Children with behavioural problems more at risk of chronic conditions

Karestan Koenen

Children with behavioural problems may be at risk of many chronic diseases in adulthood including heart disease, obesity, diabetes, as well as inflammatory illnesses (conditions which are caused by cell damage).

Analyzing data on more than 4,000 participants in the Children of the 90s study at the University of Bristol, researchers from Harvard and Columbia's Mailman School of Public Health found that children with behavioral problems at the age of 8, had higher levels of two proteins (C-reactive protein—CRP; and Interleukin 6—IL-6) in their blood when tested at the age of 10.

This was the case even after a large number of other factors, including sex, race, background, and medication use, were taken into account.

Having raised levels of CRP and IL-6 can be an early warning sign that a person may be at risk of chronic or inflammatory conditions later in life.

Previous research has shown that children with behavioural problems can go on to develop health problems during adulthood, but this is the first time that a link has been found between mental health and inflammation in childhood.

The researchers believe the link may be due to the fact that many behavioral problems are associated with how the hypothalamic pituitary adrenal (HPA) axis works.

The HPA axis plays a major role in controlling reactions to stress and the immune system and, if it malfunctions, it can stimulate the release of the two proteins that cause chronically elevated levels of inflammation, which is tissue's response to injury.

Speaking about the findings, Karestan Koenen, PhD, the report's senior author and associate professor of Epidemiology at Harvard, said:
"This new research shows for the first time that having behavioural problems in childhood can put children on the path to ill health much earlier than we previously realized." 

"The important message for healthcare professionals is that they need to monitor the physical health as well as the mental health of children with behavioural problems to identify those at risk as early as possible."

Findings are published in the journal Psychoneuroendocrinology.

More Information: article/pii/S030645301300262X

Children With Sleep Apnea Have Higher Risk of Behavioral, Adaptive and Learning Problems

A new study found that obstructive sleep apnea, a common form of sleep-disordered breathing (SDB), is associated with increased rates of ADHD-like behavioural problems in children as well as other adaptive and learning problems.

Michelle Perfect

"This study provides some helpful information for medical professionals consulting with parents about treatment options for children with SDB that, although it may remit, there are considerable behavioral risks associated with continued SDB," said Michelle Perfect, PhD, the study's lead author and assistant professor in the school psychology program in the Department of disability and psychoeducational studies at the University of Arizona in Tucson.

"School personnel should also consider the possibility that SDB contributes to difficulties with hyperactivity, learning and behavioural and emotional dysregulation in the classroom."

The five-year study, which appears in the April issue of the journal SLEEP, utilised data from a longitudinal cohort, the Tucson Children's Assessment of Sleep Apnea Study (TuCASA).

The TuCASA study prospectively examined Hispanic and Caucasian children between 6 and 11 years of age to determine the prevalence and incidence of SDB and its effects on neurobehavioral functioning.

The study involved 263 children who completed an overnight sleep study and a neuro-behavioral battery of assessments that included parent and youth reported rating scales.

Results show that 23 children had incident sleep apnea that developed during the study period, and 21 children had persistent sleep apnea throughout the entire study.

Another 41 children who initially had sleep apnea no longer had breathing problems during sleep at the five-year follow-up.

The odds of having behavioral problems were four to five times higher in children with incident sleep apnea and six times higher in children who had persistent sleep apnea.

Compared to youth who never had SDB, children with sleep apnea were more likely to have parent-reported problems in the areas of hyperactivity, attention, disruptive behaviors, communication, social competency and self-care.

Children with persistent sleep apnea also were seven times more likely to have parent-reported learning problems and three times more likely to have school grades of C or lower.

The authors report that this is the first sleep-related study to use a standardized questionnaire to assess adaptive functioning in typically developing youth with and without SDB.

"Even though SDB appears to decline into adolescence, taking a wait and see approach is risky and families and clinicians alike should identify potential treatments," said Perfect.

Reference
Risk of Behavioral and Adaptive Functioning Difficulties in Youth with Previous and Current Sleep Disordered Breathing. SLEEP, 2013; DOI: 10.5665/sleep.2536