Study links sleep patterns with pain persistence after pediatric surgery
June 22, 2017
Science Daily/American Pain Society
About 20 percent of children develop persistent pain after surgery, and a new study showed that poorer night-time sleep quality was significantly associated with greater next-day pain intensity over four months after surgery.
Researchers from the University of Washington and Seattle Children’s Hospital studied 66 children who had major surgery and examined the longitudinal sleep patterns over four months to assess the relationship between daily sleep and pain. They hypothesized that poorer night-time sleep quality would be associated with greater pain intensity.
In adults, the role of sleep disruption is considered a relevant predictor of acute as well as chronic post-surgical pain. However, perioperative daily sleep patterns have not been longitudinally assessed in children, and the role of sleep in persistence of children’s pain after surgery has not been explored.
Results of the study showed, on average, children’s sleep duration and quality returned to baseline four months following surgery. But at the individual level, significant temporal relationships were found between daily sleep and pain.
“Poor sleep quality predicted greater subsequent pain intensity the next day and our findings suggest that poor sleep quality may continue to influence the experience of post-surgical pain in children even four months after surgery,” said lead author Jennifer Rabbits, MB, ChB, Department of Anesthesiology at Seattle Children’s Hospital.
The authors concluded that improving sleep quality could be an important factor to reduce post-surgical pain and improve surgical recovery time in children.
https://www.sciencedaily.com/releases/2017/06/170622122754.htm
Many children affected by PTSD after traffic accidents
- May 27, 2014
Science Daily/University of Gothenburg
Many children who are injured in traffic is subsequently affected by post traumatic stress disorder, a new study has shown. Many continue to suffer from mental and psychosocial problems one year after the accident. In addition, the rate still remains low of children who are involved in traffic accidents while wearing a helmet when cycling.
Nearly every third child in Sweden who is injured in traffic is subsequently affected by post traumatic stress disorder. Every fifth child is still suffering from mental and psychosocial problems one year after the accident. These are the conclusions of a thesis submitted at the Sahlgrenska Academy, which shows also that only 6 out of 10 Swedish children and adolescents who are involved in a traffic accidents wear a helmet when cycling.
Research student Eva Olofsson has examined the consequences of road traffic injuries in children. One of her studies shows that approximately 30% of children who are injured in traffic suffer from posttraumatic stress disorder one month after the accident.
Life in danger
The stress disorder lasts from three to six months in one sixth of the children. The children often experience much stress and fear in association with the accident, and may feel that their life is in danger. This can cause posttraumatic stress disorder (anxiety disorder) in the long term, and this may constitute a major obstacle in their everyday lives," says Eva Olofsson
Cycling accidents are the most common cause of traffic injuries in children. Eva Olofsson's results show that it has become significantly more common that children who are injured in traffic are wearing a cycle helmet: In 1993 approximately 40% of children who were injured were wearing a helmet, while the figure in 2006 was 80%.
The fraction of children with skull or brain injuries after a cycling accident who received care at Drottning Silvia's Children's Hospital in Gothenburg fell during the period 1993-2006, but the fall was not statistically significant.
The incidence of facial injuries also fell, while the fraction with injuries to the arms, in contrast, increased. "We can see that a cycle helmet provides good protection against severe and life-threatening skull and brain injuries, in all types of cycling accident. Further, a helmet protects against facial injuries," says Eva Olofsson.
http://www.sciencedaily.com/releases/2014/05/140527114459.htm
School-based interventions could benefit children from military families
- May 20, 2014
Science Daily/University of Missouri-Columbia
Nearly two million children in the United States have experienced a parent's military deployment. Previous research has shown that these children may be at increased risk for emotional, behavioral and relationship difficulties, yet little is known about how best to address military children's specialized needs. Now, a researcher says school-based interventions could benefit children whose parents have deployed.
David Albright, an assistant professor at the MU School of Social Work, says military children are an overlooked population in need of more attention from school officials. To best help military children, teachers, administrators, guidance counselors and social workers should be aware of military culture and how it may influence children's behaviors at school.
