Study: Enforcing bed times helps kids get better sleep

Enforcing bed times and rules helps kids get better sleep, a study claims.

A regular bedtime and other sleep-related rules help children and teens get a good night's sleep, a new study suggests.

"Good quality and sufficient sleep are vital for children," study leader Orfeu Buxton, an associate professor of biobehavioral health at Penn State in College Park, Pa., said in a university news release.

"Just like a healthy diet and exercise, sleep is critical for children to stay healthy, grow, learn, do well in school, and function at their best," Buxton added.

Researchers analyzed survey responses from more than 1,100 American parents or guardians of youngsters aged 6 to 17.

Even though most of the parents believed sleep was important, only 10 percent of the children and teens in the study got the recommended amount of sleep for their age group. For ages 6 to 11, the amount of recommended sleep is at least nine hours a night. It's at least eight hours nightly for ages 12 to 17, according to the study.

Youngsters were more likely to get better and more sleep if they had a regular bedtime and rules such as limited caffeine consumption and no electronic devices on in the bedroom after bedtime, the researchers found.

"An important consequence of our modern-day, 24/7 society is that it is difficult for families -- children and caregivers both -- to get adequate sleep," Buxton noted.

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A parent's thoughts on concussions can hinder treatment and recovery

A study shows that a parent's misconceptions about concussions and treatment hinders treatment and recovery.

With football season in full swing, there's no shortage of talk about young players -- from high school down to the pee wee levels -- suffering from concussions. Yet many parents may lack knowledge about this mild traumatic brain injury, according to two studies to be presented Oct. 10 at a pre-conference symposium on pediatric sports medicine at the American Academy of Pediatrics (AAP) National Conference & Exhibition in San Diego.

Nearly 175,000 children are treated in U.S. emergency rooms each year for concussions due to sports-related activities, according to the Centers for Disease Control and Prevention. Parental knowledge of the signs and symptoms of concussion and recognizing that this is a brain injury is important to ensure children are diagnosed in a timely manner and get appropriate treatment.

Two separate studies looked at parents' knowledge of concussion and common misconceptions. They will be presented as part of the Peds21 symposium, "1, 2, 3, Go! Sports in the World of Pediatrics -- Playing it Safe and Making it Fun!" in the San Diego Convention Center.

For the first abstract, titled "Parental Knowledge of Concussion," 511 parents of children ages 5-18 years who sought care at a pediatric emergency department within two weeks of their child suffering a head injury filled out a 24-item survey. They were asked questions about their demographics, their child's head injury, and general questions related to their knowledge of concussion and its treatment.

Results showed about half of parents correctly identified a concussion as a brain injury that could lead to symptoms such as headache or difficulty concentrating. No parental demographics (age, sex, education or prior history of sports participation) significantly predicted parents' knowledge about concussions.

The survey also indicated that almost all parents (92 percent) were aware that they should stop their child from playing and see a physician if they suspected a concussion. Yet only 26 percent were aware of guidelines on when their child could return to sports and school work.

"Our study showed that the vast majority of parents knew what to do if they suspected a concussion in their child and in most cases understood the clinical importance of this injury as a brain injury," said lead author Kirstin D. Weerdenburg, MD, FAAP, pediatric emergency medicine fellow at Hospital for Sick Children, Toronto, Ontario, Canada.

"The study also highlights that a physician visit shortly after the injury is important to confirm the diagnosis for parents and to inform parents of return to play/learn guidelines to ensure a proper recovery and prevent a second concussion while the brain is still healing," Dr. Weerdenburg said.

The authors of the second abstract, "Parental Misconceptions Regarding Sports-Related Concussion," also surveyed parents to assess their knowledge of concussions. The online survey was completed by two groups -- 214 parents whose children were evaluated at a sports medicine clinic for musculoskeletal or mild traumatic brain injuries (group 1) and 250 parents of students at a local private school (group 2).

The survey included questions that gauged their knowledge of and attitudes about concussions as well as demographic information.

The majority of parents in both groups did well overall but had several misconceptions:

• About 70 percent in group 1 and 49 percent in group 2 incorrectly believed that brain imaging (CT/MRI scans) can be used to diagnose concussion.
• About 55 percent in group 1 and 52 percent in group 2 did not know that "bell ringer or ding" is synonymous with concussion.
• Reduced breathing rate was incorrectly identified as a symptom by 25 percent and 29 percent, respectively.
• Difficulty speaking was incorrectly identified as a symptom by 75 percent and 79 percent, respectively.

