Monday, April 29, 2013

Diagnosing the Wrong Deficit - A Great Read about ADD-ADHD & Sleep from the NYTimes

Diagnosing the Wrong Deficit

IN the spring of 2010, a new patient came to see me to find out if he had attention-deficit hyperactivity disorder. He had all the classic symptoms: procrastination, forgetfulness, a propensity to lose things and, of course, the inability to pay attention consistently. But one thing was unusual. His symptoms had started only two years earlier, when he was 31.
Though I treat a lot of adults for attention-deficit hyperactivity disorder, the presentation of this case was a violation of an important diagnostic criterion: symptoms must date back to childhood. It turned out he first started having these problems the month he began his most recent job, one that required him to rise at 5 a.m., despite the fact that he was a night owl.
The patient didn’t have A.D.H.D., I realized, but a chronic sleep deficit. I suggested some techniques to help him fall asleep at night, like relaxing for 90 minutes before getting in bed at 10 p.m. If necessary, he could take a small amount of melatonin. When he returned to see me two weeks later, his symptoms were almost gone. I suggested he call if they recurred. I never heard from him again.
Many theories are thrown around to explain the rise in the diagnosis and treatment of A.D.H.D. in children and adults. According to the Centers for Disease Control and Prevention, 11 percent of school-age children have now received a diagnosis of the condition. I don’t doubt that many people do, in fact, have A.D.H.D.; I regularly diagnose and treat it in adults. But what if a substantial proportion of cases are really sleep disorders in disguise?
For some people — especially children — sleep deprivation does not necessarily cause lethargy; instead they become hyperactive and unfocused. Researchers and reporters are increasingly seeing connections between dysfunctional sleep and what looks like A.D.H.D., but those links are taking a long time to be understood by parents and doctors.
We all get less sleep than we used to. The number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011. Sleep is even more crucial for children, who need delta sleep — the deep, rejuvenating, slow-wave kind — for proper growth and development. Yet today’s youngsters sleep more than an hour less than they did a hundred years ago. And for all ages, contemporary daytime activities — marked by nonstop 14-hour schedules and inescapable melatonin-inhibiting iDevices — often impair sleep. It might just be a coincidence, but this sleep-restricting lifestyle began getting more extreme in the 1990s, the decade with the explosion in A.D.H.D. diagnoses.
A number of studies have shown that a huge proportion of children with an A.D.H.D. diagnosis also have sleep-disordered breathing like apnea or snoring, restless leg syndrome or non-restorative sleep, in which delta sleep is frequently interrupted.
One study, published in 2004 in the journal Sleep, looked at 34 children with A.D.H.D. Every one of them showed a deficit of delta sleep, compared with only a handful of the 32 control subjects.
A 2006 study in the journal Pediatrics showed something similar, from the perspective of a surgery clinic. This study included 105 children between ages 5 and 12. Seventy-eight of them were scheduled to have their tonsils removed because they had problems breathing in their sleep, while 27 children scheduled for other operations served as a control group. Researchers measured the participants’ sleep patterns and tested for hyperactivity and inattentiveness, consistent with standard protocols for validating an A.D.H.D. diagnosis.
Of the 78 children getting the tonsillectomies, 28 percent were found to have A.D.H.D., compared with only 7 percent of the control group.  
Even more stunning was what the study’s authors found a year after the surgeries, when they followed up with the children. A full half of the original A.D.H.D. group who received tonsillectomies — 11 of 22 children — no longer met the criteria for the condition. In other words, what had appeared to be A.D.H.D. had been resolved by treating a sleeping problem.
But it’s also possible that A.D.H.D.-like symptoms can persist even after a sleeping problem is resolved. Consider a long-term study of more than 11,000 children in Britain published last year, also in Pediatrics. Mothers were asked about symptoms of sleep-disordered breathing in their infants when they were 6 months old. Then, when the children were 4 and 7 years old, the mothers completed a behavioral questionnaire to gauge their children’s levels of inattention, hyperactivity, anxiety, depression and problems with peers, conduct and social skills.
The study found that children who suffered from sleep-disordered breathing in infancy were more likely to have behavioral difficulties later in life — they were 20 to 60 percent more likely to have behavioral problems at age 4, and 40 to 100 percent more likely to have such problems at age 7. Interestingly, these problems occurred even if the disordered breathing had abated, implying that an infant breathing problem might cause some kind of potentially irreversible neurological injury.

