Study: Texting negatively affects teen's sleep and academic performance

A study shows that teenagers who text at night hurts their sleep and academic performance.

Can't stop texting? If you're a teenager, it may be to blame for falling grades and increased yawning in school, according to a new Rutgers study.

The study, published in the Journal of Child Neurology, is the first of its kind to link nighttime instant messaging habits of American teenagers to sleep health and school performance.

"We need to be aware that teenagers are using electronic devices excessively and have a unique physiology," says study author Xue Ming, professor of neuroscience and neurology at Rutgers New Jersey Medical School. "They tend to go to sleep late and get up late. When we go against that natural rhythm, students become less efficient."

The American Academy of Pediatrics reports that media use among children of all ages is increasing exponentially; studies have found that children ages 8 to 18 use electronic devices approximately seven-and-a-half hours daily.

Ming's research is part of a small but growing body of evidence on the negative effects of electronics on sleep and school performance. But few studies, Ming says, have focused specifically on instant messaging.

"During the last few years I have noticed an increased use of smartphones by my patients with sleep problems," Ming says. "I wanted to isolate how messaging alone - especially after the lights are out - contributes to sleep-related problems and academic performance."

To conduct her study, Ming distributed surveys to three New Jersey high schools - a suburban and an urban public school and a private school - and evaluated the 1,537 responses contrasting grades, sexes, messaging duration and whether the texting occurred before or after lights out.

She found that students who turned off their devices or who messaged for less than 30 minutes after lights out performed significantly better in school than those who messaged for more than 30 minutes after lights out.

Students who texted longer in the dark also slept fewer hours and were sleepier during the day than those who stopped messaging when they went to bed. Texting before lights out did not affect academic performance, the study found.

Although females reported more messaging overall and more daytime sleepiness, they had better academic performance than males. "I attribute this to the fact that the girls texted primarily before turning off the light," Ming says.

The effects of "blue light" emitted from smartphones and tablets are intensified when viewed in a dark room, Ming says. This short wavelength light can have a strong impact on daytime sleepiness symptoms since it can delay melatonin release, making it more difficult to fall asleep - even when seen through closed eyelids.

"When we turn the lights off, it should be to make a gradual transition from wakefulness to sleep," Ming says. "If a person keeps getting text messages with alerts and light emission, that also can disrupt his circadian rhythm. Rapid Eye Movement sleep is the period during sleep most important to learning, memory consolidation and social adjustment in adolescents. When falling asleep is delayed but rising time is not, REM sleep will be cut short, which can affect learning and memory."

Ming notes some benefits to early-evening media use, such as facilitating collaboration for school projects, providing resources for tutoring, increasing school readiness and possibly offering emotional support systems.

She suggests that educators recognize the sleep needs of teenagers and incorporate sleep education in their curriculum. "Sleep is not a luxury; it's a biological necessity. Adolescents are not receiving the optimal amount of sleep; they should be getting 8-and-a-half hours a night," says Ming. "Sleep deprivation is a strong argument in favor of later start times for high schools - like 9 a.m."

Read more here

Health consequences of texting in bed

A study indicates that texting in bed can lead to losing sleep in addition to poor school performance in teens.

Many American teens text in bed, leading to lost sleep, daytime drowsiness and poorer school performance, a new study says.

Researchers from New Jersey looked at nearly 3,200 middle and high school students in the state. They found that nearly 62 percent of the kids used their smartphones in some capacity after bedtime; nearly 57 percent texted, tweeted or messaged in bed; and nearly 21 percent awoke to texts.

"Our study confirms that many teenagers are texting late at night when they should be sleeping. This behavior is more common among older teenagers, especially those in high school, and among girls," said study co-author Vincent DeBari. He is director of research at the Seton Hall University School of Health and Medical Sciences, in South Orange.

"One of the most worrisome aspects of our findings is that in addition to affecting the quality and amount of sleep teenagers are getting, bedtime smartphone use seems to be having a negative impact on their level of alertness during the day and on their grades in school," DeBari said in a university news release.

His study co-author, Dr. Peter Polos, added that teens whose sleep is disrupted by incoming texts may feel compelled to respond to those texts immediately. These exchanges can go on for hours.

"This leads to excessive stimulation at night. Light from electronic devices can suppress the secretion of melatonin, a hormone that promotes sleep. All of these factors combine to make sleep difficult in the face of excessive smartphone use at night," said Polos, a member of the sleep medicine division of the JFK Neuroscience Institute in Edison, N.J.

The researchers also found that smartphone use just before or after bedtime may worsen teens' tendency to go to bed much later and sleep until late morning. This behavior has been linked with depression, anxiety and attention-deficit hyperactivity disorder, the study authors said.

