Treating sleep apnea helps children behave

According to this article, treating sleep apnea helps children behave.

Obstructive sleep apnea makes it nearly impossible to get a good night's sleep. Imagine air stopping in your throat, prompting you to choke anobesity, AHDH, and heart disease. If that weren't reason enough to seek treatment, maybe this will: A recent study conducted by the University of Michigan Health System found remedying a child’s sleep apnea improves their behavior, no matter if they have a low or high IQ.

"When a clinician sees a pediatric patient who has a problem in school, they ask about sleep," said Dr. Ronald Chervin, neurologist and director of the University of Michigan Sleep Disorders Center, in a statement. "We wondered, in high-performing children, do we still need to worry about snoring or sleep issues?"

Chervin and his colleagues recruited 147 children between the ages of 3 and 12 who were scheduled to undergo an adenotonsillectomy — a procedure that removes the patient’s tonsils and adenoids. Adenotonsillectomy is usually performed when children are suspected of having obstructive sleep apnea, which is characterized by enlarged tonsils and adenoids that stop children from breathing up to ten seconds throughout the night.

Researchers conducted sleep tests that monitored brain wave patterns, eye movements, heart rhythm, muscle activity, airflow out the nose and mouth, chest movements, and snoring. They then asked parents to grade their child's behavior with regard to inattention, hyperactivity, social problems, and perfectionism. The results showed children from both low and high IQ groups experienced similar behavioral improvements when they were reevaluated six months after the adenotonsillectomy.

"Regardless of intellectual level, we can expect to see some behavioral improvement along with better sleep," said Dr. Bruno Giordani, a professor of neurology, psychiatry, psychology, and nursing. "Once behavior improves, attention in school improves, and emotional ability and behavioral and impulsivity control improve."

Although children with high IQs were included in the study, identifying children with high IQs and obstructive sleep apnea is difficult in practice because they don't typically show problems with school performance. Spotting a child who is struggling from a lack of good sleep is a lot tougher than an adult who almost certainly will appear to be tired the next day, if not outright complain about it. Children, on the other hand, often react to a lack of sleep by being hyperactive the next day.

"Children with obstructive sleep apnea are fidgeting and not able to stay on task, because they're doing anything they can to stay awake," said Dr. Seockhoon Chung. "Even when those behavioral problems are minimal, improvement is still possible."

Studies have shown improved behavioral problems related to sleep apnea is imperative to ensuring these behaviors don't carry over into teenage years. A study presented at SLEEP 2012 found children with untreated obstructive sleep apnea suffered more from long-term behavioral problems, including aggression, hyperactivity, difficulty in controlling their behavior, and many other social and behavioral problems.

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Preemies may face neurodevelopmental problems

A study shows that preemies born at or earlier than 25 weeks are likely to have extremely low IQ or other neurodevelopmental issues during childhood.

Babies who are born at 25 weeks' gestation or earlier and survive early life have a "substantial likelihood" of having a very low IQ or other neurodevelopmental problems in childhood, researchers said today.

In a review of nine past studies, they found between 24 and 43 percent of extremely premature infants went on to have moderate or severe impairment, depending on just how early the babies were born.

Dr. Henry Lee, from the Division of Neonatal & Developmental Medicine at Stanford University and Lucile Packard Children's Hospital in California, said it's a "very difficult circumstance for the family" when a baby is born between 22 and 25 weeks.

Normal gestation is 37 to 42 weeks. Twenty-two weeks is considered the earliest a baby can be born and still have a chance of surviving. But the odds can be so low, and the risks so high, that some hospitals might not even offer aggressive care to preemies delivered at 22 to 23 weeks, said Lee, who wasn't involved in the new research.

"First of all, they're at high risk of not even surviving, even when everything is done to help them," he told Reuters Health. "Even when they do survive, they have high rates of disability."

By 25 weeks in the womb, a baby's chances of surviving and going on to lead a normal life are thought to be significantly better.

Lee said the new data could be used to help counsel families of extremely premature infants.

