More Kids Visiting ERs for Suicidal Thoughts, Self-Harm

A new report published by the US Centers for Disease Control and Prevention (CDC) warns there’s been a significant increase in the number of emergency room visits for suicidal thoughts or self-harm by children ages 10 to 19.

According to the report published January 31, 2020 in the CDC’s Morbidity and Mortality Weekly Report, there were more than two million emergency room visits between January 2017 and December 2018 involving suicidal thoughts, self-harm or both, out of a total 163 million emergency room visits. The numbers rose in an increase of 25.5 percent from 2017 to 2018.

But the highest increase in the number of emergency room visits for suicidal thoughts or self-harm was among children: specifically girls ages 10 to 19 who showed an increase of nearly 34 percent, and boys ages 10 to 19 who showed an increase of 62 percent.

There was also a significant seasonal pattern to the visits of the children, said Marissa Zwald, PhD, lead researcher, employed at the CDC: there were far fewer visits to the emergency room in the summer months.

The highest increase in the number of emergency room visits for suicidal thoughts or self harm was among children.

Sleep Hygiene Matters for ADHD Kids

Researchers have found a link between ADHD and the “CLOCK” gene which helps to regulate the circadian rhythm, which tells the body when to sleep, wake up and eat.

Good sleep hygiene is essential for daily functioning, especially for children who must be wide awake and fresh to start their studies every day at school.

It’s important therefore to know that researchers have found a link between ADHD and the so-called “CLOCK” gene, which helps to regulate the circadian rhythm, which tells the body when to sleep, wake up and eat.

Children with ADHD tend to have more disturbances in their circadian rhythm, and they have more difficulty falling asleep at the bedtime, according to a 2005 study published in The Journal of Biological and Medical Rhythm Research.

Lead researcher Kristiaan B. Van der Heijden of the Department of Child and Adolescent Psychiatry at University of Amsterdam in The Netherlands, and a team of three other researchers, found that children with ADHD who had chronic difficulty getting to sleep, had a delayed sleep phase and delay in the body’s production of melatonin, as compared to ADHD children without sleep-onset insomnia.

But there are other reasons that children with ADHD have trouble getting to sleep that involve the circadian rhythm that involve the environment.

Sunlight – as opposed to a darkened room – negatively affects the body’s production of melatonin. So does exposure to artificial light – particularly blue light, such as that produced from electronic devices like computers, cell phones, video games, laptops and tablets.

When children use electronics just before bedtime, they’re much less likely to feel tired, let alone sleepy.

In a 2017 study published by the Journal of European Child & Adolescent Psychiatry, lead researcher Harriet Hiscock of the Department of Family Medicine at McGill University in Montreal, Canada together with four researchers from Australia found, “More consistent parenting was associated with decreased bedtime resistance and decreased sleep anxiety… poorer sleep hygiene was associated with increased bedtime resistance, increased daytime sleepiness and increased sleep duration problems. In conclusion, sleep hygiene and parenting are important modifiable factors independently associated with sleep problems in children with ADHD.”

According to the study, 36 percent of children with ADHD were using electronics right before lights were turned off. Not only does this stop melatonin production, but it also provides excess stimulation to the central nervous system, making it that much harder for the child to wind down.

So, best bets:

  • One hour before bedtime, train the child to put away electronics, dim the lights and bring out a book (hard copy, not a Kindle edition).
  • Bedtime should be consistent. Develop a daily routine, which helps the body get into the “rhythm” the child needs to wind down to sleep. This means weekends too!
  • Avoid stress in the bedroom. Good sleep hygiene means a calm, positive bedroom environment. Your child’s bedroom (and yours!) should be seen as a refuge, rest and relaxation place. This will make “winding down” that much easier.
  • Ensure there are fresh-smelling, clean linens. Probably an unnecessary reminder, but children can create havoc in the bedroom so a quick note about laundry – check your child’s bed sheets for odor. If the bed smells fresh, your child is much more likely to hop in and snuggle under.

Sweet dreams!
Continue reading “Sleep Hygiene Matters for ADHD Kids”

New form of depression identified, doesn’t respond to current medications

“These mice showed a new type of depression,” Saito said. “Monoamines appeared not to be involved in this depressive behavior. MCHR1 was.”

