Some children with autism show symptom improvement by 6 years old - Early diagnosis associated with likelihood of improvement

A study shows that over 10% of children with autism show improvement with their symptoms by age 6.  20% improve in adaptive functioning. 

Here is the most interesting finding " The earlier the children were diagnosed, the more likely they were to show improvement in functioning, the study found."

Please ask friends, family and physicians to encourage the earliest possible diagnosis.

JR

More than 10 percent of preschool-age children diagnosed with autism saw some improvement in their symptoms by age 6. And 20 percent of the children made some gains in everyday functioning, a new study found.

Canadian researchers followed 421 children from diagnosis (between ages 2 and 4) until age 6, collecting information at four points in time to see how their symptoms and their ability to adapt to daily life fared.

"Between 11 and 20 percent did remarkably well," said study leader Dr. Peter Szatmari, chief of the Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health in Toronto.

However, improvement in symptom severity wasn't necessarily tied to gains in everyday functioning, Szatmari said. Eleven percent of the children experienced some improvement in symptoms. About 20 percent improved in what experts call "adaptive functioning" -- meaning how they function in daily life. These weren't necessarily the same children, he said.

"You can have a child over time who learns to talk, socialize and interact, but still has symptoms like flapping, rocking and repetitive speech," Szatmari said. "Or you can have kids who aren't able to talk and interact, but their symptoms like flapping reduce remarkably over time."

The interplay between these two areas -- symptom severity and ability to function -- is a mystery, and should be the topic of more research, Szatmari said.

One take-home point of the research, Szatmari said, is that there's a need to address both symptoms and everyday functioning in children with autism spectrum disorder.

"If it were my kid, I would want adaptive functioning to improve and [feel] symptoms are less important," he said. "Adaptive functioning determines your place in the world."

Only 66 of the study participants were girls, and Szatmari found they had less severe symptoms and more improvement in symptoms than boys. The earlier the children were diagnosed, the more likely they were to show improvement in functioning, the study found.

The findings were published online Jan. 28 in the journal JAMA Psychiatry.

About 1 in 68 children in the United States is affected by autism spectrum disorder (ASD), and boys more so than girls, according to the U.S. Centers for Disease Control and Prevention. ASD is a group of developmental disabilities marked by social, communication and behavioral difficulties. Symptoms can range from mild to severe, and the condition is thought to be lifelong.

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York in New Hyde Park, N.Y., called the new research well done and said it yielded some important points for parents and doctors.

"This study highlights not only the variability of autism symptom severity among young children with ASD, but also the variability in adaptive functioning such as self-care skills," said Adesman, who wasn't involved in the study.

For parents discouraged by the relatively small percentage of children in the study who showed improvement in either area, Adesman noted that kids diagnosed earlier with autism may be more severely affected. Also, parents shouldn't generalize the study findings to children who are older when diagnosed, as they may be less severely affected, he said.

Szatmari added that parents who suspect their child shows symptoms of autism, such as an inability to interact or speak properly, should seek an evaluation.

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Sleep education for preschoolers helped them get more sleep

A study based on a sleep education program for preschoolers caused the children to get 30 minutes more sleep per night.

Taking part in an educational sleep program resulted in a 30-minute average increase in sleep duration at a one-month follow-up for preschoolers, according to a new study from the University of Michigan.

In the study, published in the journal SLEEP, families in two Head Start programs participated in the Sweet Dreamzzz Early Childhood Sleep Education Program™. The Detroit-area nonprofit organization, Sweet Dreamzzz, Inc. developed the program and offers it for free when funding allows. Head Start programs aim to give preschool opportunities to low-income families, in part to improve readiness for elementary school.

Researchers found that among 152 preschool children and their families, the sleep education program produced a 30-minute increase in sleep duration among the kids, says lead author Katherine (Wilson) DeRue, M.D., M.S., who conducted the study while a postgraduate fellow at the University of Michigan Sleep Disorders Center and Departments of Neurology and Pediatrics.

"We know that an increase in sleep duration of that magnitude is associated with better function for kids during the day" says DeRue, who is now a pediatrician and sleep physician at IHA Pulmonary, Critical Care and Sleep Consultants in Ann Arbor, Mich.

"Parents often underestimate how much sleep their kids require, so an educational program like this, directed at parents when they have more control over their kids' sleep schedules, can have great impact."

The study also found that parents' awareness and knowledge of good sleep behaviors also improved after program participation, but this effect was not sustained when parents were retested one month later.

