Attention Problems May Be Sleep-Related

 

By KATE MURPHY

| April 16, 2012, 6:15 pm 34

 

Diagnoses of attention hyperactivity disorder among children have increased dramatically in recent years, rising 22 percent from 2003 to 2007, according to the Centers for Disease Control and Prevention. But many experts believe that this may not be the epidemic it appears to be.

Many children are given a diagnosis of A.D.H.D., researchers say, when in fact they have another problem: a sleep disorder, like sleep apnea. The confusion may account for a significant number of A.D.H.D. cases in children, and the drugs used to treat them may only be exacerbating the problem.

“No one is saying A.D.H.D. does not exist, but there’s a strong feeling now that we need to rule out sleep issues first,” said Dr. Merrill Wise, a pediatric neurologist and sleep medicine specialist at the Methodist Healthcare Sleep Disorders Center in Memphis.

The symptoms of sleep deprivation in children resemble those of A.D.H.D. While adults experience sleep deprivation as drowsiness and sluggishness, sleepless children often become wired, moody and obstinate; they may have trouble focusing, sitting still and getting along with peers.

The latest study suggesting a link between inadequate sleep and A.D.H.D. symptoms appeared last month in the journal Pediatrics. Researchers followed 11,000 British children for six years, starting when they were 6 months old. The children whose sleep was affected by breathing problems like snoring, mouth breathing or apnea were 40 percent to 100 percent more likely than normal breathers to develop behavioral problems resembling A.D.H.D.

Children at highest risk of developing A.D.H.D.-like behaviors had sleep-disordered breathing that persisted throughout the study but was most severe at age 2 1/2.

“Lack of sleep is an insult to a child’s developing body and mind that can have a huge impact,” said Karen Bonuck, the study’s lead author and a professor of family and social medicine at Albert Einstein College of Medicine in New York. “It’s incredible that we don’t screen for sleep problems the way we screen for vision and hearing problems.”

Her research builds on earlier, smaller studies showing that children with nighttime breathing problems did better with cognitive and attention-directed tasks and had fewer behavioral issues after their adenoids and tonsils were removed. The children were significantly less likely than untreated children with sleep-disordered breathing to be given an A.D.H.D. diagnosis in the ensuing months and years.

Most important, perhaps, those already found to have A.D.H.D. before surgery subsequently behaved so much better in many cases that they no longer fit the criteria. The National Institutes of Health has begun a study, called the Childhood Adenotonsillectomy Study, to understand the effect of surgically removing adenoids and tonsils on the health and behavior of 400 children. Results are expected this year.

“We’re getting closer and closer to a causal claim” between breathing problems during sleep and A.D.H.D. symptoms in children, said Dr. Ronald Chervin, a neurologist and director of University of Michigan Sleep Disorders Center in Ann Arbor.

In his view, behavioral problems linked to nighttime breathing difficulties are more likely a result of inadequate sleep than possible oxygen deprivation. “We see the same types of behavioral symptoms in children with other kinds of sleep disruptions,” he said.

Indeed, sleep experts note that children who lose as little as half an hour of needed sleep per night — whether because of a sleep disorder or just staying up too late texting or playing video games — can exhibit behaviors typical of A.D.H.D.

Not only is a misdiagnosis stigmatizing, but treatment of A.D.H.D. can exacerbate sleeplessness, the real problem. The drugs used to treat A.D.H.D., like Ritalin, Adderall or Concerta, can cause insomnia.

“It can become a vicious, compounding cycle,” said Dr. David Gozal, chairman of the department of pediatrics at the University of Chicago Pritzker School of Medicine, whose clinical practice focuses on children with sleep disorders.

Sleep deprivation is difficult to spot in children. Of the 10,000 members of the American Academy of Sleep Medicine, only 500 have specialty training in pediatric sleep issues. And pediatricians may not even know to make a referral, because they often depend on parents to bring up their children’s sleep problems during checkups.

But parents themselves often are uninformed about healthy sleep habits. A study conducted last year by researchers at Penn State University-Harrisburg and published in The Journal of Sleep Research showed that of 170 participating parents, fewer than 10 percent could correctly answer basic questions like the number of hours of sleep a child needs.

“Parents didn’t know what was normal sleep behavior,” said Kimberly Anne Schreck, a psychologist and behavioral analyst at Penn State who was the study’s lead author. “Many thought snoring was cute and meant their child was sleeping deeply and soundly.”

