclear what blood-lead level makes them eligible, said Jennifer Valvarde, a law professor at Rutgers University who specializes in special education. Since lead-exposed children often display only subtle effects or no effects at all until years later, they may be deemed ineligible for special education even though they need help immediately to start mitigating the effects of exposure.
Another problem is the cost of neuropsychological testing to determine eligibility, which can run $5,000 or more per child.
“No school district will ever, ever, ever pay for it willingly, without you suing them. That’s based on experience,” Valvarde said “If you show that a child has extremely high levels of lead, and you saw already signs of it affecting their education at school, then you can make a good argument to get it paid for, but it’s not guaranteed.”
Valvarde and other speakers acknowledged that they sounded pessimistic about the prospects for lead-exposed children getting the help they need. But some, like Chen, also said it was possible to drive public policy in the direction of supporting more focused and collaborative efforts that are needed to address such a major public health problem. He urged conference attendees to think about the best ways to lobby public officials to make lead-exposure mitigation a priority.
The conference speakers included experts from communities that are aggressively addressing lead exposure in children.
Ralph Spezio, a retired principal from Rochester, NY, described his discovery of rampant lead-poisoning among his students and his participation in a coalition whose efforts drove down lead poisoning in his county 84 percent over a decade.
Mona Hanna-Attisha, a pediatrician who was the first to raise the alarm about lead-tainted water in Flint, spoke over a live video link, reviewing the health and educational programs that are being set up in Flint or that she is working to get funded. David Sciarra of New Jersey’s Education Law Center discussed a federal lawsuit his organization recently filed in Michigan meant to force the state and the Flint schools to fund screening of all children, more special education, universal preschool, and other interventions.
The conference was organized by Isles, Inc., a community development organization in Trenton, and by the Education Research Section and the Center for Health and Wellbeing of Princeton University’s Woodrow Wilson School.