Concerns about concussions in high school football

Concussion awareness is raising concerns about the safety of football for high schoolers.- JR

Awareness of the seriousness of concussions has been at the forefront of recent discussions involving the dangers of playing football.

Earlier this year, the NFL settled a class-action lawsuit with more than 5,000 ex-players who asserted that the league willfully hid information about the dangers of concussions.

While many hailed that as progress, high school coaches wonder if the risks involved with concussions will affect the numbers of participants in the future.

“As a high school coach, my big worry is that parents start moving kids away from the game,” Steele coach Scott Lehnhoff said. “We’re going to do everything we can to make sure protocols are followed and kids aren’t going back until it’s completely safe for them.”

The University Interscholastic League, which governs most high school sports in Texas, has a “return-to-play” protocol in which an athlete who has been diagnosed with a concussion must get a doctor’s approval before returning to play.

“If something looks like a possible concussion, then we get him out of there and make sure there are no coaches jumping in and saying, ‘Get him back in there,’” Highlands coach Juan Morales said.

But what more can be done?

Some things are already in place. Players are penalized for leading with their helmets. Helmet-to-helmet contact is also flagged as a penalty. Therefore, players are being taught not to lead with the heads.

“We need to try to take the head out of the game as much as possible,” Lehnhoff said. “As a coach in the past, maybe if a kid tackled with his head, you didn’t say anything, but now you are going to say something.”

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Special Needs Students Are Rescued in Texas Floods

As a floodie, my heart goes out to these children and families. I hope they get the ongoing support that will be needed. - JR

Special Needs Students Rescued in Texas Floods (PHOTOS)

As floods and possible tornadoes made their way across a swath of Central Texas on Friday, first responders rescued special needs students on a school bus stranded in floodwaters.

According to the Bexar County Sheriff's Twitter account, officers helped rescue students and adults from a school bus stuck in flood waters on a scenic loop. The team helped bring four special needs students and two adults to safety. The Twitter account reports that all received medical help as part of the rescue. 

According to the San Antonio Express-News, the bus was headed to Los Reyes Elementary School around 7:10 a.m. local time when it was stuck in floodwaters. 

The storm system responsible for the flooding that resulted in this rescue is drenching much of the Lone Star State. San Antonio officials have reported more than two dozen road closures.

Severe weather is expected to continue throughout the region throughout the day and even into the weekend. 

"The threats are two-fold. First, warm and very humid air coupled with an approaching southward dip in the jet stream will spawn severe thunderstorms, some of which may spawn tornadoes, in Texas and the Deep South through Saturday," said weather.com meteorologist Jon Erdman. "Secondly, areas of slow-moving, heavy rain will trigger flash flooding in Texas and Oklahoma through early Saturday, then spread into the Lower Mississippi Valley and Deep South later Saturday. This flood threat includes San Antonio, Austin, Dallas and Houston."

Melatonin use in children

This article discusses melatonin use in children.

What we do know: Supplemental melatonin can help children with sleep dysfunction (those who lie awake for hours at bedtime) fall asleep. However, melatonin only helps with sleep initiation (falling asleep) not staying asleep. So if you are dealing with wake ups during the night... melatonin is not the solution. Normal awakenings shift and change due to all sorts of developmental milestones and changes as children grow. Overnight awakenings will always be normal although how our children get back to sleep on their own changes our night of sleep dramatically!

What Is Melatonin?
Melatonin is a naturally-occurring hormone that our brains produce to help regulate sleep and wake cycles. People call it the "sleep hormone" because unlike the parts of body that drive wakefulness, melatonin drives sleepiness. Normally, melatonin levels begin to rise in the late evening (around 8 p.m. for kids, around 10 p.m. for teens), remain high for most of the night, and then drop in the early morning a couple hours before we wake up. Light inhibits melatonin and affects how much melatonin your body produces. Hence why being outside in the light during the day with a newborn (especially the ones who want to party all night) or when switching time zones makes a lot of sense! Light from screens (Kindles, iPads, tablets, computers, TVs) inhibits melatonin from being released. Getting outside during the day helps teach your brain day vs. night -- an important strategy for anyone struggling with sleep.

The Melatonin Supplement
The melatonin supplement you find at your local drug store is synthetically produced in factories. Because it's a supplement and not a medicine it's not regulated by the FDA like medicines. Therefore inconsistency in dosing is possible (no one can say that one brand's 1-mg tablet is the same dose as another's). Potency varies by brand and even between different batches from the same manufacturer. Always avoid "natural" melatonin (derived from cow or pig brains) and purchase only the man-made synthetic supplement that is far more readily available.