"It's hopefully an informed decision that the family makes in terms of how they're going to proceed, whether to try to provide very aggressive, intensive care to these infants or potentially to provide palliative and comfort care," he said.

"The hard part too is there is still uncertainty. Even though there is this risk, there are some infants at each of these gestational ages that will survive and not have disability."

For their analysis, researchers led by Dr. Gregory Moore from The Ottawa Hospital in Ontario, Canada, pooled the results of nine studies that assessed kids born between 22 and 25 weeks' gestation when they were four to eight years old. Most of the studies were conducted in Europe and together they included close to 900 children.

Moderately or severely impaired children were those scoring in the lowest 2 to 3 percent on IQ tests, children with cerebral palsy and those who were fully or mostly deaf or blind.

Studies varied widely in the frequency of impairment they reported, likely based in part on different practices in different regions, the researchers said.

They found that across the board, children were at risk of neurodevelopmental problems - although those risks declined for every extra week in the womb.

Among babies born at 22 weeks, 43 percent were impaired. That compared to 40 percent of those born at 23 weeks, 28 percent born at 24 weeks and 24 percent born at 25 weeks' gestation, the study team reported Monday in JAMA Pediatrics.

About 4 to 5 percent of full-term babies go on to have some type of developmental problem, Moore said, but that includes children with milder impairment as well.

"Although substantial numbers of extremely preterm infants go on to develop moderate to severe (neurodevelopmental impairment), the results are not completely bleak in that over half of the children studied did not go on to develop moderate to severe impairment," Dr. Kimberly Noble, a pediatrician who studies child brain development at Columbia University in New York, said.

Noble, who wasn't involved in the new research, told Reuters Health in an email that it's unclear whether rates of impairment would be similar for U.S. babies born very early.

Moore, also from The Children's Hospital of Eastern Ontario, said the findings were limited by the small number of children born at the earliest gestations included in the studies.

"We don't want these (data) to make a physician automatically say, ‘There's no hope' or, ‘There's no chance,'" he told Reuters Health.

But, he added, "Many parents do think of long-term impairment as a major concern for them, and some parents think of it as a bigger concern than death, for example. For some parents knowing this data and knowing the limitations of it and speaking with a caring neonatologist about it, we would hope that that would help them in their decision making."

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Study: Children with autism outscore other children on math tests

A study reports that autistic children outscore non-autistic children on math tests.

Children with autism and average IQs consistently did better on math tests than non-autistic children in the same IQ range, according to a small new study.

The superiority in math skills among children with autism was tied to patterns of activation in a particular area of the brain, an area normally associated with recognizing faces and visual objects.

"There appears to be a unique pattern of brain organization that underlies superior problem-solving abilities in children with autism," study senior author Vinod Menon, a professor of psychiatry and behavioral sciences at Stanford University, said in a university news release.

The study included 18 children with autism, aged 7 to 12, and a control group of 18 children without autism. All participants showed normal verbal and reading skills on standardized tests, but the children with autism outperformed their peers without autism on standardized math tests.

The researchers also had all of the children work on math problems while their brain activity was measured using MRI. The brain scans of the children with autism revealed an unusual pattern of activity in the ventral temporal occipital cortex, an area of the brain specialized for processing faces and other visual objects.

The study will be published online Aug. 17 in the journal Biological Psychiatry.

"[Previous research] has focused almost exclusively on weaknesses in children with autism," said Menon, a member of the Child Health Research Institute at Lucile Packard Children's Hospital. "Our study supports the idea that the atypical brain development in autism can lead not just to deficits, but also to some remarkable cognitive strengths. We think this can be reassuring to parents."

Menon said children with autism sometimes exhibit exceptional talents or skills. For example, some can instantly recall the day of the week of any calendar date within a particular range of years, and others have outstanding math skills.

"Remembering calendar dates is probably not going to help you with academic and professional success," Menon said. "But being able to solve numerical problems and developing good mathematical skills could make a big difference in the life of a child with autism."

About one in 88 children has some form of autism, according to the U.S. Centers for Disease Control and Prevention.