Researchers at Hiroshima University (HU) in Japan have identified a new form of depression they believe explains why some many patients are unresponsive to current medications.

The findings of the study, published in May 2018 in the journal Neuroscience, shed light on how a certain protein — RGS8 — plays a role in the condition.

Depression, which can be lethal, affects more than 300 million people around the world and is 2.7 times more prevalent among adults with Attention-Deficit Hyperactivity Disorder (ADHD).

According to a 1995 study published in the American Journal of Psychiatry (Biederman, Wilens, Mick, et al, Am J of Psychiatry 152:11, p. 1654, November 1995) major depression and anxiety disorders have been found in more than 30 percent of clinical and epidemiological samples of children, teens and adults with Attention-Deficit Hyperactivity Disorder (ADHD).

There are many reasons for the high rates of depression in the ADHD population, but the fact remains that treating the condition is still a serious challenge for many psychopharmacologists, particularly when faced with the need to create “cocktails” — combinations of medications — and particularly when the depression doesn’t respond to the standard medications.

According to the monoamine hypothesis theory, people who struggle with depression lack two chemicals (neurotransmitters) in the brain: serotonin and norepinephrin (NE). Currently some 90 percent of all anti-depressant medications that are produced are produced based on this concept. However, some 30 percent of people in treatment, however, are non-responders to these medications.

“Obviously, we need a new drug!” said Yumiko Saito and Yuki Kobayashi, neuroscientists at HU’s Graduate School of Integrated Arts and Scientists. “We need another explanation for what could cause depression.”

In their study, Saito’s team studied depression in mice at the behavioral level, and at the immunohistological level.  First the mice were taken through a swim test, with researchers measuring the time each mouse was active and subtracting that from the total test time. The amount of immobility time was used to determine depressive behavior in the mice on the swim test.

At the immunohistological level, Saito and her team built upon previous work in which the team had discovered that the RGS8 protein controls a hormone receptor called MCHR1.

The researchers discovered that the MCHR1 hormone receptor, when active, helps regulate sleep, feeding and mood responses. And the RGS8 protein shuts off the MCHR1 hormone receptor in cultured cells.

Mice with more RGS8 in their nervous systems were recorded with shorter immobility times than those with a normal amount of RGS8.  Immobility times did not change in mice who received medication that blocked MCHR1, and when given antidepressant medication that acts on monoamines, the RGS8 mice recorded even shorter immobility times.

The team concluded that the mice were exhibiting a form of depression, one that was treatable with current medication regimens.

“These mice showed a new type of depression,” Saito said. “Monoamines appeared not to be involved in this depressive behavior. MCHR1 was.”

The researchers later examined the brains of the mice under the microscope and found the RGS8 mice had longer cilia (antennae-like organelles involved in cellular communication) sprouting from cells in a region of the hippocampus called the CA1, where RGS8 concentration was highest.

The RGS8 mice who received medication that blocked MCHR1 from working had longer cilia — and less depressed behavior.

Saito’s group concluded that RGS8 appears to be a promising candidate towards the development of new antidepressant medications and a focus for future research.

“The present study may support the possible modulation of RGS8 function in mood disorders,” they wrote in their findings.

Excessive acetaminophen use during pregnancy linked to ADHD, Autism

A new study published April 24, 2018 in the American Journal of Epidemiology by a team of researchers at the Hebrew University of Jerusalem (HUJ) has found excessive use of acetaminophen during pregnancy increases the risk for development of attention-deficit hyperactivity disorder (ADHD) and/or autistic spectrum disorder (ASD) in offspring.

Acetaminophen, commonly used for treatment of pain and fever, is considered relatively safe and is the most commonly used analgesic and antipyretic used in pregnancy. It is marketed in the United States as Tylenol, and in Israel as Acamol (paracetamol) and Dexamol.

However researchers said, “evidence of neuro-disruptive properties is accumulating” and therefore, they sought to evaluate the risk for ADHD and ASD in the offspring of women exposed to acetaminophen during pregnancy.

