Optimal infant sleep habits may help prevent childhood obesity

"When parents keep babies up longer, they just sleep less". 

"the babies in the bedtime techniques group gaining weight more slowly than the control group, and less likely to be overweight by age one"- JR

Healthy infant sleep habits may help prevent childhood obesity

Perfect Baby (free image labeled for reuse. Not a patient)

-Review of research published in JAMA Pediatrics discussing the importance of regulating an infant's sleep schedule. -JR

US research out this week suggests that teaching parents techniques to help encourage healthy sleep habits in their children could help to prevent obesity. The new study, conducted by Penn State College of Medicine researchers, could lead to a new intervention technique to help tackle the growing levels of obesity worldwide.

The team studied the use of the intervention using data from the INSIGHT study (Intervention Nurses Start Infants Growing on Healthy Trajectories), a longitudinal trial study which looks at how responsive parenting intervention can prevent obesity.

A total of 291 mother and baby pairs were recruited, with the mothers randomly assigned to one of two groups.

One group was given obesity prevention education that covered sleep-related behaviours, bedtime routines, improving sleep duration and avoiding feeding and rocking to sleep. The other group, a control, were given safety education about preventing sudden infant death syndrome.

The study showed that the infants of parents who had learned the bedtime techniques went to bed earlier, had a more consistent bedtime routine, and slept for longer than the infants whose parents had been given safety education.

The infants were also more likely to self-soothe to sleep without being fed, and were less likely to be fed back to sleep when they awoke during the night.

And at nine months, infants who both self-soothed and went to bed by 8 p.m. slept for on average 80 minutes longer or more than those whose bedtimes were after 8 p.m. and did not self-soothe.

In addition, the team saw that the intervention also had a positive effect on obesity as well as sleep, with the babies in the bedtime techniques group gaining weight more slowly than the control group, and less likely to be overweight by age one.

Misconceptions about infant sleep

Commenting on the findings lead author Ian M. Paul had this advice for parents, “A lot of parents try to keep their babies up longer, thinking that then they’ll sleep longer at night and they won’t wake up. We found that’s not true. When parents keep babies up longer, they just sleep less.”

“If you want your baby to sleep longer and better, put them to sleep earlier. Regardless of what time you put babies to sleep, they wake overnight. If we don’t set the expectation that they’re going to be picked up and fed, they learn to soothe themselves back to sleep.”

In addition to helping prevent obesity, better sleep habits also have added health benefits for both parents and children, with lack of sleep previously shown to have a negative effect on a child’s development and parents’ psychological well-being.

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Study: Significant association between obesity and ADHD

A recent study showed a significant association between obesity and ADHD in adults and children.

Results from a meta-analysis published in the American Journal of Psychiatry indicated a significant association between obesity and attention-deficit/hyperactivity disorder among children and adults.

“The putative association between ADHD and obesity might seem paradoxical because, rather than being hyperactive, individuals with obesity are often described as ‘lazy.’ However, the impulsivity and inattention that characterize ADHD might lead to dysregulated eating patterns with consequent weight gain,” Samuele Cortese, MD, PhD, of the University of Southampton, United Kingdom, and colleagues wrote. “The role of possible confounders, including low socioeconomic status and comorbid mental health conditions, in explaining the association between obesity and ADHD is still unclear. In addition, the role of age, gender, study setting, or study country is also uncertain.”

Researchers conducted a meta-analysis of 42 studies to assess the association between ADHD and obesity. The analysis included 728,136 study participants, of which 48,161 had ADHD.

Researchers found a significant association between obesity and ADHD among children (OR = 1.2; 95% CI, 1.05-1.37) and adults (OR = 1.55; 95% CI, 1.32-1.81).

Pooled prevalence of obesity increased by approximately 70% for adults with ADHD compared with those without ADHD, and by approximately 40% for children with ADHD vs. those without ADHD.

The significant association between obesity and ADHD remained when limited to studies that adjusted for potential confounding factors, diagnosed ADHD by direct interview and directly measured height and weight.

Researchers also found a significant association between ADHD and overweight.

Individuals medicated for ADHD did not have a higher risk for obesity.

“We found meta-analytic evidence of a significant association between obesity/overweight and ADHD, regardless of possible confounders. Mediational effects and causal mechanisms underlying the association, as well as the long-term effects of ADHD medications on weight status in individuals with obesity and ADHD, deserve further attention because of their important public health implications,” the researchers concluded.”

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Young kids' sleep and obesity

Young kids not getting enough sleep could lead to obesity later in life.

Lack of sleep and sleep-related breathing problems appear to boost children's risk of obesity, a new study finds.

