Blood pressure connected to eye health in young children
June 29, 2020
Science Daily/American Heart Association
Young children with narrow retinal artery diameters were more likely to develop higher blood pressure, and children with higher blood pressure levels were more likely to develop retinal microvascular impairment during early childhood, according to a new study published today in Hypertension, an American Heart Association journal. This is the first study to show this connection in children.
High blood pressure, the main risk factor for the development of cardiovascular disease (CVD), can manifest as early as childhood, and the prevalence of high blood pressure among children continues to rise. In previous studies, analysis of blood vessels in the retina has shown promise as a predictor of CVD risk among adults. In the study titled, "Retinal Vessel Diameters and Blood Pressure Progression in Children," researchers sought to predict the development of high blood pressure in children over four years based on retinal blood vessel measurements.
"Hypertension continues as the main risk factor for the development of cardiovascular diseases and mortality," says Henner Hanssen, M.D., the study's lead author and a professor in the department of sport, exercise and health at the University of Basel in Switzerland. "Primary prevention strategies are needed to focus on screening retinal microvascular health and blood pressure in young children in order to identify those at increased risk of developing hypertension. The earlier we can provide treatment and implement lifestyle changes to reduce hypertension, the greater the benefit for these children."
Researchers screened 262 children ages six to eight from 26 schools in Basel, Switzerland, in 2014, for baseline blood pressure and retinal arterial measurements. Both measures were taken again in 2018. Blood pressure measurements at both baseline and follow-up were performed in a sitting position after a minimum of five minutes of rest and were categorized based on the American Academy of Pediatrics' blood pressure guidelines. These guidelines utilize the same measurements as the American Heart Association/American College of Cardiology 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.
Results from the analysis indicate:
children with narrower retinal vessel diameters at baseline developed higher systolic blood pressure at follow-up;
retinal vessel diameters could explain 29 -31% of the changes in systolic blood pressure progression between 2014 and 2018;
children with higher blood pressure levels at baseline developed significantly narrower arteriolar diameters at follow-up, depending on weight and cardiorespiratory fitness; and
initial blood pressure measures explained 66-69% of the change in retinal arteriolar diameter from baseline to follow-up.
"Early childhood assessments of retinal microvascular health and blood pressure monitoring can improve cardiovascular risk classification. Timely primary prevention strategies for children at risk of developing hypertension could potentially counteract its growing burden among both children and adults," said Hanssen.
Researchers noted limitations of their study include that they could not confirm blood pressure measurements over a single 24-hour period, so they would not account for "white coat" hypertension, a condition where patients have high blood pressure readings when measured in a medical setting. Developmental stage
Children of academics exhibit more stress
June 25, 2020
Science Daily/Ruhr-University Bochum
Starting university is an exciting phase for everyone. However, children from academic households exhibit significantly more stress during this period than those from non-academic families. A Swiss-German research team has found this out by analysing the hair of female first-year students. Study authors Professor Alex Bertrams from the University of Bern and Dr. Nina Minkley from Ruhr-Universität Bochum (RUB) have concluded that students may be stressed by the fear of jeopardising the social status of their families if they fail their degrees. They published their report in Frontiers of Psychiatry on 5 June 2020.
Stress hormone accumulates in the hair
In stressful situations, the body releases an increased amount of the hormone cortisol, which also reaches growing hair and is stored there if the levels remain high over a lengthy period of time. By analysing the hair, researchers can identify the phases when a person had more stress.
In order to find out whether the stress levels of young people from different family backgrounds differ when they're starting university, the research team recruited a total of 71 test persons. "The only inclusion criteria were that they started their first semester and that they had sufficiently long hair," explains Nina Minkley from the Behavioural Biology and Didactics of Biology research group at RUB. "In the end, this meant that we recruited almost only women, and we decided not to include the few eligible men to avoid falsifying the results."
Strands of hair and questionnaires
The participants supplied the research team with three thin strands of hair each, which were cut off near the scalp. Since a hair grows about one centimetre per month, the researchers examined the latest one and a half centimetres that had grown in the six weeks since the beginning of the semester. In addition, the participants filled out questionnaires in which they provided information about their parents' educational background. They were also asked about the stress they subjectively perceived.