"Our study highlights the fact that many parents are still in need of education regarding concussion identification and post-injury evaluation. Even those highly educated parents were prone to misconceptions," said senior author Tracy Zaslow, MD, FAAP, medical director of the sports medicine and concussion program at Children's Orthopaedic Center, Children's Hospital Los Angeles. "False perceptions such as the ones pinpointed by our study may impact when medical care is sought after concussion and lead to less than optimal home care."

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Informing does not make parents confident to handle concussions

A survey showed that informing parents does not make them confident enough to treat a concussion.

Many parents whose kids participate in athletics will be asked to sign a waiver about concussion education, but that's not enough to ensure parents are confident about handling the injury, according to a new University of Michigan C.S. Mott Children's Hospital National Poll on Children's Health.

In the poll, about half of the 912 parents of middle and high school children surveyed reported participation in some type of concussion education:

• 23% have read a brochure or online information

• 17% have watched a video or attended a presentation

• 11% have signed a waiver form, with no other educational component

• 49% report no concussion education at all

Concussion education is more common among parents of children who play sports compared to non-sports parents (58% vs 31%).

"It is good news that many parents report they have received concussion education. We found, however, that the format of that concussion education really matters. The way the concussion information is delivered is linked to the parents' confidence about managing their child's injury," says Sarah J. Clark, M.P.H., associate director of the National Poll on Children's Health and associate research scientist in the University of Michigan Department of Pediatrics and U-M Medical School.

"Many schools mandate that a waiver form to be signed, but the danger is that parents will skip over information to get to that required signature line."

The poll showed that 63 percent of parents who watched a video or a presentation rated it as very useful. Forty-one percent of parents who read a brochure or online information rated that as very useful.

However, only 11 percent of parents whose only concussion education was signing a waiver form reported that was very useful.

"If the waiver is done online or on a form returned to school, parents may be left without information at home to guide them if or when their child is injured," says Clark, who is also a member of the U-M Institute for Healthcare Policy and Innovation.

The U.S. Centers for Disease Control estimates that each year, nearly 175,000 children are treated in US emergency rooms for concussions related to sports or recreational activities, including bicycling, football, playground activities, basketball and soccer.

Research has shown that the healing process for a concussion is different for kids than adults and that repeated concussions in a short time period are particularly dangerous.

Parents should get information about when to seek medical attention, monitoring the child's symptoms, and limiting physical activity until symptoms have subsided, says Clark. Health care providers also may recommend limiting homework and other mental activities to allow the brain to heal.

"Parents play a key role in deciding when a child returns to school and extracurricular activities, and concussion education can assist them in making good decisions," Clark says. "So one solution could be to offer multiple education formats to ensure that parents truly hear the concussion information rather than focusing on just signing a form."

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What price new parents pay for interrupted sleep

This article discusses what happens to parents of newborns after one night of interrupted sleep, such as being in a bad mood and other consequences of interrupted sleep.

The familiar cry in the night, followed by a blind shuffle to the crib, a feeding, a diaper change, and a final retreat back into oblivion—every hour on the hour. Such is the sleep pattern of most new parents, who report feeling more exhausted in the morning than when they went to bed the night before.

Now, in the first study of its kind, Prof. Avi Sadeh and a team of researchers from Tel Aviv University's School of Psychological Sciences explain why interrupted sleep can be as physically detrimental as no sleep at all. In the study, published in the journal Sleep Medicine, Prof. Sadeh and his colleagues Michal Kahn, Shimrit Fridenson, Reut Lerer and Yair Ben-Haim establish a causal link between interrupted sleep patterns and compromised cognitive abilities, shortened attention spans, and negative moods. The researchers discovered that interrupted sleep is equivalent to no more than four consecutive hours of sleep.

"The sleep of many parents is often disrupted by external sources such as a crying baby demanding care during the night. Doctors on call, who may receive several phone calls a night, also experience disruptions," said Prof. Sadeh. "These night wakings could be relatively short – only five to ten minutes – but they disrupt the natural sleep rhythm. The impact of such night wakings on an individual's daytime alertness, mood, and cognitive abilities had never been studied. Our study is the first to demonstrate seriously deleterious cognitive and emotional effects."

Putting Mom and Dad in a bad mood

"In the process of advising these parents, it struck me that the role of multiple night wakings had never been systematically assessed," said Prof. Sadeh, who directs asleep clinic at TAU, where he advises exhausted and desperate parents on how to cope with their children's persistent night wakings. "Many previous studies had shown an association, but none had established a causal link. Our study demonstrates that induced night wakings, in otherwise normal individuals, clearly lead to compromised attention and negative mood."