What isn't clear from the study, however, is whether the sleep issues actually cause obesity, or if something else might explain the association between sleep problems and obesity.

Researchers analyzed data from about 1,900 youngsters in England. The researchers had about 15 years of follow-up on the children. Those who got the least amount of sleep at ages 5 and 6 had between a 60 percent and 100 percent increased risk of being obese at age 15. (For children aged 5 or 6, fewer than 10.5 hours of sleep a night is considered too little, according to the researchers.)

Children who got too little sleep at other ages were not at increased risk for obesity, according to the study.

The researchers also found that one-quarter of the children were at increased risk of obesity due to sleep-related breathing problems such as snoring and sleep apnea. Those with the most severe sleep-related breathing problems were twice as likely to become obese by ages 7, 10 and 15.

The risk was slightly lower in children whose sleep-related breathing problems peaked at ages 5 or 6, but was still 60 percent to 80 percent higher than among those without sleep-related breathing problems.

The researchers didn't look at whether children with both these risk factors had a higher risk of obesity than those with just one of the risk factors.

"In recent years, lack of sleep has become a well-recognized risk for childhood obesity," study author Karen Bonuck, a professor of family and social medicine, and obstetrics, gynecology and women's health at Albert Einstein College of Medicine in New York City, said in a college news release.

"We know that the road to obesity often begins early in life. Our research strengthens the case that insufficient sleep and SDB (sleep-disordered breathing) -- especially when present early in childhood -- increase the risk for becoming obese later in childhood," she added.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented. With childhood obesity hovering at 17 percent in the United States, we're hopeful that efforts to address both of these risk factors could have a tremendous public health impact," Bonuck concluded.

A common cause of sleep-related breathing problems in children is enlarged tonsils or adenoids. If these are a problem, they can be removed through surgery. Another possible cause is misalignment of the jaws and teeth. This problem can be treated with a night guard or orthodontics.

Learning good sleep habits can help children get adequate sleep, Bonuck said.

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Short sleep and breathing issues increases obesity risk in children

A child's risk of obesity is increased by sleeping for short amounts of time and breathing issues while sleeping.

Too little sleep has officially been linked to an increased risk of obesity, particularly among young children. Recent findings published in The Journal of Pediatrics reveals a high connection between sleep-related breathing problems and obesity.

For the study, researchers analyzed data from 1,900 children in England and followed the participants for about 15 years. Study results showed that those who got the least amount of sleep between the ages 5 and 6 had between a 60 percent and 100 percent increased risk of obesity by age 15.

"In recent years, lack of sleep has become a well-recognized risk for childhood obesity," said lead study author Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women's health at Einstein, in a news release. "Sleep-disordered breathing, or SDB, which includes snoring and sleep apnea, is also a risk factor for obesity but receives less attention. These two risk factors had not been tracked together in children over time to determine their potential for independently influencing weight gain. Our study aimed to fill in that gap."

Furthermore, researchers found that children with the most severe sleep-disorder breathing (SDB) had the highest obesity risk. Children whose SDB levels peaked at around 5 to 6 years old still had a 60 to 80 percent increased risk of obesity, but fared better overall.

"If impaired sleep in childhood is conclusively shown to cause future obesity, it may be vital for parents and physicians to identify sleep problems early, so that corrective action can be taken and obesity prevented. With childhood obesity hovering at 17 percent in the United States, we're hopeful that efforts to address both of these risk factors could have a tremendous public health impact," Bonuck concluded.

A common cause of sleep-related breathing problems in children is oftentimes due to enlarged tonsils or adenoids, which can be removed with surgery if a problem occurs. Misalignment of jaws or teeth can also cause issues.

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Teens who sleep less gain more weight in 20s

A study shows that less sleep during the teen years means a person gains more weight by age 21.

Lack of sleep not only puts teens at risk for poor grades, it also puts them at increased risk for obesity, researchers warn.

The study authors analyzed data collected from more than 10,000 Americans when they were aged 16 and 21. Nearly one-fifth of them got less than six hours of sleep a night when they were age 16, and this group was 20 percent more likely to be obese at age 21 than those who got more than eight hours of sleep per night at age 16, the investigators found.

Although lack of exercise and too much time spent watching television were also risk factors for obesity, these behaviors did not account for the link between lack of sleep and obesity, according to the study published online recently in the Journal of Pediatrics.

"Lack of sleep in your teenage years can stack the deck against you for obesity later in life. Once you're an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer," study author Shakira Suglia, an assistant professor of epidemiology at the Mailman School of Public Health at Columbia University in New York City, said in a university news release.