Saturday, April 27, 2013

Epilepsy drug Potiga linked to skin and eye abnormalities

Epilepsy Update- Drug Warning - JR

Epilepsy drug Potiga linked to skin and eye abnormalities 

On April 26, 2013, the U.S. Food and Drug Administration (FDA) issued a safety alertregarding the anti-seizure medication Potiga (ezogabine). Potiga is used to treat partial-onset seizures in adults with epilepsy.
Epilepsy is a brain disorder that causes recurring seizures. Approximately 60,000people in Connecticut have epilepsy. One out of every ten people will experience a seizure at some point in their lives.
The FDA reports that Potiga may cause blue skin discoloration and eye abnormalities (such as changes in the color of the retina). Pigment changes in the retina can cause serious eye disease with loss of vision. It is not yet known if these changes are reversible. The skin discoloration is blue, predominantly on the lips or in the nail beds of the fingers or toes. Eye discoloration can occur in thesclera and conjunctiva of the eye as well as on the white of the eye and inside eyelids.
It is recommended that anyone taking Potiga have a baseline eye exam and periodic eye exams. Anyone taking Potiga, who develops changes in vision or discoloration of skin, should contact their doctor immediately. Also, report any side effects to the FDA MedWatch program (online or by calling 1-800-332-1088). It is important that patients should not stop taking Potiga without talking to their doctor. Stopping treatment suddenly can cause serious and life-threatening medical problems, such as withdrawal seizures.
The FDA is working with the manufacturer to better understand these events and will update the public when more information is available.

Study: Sleep Apnea Symptoms Vary by Race

This new study adds to our knowledge of the effect of race/ethnicity on sleep disorders and the PERCEPTION of sleep problems. 

We have known for some time that certain groups are more susceptible. 

Sleep apnea is another possible element of the study of the prevalence of hypertension and vascular disorders in certain ethnic groups. - JR

From the Huffington Post.....

"Risk factors for obstructive sleep apnea -- the sleep disorder in which breathing repeatedly stops and starts -- run the gamut, from smoking and high blood pressure, to the most common, high body mass index (BMI). But a recent study by researchers at Wayne State University School of Medicine reveals that even with BMI accounted for, one key risk factor remains -- race.

In the study of 512 patients observed at the Detroit Receiving Hospital Sleep Disorders Center between July 1996 and February 1999, the severity of sleep apnea was shown to be higher among African-American men under 40 years old and between 50 and 59 years old. No difference was found between African-American and white women, however.
Lead researcher, James Rowley, PhD, professor of medicine at Wayne State Medical Director of the sleep disorders center, says that the mechanism for a racial difference in sleep apnea severity is unclear, but potential mechanisms include anatomic differences that affect the way the upper airway open and close, as well as differences in the neurochemical control of breathing.
According to the Mayo Clinic, there are two main types of sleep apnea:
Obstructive sleep apnea, the more common form that occurs when throat muscles relax
Central sleep apnea, which occurs when your brain doesn't send proper signals to the muscles that control breathing
Rowley's research isn't the first to identify differences in how race affects the quality of sleep.
In two presentations at the annual meeting of the Associated Professional Sleep Societies in Boston last year, scientists reported that the amount and quality of sleep people get each night vary across racial and ethnic lines, with one study showing that blacks and Asians don’t sleep as much as whites do, and another study showing thatforeign-born Americans are less likely to report having sleep problems than those born in the U.S.
Unlike Rowley's study, however, the authors of last year's research surmise that the majority of the differences in sleep patterns between races can be chalked up to environmental or even geographical factors — rather than genes or physical characteristics like variations in facial structure that could interfere with breathing and sleep, TIME's Alice Park noted.

Read more here

Thursday, April 25, 2013

New Hope for Autistic Children Who Never Learn to Speak

This is an evidence-based article on autism treatment. JR

New Hope for Autistic Children Who Never Learn to Speak

Apr. 24, 2013 — An Autistica consultation published this month found that 24% of children with autism were non-verbal or minimally verbal, and it is known that these problems can persist into adulthood.

Professionals have long attempted to support the development of language in these children but with mixed outcomes. An estimated 600,000 people in the UK and 70 million worldwide have autism, a neuro-developmental condition which is life-long.

Today, scientists at the University of Birmingham publish a paper in Frontiers in Neuroscience showing that while not all of the current interventions used are effective, there is real hope for progress by using interventions based on understanding natural language development and the role of motor and "motor mirroring" behaviour in toddlers.

