Common pesticide may increase risk of ADHD

Mice exposed to a commonly used pesticide in utero and through lactation exhibited several features of ADHD, including dysfunctional dopamine signaling in the brain, hyperactivity, working memory, attention deficits and impulsive-like behaviour.

A commonly used pesticide may alter the development of the brain's dopamine system, responsible for emotional expression and cognitive function, and increase the risk of attention deficit hyperactivity disorder in children, according to a new Rutgers study.

The research published Wednesday in the Journal of the Federation of American Societies for Experimental Biology (FASEB J.), by Rutgers scientists and colleagues from Emory University, the University of Rochester Medical Center, and Wake Forest University discovered that mice exposed to the pyrethroid pesticide deltamethrin in utero and through lactation exhibited several features of ADHD, including dysfunctional dopamine signaling in the brain, hyperactivity, working memory, attention deficits and impulsive-like behaviour.

Attention deficit hyperactivity disorder most often affects children, with an estimated 11 percent of children between the ages of 4-17, about 6.4 million, diagnosed as of 2011.

Boys are three to four times more likely to be diagnosed than girls. While early symptoms, including an inability to sit still, pay attention and follow directions, begin between the ages of 3 to 6, diagnosis is usually made after the child starts attending school full time.

Importantly, in this study, the male mice were affected more than the female mice, similar to what is observed in children with ADHD.

The ADHD-like behaviours persisted in the mice through adulthood, even though the pesticide, considered to be less toxic and used on golf courses, in the home, and on gardens, lawns and vegetable crops, was no longer detected in their system.

Although there is strong scientific evidence that genetics plays a role in susceptibility to the disorder, no specific gene has been found that causes ADHD and scientists believe that environmental factors may also contribute to the development of the behavioural condition.

Using data from the Centers for Disease Control, National Health and Nutrition Examination Survey (NHANES) the study analyzed health care questionnaires and urine samples of 2,123 children and adolescents.

Researchers asked parents whether a physician had ever diagnosed their child with ADHD and cross-referenced each child's prescription drug history to determine if any of the most common ADHD medications had been prescribed.

Children with higher pyrethroid pesticide metabolite levels in their urine were more than twice as likely to be diagnosed with ADHD.

These findings provide strong evidence, using data from animal models and humans, that exposure to pyrethroid pesticides, including deltamethrin, may be a risk factor for ADHD, says lead author Jason Richardson, associate professor in the Department and Environmental and Occupational Medicine at Rutgers Robert Wood Johnson Medical School and a member of the Environmental and Occupational Health Sciences Institute (EOHSI).

"Although we can't change genetic susceptibility to ADHD, there may be modifiable environmental factors, including exposures to pesticides that we should be examining in more detail," says Richardson.

Young children and pregnant women may be more susceptible to pesticide exposure because their bodies do not metabolize the chemicals as quickly.

This is why, Richardson says, human studies need to be conducted to determine how exposure affects the developing fetus and young children.

"We need to make sure these pesticides are being used correctly and not unduly expose those who may be at a higher risk," Richardson says.

More information: "Developmental pesticide exposure reproduces features of attention deficit hyperactivity disorder." FASEB J fj.14-260901; published ahead of print January 28, 2015, doi: 10.1096/fj.14-260901

Bullying affects most Adolescents, Popularity Increases the Risk of Getting Bullied

Bullying affects more than just those children who are seen to be isolated and marginalised, according to sociologists.

In fact, researchers have found that the 'popular' students are affected and may actually suffer more from a single act of social aggression.

"We did find that students who are isolated do get bullied," said Diane Felmlee, professor of sociology, Penn State.

Diane Felmlee

"However, for most students, the likelihood of being targeted by aggressive acts increases as a student becomes more popular, with the exception of those at the very top."

In a study of students and their friendship networks in 19 North Carolina schools, the researchers found that the risk of being bullied drops dramatically only for the adolescents in the top five percent of the school's social strata.

Bullying may be a tactical form of aggression, according to the researchers, who report their findings in the current issue of American Sociological Review (pdf).

Young people who are attempting to climb in status may increase their risk of victimization.

Robert Faris

"When youth are vying for status, they probably gain little from attacking students who are already marginalised, in fact, it might backfire," said Felmlee, who worked with Robert Faris, associate professor, University of California Davis.

"But, if adolescents put down someone who is trying to be a leader in their group, or who constitutes a threat to their status, then there is a lot more to be gained."

Faris and Felmlee also found that girls are more likely to be victims of both male and female bullies. Girls who date are at increased risk of physical violence.

"Girls may pose particular threats to other female students' social standing and represent potential rivals when it comes to securing a boyfriend," said Felmlee.