"The message for parents is to make sure their teenagers get more than eight hours a night. A good night's sleep does more than help them stay alert in school. It helps them grow into healthy adults," Suglia added.

Teens should get nine to 10 hours of sleep a night, according to the U.S. Centers for Disease Control and Prevention.

It's known that daytime sleepiness and fatigue affect what and how people eat by triggering cravings and altering appetite. For example, sleep-deprived people find it easier to buy calorie-laden fast food rather than preparing a healthy meal.

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Sleep deprivation and obesity in children

This article explains that sleep deprived children are more likely to be obese than children who get enough sleep.

Tired and hungry. There is a reason why these two conditions seem to go together so easily.

A “well established” link in medical research suggests young children and infants who do not get enough sleep are likely to develop obesity —and a host of devastating related health conditions — before they enter their teen years.

And by then, reversing the obesity is almost impossible, health experts say.

A study published in May in the journal “Pediatrics” hypothesizes that children sleeping less in early childhood developed obesity by age 7.

But the findings — from researchers at Massachusetts General Hospital for Children — are hardly shocking, say local physicians.

While studies such as this are likely to be confirmed by additional research in the years ahead, the other non-controversial conclusion is that obese children who suffer from obstructive sleep apnea also experience a variety of health issues, according to Dr. Ignacio Tapia, a pediatric pulmonologist and sleep medicine specialist at the Sleep Center in The Children’s Hospital of Philadelphia.

Tapia notes that youngsters of normal weight who experience deep sleep and REM or rapid eye movement sleep find sleep restorative, resulting in benefit for everything from brain activity to hormone secretions.

But the obese often cannot attain deep sleep because of the apnea, a condition characterized by brief, numerous involuntary breathing pauses that prevent people from reaching restorative levels of slumber.

When children do not get the sleep they need, they are at risk for health, performance and difficulties in school; researchers find that sleep deficiencies in children can be misdiagnosed as attention-deficit or behavior disorders.

Young patients with sleep apnea can be treated effectively with surgery to remove their tonsils and adnoids but for obese children, such a procedure may not resolve the issue. Further treatment can involve wearing cumbersome masks that help regulate breathing.

“Remember when your grandparents told you you need to go to sleep to grow?” Tapia asked. “Well, that turned out to be true. Growth is associated with longer sleep. The people who sleep less (for example) may have less insulin secretion which can be related to diabetes and pre-diabetes.”

Since the 1800s, each generation has lived longer than the one that preceded it, said Tapia, also assistant professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. Such longevity can be linked to the development of antibiotics and advances in cardiac care.

Now, this generation may be the one that loses ground, because of the epidemic of obesity, which is a complex issue relating to social and cultural issues as well and having income components, physicians say. Those who earn less may not have ready access to healthy foods while eating at fast-food chains has been made increasingly affordable, Tapia said. Portion size also is an issue in this country.

“We are seeing patients who are not a little big but really really big,” he said. “It is not rare to see patients who have doubled their ideal weight. They do not weigh 20 or 30 percent more but 100 percent more’’ than growth charts indicate.

The “Pediatrics” study measured the effect of sleep deficiencies over time, using data from Project Viva, a longitudinal research study of women and children that examines the effects of mothers’ diets and other factors during pregnancy and after birth.

Obesity “definitely spans all ages,” said Dr. Tina Rakitt, a pediatric gastroenterologist at the Unterberg Children’s Hospital at Monmouth Medical Center. But the study published in May “is unique enough to say the obesity and sleep link even exists in young children,” she added. “There are many reasons for that link. People who don’t sleep well tend to eat more and they tend to eat more of the wrong things.”

The battle is lost once children are old enough to select their own snacks or meals, unless they are taught correctly. Physicians say healthy eating must be established when children are infants and must be carried on by the family. Obesity does not exist in a vacuum, the experts said.

“The obesity epidemic is not only an adult problem; it is a adult-pediatric problem,” Rakitt said. “We are seeing more sleep apnea…That is a terrible one. Children are developing fatty liver disease. We are starting to see some kids with serious complications either in their childhood or young adult years.”

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Whole family needs to sleep to protect against childhood obesity

A study looked into familial sleeping patterns and found that parents and children must get enough sleep to protect against childhood obesity.

Is sleep one of your most important family values? A new University of Illinois study suggests that it should be, reporting that more parental sleep is related to more child sleep, which is related to decreased child obesity.

"Parents should make being well rested a family value and a priority. Sleep routines in a family affect all the members of the household, not just children; we know that parents won't get a good night's sleep unless and until their preschool children are sleeping," said Barbara H. Fiese, director of the U of I's Family Resiliency Center and Pampered Chef Endowed Chair.