The study was conducted on student volunteers at TAU's School of Psychological Sciences. Their sleep patterns were monitored at home using wristwatch-like devices that detected when they were asleep and when they were awake. The students slept a normal eight-hour night, then experienced a night in which they were awakened four times by phone calls and told to complete a short computer task before going back to sleep after 10-15 minutes of wakefulness. The students were asked each following morning to complete certain computer tasks to assess alertness and attention, as well as to fill out questionnaires to determine their mood. The experiment showed a direct link between compromised attention, negative mood, and disrupted sleep—after only one night of frequent interruptions.

Paying a high price

"Our study shows the impact of only one disrupted night," said Prof. Sadeh. "But we know that these effects accumulate and therefore the functional price new parents—who awaken three to ten times a night for months on end—pay for common infant sleep disturbance is enormous. Besides the physical effects of interrupted sleep, parents often develop feelings of anger toward their infants and then feel guilty about these negative feelings.

"Sleep research has focused in the last 50 years on sleep deprivation, and practically ignored the impact of night-wakings, which is a pervasive phenomenon for people from many walks of life. I hope that our study will bring this to the attention of scientists and clinicians, who should recognize the price paid by individuals who have to endure frequent night-wakings."

Prof. Sadeh is currently researching interventions for infant sleep disturbances to reduce the detrimental effects of disrupted sleep on parents.

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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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Autism risk may be influenced by parental obesity

A study looked into how autism risk in a child may be influenced by parental obesity and found that paternal obesity is a greater risk factor than maternal obesity.

Several studies have looked at possible links between maternal obesity during pregnancy and the risk of developmental disorders in the child. However, paternal obesity could be a greater risk factor than maternal obesity, according to a new study from the Norwegian Institute of Public Health.

As the first researcher to study the role of paternal obesity in autism, Dr. Pål Surén emphasises that this is still a theory and requires much more research before scientists can discuss possible causal relationships.

"We have a long way to go. We must study genetic factors in the relationship between obesity and autism, as well as environmental factors associated with switching the genes on or off -- so-called epigenetic factors," he explains.

Surén and his fellow researchers used data from the Norwegian Mother and Child Cohort Study (MoBa). The researchers studied questionnaire data from over 90,000 Norwegian children at three, five and seven years of age. The mothers had answered detailed questions about their own mental and physical health, and about their children. The fathers completed a questionnaire about their mental and physical health while their partner was pregnant. The researchers also collected data from the Norwegian Patient Registry and from studies of children who were referred for evaluation and treatment of possible autism or Asperger's syndrome. By the end of the follow-up period, the children were aged 4 to 13 years.

Surprising findings

419 children, approximately 0.45 per cent of the sample, had an autism spectrum diagnosis (ASD). This is slightly lower than in the general population (0.8 per cent) because it is difficult to diagnose autism among the youngest children.

In the sample, 22 per cent of the mothers and 43 per cent of the fathers were overweight, with a body mass index (BMI) of between 25 and 30. Approximately 10 per cent of mothers and fathers were obese, with a BMI of 30 or more.

The researchers found that maternal obesity had little association with the development of autism in the child. However, they found a doubled risk for development of autism and Asperger's syndrome in the child if the father was obese, compared with a normal weight father.

"We were very surprised by these findings because we expected that maternal obesity would be the main risk factor for the development of ASD. It means that we have had too much focus on the mother and too little on the father. This probably reflects the fact that we have given greater focus to conditions in pregnancy, such as the growth environment for the fetus in the womb than both environmental and genetic factors before conception," says Surén.

The researchers adjusted for variables that may also be associated with the development of autism in the child. In addition to adjusting for maternal obesity, they considered education, age, smoking, mental disorders, hormone therapy before pregnancy, use of folic acid, maternal diabetes , pre-eclampsia and the baby's weight at birth.

Risk genes

Surén believes that the finding about paternal obesity is sound. The researchers found that the risk remained unchanged when adjusted for sociodemographic and lifestyle factors.

"Our findings therefore suggest that there may be a genetic link between obesity in the father and the development of ASD in the child," says Surén.

He points out that genetic mutation may play a role in the development of both extreme obesity and autism. Researchers have shown, for example, that if a section of chromosome 16 is missing this can lead to morbid obesity or developmental disorders in children. Mutations may be a basis for the development of a number of complex syndromes and diseases.