"Repeatedly, studies have shown that today's adolescent students are seriously sleep-deprived, and that it affects their health, their mood and their safety behind the wheel. Our study shows that the unrestricted use of smartphones at night may be a major contributing factor," Dr. Sushanth Bhat, an assistant professor of neuroscience at Seton Hall, said in the news release.

"Since getting the proper amount of sleep is very important for brain development and learning in the teenage years, our study should prompt parents and guardians to consider placing reasonable limitations on adolescent smartphone usage at night," Bhat concluded.

The study findings appear in the October issue of the Journal of Adolescence.

Read more here

Teenagers in the US are getting less sleep than ever

A study showed that teenagers in the US are getting less sleep than they ever have.

American teens don't get enough sleep, and the problem has only gotten worse since the 1990s, new research shows.

Just 63 percent of 15-year-olds reported getting seven or more hours of sleep a night in 2012. That number is down from 72 percent in 1991, according to the study.

Regardless of the time period studied, the number of teens reporting seven or more hours of sleep nosedives between the ages of 13 and 18, the study showed. At 13, roughly two-thirds of teens get at least seven hours of sleep a night; by 18 that percentage drops to about one-third.

"After age 16, the majority are not meeting the recommended guidelines," said study author Katherine Keyes, an assistant professor of epidemiology at Columbia University's Mailman School of Public Health in New York City.

Sleep experts have noted that too little sleep boosts the risk of weight gain, poor school performance, depression and other problems.

The study is published online Feb. 16 in Pediatrics.

For the study, researchers from Columbia University looked at sleep data from a national survey of more than 270,000 teens from 1991 to 2012. Each year, teens reported how often they got seven or more hours of sleep, as well as how often they got less sleep than they need.

The most recent recommendation from the National Sleep Foundation says teens aged 14 to 17 need eight to 10 hours a night and people aged 18 to 25 need seven to nine hours.

The largest declines in those getting enough sleep occurred between 1991 through 2000; then the problem plateaued, Keyes said.

The researchers also found gender differences in sleep. "Girls are less likely to get an adequate amount of sleep compared to boys," she said.

Both boys and girls whose parents had less education were not as likely to get enough sleep. Keyes found racial differences, too, with black and Hispanic teens less likely than others to get enough sleep.

One worrisome finding, she said, was that some teens who weren't getting enough sleep often thought their sleep duration was fine.

Keyes did not have access to information about the teens' use of electronic media, a factor often blamed for lack of sleep as teens text, check social media, play video games and work on laptops late into the night. However, that might be a factor, she said.

"On an individual level, excessive use of technology may impair an adolescent's ability to sleep," Keyes said.

The study findings aren't surprising, said Dr. Marcel Deray, a pediatric neurologist and director of the sleep disorders center at Miami Children's Hospital.

Deray said that while this study didn't offer information about whether electronic use is to blame for teens' lack of sleep, an American Academy of Pediatrics report in 2014 cited technology, along with caffeine use and other habits, as contributing factors in teen sleep deprivation. Deray said instructing teens to stop all electronic media use by at least an hour before bed might help.

Another issue? Early school start times can play havoc with teens' sleep, according to Deray.

Like some other experts, Deray said later school start times -- even an hour later -- could help teens get more sleep. Teens naturally go to sleep later, he said, due to their sleep cycles and the release of the hormone melatonin. "When we fall asleep, melatonin goes up. Teens make it later, so they tend to be night owls," Deray said.

Left alone, he said, teens would go to sleep later and get up later. Starting school an hour later, for instance at 8:30 a.m., is an approach favored by the American Academy of Pediatrics and would likely help, he added.

Lack of sleep is linked with many other health problems for teens, he said, including obesity, car accidents, depression and a drop in school performance.

Parents of teens can educate their children about not overscheduling, limiting caffeine before bed and having a bedtime routine, just as they did when they were younger, Keyes said.

Deray said teens can also try to get up by 9 a.m. on the weekend and to expose themselves to sunlight in the morning, helping to make them sleepier earlier at night.

Read more here

Study: Drinking problems later for teens who skip sleep now

A study shows that teens who skip sleep now have more drinking problems later in life.

Sleep-deprived teenagers find it difficult to focus in class, and they're more likely get sick. They are also more likely to develop problems with alcohol later on, according to a study published Friday in the journal Alcoholism: Clinical & Experimental Research.

The study included teens who suffered from conditions like insomnia as well as those who simply weren't getting enough sleep. Teenagers ages 14 through 16 who had trouble falling or staying asleep were 47 percent more likely to binge drink than their well-rested peers.

Sleep problems were linked to even more issues with alcohol later on.