And the effects of sleeplessness go beyond just being tired the next day. Studies show that moms, dads, and their children are likely to gain weight as they lose sleep, she said.

Fiese suggests limiting your children's exposure to TV and other electronic devices to two hours a day and turning them off a half-hour before bedtime (needless to say, children should not have televisions in their bedrooms); spending some time in a calming, predictable routine, such as giving the child a bath or reading together; and making sure preschoolers are in bed in time to get the recommended 10 hours of sleep a night.

Then adults should follow a calming routine themselves. "We're learning more and more about how important it is to unplug for a half-hour or so before we go to bed. At a certain time, turn off your electronic devices -- even e-books -- and engage in whatever soothing ritual helps you to relax enough to sleep," she said.

Although the mechanism hasn't yet been identified, Fiese said that restorative sleep is thought to help regulate our metabolism. Her recent study showed that sleep is a protective factor in lowering the incidence of obesity in parents and being overweight in preschool children.

In the study, socioeconomic characteristics were assessed in relation to protective routines and prevalence of being obese or overweight for 337 preschool children and their parents. The routines assessed in parents included adequate sleep (over seven hours) and family mealtime routine. The four protective routines assessed in children were adequate sleep (10 or more hours per night), family mealtime routine, limiting screen-viewing time to less than two hours a day, and not having a bedroom TV.

The only significant individual protective factor against obesity or overweight in children was getting adequate sleep. Children who did not get enough sleep had a greater risk for being overweight than children who engaged in at least three of the protective routines regularly, even after controlling for parents' BMI and socio-demographic characteristics, Fiese said.

But the researchers also learned that the number of hours a parent sleeps is related to how much sleep children are getting, so that a parent's sleep has an effect on the likelihood that their children will be overweight or obese.

"We viewed how long parents slept and how long children slept as part of a household routine and found that they really did go together," she said.

In an earlier study, Fiese followed families for a year and was surprised when parents reported that their five- to seven-year-old children were going to bed as late as 11 p.m. When she looked deeper into the reason for these late bedtimes, she found that parents who worked late into the evening viewed those late-night hours with their children as a special time.

"They described cuddling on the couch, watching television, and the child falling asleep in his parent's arms at 10 or 11 p.m. and being carried to bed. You can understand how it happens, but that's too late for a child who has to get up and go to school the next day," she noted.

She noted that inadequate sleep is not just a problem for preschoolers but for elementary school children and high school students whose brains are still developing. Adults don't function well on inadequate sleep either, she noted.

Fiese sees obesity intervention as a three-legged stool in which every member of the family is able to eat well, play well, and sleep well.

"Paying attention to those three pillars of health -- good nutrition, enough exercise, and adequate sleep -- benefits everyone in the family," she said.

"Parent routines, child routines, and family demographics associated with obesity in parents and preschool-aged children" was published in the April 2014 issue of Frontiers in Psychology. Blake L. Jones of Purdue University and Barbara H. Fiese and the STRONG Kids Team of the University of Illinois co-authored the article. The Illinois Council for Agriculture Research, the U of I Health and Wellness Initiative, and USDA funded the study.

Members of the U of I's Strong (Synergistic Theory and Research on Obesity and Nutrition Group) Kids research team include Kristen Harrison, now of the University of Michigan, and the U of I's Kelly Bost, Sharon Donovan, Brent McBride, Diana Grigsby-Toussaint, Angela Wiley, and Margarita Teran-Garcia.

The University of Illinois Family Resiliency Center is dedicated to advancing knowledge and practices that strengthen families' abilities to meet life's challenges and thrive.

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Obesity and body fat in children are affected by chronic insufficient sleep

A study shows that chronic insufficient sleep can affect obesity and body fat in children.

One of the most comprehensive studies of the potential link between reduced sleep and childhood obesity finds compelling evidence that children who consistently received less than the recommended hours of sleep during infancy and early childhood had increases in both obesity and in adiposity or overall body fat at age 7. The study from MassGeneral Hospital for Children (MGHfC) investigators, published in the June issue of Pediatrics, also finds no evidence of a specific period during which insufficient sleep has greater influence on later obesity.

"Our study found convincing evidence that getting less than recommended amounts of sleep across early childhood is an independent and strong risk factor for obesity and adiposity," says Elsie Taveras, MD, MPH, chief of General Pediatrics at MGHfC and lead author of the Pediatrics paper. "Contrary to some published studies, we did not find a particular 'critical period' for the influence of sleep duration on weight gain. Instead, insufficient sleep at any time in early childhood had adverse effects."