Another explanation may lie in epigenetics. Epigenetic changes do not mean that the gene is altered, but that the gene is activated or inactivated as a result of environmental conditions. Switching a gene on or off at the wrong time and place can lead to adverse consequences for the individual and the epigenetic changes can be passed on to the next generation.

"We still know very little about how epigenetic changes in germ cells are affected by obesity or other environmental factors but animal experiments have shown that obese males have offspring with altered gene expression in early growth regulation," says Surén.

Further research

Researchers are still in the early stages of studying possible links between obesity in the father and the development of ASD in the child. The first study was recently published in the Pediatrics journal. The research paper is included in Surén's doctoral thesis and it was written with a large group of researchers from university and hospital environments in Norway, England and the USA.

"We have begun to sequence all genes to find mutations and we must do more epigenetic analysis. If there is a correlation between obesity and ASD, this is a risk factor where the incidence is increasing in the population. Further research is therefore of great importance to public health," says Surén.

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Sleep Tips for Parents of Autistic Children

A study shows that teaching sleep tips to parents of children with autism helps the child's behavior.

Sleep education for parents of children with autism helps improve the youngsters' behavior and quality of life, according to a new study.

Autism is a neurodevelopmental disorder marked by difficulties in social interactions and communications. Autism spectrum disorders encompass a wide range from mild to severe.

For the study, researchers provided sleep education for the parents of 80 children, aged 2 to 10, with an autism spectrum disorder. During the sessions, the parents learned about daytime and evening habits that promote sleep, including the importance of increasing exercise, limiting caffeine, and lessening the use of video games and computers close to bedtime.

In addition, sleep educators helped the parents create a visual schedule for their children to help them establish a bedtime routine and talked about ways to help kids get back to sleep if they woke up at night.

"We found that one hour of one-on-one sleep education or four hours of group sleep education delivered to parents, combined with two brief follow-up phone calls, improved sleep as well as anxiety, attention, repetitive behavior and quality of life in children with [autism spectrum disorders] who had difficulty falling asleep," study author Dr. Beth Malow, a professor of neurology and pediatrics, and a professor of cognitive childhood development at Vanderbilt University, said in a university news release.

"The parents also benefited; they reported a higher level of parenting competence after completing the education sessions," Malow added. "The one-on-one and group sessions showed similar levels of success. In contrast, an earlier study that simply gave parents a pamphlet without guidance on how to use it did not provide the same level of improvement in child sleep."

The study was published in a recent issue of the Journal of Autism and Developmental Disorders.

Future research is needed to determine the best methods for providing sleep education to families, including telemedicine- and Internet-based approaches, Malow said. She and her colleagues within the Autism Speaks Autism Treatment Network are also building partnerships with local pediatric practices to offer training on sleep education.

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Tips for Parents to get Bedtime Right

This article discusses tips to help parents get their children back on a regular bedtime schedule.

There’s nothing like back-to-school schedules to knock parents on our heels in a public way. The dog days – and late bedtimes – of summer are gone. Parents are left crying in their coffee at 7 a.m. after late nights spent barricading children in their rooms, caving in and crawling into bed with them or any one of a number of other jury-rigged solutions to avert sleep deprivation.

Getting kids to sleep is one of the dominant parenting woes of our times – just ask author Adam Mansbach, who scored a roaring bestseller with his ode to bedtime defeat, 2011’s Go the F–– To Sleep. Scientific researchers are refining what we know about sleep and its crucial function in memory, cognition and general health for all of us. And as they increasingly turn their focus to children and the relationship between sleep, biology and development, the reasons to get it right are only proliferating. It’s no wonder modern parents are whining about their perceived failures and grasping for sleep solutions from professionals.

“My phone has not stopped ringing this week,” says Tracey Ruiz, a respected Toronto sleep consultant. Ruiz, who goes by the professional handle Sleep Doula, started her business focused on babies, but now says her biggest growth area is the under-10 set. Clients have been desperate enough to fly her across the continent for bedtime triage.

Maybe they read about studies like the one released in July that looked at 9,000 four-year-olds. It found that those who had shorter-than-average sleep times have increasing rates of “externalizing” behavior such as anger, overactivity, aggression and impulsivity.

“It’s becoming a bigger issue because we’re all more scheduled, even the kids,” says Rachel Y. Moon, the sleep expert who has written the newest book on the subject, Sleep: What Every Parent Needs to Know. “In my practice, I see so many parents making decisions based on emotion and desperation,” the Washington, D.C.-based pediatrician says.