It emerged that first-year students from academic households where at least one parent had a university degree exhibit higher stress levels than those from non-academic households, even though they didn't differ in other respects. The subjectively perceived stress levels, for example, were the same.
Stress due to impending loss of status
The research team interprets this result as an indication of female students from academic households being under greater pressure, because failing their study would result in a loss of status for them and their families. This is in line with findings in sociological studies, which have shown that children of academics tend to go to university even if their academic performance isn't expected to be successful, based on their school grades. "Children of non-academics, on the other hand, can only win and are therefore probably less stressed," concludes Minkley.
https://www.sciencedaily.com/releases/2020/06/200625144820.htm
Cyberbullying linked to post traumatic stress for victims and perpetrators
Children should be screened for symptoms, suggest researchers
June 23, 2020
Science Daily/BMJ
Cyberbullying -- bullying online rather than face to face -- is linked to various types of post traumatic stress disorder (PTSD) symptoms, both for victims and perpetrators, suggests the first study of its kind, published online in the Archives of Disease in Childhood.
Their findings prompt the researchers to suggest that asking about cyberbullying should become a routine part of any children's mental health or psychological assessment.
The prevalence of cyberbullying among teens is thought to be between 10% and 40% and to pose specific risks because it can be done day and night, in various contexts, is rapid, anonymous, and reaches a wide audience, say the researchers.
It has been suggested that there may be some overlap between traditional bullying and cyberbullying.
To explore this further, and find out what the mental health impact of cyberbullying might be, the researchers questioned 2218 pupils aged between 11 and 19 from four secondary schools in London about their experiences of bullying.
They used The Olweus Bully/Victim Questionnaire to find out what type of bullying the teens had been involved with, how often this had happened, and for how long it had lasted.
And they screened for PTSD symptoms using the Children Revised Impact of Events Scale (CRIES), which has two dimensions: intrusive thoughts and avoidance behaviours.
Just over half the teens were girls (55%). Around a third (34%) were of white ethnicity; two thirds were of black, Asian and other minority ethnic backgrounds. Most of the children (80%) had been born in the UK.
The survey responses showed that nearly half (46%) of all the pupils reported a history of any type of bullying: 17% as victims; 12% as perpetrators; and 4% as both.
But involvement in traditional bullying (1 in 3 of the teens) was more common than involvement in cyberbullying (1 in 4).
Some 13% of the teens had been cyberbullied; 8.5% had bullied others online; and 4% had been both victim and perpetrator. Some 16% of the teens had been bullied in person; 12% had bullied others in person; and 6.5% had been both victim and perpetrator.
There was some overlap between both types of bullying, although pure cyberbullies were less likely to also be traditional bullies.
Half of those involved in a specific role in cyberbullying were also involved in the same role in traditional bullying: 52% of cyber victims were also traditional victims; 45.5% of cyber victims were also traditional bully victims; and 48% of the cyberbullies were also traditional bullies.
Around 72% (1516) of the teens completed the CRIES assessment. More than a third of cyber victims (35%), more than one in four (29%) of the cyberbullies, and a similar proportion (28%) of those who were both, scored above the threshold for clinically significant PTSD symptoms.
Further analysis indicated that cyber victims displayed significantly more PTSD symptoms than did cyberbullies, and they experienced more intrusive thoughts and avoidance behaviours.
Cyberbullies also had significantly more PTSD symptoms than teens who weren't involved in any form of bullying.
This is an observational study, so can't establish cause and effect. It also relied on subjective reports, and it didn't include a full clinical assessment of suspected PTSD symptoms.
And while the sample was representative of UK urban teens, the findings may not be applicable to other regions or countries, caution the researchers.
Nevertheless, they suggest their findings have important implications. "Parents, teachers and health professionals need to be aware of possible PTSD symptoms in young people involved in cyberbullying," they write.
And they note: "Despite cyberbullying being less frequent than traditional bullying, it is noteworthy that more than a third of the cyberbullies were not involved in traditional bullying, whereas a huge majority of the cyberbully victims were involved in traditional bullying, mainly as traditional victims or [as both victim and perpetrator].
"This suggests that the anonymity provided to perpetrators online may constitute a new platform for bullying to occur, though this finding requires further study."
https://www.sciencedaily.com/releases/2020/06/200623185242.htm
Poor sleep significantly linked with teenage depression
Depression group slept 30 minutes less per night than other groups in study
June 17, 2020
Science Daily/University of Reading
Teenagers who experience very poor sleep may be more likely to experience poor mental health in later life, according to a new study.
