Getting to bed early helps mental health

Going to sleep early can help a person's mental health.

There are many benefits of going to bed early- and now, a team of researchers have found how this teeny tiny habit could have a positive impact on not just your physical health, but mental health as well.

Researchers from Binghamton University have found a possible connection between sleeping disorders and anxiety. It has been found that depression, anxiety, stress and obsessive compulsive disorders may cause heavy psychological traffic that could have an individual clinging too much to the past.

This new study, which took into consideration one hundred young adults, asked them to fill out questionnaires and carry out certain computerized tasks while the researchers assessed the extent of their obsessive behavior and thinking and worrying with respect to it. The study subject included individuals having different sleeping habits- some of them were night owls, while others had regular sleeping hours.

They found that individuals who slept less or went to bed late had signs of negative thinking as compared to those who slept early. While repetitive negative thinking isn’t a disorder as such, it does increase the risk of several anxiety disorders including depression and stress.

While the reason behind this phenomenon is unclear, scientists are making assumptions to decode it all. They have noted that sleeping late at night tends to disrupt the biological clock of the body, which also plays a negative impact on the levels of certain chemicals in our body.

These kinds of irregular sleeping patterns tend to upset the chemical production in the brain as well as other organs, even if you manage to get your much needed 8 hours of sleep a day.

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Teenagers proscribed anti-anxiety or sleep medications more likely to abuse them

When teenagers are proscribed anti-anxiety or sleep medication, they are more likely to abuse those drugs later in life.

The medical community may be inadvertently creating a new generation of illegal, recreational drug users by prescribing anti-anxiety or sleep medications to teenagers, say University of Michigan researchers.

Teens prescribed anxiety or sleep medications are up to 12 times more likely to abuse those drugs than those who had never had a prescription, either by using someone else's prescription pills or to get high or experiment, according to a study from the U-M School of Nursing.

Nearly 9 percent of the 2,745 adolescent study participants had received a prescription for anxiety or sleep medications during their lifetime, and more than 3 percent received at least one prescription during the three-year study period.

"I recognize the importance of these medications in treating anxiety and sleep problems," said the study's first author Carol Boyd, the Deborah J. Oakley Professor of Nursing. "However, the number of adolescents prescribed these medications and the number misusing them is disturbing for several reasons."

Anxiety and sleep medications can be addictive or even fatal when mixed with narcotics or alcohol, said Boyd, who is also a professor of women's studies and research professor at the Institute for Research on Women and Gender and at the U-M Addiction Research Center in the Department of Psychiatry.

"What happened to [actor] Heath Ledger could happen to any teen who is misusing these medications, particularly if the teen uses alcohol in combination with these drugs," Boyd said.

Examples of anti-anxiety medications include Klonopin, Xanax and Ativan; sleep medications include Ambien, Restoril and Lunesta. These are controlled substances partly because of the potential for abuse, and it's a felony to share them, Boyd said.

The U-M study included students from five Detroit-area schools grouped into three categories: those never prescribed anxiety or sleep medications; those prescribed those medications within the three-year study period; and those previously prescribed those medications but not during the study period.

Key findings include:

Adolescents prescribed anxiety medications during their lifetime, but not during the study, were 12 times more likely to use someone else's anxiety medication than participants who had never been prescribed such drugs.

Those prescribed anxiety or sleep medications during the study period were 10 times more likely to abuse them within two years, to get high or to experiment, than teens without prescriptions.

White students were twice as likely as black students to use others' medications, and females older than 15 and teens who had prescriptions for longer periods of time were more likely to abuse the medications.

It's the first longitudinal study to determine whether teens' recent medical use of anxiety or sleep medications is associated with later taking somebody else's prescription medication illegally, either for self-treatment or recreational use.

Boyd said the group intended to write a paper about teens abusing their own prescriptions, but changed course when the results became clear.

"I looked at these numbers and said, 'There's a story here.' It just catches you off guard that so many adolescents are being prescribed these medications," Boyd said. "Why is it that our youth are anxious and sleepless? Is it because they are under stress, consuming too much caffeine or seeking an altered state? "

The study recommends better education for parents and adolescents prescribed these medications, monitoring refills and making it standard practice to give teens a substance use assessment before prescribing these drugs.

Boyd's co-authors include Elizabeth Austic, Quyen Epstein-Ngo, Philip Veliz and Sean Esteban McCabe of the U-M Institute for Research on Women and Gender. Epstein-Ngo also has appointments at the U-M Injury Research Center and Institute for Clinical and Health Research.