"For boys, girls who date represent rewarding, often popular and relatively easy targets who are unlikely to retaliate physically."

Students who have an aggressive friend tend to avoid being victimized. This may be further evidence that bullying is rarely an individual act, but associated with how friends establish and maintain hierarchies by protecting their own, according to the researchers.

There are serious costs associated with bullying over time, Felmlee said. Victims suffer elevated levels of anxiety, depression and anger. They tend to develop negative feelings about their schools, as well.

Bullying's detrimental effects can be even more pronounced among relatively popular students, according to the researchers.

Higher status students experienced significantly larger increases in depression, anxiety and anger than low-status students.

The friendships of these students also deteriorated.

"The effects of social aggression were magnified by the student's friendship status," said Felmlee.

"It may be that the kids who are extremely popular and rarely victimized had farther to fall than those more accustomed to being a target, so, although socially vulnerable youth suffer significantly from frequent harassment, more central victims of bullying, those who may be 'hidden in plain sight' face serious consequences."

The researchers examined data from the Context of Adolescent Substance Use study, which surveyed about 4,200 middle and high school students twice during the school year.

The surveys included questions on serious verbal and physical harassment, but did not include minor incidents, such as playful teasing.

The students were asked to provide information about their friendships, as well as information about students whom they believe they harassed and about those who they believe harassed them.

Childhood Ashtma: Cat and Dog Allergens on your pets' soft toys

Children's soft toys can harbour high levels of cat and dog allergens as well as house dust mite allergens, according to new research by the University of Otago, Wellington.

After house dust mite allergens, exposure to cat and dog allergens is the next most common indoors. All are strongly associated with asthma.

Children often sleep with soft toys close to their airways, so any allergens present can be a potential problem for asthmatics, says Associate Professor Rob Siebers.

"What that means is that exposure to allergens on toys tends to be great than exposure to mattresses," Professor Siebers says.

The study analysed dust collected from 40 children's soft toys and mattresses. Most had detectable cat and dog allergen levels even in homes without cats or dogs.

Thirty-five of the 40 soft toys (87.5%) had detectable cat allergen levels, and 34 (85%) had detectable dog allergen levels. By comparison, 80% of mattresses had detectable levels of the allergens.

Furthermore, while all mattresses and soft toys had detectable house dust might allergen levels, soft toys contained about three times the level of those on mattresses.

Rob Siebers

While soft toys have long been recognised as a source of house dust mite allergens, this is the first major study of its kind to confirm they are also a source of cat and dog allergens, regardless of whether the home has pets, Professor Siebers says.

"Cat and dog allergens are aerodynamic and can be transported on clothing into animal-free areas, even in cat-free areas such as the Antarctic."

Professor Siebers says the good news is that a regular cold wash in the washing machine has been proven to get rid of cat and dog allergens.

"My advice to parents, particularly of children who are sensitised asthmatics, is to put the toy their child sleeps with through the wash at least weekly."

The research has just been published in the online Journal of Asthma, and was carried out in association with colleagues at the Show Chwan Memorial and Changhua Christian hospitals in Taiwan.

Air pollution and genetics combine to increase risk of autism

Exposure to air pollution appears to increase the risk for autism among people who carry a genetic disposition for the neurodevelopmental disorder, according to newly published research led by scientists at the Keck School of Medicine of the University of Southern California (USC).

"Our research shows that children with both the risk genotype and exposure to high air pollutant levels were at increased risk of autism spectrum disorder compared to those without the risk genotype and lower air pollution exposure," said the study's first author, Heather E. Volk, Ph.D., M.P.H.

Heather Volk is assistant professor of research in preventive medicine and pediatrics at the Keck School of Medicine of USC and principal investigator at The Saban Research Institute of Children's Hospital Los Angeles.

The study, "Autism spectrum disorder: Interaction of air pollution with the MET receptor tyrosine kinase gene," is scheduled to appear in the January 2014 edition of Epidemiology.

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disability characterized by problems with social interaction, communication and repetitive behaviors.

The Centers for Disease Control and Prevention estimates that one in 88 children in the United States has an ASD.

ASD is highly heritable, suggesting that genetics are an important contributing factor, but many questions about its causes remain. There currently is no cure for the disorder.

"Although gene-environment interactions are widely believed to contribute to autism risk, this is the first demonstration of a specific interaction between a well-established genetic risk factor and an environmental factor that independently contribute to autism risk," said Daniel B. Campbell, Ph.D.

David Campbell is assistant professor of psychiatry and the behavioral sciences at the Keck School of Medicine of USC and the study's senior author.

"The MET gene variant has been associated with autism in multiple studies, controls expression of MET protein in both the brain and the immune system, and predicts altered brain structure and function."