In a paper published in the Journal of Child Psychology and Psychiatry, researchers analysed self-reported sleep quality and quantity from teenagers and found that there was a significant relationship between poor sleep and mental health issues.
The team, based at the University of Reading, and Goldsmiths and Flinders Universities found that among the 4790 participants, those who experienced depression reported both poor quality and quantity of sleep, while those with anxiety had poor quality of sleep only, compared to those teenagers who took part who didn't report anxiety or depression.
Dr Faith Orchard, a Lecturer in Clinical Psychology at the University of Reading said:
"This latest research is another piece of evidence to show that there is a significant link between sleep and mental health for teenagers. This study highlights that those young people who have experienced depression and anxiety had overwhelmingly experienced poor sleep during their teens.
"What's noticeable is that the difference in average amount of sleep between those who experienced depression, which amounts to going to sleep 30 minutes later each night compared to other participants. Within the data, there were some participants who reported hugely worse quality and quantity of sleep, and the overall picture highlights that we need to take sleep much more into account when considering support for teenager wellbeing."
Teens were asked to self-report on sleep quality and quantity over a series of issues, and the researchers found that the control group of teenagers were on average getting around eight hours of sleep a night on school nights and a little over nine and half hours sleep on weekends.
Meanwhile, the group who had a depressive diagnosis were getting less than seven and a half hours sleep on week nights and just over nine hours sleep at weekends.
A co-author, Professor Alice Gregory from Goldsmiths University, said:
"The National Sleep Foundation recommends that adolescents aged between 14-17 years typically need around 8-10 hours of sleep each night. What is notable here is that the group with a diagnosis of depression most clearly fell outside of these recommendations during the week -- getting on average 7.25 hours of sleep on each school night."
The depression group were therefore reporting an average total of 3325 minutes of sleep a week compared to the control group who reported 3597, meaning that the depression group were on average getting 272 minutes or three and a half hours less sleep a week.
While the team noted that although the data was based on self-reporting of sleep and therefore less accurate, the fact of self-reported worse quality and quantity of sleep was still significant.
Dr Orchard said:
"What we are now seeing is that the relationship between sleep and mental health for teenagers is a two way street. While poorer sleep habits are associated with worse mental health, we are also seeing how addressing sleep for young people with depression and anxiety can have a big impact on their wellbeing.
"It's also important to note that the numbers of young people who report anxiety and depression are still low overall. Good sleep hygiene is important, and if you are concerned about yours or your child's wellbeing we strongly encourage you to seek support from your doctor, but any short term negative impact on sleep is not a cause for alarm."
Professor Gregory said:
"The Department for Education is aware of the importance of sleep in children and adolescence -- and it is really good news that from September 2020 Statutory Guidance will mean that they will be taught about the value of good quality sleep for many aspects of their lives including their mood."
Co-author Professor Michael Gradisar from Flinders University, Australia said:
"This longitudinal study confirms what we see clinically -- that poor sleep during adolescence can be a 'fork in the road', where a teen's mental health can deteriorate if not treated. Fortunately there are sleep interventions available for schools and individual families -- and these can place teens back on the road to healthy sleep.."
https://www.sciencedaily.com/releases/2020/06/200617194508.htm
Air quality impacts early brain development
Study explores how living close to roadways may impact the brain
June 17, 2020
Science Daily/University of California - Davis
Researchers at the University of California, Davis, have found a link between traffic-related air pollution and an increased risk for changes in brain development relevant to neurodevelopmental disorders. Their study, based on rodent models, corroborates previous epidemiological evidence showing this association.
While air pollution has long been a concern for pulmonary and cardiovascular health, it has only been within the past decade that scientists have turned their attention to its effects on the brain, said UC Davis toxicologist Pamela Lein, senior author of the study, recently published in Translational Psychiatry.
Researchers had previously documented links between proximity to busy roadways and neurodevelopmental disorders such as autism, but preclinical data based on real-time exposures to traffic-related air pollution was scarce to nonexistent.
