In a Cochrane analysis of therapeutic or educational interventions for very young children with or at high likelihood for autism, researchers found that certain types of interventions were beneficial. The analysis, published in Developmental Medicine & Child Neurology, included seven reviews which summarised the results of 63 studies from 2009 to 2020.
The analysis found that naturalistic developmental behavioural interventions, developmental interventions, and behavioural interventions were effective.
Heterogeneity in design, intervention and control group, dose, delivery agent, and measurement approach was noted. Inconsistent methodological quality and potential biases were identified.
“We have a growing evidence base that supports the importance of early intervention and its ability to promote communication, adaptive behavior, and facilitate social interactions and relationships. However, there are limitations to this evidence base, which leaves families with some work to do in order to understand which approach is the best fit for themselves, their child, or their family,” said lead author Lauren Franz, MBChB, MPH, of Duke University Medical Center.
Concussion may cause different types of brain damage which lead to similar symptoms in children, according to research published in eLife. A new way of studying concussions could help inform the development of future treatments.
While most children fully recover after a concussion, some will have lasting symptoms. The findings help explain the complex relationships that exist between symptoms and the damage caused by the injury.
The researchers found that certain combinations of brain damage were associated with specific symptoms such as attention difficulties. Other symptoms, such as sleep problems, occurred in children with multiple types of injuries. For example, damage to areas of the brain that are essential for controlling sleep and wakefulness could cause challenges with sleeping, as could damage to brain regions that control mood.
The brain’s white matter holds clues
To do this, they examined how damage to the brain resulting from concussion affected its structural connection network, known as white matter. They then used statistical modelling techniques to see how these changes related to 19 different symptoms reported by the children or their caregivers.
Analysing symptoms may advance treatment
“Despite decades of research, no new treatment targets and therapies for concussions have been identified in recent years,” said lead author Guido Guberman, a Vanier Scholar and MDCM Candidate at McGill University. “This is likely because damage to the brain caused by concussions, and the symptoms that result from it, can vary widely across individuals. In our study, we wanted to explore the relationships that exist between the symptoms of concussion and the nature of the injury in more detail.”
Guberman and his colleagues analysed data collected from 306 children, aged nine to 10 years old, who had previously had a concussion. The children were all participants in the Adolescent Brain Cognitive Development (ABCD) Study.
“The methods used in our study provide a novel way of conceptualising and studying concussions,” says senior author Maxime Descoteaux, a Professor of Computer Science at Université de Sherbrooke. “Once our results are validated and better understood, they could be used to explore potential new treatment targets for individual patients. More broadly, it would be interesting to see if our methods could also be used to gather new insights on neurological diseases that likewise cause varied symptoms among patients.”
Effective anti-vaping advertisements geared to teens have the greatest impact when they emphasise the adverse consequences and harms of vaping e-cigarettes, use negative imagery, and avoid memes, hashtags and other ‘teen-centric’ communication styles, according to a first-of-its-kind study by researchers in the journal Tobacco Control.
The researchers also found that certain messaging content currently being used, especially sweets and flavour-related imagery, increases the appeal of vaping and should be avoided when designing prevention messages.
“E-cigarettes and vaping have become a major public health concern, with nicotine addiction and other harmful outcomes looming large for youth,” said Seth M. Noar, PhD, the paper’s corresponding author and UNC Lineberger professor. “The percentage of teens vaping increased from about 5% in 2011 to over 25% in 2019,” Prof Noar said. “That is an alarming trend, making an understanding of effective vaping prevention messages especially urgent.”
Since the introduction of e-cigarettes, numerous US health departments have created their own anti-vaping messaging geared to teens, as have national health organisations such as the US Food and Drug Administration and Centers for Disease Control and Prevention.
The online study asked 1501 teens to rate seven randomly selected vaping prevention ads from a pool of more than 200 ads. Vaping prevention ads that clearly communicated the health harms of vaping, or compared vaping to cigarette smoking, were comparatively more effective. Neutral or less personally relevant content, such as referencing the environmental impact of vaping or the targeting of youth by the tobacco industry, was less impactful.