"It will be important to replicate this finding and to determine the mechanisms by which these genetic and environmental factors interact to increase the risk for autism."

Independent studies by Volk and Campbell have previously reported associations between autism and air pollution exposure and between autism and a variant in the MET gene.

The current study suggests that air pollution exposure and the genetic variant interact to augment the risk of ASD.

Campbell and Volk's team studied 408 children between 2 and 5 years of age from the Childhood Autism Risks From Genetics and the Environment Study, a population-based, case-control study of preschool children from California.

Of those, 252 met the criteria for autism or autism spectrum disorder. Air pollution exposure was determined based on the past residences of the children and their mothers, local traffic-related sources, and regional air quality measures. MET genotype was determined through blood sampling.

Campbell and Volk continue to study the interaction of air pollution exposure and the MET genotype in mothers during pregnancy.

Children with Autism: Risk of Vitamin deficiencies from food refusal

The life-threatening health problems that a 9-year-old boy with autism faced recently shed light on an issue that is rarely discussed.

Many children with autism or other developmental disorders tend to eat an extremely narrow range of foods, and this may put them at risk for serious health problems, said Dr. Melody Duvall, lead author of the case report, which was published online Nov. 4 in the journal Pediatrics.

What is it about autism that often makes children resistant to eating a normal and varied diet? One expert had some theories.

"We know many children with autism spectrum disorder have sensory issues, are overly sensitive to certain textures, sounds and perhaps tastes," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven & Alexandra Cohen Children's Medical Center in New Hyde Park, N.Y.

"And many children with an autism spectrum disorder will have an insistence on sameness, are comfortable with routines and have difficulty with transitions."

Those traits often make children insist on eating only a very limited combination of foods, Adesman explained.

"This case report highlights how atypical and narrow the diets are with some children with autism or other severe developmental problems, and that the potential for serious health consequences can follow," said Adesman.

In the case of the 9-year-old boy, the situation was extremely challenging to figure out, explained Duvall, his physician at Boston Children's Hospital.

He came to the emergency department twice, complaining of hip pain so severe he refused to walk.

Physicians looked for neurological or orthopedic reasons for the limp, but found no underlying cause. Physical therapy only worsened his discomfort. He had the usual blood tests, and they were normal.

The physicians then thought he might have Lyme disease, but it was ruled out, Duvall said. He then started developing serious lung and heart problems, had a rapid heart rate, dry cough and difficulty breathing. Eventually, he became so ill he was taken to the intensive care unit, she added.

A chest x-ray showed his right lung and the lower parts of his left lung were filling up with fluid. Tests showed the right side of his heart was functioning poorly.

Physicians thought he might have pneumonia, or even cancer, but those possibilities were eliminated by further tests.

The physicians had no idea what was happening. "The definitive diagnosis of what was underlying his pulmonary hypertension [lung problems] was hard," recalled Duvall. "But then his mother told us he had bleeding gums when his teeth were brushed."

That simple clue led to the boy's diagnosis: severe nutritional deficiency. The bleeding gums were a classic sign of scurvy, a disease caused by not getting enough vitamin C.

The doctors ordered a blood test to check his vitamin and mineral levels. They discovered he had a completely undetectable level of vitamin C and inadequate amounts of vitamin B1, B6, B12 and D.

It was then that the physicians asked about the boy's diet. His mother told them that he would only eat chicken nuggets, crackers, cookies and water. He refused milk, juice, vegetables and fruits, and would not take any form of vitamin.

To treat him, the physicians put him on "an intravenous concoction of vitamins to replete his total body deficiency," explained Duvall.

His heart and lung problems were soon resolved, as was his limp, which had been caused by bone disease associated with his poor diet.

Once home, his mother finally found a way to get him to accept taking a vitamin, Duvall said. She crushed the pill and mixed it into a "peanut butter fluff" sandwich, which involves putting marshmallow cream and peanut butter on bread.

That combination successfully disguised the taste of the vitamin. He also started getting regular vitamin injections from his pediatrician.

Duvall emphasized that the risk of severe health problems from nutritional deficiencies goes beyond children with autism or behavioral problems.

Those also at risk include people with anorexia and other restrictive eating disorders; the elderly; those with severe mental illness, such as schizophrenia; alcoholics; immigrants and refugees; and patients with chronic diseases, such as HIV/AIDS.

The researchers noted that while they did not prove definitively that the nutritional deficiency caused the boy's problems, his health issues were resolved soon after he was given vitamins.

Physicians, especially pediatricians, often overlook the topic of nutrition, Duvall said.

"Pediatricians are supposed to talk about immunization, diet and weight maintenance, blood pressure, bullying, parent violence, all in a 10-minute visit," she said. "They have to pick and choose what they talk about."