Teens who had trouble sleeping when the researchers first checked in with them were 14 percent more likely to drive drunk and 11 percent more likely to have interpersonal issues related to alcohol a year later. And five years after that — when everyone was college-aged or older — those who had sleep issues in high school were 10 percent more likely to drive drunk.

About 45 percent of adolescents don't get the recommended eight to 10 hours a night, polls show.

The findings are based on data collected from 6,500 adolescents who were part of the larger National Longitudinal Study of Adolescent Health, which began tracking a group of adolescents in the mid-90s.

Researchers have known for a while that lack of sleep and alcohol use are related, says Maria Wong, a psychologist at Idaho State University who led the study. "This study shows that sleep issues can actually precede and even predict alcohol use later on."

And the influence of sleep on drinking behaviors can be dramatic, Wong tells Shots. In the study, each extra hour of sleep the teens got corresponded with a 10 percent decrease in binge drinking.

"We're not saying that sleep is the only risk factor for alcohol use," Wong says. In fact, another study published in the same journal issue found that a combination of genetics and peer influence affect teens' decisions to drink.

But a child's genetic makeup isn't something anyone can change, Wong says, "and beyond a certain extent, we cannot control whom kids spend time with outside the home."

Sleep, however, may be something that teenagers and their parents can control. "If we can make sure they have enough sleep, we can help them make good choices," Wong says.

Of course, that's much easier said than done. Teens don't usually take well to having bedtimes imposed on them. And even if they did, forcing kids to get in bed early won't necessarily help, says Dr. Maida Chen, the director of the Pediatric Sleep Disorders Center at Seattle Children's Hospital. "Because of their biology, simply saying to teens, 'Go to sleep earlier' is not a plausible solution," says Chen, who wasn't involved in the recent research.

The body's natural circadian rhythms tend to shift during adolescence, Chen explains, so teens may find it difficult fall asleep until 11 p.m. or midnight.

That's why many parents and pediatricians have been pushing to delay school start times for middle and high school students. "Teens have to get up at 5 or 6 in the morning in order to get to school by 7 or 8," Chen says, which means that most of them aren't getting nearly enough rest.

Last year the American Academy of Pediatrics issued a policy statement calling on middle and high school to start at 8:30 a.m. or later.

"This new research shows what we have long suspected — there seems to be a link between lack of sleep and risky behaviors in teenagers," Chen says.

The people involved in the recent study were teenagers in the 1990s, Chen points out. "I wouldn't be surprised if the situation was in some ways worse these days," she says, "because nowadays, everyone has some electronic distraction that they carry into bed with them."

Many of the patients Chen sees at Seattle's Children come in because their grades have started to fall or because they're having behavior issues at school, she says.

"This is not just about teens not sleeping enough and then feeling a bit grumpy the next day," Chen says. "Sleep really affects their ability to function and make good decisions."

Read more here

Twin study shows there is a genetic component to insomnia

According to a study on twins, there is a genetic component to insomnia.

A new study of twins suggests that insomnia in childhood and adolescence is partially explained by genetic factors.

Results show that clinically significant insomnia was moderately heritable at all stages of the longitudinal study. Genetic factors contributed to 33 to 38 percent of the insomnia ratings at the first two stages of the study, when participants had an average age of 8 to 10 years. The heritability of insomnia was 14 to 24 percent at the third and fourth follow-up points, when the average age of participants was 14 to 15 years. The remaining source of variance in the insomnia ratings was the non-shared environment, with no influence of shared, family-wide factors. Further analysis found that genetic influences around age 8 contributed to insomnia at all subsequent stages of development, and that new genetic influences came into play around the age of 10 years.

"Insomnia in youth is moderately related to genetic factors, but the specific genetic factors may change with age," said study author Philip Gehrman, PhD, assistant professor in the Department of Psychology at the University of Pennsylvania in Philadelphia. "We were most surprised by the fact that the genetic factors were not stable over time, so the influence of genes depends on the developmental stage of the child."

Study results are published in the January issue of the journal Sleep.

Insomnia involves difficulty initiating or maintaining sleep, or waking up earlier than desired, according to the American Academy of Sleep Medicine. Children with insomnia may resist going to bed on an appropriate schedule or have difficulty sleeping without intervention by a parent or caregiver. An insomnia disorder results in daytime symptoms such as fatigue, irritability or behavioral problems.

According to the authors, the results suggest that genes controlling the sleep-wake system play a role in childhood insomnia. Therefore, molecular genetic studies are needed to identify this genetic mechanism, which could facilitate the development of targeted treatments.

"These results are important because the causes of insomnia may be different in teens and children, so they may need different treatment approaches," said Gehrman.