“Although we anticipated that vaping prevention ads with neutral or pleasant imagery would not be as effective, we were alarmed to find that flavour-related messages actually heightened the attractiveness of vaping,” said Marcella H. Boynton, PhD, first author
“In retrospect, it stands to reason that by reminding teens about pleasurable aspects of e-cigarettes, even within the context of a prevention ad, we run the risk of doing harm. Notably, we found that flavour-related prevention ad content was associated with vaping appeal among both users and non-users of e-cigarettes, which is a good reminder of how much candy and fruit flavours in e-cigarettes have driven the youth vaping epidemic.”
The researchers hope to next investigate the effects of other types of anti-vaping ads on a wide range of audiences. They also are developing a series of messages and a companion website to test the ability of a text message-driven intervention to reduce youth vaping. In that regard, Prof Noar noted that “We have been developing our own evidence-based messages based on the latest science about the harms of vaping. Our messaging approach has been greatly influenced by the insights generated by this study.”
The study used UNC’s Vaping Prevention Resource, a website designed to provide practitioners, researchers and communities with vaping prevention media content from around the world, as well as strategies and resources for youth vaping prevention. It is the largest repository of free, open-access vaping prevention materials, all available for download at https://vapingprevention.org/.
Per- and polyfluoroalkyl substances (PFAS) and phthalates (two types of endocrine-disrupting chemicals) may be associated with lower areal bone mineral density (aBMD) in teenage boys, according to a new study published in the Journal of Clinical Endocrinology and Metabolism.
Endocrine disrupting chemicals (EDCs) and potential EDCs are mostly man-made found in various materials. By interfering with the body’s endocrine system, endocrine disruptors produce adverse developmental, reproductive, neurological, and immune effects in humans, abnormal growth patterns and neurodevelopmental delays in children. These include per- and polyfluoroalkyl substances (PFAS) are used in non-stick pots and pans, clothing and food packaging, and are increasingly being found in US water supplies. Phthalates are used in medical devices, personal care products, food processing and children’s toys.
“Adolescence is an important time when our bodies build up bone. Almost all US children and adolescents are exposed to PFAS and phthalates, but few studies have looked at how these chemicals could be impacting our bone health,” said Abby F. Fleisch, MD, MPH, of the Maine Medical Center Research Institute and Maine Medical Center. “Our research found an association between certain PFAS and phthalates and reduced bone mineral density in adolescent males. Because bone accrual primarily occurs during adolescence, if replicated, this finding may have implications for lifelong bone health.”
The researchers accessed data on urine and blood samples from 453 boys and 395 girls from the National Health and Nutrition Examination Survey (NHANES). Participants were on average 15.1 years old, and found that higher levels of PFAS and phthalates may be associated with lower aBMD in adolescent males. The same effect was not found in girls; rather a slight increase in aBMD was observed for certain PFAS and phthalates.
The researchers noted that bone mineral density tracks across a lifetime, so if the same results are seen in longitudinal cohorts, this finding may have implications for lifelong skeletal health.
A new study has found a bi-directional relationship between gastrointestinal (GI) issues and internalised symptoms such as anxiety in children and adolescents with autism, which means the symptoms seem to be affecting each other. The findings could inform future precision medicine research aimed at developing personalised treatments for people with autism experiencing gastrointestinal issues. The study appears in the Journal of Autism and Developmental Disorders.
Autism is known to be often associated with GI issues, and is often overlooked in children despite being a source of pain and anxiety. Food preferences are often for carbohydrates and processed foods. The most common cause of GI issues in children with autism are abdominal pain, constipation, chronic diarrhea and gastroesophageal reflux disease (GERD).
“Research has shown gastrointestinal issues are associated with an increased stress response as well as aggression and irritability in some children with autism,” said Brad Ferguson, an assistant research professor. “This likely happens because some kids with autism are unable to verbally communicate their gastrointestinal discomfort as well as how they feel in general, which can be extremely frustrating. The goal of our research is to find out what factors are associated with gastrointestinal problems in individuals with autism so we can design treatments to help these individuals feel better.”