The research team, led by Dr. Ilan Matok of the Institute for Drug Research in the School of Pharmacy at HUJ’s Faculty of Medicine and doctoral student Reem Masarwa, conducted a meta-analysis of data covering 132,738 mother and child pairs, with a follow-up period of three to 11 years. Dr. Amichai Perlman and Dr. Hagai Levine of Hebrew University of Jerusalem and Hadassah Medical Center took part in the research as well.

The analysis shows that prolonged exposure to acetaminophen during pregnancy is associated with a 30 percent increase in relative risk for ADHD (compared to those who did not take the medication during pregnancy) and a 20 percent increase in relative risk for ASD. This is the first study of its kind on the subject.

However, researchers warn that the findings should be interpreted with some caution: pain and fever during pregnancy are also damaging to a developing fetus, and infrequent use of acetaminophen is still considered safe under a doctor’s care. If the symptoms persist, the pregnant woman obviously should consult her physician.

“Our findings suggest an association between prolonged acetaminophen use and an increase in the risk of autism and ADHD,” said Dr. Matok. “However, the observed increase in risk was small, and the existing studies have significant limitations.

“While unnecessary use of any medication should be avoided in pregnancy, we believe our findings should not alter current practice and women should not avoid use of short-term acetaminophen when clinically needed.”        (Photo credit: Pixabay / StockSnap)
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Reem Masarwa et al, Prenatal Exposure to Acetaminophen and Risk for Attention Deficit Hyperactivity Disorder and Autistic Spectrum Disorder: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis of Cohort Studies, American Journal of Epidemiology (2018). DOI: 10.1093/aje/kwy086

ADHD Linked to Suicidality in Young Adults Who Ruminate When Stressed

“These findings shed light on one explanation of the elevated levels of suicide ideation seen in emerging adults with elevated ADHD symptoms: heightened levels of stressful events and a tendency to respond to stress by ruminating.”

Researchers in the United States have discovered that the connection between Attention-Deficit Hyperactivity Disorder and suicidal ideation is due to stress, “and this effect was strongest at high levels of stress-reactive rumination.”

Moreover, the conclusions did not change after controlling for depressive symptoms, according to principal investigator of the study, Dr. Carlos Y. Yeguez of the Department of Psychology at Florida International University in Miami.

Entitled “Stress Accounts for the Association Between ADHD Symptoms and Suicide Ideation When Stress-Reactive Rumination is High,” the study was published by the team online March 31, 2018 and then in print on pp 1-7 in the journal, Cognitive Therapy and Research.

Yeguez examined a sample of 432 “emerging adults,” most of whom were Hispanic females (approximately 70 percent), with a mean age of 19.73 years old. Yeguez, co-researcher Dr. Ryan M. Hill of the Department of Pediatrics at Baylor College of Medicine in Houston, TX, Florida International University team members Victor Buitron and Jeremy W. Pettit analyzed demographic and clinical information collected via self-reported rating scales, including ADHD symptom, stress, stress-reactive rumination and depressive symptoms.

The researchers found that ADHD symptoms were significantly and positively associated with stress, stress-reactive rumination and suicide ideation.

“As hypothesized, the association between ADHD symptoms and suicide ideation was accounted for by stress, and this effect was strongest at high levels of stress-reactive rumination. Conclusions did not change after controlling for depressive symptoms,” the researchers wrote.

“These findings shed light on one explanation of the elevated levels of suicide ideation seen in emerging adults with elevated ADHD symptoms: heightened levels of stressful events and a tendency to respond to stress by ruminating,” they added.

Photo: Pixabay / RebCenter-Moscow

Executive function deficits in childhood linked to increased aggression in teens

The findings suggest that helping children increase their executive function – self-regulation, planning and mental control – could reduce their aggression.

March 20, 2018 – A new study has found that children who have problems controlling their behavior are at higher risk for aggression in adolescence.  The findings suggest that helping children increase their executive function skills – self-regulation, planning and mental control – could reduce their aggression.

Researchers at the University of Potsdam in Germany have discovered that young boys and girls who had deficits in executive function were more likely to show increased reactive aggression in their teen years, but not proactive aggression.

Executive skills are the neurologically-based skills involving mental control, planning and self-regulation.