Lein worked with UC Davis atmospheric scientist Anthony Wexler and first author Kelley Patten, a doctoral student in the UC Davis graduate group for pharmacology and toxicology, to develop a novel approach to study the impacts of traffic-related air pollution in real time. They set up a vivarium near a traffic tunnel in Northern California so they could mimic, as closely as possible, the experience of humans in a rodent model.
"This approach was a creative way to get at the question of what impacts air pollution has on the brain in the absence of confounding factors such as socioeconomic influences, diet, etc.," Lein said. "It's important to know if living close to these roadways poses a significant risk to the developing human brain.
"If it does," Lein continues, "scientists can warn susceptible individuals, such as pregnant women -- particularly those who have already had a child diagnosed with a neurodevelopmental disorder -- to take appropriate precautions to minimize risks to the health of their child's brain."
EARLY EXPOSURE OUTCOMES
The researchers compared the brains of rat pups exposed to traffic-related air pollution with those exposed to filtered air. Both air sources were drawn from the tunnel in real time.
They found abnormal growth and increased neuroinflammation in the brains of animals exposed to air pollution. This suggests that air pollution exposure during critical developmental periods may increase the risk for changes in the developing brain that are associated with neurodevelopmental disorders.
"What we witnessed are subtle changes," Patten said. "But we are seeing these effects using air pollution exposures that fall within regulatory limits. With the backdrop of other environmental and genetic risk factors in humans, this may have a more pronounced effect. This exposure also contains very fine particulate matter that isn't currently regulated."
In a separate study, Patten extended this exposure for 14 months to look at longer-term impacts of traffic-related air pollution and is in the process of writing up those results.
The team is also interested in what component of traffic-related air pollution is driving the neurodevelopmental outcomes.
If they can identify the culprits, Lein said, then scientists can approach legislators to develop scientifically based regulations to protect the developing human brain.
TEAM EFFORTS
UC Davis atmospheric scientist and co-author Keith Bein said that the single most challenging aspect of studying the health effects of air pollution may be replicating how, when and what people are exposed to throughout their lifetimes.
Tackling this requires creative thinking and a multidisciplinary team of researchers, including exposure engineers, atmospheric scientists, toxicologists, biologists, behaviorists and animal care specialists.
"We have managed to build a unique and talented team and taken advantage of our built environment to bring us closer than we've been before to achieving these objectives," Bein said. "Increasingly, these types of efforts are required to continue advancing the field, thereby informing policymakers and stakeholders about how best to protect human health."
Other study co-authors include: Eduardo González and Anthony Valenzuela, UC Davis School of Veterinary Medicine; Elizabeth Berg, UC Davis School of Medicine; Christopher Wallis, UC Davis Air Quality Research Center; Joel Garbrow, Washington University; and Jill Silverman at the UC Davis MIND Institute and School of Medicine. The study was supported by the National Institutes of Health.
https://www.sciencedaily.com/releases/2020/06/200617145934.htm
Impact of children's loneliness today could manifest in depression for years to come
May 31, 2020
Science Daily/University of Bath
Children and adolescents are likely to experience high rates of depression and anxiety long after current lockdown and social isolation ends and clinical services need to be prepared for a future spike in demand, according to the authors of a new rapid review into the long-term mental health effects of lockdown.
The research, which draws on over 60 pre-existing, peer-reviewed studies into topics spanning isolation, loneliness and mental health for young people aged 4 -- 21, is published today (Monday 1 June 2020) in the Journal of the American Academy of Child and Adolescent Psychiatry.
According to the review, young people who are lonely might be as much as three times more likely to develop depression in the future, and that the impact of loneliness on mental health could last for at least 9 years.
The studies highlight an association between loneliness and an increased risk of mental health problems for young people. There is also evidence that duration of loneliness may be more important than the intensity of loneliness in increasing the risk of future depression among young people.
This, say the authors, should act as a warning to policymakers of the expected rise in demand for mental health services from young people and young adults in the years to come -- both here in the UK and around the world.
Dr Maria Loades, clinical psychologist from the Department of Psychology at the University of Bath who led the work, explained: "From our analysis, it is clear there are strong associations between loneliness and depression in young people, both in the immediate and the longer-term. We know this effect can sometimes be lagged, meaning it can take up to 10 years to really understand the scale of the mental health impact the covid-19 crisis has created."