Duvall said physicians should routinely screen for vitamin and mineral deficiency with a simple blood test.

The bottom line for young and old on less-than-ideal diets? Take a multivitamin, Duvall said.

More information: Learn more about healthy diets from the U.S. Centers for Disease Control and Prevention.

PTSD: Identifying trauma risk in small children early after an accident

Small children also suffer from post-traumatic stress disorders (PTSD) after a serious accident. With the aid of a new test, children with an increased risk can already be identified in the space of a few days.

The test devised by scientists from the University of Zurich and the University Children's Hospital Zurich helps to treat traumatized small children at an early stage.

Accidents also traumatize small children. Around one in ten children still suffers from a post-traumatic stress disorder a year after a road accident or burn injury, reliving aspects of the traumatic experience in the form of flashbacks or nightmares.

In doing so, young children keep replaying the stressful memories while avoiding anything that might remind them of the accident in any way.

As a result of this constant alertness to threatening memories, the children can develop sleeping disorders, concentration problems or aggressive behaviour.

Assessing the risk of illness accurately
Researchers from the University of Zurich and the University Children's Hospital Zurich have now devised and evaluated a systematic questionnaire, which can be used to identify pre-school children with an increased risk of long-term post-traumatic disorders within a few days of an accident.

Markus Landolt

For the first time, it is now possible for first responders such as pediatricians, nursing staff or emergency psychologists to assess small children accurately with regard to their risk of illness.

"Children with an increased risk can thus be identified early and referred to an emergency psychologist for treatment," explains Professor Markus Landolt.

This prevents an acute stress response from developing into chronic mental illness that causes the child to suffer and spells a lengthy and expensive course of treatment.

For the study, Professor Landolt's doctoral student Didier Kramer interviewed a total of 134 parents of two to six-year-old children seven days after a road accident or burn injury.

Didier Kramer

The screening instrument used comprised 21 questions on changes in the child's behavior after the accident and recorded a high degree of accuracy: 85 percent of the children examined who suffered from a post-traumatic stress disorder after six months had already been identified correctly a week after the accident with the aid of the questionnaire.

Markus Landolt is now planning an app for Smartphones in collaboration with IT scientists: "This app will enable the screening to be conducted even more easily and quickly, and above all implemented broadly."

More information: Didier N. Kramer, Matthias B. Hertli, & Markus A. Landolt. Evaluation of an early risk screener for PTSD in preschool children after accidental injury. Pediatrics journal. September 23, 2013. DOI: 10.1542/peds.2013-0713

Childhood Obesity: In-home intervention improves risk reduction routines

This is one of the pieces sent to parents as part of the "Healthy Habits, Happy Homes" program.

Credit: Healthy Habits, Happy Homes Study Group, Harvard Pilgrim Healthcare Institute

In the battle to reduce childhood overweight and obesity, several in-home factors have been identified as reducing those risks – participation of children in regular family dinners, getting enough sleep and less time watching television or other "screen time."

A new study appearing in JAMA Pediatrics describes how a home-based program that helped at-risk families improve household routines was able to slow weight gain in a group of young children.

"While childhood obesity rates may have stabilized in some population subgroups, overall rates remain stubbornly high, and racial/ethnic and socioeconomic disparities persist.

Elsie Taveras

For these reasons, seeking solutions that will particularly influence high-risk families is important." says Elsie Taveras, MD, MPH, chief of General Pediatrics at Massachusetts General Hospital for Children who led the study.

"Our findings demonstrate that relatively simple, no-cost changes in routines within the home can help children maintain or achieve a healthful weight."

The study was conducted at four community health centers in Boston, Cambridge, and Somerville, Mass., all of which serve predominantly low-income, minority populations.

The research team enrolled 121 families – each with a child aged 2 to 5 who slept in a room with a television – that were randomly divided into two groups.

At the beginning and end of the 6-month study period, each family received an in-home visit during which research assistants administered surveys about household routines, measured the child's height and weight, and observed other aspects of the home environment.

Throughout the study period, the control group received monthly packages with educational information on early childhood development.

Families in the intervention group participated in a program called "Healthy Habits, Happy Homes," designed to encourage families to have regular meals together, ensure adequate sleep for children, limit the time children spend watching television and remove television from rooms where children sleep.

The intervention also encouraged parenting practices such as role modeling and limit setting. Parents were not told that these changes were designed to limit weight gain in their child.

Interventions were delivered in four home visits that addressed project goals and checked in on progress, monthly coaching phone calls, and frequent text messages to encourage healthy practices.

Mailings included newsletters for the parents and, for the children, toys focused on the program goals – such as stickers, coloring books, a copy of Good Night Moon for bedtime reading, and toys for active play.