The study group comprised 1,412 twin pairs who were between the ages of 8 and 18 years: 739 monozygotic pairs, 672 dizygotic pairs and one pair with unknown zygosity. Participants were followed up at three additional time points. Average ages at each of the four waves of the study were 8, 10, 14 and 15 years. Results were interpreted in terms of the progression across time, rather than differences between discrete age groups. Clinical ratings of insomnia symptoms were assessed by trained clinicians using the Child and Adolescent Psychiatric Assessment and rated according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition.

Read more here

Kids with ADHD may be more likely to drink and smoke

A study shows that kids who have ADHD may be more likely to drink and smoke as teenagers.

Teens are more likely to start smoking or drinking with each additional symptom they have of attention-deficit hyperactivity disorder (ADHD) or conduct disorder, new research suggests.

"Our findings underscore the need to counsel families about the risk of substance use as [these] children approach adolescence," said study author Dr. William Brinkman, research director at Cincinnati Pediatric Research Group, which is part of Cincinnati Children's Hospital. "This need is heightened among children with ADHD and/or conduct disorder diagnoses or symptoms."

Brinkman's team analyzed data on more than 2,500 teens, aged 12 to 15, in a national survey conducted with their parents between 2000 and 2004.

First, the researchers identified the teens with an ADHD and/or conduct disorder diagnosis, as well as those with the symptoms of either disorder, regardless of whether there was a diagnosis. Conduct disorder is characterized by aggressive, destructive or deceitful behavior. Children with ADHD tend to be hyperactive, impulsive and/or inattentive.

Then Brinkman's team compared use of tobacco and alcohol among the teens, to look for a link between symptoms of ADHD or conduct disorder and substance use.

Brinkman said that 45 percent of the children in the study had at least one ADHD symptom, and nearly 15 percent had at least one conduct disorder symptom.

For each additional ADHD symptom related to inattention -- but not hyperactivity or impulsivity -- the risk that a teen would use tobacco or alcohol increased by 8 percent to 10 percent. Similarly, each additional conduct disorder symptom was linked to a 31 percent increase in the likelihood of using tobacco, according to the study.

A very small percentage of teens in the study -- about 1.5 percent -- were diagnosed with both ADHD and conduct disorder. These teens were more than three times more likely to use tobacco or alcohol, even after accounting for differences in age, race/ethnicity, sex, household income and having a household member who smoked.

The findings were published recently in the journal Drug and Alcohol Dependence.

Brinkman said more research may provide clues as to why the link exists between these disorders and substance use.

"Because nicotine can improve attention and arousal, some have speculated that the association between inattention symptoms and higher rates of tobacco use suggests a form of self-medication for ADHD," Brinkman said. "Certainly higher rates of risk taking and novelty seeking has been documented among children with a diagnosis of ADHD, as well as those with ADHD symptoms [but too few for a diagnosis]."

Social pressures may be involved as well, suggested Dr. Glen Elliott, chief psychiatrist and medical director of Children's Health Council in Palo Alto, Calif.

"It is important to emphasize that not all teens with ADHD follow this path, just a higher percentage than those without ADHD," Elliott said. "We believe it is a combination of impulsive decision-making and perhaps the social strain that ADHD can place on the individual, who may feel unable to connect with peers in socially acceptable ways and therefore more vulnerable to trying other methods such as doing things peers dare them to do or that they view as 'cool' or 'adult.' "

Elliott said the study provides new insights into the interplay between ADHD and conduct disorder. But it sheds little light on whether treating ADHD, either earlier in childhood or during adolescence, might change the risk of starting to smoke or drink, he said.

"We believe medication can make a difference, but the evidence is not nearly as compelling as we wish it were -- partly because teens often go through a phase of refusing to take medications just when it might do them the most good," Elliott said. "Just as with parents of any teenager, there is no guaranteed way to prevent a son or daughter from experimenting if they are determined to do so."

The best tools parents have, Elliott said, are setting consistent and clear expectations for their children, closely monitoring them, praising them for good choices and administering appropriate, meaningful consequences for poor choices -- while also showing children early on what behavior is acceptable.

"Adolescence is hard," Elliott said. "And having ADHD can make it harder. So parents need to be vigilant, caring, consistent and involved."

Read more here

Most US teens are sleep deprived

A recent study shows that most of the teens in the US are sleep deprived.

More than 90 percent of American high school students are chronically sleep-deprived, putting their health and academic performance in jeopardy, a new report finds.

The study, based on U.S. national data, finds that most teens don't get the minimum 9 to 10 hours of sleep per night that's recommended by standard guidelines.

Teenagers do face a number of challenges as they try to get adequate sleep, experts say.