While several studies have found evidence of an association between sleep and obesity in young children, few have examined the effects of constant sleep deprivation across time or used measures other than body mass index (BMI), which determines obesity based solely on height and weight. The current study analyzed data from Project Viva, a long-term investigation of the health impacts of several factors during pregnancy and after birth. Information used in this study was gathered from mothers at in-person interviews when their children were around 6 months, 3 years and 7 years old, and from questionnaires completed when the children were ages 1, 2, 4, 5 and 6.

Among other questions, the mothers were asked how much time their children slept, both at night and during daytime naps, during an average day. Measurements taken at the seven-year visit included not only height and weight but also total body fat, abdominal fat, lean body mass, and waist and hip circumferences -- measurements that may more accurately reflect cardio-metabolic health risks than BMI alone. Curtailed sleep was defined as less than 12 hours per day from ages 6 months to 2 years, less than 10 hours per day for ages 3 and 4, and less than 9 hours per day from age 5 to 7. Based on the mothers' reports at each age, individual children were assigned a sleep score covering the entire study period -- from 0, which represented the highest level of sleep curtailment, to 13, indicating no reports of insufficient sleep.

Overall, children with the lowest sleep scores had the highest levels of all body measurements reflecting obesity and adiposity, including abdominal fat which is considered to be particularly hazardous. The association was consistent at all ages, indicting there was no critical period for the interaction between sleep and weight. Lower sleep scores were more common in homes with lower incomes, less maternal education and among racial and ethnic minorities; but the association between sleep and obesity/adiposity was not changed by adjusting for those and other factors.

Facts and tips for healthy sleeping habits

While more research is needed to understand how sleep duration affects body composition, Taveras notes, potential mechanisms could include the influence of sleep on hormones that control hunger and satiety; the disruptions of circadian rhythms or possible common genetic pathways involved in both sleep and metabolism; poor ability to make good decisions on food choices and eating behaviors caused by sleep deprivation, or household routines that lead to both reduced sleep and increased food consumption. Insufficient sleep may also lead to increased opportunities to eat, especially if time is spent in sedentary activities, such as TV viewing, when snacking and exposure to ads for unhealthy foods are common.

"While we need more trials to determine if improving sleep leads to reduced obesity," she says, "right now we can recommend that clinicians teach young patients and their parents ways to get a better night's sleep -- including setting a consistent bedtime, limiting caffeinated beverages late in the day and cutting out high-tech distractions in the bedroom. All of these help promote good sleep habits, which also may boost alertness for school or work, improve mood and enhance the overall quality of life." Taveras is an associate professor of Pediatrics and Population Medicine at Harvard Medical School (HMS).

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Sleep, academics, and behavior all improved by limited screen time

A study shows that limiting screen time improves sleep quality, academic performance, and behavior in children. JR

Parents may not always see it, but efforts to limit their children's screen time can make a difference. A new study, published inJAMA Pediatrics, found children get more sleep, do better in school, behave better and see other health benefits when parents limit content and the amount of time their children spend on the computer or in front of the TV.

Douglas Gentile, lead author and an associate professor of psychology at Iowa State, says the effect is not immediate and that makes it difficult for parents to recognize. As a result, parents may think it is not worth the effort to monitor and limit their children's media use. But Gentile says they have more power than they realize.

"When parents are involved it has a powerful protective effect across a wide range of different areas that they probably never would have expected to see," Gentile said. "However, parents aren't likely to notice that putting limits on the children's media is having these effects seven months later."

Considering that children average more than 40 hours of screen time a week, not counting time spent on a computer at school, even small changes can make a difference, researchers said. They are not suggesting parents completely eliminate screen time, but find a healthy balance.

The study found there is a ripple effect associated with the benefits of limiting both screen time and media content. Gentile is not surprised to see a direct impact on sleep, academics and behavior. However, limited screen time also indirectly affects body mass index. The study found that children got more sleep if parents limited screen time, which also resulted in lower risk of obesity. Parents limiting exposure to violent media resulted in increased prosocial behavior and lowered aggressive behavior seven months later.

Researchers analyzed the media habits of more than 1,300 school children who were recruited to participate in an obesity prevention program. Students and parents were surveyed about everything from screen time limits, to violent media exposure, to bedtimes and behavior. Teachers reported grades and commented on student behavior and school nurses measured each student's height and weight.

Data were collected at the start of the program and seven months later at the end of the program. By looking at these factors collectively with a group of children over a school year, it was easier for researchers to identify patterns that are hard to recognize in individual children.

"As parents, we don't even see our children get taller and that's a really noticeable effect. With media, what we're often looking for is the absence of a problem, such as a child not gaining weight, making it even more difficult to notice," Gentile said.