"Many children who act out in school are asked about common causes of bad behavior, such as bullying or parents' divorce," Albright said. "Rarely are children asked whether parents or siblings serve in the military. If their loved ones are away, these children may be experiencing feelings of separation or worrying about whether their parents will be injured or killed. If family members recently have returned from active duty, they may be displaying symptoms of Post-Traumatic Stress Disorder (PTSD) or Traumatic Brain Injury (TBI) that can make children's home lives more stressful."
Albright recommends school counselors, social workers, teachers and administrators re-examine how they evaluate children who are struggling or misbehaving in school. Albright says that when asking children about factors at home, school officials should determine whether parents or siblings are deployed or have been deployed because those experiences affect children's home lives and may reflect in their behaviors at school.
Schools can develop better interventions to help these children once officials begin to ask if behavioral problems may be related to parents' military experience, Albright said.
"Right now, we don't have a set of approved best practices for supporting children from military families," Albright said. "If schools begin asking whether family members serve, then we can better help these children."
Albright suggests developing interventions that could be implemented in schools that directly target military children and their family members.
http://www.sciencedaily.com/releases/2014/05/140520123517.htm
Tackling test anxiety may help prevent more severe problems
- May 8, 2014
Science Daily/Springer
Showing students how to cope with test anxiety might also help them to handle their built-up angst and fretfulness about other issues. The results of a new study show that anxiety intervention programs that focus on academic matters fit well into the demands of the school routine, and do not carry the same stigma among youth as general anxiety programs do.
Weems says that anxiety problems are among the most common emotional difficulties youths experience, and are often linked to exposure to disasters. If not addressed these feelings could lead to academic difficulties, the increased risk of developing depressive or anxiety disorders, and substance use problems in adulthood.
It is, however, an issue that often falls under the radar in school settings. Therefore Weems and his team turned their attention to teaching students how to handle test anxiety, as such nervousness is one way in which anxieties commonly manifest among school-aged youth.The article highlights the results of initial tests among students from grades three to 12 in five public schools in the gulf south region of the United States.
The research was conducted between three and six years after Hurricane Katrina struck in 2005. A group-administered, test-anxiety-reduction intervention was presented to 325 youths between the ages of eight- and 17-years-old who experienced elevated test anxiety. The intervention -- through which the learners were taught behavioral strategies such as relaxation techniques -- was conducted as part of each school's counseling curriculum.The wider age group who received the intervention found it to be useful, felt glad they had participated and effectively learned the intervention content.
Overall, the program was associated with decreases in test anxiety, anxiety disorder and depression symptoms, and especially helped the older students to feel more in control. In turn, decreases in test anxiety were linked with changes in symptoms of depression and anxiety , such as posttraumatic stress disorder (PTSD). The results suggest high participant satisfaction with the program.
"Test anxiety interventions may be a practical strategy for conducting emotion-focused prevention and intervention efforts because of a natural fit within the ecology of the school setting," believes Weems. He cautions that school-based test anxiety interventions should not be considered a first line approach to treating severe anxiety disorders such as PTSD, but could be employed preventatively to teach students how to handle anxious emotions and internalizing problems more generally.
http://www.sciencedaily.com/releases/2014/05/140508141837.htm
Hereditary trauma: Inheritance of traumas and how they may be mediated
April 13, 2014
Science Daily/ETH Zurich
Extreme and traumatic events can change a person -- and often, years later, even affect their children. Researchers of the University of Zurich and ETH Zurich have now unmasked a piece in the puzzle of how the inheritance of traumas may be mediated.
The phenomenon has long been known in psychology: traumatic experiences can induce behavioural disorders that are passed down from one generation to the next. It is only recently that scientists have begun to understand the physiological processes underlying hereditary trauma. "There are diseases such as bipolar disorder, that run in families but can't be traced back to a particular gene," explains Isabelle Mansuy, professor at ETH Zurich and the University of Zurich. With her research group at the Brain Research Institute of the University of Zurich, she has been studying the molecular processes involved in non-genetic inheritance of behavioural symptoms induced by traumatic experiences in early life.
Mansuy and her team have succeeded in identifying a key component of these processes: short RNA molecules. These RNAs are synthetized from genetic information (DNA) by enzymes that read specific sections of the DNA (genes) and use them as template to produce corresponding RNAs. Other enzymes then trim these RNAs into mature forms. Cells naturally contain a large number of different short RNA molecules called microRNAs. They have regulatory functions, such as controlling how many copies of a particular protein are made.