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How anxiety affects kids' brains

A study shows how anxiety can affect children's brains.

Children with anxiety problems actually have a bigger "fear center" in their brain, researchers report.

The study included 76 children aged 7 to 9, which is when anxiety-related traits and symptoms can first be reliably detected, according to the Stanford University School of Medicine researchers.

The parents provided information about their youngsters' anxiety levels, and the children also underwent MRI scans of their brain structure and function.

The investigators focused on an area of the brain called the amygdala, which is a person's "fear center," and found that kids with high anxiety levels had a larger amygdala compared to children with low anxiety levels. This part of the brain, the researchers noted, had more connections to other brain regions involved in attention, emotion perception and regulation.

The researchers also developed a way to predict children's anxiety levels based on brain scan measurements of amygdala size and its level of connection to other brain areas, according to the study in the June issue of the journal Biological Psychiatry.

"It is a bit surprising that alterations to the structure and connectivity of the amygdala were so significant in children with higher levels of anxiety, given both the young age of the children and the fact that their anxiety levels were too low to be observed clinically," first author Dr. Shaozheng Qin said in a journal news release.

The study is an important advance in identifying young children at risk for anxiety disorders and improves understanding of how anxiety develops in people, according to Qin.

While the study found an association between reported levels of anxiety and the structure and connectivity of the amygdala in kids, it did not prove a cause-and-effect relationship.

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Study: Treating youth anxiety has long lasting benefits

A study shows that treating youth anxiety has many beneficial long-lasting benefits for the child. - JR

A study published in the March 2014 issue of the Journal of the American Academy of Child and Adolescent Psychiatry found that the majority of youth with moderate to severe anxiety disorders responded well to acute treatment with cognitive behavioral therapy (CBT), medication (sertraline), or a combination of both. They maintained positive treatment response over a 6 month follow-up period with the help of monthly booster sessions.

As part of the NIMH Child/Adolescent Anxiety Multimodal Study (CAMS), a group of researchers led by Dr. John Piacentini of the UCLA Semel Institute for Neuroscience and Human Behavior, followed 412 children and adolescents ages 7-17 after they completed 12 weeks of acute treatment. Treatment responders were offered 6 additional monthly booster sessions, with those initially on medication continuing this treatment; all youth, regardless of status at week 12, were re-evaluated 3 and 6 months later by trained clinicians. Twenty-seven percent of study participants also reported receiving outside (e.g. nonstudy) psychotherapy and/or medication for mental health symptoms over the 6 month follow-up period.

The study found that over 80% of youth rated as positive responders to one of the three CAMS treatments at Week 12 were also rated as responders at both the 3 and 6 month follow-up evaluations. Conversely, only 5% of youth who received combined CBT plus sertraline, and 15-16% of youth receiving either CBT-only or sertraline-only, failed to achieve responder status at any time during the study. Youth in the combined CBT+sertraline group showed greater treatment benefits on some but not all outcome measures and used less nonstudy treatments than those in the CBT-only and sertraline-only groups.

Collectively, anxiety disorders are the most common mental disorders in children and adolescents. Often overlooked, severe anxiety can significantly impair children's school, social, and family functioning, and if untreated, can increase the risk of depression, alcohol and substance abuse, and occupational difficulties in adulthood.

CAMS is the largest randomized controlled comparative treatment trial for child/adolescent anxiety disorders ever conducted. Participants were recruited at six regionally dispersed sites throughout the United States (UCLA, Duke University, Columbia University/New York University, Johns Hopkins University, Temple University, and the Western Psychiatric Institute and Clinics/University of Pittsburgh) and randomly assigned to 12 weeks of treatment with cognitive behavioral therapy (Coping cat), the selective serotonin reuptake-inhibiting [SSRI] medication sertraline, cognitive behavioral therapy combined with sertraline, or pill placebo. All participants had moderate to severe separation anxiety disorder, generalized anxiety disorder or social phobia, with most having multiple anxiety or other mental health disorders..

"The results of this study provide further evidence of the benefits of cognitive behavioral therapy and SSRI medication, alone or in combination, for treating clinically significant anxiety in children and adolescents," said Dr. Piacentini. "A separate project by the CAMS researchers is now gathering information on how study participants are doing up to 10 years after study participation."

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Children with autism face more health complications when obese

Children who have autism and are obese are more likely to suffer from other health complications, such as anxiety, depression, and sleep problems.

Adding to the complications of autism, overweight and obese children with the disorder are prone to a host of other troubles, including depression, anxiety and sleep problems, reports a study published 2 February in the Journal of Autism and Developmental Disorders.