In the study, Ferguson and his team analysed health data from more than 620 under-18 patients with autism who experience gastrointestinal issues. Then, the researchers examined the relationship between the GI issues and internalised symptoms. Ferguson explained the findings provide more evidence on the importance of the ‘gut–brain axis’ in GI disorders in individuals with autism.
“Stress signals from the brain can alter the release of neurotransmitters like serotonin and norepinephrine in the gut which control gastrointestinal motility, or the movement of stool through the intestines. Stress also impacts the balance of bacteria living in the gut, called the microbiota, which can alter gastrointestinal functioning,” Ferguson said. “The gut then sends signals back to the brain, and that can, in turn, lead to feelings of anxiety, depression and social withdrawal. The cycle then repeats, so novel treatments addressing signals from both the brain and the gut may provide the most benefit for some kids with gastrointestinal disorders and autism.”
Ferguson is collaborating with David Beversdorf, a neurologist who also studies gastrointestinal problems in individuals with autism. Beversdorf had recently helped identify specific RNA biomarkers linked with gastrointestinal issues in children with autism.
“Interestingly, the study from Beversdorf and colleagues found relationships between microRNA that are related to anxiety behaviour following prolonged stress as well as depression and gastrointestinal disturbance, providing some converging evidence with our behavioural findings,” Ferguson said.
Ferguson and Beversdorf are now together investigating the effects of a stress-reducing medication on GI issues in a clinical trial. Ferguson cautioned that treatment could be effective for certain people with autism but not others.
“Our team uses a biomarker-based approach to find what markers in the body are common in those who respond favourably to certain treatments,” Ferguson said. “Our goal is to eventually develop a quick test that tells us which treatment is likely to work for which subgroups of patients based on their unique biomarker signature, including markers of stress, composition of gut bacteria, genetics, co-occurring psychological disorders, or a combination thereof. This way, we can provide the right treatments to the right patients at the right time.”
Public health officials are puzzling over cases of severe hepatitis in children reported in Europe and the US. A number of the cases have tested positive for adenovirus and/or SARS-CoV-2, though what role these viruses play is not yet clear.
On 5 April 2022, UK authorities notified the World Health Organization was of 10 cases of severe acute hepatitis of unknown aetiology in previously healthy young children ranging in from 11 months to five years old across central Scotland. Nine had onset of symptoms in March 2022, and all cases were detected on hospitalisation. Symptoms included jaundice, diarrhoea, vomiting and abdominal pain. An article published in Eurosurveillance detailed the cases.
Further investigations across the UK identified a total of 74 cases as of 8 April (including the 10 cases) that fulfilled the case definition. The clinical syndrome in identified cases is of acute hepatitis with markedly elevated liver enzymes, often with jaundice, sometimes preceded by gastrointestinal symptoms, in children principally up to 10 years old. Some cases have required transfer to specialist children’s liver units and six children have undergone liver transplantation. As of 11 April, no death has been reported among these cases and one epidemiologically linked case has been detected.
Laboratory testing has excluded hepatitis type A, B, C, and E viruses (and D where applicable) in these cases while SARS-CoV-2 and/or adenovirus have been detected in several cases. The United Kingdom has recently observed an increase in adenovirus activity, which is co-circulating with SARS-CoV-2, though the role of these viruses in the pathogenesis is not yet clear. They have however been linked to bladder inflammation and infection, and on occasion to hepatitis, but it is rare in children who are not immunocompromised.
To date, no other epidemiological risk factors have been identified, including recent international travel. Overall, the aetiology of the current hepatitis cases is still considered unknown and remains under active investigation. Laboratory testing for additional infections, chemicals and toxins is underway for the identified cases.
Following the notification from the UK, less than five cases (confirmed or possible) have been reported in Ireland, further investigations into these are ongoing. Additionally, three confirmed cases of acute hepatitis of unknown aetiology have been reported in children (ranging in age from 22 months-old to 13 years old) in Spain. A further 9 have been reported in the US state of Alabama, with five testing positive for adenovirus.
Karen Landers, district medical officer for the Alabama Department of Public Health, said that the cases were spread across the state, and no links were found among the children.
“It is not common to see children with severe hepatitis,” Landers told STAT in an interview. “Seeing children with severe [hepatitis] in the absence of severe underlying health problems is very rare. That’s what really stood out to us in the state of Alabama.”