"With the imbalance in microRNAs in sperm, we have discovered a key factor through which trauma can be passed on," explains Mansuy. However, certain questions remain open, such as how the dysregulation in short RNAs comes about. "Most likely, it is part of a chain of events that begins with the body producing too much stress hormones."
Importantly, acquired traits other than those induced by trauma could also be inherited through similar mechanisms, the researcher suspects. "The environment leaves traces on the brain, on organs and also on gametes. Through gametes, these traces can be passed to the next generation. The scientists hope that their results may be useful to develop a blood test for diagnostics.
http://www.sciencedaily.com/releases/2014/04/140413135953.htm
Experiential avoidance increases PTSD risk following child maltreatment
- March 5, 2014
Science Daily/Penn State
Child abuse is a reliable predictor of post-traumatic stress disorder, but not all maltreated children suffer from it, according researchers, who examined why some maltreated children develop PTSD and some do not.
The research team found that adolescent girls who experienced maltreatment in the past year and were willing to talk about their painful experiences and their thoughts and emotions, were less likely to have PTSD symptoms one year later. Those who tried to avoid painful thoughts and emotions were significantly more likely to exhibit PTSD symptoms down the road.
Approximately 40 percent of maltreated children develop PTSD at some point in their lives. Shenk sought to identify the factors that kept the remaining 60 percent from experiencing the disorder.
"Children and adolescents react very differently to abuse, and we don't yet know who is going to develop PTSD and who won't," said Shenk. "What factors explain who will develop PTSD and who will not? This study attempted to identify those causal pathways to PTSD."
"If we can find what the cause or risk pathway is, then we know what to target clinically," he said.
http://www.sciencedaily.com/releases/2014/03/140305125239.htm
40 percent of minors in Lorca suffer post-traumatic stress a year after earthquake
- January 22, 2014
Science Daily/Plataforma SINC
Spanish researchers have analyzed the impact of the Lorca catastrophe by the percentage of minors suffering post-traumatic stress. Results reveal that 55% of young people displayed this disorder a month on from the earthquake and 40% were still suffering a year later.
On 11 May 2011, Lorca suffered an earthquake measuring 5.1, preceded by another of 4.5, which killed nine people and caused significant material damage.
"The analysis indicates that 55% of the minors suffered from post-traumatic stress one month after the earthquake, while after one year this had decreased to 40%," as Concepción López Soler, researcher from the University of Murcia and co-author of the study with Juan José López García, explained.
"It is important to highlight that the younger age groups and girls are more sensitive to developing these symptoms, which coincides with the results of other studies," the Murcian researcher points out. "Young girls in particular are a special risk group." Among the younger students, 54% of girls showed symptoms of post-traumatic stress compared to 39% of boys.
Stress after trauma
"Natural disasters create a sense of loss of personal safety and endangered survival among the population," adds López Soler. Earthquakes are one of the disasters which cause the greatest psychological disturbances in the population and PTSD is the reaction most associated with adverse conditions.
"With previous earthquakes, the affected population has been quite variable," she states. Three years after the Turkey earthquake in 1999, the prevalence of PTSD was 59%; 18 months after the earthquake in Kashmir (between India and Pakistan), it was 64.8% and ten months after the disaster in L'Aquila (Italy) in 2009, it was greater than 60%.
http://www.sciencedaily.com/releases/2014/01/140122091734.htm
Study finds troubling relationship between drinking, PTSD symptoms in college students
- January 16, 2014
Science Daily/University at Buffalo
The estimated 9 percent of college students who have symptoms of PTSD are likely to drink more alcohol than peers without the psychological condition. In turn, heavy alcohol consumption exacerbates their PTSD symptoms.
These are the conclusions of the first empirical study to examine the bidirectional influences of the two phenomena, influences that had been theorized but never tested. The study, "Reciprocal Associations Between PTSD Symptoms and Alcohol Involvement in College: A Three-Year Trait-State-Error Analysis," was funded by the National Institute on Drug Abuse and is published in the most recent edition of the Journal of Abnormal Psychology (Vol. 22/4).