"Even with changes that we do notice, we really don't recognize in the moment how all these things are related to each other across time," he added. "Yes, as screen time goes up, school performance goes down, but that doesn't happen overnight. If I watch a lot of TV today, I don't get an F in my class tomorrow."

Doctors can make a difference, too

The American Association of Pediatrics recommends no more than one to two hours of screen time a day for children two years and older. Reality far exceeds those recommendations, which might explain why doctors feel it is futile to talk with parents about guidelines for media use, Gentile said. The study provides further evidence of why pediatricians need to have that conversation.

"Hopefully, this study will give pediatricians a better sense of efficacy that it's worth taking the time to talk to parents," Gentile said. "Even if doctors only influence 10 percent of the parents, that's still millions of children having much better health outcomes as a result."

Researchers recommend doctors talk with parents about setting limits and actively monitoring media use. This can include talking with children about media content, explaining the purpose of various media and providing overall guidance.

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One stop shop for a scholarly review of state-of-the-art research on autism in children

This article reviews the recent research that has been done on autism in 6 main areas.

Recent years have seen exciting progress in key areas of research on autism spectrum disorders (ASD): from possible genetic causes, to effective treatments for common symptoms and clinical problems, to promoting success for young people with ASD entering college. Updates on these and other advances in ASD research are presented in the March special issue of Harvard Review of Psychiatry.

"Autism is one of the most challenging disorders to treat and the public health concerns associated with the disorder are numerous due to its burden on the individual, on the family and on society," write guest editors Drs Jean A. Frazier of University of Massachusetts Medical School and Christopher J. McDougle of Harvard Medical School. The special issue provides a timely update on research into the causes, important clinical issues, and evidence-based treatments for ASD.

Updates on ASD Research in Six Key Areas

Leading experts provide state-of-the-art reviews on six topics: the genetics of ASD; the use of psychoactive drugs; symptoms of special clinical problems, including obesity, gastrointestinal problems, and sensory issues; and transitioning to college.

Genetics. Over the last few years, there have been "unprecedented advances" in understanding the genetic causes of ASD. Hundreds of genes conferring varying degrees of ASD risk have been identified to date. Many of these genes also appear to be risk factors for related neurodevelopmental disorders and psychiatric problems. While many unanswered questions remain, it may soon be possible to make specific genetic diagnoses in children with ASD.

Psychoactive medications. Despite limited evidence, psychotropic drugs are widely used to manage behavior problems and mental health disorders in children with ASD. For medication classes -- including antidepressants and stimulants -- effectiveness may differ for youth versus adults with ASD. New treatments affecting specific neurotransmitters and the hormone oxytocin are under development, and may help in targeting the "core symptoms" of ASD.

Obesity. Obesity is a common problem with a major impact on the health of children with ASD. Some ASD-related genes may also promote obesity; the same is true for antipsychotic drugs used to help manage behavior problems. Other contributing factors may include sleep disorders and barriers to getting enough exercise. Childhood obesity and related health issues may be a "significant threat" to the health and quality of life of children with ASD.

Gastrointestinal issues. Children with ASD also have high rates of gastrointestinal symptoms and disorders. Some genes linked to ASD may also play a role in gastrointestinal disturbances, with a possible link to immune system dysfunction. There's also emerging evidence of a potential "gut-brain" connection, with gastrointestinal dysfunction contributing to the development or severity of ASD symptoms.

Sensory symptoms. Children with ASD have various abnormalities of sensory function, including both over- and under-responsivity as well as "sensory seeking behavior." Although the neurobiology of these sensory symptoms remains unclear, some researchers suggest they are related to known abnormalities of brain structure and function. Recent studies show that sensory symptoms are related to other ASD-related symptoms and behaviors; more research is needed to demonstrate the effectiveness of "sensory integration therapy" and other occupational therapy approaches.

Preparing for college. The final article highlights the need for new approaches to meeting the needs of "high-functioning" ASD patients entering college. Students "on the spectrum" transitioning to college are at risk of both academic and social problems, and may benefit from accommodation and supports. Based on a growing body of research, a set of recommendations for developing more effective transition plans for children with ASD are proposed.

Along with the editors of Harvard Review of Psychiatry, Drs Frazier and McDougal hope their special issue will provide a useful update for clinicians caring for the growing numbers of individuals and families living with ASD. They conclude, "Clearly, more research is needed on every level for the field to help support and treat individuals on the spectrum so that they can optimize their developmental trajectory and as adults become integral members of our work force."

The journal can be found online at:http://journals.lww.com/hrpjournal/Pages/default.aspx

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ADHD medication use leads to BMI rebound

A study of ADHD stimulant medication shows that its use is associated with BMI rebound later in adolescence.