Melatonin Dosing Recommendations
"There are no clear-cut dosage guidelines because neither melatonin nor any other medication or supplement is approved by the FDA for the purpose of treating insomnia in children," said sleep expert Dr. Maida Chen of Seattle Children's Hospital.

Typically you always want to use the lowest dose: 0.5mg or 1mg -- then consider increasing by 0.5mg every few days if your child isn't falling asleep within an hour of bedtime. While increasing dose, make sure you're also working on consistent bedtimes, policing screens in the bedroom, and working to get good exercise OUTSIDE during the day. Many children will respond to a dose 0.5mg or 1mg an hour or two prior to bedtime. Some children and teens with significant challenges falling asleep are often given doses as high as 3mg to 6mg with severe insomnia at bedtime but in my experience many children get the hypnotic effect at smaller doses. Talk with your child's physician about how to determine a dose if or when melatonin is being used and if it's not working, GET OFF OF IT. Not all children respond to the hypnotic effect of supplemental melatonin.

Timing: You want to give melatonin prior to bedtime to help with increasing sleepiness. Most physicians recommend giving about 1-2 hours prior to ideal bedtime when helping little children fall asleep. However, it does depend why and how you plan to use melatonin. Here's a GREAT on how melatonin works and when to administer from Dr. Craig Canapari -- a pediatric sleep expert at Yale.

Children With ADHD and/or Autism Spectrum Disorders (ASD)
Children with ADHD and/or autism spectrum disorder are known to have challenges falling asleep. Studies with melatonin have been done in these populations of children. Dr. Chen explains:
"More trials of melatonin for sleep difficulties have been done in children with ADHD or ASD than studies for typically developing children. Evidence from these trials suggests that melatonin is safe and does shorten the length of time it takes to fall asleep. However, the effects are not generally overwhelming and not every child who takes melatonin shows sleep improvement. The studies mostly evaluate short-term use only." Most worries about long-term use and safety are speculative (based on studies in animals or adults) but without clarity from research it's always best to get kids off melatonin when you can.

Sleep matters. Good sleep is essential. But it's rare for a child to need meds.

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Health effects of sleep apnea

This article discusses the effects of sleep apnea beyond snoring.

According to the American Sleep Apnea Association, about 22 million Americans have sleep apnea and about 80 percent of those cases are undiagnosed. Sleep apnea is an involuntary sleep disorder in which breathing repeatedly stops and starts.

Sleep apnea can occur when tissue in the back of the throat blocks the airway. If the airway is blocked, the amount of oxygen delivered to the body’s organs is reduced. When blood-oxygen levels drop low enough, the body wakes itself up. Sometimes it happens so fast that it goes unnoticed to the sleeper. People with sleep apnea can stop breathing hundreds of times during the night and often for a minute or longer.

Sleep apnea can have serious and life-shortening consequences if it is not treated. These include high blood pressure, heart disease, stroke, memory problems, diabetes and depression.

Symptoms of sleep apnea:

• loud snoring
• fatigue
• insomnia
• persistent daytime sleepiness
• awakening out of breath during the night
• frequently waking in the morning with a dry mouth or a headache

The most widely used treatment for sleep apnea is a Continuous Positive Airway Pressure (CPAP) machine. The CPAP has a mask that goes over the nose, or sometimes nose and mouth, during sleep and supplies pressurized air that flows into the person’s throat. The increased air pressure keeps the airway open. Sometimes people still struggle with sleep apnea even after they use a CPAP. In those cases, surgery may be needed.

Sleep apnea is sometimes caused by the back of the tongue or tonsils blocking the airway. In these cases, an uvulopalatopharyngoplasty (UVPPP) is required. UVPPP involves shortening the soft palate and removing the tonsils, and it has been the most common sleep apnea surgical procedure performed in the past 25 years. In addition, robotic-assisted resection of the base of tongue is a minimally invasive approach to remove obstructive tongue tissue blocking the airway. After this surgery, sleep apnea is often corrected. At Long Beach Memorial, the da Vinci Si Robotic Surgical System is used to remove redundant tongue tissue and is performed in conjunction with the UVPPP to help our patients get a good night’s rest.