The study, entitled, Longitudinal Links between Executive Function, Anger, and Aggression in Middle Childhood, was published in the Feb. 27, 2018 issue of the open-access journal, Frontiers in Behavioral Neuroscience.

The findings also indicate that children with reduced executive function had a tendency to get angry easily, which researchers said might partly explain their increased aggression in adolescence.

The research team studied German elementary school-age children ages 6 to 11 at three points in time: at the start of the study, one year later and around three years later.

Children were asked to complete behavioral tasks that showed different aspects of their executive functioning levels, such as memory, ability to plan and self-restraint.

The children’s teachers were asked to record the children’s tendency towards different types of aggression.

In addition to physical aggression, the researchers measured relational aggression (a child socially excluding another, or threatening to end a friendship), reactive aggression (a child’s aggressive reaction to a provocation) and proactive aggression (a child’s aggression in “cold blood” without having first been provoked).

The children’s parents were also asked to complete a questionnaire detailing the ease with which their child tended to get angry.

“We found that deficits in executive function affected later physical and relational aggression,” said Helena Rohlf, the lead author on the study. “The more deficits children showed at the start of the study, the higher their aggression one and three years later.”

However, increased risk of proactive aggression over time was not linked to deficits in executive function.

“This ties in with the idea of proactive aggression as “cold-blooded,” planned aggression,” said Rohlf. “Executive function allows children to behave in a planned and deliberate fashion, which is characteristic of proactive aggression.”

Although aggressive behavior was more common among boys, the researchers found the links between executive function, anger and aggression appeared to be similar for both sexes.

The results suggest that training programs that help children to increase their executive function, and manage their anger, could reduce their aggression. The researchers plan to conduct further work to see if their results also apply to children with serious levels of aggression.

For citations:

Helena L. Rohlf, Anna K. Holl, Fabian Kirsch, Barbara Krahé, Birgit Elsner. Longitudinal Links between Executive Function, Anger, and Aggression in Middle Childhood. Frontiers in Behavioral Neuroscience, 2018; 12 DOI: 10.3389/fnbeh.2018.00027

Photo: Pixabay / Anna Kovalchuk

FDA approves blood test for concussions

This could be the answer for ADHD families who need to know if that “bump” left a mild traumatic brain injury.

Anyone who has parented a child with Attention-Deficit / Hyperactivity Disorder knows the chances of bringing their youngster to adulthood unscathed and concussion-free are about 50-50. Adults with ADHD often wonder later in life whether their “hard knocks” in childhood had anything to do with some of their current difficulties, but rarely have any way to find out.

But a new test just approved by the U.S. Food and Drug Administration could be the answer that ADHD families have been waiting for, at least in determining whether that “bump on the head” resulted in mild TBI.

The FDA has approved the first blood test to evaluate mild TBI (mTBI) or “concussion” in adults.

A “mild traumatic brain injury” can be classified as such if loss of consciousness and/or confusion and disorientation is shorter than 30 minutes, according to Traumatic Brain Injury.com.   Mild traumatic brain injury (mTBI) can be difficult to diagnose and particularly frustrating to diagnose and deal with on a day-to-day basis.

 

The new test, called the Banyan Brain Trauma Indicator, works by measuring levels of two proteins UCH-L1 (ubiquitin C-terminal hydrolase L1) and GFAP (glial fibrillary acidic protein) that are released from the brain following a head injury and which appear in the blood within hours.

TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the brain’s normal functioning.  Its severity may range from mild to severe, with 75 percent of TBIs that occur each year being assessed as mTBIs (mild traumatic brain injuries) or concussions.

The problem is, a majority of patients — 90 percent — who come to the emergency room with concussion symptoms have a negative CT scan, according to Banyan Biomarkers, Inc., the developer of the Brain Trauma Indicator.

Potential effects of TBI can include impaired thinking or memory, movement, sensation or emotional functioning.

Most patients with a suspected head injury are examined using a neurological scale, called the 15-point Glasgow Coma Scale, followed by a CT scan (computed tomography) of the head to detect brain tissue damage or intracranial lesions that may require treatment.

A majority of patients evaluated for mTBI/concussion do not have detectable intracranial lesions that are seen on a CT scan.