The educational program included a one-time, 45-minute sleep education program for parents, and two weeks of classroom sleep education for the preschoolers. Parents were asked to keep diaries for assessment of their children's sleep habits.

"So we found that a two-week program of daily exposure to sleep education in the preschool classroom, along with an initial presentation for parents, can be an effective strategy," says Ronald D. Chervin, M.D., M.S., the study's senior author, director of the U-M Sleep Disorders Center, and a volunteer on Sweet Dreamzzz's Advisory Board.

"But repeated exposure or reminders about the sleep information may be necessary to maintain the effects for kids and especially parents over time." This is believed to be the first study to examine the effect of a sleep education program on the sleep of preschool age children.

The Head Start programs were located in greater Lansing, Mich. and Detroit, Mich.

The lessons taught in school seemed to stick with the children. Among the lessons were recognizing 8 p.m. as the desirable bedtime; learning that an apple is a better snack before bedtime than a candy bar; and identifying reading rather than watching TV as a relaxing activity before bedtime.

"We are pleased to see that the University of Michigan researchers have been able to measure the impact of our sleep program. We know a proper sleep environment, regular bedtime routine, and the right amount of sleep hours each night can impact the future of our children," says Nancy Maxwell, executive director of the non-profit Sweet Dreamzzz, Inc.

Sweet Dreamzzz provides educational programs on sleep, along with free sleep essentials- such as sleeping bags, toothbrushes, and books about sleep -- to schoolchildren in low-income areas. Sweet Dreamzzz's main aims are to encourage better sleep -- and thereby better health and learning -- at the earliest ages.

Most evidence indicates that children commonly obtain insufficient sleep, says DeRue, and this study provides a critical demonstration that minimal, relatively inexpensive interventions can make a difference.

"Family sleep education during early childhood years, when the sleep habits are being established, could prove to be a cost-effective but impactful strategy to improve children's overall health," says DeRue.

"Nutrition and exercise are commonly the focus of educational efforts to improve children's health," adds Chervin. "Good sleep -- in quality and quantity -- is no less vital to our kids' future, yet it's rarely if ever discussed. Our new findings suggest that a small amount of effort to promote better sleep could have substantial benefit now, and conceivably for years to come as these youngsters grow older."

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Sleep quality and obesity in children

A new study provides more evidence that sleep and sleep quality are linked to obesity in children.

Young children who get too little sleep are more likely than others to be obese by age 7, according to a new study.

Previous research has suggested insufficient sleep before age 4 raised the risk of obesity. But the new study, published online May 19 inPediatrics, observed the link from infancy to mid-childhood.

"Insufficient sleep is an independent and strong risk factor for childhood obesity and the accumulation of total fat and abdominal fat," said study researcher Dr. Elsie Taveras, chief of general pediatrics at Massachusetts General Hospital for Children in Boston.

"The main strength of this study is we looked at sleep at multiple periods," she added.

Excess body fat in childhood sets the stage for serious health problems, such as heart disease and diabetes.

Taveras and her team studied more than 1,000 children. Curtailed sleep was defined as fewer than 12 hours a day from ages 6 months to 2 years, fewer than 10 hours daily for ages 3 and 4, and fewer than nine hours a day for ages 5 to 7.

Kids who were most sleep deprived were about 2.5 times more likely to be obese than those who slept the most, the study found.

They were also 2.5 times more likely to have higher total fat, higher abdominal fat and a higher waist and hip circumference, said Taveras.

Many possible explanations exist for this association, Taveras said.

"If you sleep too little, it disrupts some of the hormones that regulate how hungry we are and how full we are," Taveras said.

In households with no consistent bedtime for children, there is likely to be chaos around regular mealtimes, too, and that can affect weight, she added.

Children who don't sleep enough may watch more television than kids who go to bed earlier, she said. Watching TV has long been linked with eating more, especially in response to food commercials, she said.

Or the children may have other "high-tech distractions," she said.

The new findings don't surprise Dr. William Muinos, director of the weight management program at Miami Children's Hospital in Florida, who was not involved in the study.

His advice for parents? Set a consistent bedtime. "Limit caffeinated beverages late in the day. Cut out all those electronic distractions; get them out of the bedroom," Taveras said.

Insist that children go to bed earlier, Muinos said. "Lack of sleep does change the physiology," he added. "It will put you in what is called stress mode. The body will read it as, 'I need to hold onto calories and accumulate fat.'"