"I don't believe there's one culprit," said the study's lead author, Charles Basch, a professor of health and education at the Teacher's College at Columbia University in New York City.

"For some children it's too much homework, for some it's health problems like asthma," he explained. "For others it may be anxiety or depression, or the prescription medications they are taking for such conditions. Recreational drugs can be a factor, as can having electronics in the bedroom."

Whatever the reason, government surveys show that poor sleep is an ongoing issue for most teenagers.

"This type of data has only been collected since 2007, so we can't say whether the situation has been getting worse historically," Basch said. "But what we can clearly say is that a very substantial portion of high school students throughout America is not getting enough sleep."

His team noted that teens, especially, need adequate sleep because it's crucial to memory, attention, emotional well-being and overall physical health.

In the study, the researchers tracked findings from four U.S. government surveys conducted in 2007, 2009, 2011 and 2013 as part of the Youth Risk Behavior Surveillance System.

Each year, between roughly 12,000 to 15,000 students in grades 9 through 12 were asked about how many average hours of sleep they got each school night.

Overall, less than 10 percent of teens said they were actually meeting current U.S. Centers for Disease Control and Prevention guidelines for sleep. Only about 7 percent of girls, and around 8 to 9 percent of boys said they got nine to 10 hours of sleep per night.

And, for the most part, sleep patterns for teenagers appeared to get worse with age -- surveys showed that by the time they reached 12th grade, a whopping 95 percent of high school seniors were not routinely meeting CDC sleep guidelines.

Girls tended to fare worse than boys, with girls being more prone to sleep five hours or fewer per night and less likely to get nine or more hours of sleep each night, the study found.

Race also appeared to figure into the equation: black teenagers were significantly more likely to get five or fewer hours of sleep per night than their white peers.

In each survey, 20 percent of black boys and girls were found to have daily sleep routines that included five or fewer hours of sleep. The same was true of 15 percent of Hispanic girls and about 12 percent of Hispanic boys.

According to Basch, early school start times are one major reason behind all those sleepless teens.

"More and more attention is being focused on the start times of schools, with the idea being that very early class schedules do not serve good sleep patterns," he said.

"That is certainly one of the problems," agreed Kelly Baron, an assistant professor of neurology and director of the Behavioral Sleep Medicine Program in the department of neurology with the Feinberg School of Medicine at Northwestern University in Chicago.

She called the data from the new report "alarming."

"While we're still trying to understand why this is happening, one of the reasons is clearly school start times," Baron said. "Having children wake up to start school at 6 or 7 a.m. is really at odds with their biology."

She explained that a person's sleep patterns "naturally change across our lifespan. And one of the most profound changes is that our natural 24-hour rhythm shifts as we enter puberty. Sure -- some of it's social, [and] kids just want to say up late and such. But the need to stay up later and sleep in later is also biological. So early school times set them up for a chronic sleep disadvantage."

So, can parents do anything to encourage more shut-eye for their kids?

"They can and should get involved," Baron said, "setting curfews, establishing sleep schedules, and limiting screen time in the bedroom. A healthy sleep environment at home is key."

The new study is published in the December issue of the CDC journal Preventing Chronic Disease.

Read more here

Concussions impact teen drivers

This article explains how concussions can impact teen drivers.

Researchers at Cincinnati Children's Hospital Medical Center are currently studying teenagers who have suffered concussions in order to help doctors determine when teen drivers are ready to get back behind the wheel of a vehicle.

A driving study is currently taking place that uses assessments of eye tracking within a driving simulator to evaluate potential impairments to reaction times following a concussion.

"This is the only pediatric driving study that I know of that's examining the behavior of concussed patients," said Dr. Adam Kiefer, assistant professor of pediatrics at Cincinnati Children's Sports Medicine. "We are looking for novel ways to assess these teens and to allow them to return to the road safely."

Cincinnati Children's Sports Medicine recently received a grant from the Ohio Department of Transportation to perform the study. Researchers are testing patients between the ages of 16-19 who have suffered a concussion within 7-10 days. They are comparing them to their peers of the same age who are healthy and driving.

They will collect the data over the next several months. The research team with expertise in sports medicine, behavioral medicine and neurology will then analyze the results.

"One of the biggest issues teens and adults face when dealing with concussions is a decreased ability to react quickly to objects in their environment," said Dr. Kiefer. "This can be a major problem, especially during driving, and that's why I think it's important for this type of research to be done."

Read more here

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

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

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

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

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

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

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

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

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

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

Key findings include:

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

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

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

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

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

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

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

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

Read more here

Lack of sleep in teens increases obesity

A study shows that teens who do not get enough sleep have an increased risk of becoming obese.