For teachers and policymakers currently preparing for a phased re-start of schools in the UK, scheduled from today, Monday 1 June, Dr Loades suggests the research could have important implications for how this process is managed too.
She adds: "There is evidence that it's the duration of loneliness as opposed to the intensity which seems to have the biggest impact on depression rates in young people. This means that returning to some degree of normality as soon as possible is of course important. However, how this process is managed matters when it comes to shaping young people's feelings and experiences about this period.
"For our youngest and their return to school from this week, we need to prioritise the importance of play in helping them to reconnect with friends and adjust following this intense period of isolation."
Members of the review team were also involved in a recent open letter to UK Education Secretary, Gavin Williamson MP, focusing on support for children's social and emotional wellbeing during and after lockdown. In their letter they suggested that:
- The easing of lockdown restrictions should be done in a way that provides all children with the time and opportunity to play with peers, in and outside of school, and even while social distancing measures remain in place;
- Schools should be appropriately resourced and given clear guidance on how to support children's emotional wellbeing during the transition period as schools reopen and that play -- rather than academic progress -- should be the priority during this time;
- The social and emotional benefits of play and interaction with peers must be clearly communicated, alongside guidance on the objective risks to children.
Acknowledging the trade-offs that need to be struck in terms of restarting the economy and reducing educational disparities, their letter to the Education Secretary concludes: 'Poor emotional health in children leads to long term mental health problems, poorer educational attainment and has a considerable economic burden.'
https://www.sciencedaily.com/releases/2020/05/200531200333.htm
Family environment affects adolescent brain development
May 20, 2020
Science Daily/Karolinska Institutet
Childhood environment and socioeconomic status affect cognitive ability and brain development during adolescence independently of genetic factors, researchers at Karolinska Institutet report in a new study published in the journal PNAS. The study demonstrates how important the family environment is, not just during early infancy but also throughout adolescence.
While the way in which genes and environment affect the brain and cognitive faculties is a hotly debated topic, previous studies have not taken genes into account when describing environmental effects. Researchers at Karolinska Institutet in Sweden have therefore studied both environmental factors and a new genetic measure -- an index value based on an aggregation of the 5,000 or so DNA locations that are most strongly associated with educational attainment.
The study involved 551 adolescents from different socioeconomic environments around Europe. At the age of 14, the participants gave DNA samples, performed cognitive tests and had their brain imaged in a MR scanner, a process that was repeated five years later.
At the age of 14, genes and environment were independently associated with cognitive ability (measured using working memory tests) and brain structure. The environmental effects were, however, 50 to 100 per cent stronger than the genetic. Differences in socioeconomic status were related to differences in the total surface area of the neocortex.
"The previous debate was whether there is a special area that is affected by the environment, such as long-term memory or language," says Nicholas Judd, doctoral student at the Department of Neuroscience, Karolinska Institutet and co-first author of the study along with his departmental colleague Bruno Sauce. "However, we've been able to show that the effect occurs across the neocortex and so probably affects a whole host of functions."
Genetic differences were also linked to brain structure, affecting not only the brain's total area but also specifically an area of the right parietal lobe known to be important for mathematical skills, reasoning and working memory. This is the first time a brain area has been identified that is linked to this genetic index.
When the researchers followed up on the teenagers five years later, they were able to examine how genes and environment had affected the brain's development during adolescence. What they discovered was that while the genes did not explain any of the cerebral changes, the environment did. However, it is unknown which aspect of the environment is responsible for this.
"There are a number of possible explanations, such as chronic stress, diet or intellectual stimulation, but the study shows just how important the environment is, not only during early childhood," says principal investigator Torkel Klingberg, professor of Cognitive Neuroscience at the Department of Neuroscience, Karolinska Institutet. "Finding the most important environmental factors for optimising childhood and adolescent development is a matter for future research."
https://www.sciencedaily.com/releases/2020/05/200520131330.htm
Healthy eating behaviors in childhood may reduce the risk of adult obesity and heart disease
May 11, 2020
Science Daily/American Heart Association
Encouraging children to make their own decisions about food, within a structured environment focused on healthy food choices, has been linked to better childhood nutrition and healthier lifelong eating behaviors. Parents and caregivers can play a significant role in creating an environment that helps children develop healthier eating behaviors early in life, which can reduce the risk for overweight, obesity and cardiovascular disease as adults.
