Embry considers the PAX game to be a behavior vaccine for classrooms that helps to build children’s self-regulation, thereby boosting their school success and reducing mental health problems, addictions, bullying, violence, and crime over the long term. Indeed, for some children the game effectively eliminates their ADHD, which is diagnosed by observing behaviors like distraction and impulsivity. By the end of one year with the game, many children no longer display those behaviors, thanks to their increased self-control.
I met Embry at a teacher workshop in Columbia, Maryland, where Johns Hopkins maintains a training center. Embry had the look of an aging elf, or perhaps Willy Wonka. He sported Elton John glasses, a small soul patch, and thinning hair with a tuft on top. This day the theme was blue: turquoise disk earrings and a royal blue skinny-cut suit with a light blue floral shirt and a darker blue floral tie. Pins attached to the breast pocket of his suit jacket resembled a set of military medals, but close up I saw that the pins were candy-colored playful shapes that would look at home on a carousel seat or a preschool playground.
Embry’s fingers clicked on his MacBook as he set up his slideshow presentation. He scoffed at my suggestion that doctors might be too aggressive these days in diagnosing disorders and that kids today have similar struggles as in the past. He pointed to the 30 percent increase in the teen suicide rate over the last decade—and the 50 percent increase in the suicide rate of children ten to fourteen years old. “Dead bodies are hard to overdiagnose,” he said.
“Something has gone dreadfully wrong in behavioral genetics in our world. Anxiety disorders are driving the suicidality and the opiate and much of the marijuana addiction. As younger and younger generations come on board, they’re having earlier depression, and a larger percentage of people are having depression.”
Teachers began to filter into the room, clutching coffee cups. He greeted each one with a cheerful handshake and word of welcome. The room filled with nearly three dozen teachers, most of them female; only three were male. Then the presentation got under way. Embry described the research supporting the PAX game, including a finding by a Johns Hopkins postdoctoral fellow that just one year of playing the game changed gene expression at ages nineteen, twenty, and twenty-one. Children carrying a gene linked to aggression, depression, and ADHD—who played the game in first grade—showed less impulsivity and aggressive behavior at college age. Your genes may incline you to be impulsive or aggressive, but you won’t display such behavior if those genes aren’t expressed. So the fact that the game dampens gene expression is potentially life-changing.
Embry talked about the importance of teachers building a strong relationship with the students in their classrooms. “If you do [things] to children, you get a foul response. If you work through and with the children, you tend to get much faster implementation and behavioral effects,” he said.
As he taught, Embry seemed to be in as constant motion as the children I would later see in Davies’s classroom. To illustrate different points, he did push-ups on a desk, twisted his nose at the thought of something gross, and lay down on a chair and waved his arms madly. During breaks in the training, when the teachers were writing a reflection, he would pace the room, walking up and down the aisles and often coming back to whisper an insight or research reference to me. He led the teachers through an exercise they would do with their students to start the year: he asked them to imagine the most wonderful classroom and to list what they would see, hear, feel, and do in that classroom. “For children to have a vision of a future, they must develop a sense of trust and reliability in peers and other adults, such as their teachers,” he said.
THE TWENTY-FOUR THIRD-GRADERS CROWDED ONTO the carpet at the front of Brandy Davies’s classroom. They gyrated. They jumped. They giggled. They aligned their bodies with the flickering shadows of dancers on the smart board. Then the board went blank. Instantly, they streamed back to their desks, panting and smiling.
This is self-regulation learning in action. Since Davies began using the PAX game, she’d seen a steady increase in her students’ ability to control themselves. When they win one of the nontangible prizes—like a minute of dancing to a GoNoodle video—they enjoy it to the fullest and then switch back into learning mode as soon as the minute ends. The harmonica at the beginning of each game commands their attention without triggering their alarm systems, as a series of claps or a teacher’s raised voice might do. Training on the impact of trauma has given the Ohio Ave teachers an understanding of their students’ vulnerabilities. With a grant, the school bought exercise bikes and fidgets—stress balls, finger toys, and other gadgets that the kids can manipulate with their hands as a way to calm themselves down. The students often ask to bike for five minutes or to use a fidget when they feel agitated.
