Being Left Out Puts Youths at Risk for Depression

The challenges that come with battling a chronic medical condition or developmental disability are enough to get a young person down. But being left out, ignored or bullied by their peers is the main reason youths with special health care needs report symptoms of anxiety or depression, according to a study to be presented`123 April 29, at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Being bullied has been shown to increase students' risk for academic and emotional problems. Little research has been done specifically on how being a victim of bullying affects youths with special needs.

In this study, researchers led by Margaret Ellis McKenna, MD, senior fellow in developmental-behavioral pediatrics at Medical University of South Carolina, investigated the impact of bullying, ostracism and diagnosis of a chronic medical condition on the emotional well-being of youths with special health care needs.

Participants ages 8-17 years were recruited from a children's hospital during routine visits with their physicians. A total of 109 youths and their parents/guardians completed questionnaires that screen for symptoms of anxiety and depression. Youths also completed a screening tool that assessed whether they had been bullied or excluded by their peers.

The main categories of youths' diagnoses included attention-deficit/hyperactivity disorder (39 percent), cystic fibrosis (22 percent), type 1 or 2 diabetes (19 percent), sickle cell disease (11 percent), obesity (11 percent), learning disability (11 percent), autism spectrum disorder (9 percent) and short stature (6 percent). Several children had a combination of these diagnoses.

Results of the youths' answers on the questionnaires showed that being bullied and/or ostracized were the strongest predictors of increased symptoms of depression or anxiety. When looking at both parent and child reports, ostracism was the strongest indicator of these symptoms.

"What is notable about these findings is that despite all the many challenges these children face in relation to their chronic medical or developmental diagnosis, being bullied or excluded by their peers were the factors most likely to predict whether or not they reported symptoms of depression," Dr. McKenna said.

"Professionals need to be particularly alert in screening for the presence of being bullied or ostracized in this already vulnerable group of students," she added.

In addition, schools should have clear policies to prevent and address bullying and ostracism, Dr. McKenna suggested, as well as programs that promote a culture of inclusion and sense of belonging for all students.

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Unruly Behavior May Be Caused By Mental Disorder

When children behave badly, it's easy to blame their parents. Sometimes, however, such behavior may be due to a mental disorder. Mental illnesses are the No. 1 cause of medical disability in youths ages 15 and older in the United States and Canada, according to the World Health Organization.

"One reason we haven't made greater progress helping people recover from mental disorders is that we get on the scene too late," said Thomas R. Insel, MD, director of the National Institute of Mental Health (NIMH) and the featured speaker at the American Academy of Pediatrics' Presidential Plenary during the Pediatric Academic Societies (PAS) annual meeting in Boston.

Dr. Insel discussed signs of mental illnesses in young children and the importance of early diagnosis and intervention in his presentation, "What Every Pediatrician Needs to Know about Mental Disorders," on April 29, in the Hynes Convention Center.

As the first line of defense, pediatricians can detect mental disorders early and ensure children get treatment as soon as possible, Dr. Insel said. While questionnaires currently are the best way for doctors to screen for mental illness, better tools are on the horizon, such as cognitive and genetic tests.

It's also important to understand that mental illnesses are a developmental brain disorder even though they can look like behavior problems, Dr. Insel explained.

"The future of mental illness has to be at the point where we aren't treating behavior separately from the rest of the person," he said. "There needs to be full integration of behavior and medical concerns to ensure that we are able to care for the whole person and not just one system."

In addition to serving as director of the NIMH, Dr. Insel is acting director of the National Center for Advancing Translational Sciences, a new arm of the National Institutes of Health that aims to accelerate the development of diagnostics and therapeutics.

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Impulsiveness Has Different Brain Localization in ADHD Than Substance Use

Teens with attention-deficit/hyperactivity disorder (ADHD) and teens who start using cigarettes, drugs or alcohol tend to share at least one personality trait: impulsiveness, experts say.

But a new brain-imaging study of nearly 1,900 14-year-olds finds that the brain networks associated with impulsivity in teens with ADHD are different compared to those who use drugs or alcohol.

What that finding suggests is that multiple underlying mechanisms drive impulsivity -- in other words, the impulsivity that leads kids to blow off their homework and the impulsiveness that drives kids to take a drag off a joint aren't the same, neurologically speaking.

"The behavior of the two groups might look the same, but it's driven by different brain networks," said lead study author Robert Whelan, a postdoctoral research fellow at the University of Vermont.

Moreover, the findings, published in the April 29 online issue of Nature Neuroscience, could suggest that the brain is primed to push some teens -- but not others -- toward substance abuse.

ADHD is a neurobehavioral disorder marked by excessive levels of activity, inattention and impulsiveness beyond what's normal for a child's age.

People with ADHD are at higher risk of substance abuse and alcoholism. The explanation was thought to lie in the lack of self-control or inability to curb impulses that are part of the disorder, Whelan said.

But the brain-imaging study suggests that from a neurological standpoint, ADHD and substance use may not be nearly as closely tied as previously believed, Whelan said.