The findings suggest that excess weight can signal, or even trigger, less obvious conditions in autism, and that variations in weight may affect results about the prevalence of sleep, mood and anxiety problems in behavioral research studies.

In the new study, researchers calculated the body mass index (BMI), a measure of body fat based on weight and height, of 376 children with autism living in Oregon. (The healthy range for a BMI is between 18 and 25.) The participants, ranging in age from 2 to 18 years, are part of the Autism Treatment Network, a group of collaborating hospitals organized by the research and advocacy group Autism Speaks.

The researchers then analyzed the relationship between parent and clinician reports and the children’s BMI. The reports documented the children’s behavior and other conditions.

Roughly 18 percent of the children in the study were overweight — with a BMI between 25 and 30 — and 17 percent were obese, with a BMI above 30. For comparison, about 32 percent of typically developing children are overweight or obese.

Among teenagers with developmental disabilities, those with autism are the most likely to be obese, according to a study published 20 February in Maternal and Child Health Journal. The study found that 32 percent of adolescents with autism are obese, compared with 20 percent of those with developmental disabilities such as intellectual disability and attention deficit hyperactivity disorder. In contrast, 13 percent of typical teenagers are obese.

Studies have suggested that depressive symptoms may be both a cause and a consequence of childhood obesity. The Oregon study found that obese children younger than 6 years are more likely to suffer from anxiety and mood problems, such as depression, than are children who weigh less.

Obese children older than 6 years do not show this trend, but that may be because their version of the test poses different questions.  

Roughly 85 percent of overweight and obese children with autism under 11 years also struggle with sleep. Children with the disorder tend not to sleep well in general.

The new study found that roughly 75 percent of the children with autism under 11 years of age with a healthy weight don’t sleep well.

Possibly as a consequence, one in three obese children with autism take the sleep-promoting hormone melatonin, compared with one in five children with autism who have a healthy BMI.

Interestingly, however, some symptoms of autism are less severe among children carrying extra weight. The study found that children with the disorder who are overweight, but not those who are obese, have lower levels of repetitive behaviorsthan their slender peers do.

This relationship is difficult to interpret, the researchers note. It’s possible that repetitive behaviors burn many calories, contributing a healthy BMI, but that does not explain the severity of the behavior among obese children with autism. The researchers also suggest that children with severe repetitive behaviors may take medications, such as risperidone, that cause them to gain weight.

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What do I do when my baby won't sleep??

This article addresses what action parents should take when their baby won't sleep, and warning signs that could require further attention.

The quest for a good night’s sleep is one of the main reasons parents take their children to a pediatrician.

But doctors familiar with sleep disorders say the issue is often more about behaviour than it is about medicine.

“In my private practice it’s a very common concern, ‘My child doesn’t sleep,’ ” said pediatrician Dr. Wilma Arruda, Island Health medical director of childhood and family health.

“It can start at a very young age and it can cause a fair bit of trouble for a family,” Arruda said in an interview. “As parents, we also need our sleep.”

She said it is entirely appropriate for parents to take their sleep concerns to a doctor. Family doctors are typically the first to be consulted. If further expertise is required, a referral can be made.

Parents should be aware, however, there is likely no easy, medical answer.

“[Doctors] can’t just give them a pill and all of a sudden the kids are falling asleep every night and it’s all perfect,” Arruda said.

“In many cases it is a behavioural situation,” she said. “A lot of things around sleep are related to certain behavioural adaptations that kids will make. And it takes some effort to a manage those behaviours into something that might be more suitable for a family.”

She and other doctors say concerns about children’s sleep appear to be increasing. One suspected reason is the increase in the rates of childhood obesity. Fat in the neck can obstruct the airway, causing snoring and often a cessation of breathing.

Another reason may be the reluctance of parents and doctors in recent decades to remove tonsils. If tonsils become enlarged, they can obstruct the airway.

There is also an increased awareness of the neurobiological disorder of ADHD, attention deficit hyperactivity disorder. Children with ADHD often say they have trouble sleeping — and the lack of sleep aggravates the challenge of their disorder.

Dr. Atul Khullar, medical director of the Northern Alberta Sleep Clinic in Edmonton, said any parent seeking help for a child with a sleep problem should consider keeping a log.

“It’s extraordinarily helpful,” Khullar said. “You can start to see the triggers yourself and that’s really helpful to a doctor.”

He said in his practice, where he treats mostly teens but also some young children, the No. 1 reason for sleep trouble is anxiety.