How children are fed may be just as important as what they are fed, according to a new scientific statement from the American Heart Association, "Caregiver Influences on Eating Behaviors in Young Children," published today in the Journal of the American Heart Association.
The statement is the first from the Association focused on providing evidence-based strategies for parents and caregivers to create a healthy food environment for young children that supports the development of positive eating behaviors and the maintenance of a healthy weight in childhood, thereby reducing the risks of overweight, obesity and cardiovascular disease later in life.
Although many children are born with an innate ability to stop eating when they are full, they are also influenced by the overall emotional atmosphere, including caregiver wishes and demands during mealtimes. If children feel under pressure to eat in response to caregiver wants, it may be harder for them to listen to their individual internal cues that tell them when they are full.
Allowing children to choose what and especially how much to eat within an environment composed of healthy options encourages children to develop and eventually take ownership of their decisions about food and may help them develop eating patterns linked to a healthy weight for a lifetime, according to the statement authors.
"Parents and caregivers should consider building a positive food environment centered on healthy eating habits, rather than focusing on rigid rules about what and how a child should eat," said Alexis C. Wood, Ph.D., the writing group chair for the scientific statement and assistant professor at the U.S. Department of Agriculture/Agriculture Research Services Children's Nutrition Research Center and the department of pediatrics (nutrition section) at Baylor College of Medicine in Houston.
The statement suggests that parents and caregivers should be positive role models by creating an environment that demonstrates and supports healthy food choices, rather than an environment focused on controlling children's choices or highlighting body weight. Parents and caregivers should encourage children to eat healthy foods by:
providing consistent timing for meals;
allowing children to select what foods they want to eat from a selection of healthy choices;
serving healthy or new foods alongside foods children already enjoy;
regularly eating new, healthy foods while eating with the child and demonstrating enjoyment of the food;
paying attention to a child's verbal or non-verbal hunger and fullness cues; and
avoiding pressuring children to eat more than they wish to eat.
Wood noted that some parents and caregivers may find it challenging to allow children to make their own food decisions, especially if the children become reluctant to try new foods and/or become picky eaters. These behaviors are common and considered normal in early childhood, ages 1 to 5 years, as children are learning about the tastes and textures of solid foods. Imposing rigid, authoritarian rules around eating and using tactics such as rewards or punishments may feel like successful tactics in the short term. However, research does not support this approach; rather, it may have long-term, negative consequences. An authoritarian eating environment does not allow a child to develop positive decision-making skills and can reduce their sense of control, which are important developmental processes for children.
In addition, the authoritarian approach has been linked to children being more likely to eat when they are not hungry and eating less healthy foods that are likely higher in calories, which increase the risk of overweight and obesity and/or conditions of disordered eating.
On the other hand, an indulgent approach, where a child is allowed to eat whatever they want whenever they want, does not provide enough boundaries for children to develop healthy eating habits. Research has also linked this "laissez-faire" approach to a greater risk of children becoming overweight or having obesity.
Research does suggest that some strategies can increase children's dietary variety during the early years if they are "picky" or "fussy" about foods. Repeatedly offering children a wide variety of healthy foods increases the likelihood they will accept them, particularly when served with foods they prefer. In addition, caregivers or parents who enthusiastically eat a food may also help a child accept this food. Modeling eating healthy foods -- by caregivers, siblings and peers -- is a good strategy for helping children to be open to a wider variety of food options.
"Children's eating behaviors are influenced by a lot of people in their lives, so ideally, we want the whole family to demonstrate healthy eating habits," said Wood.
It is important to note that not all strategies work for all children, and parents and caregivers should not feel undue stress or blame for children's eating behaviors. "It is very clear that each child is an individual and differs in their tendency to make healthy decisions about food as they grow. This is why it is important to focus on creating an environment that encourages decision-making skills and provides exposure to a variety of healthy, nutritious foods throughout childhood, and not place undue attention on the child's individual decisions," concluded Wood.