In order to properly diagnose sleep apnea, a physician must conduct a sleep study in a sleep lab, usually overnight. A sleep study monitors activity during sleep such as measuring brain waves, heart rate and rhythm, breathing patterns and oxygen levels.

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Can a school discriminate against a student with disabilities when it comes ot the National Honor Society? No...and Yes

Dear Dr. Rotenberg,

My daughter was born prematurely. She has anxiety, ADD and retinopathy of prematurity. She has very thick glasses and the glare is sometimes difficult for her.

At times during high school, she stopped taking her medication or needed changes in the medication. She needed eye surgery last year because of strabismus.

She attends a private school. We did not ask her school for accommodations.

She really wanted to succeed on her own.






Pregnancy

http://www.principals.org/portals/0/content/50115.pdf

Study: CPAP use may reverse negative changes in brain stem activity

A study shows that treating sleep apnea with a CPAP may reverse brain stem activity. -JR

Sleep apnea treatment may reverse changes in brain stem activity associated with increased risk of heart disease, a new study suggests.

The findings "highlight the effectiveness of CPAP treatment in reducing one of the most significant health issues [heart disease] associated with obstructive sleep apnea," the researchers concluded. CPAP stands for continuous positive airway pressure.

Previous research suggests that people with obstructive sleep apnea have greater activity in nerves associated with stress response, which can lead to high blood pressure and heart problems. This increased nerve activity is due to altered brain stem function caused by sleep apnea, earlier studies have shown.

In this small study, published recently in the Journal of Neurophysiology, Australian researchers found that CPAP treatment reduced that nerve activity by restoring normal brain stem function.

The study included 13 sleep apnea patients who were assessed before and after six months of CPAP treatment.

"These data strongly suggest that functional and anatomical changes within the brain stem, which we believe underlie the elevated sympathetic activity in individuals with untreated obstructive sleep apnea, can be restored to healthy levels by CPAP treatment," the University of Sydney researchers wrote.

In obstructive sleep apnea, muscles in the airway collapse during sleep and block breathing. A CPAP device keeps airways open by delivering a steady flow of air while patients sleep.

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Different types of memory and epilepsy

This article discusses different types of brainwaves, and how they relate to epilepsy.

Our long-term memory is consolidated when we sleep. Short-term memory traces in the hippocampus, an area deep in the brain, are then relocated to more outer parts of the brain. An international team of neuroscientists, among who Mathilde Bonnefond and Til Ole Bergmann from the Donders Institute at Radboud Universiy, now shows how a three-step brain oscillation plays an important part in that process. Nature Neurosciences publishes the results on September 21st.

Bonnefond and Bergmann specialize in research on oscillations: waves of brain activity. 'Non-rapid eye movement (NREM) sleep is responsible for the memory consolidation during our sleep', Bonnefond explains. 'NREM is known for its very slow oscillations (SOs). Other types of oscillations are hidden inside these SOs. We discovered that three types of oscillations are nested inside each other in the hippocampus and have a joint function.'

Slow waves, spindles and ripples

Slow oscillations only happen about once per second (~0.75 Hz). In a specific time frame within these SOs, Bergmann, Bonnefond and their colleagues found clusters of oscillations of an intermediate speed: the so called spindles which happen about 15 times per second (12 -- 16 Hz). And within these spindles, they found clusters of superfast oscillations called ripples, which happen about 90 times per second (80 -- 100 Hz), and which reflect the local reactivation of the memory trace to be shuttled to the cortex.

To summarize: SOs contain spindles, which in their turn contain ripples. 'Earlier studies only coupled these oscillation types in pairs', Bonnefond explains. 'But now, we see that SOs, spindles and ripples are functionally coupled in the hippocampus. And we hypothesize that they provide fine-tuned temporal frames for the transfer of memory traces to the neocortex.'

Epilepsy

The group of researchers investigated the process in human epilepsy patients during natural sleep. Doctors were looking for the brain areas responsible for their epilepsy, and the current research was done at the same time: with special electrodes, the researchers recorded oscillations from inside the brain. Bonnefond: 'This was a great opportunity to investigate the hippocampus, since it's difficult to measure deep brain regions with classical electrophysiological techniques.'

The patients did not have to remember any specific information. 'You're consolidating memories every night, so we investigated the process in general. The next step would be to link these clustered oscillations to specific memories.'

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Study: Significant association between obesity and ADHD

A recent study showed a significant association between obesity and ADHD in adults and children.

