Friday, June 26, 2015
Children with ADD, ADHD, and attention issues might be able to be helped by music therapy.
Focus can be a real struggle for people with learning disabilities like ADHD and ADD, but music is being found to be a powerful tool to train minds.
Middle school student Thomas Beckman has the developmental disability Down syndrome and uses music to help him focus.
He takes adapted music lessons at Rhythm & Rehab in Durham, where he gets to play his favorite instrument -- the drums -- as a form of neurologic music therapy.
"Music therapy is using music to accomplish non-musical goals," said Paula Scicluna, the founder and executive director of Rhythm & Rehab. "So, using music to improve speech skills, language, sensory motor skills, cognitive skills, social emotional skills."
At the beginning of his lesson, Thomas banged the drums loudly, looked around at his surroundings and was not focused. He was very distracted.
Encouraging him to keep in time, Scicluna patted the drums saying, "Together, together, together. Can you do it together?"
Thomas ignored instruction.
However, as the session progressed -- in a matter of minutes -- something clicked and his focus increased.
He and Scicluna then moved to the keyboard, and as they attempted to play a duet, he was more in tune to the rhythm and "making music." He intently glanced up at his song sheet and glanced down making sure he hit each key precisely.
"I don't expect him to leave here playing Chopin," said Donna Beckmann, Thomas' mother.
She said the benefits of playing music, such as hand-eye coordination, helps him in his everyday life.
"Whether he's writing something, whether he's helping in the kitchen and cutting up vegetables, it's all connected, she said.
Scicluna pointed out that the quality of Thomas' playing is not what matters, but rather he "continued to play and that he stayed with the activity until I told him to stop."
She said music helps organize the brain, and repetition is key.
"Once you add that rhythm and you add that structure, it helps actually organize the firing of the neurons. Focus, attention [and] impulse control -- all those behaviors that you see children with ADHD and ADD struggle with," Scicluna said. "That's how music therapy is helpful to those children."
So, while some may view Thomas' drumming as noise, he hears music.
"He gets a lot of feedback from heavy movements. So for him to be banging on the drums, that does something for him," his mother said. "The type of focus that this trains him in is to focus when he needs to. The therapy gives him tools to reach his goals."
Beckmann said the structure grounds him, and his instructors have high expectations.
"They know the potential. They know what these individuals are able to do, and they don't settle for less," she said. "That's why you see the phenomenal things my son can do."
Thomas was so focused, he continued to play the keyboard.
"To see him so focused and visually tracking and using the right fingers on the right keys," Scicluna said. "For those of us that don't have to really think about all of those skills independently, you think of all those skills that have to come together in order for that to happen, it's incredible."
Beckmann said, "It's working on so many different pieces of what he needs. I see a more whole child because of music therapy. It's music, it's fun."
A study claims that adults need 7 hours of sleep each night.
Seven hours of shut-eye: That's the minimum amount of sleep that adults need each night for best health, according to new recommendations from a panel led by a University of Washington sleep expert.
And functioning effectively - without guzzling gallons of coffee - could require even more sleep, said Dr. Nathaniel F. Watson, a professor of neurology and co-director of the UW Medicine Sleep Center.
"Seven hours - that's the lower limit of the threshold," said Watson. "We don't want people walking away thinking, 'I need only seven hours of sleep a night.'"
In fact, the 15-member panel declined to put an upper limit on ideal sleep for adults ages 18 to 60 after spending a year reviewing more than 5,300 scientific articles about the link between sleep and optimal health. The results were published in the journal Sleep.
"This is a general recommendation for what it takes to remain alert and productive without stimulants," Watson said, adding that the advice applies to those older than 60, as well.
Sleeping nine hours or more a night might be appropriate for young adults, people recovering from sleep deficits and those who are ill. It's not clear whether sleeping so long is ideal for everyone else - but it's almost certainly better than sleeping too little, the researchers agreed.
Getting that message across may be difficult in the U.S., where about one-third of people ages 18 and older say they sleep six hours or less a night, according to a new federal study.
Sleep deprivation is sometimes seen as a badge of the busy or a marker of determination, Watson said.
"It's the zeitgeist of our times," he said. "We're trying to get at this notion that if you're Type A, you don't sleep. How do we change that?"
In fact, sleeping less than seven hours a night is associated with all kinds of health problems: weight gain and obesity, diabetes, high blood pressure, heart disease, depression - and a higher risk of early death, the researchers found. It is also linked to decreased immune-system function, greater pain sensitivity, problems performing at work or other activities, increased errors and a higher risk of accidents, the group noted.