 

 

KIDZ THERAPY SUMMER PROGRAM JULY 9 TO AUGST 17 2012

(Click Below)

http://www.kidztherapy.com/webfiles/PRI-201232344927.pdf

Dear Parents, Professionals, and Friends of Early Intervention:

 

Click Here for ONE-STEP to STOP the Insurance Industry Take-Over of Early Intervention!

 Governor Cuomo has proposed changes for Early Intervention which will greatly impede our ability to provide services, drastically limit parental-choice, and dramatically drive up the administrative costs of Early intervention. 

 In short, the Governor proposes turning over much of the Early Intervention Program to insurance companies, who would: 

(1) be in charge of setting rates,

(2) impact service utilization, and

(3) limit a parent’s ability to be served by the provider or evaluator of their choice.

 

The Governor’s proposal originates from the desire of local Counties to be relieved of their role and responsibility in providing quality and accessible E.I. programs. There is also talk of allowing new co-pays to be levied and insurance policy deductibles to be met.  Additionally, if a particular provider is not on the panel of a child’s insurance company, that provider would not be allowed to evaluate or deliver therapy for that child, in spite of being a licensed professional with credentials and experience providing E.I. services! 

 

These proposals will destroy the very fabric of the necessary and successful Early Intervention Program that has been built in New York State. We URGE you to voice your opposition to this insurance scheme IMMEDIATELY while the Legislature is still in a position to reject it in the State budget.  The Early Intervention Program’s children and their families need your help and support….

 

Click Here for ONE-STEP to STOP the Insurance Industry Take-Over of Early Intervention!

 

Blinking May Yield Clues About Autism (WebMD)

Blinking May Yield Clues About Autism

Autistic Children Blink Differently Than Children Without the Condition

By Denise Mann
WebMD Health News

Reviewed by Laura J. Martin, MD

  

Dec. 12, 2011 — When and why children blink may provide researchers some important clues about how children with autism process and take in information.

Although it may not feel like it, blinking interrupts what we are watching. If a story or scene is engrossing, we can keep our eyes peeled. This is called blink inhibition. There are key differences between toddlers with and without autism spectrum disorder and when they blink their eyes.

The new finding appears in the Proceedings of the National Academy of Sciences.

The CDC states that one in 110 children in the U.S. has an autism spectrum disorder. This is a range of developmental disorders that affect the ability to communicate and relate to others.

In the new study, 2-year-olds with or without autism watched a video of a boy and girl playing. The video included physical movements as well as children interacting with each other. For the typical children, the rate of blinking decreased more when watching the emotional part than during physical movements. This pattern was reversed among children with autism.

Blinking Patterns Shed Light on Autism

“When we blink and when we don’t can actually index how engaged people are with what we’re looking at, and how important they perceive that thing to be,” says Warren Jones, PhD. He is the director of research at the Marcus Autism Center at Emory University School of Medicine in Atlanta. 

Children without autism seem to be able to anticipate what is coming next based on facial expressions and wordplay. This is not the case among children with autism. “Without understanding the social context in which actions happen, children with autism may often be reacting, after the fact, to physical events that have already happened,” Jones says in an email.

The findings give “researchers a new tool for trying to understand how children with autism look at, engage with, and learn from what they see,” he says. “This might give us more information about cues that are distracting to children with autism, and it might also give us information about cues that are naturally engaging to [these] children.”

Study Findings May Help Diagnose, Treat Autism

Autism experts are excited about the implications of the study.

“This is a very well-done study that demonstrates the unique patterns of social attention in autism,” says Thomas Frazier II, PhD. He is the director of research at the Cleveland Clinic Children’s Hospital Center for Autism.

“In fact, if replicated, this information may become useful for developing earlier and more objective diagnostic tools,” he says in an email.

Geraldine Dawson, PhD, is the chief science officer for Autism Speaks, an autism advocacy and science group. She says the findings may help researchers develop effective therapies. “This is the first study to my knowledge that has used blinking to assess how engaged a child is with what he or she is viewing,” she says. 

“These results suggest that therapy should focus on helping the child to become more emotionally engaged with the social world and to learn that people are important and rewarding,” Dawson says in an email. “The hope is that, as a result of therapy, the young child with autism will show higher levels of attention.”

What’s more, blinking rate could provide a way to measure social engagement, she says. This “could be used in clinical trials that are testing treatments that aim to increase the child’s interest and engagement with the social world.”