Teenagers who don't get enough sleep may wake up to worse consequences than nodding off during chemistry class. According to new research, risk of being obese by age 21 was 20 percent higher among 16-year-olds who got less than six hours of sleep a night, compared with their peers who slumbered more than eight hours. (The Centers for Disease Control and Prevention recommends nine to ten hours of sleep for teenagers.)

Researchers at the Mailman School of Public Health at Columbia University and the University of North Carolina Gillings School of Public Health are the first to examine the effect of sleeplessness on obesity in teenagers over time, providing the strongest evidence yet that lack of sleep raises risk for an elevated BMI. Results appear in Journal of Pediatrics.

Shakira F. Suglia, ScD, assistant professor of Epidemiology at the Mailman School, and colleagues analyzed health information from more than 10,000 American teens and young adults, ages 16 and 21, as part of the National Longitudinal Study of Adolescent Health. Information on height and weight and sleep was collected during home visits in 1995 and 2001.

Nearly one-fifth of the 16-year-olds reported getting less than six hours of sleep. This group was 20 percent more likely to be obese by age 21, compared to their peers who got more than eight hours of sleep. While lack of physical activity and time spent watching television contributed to obesity, they did not account for the relationship between sleeplessness and obesity.

"Lack of sleep in your teenage years can stack the deck against you for obesity later in life," says Suglia. "Once you're an obese adult, it is much harder to lose weight and keep it off. And the longer you are obese, the greater your risk for health problems like heart disease, diabetes, and cancer."

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

Daytime sleepiness and fatigue are known to affect what and how people eat, by altering appetite and stimulating cravings. Energy levels may also play a role. For the sleep-deprived, ordering calorie-dense fast food is easier than preparing a nutritious meal. Information on what the teens ate was not captured in the surveys, although it could play a role. Future research may look whether, for example, soda consumption is a factor in sleeplessness and, in turn, obesity. (A 2013 study by Suglia found young children who drink soda are more likely to have behavioral problems.)

Read more here

Pediatricians urge later school start time

This article explains why pediatricians are urging for later school start times for older kids in middle and high schools.

U.S. high schools and middle schools should start classes later in the morning to allow kids some much-needed sleep, a leading group of pediatricians is urging.

Ideally, the American Academy of Pediatrics says, the first bell should ring at 8:30 a.m. or later -- which is the case at only 15 percent of U.S. high schools right now.

At the very least, classes should start no earlier than 8 a.m., said Dr. Judith Owens, the lead author of a new academy policy statement on school start times.

The recommendations, published in the academy's journal Pediatrics, are based on research showing that U.S. kids are sleep-deprived, which has consequences for their health, school performance and safety.

"This is an important issue," said Dr. Marcel Deray, a Florida sleep specialist who wasn't involved in the recommendations.

"I see a lot of teenagers who are tired and have problems in school because they have to get up so early," said Deray, who directs the Sleep Disorders Center at Miami Children's Hospital. "Some kids are getting up at 5 a.m., 6 a.m."

Many people think the answer is for kids to just get to bed earlier, Owens noted. But it's not that easy, she said, because biology has other plans.

Around puberty, the body's natural sleep-wake cycle shifts, and it's actually hard for teenagers to fall asleep earlier than 11 p.m.

"Teenagers' bodies release melatonin later than (adults') do," Deray explained, referring to a hormone the brain secretes in the evening to induce drowsiness.

"The other issue," Owens said, "is that teenagers' sleep needs are greater than many people think. They need nine to nine-and-a-half hours."

Yet, 43 percent of U.S. public high schools start classes before 8 a.m., according to the U.S. Department of Education. Middle schools, meanwhile, typically start classes at 8 a.m. -- with about 20 percent starting earlier than that.

"And that's the first bell," Owens said. "That's not even counting the commute time."

So in areas where kids take the school bus, the actual school day could begin before sunrise.

According to Owens, U.S. high schools started bumping up start times back in the 1950s and '60s, mainly to space out bus runs. Many school districts start high schools and middle schools first, then circle buses back to pick up elementary school kids.

One option would be to flip elementary and high school start times, but parents often oppose that -- since young children could be standing at bus stops in the early-morning dark, or have no one at home after school. Another option -- running more buses -- would be expensive.

Transportation is not the only obstacle, according to the National Sleep Foundation, which supports pushing back school start times. Some other arguments are that sports and extracurricular activities would end too late; teenagers would have no time for after-school jobs; and a later start could conflict with working parents' schedules.

Owens acknowledged the logistical challenges, and said parents and school staff sometimes oppose later start times. As an example, she said the Fairfax County, Va., school district has been debating the issue for years. Four options, including one with a 9:15 a.m. high school start, will be put to a vote this fall.