“We see a lot of kids with the first onset of an anxiety disorder,” Khullar said. “It doesn’t necessarily require medication, but some sort of acknowledgment of the anxiety, perhaps getting them into some sort of therapy or group, is helpful.”

Khullar also said a growing realization is dawning of the medical importance of sleep. An entire family needs to recognize and work to ensure everyone gets a good night’s sleep, he said. Parents and children should acknowledge and speak to its importance and develop good sleep habits.

“Kids tend to model what their parents are doing,” Khullar said. “A kid starts out OK, but they start imitating the maladapted behaviour of their parents.

“The parents, if they have sleep problems, they tend to pass them along to their children — subconsciously, but they do.”

Warning signs

Snoring. Children who struggle to breathe, noisily pause, gasp or choke at night are at risk for obstructive sleep apnea, a treatable condition.
Difficulty falling or staying asleep. Everyone, adults included, has occasional problems falling asleep. But chronic insomnia can make it difficult for children to stay focused and alert during the day.
Sleepwalking, night terrors or other nighttime activities. Many children walk, talk or cry out during sleep. If these incidents become frequent, parents should seek help to learn potential triggers.
Sleeping too much. Children who have trouble waking up in the morning, getting to school on time or fall asleep in class have clear signs of a sleep problem.

Snoring. Children who struggle to breathe, noisily pause, gasp or choke at night are at risk for obstructive sleep apnea, a treatable condition.
Difficulty falling or staying asleep. Everyone, adults included, has occasional problems falling asleep. But chronic insomnia can make it difficult for children to stay focused and alert during the day.
Sleepwalking, night terrors or other nighttime activities. Many children walk, talk or cry out during sleep. If these incidents become frequent, parents should seek help to learn potential triggers.
Sleeping too much. Children who have trouble waking up in the morning, getting to school on time or fall asleep in class have clear signs of a sleep problem.

Tips for sleeping

Make sleep a priority. Without a good night’s sleep, kids will have trouble participating fully in school, homework, sports or play.
Develop a bedtime routine. Everyone needs a short period of calm time before bed.
Keep schedules consistent between weekdays and weekends. Sleeping in a bit on Saturdays or staying up a little bit late is OK. But try to keep the flex to 45 minutes.
In fact, keep schedules consistent every day. Going to bed and getting up around the same time trains the brain to account for the hours needed for regular activities.
Make the bedroom restful. TVs and videogames are distracting and can produce a bright light that signals the brain to wakefulness.
Sleep in the same place every night. Children who sleep on the couch, on the floor, or in different beds have more trouble developing good sleep habits.
Avoid caffeine. Soft drinks, coffee, tea or energy drinks can keep children and adults awake.
Put your child to bed when they are sleepy, but not fully asleep. Self-soothing and relaxation are good skills for children to learn. Putting them to bed before they are fully asleep gives them a chance to develop them.
Address anxiety. Anxiety makes sleep difficult for everyone.

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Teaching children with Autism to turn their symptoms into strengths

This article looks at how some treat Autism symptoms by helping the child turn his or her symptoms into strengths.

A novel approach to treating children diagnosed with autism spectrum disorder could help them navigate their world by teaching them to turn their symptoms into strengths.

In the article "Symptoms as Solutions: Hypnosis and Biofeedback for Autonomic Regulation in Autism Spectrum Disorders," published in the winter edition of the American Journal of Clinical Hypnosis, Dr. Laurence Sugarman, a pediatrician and researcher at Rochester Institute of Technology, details a treatment method that teaches affected children how to control their psychophysiology and behavior using computerized biofeedback and clinical hypnosis.

The article coincides with the publication of the second edition of Sugarman's textbook, Therapeutic Hypnosis with Children and Adolescents, Crown House Publishing, 2013, written with William Wester.

Sugarman's model is tied to learning to self-regulate the autonomic nervous system -- including the fight or flight mechanism -- that, for many people with autism, is an engine idling on high.

"Teaching kids with autism spectrum disorder skills in turning down their fight or flight response and turning up the opposite may fundamentally allow them to be more socially engaging, decrease some of the need for cognitive rigidity and repetitive behaviors and, more importantly, allow them to feel better," says Sugarman, director of RIT's Center for Applied Psychophysiology and Self-regulation in the Institute for Health Sciences and Technology.