Results from a meta-analysis published in the American Journal of Psychiatry indicated a significant association between obesity and attention-deficit/hyperactivity disorder among children and adults.

“The putative association between ADHD and obesity might seem paradoxical because, rather than being hyperactive, individuals with obesity are often described as ‘lazy.’ However, the impulsivity and inattention that characterize ADHD might lead to dysregulated eating patterns with consequent weight gain,” Samuele Cortese, MD, PhD, of the University of Southampton, United Kingdom, and colleagues wrote. “The role of possible confounders, including low socioeconomic status and comorbid mental health conditions, in explaining the association between obesity and ADHD is still unclear. In addition, the role of age, gender, study setting, or study country is also uncertain.”

Researchers conducted a meta-analysis of 42 studies to assess the association between ADHD and obesity. The analysis included 728,136 study participants, of which 48,161 had ADHD.

Researchers found a significant association between obesity and ADHD among children (OR = 1.2; 95% CI, 1.05-1.37) and adults (OR = 1.55; 95% CI, 1.32-1.81).

Pooled prevalence of obesity increased by approximately 70% for adults with ADHD compared with those without ADHD, and by approximately 40% for children with ADHD vs. those without ADHD.

The significant association between obesity and ADHD remained when limited to studies that adjusted for potential confounding factors, diagnosed ADHD by direct interview and directly measured height and weight.

Researchers also found a significant association between ADHD and overweight.

Individuals medicated for ADHD did not have a higher risk for obesity.

“We found meta-analytic evidence of a significant association between obesity/overweight and ADHD, regardless of possible confounders. Mediational effects and causal mechanisms underlying the association, as well as the long-term effects of ADHD medications on weight status in individuals with obesity and ADHD, deserve further attention because of their important public health implications,” the researchers concluded.”

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Adolescent brain sensitivity

A few studies indicate that an adolescent's brain may be especially sensitive to new memories, drug use, and social stress.

Adolescence, like infancy, has been said to include distinct sensitive periods during which brain plasticity is heightened; but in a review of the neuroscience literature published on September 23 in Trends in Cognitive Sciences, University College London (UCL) researchers saw little evidence for this claim. However, a small number of studies do support that memory formation, social stress, and drug use are processed differently in the adolescent brain compared to other periods of life.

"Conclusively proving that adolescent sensitive periods exist will require studies comparing children, adolescents, and adults and will need to take into account individual differences in adolescent development," says Delia Fuhrmann, a PhD student in UCL's Institute of Cognitive Neuroscience Developmental Group. "Adolescents are much more likely than children to choose their own environments and choose what they want to experience."

Humans retain some plasticity--changes in brain and behavior in response to environmental demands, experiences, and physiological changes--throughout life. However, during sensitive periods plasticity is heightened and the brain "expects" to be exposed to a particular stimulus. For example, the brains of infants are primed to process visual input and language.

The ability to form memories seems to be augmented during adolescence, one example for how it may be a sensitive period. Memory tests in different cultures show a "reminiscence bump"; at 35 or later, we are more likely to recall autobiographic memories from ages 10 to 30 years than memories prior or subsequent. The recall of music, books, films, and public events from adolescence is also superior compared with that from other periods.

Further, they point out that simple aspects of working memory or ongoing information processing may reach maturity in childhood, while more complex, self-organized working memory abilities continue to improve during early adolescence and recruit frontal brain regions that are still developing. "Working memory can be trained in adolescents, but we don't know how these training effects differ from other age groups," Fuhrmann says. "Such data would be useful for planning curricula because it would tell us what to teach when."

Many mental illnesses have their onset in adolescence and early adulthood, possibly triggered by stress exposure. The UCL team explored studies indicating that both social stress and social exclusion have a disproportionate impact during adolescence. They also argue that adolescence may be a vulnerable period for recovery from these negative experiences.

"Adolescents are slower to forget frightening or negative memories," says Fuhrmann. "This might mean that some treatments for anxiety disorders, which are based on controlled exposure to whatever a patient is afraid of, might be less effective in adolescents and alternative treatments might be needed."

Finally, studies showed that adolescence is also a time of heightened engagement in risky health behaviors, such experimenting with alcohol and other drugs. Young adolescents seem to be particularly susceptible to peer influence on risk perception and risk taking compared with other age groups. Research in rodents also supports that adolescent brains might have an increased sensitivity to marijuana.

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Pregnancy intervals might affect autism in children

A study shows that the intervals at which mothers space their children may influence the child's risk of autism.