The new research, Muinos said, "is very good because it studied a large group of children for a long period of time."

Ongoing studies are looking at whether improving sleep may directly improve weight control in children, Taveras said. And it's already known that good sleep has other benefits. "There's really good evidence that shows it improves schoolwork," she said.

For the study, mothers reported their children's usual sleep duration in a 24-hour period, beginning at age 6 months. They also reported it every year from age 1 to 7.

The children got a sleep score, ranging from zero (insufficient sleep) to 13 (consistent sufficient sleep). The average sleep score was 10.2. However, about 4 percent of kids were in the insufficient range, zero to 4. About 40 percent had a score of 12 or 13, termed enough sleep.

Those who slept less than average were more likely to be from poorer families with less educated mothers, the study found.

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Children's internal clock could result in trouble sleeping

This article discusses how a child's internal clock, which regulates their natural melatonin levels, could result in the child fighting off sleep at bedtime.

"Just one more story, please?" ''I need a glass of water." ''Mom, I can't sleep!"

When youngsters continually struggle to fall asleep at night, new research suggests maybe their body clock doesn't match their bedtime.

That doesn't mean tots should be up at all hours.

"Just like nutrition and exercise, sleep is critical for good health," said sleep scientist Monique LeBourgeois of the University of Colorado, Boulder, who is leading the research.

The ultimate goal is to help reset a delayed sleep clock so that young children can settle down more easily, she said. Hint: It seems to have a lot to do with light.

We all have what's called a circadian rhythm, a master biological clock, that regulates when we become sleepy, and when we're more alert. Those patterns vary with age: It's the reason teenagers are notorious for late nights and difficult-to-wake mornings.

But how does that clock work in preschoolers, who need more sleep than older kids or adults? A first-of-its-kind study tracked 14 healthy youngsters for six days to begin finding out.

The children, ages 2½ to 3, wore activity monitors on their wrists to detect when they slept. Parents kept diaries about bedtime routines.

Then on the last afternoon, researchers visited each home, dimming lights and covering windows. Then, every 30 minutes for six hours leading up to the child's appointed bedtime, they also coaxed each tot to chew on some dental cotton to provide a sample of saliva.

The reason: To test for levels of a hormone named melatonin that is key to the sleep cycle and also sensitive to light. At some point every evening, people's melatonin levels surge and a while later, they begin to feel sleepy. Among adults who sleep well, that melatonin rise tends to happen about two hours before whatever is their chosen bedtime.

For preschoolers, the new study found that on average, the melatonin surge occurred around 7:40 p.m. The children tended to be tucked in around 8:10 p.m., and most were asleep 30 minutes later, LeBourgeois reported in the journal Mind, Brain and Education.

When melatonin rose earlier in the evening, tots who hit the sack around 8 fell asleep a bit faster. But when the melatonin surge was closer to bedtime, the youngsters were more likely to fuss or make curtain calls after lights-out.

Two children in the study actually were tucked in before their rise in melatonin ever occurred, and it took them up to an hour past bedtime to fall asleep, she said.

"We don't know what that sweet spot is yet," LeBourgeois said, but the data suggest bedtime is easiest if the melatonin surge occurred at least 30 minutes earlier.

The study reinforces what doctors have long suspected is one bedtime barrier, said Dr. Jyoti Krishna, a pediatric sleep expert at the Cleveland Clinic. Other factors can disrupt a child's sleep, too, such as noise, stress or anxiety, or disrupted home routines, he cautioned.

"But this paper reminds us that, hey, there is a time that the body is more ready to sleep than at other times," Krishna said.

The National Institutes of Health says preschoolers need 11 to 12 hours of sleep each day; some typically comes from an afternoon nap.

Parents don't have melatonin tests as a guide, so Krishna advises looking for cues when setting a bedtime — yawning, rubbing eyes — and then to adjust that bedtime as the child gets older.

"The melatonin onset and our body rhythms change," Krishna said. "You can't stick to what worked two years ago with this child, because this child is now a different child."

About 25 percent of young children experience some type of sleep difficulty, including trouble settling down at bedtime, LeBourgeois said. Harried parents aside, there's concern that early-in-life bedtime frustration might lead to more persistent sleep trouble.

"Listen to your child's physiology," she advised. Some steps that might help:

—Research shows that in adults, too much light in the evening delays the melatonin surge and subsequent sleepiness. While there's no data in young children yet, LeBourgeois says dimming the lights about an hour before bedtime makes sense.