His treatment model underlies three ongoing projects at the center involving different age groups: teaching coping skills to RIT students with anxiety or autism; developing a computer-based role-playing game using autonomous biofeedback for teenagers; and creating a new service and research program for family members with autism for AutismUp (formerly Upstate New York Families for Effective Autism Treatment). The latter, called the Parent Effectiveness Program, began this fall and will repeat in the spring. The study trains parents of young children diagnosed with autism and measures results of their training on the behaviors of their affected children.

Sugarman developed his method in response to the rise in autism spectrum disorders he has witnessed in his 30 years working with children in primary care and, then, in developmental behavioral pediatrics at the Easter Seals Diagnostic and Treatment Center in Rochester. Instead of trying to change the symptoms associated with autism, his approach recognizes the symptoms as an effort to self-regulate inner turmoil.

The treatment integrates autonomic biofeedback and clinical hypnosis into his therapy. Sensors attached to his patients measure respiration, perspiration, heart rate and variation, and blood flow/circulation. Children with autism learn to correlate the signals and visual representations displayed on the computer screen (the "Dynamic Feedback Signal Set") with their emotions. During therapy sessions, the children practice changing their feedback response and learn to manipulate their own internal wiring. Sugarman uses clinical hypnosis to generalize and internalize feedback techniques -- discerning situations and controlling their responses -- into their daily lives.

Sugarman is a proponent of clinical hypnosis. He is the past-president of the American Board of Medical Hypnosis, the credentialing body for competency in clinical hypnosis for physicians in the United States. He also has a long association with the American Society of Clinical Hypnosis as an approved consultant, fellow in clinical hypnosis, past vice president and past co-director of education for the society.

"Hypnosis is a 250-year-old Western study of how social influence and internal physiology can be changed," he says. "Mindfulness is a slice of this."

Sugarman teaches pediatric hypnosis workshops around the world. This fall, he presented at the Regional Center for Child and Adolescent Psychiatry in Oslo, Norway, and the Milton Erickson Geselleschaft in Heidelberg, Germany. In Heidelberg, Sugarman also presented his treatment model and research using biofeedback and hypnosis with children with autism receiving "very affirmative responses."

"We think we can make a big difference for young people with autism spectrum disorder," Sugarman says. "The need is there."

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Genetics may influence children's school anxiety

A study discusses how parents' anxiety genetically passes to children and can influence the child's back to school attitude and anxiety level.

Many parents may have noticed their children seemed on edge during their first week of school. They may have been agitated, withdrawn or more focused on themselves, rather than what was going on around them. Such behaviours are classic symptoms of high anxiety, says Université de Montréal researcher Richard Tremblay.

Tremblay is a professor emeritus whose area of expertise is childhood psychology and psychiatry, particularly antisocial behaviour. In 1984, he launched a longitudinal study that focused on the development of children from conception on. Many of the original participants are now in their mid-30s. Thanks in part to funding from the Canada Foundation for Innovation, Tremblay was able to build a mobile lab in 2005 that allowed him to park this study at participants' front door -- a convenience that helped ensure their cooperation over decades.

He says the longer timelines of his study gave him the chance to better understand the hereditary and environmental factors that lead a child to become aggressive, depressed or anxious.

Tremblay says the anxiety young students feel as they return to school is often related to the uncertainties they feel about their new teacher and classroom environment, the kids they'll interact with and whether their bullies will hunt them down during recess.

"It's a big change in the rhythm of life for everybody, especially children," says Tremblay. "Those who have problems with anxiety often create worst-case scenarios, almost like horror stories in their minds."

But Tremblay adds that being prone to such back to school horrors is not isolated to the imaginations of young students. Rather, their sky-is-falling tendencies may have been inherited from their parents, he says.

"There is a big genetic effect in terms of anxiety behaviours," says Tremblay. "The best predictors of anxiety or depression among children are their parents' own struggles with the same disorders. In other words, if you have a very anxious mother or father, you are at high risk of being an anxious child."

Parents pass their anxious tendencies to children through their genes, predisposing the next generation to bouts of apprehension, says Tremblay. "But a child's anxiety can be amplified by their environment," he adds. "If you're brought up by an anxious mother or father and you're genetically predisposed to these conditions, you will have a difficult time learning how to control your anxiety."

Tremblay outlines the consequences of this increased on-edge behaviour, suggesting the tightly-wound types are more likely to become depressed. They may have serious problems paying attention in school which could eventually affect their scholastic achievement and social relations.

And jittery students often have an additional worry to deal with. Not only are they nervous about going back to school but they tend to be anxious about being anxious once they get there. "It's a meta problem," says Tremblay, referring to how anxiety about one thing can generate anxiety about another.