One in four preschool children (aged four to five years) shows signs of long-term malnutrition, according to a new survey.
The Thrive by Five Index, released on 8 April, was produced by First National Bank and Innovation Edge in collaboration with the Department of Basic Education (DBE). The study surveyed more than 5000 children enrolled in early learning programmes across the country.
The study found about 25% of children were physically stunted, as a result of malnutrition in pregnancy and the early years of life. About 65% of children are either cognitively delayed, physically stunted, or both. This means they are not meeting the learning or growth standards expected of a child their age, and will start school at a disadvantage.
“Children from poorer households tended to perform worse,” said Sonja Giese, the lead researcher in the study. Giese is the founder of Innovation Edge, which was set up to support innovation in early childhood development. The rates of stunting were highest among the poorest children.
She said each child was assessed for about an hour. Children were assessed for things such as early mathematical skills, literacy and communication, motor development and coordination, among other things.
But Giese also drew attention to the positive outcomes of the study, saying that even within the poorest group of children there were some children who performed very well, causing a kind of “positive deviance”.
“I think there are some really interesting lessons we can learn from these outliers …Some children just thrive in difficult circumstances,” said Giese. She said more research could help to figure out how and why these children are thriving.
Giese said as the DBE had just taken over responsibility for early childhood education from the Department of Social Development, the study could show where attention should be focused.
In a statement about the survey, the DBE said that the first five years of the child’s life are the most important and stressed the importance of physical development during this stage.
Data for the survey was collected in late 2021 from a nationally representative sample of children aged 50-59 months enrolled in early learning programmes. The final weighted sample used for analysis included 5,139 children from 1,247 programmes across the country. The school quintile system was used to measure the probable socio-economic background of the children who were assessed. School quintiles are based on the income, education and unemployment levels of households in the school catchment area and for the purposes of the Thrive by Five study, the researchers assumed that the income level of children attending early learning programmes within each school cluster matched the income level of children attending the nearest school.
The researchers included more children from quintile 1 – the poorest – in order for the study to be representative of the country and each province. “That’s how we tried to make sure that it really provides a window into the world of children today in South Africa, exactly where they are and how they’re living,” said Giese.
Giese said that some of the data had not yet been analysed and further findings would be released over the next year.
This story was written by Liezl Human for GroundUp and is reproduced under a Creative Commons 4.0 Licence.
By tracking more than 38 000 participants from childhood for fifty years, researchers have uncovered direct evidence that the five cardiovascular risk factors when present in childhood predicted cardiovascular risk in adulthood.
Body mass index, blood pressure, cholesterol, triglycerides and youth smoking, particularly in combination in early childhood, were clinically linked with cardiovascular events that predict poor cardiovascular health in adults.
Paper co-author Prof Terence Dwyer at the University of Oxford commented: “Despite the effect medical and surgical care have had on treating heart disease, achieving the greatest possible reduction in the heart disease burden will depend on including preventive strategies that commence in childhood.”
The findings confirm that prevention must start in childhood. “Longitudinal studies like these have been hampered by a lack of inclusion of comprehensive childhood data around body measurements, blood pressure, and blood lipids and a failure to follow-up at ages when cardiovascular disease becomes common.”
The study involved 38 589 participants from Australia, Finland and the US, who were followed from age 3-19 years for a period of 35-50 years.
The results showed that increased risk for cardiovascular events was seen in over half the children, with those having the highest risk factor levels, at 9 times the risk for an event as for children with below average risk factors.
“While this evidence had not been available previously, the findings were not entirely surprising as it had been known for some time that children as young as five already showed early signs of fatty deposits in arteries. This new evidence justified a greater emphasis on programs to prevent the development of these risk factors in children. Clinicians and public health professionals should now start to focus on how this might best be achieved,” Prof Dwyer concluded.
A large study has shown that opioid prescriptions for children who underwent one of eight common outpatient surgeries declined over a period of five years. These findings, reported in the journal Pediatrics, suggest that clinicians are using more discretion when considering which paediatric patients require an opioid prescription after their procedures.