The researchers, led by Dr Joe McCleery, who is supported by autism research charity Autistica, examined over 200 published papers and more than 60 different intervention studies, and found that:
  • Motor behaviours, such as banging toys and copying gestures or facial expressions ("mirroring"), play a key role in the learning of language.
  • Children with autism show specific motor impairments, and less "mirroring" brain activity, particularly in relation to strangers in whom they show very little interest. This finding may hold the key to language problems overall.
  • Despite extensive use of sign language training to improve speech and communication skills in non-verbal children with autism, there is very little evidence that it makes a positive impact, potentially due to the impairments in motor behaviours and mirroring.
  • Picture exchange training can lead to improvements in speech. Here, children gradually learn to "ask" for things by exchanging pictures. This may work well because it does not depend on complex motor skills or mirroring.
  • Play-based approaches which employ explicit teaching strategies and are developmentally based are particularly successful.
  • New studies involving a focus on motor skills alongside speech and language intervention are showing promising preliminary results. This is exciting because these interventions utilise our new understanding of the role of motor behaviours in the development of speech and social interaction.

Christine Swabey, CEO of Autistica, says: "80% of the parents in our recent consultation wanted interventions straight after diagnosis. Dr McCleery's work shows how critical it is for all intervention to be evidence-based, and that the best approaches are based on a real understanding of the development of difficulties in autism. We are proud to be supporting the next steps in this vital research which will improve the quality of life for people with autism."

Alison Hardy, whose son Alfie is six, says: "As a parent of an autistic child, who is non-verbal, I feel quite vulnerable. People are always saying "try this, it worked wonders for us." But you can't try everything. We need a proper, scientific evidence base for what works and what does not. Then we can focus our time and our effort, with some confidence that we have a chance of helping our children."

link here

Wednesday, April 24, 2013

Colic in infants may be an early sign of migraines

Colic in infants may be an indicator of migraine headaches.

Colic has long been believed to be gastrointestinal pain in babies, say doctors, but new research suggests it may actually be related to migraine headaches instead.

Could colic — bouts of frequent, inconsolable crying during an infant's first months of life — be an early symptom of a migraine? A study out today is the latest to suggest that the two common pain conditions may be connected.

According to the study in the Journal of the American Medical Association, children diagnosed with migraine headaches were more likely to have experienced colic as infants (72.6%) than those who did not have migraine (26.5%).

And the increased odds existed for the two major migraine subtypes, as well: migraines preceded or accompanied by an "aura" — sensory warning symptoms such as flashes of light or blind spots (69.7%) and migraine without aura (73.9%). This association was not found for children with tension-type headaches (35%).

Researchers analyzed health records and questionnaires completed by parents for 208 children ages 6 to 18 who were diagnosed as having migraines and compared them with information on 471 kids and teens who were not. A comparison group of 120 children diagnosed with tension headaches also was studied.

A study published last year found that mothers who suffer from migraines are more than twice as likely to have babies with colic than mothers without a history of migraines.

Often thought of as a disorder of adulthood, migraine is "one of the most common causes of primary headaches in children," according to the article, written by Silvia Romanello of the APHP-Hospital Robert Debré, Paris, and colleagues.

An accompanying editorial notes that the prevalence of migraine headache by age groups is 1% to 3% from ages 3 to 7; 4% to 11% from ages 7 to 11; and 8% to 23% from ages 11 to 15 years old. Colic occurs in about 16% to 20% of infants.

Much more than a headache, a migraine is a "brain condition that can produce a variety of neurological symptoms," ranging from nausea and vomiting to sensitivity to light, sound, touch and smell, to dizziness and extreme fatigue, says Andrew Charles, a professor of neurology and director of the Headache Research and Treatment Program at UCLA School of Medicine. He was not involved in the new study.

"We've assumed for some time that colic was a gastrointestinal phenomenon, but in fact, that may not necessarily be true," says Charles. "That's one of the things that may surprise people about this study. It points out the possibility that this may be more of a brain issue than a gut issue."

Brain chemicals that are also shared by the gastrointestinal tract may be involved, but the actual mechanism at work "remains quite a mystery," he says.

Read more here

How exercise helps sleep

This article discusses the positive influences exercise has on your sleep.