To deal with such concerns, Tremblay encourages parents to monitor their children's behaviour in the first week of school. "Parents need to think about who their child is, how they're child has coped in the past and what worked and what didn't," says Tremblay.

He suggests parents who've suffered from anxiety watch for any behavioural similarities reflected in their children. Once identified, they can use their own memories of how they coped to guide their children through nerve-wracking encounters.

If children aren't able to relax within the first few weeks of school, Tremblay recommends parents seek help from the school, from counsellors or even from the young child's grandparents. He believes they can offer grounded insight into what it's like raising a high-strung kid who then has an anxious child of their own.

"Grandmama knows things that can be very helpful," says Tremblay. "People imagine that new psychological knowledge will solve all their problems but those old experiences are very good."

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Childhood obesity results in adult diseases in children

The recent increase in childhood obesity has resulted in more children with adult diseases such as high cholesterol, depression, and anxiety.

Childhood obesity has skyrocketed over the years, and now doctors are seeing children with adult diseases.

“We have seen a 300 percent increase in childhood obesity over the last 30 years,” said Childrens Healthcare of Atlanta Dr. Stephanie Walsh.

She told Channel 2’s Craig Lucie children are getting diseases pediatricians haven’t seen before, “Adult diseases, meaning type 2 diabetes, high blood pressure, high cholesterol, sleep apnea. These are diseases we didn't really see in children.”

Lucie spoke to a local teen who struggled with being overweight, but turned her life around. Drew Beaty, 16, credits karate, her parents and her pediatrician for helping her lead a healthier life. When Beaty was 11, she was considered overweight.
 
"I remember when I used to go shopping with my friends, I'd feel bad because they were all a size 4 or a size 2, and I was a size 12," Beaty said.
 
Beaty's father, Renard, took her to a pediatrician.   The doctor recommended the family keep a food diary to see what they were eating.  The results showed something no parent wants to hear.
 
"When she saw that diary, she said, ‘It's you.  You guys are the ones feeding your daughters,’" Renard Beaty said.  "We actually felt guilty.  We went from great parents to, ‘Oh my gosh, we are killing our kids.’"
 
Dr. Jeff Hopkins, a pediatrician at Northside Hospital Pediatrics, said what is happening is alarming.
 
"We've even had some children as young as 3 who have high enough cholesterol that it's something their family needs to a monitor," Hopkins said.
 
Hopkins’ colleague, Dr. Sally Marcus, said childhood obesity can have psychological impacts too, "Depression and anxiety.  Kids who are overweight also are bullied more often in school and on the playground."
          
Children's Healthcare of Atlanta has started training pediatricians throughout metro Atlanta on how to approach parents who don't want to hear their child has a weight problem.
 
Hopkins and Marcus went through the training.
 
"So, the approach we take is similar to the approach to helping parents quit smoking," Marcus said.  “It's meet them where they are.  Find out what it would take to change their level of motivation.  So if they say, ‘I'm not really interested in making a change,’ then we may ask, ‘What would make you consider making a change?’"
 
It was a conversation that was hard for Renard Beaty to swallow, but one that has changed his life and his daughter's life.  Together, they have lost more than 80 pounds.
 
“It's a lifestyle adjustment you have to make.  But once you have that, you got it," he said.

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Brain differences seen in children with epilepsy and anxiety

A study shows that brain changes in epileptic children with anxiety may not be very different than brain changes in children with anxiety but without epilepsy.

Children with both epilepsy and anxietyhave volumetric brain changes similar to those found in nonepileptic patients with anxiety, according to new research presented at the 30th International Epilepsy Congress (IEC).

“Frequently, anxiety in epilepsy is viewed as a result of the unpredictability of seizures and is not treated,” said Jana Jones, PhD, assistant professor in neuropsychology at the University of Wisconsin School of Medicine and Public Health in Madison.

“But the results of this study suggest that there is a presence of an abnormal underlying neural biology that may be affecting some subcortical and cortical regions implicated in anxiety.”

“The clinical implication of this finding is that evidenced-based treatments for anxiety disorders should be utilized in children with epilepsy and anxiety, particularly if the neurobiology is similar in individuals with anxiety regardless of seizure status.”

The research involved 88 children with epilepsy (24 with anxiety and 64 without) and 50 control participants without epilepsy or anxiety who were first-degree cousins of the epilepsy patients.

The median age of participants was between 12 and 13 years old.

Age at seizure onset for those with anxiety was about 12 years old, and for participants without anxiety, about 11 years old.