Opioids are routinely prescribed after a surgery to help paediatric patients manage mild or moderate pain. However, recent studies have suggested that recovery is similar with limited or no opioid use. Additionally, opioids prescribed to children can result in respiratory depression, which causes carbon dioxide to not be expelled from the lungs properly, and the continued use of those opioids, after acute pain has resolved. Despite these findings, no prior studies had looked at recent data on national opioid trends for surgery in children in the context of whether there has been any shift away from prescribing opioids more broadly.
“Children grow throughout their childhood, and because opioids are often prescribed based on weight, we cannot assume that what is appropriate for a 5-year-old could also apply to an adolescent,” said the study’s lead author Tori N. Sutherland, MD, MPH. “In our study, we wanted to be responsible with our data and consider surgical distribution by age group.”
In this study, the researchers used data from a private insurance database to study opioid-naïve patients under the age of 18 who underwent one of eight surgical procedures between 2014 and 2019. The procedures ranged from tonsillectomies to knee surgery. The primary outcome of the study was whether a prescription for opioids was filled within 7 days of surgery, and the secondary outcome was the total amount of opioid dispensed. A total of 124 249 patients were included in the study. Patients were separated by age into adolescents, school-aged children and preschool-aged children.
The researchers found that the percentage of children who had an opioid prescription filled after their surgery fell across all three age categories. For adolescents, prescriptions dropped from 78.2% to 48%; for school-aged children, from 53.9% to 25.5%; and for preschool-aged children, from 30.4% to 11.5%. Additionally, the average morphine milligram equivalent dispensed declined by approximately 50% across all three age groups.
The researchers also found that there was a steeper decline in opioid prescriptions beginning in late 2017, first in the adolescent group and then followed by school- and preschool-aged children. This trend appeared to represent a ‘trickle down’ effect, but more research is needed to explore the difference in trends by age group.
“Our findings demonstrate that pain treatment for children and adolescents undergoing surgery has changed dramatically over the past 5 years,” said Mark Neuman, MD, senior author. “Understanding what these trends mean for patient experiences and health outcomes is a key next step.”
Long-term brain damage resulting from neonatal hypoglycaemia can be warded off with proper treatment such as later education and dextrose gel after birth, new studies have found.
The study is the first of its kind to show that stabilising blood sugar levels in neonatal hypoglycaemia prevents brain damage.
Hypoglycaemia is very common, affecting more than one in six babies. Since glucose is the main energy source for the brain and the body, untreated low blood sugar can cause adverse effects on a child’s neurodevelopment up to the age of 4.5 years old.
While hypoglycaemia is known to alter early development, there has been a significant gap in our understanding of how hypoglycaemia can alter a child’s development after early childhood. A study in JAMA investigated the long-term impact on brain development in mid-childhood – ages 9 to 10 – and found that, compared to peers, there was no significant difference in academic outcomes for children exposed to hypoglycaemia as newborns.
“Rich pre-school and school experiences may help a child’s brain to re-organise and improve their academic abilities up to the developmental milestones of their peers,” said Professor Ben Thompson, who is part of the research team.
Following 480 children born at risk of neonatal hypoglycaemia, researchers assessed each child at aged nine to 10 in five key areas: academic achievement, executive function, visual-motor function, psychosocial adaptation, and general health. All child participants were involved in previous studies, providing researchers with information on their neuro-development outcomes at two and 4.5 years old.
This ability to catch-up in neuro-cognitive function could be because of the brain’s plasticity, the researchers suggest.
“It’s a big relief to know that babies who are born with and treated for a condition as common as hypoglycaemia are not likely to suffer long-term brain damage,” Prof Thompson said.
The researchers have also continued studying the efficacy of dextrose gel to treat low blood sugar in the first 48-hours of a newborn’s life, avoiding the need for babies to go to newborn intensive care units immediately after delivery.
In an additional study published in JAMA, the team assessed the later risks of dextrose gel as a treatment for hypoglycaemia in infancy, and found change to the risk of neuro-sensory impairment at age two. This treatment continues to be widely used in a growing number of countries, including Canada, Australia, the United Kingdom and the United States.