We all know exercise is good for us. Good for our health, good for our waistlines, good for stress and for our clarity of mind. Exercise is also very—very—good for sleep. Research has shown that exercise can improve sleep, including for people with sleep disorders and other sleep-related illnesses. And now there’s even more evidence of the sleep benefits that can come with regular physical activity.
The National Sleep Foundation devoted its annual Sleep in America poll to exploring the relationship between exercise and sleep. Their results found that people who exercise regularly experience better quality and more consistent sleep than those who do not. People who exercise are also significantly less likely to feel sleepy during the day, and to experience symptoms of sleep disorders such as insomnia and obstructive sleep apnea. And the news gets better: while more vigorous exercise is best, people participating in light exercise—as little as 10 minutes of walking a day—reported substantially better sleep than non-exercisers.
The NSF interviewed a nationally representative sample of 1,000 adults between the ages of 23-60. Participants were asked to report on their physical activity in the past week, providing details on the frequency, duration, and intensity of their exercise. They also were asked to report on the quantity and quality of their sleep, as well as sleep problems including symptoms of disordered sleep and daytime drowsiness. Participants provided information about their overall health, and personal habits including alcohol and smoking.
Based on the reports of physical activity, respondents were divided into four categories, according to their exercise habits:
  1. Vigorous: These people participated in activities like running, biking, swimming, and other pursuits that require significant physical exertion.
  2. Moderate: Respondents in this category spent time doing activities that included higher-than-normal levels of physical exertion, including yoga and weight training.
  3. Light: People in this category were physical active at normal levels of exertion, getting their exercise primarily by walking.
  4. No activity: The respondents in this category did not engage in exercise.

The results were striking. All respondents—from vigorous exercisers to non-exercisers—reported getting roughly the same amount of sleep on a nightly basis, an average of 6 hours and 51 minutes on workdays, and 7 hours and 37 minutes on non-workdays. All groups also reported needing about the same amount of sleep to meet the demands of their daily lives: an average of 7 hours and 17 minutes. But exercisers at all levels reported sleeping substantially better than those who did not exercise:
  • More than half of exercisers (56-67%) reported getting a good night’s sleep every night or almost every night, compared to 39% of non-exercisers.
  • Exercisers at all levels also reported higher quality of sleep than non-exercisers. More than three-quarters (76-83%) said their sleep was “very good” or “fairly good,” compared to 56% of non-exercisers.
  • More than half of exercisers at all levels also reported feeling their quality of sleep improve on days they engaged in physical activity.
While all exercisers reported significantly better sleep, the highest quality sleep was reported by those who engaged in the most vigorous physical activity. Vigorous exercisers reported the highest sleep quality, and the most robust daytime energy levels. And they were least likely to have problems with their sleep:
  • 26% of vigorous exercisers said their quality of sleep was “very good,” compared to 16% of light exercisers.
  • 66% of vigorous exercisers said they got more sleep than they needed, compared to 53% of moderate and light exercisers.
  • Vigorous exercisers had fewer sleep problems than moderate and light exercisers, including less difficulty falling asleep and staying asleep, waking too early and not being able to fall back asleep. All exercisers reported fewer of these problems than people who did not exercise at all.
  • 50% of vigorous exercisers said they had no problems maintaining enthusiasm for the demands of their daily lives, compared to 40% of moderate and light exercisers and 33% of non-exercisers.
People who engaged in no exercise didn’t just report lower quality sleep, they also reported in greater numbers a range of difficulties with their health and their daily lives:
  • Non-exercisers were significantly more likely to say they experienced “very bad” sleep than exercisers. Fourteen percent of non-exercisers categorized their sleep as very bad, compared to 3-4% of exercisers.
  • More than half—61%–of non-exercisers reported “rarely” or “never” getting a good night’s sleep on workdays, compared to 29% of vigorous exercisers.
  • Non-exercisers were more likely to feel sleepy during the day. Nearly twice as many non-exercisers reported daytime sleepiness as exercisers.
  • Daytime sleepiness interfered with non-exercisers daily activities and their safety more often than for those who exercised. 14% of non-exercisers reported having trouble staying awake while driving, eating, or engaging in social activity 1 or more times in the previous two weeks, compared to 4-6% of exercisers.
  • Non-exercisers were significantly more likely to have symptoms of sleep disorders including obstructive sleep apnea. Forty-four percent of non-exercisers demonstrated a moderate risk for sleep apnea, based on standard clinical indications for the sleep disorder. This number was more than twice as high as for vigorous exercisers, only 19% of whom indicated a moderate risk of sleep apnea.
The message here is clear: put some time every day toward exercise, and when bedtime comes around you’ll sleep better. For those trying to juggle a regular exercise routine amid busy schedules, there’s some more good news in these poll results. The survey found that exercise at any time of day was good for sleep, including within 4 hours of bedtime. It’s been a common recommendation—including from the National Sleep Foundation itself—to avoid exercise during the final 4 hours of the waking day, in order to prevent physical exertion from interfering with sleep. Based on these results, the NSF has revised its recommendation, and encourages normal sleepers to exercise at any time of day, provided that their exercise does not interfere with their sleep. People with insomnia and other sleep disorders should continue to schedule their exercise earlier in the day. And anyone who finds their sleep diminished by late-day exercise should do the same.
So, where do you fit in the sleep-exercise picture that these survey results illustrate? Are you sleeping as much, and as well, as you need? If you’re looking for ways to improve your sleep, your daily exercise routine is a great place to start.
Read more here