To determine how much sleep is enough, Watson recommended that people conduct a three-week experiment.
"Go to bed when you're tired; wake up spontaneously when you feel rested," he said. "Then assess how you feel during the day, how you perform during the day."
At least seven hours of snooze time will likely boost both measures, he predicted. While caffeine and other stimulants temporarily mask the effects of fatigue, they do nothing to prevent the toll on health.
"It's really important for people to understand there's no substitute for sleep," Watson said.
Obstructive sleep apnea in children may be missed due to misdiagnosis of symptoms such as hyperactivity, tossing and turning, and irregular breathing at night.
Is your hyperactive child having trouble learning at school? Does your son constantly toss and turn at night? Can you hear your daughter's irregular breathing during sleep?
All of these symptoms could be the result of obstructive sleep apnea, a serious but treatable disorder that can lead to health problems, behavioral issues and learning difficulties in children and adolescents.
"One to 4 percent of all children have obstructive sleep apnea, but many go undiagnosed and untreated because people do not recognize the symptoms," says Dr. Rochelle Goldberg, director of sleep medicine services at Main Line Health and an associate professor at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.
Further complicating matters is that some children with sleep apnea are misdiagnosed with attention deficit hyperactivity disorder because, unlike adults, disrupted sleep makes kids hyperactive, experts say.
"As many as 25 percent of children diagnosed with ADHD may in fact have obstructive sleep apnea," says Tracy Nasca, executive director of the American Sleep Apnea Association, a nonprofit organization based in the District of Columbia.
Blocked Airways Impede Breathing
Sleep apnea is caused by a blockage of the airway, usually when the soft tissue in the rear of the throat collapses and closes during sleep. People with untreated sleep apnea stop breathing repeatedly during sleep, often waking or almost waking multiple times during the night.
"The result is fragmented sleep that can impact every aspect of your life," Goldberg says.
Sleep apnea can occur at any age, but the prime ages for children to develop the condition is between 4 to 7 years, when the tonsils and adenoids are largest, Goldberg says. Those most at risk include males, children with special needs and youth who are obese.
"With increasing childhood obesity comes increasing risk for sleep apnea," Goldberg says, noting thatobesity among youth has skyrocketed in the past three decades. Obesity rates in children ages 6 to 11 increased from 7 to 18 percent from 1980 to 2012, while the rate in youth ages 12 to 19 jumped from 5 to 21 percent, according to the Centers for Disease Control and Prevention.
Hyperactivity in Sleepy Children
Diagnosing sleep disorders in children requires special expertise because youngsters respond differently than adults when it comes to a lack of sleep, says Amber McAfee, a pediatric nurse practitioner at the Sleep Center at Seattle Children's Hospital.
"Adults with sleep apnea may feel sluggish during the day," McAfee says. "But children with sleep apnea are quite active and may even be hyperactive. They may also start experiencing learning difficulties at school because they can't remember things as well."
Adds Goldberg: "Unfortunately some of these kids get mislabeled by their well-meaning teachers as having ADHD and start taking medications they don't need." She advises parents to seek the expertise of a pediatrician and pediatric sleep specialist before assuming their child has ADHD.
In recent years, more parents have been requesting sleep evaluations for children diagnosed with ADHD, McAfee says. "We have seen an improvement in hyperactivity after treatment and we have parents who report taking their children off medication for ADHD because their hyperactivity was related to sleep apnea," she says.
Nighttime symptoms between children and adults vary, too. Kids are more likely to be restless and wake up. "The symptoms are a little more subtle in kids because their brains are responsive," McAfee says. "The brain alerts them that they aren't breathing well."
Some children may sleep with their head hanging from the end of the bed as a way to extend their neck and open their air pathway, Goldberg says. At times, children with sleep apnea may experience increased bedwetting or a recurrence of bedwetting.
Expert Diagnosis and Treatment
Experts recommend that parents whose children are experiencing sleep problems or sudden difficulties at school visit a certified pediatric sleep specialist for evaluation and testing, including an overnight sleep study, to rule out or confirm a diagnosis.
"We do a lot of hand holding and comforting," says Nasca, who assures parents that pediatric specialists can provide a child-friendly diagnostic experience. "Many pediatric sleep labs allow a parent to spend the night in the testing room and also encourage the children to bring a favorite 'blankie' or stuffed animal to create a more home-like sleep setting."