Some districts have found "creative solutions" to certain obstacles -- like having high school students switch from school buses to public ones, according to the academy.

Deray thinks tackling the practical challenges is worthwhile. He said studies have linked kids' sleep deprivation not only to poorer school performance, but also to higher rates of car accidents, obesity and depression.

In a recent study of eight U.S. high schools that delayed their start times, researchers found improvements in kids' grades, attendance and car crash rates.

Later school starts are just one way to help sleepy kids, however. Deray offered parents some tips.

"All electronic devices should be turned off an hour or two before bed," he said. "The blue light from them suppresses melatonin production."

He also advised avoiding physical and mental stimulation close to bedtime -- which means exercise and homework should be done earlier in the evening. And while teenagers love to sleep till noon on weekends, that will only further disturb their sleep/wake cycle. Deray said kids should get up by 9 a.m. on weekends and get plenty of morning sunlight.

He acknowledged, though, that all of that is easier said than done.

Owens agreed. "One of the issues is that kids are overscheduled," she said. "Don't give them so many things to do that they can't get to bed before midnight."

Read more here

How teens experience concussions

This article explains how teens experience concussions, and the relationship between physical and emotional symptoms that results from them.

With multiple concussions between the two of them, Dan Han and Lisa Koehl's latest research interest isn't surprising.

"I played competitive soccer through high school and continue to play recreationally," says Koehl, a doctoral candidate in the University of Kentucky's Department of Psychology, "so I have firsthand experience with the dynamics that come into play when a teen suffers a concussion."

As a former high school assistant principal in the Chicago public school system, Han was responsible for overseeing student-athletes' return to school after a concussion. Han left educational administration to pursue his doctorate in neuropsychology. Now director of the Multidisciplinary Concussion Program at the UK HealthCare, Han has a reputation for top-notch clinical work and research on concussion.

"There aren't many places in Kentucky where you find a true multidisciplinary concussion program," Han says. "UK HealthCare's Multidisciplinary Concussion Program embraces an interdepartmental group effort -- from Neurology, from Neurosurgery, Sports Medicine, Physical Medicine and Rehabilitation, from the Trauma team -- we all work together to look at how brain injury affects the cognitive, physical and emotional state of our patients."

This group effort puts the athlete's safety first. For that reason, UK HealthCare's concussion program is the go-to for the athletics programs at Fayette County Public Schools, the University of Kentucky, Eastern Kentucky University, and Kentucky State University, who all rely on the UK Multidisciplinary Concussion Program's clinical expertise in sports concussion for state-of-the-art input to help make decisions affecting an athlete's return to play.

Add to Han's clinical skills a lifelong love of full contact martial arts (Han practices kickboxing and Brazilian jujitsu), and it's easy to see how Han and Koehl are well-suited to study the symptoms of sports concussions.

Drawing from a large UK database of patients with brain injury, Koehl and Han used a subset of 37 athletes aged 12 to 17 to explore post-concussion changes in physical, emotional, and cognitive symptoms over time.

According to Koehl, 22 of the 37 study participants demonstrated post-concussive emotional symptoms. Of those, 23 percent were sensitive to light while 14 percent were sensitive to noise. In comparison, of the 15 teens without emotional symptoms, 13 percent were sensitive to light and no teens were sensitive to noise.

There were no differences between the two groups in factors such as what percentage experienced loss of consciousness, amnesia, nausea and/or headaches, indicating that the groups were likely comparable in the level of severity of concussion.

"We discovered a bidirectional relationship between both emotional symptoms developing in conjunction with physical symptoms, and also emotional symptoms developing because of the physical symptoms," said Koehl.

In other words, said Koehl, "This research gives us a better understanding of the interaction between physical and emotional symptoms in concussion and will allow us to explore ways to help adolescents recover in a more timely fashion."

According to Han, teens in the study who reported anxiety were 55 percent more likely to experience attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability.

"While these findings are preliminary and require a larger sample size to predict outcomes with more confidence, we are intrigued by the potential these data offer in terms of providing teens with a better treatment plan based on their unique cognitive, physical and emotional response to concussion," Han said.

"Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school during recovery."

Read more here

Teenagers with emotional problems after concussion

This article discusses which symptoms after a concussion, such as sensitivity to light or noise, that may indicate a teen is more likely to have emotional problems.

After a concussion, teens who are sensitive to light or noise may be more likely to also have emotional symptoms such as anxiety, according to a study released today that will be presented at The Sports Concussion Conference in Chicago, July 11 to 13, 2014, hosted by the American Academy of Neurology.

The symptoms after a concussion can vary widely from person to person. Symptoms can include physical, emotional and cognitive difficulties.