“It has been such a benefit to these kids in bringing their anxiety levels down and getting them focused on their work,” Davies said. We stood together looking at the line of kid-sized exercise bikes in the hallway. A row of raised knobs and plastic animal shapes dotted the walls at waist level, their surfaces worn smooth by children’s fingers.
Teachers can’t just hand over these toys—different tools work best for each child, she said. First, teachers need to have a strong relationship with the children so that they can learn whether dysregulation is the culprit or whether misbehavior stems perhaps from something as simple as hunger. And of course, they’ve taught the kids to use the toys and the bikes only for stress relief, not when they’re merely bored. During a quiet moment in the classroom Jayliana and Keelin crowded around me to explain the fidgets. “When you’re mad or sad, you can have a fidget. Or you can go pedal,” Jayliana said. “Or you can stay in the classroom, and then you can squeeze and squeeze until you get your stress out.”
I asked how the fidget toy helps her. “It’s soft and everything, and it makes me not feel mad or sad, because if you mad or sad and try to act like you mad or sad, you get in trouble and they gonna call your mom,” she said. Later in the day, she and another girl exchanged heated words as one of them crossed the room. I saw Jayliana return to her desk and pick up a squishy pink ball. She squeezed it, tugged the center, and finally pressed it against her forehead, closing her eyes. Then she went back to her work.
This year Davies’s students had experienced their share of trauma. Kids had been bounced around from Mom’s house to Grandma’s house, eagerly awaited news of their dad’s release from prison, or struggled through their parents’ separation. One girl had lost her stepdad to a fatal shooting while she was in the same house, supposedly sleeping; the teachers suspected, however, that she heard the argument and commotion that led to his death. Another girl’s mother had disappeared and turned up dead. “It’s a handful,” Davies said. “Something will strike her or it’s a time of day, maybe if I’ve said something, tears will just start pouring down her face. If that happens and I see her with tears on her face and she starts coloring and writing, if that’s what she needs to get settled, I don’t mind. She’s not listening anyway.”
At recess, I found the Ohio Ave principal, Olympia Williams, overseeing a playground of children dancing, playing ball, or chasing each other around the jungle gym. She places her priority on teaching behavioral skills through the PAX game, before academics. If the children can’t sit still or are persistently fighting, they’re never going to learn. She also supplements with trauma-informed lessons that teach kids language for their emotions and social skills. “Yes, on the front end you are giving up time. We’re not getting to curriculum on day one. We’re not. But just like you teach the kids what you want to do in reading centers, you really have to teach them about their feelings and give them vocabulary words to describe their feelings.”
Embry likes to describe his debate with officials at a state department of education, who have bought four different reading curriculums over seven years. “How’s that working for you?” he asked them. “Regardless of the curriculum, PAX made reading better. As the child changes at
school, that changes the parent-child relationship with the school. You have fewer calls home, not as much spanking, etc., for getting in trouble in school.”
The PAX chart that collects what the children want to see, hear, feel, and do in their classroom becomes a visible reference throughout the year. “Just like they have an anchor chart for reading and math, they have this anchor chart they can look up to as a reminder, these are the things you guys said you wanted to see more of in the classroom. The teacher didn’t make that up. The principal didn’t make that up. This is your community, and this is what you guys agreed to,” Williams said. “It pushes the ownership and accountability onto the students. A lot of time teachers try to take too much of that, and kids feel like they have no power. They already have no power out of school.”
In the 2016–2017 school year, Ohio Ave received a fourth-grade transfer student who had seen his mother shoot another woman. While his mom was in jail, the boy’s dad had taken custody of him, his first time raising children. The boy spiraled out of control, eventually stabbing a teacher at his previous school in the chest and hand with scissors. The teacher pressed criminal charges. The school requested a psychological evaluation, suspecting emotional disturbance, and transferred him to Ohio Ave.