The amount of time between a woman's pregnancies may matter when it comes to the possible risk of her children developing autism, new research suggests.

"Children conceived in less than two years after the birth of their older sibling or greater than six years have [about] a two- to threefold increased risk of being diagnosed with autism," said study researcher Lisa Croen, director of the autism research program at Kaiser Permanente division of research, in Oakland, Calif.

Croen said that previous studies have shown an increased risk associated with very short pregnancy intervals, and a higher risk with longer than usual intervals. "We are finding the same thing. I think now there is a growing body of evidence that is pointing in the same direction," she said.

She cautioned, however, that "this is not causal. These kinds of studies can't prove cause, this is association."

And at least one neonatologist reiterated that the study only found an association between pregnancy intervals and possible autism, and much more research is needed into the topic.

Croen said the findings lend support to the current recommendation by the World Health Organization to wait at least two years after a child is born before attempting the next pregnancy.

The research was released online Sept. 14 and will be published in the October print issue of the journal Pediatrics.

One in 68 U.S. children has an autism spectrum disorder, according to the U.S. Centers for Disease Control and Prevention. Boys are more likely than girls to be diagnosed with autism, the CDC reports. Genetic and environmental factors may play a role in the condition, which involves problems with communication and socialization.

The new study included medical record reviews of about 45,000 second-born children, delivered between 2000 and 2009 in Kaiser Permanente Northern California hospitals.

The researchers looked at codes that encompass a diagnosis of any condition under the umbrella of autism spectrum disorder (ASD), which can range from mild to severe. The study team also looked at interpregnancy intervals, defined as the time from the first birth to conception of the second child.

Most older siblings of the 45,000 second-born children did not have a diagnosis of ASD, but 878 did. The researchers first analyzed the group without an older sibling with ASD.

For these children, the risk of autism was 1.5 to three times higher for intervals less than 24 months and 72 months or longer, when compared with an interval of 36 to 47 months. Intervals of less than six months appeared to carry the highest risk, the study found.

The researchers did a secondary analysis of those whose older siblings had ASD and found the same pattern -- that short or long intervals increased the risk of an ASD diagnosis.

The researchers don't know how to explain the association with certainty, according to Croen. One possible explanation is that mothers with short intervals between a pregnancy may have depleted levels of folic acid. "Folic acid is a critical nutrient in terms of healthy brain development," she said.

Dr. David Mendez, a neonatologist at Nicklaus Children's Hospital in Miami, said many researchers have looked at the pregnancy gap and investigated the effects of long ones versus shorter ones. Some have linked short intervals to psychiatric disorders, such as schizophrenia, he added.

However, Mendez said, "more specific studies need to be done before anyone can say anything definitive."

Pregnancy interval is one of many factors that may affect a child's health and upbringing. However, he suggested that avoiding short intervals between pregnancy may make it easier for parents to cope.

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CPAP can help adults with sleep apnea and depressive symptoms

Depressive symptoms in adults with sleep apnea are improved when the person uses a CPAP.

A new study shows that depressive symptoms are extremely common in people who have obstructive sleep apnea, and these symptoms improve significantly when sleep apnea is treated with continuous positive airway pressure therapy.

Results show that nearly 73 percent of sleep apnea patients (213 of 293 patients) had clinically significant depressive symptoms at baseline, with a similar symptom prevalence between men and women. These symptoms increased progressively and independently with sleep apnea severity.

However, clinically significant depressive symptoms remained in only 4 percent of the sleep apnea patients who adhered to CPAP therapy for 3 months (9 of 228 patients). Of the 41 treatment adherent patients who reported baseline feelings of self-harm or that they would be "better dead," none reported persisting suicidal thoughts at the 3-month follow-up.

"Effective treatment of obstructive sleep apnea resulted in substantial improvement in depressive symptoms, including suicidal ideation," said senior author David R. Hillman, MD, clinical professor at the University of Western Australia and sleep physician at the Sir Charles Gairdner Hospital in Perth. "The findings highlight the potential for sleep apnea, a notoriously underdiagnosed condition, to be misdiagnosed as depression."

Study results are published in the September issue of the Journal of Clinical Sleep Medicine.

The American Academy of Sleep Medicine reports that obstructive sleep apnea (OSA) is a common sleep disease afflicting at least 25 million adults in the U.S. Untreated sleep apnea increases the risk of other chronic health problems including heart disease, high blood pressure, Type 2 diabetes, stroke and depression.