At the end of the study period, children in the intervention group were sleeping about 45 minutes longer than children in the control group.

Time spent watching television on weekends dropped about an hour per day in the intervention group, leading to a significant difference from the control group, which increased weekend TV viewing.

Both groups had a small reduction in weekday TV viewing, with a greater decrease in the intervention group.

Neither group had any significant change in the frequency of family meals together – which may reflect the fact that participating families already shared an average of six meals per week together – and there was little change in the presence of television sets in the rooms where children slept, possibly because 80 percent of parents reported that their child slept in the parents' bedrooms.

At the end of the study period, the body mass index of children in the intervention group dropped an average of 0.18, while it rose 0.21 in the control group.

Taveras explains that increasing height, weight, and body mass index would be expected among children in this age group, as they are developing and growing.

"The Healthy Habits, Happy Homes intervention was able to slow weight gain relative to height increase in these children, which is important because – as our earlier research has shown – rapid weight gain in these early years can lead to higher rates of obesity later in life."

Jess Haines

Jess Haines, PhD, MHSc, RD, University of Guelph, Ontario, lead author of the study, adds, "Our findings suggest that, by encouraging parents to establish household routines that increase children's sleep and decrease TV viewing, health professionals can help prevent children from becoming overweight or obese.

Almost 90 percent of participating parents reported they were satisfied with the program, and 98 percent said they would recommend it to family and friends.

A longer-term study, currently being planned by our research group,will tell us how long the changes we observed here can be maintained.

We also need to investigate how large an interventional 'dose' is required to change these behaviours – for example, could they be accomplished with a single visit or just with phone calls?"

Taveras, an associate professor of Pediatrics and Population Medicine at Harvard Medical School, adds, "For now, interventions such as ours can be one way of keeping young children off an obesity trajectory that would be hard to alter by the time they enter middle school."

Antipsychotic drug use in children for mood, behaviour disorders increases type 2 diabetes risk

Prescribing of "atypical" antipsychotic medications to children and young adults with behavioral problems or mood disorders may put them at unnecessary risk for type 2 diabetes, a Vanderbilt University Medical Center study shows.

Young people using medications like risperidone, quetiapine, aripiprazol and olanzapine led to a threefold increased risk of developing type 2 diabetes within the first year of taking the drug, according to the study published Aug. 21 in the journal JAMA Psychiatry.

Wayne A. Ray

While other studies have shown an increased risk for type 2 diabetes associated with the use atypical antipsychotic medications, this is the first large, well-designed study to look at the risk in children, said Wayne A. Ray, Ph.D., professor of Preventive Medicine, and senior author of the study.

The authors note the use of these drugs for non-psychosis-related mood, attention or behavioral disorders in youth/children now accounts for the majority of prescriptions.

"Because we wanted to address this question of risk for indications for which there were therapeutic alternatives, we deliberately excluded those taking antipsychotics for schizophrenia and other psychoses; thus, our entire sample consisted of patients for whom there were alternatives to antipsychotics," Ray said.

State-provided, de-identified medical records were examined for TennCare youths ages 6-24 from 1996 through 2007.

During that time children and youth who were prescribed treatment with atypical antipsychotics for attention, behavioral or mood disorders, were compared with similar youth prescribed approved medications for those disorders.

Even with the further elimination of certain disorders that are commonly associated with diabetes, like polycystic ovarian syndrome, those taking antipsychotics had triple the risk of developing type 2 diabetes in the following year, with the risk increasing further as cumulative dosages increased.

The increased risk persisted for at least a year after the medications were stopped.

Ray and his colleagues point out developing type 2 diabetes is still rare in this age group. Of the nearly 29,000 children and youth in the antipsychotic medication group and 14,400 children in the control group, 106 were ultimately diagnosed and treated for type 2 diabetes.

"That's why this study had to be so large, in order to detect clinically meaningful differences in the risk of type 2 diabetes, a relatively uncommon, but serious condition for children and youth," Ray said.

The take-away message for providers, said Ray, is to carefully examine alternatives to antipsychotic use.

"This is particularly important for high-risk children, for example, those with elevated weight. Children should be monitored carefully for metabolic effects predisposing them to diabetes, and use of the drug should be at the lowest possible dose for the shortest possible time," he said.

More Information:  Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth -

Childhood Obesity: After-school exercise and nutrition programs

Research has shown that children from low-income neighbourhoods are at higher risk of being obese and overweight than children from affluent neighbourhoods; in fact, one-third of low-income children enter kindergarten either overweight or obese.