Caregivers can be a powerful force in helping children develop healthy eating habits, and yet their role is limited by other factors. The statement authors encourage policies that address barriers to implementing the statement's recommendations within the wider socioeconomic context, including social determinants of health such as socio-economic status, food insecurity and others. While efforts that encourage caregivers to provide a responsive, structured feeding environment could be an important component of reducing obesity and cardiometabolic risk across the lifespan, they note that they will be most effective as part of a multi-level, multi-component prevention strategy.
https://www.sciencedaily.com/releases/2020/05/200511092923.htm
Sleep difficulties linked to altered brain development in infants who later develop autism
May 7, 2020
Science Daily/University of Washington
Infants spend most of their first year of life asleep. Those hours are prime time for brain development, when neural connections form and sensory memories are encoded.
But when sleep is disrupted, as occurs more often among children with autism, brain development may be affected, too. New research led by the University of Washington finds that sleep problems in a baby's first 12 months may not only precede an autism diagnosis, but also may be associated with altered growth trajectory in a key part of the brain, the hippocampus.
In a study published May 7 in the American Journal of Psychiatry, researchers report that in a sample of more than 400 6- to 12-month-old infants, those who were later diagnosed with autism were more likely to have had difficulty falling asleep. This sleep difficulty was associated with altered growth trajectories in the hippocampus.
"The hippocampus is critical for learning and memory, and changes in the size of the hippocampus have been associated with poor sleep in adults and older children.
However, this is the first study we are aware of to find an association in infants as young as 6 months of age," said lead author Kate MacDuffie, a postdoctoral researcher at the UW Autism Center.
As many as 80% of children with autism spectrum disorder have sleep problems, said Annette Estes, director of the UW Autism Center and senior author on the study. But much of the existing research, on infants with siblings who have autism, as well as the interventions designed to improve outcomes for children with autism, focus on behavior and cognition. With sleep such a critical need for children -- and their parents -- the researchers involved in the multicenter Infant Brain Imaging Study Network, or IBIS Network, believed there was more to be examined.
"In our clinical experience, parents have a lot of concerns about their children's sleep, and in our work on early autism intervention, we observed that sleep problems were holding children and families back," said Estes, who is also a UW professor of speech and hearing sciences.
Researchers launched the study, Estes said, because they had questions about how sleep and autism were related. Do sleep problems exacerbate the symptoms of autism? Or is it the other way around -- that autism symptoms lead to sleep problems? Or something different altogether?
"It could be that altered sleep is part-and-parcel of autism for some children. One clue is that behavioral interventions to improve sleep don't work for all children with autism, even when their parents are doing everything just right. This suggests that there may be a biological component to sleep problems for some children with autism," Estes said.
To consider links among sleep, brain development and autism, researchers at the IBIS Network looked at MRI scans of 432 infants, surveyed parents about sleep patterns, and measured cognitive functioning using a standardized assessment. Researchers at four institutions -- the UW, University of North Carolina at Chapel Hill, Washington University in St. Louis and the Children's Hospital of Philadelphia -- evaluated the children at 6, 12 and 24 months of age and surveyed parents about their child's sleep, all as part of a longer questionnaire covering infant behavior. Sleep-specific questions addressed how long it took for the child to fall asleep or to fall back asleep if awakened in the middle of the night, for example.
At the outset of the study, infants were classified according to their risk for developing autism: Those who were at higher risk of developing autism -- about two-thirds of the study sample -- had an older sibling who had already been diagnosed. Infant siblings of children with autism have a 20 percent chance of developing autism spectrum disorder -- a much higher risk than children in the general population.
A 2017 study by the IBIS Network found that infants who had an autistic older sibling and who also showed expanded cortical surface area at 6 and 12 months of age were more likely to be diagnosed with autism compared with infants without those indicators.
In the current study, 127 of the 432 infants were identified as "low risk" at the time the MRI scans were taken because they had no family history of autism. They later evaluated all the participants at 24 months of age to determine whether they had developed autism. Of the roughly 300 children originally considered "high familial risk," 71 were diagnosed with autism spectrum disorder at that age.
Those results allowed researchers to re-examine previously collected longitudinal brain scans and behavioral data and identify some patterns. Problems with sleep were more common among the infants later diagnosed with autism spectrum disorder, as were larger hippocampi. No other subcortical brain structures were affected, including the amygdala, which is responsible for certain emotions and aspects of memory, or the thalamus, a signal transmitter from the spinal cord to the cerebral cortex.