The study group comprised 426 new patients referred to a hospital sleep center for evaluation of suspected sleep apnea, including 243 males and 183 females. Participants had a mean age of 52 years. Depressive symptoms were assessed using the validated Patient Health Questionnaire (PHQ-9), and the presence of obstructive sleep apnea was determined objectively using overnight, in-lab polysomnography. Of the 293 patients who were diagnosed with sleep apnea and prescribed CPAP therapy, 228 were treatment adherent, which was defined as using CPAP therapy for an average of 5 hours or more per night for 3 months.

According to the authors, the results emphasize the importance of screening people with depressive symptoms for obstructive sleep apnea. These patients should be asked about common sleep apnea symptoms including habitual snoring, witnessed breathing pauses, disrupted sleep, and excessive daytime sleepiness.

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Autism may be covered by ADHD risk

According to a study, autism may be covered by ADHD in children.

Symptoms attributed to attention-deficit hyperactivity disorder (ADHD) may overshadow or mask autism spectrum disorder in very young children, a new study reveals.

This can create a significant delay in the diagnosis of autism. It took an average of three years longer to diagnose autism in children initially thought to have just ADHD, the researchers said.

That delay can make a big difference in the future of the child, said study author Dr. Amir Miodovnik, a developmental pediatrician at Boston Children's Hospital.

"It's been shown the earlier that you implement these therapies for autism, the better children do in terms of outcomes," Miodovnik said. "Three years is a significant amount of time for the kids to not be receiving therapy."

The study was published online Sept. 14 and will appear in the October print issue ofPediatrics.

Autism and ADHD are very different neurological conditions, but they share a number of symptoms, genetic factors and brain pathways, the study authors said in background information.

For example, children who are hyperactive, impulsive and inattentive could be diagnosed with ADHD, but similar symptoms also are found in kids with autism spectrum disorder, the study said.

To see whether an early diagnosis of ADHD would interfere with detection of autism, the researchers looked at data on nearly 1,500 children with autism drawn from the 2011-2012 National Survey of Children's Health.

In the survey, parents were asked whether their children had been diagnosed with ADHD or autism. They were also asked to provide the ages when they received their diagnosis. About 43 percent of the kids had been told they have both conditions, parents reported.

More than two out of every five kids diagnosed with both ADHD and autism had been diagnosed with ADHD first, the researchers found.

Most of those children initially diagnosed with ADHD -- about 81 percent -- wound up diagnosed with autism after age 6.

In fact, kids diagnosed first with ADHD were nearly 17 times more likely to be diagnosed with autism after age 6 compared to kids who only received a diagnosis of autism.

The children also were 30 times more likely to receive an autism diagnosis after age 6 when compared with kids who were diagnosed with ADHD and autism at the same time, or diagnosed initially with autism and later with ADHD.

These results indicate that doctors may be rushing to apply a diagnosis of ADHD at an age that's much too early, said Dr. Daniel Coury, chief of developmental and behavioral pediatrics at Nationwide Children's Hospital and a professor of clinical pediatrics and psychiatry at the Ohio State University College of Medicine.

"In fact, these children may have a neurodevelopmental problem that is going to change over the next few years, and will be much more apparent at 4 or 5 years than it is at 2," Coury said. "We don't usually make a diagnosis of ADHD in 3- and 4-year-old children. If we're making a diagnosis at that early age, maybe we should be thinking about a developmental disorder that is more common for that age group, like autism."

Miodovnik agreed, noting that in his study kids with autism were diagnosed with ADHD at around 5 years old on average, much younger than the national average of 7 years old for a typical ADHD diagnosis.

Coury said the findings line up with what he's seen in his practice.

"My personal clinical experience is that we see a fair number of children we evaluate for autism spectrum disorder at an older age who previously have had an ADHD diagnosis," he said. "There is a tendency that once a patient has a diagnosis, because they have a number of symptoms that fit that diagnosis, clinicians can develop a bit of tunnel vision where some other findings might be overlooked."

Parents who believe that a child younger than 5 has ADHD should take their child to a developmental pediatrician, rather than a family physician, to make sure that possible autism will not be overlooked, Miodovnik said.

"If you suspect ADHD in very young children, it's probably best for them to be evaluated by a specialist, partly to not miss a diagnosis of autism, and also because managing a child with ADHD can be complicated," he said.

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Being in nature can help your sleep

A study suggests that being in nature can help your sleep quality.