In the study, researchers used data from an ongoing study of European teens who underwent brain imagining tests every two years starting at age 14. The youths were asked about symptoms of ADHD and if they had tried alcohol, cigarettes or other drugs.

While having their brains scanned, the students took a test used to measure self-control, or inhibition: Participants were told to press a button when they saw a right or a left arrow flash on a screen, but not to press the button when the arrow pointed up.

The kids with ADHD and those who had tried various substances didn't perform any worse on the test of self-control than other kids. However, researchers did find distinct patterns of brain activity in ADHD and in kids who'd tried alcohol, cigarettes or drugs while taking the test.

Among the kids who had tried alcohol, cigarettes or other drugs (mostly marijuana), scans showed different patterns of brain activity in the right inferior frontal gyrus and in the orbital frontal cortex compared to teens who had abstained. Prior research has found the inferior frontal gyrus is involved with inhibition. For example, people with head injuries that damaged that area of the brain have problems with inhibition, Whelan said, while the orbital frontal cortex has been implicated in drug use.

Even teens who reported having only tried a drink or two by age 14 showed a different pattern of activity in the orbital frontal cortex, suggesting the brain differences aren't caused by the substances, but are already present and play a role in what drives certain teens to experiment with alcohol and others to abstain, Whelan said.

In the teens who had symptoms of ADHD, different networks lit up during the self-control test. Kids with ADHD symptoms showed differences in the bilateral frontal lobe and the basal ganglia.

"The fact that we found there were different networks lends credence to the argument that ADHD and substance abuse are not so tightly coupled," Whelan said.

Dr. Lukshmi Puttanniah, director of child and adolescent psychiatry at Lenox Hill Hospital in New York City, said the study strongly suggests that impulsiveness can have many underlying explanations.

"It's adding to a body of knowledge that the fundamental thing underlying both ADHD and substance use is difficulty controlling impulses," Puttanniah said. "Some people thought that whatever neurobiological pathway that underlies it is common between ADHD and substance abuse. But what this study shows is the neurobiological pathways underlying the impulsivity of ADHD and substance use disorders are actually distinct."

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2012 Football Helmet Ratings

Virginia Tech has just released the results of its 2012 rating for adult football helmets that is designed to assess a helmet's ability to reduce the risk of concussion. A total of three helmets achieved a "5 star" mark, which is the highest rating awarded by the Virginia Tech Helmet Ratings™. In addition to the Riddell Revolution Speed, which was the only helmet to receive 5 stars last year, the Rawlings Quantum Plus and Riddell 360 also earned 5 stars as the best available helmets.

The process used for evaluating the head protector involves performing 120 impacts on each helmet model at multiple locations and impact energies. To date, the Virginia Tech Helmet Ratings™ for adult football include 15 helmet models that were evaluated using more than 2000 laboratory tests. The ratings, first introduced in 2011, utilize the STAR Evaluation System to assess helmet performance. The STAR, an acronym for the Summation of Tests for the Analysis of Risk, evaluation system was developed using data collected from over 1.8 million head impacts experienced by football players throughout an eight-year span.

"This is a perfect example of a National Institutes of Health (NIH) funded project resulting in translational research. The NIH supported the development of the sensors and data collection that provided the foundation for our rating system. Specifically, you can see Riddell and Rawlings using this research to develop the very best helmets," said project director Stefan Duma, the Harry C. Wyatt Professor and Department Head of the Virginia Tech -- Wake Forest School of Biomedical Engineering and Sciences (SBES).

A total of five new adult football helmet models by Rawlings, Riddell, and Xenith have been released since the Virginia Tech Helmet Ratings™ were first made available in 2011. The Riddell 360 (5 stars), Rawlings Quantum Plus (5-stars), Rawlings Impulse (4-stars), and Rawlings Quantum (4 stars) were new models that are recommended by the researchers. "We recommend any of the 4 or 5 star helmets for players. The specific helmet a player chooses will be dependent on other factors such as a fit and comfort," said Duma. The remaining new helmet model included in the 2012 ratings was the Xenith X2, which earned a 3 star rating.

Seven helmets are now rated with 4 stars in the 2012 Virginia Tech Helmet Ratings™: Schutt ION 4D, Schutt DNA Pro+, Rawlings Impulse, Xenith X1, Riddell Revolution, Rawlings Quantum, and Riddell Revolution IQ. The remaining five football helmet models were rated with 3 stars or less. The complete ratings are publicly available onlinewww.SBES.vt.edu/nid so that consumers can make educated decisions when purchasing football helmets.

"The three lowest rated helmets from last year are now all off the market. It is encouraging to see this positive shift towards better head protection," said Steven Rowson, assistant professor of biomedical engineering at Virginia Tech. Rowson was responsible for the development of the STAR Evaluation System and testing of the helmets. "Four of the five new helmet models introduced in the last year earned a 4 or 5 star rating. This helps demonstrate that a data-driven approach can be utilized to optimize helmet design to reduce concussion risk," he said.

