Tuesday, December 11, 2018

By Laura Hedli

Can mindset help teens remember to take their medication? Or a fourth grader to keep trying when homework is hard?

Developmental-behavioral pediatrician, Irene Loe, MD, began to think of these questions around two years ago as she listened to pediatric surgeon, Claudia Mueller, PhD, MD, give a talk about growth mindset and physical health. Dr. Mueller has found that children with Type 1 diabetes who adopted growth mindsets had lower blood glucose levels than children who believed their health couldn’t change or was governed purely by genetics.

Growth mindset is a popular concept in educational psychology that at its core is a belief in the power of self-improvement through application and hard work. Much like Dr. Mueller, Dr. Loe was eager to apply growth mindset—historically used to influence academic performance—to alter behavior in different domains.

The Maternal and Child Health Research Institute (MCHRI) was an early supporter of mindset and has been actively engaged in funding work in this area since 2008, when it named Dr. Mueller the Tashia and John Morgridge Faculty Scholar in Pediatric and Translational Medicine. Earlier in 2018, MCHRI named Dr. Loe the Akiko Yamazaki and Jerry Yang Faculty Scholar in Pediatric Translational Medicine, which provides her with $500,000 in funding over five years. This award will allow her pursue not only a passion project that she’s been piecing together for several years but also a line of research that is different from anything she has ever done before. Dr. Loe and her collaborators will incorporate community-based participation to design and implement a growth mindset intervention in an underserved community school in the Tenderloin neighborhood of San Francisco.

Conducting research in a school environment, while new for Dr. Loe, is highly relevant to her work as a pediatrician. The patients she sees in the clinic often are referred because they are having trouble in school due to behavior problems, developmental delays, Attention Deficit Hyperactivity Disorder, or learning disabilities that affect overall health and wellbeing. She wonders whether pediatricians can empower parents by talking openly about growth mindset, providing them with knowledge and approaches they can use to help their children succeed—it’s what she’ll test in her Faculty Scholar research.

Indeed, research has shown that children who are taught to cultivate a growth mindset are not only able to boost their academic performance, but they may exhibit less aggression in their social relationships and can improve their physical health.

Broadening the application of growth mindset

One of the classic growth mindset papers by Dr. Mueller and Carol Dweck, PhD—the Lewis and Virginia Eaton Professor of Psychology who has written 5 books on mindset—showed that praise for effort is more effective than praise for intelligence. A child who is praised for their efforts and learns a growth mindset is more likely to persist when given a challenge. A child who is praised for their intelligence and adopts a more fixed mindset is less likely to keep trying when they encounter an obstacle. In fact, praising for intelligence may actually undermine children’s abilities and achievement motivation.

Dr. Loe believes “mindset could have application to other areas besides just intelligence.” Indeed, research has shown that children who are taught to cultivate a growth mindset are not only able to boost their academic performance, but they may exhibit less aggression in their social relationships and can improve their physical health, as Dr. Mueller has shown with her research on children with diabetes.

Dr. Mueller, who was a Faculty Scholar from 2008-2013, credits MCHRI with providing her the funding to do preliminary research on growth mindset and health that now forms the cornerstone of her career. “To get those studies out that helped prove, to me at least as well as others, that mindset has legs and actually could function in a very different setting than had been established previously in psychology,” she says.

Dr. Mueller will serve as a co-investigator on Dr. Loe’s Faculty Scholar research, which will focus on applying a growth mindset to the domains of health, behavior and learning. Researchers are specifically interested in executive function as it relates to behavior and learning.

“Executive function is something that develops over time,” Dr. Loe explains, adding that it’s a domain of school readiness that she assesses in young children. “It refers to a set of related cognitive skills that are really important for later academic achievement, social skills and even linked to adaptive function.”

Working memory is a subcomponent of executive function. So if somebody gives you their telephone number, can you remember the digits in your head while continuing to listen to what the other person is saying? Executive function is also involved in goal setting, organization, prioritizing, and planning. For example, can you engage in both short-term and long-term planning to complete a task or achieve a specific goal?

“Part of the reason I’ve been going after executive function is that we think of these skills as things that you could practice or that might be more malleable,” says Dr. Loe. The intervention she designs will target parents of children who are in preschool through fifth grade at Tenderloin Community School. She and her collaborators will educate parents about growth mindset, executive function, and attention, and will teach parents strategies they can use to encourage growth mindsets in their children. A secondary outcome will involve measuring children’s behavior change and learning outcomes before and after intervention to see if their parents have become, as Dr. Loe says, “agents for change.”

Designing a culturally sensitive intervention

Dr. Loe previously received two MCHRI Pilot Early Career awards of $35,000 each to research executive function. Her earlier efforts focused on measuring executive function differences between preschoolers who were born preterm versus full-term, and many of her subjects were recruited from Stanford’s High-Risk Infant Follow-Up Program. By comparison, her Faculty Scholar research will involve the parents and children of an underserved, diverse community school in a neighborhood beset by poverty, homelessness, violence and barriers to healthcare access.

Emphasis of growth mindset in a school setting has been received with some caution by certain educators and researchers who say it undervalues systemic factors like racism or socioeconomic inequity and solely attributes academic performance to individual character. While Dr. Loe feels mindset may be more under the control of an individual than larger societal factors and may therefore serve as an empowering tool for parents and children, she is taking steps to ensure the project is sensitive to the community’s needs.

Her collaborators have a long history of advocating on behalf of children in the Tenderloin. Midge Wilson, who is the Executive Director and Co-Founder of the nonprofit Bay Area Women’s and Children’s Center, led a 10-year campaign to have San Francisco Unified School District build an elementary school in the Tenderloin in 1998. (Previously, there was no public school in the neighborhood, and children were being bused as far as Treasure Island for classes.)  Barbara Berman, PhD, is the principal at Tender Community School, and community principal investigator on the project, Kara Wright, MD, MPH, runs an advocacy program there. Years ago, Dr. Wright found that many children in the neighborhood were lacking dental care, so she was able to help open a free dental clinic at the school.

To better understand socio-cultural differences, the researchers will lead focus groups with parents during the first phase of the project. These groups will be conducted in a variety of languages including English, Spanish, Arabic, Vietnamese, and perhaps others.

“We can’t fix every single problem that underserved communities face, but I was trying to think of it more from [the perspective of]: Can we empower parents to feel more engaged with their kids?

Thinking big picture

“I was inspired to think about this more globally,” says Dr. Loe of her growth mindset intervention. “We can’t fix every single problem that underserved communities face, but I was trying to think of it more from [the perspective of]: Can we empower parents to feel more engaged with their kids? To feel more engaged with their communities? To feel that they have more control over some of these things that they might otherwise feel they don’t have a lot of control over?”

Dr. Mueller adds that the study may help parents have a different view of what’s possible in education and may change how parents utilize what’s available to them. For the researchers, she says it will be useful to see how growth mindset can be passed from parent to child. “We always ask ourselves: Where do these mindsets come from? The obvious answer is: Oh, they come from parents,” Dr. Mueller says. “But that link between parents and kids—it isn’t as clear as you might think physiologically and hasn’t actually been well substantiated in the literature.”

Dr. Loe credits MCHRI with providing her with the opportunity to collect pilot data from Tenderloin Community School to understand if she and her collaborators are moving in the right direction in the ways they’re aiming to apply growth mindset.

“This is a dream project of mine,” she says. “It has many elements of different types of research, things that I’ve been thinking about for many years but never really put together until now.”

Laura Hedli is a writer for the Division of Neonatal and Developmental Medicine in the Department of Pediatrics and contributes stories to the Stanford Maternal and Child Health Research Institute.