Getting close to nature might improve the quality of your sleep, new research suggests.

Seniors and men sleep more soundly if they have access to natural surroundings, such as beaches or parks, according to a study published in the September issue of the journal Preventive Medicine.

"It's hard to overestimate the importance of high-quality sleep," study author Diana Grigsby-Toussaint, a professor of kinesiology and community health at the University of Illinois.

"Studies show that inadequate sleep is associated with declines in mental and physical health, reduced cognitive function and increased obesity," she said in a university news release. "This new study shows that exposure to a natural environment may help people get the sleep they need."

More than 255,000 adults from across the United States were surveyed about their quality of sleep in the previous month. Most said they slept poorly fewer than seven nights during the month.

But those who said they slept poorly on 21 to 29 nights were less likely to have access to green spaces or other natural areas than those who said they slept poorly on fewer than seven nights.

The link between good sleep and exposure to natural areas was much stronger for men than for women, the researchers found.

Living near parks and other natural areas can boost seniors' physical activity levels, which can help them sleep better, Grigsby-Toussaint explained.

She said the stronger link between green spaces and sleep among men could reflect women's reluctance to take advantage of such areas out of concern for their safety. More research is needed to understand this difference, she said.

"If there is a way for persons over 65 to spend time in nature, it would improve the quality of their sleep -- and their quality of life -- if they did so," Grigsby-Toussaint said.

The results provide an incentive for nursing homes and retirement communities to design buildings with nature trails and dedicated garden spaces, and to provide safe, inviting outdoor areas, she added.

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Study: Caffeine before bedtime offsets your internal clock

A study shows that drinking caffeine three hours before bedtime can delay your internal clock significantly.

A double espresso three hours before bedtime can induce a 40-minute time delay in your body's internal clock, making it harder to go to sleep on time and more challenging to wake up in the morning, scientists have shown for the first time.

The study led by the University of Colorado Boulder and the Medical Research Council's Laboratory of Molecular Biology in Cambridge, shows for the first time that evening caffeine delays the internal circadian clock that tells us when to get ready for sleep and when to prepare to wake up.

The research team showed the amount of caffeine in a double espresso or its equivalent three hours before bedtime induced a 40-minute phase delay in the roughly 24-hour human biological clock.

The study also showed for the first time how caffeine affects "cellular timekeeping" in the human body, said CU-Boulder Professor Kenneth Wright, who co-led the study.

"This is the first study to show that caffeine, the mostly widely used psychoactive drug in the world, has an influence on the human circadian clock," said Wright.

"It also provides new and exciting insights into the effects of caffeine on human physiology," he said.

For the study the team recruited five human subjects, three females and two males, who went though a double-blind, placebo-controlled 49-day protocol.

The subjects were tested under four conditions: low light and a placebo pill; low light and the equivalent of a 200-milligramme caffeine pill dependent on the subject's weight; bright light and a placebo pill; and bright light and the caffeine pill.

Saliva samples of each participant were tested periodically during the study for levels of the hormone melatonin, which is produced naturally by the pineal gland when directed to do so by the brain's "master clock."

The master clock is re-set by exposure to light and coordinates cellular clocks throughout the human body.

Melatonin levels in the blood increase to signal the onset of biological nighttime during each 24-hour period and decrease at the start of biological daytime, said Wright.

Those who took the caffeine pill under low-light conditions were found to have a roughly 40-minute delay in their nightly circadian rhythm compared to those who took the placebo pill under low light conditions, said Wright.

The magnitude of delay from the caffeine dose was about half that of the delay induced in test subjects by a three-hour exposure to bright, overhead light that began at each person's normal bedtime.

The study also showed that bright light alone and bright light combined with caffeine induced circadian phase delays in the test subjects of about 85 minutes and 105 minutes respectively.

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Study: Those with ongoing central pain may be linked to ADHD

A study indicates that those with central pain could also have ADHD.

More than a third of people with ongoing "central pain" may also have ADHD, a small study suggests.

Central pain stems from damage to the central nervous system -- the brain, brain stem and spinal cord. It differs from ongoing pain from bone or muscle conditions such as arthritis, or peripheral nerve pain like diabetic neuropathy.

Researcher Forest Tennant, MD, of Intractable Pain Management, presented the findings at the PAINWeek 2015 conference.

For the study, 45 people with chronic pain attending a treatment clinic completed a 16-item questionnaire. The questions asked whether the person had trouble with concentration, attention, distractibility, impulsivity, reading and retention, coordination, temper, and short-term memory.