“I was looking at this kid’s records like, ‘Oh my gosh!’ The first couple of weeks I had to call security,” Williams said. The boy would run out of the classroom without permission and curse at any adult around. But since he arrived, the boy had done a 180. “He used to have four to five incidents a day, and now he has one a month.”
He loved the PAX game and worked with his team to try to win a prize. The school gave him four daily “passes” to leave the classroom when he was feeling overwhelmed, so he had control over when to walk out, but he had to plan and ration the passes. He used to burn through all four. Now he was down to one pass a day, and some days he didn’t even need it.
“It really goes through my mind—how many kids are being identified as emotionally disturbed when in actuality it’s not that they are having this long-term emotional disability but it’s some kind of exposure to trauma and we’re not taking the time to delve into the root cause and figure out what to do to support him?” she said.
As a child, Williams had gone to school with lots of kids who survived trauma. Her mom, a teacher, decided to bus Williams and her siblings to inner-city schools. Rather than walking five minutes to her neighborhood middle school, Williams took a twenty-five-minute bus ride to Champion Middle School in the center of the city. “She felt the teachers were stronger in the schools that were in the bad neighborhoods because they had to do more, they had to overcome more,” she explained. “People said: ‘You’re picking the schools in the bad neighborhood?’ It was more about programming for her.”
Williams majored in biology in part because of the science focus she’d enjoyed in middle school, when she planned to become a doctor. But after earning her bachelor’s, she changed her mind. Why go to school forever and end up in debt? She got a master’s degree in elementary education and became a teacher. In 2012, seeking greater autonomy to make decisions that would impact more children, she made the leap to principal. “I love what I do. I love the school,” she said. “I also advocate for principals and for people who supervise principals to understand the level of the work of the principal. You can’t even describe it. It’s nonstop.”
During the school day, Williams likes to be in the hallways and classrooms, available to students and teachers who may need her. As a result, mountains of papers pile up on her desk. She told me: “The staff jokes, ‘Your mountains are lower today,’ or, ‘It looks like the mountain is high.’” Williams does her own self-regulating through weekly visits with a counselor and stress management exercises, including breathing.
There’s simply too much work to do in the day. Williams stays after school to complete paperwork and takes pride in her work. But whenever she has to choose between meeting the needs of the children in front of her and filling out forms, the kids win.
“You’re going to have to decide what you’re going to be known for and what you won’t bend for. For me, it’s this whole premise of the whole child. That’s the thing that will take precedence over me doing budgetary stuff or a compliance notebook. I will say, you can’t do everything and do it well,” she said. “I’m a perfectionist. I really care about my job. I want to do well at everything; however, some things have to go to the wayside.”
Before implementing PAX, the school used the red-green-yellow behavior charts that are so common in US classrooms. Each child has the three colors beside their name, with a clip to indicate the teacher’s assessment of their behavior so far that day. In retrospect, Williams sees how that system actually exacerbates bad behavior. Children who are prone to outbursts flip out when they’re moved down to yellow or red—especially since it’s publicly visible to all their classmates.
“They do not want to be singled out for a negative,” she said. Often these kids would just give up and stop trying to behave better. “Some kids couldn’t get back from that. If they got red, they’d be, ‘I’m done.’”
Ohio Ave began PAX in earnest with one dozen teachers trained in 2014–2015, and then the majority on board by the 2016–2017 school year. You can see the results in the drop in use of the time-out room. Teachers used to send students out all the time, and sometimes they’d stay out for hours. In 2013–2014, the school saw 355 time-outs for under an hour; that number fell 77 percent, to 83 time-outs, in 2016–2017. They experienced an even more dramatic drop in time-outs lasting more than an hour, which significantly impact instructional time. Those fell from 317 in the baseline year to 39 three years later—a whopping 88 percent decline.