“Children with epilepsy were assessed within 12 months of their diagnosis, had normal neurological exams and normal clinical MRI,” said Jones.

For the study, all participants and their parents took part in a semi-structured psychiatric interview (Kiddie Schedule for Affective Disorders and Schizophrenia).

In terms of types of anxiety disorders that were identified, “the most frequent diagnosis was specific phobia, and then second was separation anxiety, followed by social phobia and generalized anxiety disorder,” she said. “Many of the children had more than one anxiety disorder, or a depressive disorder was also present.”

Participants were also given T1 MRI brain scans.

“We focused on amygdala volumes and the prefrontal cortex thicknesses related to hypotheses from the general literature that we know about anxiety disorders and their involvement in these brain regions,” said Jones.

“These brain regions have not really been examined in kids with new or recent-onset epilepsy who also have a current anxiety disorder.”

The findings revealed that children who have an anxiety disorder plus epilepsy have much larger left amygdala volumes compared with children who have only epilepsy and also control individuals.

“In children with epilepsy plus anxiety, both the left and right amygdala volumes were greater — but only significantly so in the left amygdala,” she noted.

Furthermore, those with both epilepsy and anxiety showed a pattern of cortical thinning in frontal lobe regions known to be associated with emotion and anxiety, she said.

She said that these findings point to the importance of diagnosing and treating anxiety in children with epilepsy.

“We know that untreated anxiety in childhood increases the likelihood of depression and other [co-occurring] psychiatric conditions in adulthood, so it is important to treat these conditions early,” she said, adding that her group recently conducted a pilot study using cognitive-behavioral therapy to which children responded “quite well.”

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Study Shows Children With Autism Experience Interrelated Health Issues

Children who have autism are more likely to also have anxiety, gastrointestinal issues, and sensory problems, all of which can effect their daily lives.

One in 88 children has been diagnosed with an autism spectrum disorder (ASD) in the United States, according to the Centers for Disease Control and Prevention. A new study by a University of Missouri researcher found that many children with ASD also experience anxiety, chronic gastrointestinal (GI) problems and atypical sensory responses, which are heightened reactions to light, sound or particular textures. These problems appear to be highly related and can have significant effects on children's daily lives, including their functioning at home and in school.

Micah Mazurek, an assistant professor of health psychology and a clinical child psychologist, found in her study of 2,973 children and adolescents with ASD that nearly one-fourth also had chronic GI problems, such as constipation, abdominal pain, bloating, diarrhea or nausea. The results also showed that children with chronic GI problems were more likely to experience anxiety and sensory problems.

"These problems can have a very real impact on daily life. Children with anxiety may be distressed or reluctant to engage in new activities, and those with sensory problems may have trouble paying attention or participating in over-stimulating enviornments," Mazurek said. "These children may also suffer uncomfortable GI problems that they may not be able to communicate about to adults."

Clinicians should be aware that anxiety, GI problems and sensory sensitivity often co-occur in individuals with ASD. Effectively managing these concurrent issues may improve children's quality of life and their responses to treatment, Mazurek said.

"Parents need to be aware that these problems may underlie some of their children's difficulties, so if they notice any symptoms, they should talk to their doctors or therapists about treatment options," Mazurek said. "Practitioners who work with children with ASD need to be mindful that there is a pretty high rate of these problems, so if children are treated for one issue, it may helpful to screen for these additional symptoms."

This is the first study to examine the relationships among anxiety, GI problems and sensory over-responsivity in a large, nationally representative sample of children and adolescents with ASD. Participants in the study were enrolled in the Autism Treatment Network, a network of 17 autism centers throughout North America that are focused on best practices for medical treatment of children with ASD.

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Researchers Show Migraines Linked To Behavioral Problems In Kids

New research claims that children who suffer from migraines are more likely to have behavioral issues, anxiety, or depression.

Children with migraines are much more inclined to suffer from behavioral issues, such as anxiety, depression, and social and attention issues than those who do not have headaches.

The more recurrent the headaches, the more likely the chance of a behavioral disorder developing, according to the new study published in Cephalagia. 

Marco Arruda, director of the Glia Institute in São Paulo, Brazil, together with Marcelo Bigal of the Albert Einstein College of Medicine in New York, conducted a study of 1,856 Brazilian children ages 5 to 11 which looked at the connection of emotional symptoms with migraine and tension-type headaches (TTH).

The study used headache surveys, in addition to the Child Behavior Checklist (CBCL), to measure emotional symptoms. The researchers instructed teachers how to walk parents through the questionnaires, step by step.