—Avoid electronics near bedtime, because they generate a specific type of light that triggers wakefulness. LeBourgeois was horrified to hear one parent offer a sleepless youngster an iPad to play with as long as the child stayed in the bedroom.

—And make sure blackout shades aren't keeping your children from getting enough morning sunlight, she said. Light in the morning also is key to keeping the biological sleep clock on schedule.

Stay tuned: With funding from the National Institute of Mental Health, LeBourgeois has begun a larger study that will track sleep patterns of 40 2-year-olds until they're 5. She'll also measure their light exposure, and periodically record their brain waves during sleep, in a bid to better understand the influence of sleep patterns on children's development.

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Preschoolers learn better with midday naps

Research shows that a midday nap helps preschool children retain what they learned that morning showing how important sleep is for learning and creating memories.

A midday nap can help pre-school children remember what they learned in the morning, according to a study by psychologists in the US.

The research suggests that carers and nurseries that phase out after-lunch sleeps may be harming children's ability to learn, by disrupting the way their brains store memories.

Pre-schoolers who went without a midday sleep fared worse on memory tests than those who napped. They also failed to improve their scores even after a good night's sleep, the researchers found.

The findings highlight the crucial role of sleep in consolidating memories, a process that underpins the brain's ability to learn new information.

The children who benefited most were "habitual nappers" who would sleep when carers encouraged them to, rather than more mature children who had outgrown the need for a nap.

For the study, psychologists went into pre-school classrooms and taught 40 children aged three to nearly five years old a simple computer game. It required them to memorize the positions on a grid of images including a cat, an umbrella, and a policeman. The children were trained from 10am until they could remember the positions of around 75% of the pictures.

The scientists visited each child twice over the course of the study. On one visit, the child slept for an hour or so between 1pm and 3pm, and stayed awake on the other. To see how sleep affected their memory, the scientists tested each child again later the same afternoon.

Those who napped saw no change in their morning score of 75%, but the ones who stayed awake fared much worse, averaging scores of 65%, according to a report in the Proceedings of the National Academy of Sciences.

"If they stayed awake they forgot more of the items they had remembered in the morning, whereas if they took a nap, they remembered all the items they had learned in the morning," said Rebecca Spencer at the University of Massachusetts in Amherst.

To check whether the nappers were simply more alert and attentive than the others, the scientists returned the next day and tested the children again. Their scores did not change, suggesting that daytime sleep was crucial.

Spencer said that parents and pre-schools are steadily cutting down the time given to children's naps to fit a convenient schedule, or to make more time for a curriculum.

"You often see children forced out of napping, and hopefully this will help parents and pre-schools to understand that maybe that's not the best decision, and that a nap is an important part of the day," said Spencer.

"This is the science that's needed to preserve nap time. If our goals are to prepare children for early education, the naps are consistent with that goal because it's really helping them to learn," she added.

The scientists went on to look at the brain activity of 14 children while they slept in the unversity's sleep lab. They found that children with the best memory recall experienced more "sleep spindles" – brief bursts of activity thought to happen when the brain shunts memories from short-term storage in the hippocampus to the neocortex.

"This demonstrates very vividly the value of sleep for consolidating memories. Very young children find it quite difficult to retain information over the course of a full day, so in those circumstances, a nap is going to be useful for ensuring that whatever they learn is retained in the longer term," said Gareth Gaskell, professor of psychology at York University.

"At these ages, children are shifting from multiple sleeps in 24 hours to a single sleep overnight. It may well be that non-habitual nappers are becoming more adult-like, and have got that little bit further in the process."

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Child's academic success affected by eating and sleeping habits

This article offers diet and sleep tips for children to ensure academic success.

Adults often hear what they should be doing to improve their health. But many of these known wellness behaviors are important for kids, too, and two University of Alabama at Birmingham (UAB) experts say school success depends on making the right choices.

Health habits, such as eating and sleep patterns, are linked to academic success, according to the Centers for Disease Control and Prevention.

"Your brain can't work if you're not consuming enough calories, and in general that's not a problem," explained Krista Casazza, Ph.D., R.D., assistant professor in the Department of Nutrition Sciences. "But when kids go to school without eating breakfast, their cognitive function can be affected."

Casazza suggests kids start the day with fruits, proteins and whole grains. Avoid sugary cereals because they cause a sugar high, then a crash.