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Study: Autistic children with low IQ could predict epilepsy

A recent study shows that autistic children who also have a low IQ are at a greater risk of developing epilepsy.

At first glance, IQ and epilepsy may seem to have no clinical relation whatsoever. Unlike the association between IQ and autism(ASD), which appears to manifest through cognitive, communication, and social impairments, the association between IQ and epilepsy is less evident. But according the results of a recent study, low IQ in children with ASD puts them at increased risk for epilepsy.

Emma W. Viscidi of the Department of Epidemiology of the Division of Biology and Medicine at Brown University in Rhode Island conducted a study comparing the IQs of children with autism to see if it could provide insight into which children were at risk for epilepsy. Using a sample of 5,815 children with ASD, Viscidi found that 12.5% had epilepsy. When she looked at adolescents between the ages of 13 and 17, the rate increased to 26%.

The study revealed that the children with epilepsy had lower IQs than those without and that language impairment, functional regression, and severity of symptoms were all common in those with comorbid ASD and epilepsy. “The association between epilepsy and the majority of these characteristics appears to be driven by the lower IQ of participants with epilepsy,” said Viscidi. In fact, the risk of epilepsy decreased by nearly 50% with every one point increase in IQ.

Interestingly, Viscidi did not find gender differences in epilepsy rates. Aside from IQ, the other strongest predictor of epilepsy was older age, with children over the age of 10 having 2.5-fold increased risk of developing epilepsy. Viscidi is unsure if this is due to the longer duration of ASD, and if the chronicity increases the vulnerability for epilepsy. Or, as has been suggested by other research, the neurological deficits responsible for ASD are also responsible for epilepsy, predisposing ASD children for epilepsy. Regardless of the exact reason for the comorbidity, this research clearly shows that IQ could be an indicator of epilepsy and that clinicians treating children with ASD should be aware of this association early on.

Reference:
Viscidi, E.W., Triche, E.W., Pescosolido, M.F., McLean, R.L., Joseph, R.M., et al. (2013). Clinical characteristics of children with autism spectrum disorder and co-occurring epilepsy. PLoS ONE 8(7): e67797. doi:10.1371/journal.pone.0067797

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Study: In-Vitro fertilization related to slight risk of mental deficit

A new study claims that children born through in-vitro fertilization have a slightly higher risk of having a mental deficit, possibly due to a lower birth weight.

Despite some concerns, children born by in vitro fertilization do not seem to have an increased risk of autism, a large new study finds. They may, however, have a slightly higher-than-normal chance of being intellectually impaired.

The study, reported in the July 3 issue of the Journal of the American Medical Association, looked at more than 2.5 million infants born in Sweden between 1982 and 2007. It found that the nearly 31,000 children conceived via in vitro fertilization (IVF) did not have an increased risk of the developmental disorder autism.

They were, however, 18 percent more likely to have an intellectual disability (which used to be called mental retardation), defined as an IQ lower than 70 and limited abilities in schoolwork .

Experts stressed that the risk is quite low: The rate of intellectual disability among IVF kids was about 46 per 100,000 each year, versus about 40 per 100,000 among kids conceived naturally.

"The vast majority of children born after the different types of IVF treatment will be perfectly healthy," said lead researcher Sven Sandin, of the Karolinska Institute, in Stockholm, and King's College London, in England.

What's more, the risk seemed largely related to the fact that babies born via IVF are often multiples (such as twins or triplets), and, therefore, frequently born preterm or at a low weight. That in itself carries a higher-than-normal risk of intellectual disability.

Experts said the findings suggest that whenever possible, IVF should involve implanting only one embryo in the woman's uterus, rather than the traditional route of implanting at least two.

"From the results of this study, we think that the use of single-embryo transfer should be extended," Sandin said.

An infertility specialist not involved in the study agreed. "I think we should be encouraging more single-embryo transfers," said Dr. Marcelle Cedars, director of reproductive endocrinology at the University of California, San Francisco.