Shalini Roy feels my pain. The Toronto mother is in the midst of trying to dial bedtime back to 7:45 for her seven-year-old son, who needs more sleep for his big Grade 3 days.

“It’s kind of a stretch – he’s moving around, getting his PJs on,” she says. “The problem is this year he’s into chapter books. It just doesn’t end. ‘Just a few more words, just till the end of the chapter.’”

Admittedly, she says she often finds herself playing timekeeper while her husband, who oversees bedtime when the deadline gets pushed toward 8:30 or 9. There may be yelling, she allows.

Most experts recommend an average of 12 hours for toddlers and school-age kids. Ruiz says that can mean 10½ for some kids and 13 for others. And all experts stress consistency in sleep and wake times as a way to maintain circadian rhythms – not to mention consistency in how parents approach sleep setbacks.

Valerie Kirk, the medical director of the Pediatric Sleep Service at the Alberta Children’s Hospital in Calgary, says about half of her clinic’s families are experiencing non-medical sleep problems .

“One person’s problem is another person’s crisis,” she says. “The spectrum of what we see, on the mild side would be a child getting up two or three times a week to one getting up many, many times a night or simply refusing to go to bed.”

Kirk says that regardless of the methods out there to get bedtime back on track – from reward-based sticker charts to timers and cut-the-apron-strings techniques – the key is that bedtime become non-negotiable, much like bad-tasting medicine for a sick child or a car seat.

What’s more, she says, if your can get bedtime right, other disturbances like nighttime waking will become less likely.

“Non-negotiable” doesn’t have to mean they retreat to their rooms and you close the door and ignore them, Ruiz says. Nor does it mean favouring consistency over an extra cuddle. “Your child is not a robot.”

And forget laying down the law through gritted teeth when you’re frustrated – such as: “You are melting down. You’re tired. You have to go to bed earlier.”

Instead, Moon suggests talking with your child at dinner or on the way to school about any new rules – when everyone can be more rational.

Many parents I’ve heard from have summoned up enough rational reserves and enforce an ironclad 6 or 6:30 bedtime.

Burlington mother Jennifer Cushing is one of them. Bedtime for her five- and 2½-year-old is 6:30 sharp (wake-up is 6:30 or 7). Dinner is at 4:15 or 4:30.

“I was getting up with them at night when my second was a newborn,” she says. She tried the “extinction method,” also known as a “modified cry-it-out” approach, advocated by pediatrician and author Marc Weissbluth.

“It’s a rush to get home, make dinner, bath them, get them ready for bed,” she says, adding that her husband gets home early enough to get the process under way. “But you have to find what works for you.”

In our house, we’re getting there, 10 minutes at a time. I’m consoling myself with Moon’s reassurance: “You are not the first parent of a kindergartener who fell asleep on the bus. It’s a big transition.”

My son even started waking up five minutes before the alarm this week. We should all get a sticker for that.

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Parent's goals for their children determine ADHD treatment

A study shows that parents who are interested in the academic success of their child are more likely to start their child on medication whereas parents who are interested in behavior modification are more likely to start behavior therapy.

Parents' goals and concerns for their children with attention-deficit/hyperactivity disorder may influence their decision to start behavior therapy or medication, according to a new study that researchers say supports a shared decision-making approach to ADHD treatment.

Researchers found parents who were focused on their child's academic achievement were twice as likely to have the child started on medications, which include Adderall and Ritalin, as other parents.

Parents who expressed goals of improved behavior and interpersonal relationships were 60 percent more likely to start behavior therapy - which involves parents meeting with a counselor to learn how to manage a child's behavior.

"Studies like this really suggest that taking a shared decision-making approach may be one way to match the kids for whom (treatment) is warranted to the best treatment," Dr. Alexander Fiks, from The Children's Hospital of Pennsylvania in Philadelphia, said.

"For parents, the real thing is to ask pediatricians to really explain the pluses and minuses of all of the different options, and to make sure they can articulate what they're really most hoping to achieve," Fiks, the study's lead author, told Reuters Health.

According to 2011 guidelines from the American Academy of Pediatrics, "family preference is essential in determining the treatment plan" for children diagnosed with ADHD.

But Fiks said no one had looked at whether there were benefits to assessing parents' preferences and goals for treatment.

"There are barriers in real-world settings," he noted. "It takes time, people are busy."

For their study, Fiks and his colleagues surveyed the parents and guardians of 148 children with ADHD, ages six to 12, about their goals for treatment and the acceptability, feasibility and side effects they associated with different treatment options.