In an effort to address this issue, UCLA researchers implemented and evaluated the effectiveness of a pilot after-school health-promotion program that focused on increasing students' opportunities for physical activity and healthy snacks—and boosting their knowledge about physical activity and nutrition—at four low-income, diverse elementary schools in Los Angeles County (four additional school sites were used as comparisons). The study involved students in grades 3 through 5.

After-school staff members were trained by UCLA researchers to implement the evidence-based, sequential nutrition and physical activity curriculum.

Data were collected by researchers on students' nutrition and physical activity knowledge and behavior, and their height and weight measurements, at the beginning and end of the academic year.

Results showed that the proportion of children who were obese or overweight in the intervention group decreased by 3.1 percent by the end of the school year, compared with a 2.0 percent reduction among children in the comparison group. The study found mixed results regarding diet and physical activity knowledge and behaviour.

The authors conclude that enhancing after-school physical activity opportunities through evidence-based programs can potentially benefit low-income children who are overweight or obese.

Findings from this study indicate that after-school programs have the potential to provide opportunities for enhanced physical activity and the development of healthy habits in children from socioeconomically disadvantaged families who may have limited access to nutritious foods and environments conducive to physical activity outside of school.

More information: muse.jhu.edu/journals/journal_of_healt_care

Autism Risk: Exposure to high pollution levels during pregnancy

Women in the U.S. exposed to high levels of air pollution while pregnant were up to twice as likely to have a child with autism as women who lived in areas with low pollution, according to a new study from Harvard School of Public Health (HSPH).

It is the first large national study to examine links between autism and air pollution across the U.S.

Andrea Roberts

"Our findings raise concerns since, depending on the pollutant, 20% to 60% of the women in our study lived in areas where risk of autism was elevated," said lead author Andrea Roberts, research associate in the HSPH Department of Social and Behavioral Sciences.

The study appeared online June 18, 2013 in Environmental Health Perspectives.

Exposure to diesel particulates, lead, manganese, mercury, methylene chloride and other pollutants are known to affect brain function and to affect the developing baby.

Two previous studies found associations between exposure to air pollution during pregnancy and autism in children, but those studies looked at data in just three locations in the U.S.

The researchers examined data from Nurses' Health Study II, a long-term study based at Brigham and Women's Hospital involving 116,430 nurses that began in 1989.

Among that group, the authors studied 325 women who had a child with autism and 22,000 women who had a child without the disorder.

They looked at associations between autism and levels of pollutants at the time and place of birth. They used air pollution data from the U.S. Environmental Protection Agency to estimate women's exposure to pollutants while pregnant.

They also adjusted for the influence of factors such as income, education, and smoking during pregnancy.

The results showed that women who lived in the 20% of locations with the highest levels of diesel particulates or mercury in the air were twice as likely to have a child with autism as those who lived in the 20% of areas with the lowest levels.

Other types of air pollution—lead, manganese, methylene chloride, and combined metal exposure—were associated with higher autism risk as well.

Women who lived in the 20% of locations with the highest levels of these pollutants were about 50% more likely to have a child with autism than those who lived in the 20% of areas with the lowest concentrations.

Most pollutants were associated with autism more strongly in boys than girls. However, since there were few girls with autism in the study, the authors said this finding should be examined further.

Marc Weisskopf

Senior author Marc Weisskopf, associate professor of environmental and occupational epidemiology at HSPH, said, "Our results suggest that new studies should begin the process of measuring metals and other pollutants in the blood of pregnant women or newborn children to provide stronger evidence that specific pollutants increase risk of autism. A better understanding of this can help to develop interventions to reduce pregnant women's exposure to these pollutants."

Parent and Teachers Concerns Block Children Playing freely

Prof Anita Bundy

Altering parents' and teachers' notion of risk taking behaviour can significantly increase children's physical activity suggests a study lead by University of Sydney researchers.

The results of the Sydney Playground Project published online in the Preventive Medicine Journal show simple, low cost, additions to a playground can increase physical activity and decreases children's sedentary behaviour during recess times.

However parental and teachers' concerns for safety and being sued remain a concern.

Lead investigator Professor Anita Bundy from the University's Faculty of Health Sciences says the trial may have helped reverse parents and teachers' perception of what constitutes risky play activities by assisting them to understand what can motivate and encourage children to be physically active and socialise with their peers.

Twelve Australian primary schools participated in the project which simultaneously focused on the school children aged between five-to-seven years, their parents and their teachers.

The initial phase of the three-year project involved a 13-week intervention program. The program that introduced new objects such as cardboard boxes, old car tyres, colourful fabrics, and Styrofoam and milk crates into schoolyards, thereby giving children opportunities for creative, outdoor play.

Workshops were also conducted with parents and teachers to discuss play and perceptions around risk taking related to play.