That is happening more often these days, said Cedars, who wrote an editorial published with the study. At her center, she said, more than half of IVF patients have a single embryo implanted -- although that is higher than the national norm.

There is still a chance, however, that certain IVF procedures carry a risk.

Sandin's team found that a specific IVF technique used for male infertility -- called intracytoplasmic sperm injection, or ICSI -- was related to an increased risk of intellectual disability, even among single babies.

Again, the actual rates of intellectual impairment were quite low, Sandin said. But the results suggest there could be something about the intracytoplasmic sperm injection, or fathers' infertility, that contributes to the risk.

"People have for some time been concerned about the ICSI procedure," Cedars said.

That is partly because intracytoplasmic sperm injection is invasive: A single sperm is injected directly into an egg, whereas in standard IVF, sperm fertilize the eggs in a lab dish. "[ICSI] also bypasses the natural selection of sperm" that happens during fertilization, Cedars said, in which sperm compete to penetrate the egg and the fittest one wins.

But an alternative explanation is that male infertility -- which may involve genetically abnormal sperm -- is raising the risk of intellectual disability, rather than some effect of intracytoplasmic sperm injection, Cedars said.

Sandin agreed, but said it's impossible to say for sure based on these findings.

The study corroborates past research that has found no excess risk of autism after IVF. But this is by far the largest and best designed study to look at the question, Cedars said.

"This gives us powerful evidence that there is no association with autism," she said. She added that expectant parents can also be reassured that the risk of intellectual disability linked to intracytoplasmic sperm injection is still very low, even if it's higher than the norm.

Although the study found an association between certain IVF procedures and a higher risk of intellectual disabilities in children, it did not establish a cause-and-effect relationship.

Cedars and Sandin both said more studies are needed to see how children fare after IVF, and to dig for reasons for the current findings on ICSI.

Between 1978 and 2012, about 5 million children worldwide were born via IVF, and the numbers will only increase, Cedars said. And in some countries -- including the United States -- intracytoplasmic sperm injection is being increasingly used in cases in which there is no clear problem with the man's fertility, because there is a perception that it's more efficient.

But that belief, Sandin's team said, is unproven.

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Epilepsy Drug Sodium Valproate Linked to Increased Chance of Autism and ADHD during Pregnancy

Children to mothers who took epilepsy drug sodium valoprate while pregnant have an increased risk of developing autism. These children should be watched closely.

Children born to mothers who took the antiepileptic drug sodium valproate during pregnancy are at significantly increased risk of autism and other neruodevelopmental disorders.

The finding came from new research published in the Journal of Neurology, Neurosurgery and Psychiatry

The research involved kids born to 528 pregnant women in England between 2000 and 2004. Fifty percent (243) of the moms had epilepsy, only 34 of those women did not take antiepileptic drugs while pregnant.

Carbamazepine was taken by 59 of the women, valproate was taken by another 59 women, lamotrigine was taken by 36, forty-one of the females took a combination, and 15 took other medications.

The researchers evaluated the physical and intellectual development of the kids at 12 months, three years, and 6 years of age.

The mothers also provided the scientists with information on whether they ever had to seek professional advice concerning their child's development, behavior, health, or educational progress.

There were 415 kids who had complete data on all 3 evaluations. A neurodevelopmental disorder was diagnosed in 19 kids by the time they were 6 years old, three of those children were affected by a physical abnormality.

Twelve of these kids had a form of autism, one child also had ADHD (attention deficit hyperactivity disorder). Three had ADHD alone and another four had dyspraxia - a condition that causes poor physical coordination and uncontrolled clumsiness.

The experts discovered that neurodevelopmental issues were notably more prevalent among those kids whose mothers had epilepsy - 7.46% vs. 1.87% of those whose mothers did not struggle with the condition.

The children whose moms took valproate by itself or with another drug during pregnancy had a considerably higher chance of being diagnosed with a neurodevelopmental condition, compared to those whose mothers took other medications for their disorder.

After examining all of the figures and adjusting for factors likely to impact the results, the investigators found that kids exposed to valproate in the womb were 6 times more likely to have a neurodevelopmental disorder.