None of the children were using a combination of behavior therapy and medication at the outset, although some were using one or the other.

Six months later, 46 of the 108 children not initially using medication had started on the drugs and 30 out of 124 had started behavior therapy, according to findings published in Pediatrics.

Not surprisingly, researchers said, parents who had initially agreed with statements such as, "Medication is a reasonable way to help my child" and, "I would have trust in my doctor to treat my child's ADHD with medicine" were more likely to go that route.

Likewise, children whose parents rated behavior therapy as more acceptable and said they would be comfortable working with a counselor were more likely to be receiving therapy six months later.

What was newer and more surprising, Fiks said, was how closely treatment goals aligned with which families opted for medication and which started behavior therapy.

Dr. Laurel Leslie, who has studied treatment of ADHD at the Tufts University School of Medicine in Boston, said those goals and subsequent choices are consistent with scientific evidence.

"What we do know is, a lot of the medications last under eight hours. So if you're taking a medication, it's probably only working during school time," Leslie, who wasn't involved in the new study, told Reuters Health.

Behavior therapy, on the other hand, is going to have the strongest effects with the family, at night and on weekends, she said.

According to the Centers for Disease Control and Prevention, parent reports suggest close to one in 10 kids and teens in the U.S. has ever been diagnosed with ADHD, and two-thirds of those with a current diagnosis are taking medication.

"I think this particular study speaks to the need to spend a little bit more time getting to know families … their own hopes and wishes for what is going to improve and preferences for how to go about making those benefits happen," said Dr. Alice Charach, the head of neuropsychiatry at The Hospital for Sick Children in Toronto.

Charach, who also wasn't involved in the new research, recommended parents collect ideas and information before meeting with their child's pediatrician.

"It's helpful to have thought about what you hope to get out of the appointment and what your goals are for the child," she told Reuters Health.

By the time children get to be nine or 10 years old, Charach added, they should be involved in the shared decision-making process as well.

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Risk of autism for full and half siblings

This study looks at how much of a higher risk fill and half siblings of children with autism have for developing the disease themselves.

A Danish study of siblings suggests the recurrence risks for autism spectrum disorders (ASDs) varied from 4.5 percent to 10.5 percent depending on the birth years, which is higher than the ASD risk of 1.18 percent in the overall Danish population, according to a study published by JAMA Pediatrics, a JAMA Network publication.

ASDs are neurodevelopmental disorders that are characterized by difficulties in social interaction and communication and also include repetitive behavior and narrow interests. Childhood autism (CA) accounts for about 30 percent of all ASD cases and the prevalence of ASDs has increased during the last two decades, according to the study background.

Therese K. Grønborg, M.Sc., of Aarhus University, Denmark, and colleagues conducted a population-based study in Denmark of all children (about 1.5 million) born between 1980 and 2004. They identified a maternal sibling group derived from mothers with at least two children and a paternal sibling group derived from fathers with at least two children.

"To date, this is the first population-based study to examine the recurrence risk for autism spectrum disorders (ASDs), including time trends, and the first study to consider the ASDs recurrence risk for full- and half-siblings," the authors note in the study.

The study results suggest an almost seven-fold increase in ASDs risk if an older sibling had an ASD diagnosis compared with no ASD diagnoses in older siblings. In children with the same mother, the adjusted relative recurrence risk of 7.5 in full siblings was significantly higher than the risk of 2.4 in half siblings. In children with the same father, the adjusted relative recurrence risk was 7.4 in full siblings and significant, but no statistically significant increased risk was observed among paternal half siblings, the results also indicate.

"The difference in the recurrence risk between full and half siblings supports the role of genetics in ASDs, while the significant recurrence risk in maternal half-siblings may support the role of factors associated with pregnancy and the maternal intrauterine environment in ASDs," the study concludes.

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Does Cosleeping Contribute to Lower Testosterone Levels in Fathers? Evidence

A previous Chinese study footnoted in this article showed that fathers had lower T than single men and married, non-fathers.

This article is a fascinating addition to the role of testosterone in males and environmental influences.  