"A balanced breakfast will fuel the body for a long period and help sustain their attention level through lunch, when they need to eat well again," Casazza said. "This will hold them until dinner, and they won't snack ravenously after school."

If the kids do need to eat something prior to dinner, consider these options: • Offer healthy choices like yogurt, fruits and veggies. • If they want "kid stuff," baked chips can be an option, in moderation. • Drink water. Soda lacks nutritional value.

Once homework and dinner are done, sleep needs to be the priority.

"Children need a good night's sleep for their overall school performance," said Kristin Avis, Ph.D., associate professor in the Department of Pediatrics Division of Pulmonary and Sleep Medicine.

"Lack of sleep can lead to problems with attention and memory in the classroom, affect impulse control and mood regulation lead to anxiety and even depression," Avis said.

Avis said kids ages 6-12 should get nine hours sleep nightly as should adolescents ages 13-18 -- but typically they average little more than seven hours per night.

"Often parents think one night of sleep loss won't matter, but that's all it takes to affect them the next day," Avis explained. "If they are chronically deprived, it can snowball and make matters worse."

Catching up on lost sleep on the weekend can make matters worse.

"If kids sleep in Saturday, they have a hard time going to bed Saturday night; so they sleep in Sunday and have a hard time going to bed Sunday night," Avis said. "Monday morning they are tired, and it's hard to wake up for school. They struggle to get back on a good sleep schedule."

Avis recommends a consistent bedtime seven days a week.

"It keeps their clock set so they can go to bed at a certain time, sleep well through night and wake up well rested the next morning," Avis said.

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Autism treatment found beneficial regardless of treatment model

A new study shows that children who receive early treatment for autism benefit regardless of the approach or treatment model used.

Researchers at the University of North Carolina at Chapel Hill have found that preschoolers with Autism Spectrum Disorder (ASD) who receive high-quality early intervention benefit developmentally regardless of the treatment model used -- a surprising result that may have important implications for special-education programs and school classrooms across the country.

"This is the first study designed to compare long-standing comprehensive treatment models for young children with ASD," said Brian Boyd, a fellow at UNC's Frank Porter Graham Child Development Institute (FPG) and one of the study's co-principal investigators. Boyd also is an assistant professor in occupational science and occupational therapy in UNC's School of Medicine.

"We know that more children are being diagnosed with ASD each year, and that it can cost an estimated $3.2 million to treat each child over a lifetime. Understanding that a child can benefit from a high-quality program, rather than a specialized program, may help reduce those costs by decreasing the need for teachers and other school practitioners to be trained to deliver multiple specialized services," Boyd said. He stressed it remains important to ensure educators are trained to provide high-quality programs that meet the special behavioral, communication and other needs of children with ASD.

Previous research has shown that when children with ASD have access to early intervention via treatment programs, they improve developmentally. Until now, however, debate has persisted over which approach to use, said Boyd. The study appeared in the June issue of Journal of Autism and Developmental Disorders.

Two frequently used comprehensive treatment models have a long history: LEAP (Learning Experiences and Alternative Program for Preschoolers and their Parents) and TEACCH (now known only by its acronym).

FPG's study examined the relative effects of the LEAP and TEACCH school-based comprehensive treatment models when compared to each other and to special-education programs that do not use a specific model. The multisite study took place only in high-quality classrooms and enrolled 74 teachers and 198 3- to 5-year-olds in public school districts.

The study found that children made gains over the school year regardless of the classroom's use of LEAP, TEACCH or no specific comprehensive treatment model. "Each group of children showed significant positive change in autism severity, communication and fine- motor skills," said Kara Hume, FPG scientist and co-author. "No statistically significant differences were found among models, which challenged our initial expectations -- and likely the field's."

"This study may shift the field's thinking about comprehensive treatment models designed for young children with ASD," said co-author Samuel L. Odom, FPG's director and the study's principal investigator. "Perhaps it's not the unique features of the models that most contribute to child gains but the common features of the models that most influence child growth."

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Preschoolers who sleep less have more behavior issues

A study shows that toddlers and preschoolers who do not get enough sleep have more behavior problems than those who get adequate sleep.

Four-year-olds with shorter than average sleep times have increased rates of "externalizing" behavior problems, reports a study in the July Journal of Developmental & Behavioral Pediatrics, the official journal of the Society for Developmental and Behavioral Pediatrics. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

"Preschool children with shorter nighttime sleep duration had higher odds of parent-reported overactivity, anger, aggression, impulsivity, tantrums, and annoying behaviors," according to the new research by Dr. Rebecca J. Scharf of University of Virginia, Charlottesville, and colleagues. They recommend that parents and health care providers discuss steps to improve sleep habits for preschool-age children with behavior problems.