Kids who were exposed to valporate and other drugs were 10 times more likely to have a neurodevelopment disorder than those whose moms did not have epilepsy.

Six out of 50 children (12%) whose mothers had taken valproate alone while pregnant had a neurodevelopmental problem, as did 3 out of 20 (15%) of those whose mothers had taken valproate with other treatments.

The women who had epilepsy and did not take drugs to treat the condition during pregnancy did not have any children diagnosed with a neurodevelopment disorder. However, the experts noted, there was only a small number of females in this group.

Boys had a 3 times higher chance of being diagnosed with a nuerodevelopmental disorder. However, no notable links were identified for the mother's age or IQ, epileptic seizure type, or length of pregnancy.

Although further studies are necessary before conclusions can be drawn, the findings of this research support prior reports that have demonstrated that there are potentially negative effects of valproate on the developing fetus.

For example, one study indicated that kids born to moms who took valproate while pregnant tended to score notably lower in IQ tests by an average of 6 to 9 points at age 3, than kids born to moms who took other anti-epilepsy drugs.

The experts concluded:

"If sodium valproate is the treatment of choice, women should be provided with as much information as possible to enable them to make an informed decision.

But on no account should pregnant women just stop taking the drug for fear of harming their developing child," the scientists concluded."

The researchers added that kids born to mothers who took the medication while pregnant need to be observed closely.


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Link Found Between Epilepsy Drug in Pregnancy and Lower IQ

A study found that mothers who took the epilepsy drug valproate resulted in a lower IQ of the child at age 6. This effect was proportional to the dosage of valproate.

Children of mothers who take the antiepileptic drug valproate during pregnancy have lower IQ scores at age 6, a new study says.

And the higher the dose of valproate during pregnancy, the greater the effect on a child's IQ, according to the report published in the Jan. 22 issue of The Lancet Neurology.

For the study, the researchers looked at 305 pregnant women in the United States and United Kingdom who took a single drug to treat the seizure disorder -- either valproate (Depakote), carbamazepine (Tegretol), lamotrigine (Lamictal) or phenytoin (Dilantin).

At age 6, the IQ of children whose mothers took valproate during pregnancy was seven to 10 points lower than children whose mothers took another antiepileptic drug. Exposure to valproate was also associated with poorer speaking and memory abilities.

"These results build on our earlier work to show that valproate usage during pregnancy has a significant negative effect on children's IQ, which lasts beyond their earliest years," said study leader Kimford Meador, a professor in the neurology department at Emory University in Atlanta.

"IQ at age 6 is strongly predictive of adult IQ and school performance, so our research suggests that valproate use during pregnancy is likely to have long-term negative effects on a child's IQ and other cognitive [mental] abilities," Meador added in a journal news release.

Another expert said the study is practice-changing.

"This important work has changed the way we practice neurology, leading us to conclude that valproate should not be used, if at all possible, in women of child-bearing potential," said Dr. Cynthia Harden, chief of the division of epilepsy and electroencephalography at the Cushing Neuroscience Institute in Manhasset, N.Y.

"The risks of valproate during pregnancy are clearly demonstrated, as the children in this research cohort continue to grow," said Harden.

However, the researchers also found that over time IQ may improve for children exposed to valproate in the womb, and that folic acid supplementation in mothers-to-be may improve children's IQ scores.

Harden called the finding about folic acid's mitigating effect "reassuring and fascinating, since the mechanism of how intrauterine valproate exposure causes cognitive [thinking] and behavioral problems in children is unknown."

For some patients, valproate is the only drug that can control their seizures. This may give particular importance to the findings that higher drug doses have a greater impact on IQ and that folic acid supplementation may have a positive effect on IQ, the researchers said.

Meador said more research in this area is urgently needed, given that many women with epilepsy do not have the option of stopping medication during pregnancy.

After a 2009 study found that taking valproate during pregnancy affected children's IQ at age 3, the U.S. Food and Drug Administration issued a warning that valproate exposure in the womb is associated with impaired mental function in children.

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