The UW-led sleep study is the first to show links between hippocampal growth and sleep problems in infants who are later diagnosed with autism.
Other studies have found that "overgrowth" in different brain structures among infants who go on to develop those larger structures has been associated, at different stages of development, with social, language and behavioral aspects of autism.
While the UW sleep study found a pattern of larger hippocampal volume, and more frequent sleep problems, among infants who went on to be diagnosed with autism, what isn't yet known is whether there is a causal relationship. Studying a broader range of sleep patterns in this population or of the hippocampus in particular may help determine why sleep difficulties are so prevalent and how they impact early development in children with autism spectrum disorder.
"Our findings are just the beginning -- they place a spotlight on a certain period of development and a particular brain structure but leave many open questions to be explored in future research," MacDuffie said.
A focus on early assessment and diagnosis prompted the UW Autism Center to establish an infant clinic in 2017. The clinic provides evaluations for infants and toddlers, along with psychologists and behavior analysts to create a treatment plan with clinic- and home-based activities -- just as would happen with older children.
The UW Autism Center has evaluated sleep issues as part of both long-term research studies and in the clinical setting, as part of behavioral intervention.
"If kids aren't sleeping, parents aren't sleeping, and that means sleep problems are an important focus for research and treatment," said MacDuffie.
The authors note that while parents reported more sleep difficulties among infants who developed autism compared to those who did not, the differences were very subtle and only observed when looking at group averages across hundreds of infants. Sleep patterns in the first years of life change rapidly as infants transition from sleeping around the clock to a more adult-like sleep/wake cycle. Until further research is completed, Estes said, it is not possible to interpret challenges with sleep as an early sign of increased risk for autism.
The study was funded by the National Institutes of Health, Autism Speaks and the Simons Foundation. Dr. Stephen Dager, professor of radiology at the UW School of Medicine and Tanya St. John, research scientist at the UW Autism Center, were co-authors. Additional co-authors, all at IBIS Network institutions, were Mark Shen, Martin Styner, Sun Hyung Kim and Dr. Joseph Piven at the University of North Carolina at Chapel Hill; Sarah Paterson, now at the James S. McDonnell Foundation; Juhi Pandey at the Children's Hospital of Philadelphia; Jed Elison and Jason Wolff at the University of Minnesota; Meghan Swanson at the University of Texas at Dallas; Kelly Botteron at Washington University in St. Louis; and Dr. Lonnie Zwaigenbaum at the University of Alberta.
https://www.sciencedaily.com/releases/2020/05/200507094747.htm
'Loss of pleasure' found in teen sleep study
But easy interventions can improve mental health
May 7, 2020
Science Daily/Flinders University
Sleep patterns around the world have been disrupted as screen time increases and sleep routines change with COVID-19 self-isolation requirements.
Negative mood is not unusual in adolescence, but lack of sleep can affect mental health, causing anhedonia (or loss of pleasure), anxiety, anger and significantly increasing the risk of depression, a global study of more than 350,000 teens shows.
The results just published in Sleep Medicine Reviews connects less sleep with a 55% increased chance of mood deficits and double the risk of reduced positive mood.
From Asia, to Australia, New Zealand, Europe and North America, sleep clearly was a modifiable risk factor that can improve or depress mood in adolescents, says Flinders University sleep researcher Dr Michelle Short.
"Sleep duration significantly predicts mood deficits on all mood states, including increased depression, anxiety, anger, negative affect and reduced positive affect," she says, with less sleep linked to an 83% higher chance or anger, 62% increased risk of depressed mood, and 41% higher risk of anxiety.
"Fortunately, there are many interventions individuals, family, the community and even public policy can encourage to maintain regular sleep in this at-risk population to reduce the likelihood of these problems spilling over into mental health issues needing clinical treatment," she says.
The researchers also recommend increased parental / guardian regulation of sleep and technology use, delayed school starting times, and monitoring academic and other pressures such as out-of-hours tutoring does not impede sleep routine.
Dr Short says that "while positive mood doesn't get much attention, it is still clinically relevant as one of the key symptoms of depression in anhedonia (loss of pleasure)."
"It is imperative that greater focus is given to sleep as for prevention and early intervention for mood deficits," the study concludes.
https://www.sciencedaily.com/releases/2020/05/200505093127.htm