Shorter Sleep Times, More Behavior Problems

The researchers analyzed parent responses from a nationally representative study of approximately 9,000 children, followed from birth through kindergarten age. When the children were four years old, nighttime sleep duration was estimated by asking the parents what time their child typically went to bed and woke on weekdays.

On a standard child behavior questionnaire, parents rated their child on six different "externalizing" behavior problems such as anger and aggression. (Externalizing behavior problems are outward behaviors, distinguished from "internalizing" problems such as depression and anxiety.) The relationship between sleep duration and behavior scores was assessed, with adjustment for other factors that might affect sleep or behavior.

The average bedtime was 8:39 pm and wake time 7:13 am, giving a mean nighttime sleep duration of about 10½ hours. Eleven percent of children were considered to have "short sleep duration" of less than 9¾ hours (calculated as one standard deviation below the average).

On the child behavior questionnaire, 16 percent of children had a high score for externalizing behavior problems. Behavior problems were more common for boys, children who watched more than two hours of television daily, and those whose mothers reported feeling depressed.

After adjustment for other factors, "Children in the shortest sleep groups have significantly worse behavior than children with longer sleep duration," Dr Scharf and colleagues write. The effect was greatest for aggressive behavior problems, which were about 80 percent more likely for children with nighttime sleep duration of less than 9¾ hours.

Shorter sleep times were also associated with 30- to 46-percent increases in rates of the other externalizing behaviors studied, including overactivity, anger, impulsivity, tantrums, and annoying behaviors. In a linear analysis, as sleep duration increased, troubling behaviors decreased.

Previous studies in smaller groups of children have identified shorter nighttime sleep duration as a risk factor for behavior problems in preschool children. The average 10½-hour sleep time in this nationally representative sample is less than in studies performed in past decades, and less than currently recommended for four-year-olds.

The new results, along with other recent studies, add to the evidence that preschoolers who sleep less will have more behavior problems, including disruptive behaviors like aggression and overactivity. Although the study can't draw any conclusions about causality, "there is good reason to believe that short nighttime sleep duration leads to externalizing behaviors," the researchers write.

Dr Scharf and coauthors recommend that doctors and health care providers ask about bed and wake times when talking to parents about young children with behavior problems. They add, "Advocating for regular sleep habits, healthy sleep hygiene, and regular bedtime routines may be helpful for young children."

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Study: Most ADHD treatments do not follow clinical guidelines

A study shows that up to 90% of clinicians do not follow treatment guidelines for ADHD.

A recent study by pediatricians from the Cohen Children's Medical Center of New York examined to what extent pediatric physicians adhere to American Academy of Pediatrics (AAP) clinical guidelines regarding pharmacotherapy in treating young patients with Attention Deficit Hyperactivity Disorder (ADHD). The results showed that more than 90 percent of medical specialists who diagnose and manage ADHD in preschoolers do not follow treatment guidelines recently published by the AAP.

"It is unclear why so many physicians who specialize in the management of ADHD -- child neurologists, psychiatrists and developmental pediatricians -- fail to comply with recently published treatment guidelines," said Andrew Adesman, MD, senior investigator and chief of developmental and behavioral pediatrics at Cohen Children's Medical Center in New Hyde Park. "With the AAP now extending its diagnosis and treatment guidelines down to preschoolers, it is likely that more young children will be diagnosed with ADHD even before entering kindergarten. Primary care physicians and pediatric specialists should recommend behavior therapy as the first line treatment."

Current clinical guidelines for pediatricians and child psychiatrists associated with the American Academy of Child & Adolescent Psychiatry (AACAP) recommend that behavior therapy be the initial treatment approach for preschoolers with ADHD, and that treatment with medication should only be pursued when counseling in behavior management is not successful.

The study also found that more than one-in-five specialists who diagnose and manage ADHD in preschoolers recommend pharmacotherapy as a first-line treatment alone or in conjunction with behavior therapy. Although the AAP recommends that pediatricians prescribe methylphenidate when medication is indicated, more than one-third of specialists who prescribe medication for preschool ADHD said they 'often' or 'very often' choose a medication other than methylphenidate initially (19.4 percent amphetamines; 18.9 percent non-stimulants).