"We wanted to capture children's intrinsic motivations to play, increase their physical activity during break times, while simultaneously helping adults reconsider their views on risky play behaviour," says Professor Bundy.

"What we found was these simple objects coupled with an education program for parents and teachers significantly increased the children's activity levels."

Whether the increases measured can be maintained remains to be seen says Professor Bundy but evidence in one school suggests they can.

"We retested children in one intervention school after two years and they had maintained their gains," she states.

Trial project manager Lina Engelen says schools and preschools are ideal sites for interventions to promote physical activity either within the school's Physical Education curriculum or via breaks such as recess and lunchtime.

"If break times are to promote physical activity in a sustained manner then available activities must be highly motivating, such as active play and have adults' support," Dr Engelen says.

Children of all sizes and shapes were delighted by the playground initiative she adds.

Signaling Pathway Linked to Fetal Alcohol Risk

Fetal alcohol syndrome is the leading preventable cause of developmental disorders in developed countries and fetal alcohol spectrum disorder (FASD), a range of alcohol-related birth defects that includes fetal alcohol syndrome, is thought to affect as many as 1 in 100 children born in the United States.

Any amount of alcohol consumed by the mother during pregnancy poses a risk of FASD, a condition that can include the distinct pattern of facial features and growth retardation associated with fetal alcohol syndrome as well as intellectual disabilities, speech and language delays, and poor social skills. But drinking can have radically different outcomes for different women and their babies.

While twin studies have suggested a genetic component to susceptibility to FASD, researchers have had little success identifying who is at greatest risk or what genes are at play.

Research from Harvard Medical School and Veterans Affairs Boston Healthcare System sheds new light on this question, identifying for the first time a signaling pathway that might determine genetic susceptibility for the development of FASD.

The study was published online Feb. 19 in the journal Proceedings of the National Academy of Sciences.

"Our work points to candidate genes for FASD susceptibility and identifies a path for the rational development of drugs that prevent ethanol neurotoxicity," said Michael Charness, chief of staff at VA Boston Healthcare System and HMS professor of neurology.

"And importantly, identifying those mothers whose fetuses are most at risk could help providers better target intensive efforts at reducing drinking during pregnancy."

Reference
Mitogen-activated protein kinase modulates ethanol inhibition of cell adhesion mediated by the L1 neural cell adhesion molecule.Proceedings of the National Academy of Sciences, 2013; DOI: 10.1073/pnas.1221386110

Co-Sleeping Ad Aims To Reduce Infant Deaths - YouTube

A controversial ad circulating in Milwaukee is meant to grab parents' attention to the potential dangers of co-sleeping.

According to the Milwaukee Journal Sentinel, at least 9 children have died in the city this year, possibly a result of unsafe sleep environments. The latest incident makes it the 10^th on record.

Co-sleeping deaths are believed to occur because the infant is usually suffocated by a parent rolling over onto them, while sharing the same bed.

In an effort to spread awareness and get a discussion going on the subject, a controversial ad campaign shows a baby nestled in its parents' bed, with a butcher knife nearby. The tagline reads: "Your baby sleeping with you can be just as dangerous."

The eye-catching ad, launched to enlighten parents over the dangers of sleeping with their infants, has sparked immense outrage among people.

ADHD: Increasing Risk Of Written Language Disorder

Children with ADHD (attention deficit hyperactivity disorder) have a higher chance of having WLD (written language disorder).

Although the risk is greater for both sexes with ADHD, girls with ADHD have a higher chance of having WLD together with reading difficulties than boys with ADHD, researchers from Mayo Clinic in Rochester, Minn., and Children's Hospital Boston reported in the journal Pediatrics.

Kouichi Yoshimasu, M.D. and team set out to determine what percentage of children - 5,718 of them, 2,762 girls and 2,956 boys - had WLD. Some of the children had ADHD, while others did not.

They were all born in Rochester between 1976 and 1982 and were still there when they were five years old. They gathered information from school, private tutorial and medical records. They calculated cumulative incidences of WLD, hazard ratios (HRs) and with or without RD.

Author Dr. Slavica Katusic explained that problems with reading and math will usually catch a teacher's attention, whereas writing difficulties are often overlooked.

The USA has one of the highest rates of ADHD in children in the world. The CDC (Centers for Disease Control and Prevention) estimates that up to 10% of 4 to 17 year old American kids have ADHD.

The investigators found that for boys and girls with ADHD, there was a considerably higher cumulative WLD rate by the time they were 19 years old, compared to children without ADHD. 64.5% of boys with ADHD and 16.5% of boys without ADHD had WLD by 19 years of age, compared to 57% and 9.4% among the girls.

Girls with ADHD were found to have a higher risk of having WLD combined with reading difficulties than boys with ADHD. The chances of having just WLD for both girls and boys with ADHD was similar.