JR

Does Cosleeping Contribute to Lower Testosterone Levels in Fathers? Evidence from the Philippines

Lee T. Gettler, James J. McKenna,

 

Thomas W. McDade,

 

Sonny S. Agustin,

 

Christopher W. Kuzawa

Because cross-species evidence suggests that high testosterone (T) may interfere with paternal investment, the relationships between men's transition to parenting and changes in their T are of growing interest. Studies of human males suggest that fathers who provide childcare often have lower T than uninvolved fathers, but no studies to date have evaluated how nighttime sleep proximity between fathers and their offspring may affect T. Using data collected in 2005 and 2009 from a sample of men (n = 362; age 26.0 ± 0.3 years in 2009) residing in metropolitan Cebu, Philippines, we evaluated fathers' T based on whether they slept on the same surface as their children (same surface cosleepers), slept on a different surface but in the same room (roomsharers), or slept separately from their children (solitary sleepers). A large majority (92%) of fathers in this sample reported practicing same surface cosleeping. Compared to fathers who slept solitarily, same surface cosleeping fathers had significantly lower evening (PM) T and also showed a greater diurnal decline in T from waking to evening (both p<0 .05="" 4.5-year="" a="" among="" arrangements="" at="" baseline="" compared="" cosleepers="" decline="" did="" experienced="" fathers.="" fathers="" follow-up="" greater="" in="" longitudinal="" men="" not="" over="" p="" period="" pm="" predict="" same="" significantly="" sleeping="" solitary="" study="" t="" the="" these="" to="" were="" who="">0.2). These results are consistent with previous findings indicating that daytime father-child interaction contributes to lower T among fathers. Our findings specifically suggest that close sleep proximity between fathers and their offspring results in greater longitudinal decreases in T as men transition to fatherhood and lower PM T overall compared to solitary sleeping fathers.

Full article here

Ten Things I Wish Someone Told Me About Parenting a Child with Special Needs

My thanks to Liane Kupferberg for an excellent article with really good advice. - JR

Ten Things I Wish Someone Told Me About Parenting a Child with Special Needs

By Liane Kupferberg Carter at 9:47 am

Liane and her son.

As part of our month-long series dedicated to Jewish Disability Awareness Month, Liane shares advice for those just starting out on the special needs journey.

I’m a proud member of a tribe. No, not just that tribe. I mean the tribe of special needs parents. There’s no way you’d spot us in a crowd. But even without a secret handshake, special needs parents manage to find each other. Maybe it’s that unmistakable look of exhaustion and resolve many of us wear. Whatever it is, I’ve been part of this particular tribe for 20 years.

Even after all this time, I still sometimes stop myself and ask, “How in the world did I get here?” When my son was initially diagnosed with autism and epilepsy years ago, I didn’t know anyone else with a child like him. That was back in the dark ages, before the internet. There were no websites or blogs to turn to for information and support. There was so much I didn’t know, and so much I was desperate to learn; I could have used advice from a seasoned tribal elder.

Now I’m that mom. The one with some mileage on her. There’s no road map to navigate raising a child with special needs, but here are some pointers I wish I’d had when I first set out on this journey.

1. You are the expert on your child. No one else. Not your child’s doctor, his teacher, his neurologist, and certainly not your Great Aunt Gussie who raised 10 kids of her own. Listen respectfully to them, but remember they are experts in their own spheres, not yours. All of them–therapists, family, friends–go home at the end of the day. You are in it for the long haul, and you know your child better than anyone.

2. You are parenting a person, not “treating” a cluster of “symptoms.” When your child is first diagnosed, you’re going to hear a lot about the deficits–all the things your child isn’t doing. Don’t lose sight of the fact that behind the “special needs” label there is the same wonderful child you had before the diagnosis, who needs your guidance and love. There’s a saying so popular in the autism community that it is practically a cliché: “Once you’ve met one person with autism, you’ve met one person with autism.” Your child is unique. Yes, you will get all caught up in searching out treatments and therapies, but please take the time to enjoy him right now, because he won’t be a child forever. Don’t let your fears of the future rob you of the pleasures of the present.

3. People will stare. This will eat at you in the beginning. It’s natural to feel uncomfortable, resentful, even mortified. It is also a natural instinct for people to look at anything that’s a little out of the ordinary. Your child’s quirky behaviors in public may draw attention, and what if they do? Stop worrying about it so much. Who cares what strangers think? And I can promise you this: you will learn to never, ever judge any other parent whose kid acts up in public. Eventually you will figure out how to handle people’s inappropriate questions. I’ll never forget how taken aback I was at a wedding 15 years ago when my husband’s uncle abruptly asked, “Is there any hope for your son?” Sometimes people may imply that you just aren’t trying hard enough. Or they will offer unsolicited advice, or press the latest miracle cure on you. Worst of all, they will talk about your child right in front of him. Don’t let them. And don’t you do it either. Your child may not be verbal (yet), but his ears are working just fine.