A positive answer to five or more questions was considered to indicate ADHD

Results showed that 37.8% of the people met these criteria for the disorder.

Most people with centralized pain have an overactive autonomic nervous system, the part of the nervous system responsible for functions like breathing. This contributes to the ADHD (which is sometimes called ADD, or attention deficit disorder).

The finding might help explain why some people with pain have trouble with activities in their daily lives, Tennant says.

"For years, I've seen the same kind of ADD in these patients that you see in children -- they can't remember half the time, they can't concentrate," he says. "It's amazing how many of these patients actually quit reading or doing things, but they won't tell you."

But once they start taking medication for ADHD, "their pain gets better and they can remember and concentrate."

Tennant stressed that the findings [do not apply to] those with arthritis or neuropathic pain.

Jack LeFrock, MD, a pain specialist at Above and Beyond Pain Management and Laser Center, says Tennant's finding "makes sense."

"I agree with him; I think he's right on," he says.

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Both too much and too little sleep can harm the heart

Too much and too little sleep can hurt the heart according to a recent study.

Otherwise healthy people who have poor sleep habits may be putting themselves at risk for early signs of heart disease, a new study suggests.

Folks who get too much or too little sleep -- or not enough quality rest -- are more likely to suffer from stiffened arteries and calcium deposits on the walls of their major arteries, said study lead author Dr. Chan-Won Kim.

"Coronary calcium develops way before heart attack symptoms occur, and a greater amount of calcium in the coronary arteries predicts future development of heart disease," said Kim, a clinical associate professor in the Center for Cohort Studies at Kangbuk Samsung Hospital in Seoul, South Korea.

The sweet spot appears to be about seven hours of sleep, the researchers reported. People who got more or less sleep tended to have increased signs of potential future heart problems.

Earlier studies have linked poor sleep to bad heart health, but this research goes a step further by looking for precursors of heart disease in people who appear healthy, said Dr. David Meyerson, a cardiologist at Johns Hopkins Bayview Medical Center in Baltimore and a national spokesman for the American Heart Association.

Because the study authors took this route, their implications more directly highlight sleep as a potential risk factor for heart disease, Meyerson said.

"Quality and duration of sleep is not always asked by every physician during a cardiovascular risk assessment session, and perhaps it should be," he said.

While the study uncovered a link between poor sleep and potential heart problems, it did not prove a cause-and-effect connection.

The study involved more than 47,000 young and middle-aged adults who completed a sleep questionnaire and had advanced tests to measure arterial stiffness and detect early artery lesions caused by calcium deposits.

The findings revealed that study participants who:

• got five or fewer hours of sleep a day had 50 percent more calcium in their arteries than those who slept seven hours a day.
• slept nine or more hours a day had at least 70 percent more calcium compared to those who slept seven hours.
• reported poor sleep quality had more than 20 percent more calcium than those who reported good sleep quality.

"Since we studied apparently healthy young and middle-age men and women without major diseases, it is unlikely that other health problems can explain the association between extreme sleep duration and early markers of heart disease," Kim said.

Doctors don't yet know exactly why the proper amount of sleep appears to protect heart health, said Meyerson and Dr. Mark Urman, a cardiologist with Cedars-Sinai Heart Institute in Los Angeles.

During sleep, a complex dance of metabolic changes, hormone releases, body repair and brain refreshment takes place. These processes affect blood pressure, blood sugar, inflammation, stress hormones and a host of other factors that can increase risk of heart disease, the cardiologists said.

"We know our bodies every day need this ability to recharge our batteries, to put everything at ease and calm everything down," Urman said, adding that poor sleep has been linked to heart risk factors like diabetes and obesity.

Sleep should be considered part of an overall heart-healthy lifestyle, Urman said.

"This adds to the importance of getting a good night's sleep on a regular basis, in addition to regular exercise and a heart-healthy diet, in reducing risk of heart disease," he said. "This is one more thing that's part of that package."

People who want to improve their sleep should dim the lights in their living room or bedroom as bedtime approaches, and they should go to bed at the same time every day, Kim said.

"It is also important to avoid exposure to electronic media at bedtime," Kim said. He added that "people who experience inadequate sleep need to avoid caffeine-containing beverages after lunch."

The study findings were published Sept. 10 in the American Heart Association journalArteriosclerosis, Thrombosis and Vascular Biology.

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