The authors concluded:

"ADHD is strongly associated with an increased risk of WLD (with or without RD) for both boys and girls. Girls with ADHD are at higher risk of having WLD with RD compared with boys with ADHD, whereas boys and girls are at the same risk of having WLD without RD."

Article Reference:
"Written-Language Disorder Among Children With and Without ADHD in a Population-Based Birth Cohort"

Kouichi Yoshimasu, MD, William J. Barbaresi, MD, Robert C. Colligan, PhD, Jill M. Killian, BS, Robert G. Voigt, MD, Amy L. Weaver, MS, Slavica K. Katusic, MD Pediatrics August 2011. doi: 10.1542/peds.2010-2581

Are Reading and other Learning Disabilities Preventable? | Reading & Other Learning Disabilities

Are Reading and Other Learning Disabilities Preventable?

Perhaps you had this experience: You approached your child’s school about your kindergarten age child, expressing concern that he or she may have a learning disability. While sympathetic, your school’s psychologist, reading specialist, or other diagnostic expert responded that learning disabilities cannot be diagnosed until a child has been unable to succeed academically despite conscientious instruction.

Several years later, you attended a meeting with your school’s multi-disciplinary team who explained that your child indeed does have a learning disability. Your emotions felt chaotic – a mixture of relief, worry, sorrow – and perhaps frustration or even anger that years had passed since you recognised that your child’s development was not typical, but rather different from his peers in subtle yet important ways.

It is a fact that learning disabilities cannot be 'positively' diagnosed in early childhood. Unlike severe developmental disabilities, learning disabilities are mild neurocognitive deficits that cannot be easily distinguished from the broad range of typical early childhood development.

However, it is also a fact that it is possible to identify children with 'increased risk' of developing learning disabilities in the future, e.g. as elementary school students.

Children with 'increased risk' of learning disabilities frequently share one or more of these characteristics:

• A mother, father, sister or brother with an Autistic Spectrum Disorders, ADHD, or Learning Disability
• Low birth weight, defined as a weight less than 2500 grams or 5.5 pounds
• Delayed speech—failure to combine two or more words into short phrases by 24 months of age
• A diagnosis of ADHD

These risk factors are associated with increased risk of learning disabilities because many learning disabilities are the result of a developmental trajectory that starts before birth, and continues through adulthood.

As preschoolers, children at 'increased risk' have trouble:

• Rhyming
• “Reading”—really recognising—signs like Coke, McDonalds and other frequently occurring printed words
• Recognising parts of books such as the cover, title
• Recognising letters of his or her own name
• Quickly retrieving words, measured by asking a child to rapidly name a category such as “animals”

If we know this then 'What about prevention?'

Many of the home-based interventions that can reduce the risk of learning disabilities, especially reading disabilities, are parenting habits that apply to all children.

The common element of all home—based interventions is the systematic exposure of children to rich, engaging, and expressive language. The best example of this is shared reading.

'Shared Reading', is when parents read to their children, and through this activity, books take on an added dimension of parental love and affection. Children hear models of reading that are more accurate and more advanced than their own.

They begin to associate letters with sounds and words with meaning. Using books with predictable rhyme patterns and simple rhythms, such as the Dr. Seuss books, teaches the acceptable and common sound system of our language.

Old fashioned entertainment, based on interaction between adults and children rather than video, fulfills a similar purpose. Telling stories about family history, sharing folk tales you learned as a child, playing word games such as 20-questions or I-Spy are ways parents teach their preschool “language apprentices.”

Apprentices need teachers who listen well and listen patiently, and who can demonstrate good conversational skills such as taking turns speaking without interrupting.

Helping children to play creatively, with other children, and with their imaginations is the oldest form of language and social skill training.

Summary

In summary, while diagnosis of learning disabilities is not possible at young ages, parents, schools, healthcare professionals and others can be very attuned to delays in language development that confer increased risk for learning disabilities.

In addition, adults can focus particular attention to Low-Birth-Weight children, and children who were not talking by their second birthday, viewing them as especially vulnerable and needing developmental assessment.

Parents, schools and speech and language therapists can team-up to help reduce the potential risk of learning disabilities.

Mediterranean diet may lower risk of brain damage that causes thinking problems

Mediterranean diet may lower risk of brain damage that causes thinking problems

The study found that people who ate a Mediterranean-like diet were less likely to have brain infarcts, or small areas of dead tissue linked to thinking problems.

The Mediterranean diet includes high intake of vegetables, legumes, fruits, cereals, fish and monounsaturated fatty acids such as olive oil; low intake of saturated fatty acids, dairy products, meat and poultry; and mild to moderate amounts of alcohol.