“This means it’s more time the child is in the classroom, they have strategies,” Williams said. “They’re still hearing the instruction that’s going on, so they’re able to get back on track or work on their work. If they go to the time-out room, they might take their work with them, but by the time they get back to the classroom they’re already behind. The other kids are doing work. That sets the kid off again.”
“Most of our kids are below grade level anyway—it’s not like they’re independent workers that can come back and get back on track,” she said. “Before this method, they might say, ‘Jeremy you’re not in your seat.’ It would escalate to more and take more time to resolve.”
Davies felt skeptical when she first took the PAX training. The high-tech language and theoretical discussion bored her. These kids are going to hate it, she remembered thinking. She’d gotten into teaching to help students like herself: no matter how hard she tried, she’d always gotten Ds and Fs. She wanted to help nontraditional learners.
But as soon as Davies saw the on-site counselor, Kady Lacy, demonstrate a game with her kids, it clicked. Whenever Davies got stuck, she’d call Lacy and they’d work through the problem. Lacy came to Ohio Ave as part of Nationwide Children’s Hospital’s outreach to the community. The hospital wants to provide universal prevention to the most at-risk communities so that behavioral and mental health problems don’t spiral out of control. Ultimately, untreated issues land children and adults alike in emergency rooms, where doctors can do little but patch them up. It’s far more effective for professionals to work with at-risk families before problems get too big.
Nationwide Children’s Hospital clinicians like Lacy receive full responsibility for individual schools: they see children for counseling and serve as a resource for each school’s staff. Some Ohio school districts even train their bus drivers in trauma-informed practices so that they can intervene in problems without escalating kids’ dysregulation. Each county’s Alcohol, Drug, And Mental Health (ADAMH) board oversees the initiatives and gives grants to support programs such as PAX. Ohio’s economy still hasn’t recovered from the Great Recession: poverty remains rampant, and more than 50 percent of children in the state are considered economically disadvantaged. Ohio Ave Elementar
y qualifies as a high-poverty school. Some students are even homeless. Of the 331 total students, 86 percent are black, 7 percent are white, 5 percent are multiracial, and 2 percent are Hispanic.
“Being involved with the schools, this is an opportunity to get kids before they hit that school-to-prison pipeline. Our missions are to decrease the gap in the access to care and to remove non-academic barriers to academic success,” said Kamilah Twymon, clinical coordinator for Nationwide’s school-based services and community partnerships. “The schools recognize that sometimes kids bring a whole lot with them. Families, if they’re at the beginning of this journey, it’s very difficult to navigate the mental health system sometimes. Even if we can point them in the right direction, they’re already dealing with a lot. It helps.”
Twymon grew up on the west side of Columbus, raised by a vigilant single mom. The few times Twymon started drifting off the rails—cutting school, getting mouthy—her mom wrenched her back. Her mother would take time off from work to go to the school, and she would contact Twymon’s friends’ parents so they could all supervise their girls better. “My mom was on it every single time. It was more than punishment. It was discussions and learning opportunities,” she said.
Twymon’s three children—a sophomore in college and a junior and a freshman in high school—all went to Columbus city schools too, even after the family moved to the Pickerington suburb. “It’s a combination of my personal values and having a personal stake and claim. I’ve always been an advocate for underprivileged and marginalized populations,” she said. Immediately after getting her counseling license, she took a job keeping delinquent kids out of restrictive placement. She joined the Nationwide program hoping to catch the children earlier, to prevent some of the damage she saw in her clients. While her division doesn’t make money for the hospital, she’s proud of the money she knows is saved by interventions such as PAX—in lower utilization of Medicaid, fewer emergency department visits, less adult drug use, lower criminal involvement, and higher graduation rates. PAX even qualifies as preventative care under grants given to address the opioid crisis.
The Good News About Bad Behavior Page 19