Sleep disorders and their clinical significance in children with Down syndrome

What I'm reading...Note the UK recommendations that ALL children have a pediatric sleep specialist see them until 5 years.....JR

Sleep disorders and their clinical significance in children with Down syndrome

Article first published online: 2 SEP 2012

Aim  Our aim was to review basic aspects of sleep disorders in children with Down syndrome in the light of present-day findings of such disorders in children in general, including other groups of children with developmental disabilities.
Methods  A literature search of adverse developmental effects of sleep disturbance, types of sleep disturbance in children with Down syndrome, their aetiology, including possible contributions of physical and psychiatric comorbidities and medication effects, principles of assessment and diagnosis, and treatment issues, was carried out.
Results  Sleep disturbance is particularly common in children with developmental disorders including Down syndrome. Although there are just three basic sleep problems (sleeplessness or insomnia, excessive daytime sleepiness, and parasomnias) there are many possible underlying causes (sleep disorders), the nature of which dictates the particular treatment required. In children with Down syndrome, in addition to the same influences in other children, various comorbid physical and psychiatric conditions are capable of disturbing sleep. Possible adverse medication effects also need to be considered.
Interpretation  Screening for sleep disorders and their causes should be routine; positive findings call for detailed diagnosis. Management should acknowledge the likely multifactorial aetiology of the sleep disorders in Down syndrome. Successful treatment can be expected to alleviate significantly the difficulties of both child and family.
Obstructive sleep apnoea, obstructive sleep apnea

What this paper adds

  •  This paper draws attention to the multifactorial nature of sleep disorders in children with Down syndrome.
  •  Sleep disorders are linked with their origins, including comorbid conditions and medication effects.
  •  Routine repeated clinical screening for sleep disorders and their possible causes is encouraged.

    "Compared with the rate in typically developing children, overall rates reported for children with Down syndrome have varied from 31% to 54%. This increased rate was generally similar to that reported in other learning disability syndromes (although particularly high rates are given for some neurodevelopmental disorders such as Smith–Magenis syndrome and, to a lesser extent, Angelman syndrome)."

    "However, screening for sleep symptoms simply highlights the possibility of a sleep disorder and does not constitute a diagnosis. 
    Adequate identification of a sleep disorder requires comprehensive clinical enquiry consisting of detailed histories especially about the sleep problem, the child’s 24-hour sleep–wake pattern including parenting practices, developmental details, family history, and family circumstances.54 
    Both physical and behavioural examination may well be appropriate, and possibly further assessment in the form of sleep diary records and objective sleep studies such as actigraphy or polysomnography. Referral for assessment at a specialist paediatric service or sleep disorders clinic may be needed. 
    The Royal College of Paediatrics and Child Health report37 recommended regular screening for overnight hypoxia in infants with Down syndrome until the age of 5 years."

Potential causes of ADD and ADHD

This article discusses possible causes of ADD and ADHD compiled from different sources. Causes include genetic factors, premature birth, and other complications. ADD/ ADHD is a complex illness with few simple solutions. JR

A study in the British Medical Journal, Lancet, has reported for the first time, direct evidence of a genetic link with ADHD. Another study published in the medical journal, Pediatrics, has suggested that increased exposure to pesticides may also be linked to ADHD. Other causes may include premature birth, complications during childbirth such as hypoxia (lack of oxygen), and prolonged exposure to anesthesia at early ages.

The study on the genetic link with ADHD, even more so, makes it increasingly clear that ADHD is not caused by bad parenting or high sugar diets. There has been too much misunderstanding about the causes of ADHD with the child and the parents being unfairly stigmatised. Misconceptions such as if the parents did a better job of parenting or if the child tried harded and wasn't lazy, then the child would not have ADHD. These are all misconceptions that only do harm to the child's self esteem as well as the parents' self esteem.

It needs to be understood that ADHD or ADD is a neurophysiologic disorder, not a result of parenting.....

The most important point is that early intervention for the child's ADHD or ADD is likely to produce the best clinical outcome. Parenting a child with ADD or ADHD is a much more challenging child rearing experience than parenting a child without ADHD or ADD. Normal parenting methods frequently are not adequate as the parents are likely to experience increased frustrations with normal parenting methods not having the impact that they desire. 

The child is more vulnerable to developing low self esteem as they feel they are not as smart as their peers, or that it will never get better for them academically,or why try hard if it doesn't make a difference. If they are impulsive, then they will trigger a lot of disapproval from adults and may get rejected by peers.