"While most people recover from a concussion within a week, a number of factors affect people's recovery, and studies have shown that teenage athletes may take up to seven to 10 days longer to recover than older athletes," said study author Lisa M. Koehl, MS, and Dong (Dan) Y. Han, PsyD, of the University of Kentucky in Lexington.

The study involved 37 athletes age 12 to 17 who had persisting symptoms for an average of 37 days following a concussion. Participants were excluded if they had a previous history of psychological issues. One group of 22 teens had emotional symptoms such as irritability, aggression, anxiety, depression, apathy, frequent mood changes or excessive emotional reactions after the concussion. The second group of 15 teens did not have emotional symptoms. There were no differences between the two groups in factors such as what percentage experienced loss of consciousness or amnesia, indicating that the groups were likely comparable in the level of severity of concussion.

The study found that of the 22 teens who had emotional symptoms, five teens (23 percent) were sensitive to light while three teens (14 percent) were sensitive to noise. In comparison, of the 15 teens without emotional symptoms only two teens (13 percent) were sensitive to light and no teens were sensitive to noise.

The number of concussions experienced and whether teens also had headaches or nausea were not related to whether they also had emotional symptoms. Researchers also found that having a family history of psychiatric problems did not make teens any more or less likely to have emotional symptoms after a concussion.

Teens who had anxiety were 55 percent more likely to self-report attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability. The authors noted that the findings are preliminary with small samples and stressed the importance of replicating this study with a larger sample size.

"Identifying factors such as these that may exacerbate issues teens experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school for these athletes," Koehl and Han said.

The study was supported by the American College of Sports Medicine Research Foundation.

Read more here

Not getting enough sleep adds to health problems in teens

A study shows that teenagers increase their risk of developing health issues due to  getting too little sleep (6 hours or less). Electronics in the bedroom are blamed for getting too little sleep.

Many teens from lower- and middle-income homes get too little sleep, potentially adding to the problems of kids already at risk for health issues, new research finds.

The study of 250 high school students found they slept an average of six hours a night, far less than the recommended amount -- about nine hours.

Kids who skimp on sleep are more likely to report feeling hopeless, as well as smoke, drink alcohol and use marijuana, according to background information in the report, published online April 21 in Pediatrics.

"Many teenagers, especially blacks, do not get enough sleep, which may contribute to their risk for poor health," said lead researcher Karen Matthews, a professor of psychiatry at the University of Pittsburgh School of Medicine.

"Inadequate sleep can result in academic underachievement, health-damaging behaviors and negative mood," she said.

Matthews said sleep deprivation isn't confined to the poor. "Many kids who come from upper class families also do not get enough sleep, but our study focused on poorer children because of a lack of data available in those [upper class] students," she said.

The researchers wondered if the challenges of living in disadvantaged circumstances would affect sleep patterns. In their sample, 60 percent of the kids lived in single-family homes. Overall, the kids were heavier than national average, the researchers said.

Matthews isn't sure why these teens aren't sleeping enough. "However, factors that determine bedtime play a key role for sleep duration because of mandatory school start times," she said.

"Bedtimes can be quite late if students are using electronic devices late into the evening, and bright light exposure [from these devices] can keep them up," she said.

Late-night studying was not a factor in this sample, Matthews said.

Dr. Metee Comkornruecha, an adolescent medicine specialist at Miami Children's Hospital, said the study shows "what a lot of us are thinking -- that adolescents aren't getting enough sleep."

Kids are prone to a lot of distractions, he said. "Cell phones are used not only for texting but to look on the Internet and for various types of social media. That frequent stimulation can keep these kids up."

Comkornruecha recommended removing electronic distractions from the bedroom. "Take the phones, computer and TVs away from the bedroom. If they're there, kids are going to use them. But if the bedroom is a safe haven for sleeping, then that's what it is going to be used for," he said.

Among the students whose sleep patterns were monitored, 57 percent were black and 54 percent were girls. All came from low- to middle-class families.

Matthews said besides looking at kids from poorer families, they wanted to look at any differences by race because two studies of middle-aged adults suggested that blacks had worse sleep than whites. "Thus, we conducted our study at an integrated high school that had black and white students of similar economic backgrounds," Matthews added.

The researchers had the students complete questionnaires and keep a diary of the length and quality of their sleep. At night, the teens were hooked up to an electronic device that monitored their sleep.

On school nights, the teens slept about six hours, and on the weekend, about seven hours. Matthews' team found that blacks and males slept less than other kids, and their sleep was more fragmented. Girls reported poorer quality of sleep and said they were often tired during the day.

The researchers previously reported that insufficient sleep is linked to higher blood pressure and insulin resistance, a risk factor for diabetes.

Read more here