At Seattle Children's Hospital, parents are welcome to stay at the Sleep Center while their children are monitored overnight. Monitors gather information about brain activity, oxygen levels, heart rate, sleep quality and stages, eye movement, air flow, limb movement and more.
"I tell kids they're going to sleep like a robot for one night," McAfee says. The Sleep Clinic conducts approximately 200 sleep studies a month.
For many youngsters, surgically removing the tonsil and adenoids can resolve sleep apnea. Children who are overweight or obese may also need to focus on weight loss, experts say.
Some children find relief by wearing a nasal mask that uses continuous positive airway pressure, also known as CPAP. "CPAP is 100 percent effective in improving your breathing," McAfee says. "But only about 40 percent of the pediatric population wear the mask effectively through the night."
Sunday, June 21, 2015
Friday, June 19, 2015
Epilepsy Behav. 2013 Dec;29(3):574-7. doi: 10.1016/j.yebeh.2013.08.037.
Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy.
Cannabidiol; Dravet syndrome; Epilepsy; Intractable; Medically refractory seizures; Pediatric; Side effects; Treatment-resistant
Plant-derived cannabinoids (phytocannabinoids) are compounds with emerging therapeutic potential. Early studies suggested that cannabidiol (CBD) has anticonvulsant properties in animal models and reduced seizure frequency in limited human trials. Here, we examine the antiepileptiform and antiseizure potential of CBD using in vitro electrophysiology and an in vivo animal seizure model, respectively. CBD (0.01–100 μM) effects were assessed in vitro using the Mg2+-free and 4-aminopyridine (4-AP) models of epileptiform activity in hippocampal brain slices via multielectrode array recordings. In the Mg2+-free model, CBD decreased epileptiform local field potential (LFP) burst amplitude [in CA1 and dentate gyrus (DG) regions] and burst duration (in all regions) and increased burst frequency (in all regions). In the 4-AP model, CBD decreased LFP burst amplitude (in CA1 only at 100 μM CBD), burst duration (in CA3 and DG), and burst frequency (in all regions). CBD (1, 10, and 100 mg/kg) effects were also examined in vivo using the pentylenetetrazole model of generalized seizures. CBD (100 mg/kg) exerted clear anticonvulsant effects with significant decreases in incidence of severe seizures and mortality compared with vehicle-treated animals. Finally, CBD acted with only low affinity at cannabinoid CB1 receptors and displayed no agonist activity in [35S]guanosine 5′-O-(3-thio)triphosphate assays in cortical membranes. These findings suggest that CBD acts, potentially in a CB1
Cannabidiol Displays Antiepileptiform and Antiseizure Properties In Vitro and In VivoS⃞
What is the evidence? Orthodontic Treatment of PEDIATRIC Sleep Apnea with Rapid Maxillary Expansion
Probably yes. - JR
Clipboard: 6Remove all items
Sleep Breath. 2011 May;15(2):179-84. doi: 10.1007/s11325-011-0505-1. Epub 2011 Mar 25.
Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up.
Sleep Breath. 2011 May;15(2):173-7. doi: 10.1007/s11325-010-0419-3. Epub 2010 Sep 17.
Sleep Med. 2009 Apr;10(4):471-8. doi: 10.1016/j.sleep.2008.04.003. Epub 2008 Aug 26.
NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome.
Sleep. 2008 Jul;31(7):953-7.
Orthodontic expansion treatment and adenotonsillectomy in the treatment of obstructive sleep apnea in prepubertal children.
- Sleep. 2009 Jan 1;32(1):table of contents.
- At the request of the corresponding (first) author, the editors of Sleep are retracting the following paper and erratum: Guilleminault C, Quo S, Huynh NT, Li K. Orthodontic expansion treatment and adenotonsillectomy in the treatment of obstructive sleep apnea in prepubertal children. Sleep;31(7):953-957 and Erratum to Guilleminault C, Quo S, Huynh NT, Li K. Orthodontic expansion treatment and adenotonsillectomy in the treatment of obstructive sleep apnea in prepubertal children. Sleep;31(7):953-957, in Sleep 2009;32(1):6.[Sleep. 2010]
- [PubMed - indexed for MEDLINE]
J Laryngol Otol. 2008 Dec;122(12):1318-24. doi: 10.1017/S002221510800279X. Epub 2008 Jun 25.
Sleep. 1998 Dec 15;21(8):831-5.
- [PubMed - indexed for MEDLINE]