Neurologically, the ADHD or ADD child's concentration or attentional system is underfunctioning so they are unable to successfully meet their academic and even sometimes day to day challenges. When their self esteem suffers, the parent's self esteem may also suffer. Again, the earliest intervention can produce the best clinical outcome and prevent psychological problems as they get older.

Read more here

Monday, April 22, 2013

What parents should know about concussions

This article reviews the signs and symptoms of concussions that parents of athletes should be aware of. - JR

Parents of young athletes know that along with the many benefits of participating in sports, there comes a certain amount of injury risk. And while most would agree that the benefits of being active and involved in athletics outweigh those risks, it’s important to make sure your child gets proper treatment if an injury occurs. As more evidence surfaces about long-term health challenges related to concussions, it’s especially crucial that parents bring themselves up to speed on the proper procedures for caring for an athlete who experiences a concussion.

The most important thing parents need to know about concussions is that if an athlete exhibits any signs or experiences any symptoms of a concussion, he or she should be immediately removed from play. While this recommendation is nothing new, the American Academy of Neurology (AAN) is again emphasizing its importance with the release of its updated 2013 sports concussion evidence-based guidelines.

“Among the most important recommendations the academy is making is that any athlete suspected of experiencing a concussion should immediately be removed from play,” says Christopher C. Giza, MD, co-author of the AAN guidelines. “We’ve moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually. There is no set timeline for safe return to play.”

For parents unfamiliar with concussion signs and symptoms, they include:

* Headache and sensitivity to light or sound

* Changes to balance, coordination and reaction time

* Changes in memory, judgment, speech and sleep

* Loss of consciousness or a “blackout” (happens in less than 10 percent of cases)

Removal from play is just the first step in properly treating a concussion. After a player who is exhibiting concussion signs or having concussion symptoms is removed, it’s equally important that the player be examined by a licensed health care professional trained in diagnosing and managing concussions. “Being seen by a trained professional is extremely important after a concussion,” says Jeffrey S. Kutcher, MD, co-author of the AAN guidelines. “If headaches or other symptoms return with the start of exercise, stop the activity and consult a doctor.”

If your athlete is diagnosed with a concussion, it’s extremely important to follow the recommendations of the health care professional, and the athlete should not be permitted to resume any sports-related activities until he or she is cleared by a licensed health care professional to do so. Parents, coaches and officials should all work together to see that the health care professional’s recommendations are followed, ensuring the best possible short- and long-term outcome for the athlete.

Parents, coaches and officials should familiarize themselves with concussion protocols before they ever get to the field or court, but the AAN also offers a smartphone app should you need to review them. The Concussion Quick Check app can be downloaded free of charge and provides a handy guide to making sure your athlete gets the proper care.

In addition to emphasizing proper care for athletes exhibiting concussion symptoms, the new AAN guidelines include the following concussion-related findings:

* Among the sports in the studies evaluated, risk of concussion is greatest in football and rugby, followed by hockey and soccer. The risk of concussion for young women and girls is greatest in soccer and basketball.

* An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another concussion.

* The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with another concussion.

* There is no clear evidence that one type of football helmet can better protect against concussion over another kind of helmet. Helmets should fit properly and be well maintained.

* Licensed health professionals trained in diagnosing and managing concussion should look for ongoing symptoms (especially headache and fogginess), history of concussions, and younger age in the athlete. Each of these factors has been linked to a longer recovery after a concussion.

* Risk factors linked to chronic neurobehavioral impairment in professional athletes include prior concussion, longer exposure to the sport and having the ApoE4 gene.

* Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC), neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.

To view the entire AAN concussion report and find more concussion resources, visit

Read more here

Study shows childhood obesity determined by environmental factors, not genetics

A study from the Scientific American claims that childhood obesity is largely determined by environmental factors, not genetics as other studies have claimed. JR