Availability of a blood test for concussion will help health care professionals determine the need for a CT scan in patients suspected of having mTBI and help prevent unnecessary neuroimaging and associated radiation exposure to patients, the FDA said in a Feb. 14, 2018 news release.

“A blood testing option for the evaluation of mTBI/concussion not only provides health care professionals with a new tool, but also sets the stage for a more modernized standard of care for testing of suspected cases,” said FDA Commissioner Scott Gottlieb, M.D.

According to the U.S. Centers for Disease Control and Prevention, in 2013 there were approximately 2.8 million TBI-related emergency department visits, hospitalizations and deaths in the U.S.; of these cases, TBI contributed to the deaths of nearly 50,000 people.

 

The FDA evaluated data from a multi-center, prospective clinical study of 1,947 individual blood samples from adults with suspected mTBI/concussion and reviewed the product’s performance by comparing mTBI/concussion blood tests results with CT scan results.  According to the FDA, the Brain Trauma Indicator was able to predict the presence of intracranial lesions on a CT scan 97.5 percent of the time, and those who did not have intracranial lesions on a CT scan 99.6 percent of the time.

“These findings indicate that the test can reliably predict the absence of intracranial lesions and that health care professionals can incorporate this tool into the standard of care for patients to rule out the need for a CT scan in at least one-third of patients who are suspected of having mTBI,” the FDA noted.

The results of the test are available within three to four hours.

Photo: Pixabay / Jarmoluk

Acetaminophen use in pregnancy and ADHD risk in offspring

Researchers found a modest association between ‘any prenatal maternal use’ of acetaminophen” in all three trimesters and ADHD in the offspring but not with use for fewer than eight days.

An international study carried out by a group of researchers in Norway, the United States and the United Kingdom has found that use of acetaminophen during pregnancy can raise the risk of attention-deficit / hyperactivity disorder (ADHD) in the offspring.

The findings of the study, ‘Prenatal Exposure to Acetaminophen and Risk of ADHD’ were published in the November 2017 edition of the medical journal, Pediatrics.

The study was led by Dr. Eivind Ystrom at the Norwegian Institute of Public Health in Oslo, Norway and carried out  with researchers from the University of Oslo; Columbia University of New York; New York State Psychiatric Institute; University of Bristol in the UK; and the University of Bergen in Bergen, Norway.

The team examined the association between maternal use of acetaminophen during pregnancy, and paternal use of acetaminophen before pregnancy, to estimate its association with ADHD in the offspring. The researchers adjusted for familial risk for ADHD and the indications of acetaminophen use.

Diagnoses were obtained from the Norwegian Patient Registry for 112,973 offspring from the Norwegian Mother and Child Cohort Study, including 2,246 with ADHD. The researchers estimated hazard ratios (HRs) for an ADHD diagnosis by using Cox proportional hazard models.

The researchers reported that they found a “modest association between ‘any prenatal maternal use’ of acetaminophen” in all three trimesters of pregnancy.

The hazard ratio for ‘more than 29 days of maternal acetaminophen use’ was nearly double that figure.

Use for ‘less than eight days’ was not associated with ADHD, according to the researchers.

“Acetaminophen use for fever and infections for 22 to 28 days was associated with ADHD,” the researchers wrote. “Paternal and maternal use of acetaminophen were similarly associated with ADHD.”

The team concluded, “Short-term maternal use of acetaminophen during pregnancy was negatively associated with ADHD in offspring.

“Long-term maternal use of acetaminophen during pregnancy was substantially associated with ADHD even after adjusting for indications of use, familial risk of ADHD, and other potential confounders.”

Photo: Pixabay / Stevepb

 

New report warns US teens get too little sleep

Not getting enough sleep can hurt school performance and create a serious risk to health.

Anyone who contends with attention-deficit hyperactivity disorder knows that more often than not, sleep problems are part of the picture. Around 75 percent of children and adults with ADHD also struggle with sleep problems as well. There are many different reasons for this.

But a new report has just sent a wake-up call across the United States after its publication (Jan. 26, 2018) by epidemiologist Anne Wheaton at the U.S. Centers for Disease Control and Prevention, confirming that most American teens are not getting enough sleep – not just those with ADHD. Not getting enough sleep can hurt school performance and create a serious risk to health.