4. Take care of yourself. Really. I’m not talking about a trip to Canyon Ranch. A study released a couple of years ago found that autism moms have stress levels similar to combat soldiers. I know there’s nothing you wouldn’t do for your child, but you count too and you’re no good to anyone if you don’t stay healthy and strong. Physically and mentally. Medication is there for a reason. No, not for your child. For you. Don’t be afraid to ask for help if you need it. Because as all special needs parents know, we need to live forever.

Full article here

6 tips to help parents of children with ADHD

This article contains six tips of a coaching approach for parents of children with ADHD.

Raising kids with ADD/ADHD can be stressful, to say the least. You try everything the “experts” tell you, but sometimes it still feels like you’re running on a treadmill. A coach-approach to parenting can take the pressure off.

Parents who learn to “coach” their kids with ADD/ADHD get out of survival mode and help their kids become more independent and successful.

There are six key strategic areas for parents to focus on when managing ADD/ADHD and literally hundreds of coaching skills to help parents help their kids. Here’s a specific tip for each strategy that will get you off that treadmill and help you rediscover the joy of parenting:

1. Educate yourself and your child about ADHD: This is a critical first step. Learn whatever you can and help your child identify the ways ADHD causes challenges at home and at school. Use this to empower your child to understand that he/she is not stupid and there is a reason for his/her challenges. If you’re not sure if something is caused by the ADD/ADHD or not, it probably has something to do with it!

2. Activate the brain: Since ADD/ADHD is based in the brain, it’s a logical step for improvement. Whether your child is taking medication or not, try exercise and/or protein before school — or before homework time — to improve focus and get better results.

3. Manage the behavior: People with ADD/ADHD often avoid structure, even though it’s what they need the most. Perhaps the most important structure is to help your child figure out his/her motivators. Identify good reasons that make sense to your child, not you, and you’ll see improved results.

4. Parent positively: Kids with ADD/ADHD make mistakes … a lot. They are constantly dropping, losing, breaking or forgetting things, and we correct them from sun up to sun down, without even realizing it. They need you to “catch ‘em being good." Let them know when they are successful, even if you think they “should” be doing it. For them, small victories mean a lot.

5. Establish appropriate expectations: On average, kids with ADD/ADHD are at least three years behind their peers in behavioral development. Keep that in mind when you set expectations for chores and following directions, especially in the evenings when they are tired. Yes, that may mean letting things slide. It helps to think of them as very mature 10-year-olds, instead of immature teenagers.

6. Take care of yourself: This may seem out of place, but it’s so important! Kids with ADD/ADHD need to learn to take care of themselves for future success more than their typical peers. When parents model self-care, their kids begin to learn to eat well, exercise, etc. On the other hand, when parents do not take care of themselves, they send a message to their kids that it’s not important. 

How you approach your child’s ADD/ADHD makes a big difference. Two final pieces of advice can have more of an impact than anything else: Believe in your kids and laugh a lot.

Kids with ADD/ADHD tend to be bright, creative, innovative and interesting. They respond well to positive encouragement and humor. When parents use coaching skills to manage the challenges and humor to downplay the mistakes, the results are positive for the entire family.

Read more here

Parents of Children With Autism More Likely to Get Ailments

Parents of Children With Autism More Likely to Get Ailments




Parents of children with autism are more likely to get common ailments such as colds, coughs and headaches as a direct result of the increased stresses linked to their caring duties, according to research from Northumbria University.

The research is published in the journal Psychoneuroendocrinology, this April which is also National Autism month.

In the first study to look at the physical and psychological well-being of these carers, psychologists Dr Mark Wetherell, Dr Mark Moss and PhD researcher Brian Lovell also discovered higher levels of C-reactive protein in the carers, a marker of inflammation that is linked to increased risk of developing coronary heart disease and diabetes.

Dr Wetherell said: "Parents of children with autism face tremendous physical, financial, emotional and social pressures and these can lead to prolonged activation of stress responses which might place them at greater risk of adverse health outcomes.

"The consequences of these effects are far-reaching and can influence the ability of the caregiver to provide consistent, effective and sustainable care for their child."

In a separate study, published in the April edition of Research in Developmental Disabilities the team discovered that carers with lower levels of social support experienced greater levels of stress, depression and anxiety and more common ailments.

The team is now to embark on a new research project looking at how writing about their emotions can have a positive impact on carers' wellbeing. Those taking part in the research will be asked to provide saliva and blood samples and write for 20 minutes for three days on an assigned topic.

Read more here