New evidence is confirming that the environment kids live in has a greater impact than factors such as genetics, insufficient physical activity or other elements in efforts to control child obesity. Three new studies, published in the April 8Pediatrics, land on the import of the 'nurture' side of the equation and focus on specific circumstances in children's or teen's lives that potentially contribute to unhealthy bulk.
In three decades child and adolescent obesity has tripled in the U.S., and estimates from 2010 classify more than a third of children and teens as overweight or obese. Obesity puts these kids at higher risk for type 2 diabetes, cardiovascular disease,sleep apnea, and bone or joint problems. The variables responsible are thought to range from too little exercise to too many soft drinks. Now it seems that blaming Pepsi or too little PE might neglect the bigger picture.
"We are raising our children in a world that is vastly different than it was 40 or 50 years ago," says Yoni Freedhoff, an obesity doctor and assistant professor of medicine at the University of Ottawa. "Childhood obesity is a disease of the environment. It's a natural consequence of normal kids with normal genes being raised in unhealthy, abnormal environments." The environmental factors in these studies range from the seemingly minor, such as kids' plate sizes, to bigger challenges, such as school schedules that may keep teens from getting sufficient sleep. But they are part of an even longer list: the ubiquity of fast food, changes in technology, fewer home-cooked meals, more food advertising, an explosion of low-cost processed foods and increasing sugary drink serving sizes (pdf) as well as easy access to unhealthy snacks in vending machines, at sports games and in nearly every setting children inhabit—these are just a handful of environmental factors research has linked to increasing obesity, and researchers are starting to pick apart which among them play bigger or lesser roles in making kids supersized.
Size matters in "obesogenic environments"
In one of the three new studies dishware size made a big difference. Researchers studied 42 second-graders in which the children alternately used child-size 18.4-centimeter (7.25-inch) diameter plates with 237-milliliter (8-ounce) bowls or adult-size 26-centimeter (10.25-inch) diameter plates with 473-milliliter (16-ounce) bowls. Doubling the size of the dishware, the researchers found, increased the amount of food kids served themselves in a buffet-style lunch line by an average of 90 calories. They ate about 43 percent of those extra calories, on average.
Although kids can typically adjust their energy intake by regulating their food, Temple University public health professor Jennifer Fisher says, their surroundings and options may change that equation for kids in the same way that it does in adults. "This notion that children are immune to the environment is somewhat misguided," says Fisher, who headed up the study. "To promote self-regulation, you have to constrain the environment in a way that makes the healthy choice the easy choice."
Fisher says much recent research in nutrition has focused on the "obesogenic" environments of today's society: a dietary environment offering widespread access to highly palatable foods in large portion sizes. "If we look at adult studies on dieting and weight loss, we know that the prospect of maintaining self-control in this environment is fairly grim," Fisher says. "I think most scientists believe our bodies have evolved to pretty staunchly defend hunger and prevent weight loss, and maybe are not so sensitive in preventing overconsumption."
Link between obesity and screen time
Overconsumption might be a key component in the link between obesity and screen time, too, according to another of the new studies. Although past research already had linked increased TV time to widening waistlines, this study dug deeper. Ninety-one 13- to 15-year-olds filled out diaries for TV, video games and computer use during a one-week period. About four to seven times a day the teens were paged to record what they were paying the most attention to at that particular moment, followed by activities receiving their second- and third-most attention. "Kids live in a multitasking world," says Harvard Medical School pediatrics professor David Bickham, lead author of the screen-time study. "We're trying to assess their technology use when they're using different forms of technology at once."
Bickham says three theories have been floated for the link between screen time and obesity: food advertising, unconscious eating and displacement—that is, the idea that the media use replaces physical activity. His team's findings lent more support to the first two variables and less to the third. They found video games and computer use had no impact on BMI (body mass index). Television did, but only if it was the main event. Background TV, for example, didn't matter.
"We're saying the level of attention may make a difference," Bickham says. "You have to pay attention to advertising for it to have the impact, and [food] advertising is much less common in computers and video games. In terms of unconscious eating, when you're watching TV, your hands are free and you're stimulating your senses with the TV, so concurrent eating is more likely to happen." Previous research (pdf) has found support for both these theories, such as a study earlier this year showing that neighborhoods with more food and soft drink outdoor advertising had higher rates of obesity. Freedhoff adds that even viewing commercials for fruits and vegetables has been shown to increase consumption of unhealthy foods. "Our hunger hormones have been honed after millions of years of dietary insecurity, so when we want to eat, we tend not to crave green leafy salads," he says.
Less physical activity is not the problem
The screen-time study did find that kids engaged in more physical activity had lower BMIs, but that does not mean that more exercise is keeping those teens lighter, Freedhoff says. "What we've seen for so many years is research looking at physical activity as the preventative or the curative solution for childhood obesity, but the data on physical activity as a means to set children's weight is abysmal," he says. "What this study confirmed is that screen time increases obesity consequent to calorie intake, not to a lack of physical activity. That's a crucial message that people don't understand—obesity is not a disease of inactivity."
The third new study, looking at the link between sleep duration and obesity in teens, further blunts the idea that physical activity accounts for much of the increase in kids' weight. Researchers tracked nearly 1,400 teenagers from ninth through 12th grade and found, like past studies, that less sleep translates to higher BMIs. By analyzing BMI distribution rather than using cutoff points, University of Pennsylvania postdoctoral fellow Jonathan Mitchell says his team detected much stronger sleep effects among already obese teens. The effect of each additional hour of sleep among teens in the 90th BMI percentile was twice as big as among those in the 10th percentile. Increasing sleep from 7.5 to 10 hours a day among 18-year-olds could shave four percentage points off the proportion of teens with a BMI over 25, the researchers predicted.
They also looked at the teens' physical activity levels. "If you're sleeping less, you're fatigued during the day and less likely to be active," Mitchell says. "But the link we observed was not fully explained by lower levels of physical activity." Another possibility is that being awake longer means more opportunities to eat, but Mitchell's team did not look at dietary intake. Past research has also found thatsleep deprivation might alter the body's regulation of hormones leptin and ghrelin, which control satiety and hunger. Or, the problem may not the total caloric intake but the timing of eating, Mitchell says. He noted mice studies where the nocturnal critters became obese if they ate during day and night but remained a normal weight if they only ate at night.
Regardless of the mechanism, these findings also support the notion that the entirety of kids' 21st-century environment—not their self-control or reduced physical activity—is the key culprit in the rise in obesity. "People like to make obesity a disease of blame, but the last 40 years has not seen an epidemic of our children losing willpower," Freedhoff says. "There are dozens and dozens of these environmental factors. Unless we reengineer our children's environments, we are not likely to see any changes in children's weights."
Freedhoff points to cities such as Philadelphia and New York, where modifying children's environments, especially in schools, may be responsible for recent reductions in obesity. Philadelphia removed sugary drinks from vending machines in 2004, then reduced snack food serving sizes, removed deep fryers from school cafeterias and replaced whole milk options with 1 percent and skim. Outside of school, more than 600 corner stores participate in the Food Trust initiative to stock their shelves with healthier snacks. New York has instituted new nutrition standards in schools (pdf) and daycare centers, as well as screen-time limits in day cares. The two metropolises also have some of the most comprehensive menu labeling laws in the country.
"This is a lot more complicated than ‘eat less, exercise more,'" Freedhoff says. "If weight management or childhood obesity prevention and treatment were intuitive, we'd have a lot of skinny kids running around." Freedhoff himself is developing a program for families that focuses on "redrafting" kids' and families' environments, starting with more home cooking. "Every parent would die for their child, but most won't cook for their children on a consistent basis with whole ingredients," he says.
But Freedhoff also says the problem of increasing childhood obesity cannot be tackled by parents alone. He suggests starting with changes within school boards, sports teams, PTAs and others who already care about kids. "What I'm amazed by is the constant use of fast food to pacify children and reward children—there is no event too small for candy or fast food." There are many places communities could start: making school lunches healthier, ditching vending machines and access to fast food inside schools, not celebrating sports wins at fast food joints, and ending the use of candy or fast food as rewards, such as "pizza days" and other unhealthy food-themed school events, to name a few. "People don't appreciate that parents are around children a minority of their days," he says, so it really will take a village to turn back the clock in terms of kids' environments. "If we had a time machine, it would be the world's best weight-loss program," Freedhoff says. "It's the world that has changed, not people."
Read more here