"Although the AAP's new ADHD guidelines were developed for primary care pediatricians, it is clear that many medical subspecialists who care for young children with ADHD fail to follow recently published guidelines," said Jaeah Chung, MD, the study's principal investigator who also practices at Cohen Children's. "At a time when there are public and professional concerns about over-medication of young children with ADHD, it seems that many medical specialists are recommending medication as part of their initial treatment plan for these children."

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Risk of ADHD higher in children whose parents are depressed or violent

A study shows that young children whose parents are depressed or are involved in partner violence are more likely to develop ADHD by age 6.

Preschoolers whose parents reportdepression and intimate partner violence may be more likely to develop attention-deficit/hyperactivity disorder (ADHD) by the age of 6, new research suggests.

And young children with depressed moms may be more likely to receive prescription drugs to treat behavioral and mental health issues down the road.

"Our study indicates that preschoolers who are diagnosed with ADHD are more likely to have been exposed to both intimate partner violence and parental depression within the first three years of life than their peers not exposed to either risk factor," said study author Dr. Nerissa Bauer, an assistant professor of pediatrics at Indiana University School of Medicine, in Indianapolis.

"There has been increasing awareness that certain psychosocial risk factors can impact the behavioral presentation of children at very young ages," she said. Still, not all children who are exposed to maternal depression and intimate partner violence will develop ADHD, she noted.

"There are other factors that can be associated with a child's higher likelihood of being diagnosed with ADHD, including a family history of ADHD," Bauer explained.

ADHD symptoms can include impulsiveness, hyperactivity and difficulty focusing.Kids with ADHD may have difficulty in school, holding down jobs and sustaining relationships. They are also at greater risk for alcohol or substance abuse, depression and anxiety disorders. Treatment typically involves medication and behavioral modifications.

"Pediatricians and family practitioners know to routinely screen for the presence of these psychosocial risk factors because of the potential negative effects on the child," Bauer said. "Families who experience intimate partner violence will need help, not only to make sure the victims stay safe from physical harm, but there [are] also psychological effects."

The study, which appeared online Feb. 4 in the journal JAMA Pediatrics, included more than 2,400 children who were 3 years old. Parents who brought them to four different pediatric community clinics filled out questionnaires regarding their personal history of depression and domestic violence while in the pediatricians' waiting room.

Fifty-eight caregivers reported a history of intimate partner violence and depression before their child turned 3. In addition, 69 reported a history of intimate partner violence and 704 had symptoms of depression during this time frame. Close to 66 percent of the parents reported neither depression nor intimate partner violence. Children who were exposed to intimate partner violence and/or parental depression were four times more likely to be diagnosed with ADHD by the age of 6.

What's more, 2.9 percent of kids whose parents reported depression received prescription drugs to treat behavioral and mental health issues, compared with 1.6 percent of children whose parents did not report a history of depression. Medications included those that treat anxiety, depression and sleep problems.

While the study showed an association, it did not prove a cause-and-effect link between intimate partner violence and/or maternal depression and likelihood of anADHD diagnosis.

Experts said the findings make sense, but more study is needed.

"This study adds to the already robust literature revealing that early life experiences can have profound effects on brain development," said Dr. Michael Duchowny, a pediatric neurologist at Miami Children's Hospital. "While heredity is known to play a strong role in the expression of ADHD symptoms, the study further suggests that additional environmental factors operating during the formative years of brain maturation are also significant."

New York City-based child psychoanalyst Dr. Leon Hoffman said the new findings make sense. "Unquestionably, intimate partner violence and maternal depression have a profound effect on children," he said.

Exactly how to deal with this is another story, said Hoffman, who is the co-director of the New York Psychoanalytic Society's Pacella Parent Child Center. "This is a public health problem that needs a lot of funds if reasonably effective programs are to be developed," he noted.

Dr. Rachel Klein, professor of child and adolescent psychiatry at NYU Langone Medical Center in New York City, said the study shows an association based on how parents answered certain questions, but it can't say how, or even if, maternal depression and intimate partner violence predict a child's risk of ADHD.

"If parents are worried, ask the pediatrician to evaluate your child for possible ADHD or refer the child to a mental health professional," she added.

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Researchers plan to study the value of preschool naps

A group of researchers have claimed that nearly nothing is known about daytime naps and how they affect children. They plan to research this in the future and determine how daytime naps affect children's behavior and learning.