A new study from researchers at Johns Hopkins Bloomberg School of Public Health found that children treated with stimulants for attention deficit hyperactivity disorder (ADHD) experienced slower body mass index (BMI) growth than their undiagnosed or untreated peers, followed by a rapid rebound of BMI that exceeded that of children with no history of ADHD or stimulant use and that could continue to obesity.

The study, thought to be the most comprehensive analysis of ADHD and stimulant use in children to date, found that the earlier the medication began, and the longer the medication was taken, the slower the BMI growth in earlier childhood but the more rapid the BMI rebound in late adolescence, typically after discontinuation of medication. Researchers concluded that stimulant use, and not a diagnosis of ADHD, was associated with higher BMI and obesity. The study was published in Pediatrics.

"Our findings should motivate greater attention to the possibility that longer-term stimulant use plays a role in the development of obesity in children," said Brian S. Schwartz, MD, MS, Professor of Environmental Health Sciences, Epidemiology, and Medicine at the Bloomberg School of Public Health and lead author of the study. "Given the dramatic rise in ADHD diagnosis and stimulant treatment for it in recent decades, this is an interesting avenue of research regarding the childhood obesity epidemic, because the rises in each of these roughly parallel one another."

Previous research has found substantial evidence that stimulant use to treat ADHD is associated with growth deficits, and some evidence of growth delays. However, the reported associations of ADHD with obesity in both childhood and adulthood was paradoxical and somewhat unexplained. The results of this study suggest it is likely due to the strong influence that stimulants have on BMI growth, with delays in early childhood and a strong rebound in late adolescence. The study also found longitudinal evidence that unmedicated ADHD is associated with higher BMIs, but these effects were small.

ADHD is one of the most common pediatric disorders, with a 9% prevalence among children in the U.S., and ADHD medication is the second most prescribed treatment among children. Over the past 30 years, treatment for ADHD with stimulants has increased rapidly. From 2007 to 2010, 4.2.% of children under age 18 had been prescribed stimulants in the past 30 days, more than five times the amount prescribed to the same-aged children between 1988 and 1984.

The study analyzed the electronic health records of 163,820 children, ages 3 to 18, in the Geisinger Health System, a Pennsylvania-based integrated health services organization. The research geographic area included 37 counties in central and northeastern Pennsylvania. There were an equal number of boys and girls. Nearly 7% -- 11,080, or 6.8% -- had an order for stimulants. (13,789, or 8.4%, received a diagnosis of ADHD. A total of 15,473 were prescribed stimulants, some for other reasons.) There were 201,854 orders for the ADHD medications used in the analysis. The median age at first stimulant use was 8.5 years. Median use was 183 days, with 50% of children taking stimulants for less than 6 months and 50% of children for more than 6 months.

The researchers compared the BMI trajectories of those who had never had a diagnosis or prescription (the "controls") with three groups: 1.) those with a diagnosis but no stimulant prescription; 2.) those with orders for stimulants without an ADHD diagnosis and 3.) those with both an ADHD diagnosis and stimulant orders.

Those in group 3 had slower rates of BMI growth in early childhood, with more rapid rates during adolescence that eventually exceeded those of the controls. Those with a diagnosis of ADHD but no stimulant orders had more rapid BMI growth after age 10 versus the controls, but the effects were small.

"Stimulant use was strongly implicated," said Dr. Schwartz. "The earlier stimulants were started and the longer they were used, the stronger was their influence on the degree of both the delayed BMI growth in early childhood and the rebound BMI growth in late adolescence. This is an important unintended consequence of stimulant use in childhood."

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The link between childhood obesity and sleep apnea

This article discusses the link between childhood obesity and sleep apnea.

Sleep apnea is a disorder where a person’s breathing is interrupted and may stop during the sleep schedule. Recent reports claim that this disorder may afflict not only adults, but also children. Previous research has focused on behavioral issues for children suffering from sleep apnea as well as other health concerns such as diabetes.

CHEO Research Institute’s principal investigator Dr. Sherri Katz claims that there is a direct link between obesity and sleep apnea. “In the past we used to see predominantly preschool-age children who had large tonsils and large adenoids, that was the basis for their obstructive sleep apnea. As time goes on we are seeing a second wave of children with obstructive sleep apnea, predominantly over the age of eight, where obesity is the major factor contributing to their sleep disorder.” Dr. Katz said before adding, “Rates of sleep apnea are about three to 10 times higher in children with obesity. There aren’t sufficient pediatric sleep laboratory resources across the country to manage the growing demand.”