Sunday, April 21, 2013

App is a great resource for those with epilepsy

A free app provides great information and resources for those with epilepsy and their family and friends.

Whether you're one of the 2.2 million Americans living with epilepsy, or have friends or family affected by the neurological disorder, a new app serves as an excellent resource for your iPhone, iPad or iPod touch.

Called E-Action Info, this free App Store download provides medical info, media and an educational game -- all designed to teach about epilepsy in a clear, accessible manner.

For those living with epilepsy, the app covers management tips, a FAQ (Frequently Asked Questions) section, an interactive and color-coded 3D model of the brain (zoom and rotate to learn about all of its areas and functions), links to epilepsy associations and the option to start a journal, called MyEpilepsyDiary, to help keep an accurate account of when seizures happen.

Be aware, however, this diary feature links to a login page at opposed to an integrated diary located within the app. While this requires an Internet connection, at least the info is not located on the iOS device itself, which could be a privacy issue if lost, stolen or damaged. Users are encouraged to login with a password to track their seizures, medicines and progress -- all of which are accessible on a computer, smartphone, tablet or other device with a web browser. If desired, users can share this information with their physicians to optimize treatment, plus there's an option to request therapy reminders by email, text or smartphone notification.

E-Action Info was also designed for those close to someone living with epilepsy. For example, along with educational info and a video (Internet connection required), there's a section on the different kinds of seizures and a helpful First Aid resource for caregivers and the public (that is, what to do if you witness someone having a seizure).

While the app was funded by a pharmaceutical company (UCB Pharma SA), there is no mention of the company, its products or even links to its website.

E-Action Info is only available for iOS devices at this point.

Read more here