Parents may feel it's clear that missing a nap means their young children will be grumpy and out-of-sorts, but scientists who study sleep say almost nothing is known about how daytime sleep affects children's coping skills and learning.

Now neuroscientist Rebecca Spencer at the University of Massachusetts Amherst has received a five-year, $2 million grant from NIH's Heart, Lung and Blood Institute to significantly advance knowledge about how napping and sleep affect memory, behavior and emotions in preschoolers.

Spencer says with pressure mounting in some school districts to eliminate naps, "we feel it's important to study this and know their value more precisely. There's a sense among some educators that kids have to 'get over' napping in preparation for kindergarten, but it could be misguided. There's some evidence in young adults and in older children that naps are beneficial. So I suspect there is a benefit for younger children too. We need to know whether keeping naps in the school day is important."

Attending preschool offers life-long benefits in physical health, emotional stability and quality of life, Spencer points out, and in the United States, 70 percent of four- and five-year-olds attend. There is a trend now toward incorporating new curricula in preschool such as anti-bullying messages and lessons on how to brush your teeth. If sleep protects and enhances physical and emotional learning in young children as it does in older kids, taking away naptime could undercut such efforts, she adds.

"Right now, there's nothing to support teachers who feel that naps can really help young children, there's no concrete science behind that," the neuroscientist says. "But if sleep is going to enhance all these benefits of attending preschool, we need to know it."

Over the next five years, Spencer and her graduate students hope to study about 480 preschoolers between 3 and 5 years old, boys and girls in diverse communities across western Massachusetts. The research will include fact-based and emotional memory studies with and without napping, measures of physical activity levels and parent reports of their children's' nighttime sleep, to find out how classroom experience interacts with sleep and physical activity and whether daytime sleep enhances learning. The research will also explore the relationship between sleep and behavior disorders.

"I think we'll have a rich data set for examining sleep, physical activity and the child's behavior," says Spencer. "We think that the nap benefit is going to be especially useful for kids who don't get optimal overnight sleep. Culture plays a role in how late you stay up, and some kids live in noisy inner city neighborhoods. If we can help them with a nap, we want to know that."

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Study Claims Preschool Children Who Can Pay Attention More Likely to Finish College

New study about how the attention span of preschool children can help predict if they complete college or not. Also, the study goes into how early learning of reading and math may not indicate if a child finishes college or not.

Young children who are able to pay attention and persist with a task have a 50 percent greater chance of completing college, according to a new study at Oregon State University.

Tracking a group of 430 preschool-age children, the study gives compelling evidence that social and behavioral skills, such as paying attention, following directions and completing a task may be even more crucial than academic abilities.

And the good news for parents and educators, the researchers said, is that attention and persistence skills are malleable and can be taught.

The results were just published online in Early Childhood Research Quarterly.

"There is a big push now to teach children early academic skills at the preschool level," said Megan McClelland, an OSU early child development researcher and lead author of the study. "Our study shows that the biggest predictor of college completion wasn't math or reading skills, but whether or not they were able to pay attention and finish tasks at age 4."

Parents of preschool children were asked to rate their children on items such as "plays with a single toy for long periods of time" or "child gives up easily when difficulties are encountered." Reading and math skills were assessed at age 7 using standardized assessments. At age 21, the same group was tested again for reading and math skills.

Surprisingly, achievement in reading and math did not significantly predict whether or not the students completed college. Instead, researchers found that children who were rated higher by their parents on attention span and persistence at age 4 had nearly 50 percent greater odds of getting a bachelor's degree by age 25.

McClelland, who is a nationally-recognized expert in child development, said college completion has been shown in numerous studies to lead to higher wages and better job stability. She said the earlier that educators and parents can intervene, the more likely a child can succeed academically.

"We didn't look at how well they did in college or at grade point average," McClelland said. "The important factor was being able to focus and persist. Someone can be brilliant, but that doesn't necessarily mean they can focus when they need to and finish a task or job."

McClelland, who is also a core director in OSU's Hallie E. Ford Center for Healthy Children and Families, said interventions aimed at increasing young children's self-control abilities have repeatedly shown to help boost "self-regulation," or a child's ability to listen, pay attention, follow through on a task and remember instructions.

In a past study, McClelland found that simple, active classroom games such as Simon Says and Red Light/Green Light have been effective tools for increasing both literacy and self-regulation skills.

"Academic ability carries you a long way, but these other skills are also important," McClelland said. "Increasingly, we see that the ability to listen, pay attention, and complete important tasks is crucial for success later in life."

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