Dr. Indra Narang, who is the director of sleep medicine at The Hospital for Sick Children in Toronto, echoed the concerns voiced by Dr. Katz, explaining that a main determinant in children visiting the sleep medicine department that she oversees is due to obesity.

“We are inundated with referrals for obesity-related sleep apnea. We also believe that probably 60 to 70 per cent of obesity-related sleep apnea isn’t even diagnosed because of a lack of an awareness of sleep apnea associated with obesity. I think the disaster is happening as we speak. Not only do they not sleep well at night, but these children are affected during the day. They are sleeping, they are tired, they don’t learn as well, they don’t do as well at school. They can’t participate in physical activity. Our concern is 75 per cent of obese children will become obese adults and will have untreated obstructive sleep apnea and what we will see is an epidemic of premature cardiovascular death because of obesity and because of related obstructive sleep apnea,” Dr. Narang said.

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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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Sleep apnea not only affects adults. It can affect children too!

This article discusses sleep apnea in children and how it is associated with obesity and heart issues. Recall that symptoms are most prevalent in preschool and younger years AND many do not improve without treatment.  Surgical treatment can be incomplete. Children and teens should consult their pediatric specialists. JR

People with sleep apnea experience pauses in their breathing or shallow breaths while they sleep. In adults, the condition has been linked to diabetes and heart disease, but that link is less clear in younger people with sleep apnea.

In a recent study, researchers found that obstructive sleep apnea (OSA) was linked with greater cardiometabolic risk markers in obese youth. Cardiometabolic risk markers are signs of a patient's overall risk for type 2 diabetes and heart disease.

The findings also showed that teenage boys had a higher risk of having OSA than teenage girls.

The authors believe this relationship needs to be considered when undergoing evaluation for OSA. They also believe further research is needed on OSA and its association with cardiometabolic risk markers — especially for young men.

This study was conducted through the Indiana University School of Medicine in Indianapolis, Indiana. The lead author was S. E. Watson, MD, from the section of Pediatric Endocrinology and Diabetology in the Department of Pediatrics.

Participant data was pulled from medical records of patients who were part of the Pediatric Overweight Education and Research (POWER) Program between January 2009 and November 2011.

The researchers assessed 96 adolescents, between the ages of 12 and 16, who were obese and referred for polysomnography (PSG; sleep study that measures brain waves, oxygen level in the blood, heart rate, breathing and leg and arm movements) during the POWER program.

In order to have been referred for PSG, there had to be either parental concern or complaints of "...snoring accompanied by excessive daytime sleepiness, morning headache and/or behavioral problems suspected to be related to sleep disruption." Patient medical history was obtained at the first visit, and the patients were tested for levels of fat cells in blood, liver enzymes, glucose and insulin.

The participants underwent overnight PSG in order to calculate their apnea-hypopnea (disorder which involves overly shallow breathing or an abnormally low respiratory rate) index, or AHI. The AHI is determined by adding the total number of OSA and hypopnea events during an hour of sleep.

The researchers then put the participants in two groups: 1) the participants with AHI scores of less than five, indicating mild or no OSA, and 2) the participants with of five or more, indicating moderate or severe OSA. Eighty of the participants had mild or no OSA, and 16 of the participants had moderate or severe OSA.

Significantly more teen boys (11) were found to have moderate or severe OSA than teen girls (5), despite similar levels of obesity. Hispanic males were especially affected, with two out of five having moderate or severe OSA.

The researchers also found that there was lower insulin sensitivity — or higher insulin resistance — in the moderate and severe cases of OSA, compared to the participants with mild or no OSA. Insulin is a hormone that the body produces to help manage levels of blood sugar. If someone has a lower insulin senstivity, the body can't use the insulin properly, which puts them at risk for high blood sugar and type 2 diabetes.

The participants with moderate or severe OSA were also found to have a higher levels of fat in their blood than the other participants.

Ultimately, there was a low percentage of participants with OSA in the study sample; therefore the researchers maintained that the OSA-related symptoms of daytime drowsiness and snoring were not reliable indicators of OSA.

The researchers see a need for further research on potential race/ethnicity determinants of OSA and the associated cardiometabolic risk factors in youth — especially in young men.

The authors mentioned a few limitations of their study.

First, there was a small number of Hispanic participants, so the findings on Hispanic men could be over- or underestimated.

Second, the researchers could not draw conclusions about the underlying pathways for the relationship between cardiometabolic risk factors and the degree of OSA because of the retrospective and clinical nature of the participant data.

Third, there were no uniform measures of the risk factors the participants were tested for—only comparisons within the study group. Lastly, the study population consisted of patients who had specifically been referred for OSA testing, so the researchers argue that the study results cannot be applied to the general pediatric population without further study.

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