In the future, the researchers will expand the Virginia Tech Helmet Ratings™ to include other sports as well as youth football helmets. To this end, Duma and his team collected the first dataset on head impacts experienced by youth football players last year. In the fall of 2012, researchers at Virginia Tech and Wake Forest will expand this dataset by instrumenting over 300 youth football players from ages 6 to 18 in what is called the KIDS study (Kinematics of Impact Data Set). "As we learn more about youth head impact exposure, we can begin to develop methods to evaluate youth-specific helmet designs," Duma added.

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Excessive Sleepiness May Cause Learning, Attention and School Problems

Children who have learning, attention and behavior problems may be suffering from excessive daytime sleepiness, even though clinical tests show them sleeping long enough at night, a new study reports.

Penn State researchers studied 508 children and found that those whose parents reported excessive daytime sleepiness (EDS) -- despite little indication of short sleep from traditional measurements -- were more likely to experience learning, attention/hyperactivity and conduct problems than children without EDS.

The culprits? Obesity, symptoms of inattention, depression and anxiety, asthma and parent-reported trouble falling asleep have been found to contribute to EDS even among children with no signs of diminished sleep time or sleep apnea.

"Impairment due to EDS in cognitive and behavioral functioning can have a serious impact on a child's development," said Susan Calhoun, PhD, the study's lead author. "When children are referred for neurobehavioral problems, they should be assessed for potential risk factors for EDS. Recognizing and treating EDS can offer new strategies to address some of the most common neurobehavioral challenges in young school-age children."

Calhoun said researchers were surprised that most of the children studied showed few signs of short sleep when tested, nor was short sleep associated with any of the learning, attention and behavior problems. She said parents and educators are good resources for determining if a child seems excessively sleepy in the daytime and the complaint should be taken seriously. Previous research found EDS prevalent in 15 percent of children from a general population sample.

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Longer Sleep Times May Counteract Genetic Weight Gain

 Editors note: hmmm.  lose weight by sleeping... it's easier than exercise. JR


Toss out another old wives' tale: Sleeping too much does not make you fat. Quite the opposite, according to a new study examining sleep and body mass index (BMI) in twins, which found that sleeping more than nine hours a night may actually suppress genetic influences on body weight.

The study looked at 1,088 pairs of twins and found that sleeping less than seven hours a night was associated with both increased BMI and greater genetic influences on BMI. Previous research has shown that genetic influences include things like glucose metabolism, energy use, fatty acid storage and satiety. In this study, the heritability of BMI was twice as high for the short sleepers than for twins who slept longer than nine hours a night.

"The results suggest that shorter sleep provides a more permissive environment for the expression of obesity related genes," said principal investigator Nathaniel Watson, MD, MSc, of the University of Washington. "Or it may be that extended sleep is protective by suppressing expression of obesity genes."

Watson and colleagues determined that for twins sleeping less than seven hours, genetic influences accounted for 70 percent of the differences in BMI, with common environment accounting for just 4 percent and unique environment 26 percent. For twins averaging more than nine hours of sleep, genetic factors were attributed to 32 percent of weight variations, with common environment accounting for 51 percent and unique environment 17 percent.

More research is needed, Watson said, but these preliminary results may suggest that behavioral weight loss measures would be most effective when genetic drivers of body weight are mitigated through sleep extension.

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Being Bullied Tied to Anxiety and Depression in Certain Children

Special-needs youth with chronic medical conditions or developmental disabilities are at risk for anxiety and depression if they're excluded, ignored or bullied by other young people, a new small study says.

It included 109 youngsters, ages 8 to 17, who were recruited during routine visits to a U.S. children's hospital. The patients and their parents completed questionnaires that screen for symptoms of anxiety and depression, and the youngsters also completed a questionnaire that asked them about bullying or exclusion by their peers.

The patients in the study had one or more conditions such as: attention-deficit hyperactivity disorder (39 percent); cystic fibrosis (22 percent); type 1 or 2 diabetes (19 percent); sickle cell disease (11 percent); obesity (11 percent); learning disability (11 percent); autism (9 percent); and short stature (6 percent).

The researchers found that being bullied and/or excluded by peers were the strongest predictors of increased symptoms of depression or anxiety in the young patients.

"What is notable about these findings is that despite all the many challenges these children face in relation to their chronic medical or developmental diagnosis, being bullied or excluded by their peers were the factors most likely to predict whether or not they reported symptoms of depression," study leader Dr. Margaret Ellis McKenna, a senior fellow in developmental-behavioral pediatrics at the Medical University of South Carolina, said in an American Academy of Pediatrics news release.

"Professionals need to be particularly alert in screening for the presence of being bullied or ostracized in this already-vulnerable group of students," she added.

McKenna said schools should have clear policies to prevent and address bullying and exclusion, as well as programs that promote a culture of inclusion and a sense of belonging for all students.

The study was slated for Sunday presentation at the Pediatric Academic Societies' annual meeting in Boston. The data and conclusions should be viewed as preliminary until published in a peer-reviewed medical journal.

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