“This is the first report to provide state-level estimates of short sleep duration among middle school and high school students using age-specific recommendations from the American Academy of Sleep Medicine,” Wheaton wrote in her summary. “A majority of both middle school and high school students in states and large urban school districts included in this report get less than the recommended amount of sleep, putting them at an increased risk for several chronic conditions.”

The report, Short Sleep Duration Among Middle School and High School Students – United States, 2015, notes that nearly 58 percent of middle school students in nine states and almost 73 percent of high school students across the United States do not get the recommended amount of sleep. Nationwide, approximately two thirds of U.S. high school students report sleeping less than eight hours a night on school nights.

Children and adolescents who do not get the recommended amount of sleep for their age are at increased risk for chronic conditions such as diabetes, obesity, and poor mental health, as well as injuries, attention and behavioral problems, and poor academic performance,” Wheaton said.

“In addition, short sleep duration has been found to be associated with engaging in health- and injury-related risk behaviors among high school students.”

According to the American Academy of Sleep Medicine, children aged 6 to 12 need nine to 10 hours of sleep a night, while teenagers aged 13 to 18 should get at least eight hours per night, the report added.

Wheaton said studies have shown that teens whose bedtimes were set by their parents get more sleep than those who don’t. She suggested a media curfew, or removing technology from the bedroom.

“School districts can also support adequate sleep among students by implementing delayed school start times as recommended by the American Academy of Pediatrics, the American Medical Association, and the American Academy of Sleep Medicine,” the report added.

Tips for Better Sleep
Good sleep habits (sometimes referred to as “sleep hygiene”) can help one get a good night’s sleep.   Some habits that can improve sleep health:

  • Be consistent. Go to bed at the same time each night and get up at the same time each morning, including on the weekends
  • Make sure the bedroom is quiet, dark, relaxing, and at a comfortable temperature
  • Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom
  • Avoid large meals, caffeine, and alcohol before bedtime
  • Get some exercise. Being physically active during the day can help one fall asleep more easily at night.

For more information on healthy sleep, go to sleepeducation.org.

Photo: Pixabay / Corrine Harleman

Cannabis abuse linked to changes in brain

The findings reveal potential negative long-term effects of heavy cannabis use on brain function and behavior.

A new study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging that looks at the effects of heavy cannabis use on brain function and behavior shows that young people with cannabis dependence have, in fact, altered brain function.

The changes in brain function may be the source of emotional disturbances and increased psychosis risk that are associated with cannabis abuse, according to the study, which was published online in November 2017 in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

The alterations were most pronounced in people who started using cannabis at a young age.

The findings reveal potential negative long-term effects of heavy cannabis use on brain function and behavior, which remain largely unknown despite the drug’s wide use and efforts to legalize the substance.

The study by Drs. Peter Manza, Dardo Tomasi, and Nora Volkow of the National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland, assessed resting brain activity data from the Human Connectome Project of 441 young adults, and compared a smaller set of 30 people who met criteria for cannabis abuse with 30 controls.

People with heavy cannabis use had abnormally high connectivity in brain regions important for reward processing and habit formation. The same regions have also been
pegged in the development of psychosis in previous research.

“These brain imaging data provide a link between changes in brain systems involved in reward and psychopathology and chronic cannabis abuse, suggesting a mechanism by which heavy use of this popular drug may lead to depression and other even more severe forms of mental illness,” said Dr. Cameron Carter, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.

The brain alterations were also associated with heightened feelings of negative emotionality, especially alienation, where one feels a sense of hostility or rejection from others.

The link points to a potential biological mechanism for why feelings of alienation are often profoundly increased in people with cannabis dependence.

“Interestingly, the hyperconnectivity was strongest in the individuals who began using cannabis in early adolescence,” said Dr. Manza, which lines up with reports of a higher risk of psychiatric problems when cannabis use begins early in life.  Adolescence is a critical period of brain development, making early use of cannabis particularly detrimental.

According to Dr. Manza, the measurement of resting brain activity is a relatively easy and non-invasive procedure, so the approach could be a useful measure for tracking the
development of psychiatric symptoms with cannabis use.

Photo: Pixabay / TechPhotoGal