Children with migraines had a much greater probability of irregular behavioral scores than children without headaches, primarily in social, anxiety-depressive, internalizing, and attention areas. 

Children with TTH were affected in the same areas, but to a lesser extent. With more frequency of headaches, abnormal behavioral scores increased. Over half of the migraine sufferers had issues with internalizing behaviors. Externalizing behaviors, such as breaking rules or becoming aggressive, were no more likely among the children with headaches. The authors advised that the CBCL may not be efficient enough to measure this correlation in detail.

Arruda explains:

"As previously reported by others, we found that migraine was associated with social problems. The 'social' domain identifies difficulties in social engagement as well as infantilized behavior for the age and this may be associated with important impact on the personal and social life."

Children frequently suffer from migraines, which affect over three percent to one fifth of children from early childhood to adolescence. Earlier research has suggested that children with migraines are more likely to have other psychological and physical problems, includingdepression, anxiety, hyperactivity, and attention disorders. 

Authors suggest including factors, such as headache frequency, is important, although often left out of studies - until recently. Health providers can now be aware of this possibility in children and properly treat the problem.

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Anxiety in adolescents born preterm or with very low birthweight: a meta-analysis of case–control studies

Anxiety in adolescents born preterm or with very low birthweight: 

a meta-analysis of case-

control studies

 Method  We used a systematic review and meta-analysis. We searched the databases ISI Web of Knowledge, PubMed, PsycNET, Educational Resources Information Center (ERIC), Latin American and Caribbean Literature on the Health Sciences (LILACS), and Virtual Health Library (VHL) with equivalent search expressions (from the databases’ inception to June 2011). Also, we screened reference lists of identified articles. We selected case–control studies of adolescents 11 to 20 years old who were very preterm/VLBW and had a matched reference group born at term with normal birthweight that reported a validated anxiety outcome measure. For data extraction, two authors independently reviewed titles, abstracts, and full articles identified through the searches. Subsequently two authors independently extracted data.

Results  We included six studies with 1519 adolescents (787 very preterm/VLBW, 732 comparisons). The general risk of developing clinically significant anxiety problems was nearly doubled (p<0 .05=".05" 1.15="1.15" 2.27="2.27" 5.5="5.5" 9.9="9.9" 95="95" and="and" comparison="comparison" confidence="confidence" group.="group." group="group" in="in" interval="interval" overall="overall" p="p" population="population" preterm="preterm" prevalences="prevalences" the="the" very="very" were="were">

Interpretation  Those born very preterm/VLBW have an increased risk of developing clinically significant anxiety problems in adolescence.

Anxiety in Children May Be Linked to Sleep Issues

This article shows a link between childhood anxiety and sleeping problems in children.

Does your child toss and turn at night? Does your child regularly wake up tired and unrefreshed? According to research, a small percentage of children who have sleep problems may be at risk of more serious emotional disorders, including anxiety and depression.

The study, authored by Flavia Giannotti, M.D., of Center of Pediatric Sleep Disorders at the University of Rome La Sapienza in Italy, was conducted on 122 children between 7 and 11 years of age, who had a major depressive disorder. All patients underwent a systematic psychiatric, cognitive and sleep evaluation and all children were medication-free. Depressed children, as well as those presenting both depression and an anxious disorder, entered the study, and their results were compared to those of 200 healthy peers.

According to the results, 82 percent of the depressed children reported problems sleeping, compared to five percent in the control group. In the group of children who suffered from both depression and anxiety, 42 percent showed a significantly higher frequency of sleep-onset insomnia, compared to 29 percent in the depression-only group. They also scored significantly higher on the “bedtime difficulties,” “sleep anxiety,” and “sleep duration” portions of the questionnaire.

Gianotti states, “Sleep problems are very common in typically developing children. Even though they are more frequent in toddlers and preschoolers, they affect also school-aged children. What was most interesting about this study was the finding that certain types of comorbid [e.g. anxiety and depression] conditions might be especially disruptive on sleep. Therefore, in childhood, considerable attention needs to be paid to the interrelation between sleep patterns and emotional disorders.”

Experts recommend that school-aged children get between 10-11 hours of sleep every night. If your child fails to get a sufficient amount of sleep of if your child is consistently tired or drowsy in the morning, he or she may have developmental or behavioral problems, like anxiety or depression.

“To ensure the most effective care, parents of sleep-disturbed children are advised to first consult with the child’s pediatrician, who may issue a referral to a sleep specialist for comprehensive testing and treatment,” Dr. Giannotti advised.

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