"College is a time of important developmental changes and a period of risk for heavy drinking, trauma exposure and post-traumatic stress symptoms," says Jennifer P. Read, PhD, associate professor of psychology at the University at Buffalo and principle investigator on the study.
"Heavy drinking is common on college campuses and related to risk for sexual assault, interpersonal violence and serious injury, any of which may trigger PTSD," says Read, who noted that although there has been an assumption that the two are mechanistically associated in the college population, until now, the nature of their relationship was unclear.
In a 2011 study of 3,000 college students, published in the journal Psychological Trauma, she found that about 9 percent met the criteria for PTSD, with the disorder found to be most common among those exposed to sexual and physical assault, most of whom were women.
A 2012 study by Read and colleagues found that the transition into college is marked by an escalation in heavy drinking, drug use and use-related negative consequences, and suggested interventions that may help to ameliorate problem substance use and ultimately facilitate a stronger transition into college and beyond.
http://www.sciencedaily.com/releases/2014/01/140116162109.htm
Children significantly more likely to develop PTSD if mother afflicted
- November 27, 2013
Science Daily/American Associates, Ben-Gurion University of the Negev
While fewer than 10 percent (8.4 percent) of the mothers were suffering from PTSD, more than a fifth (21 percent) of their children presented PTSD symptoms in a recent study on the topic. Children who developed PTSD symptoms also had more psychosomatic complaints such as constipation, diarrhea and headaches.
In the study published in the Journal of Depression & Anxiety, while fewer than 10 percent (8.4 percent) of the mothers were suffering from PTSD, more than a fifth (21 percent) of their children presented PTSD symptoms. Children who developed PTSD symptoms also had more psychosomatic complaints such as constipation, diarrhea and headaches.
"This study reinforces the existing body of knowledge regarding the importance of evaluating and treating parental responses in time of stress," the researchers explain.
"Parents are often the key to understanding children's responses generally and specifically in times of stress. The study also highlights the close interrelations between 'body and soul' among children and adults."
In the study, some 160 mothers of preschool children were interviewed about symptoms exhibited by their children and their own responses during Operation Cast Lead. More than 750 rockets were fired into Southern Israel from Gaza from December 2008 to January 2009.
Working with the Preschool Psychiatric Unit at Soroka University Medical Center, the BGU researchers examined the relationship between PTSD symptoms and socio-demographic, family attributes and psychosomatic symptoms among children exposed to Grad missile attacks in Beer-Sheva, Israel.
http://www.sciencedaily.com/releases/2013/11/131127110607.htm
Teens from military families suffer from deployments
- November 19, 2013
Science Daily/Health Behavior News Service
Teens that have had a parent or sibling on military deployment were more likely to have suicidal thoughts or be depressed than teens without military connections, finds a new study.
"We've been in the longest war in recent history with increased numbers of individuals experiencing combat and being deployed for longer periods of time -- and multiple times," says study co-author Julie Cederbaum, Ph.D., a researcher at the University of Southern California. "We are logically thinking about the adult that is being deployed, but we're not talking enough about the kids left behind and how they might manage the military experience of their parent."
More than 13 percent of the teens surveyed had a parent or sibling in the military. Teens who had experienced just one deployment of a parent or sibling were 40 percent more likely to feel sad or hopeless, 24 percent more likely to have suicidal thoughts and 15 percent more likely to be depressed than teens that did not have military connections.
"You see an even bigger shift with two or more deployments," Cederbaum says. "These kids were 56 percent more likely to experience feelings of sadness or hopelessness, 34 percent to have thought about suicide and 41 percent more likely to experience depressive symptoms."
Anita Chandra, Ph.D., a researcher at the RAND Corporation who has extensively studied military families says that there are many important factors that influence the mental health of teens with military connections, including the teens' age, the total number of months a parent is deployed and whether the parent was deployed into combat. Reintegration -- when a parent returns home -- can be an emotionally difficult time for military families, as well.
Additionally, Chandra notes, not all mental health findings of teens with military connections are negative. "We also know that kids in these families have exhibited a lot of rebound and recovery from deployment stress and a lot of resilience."
Even though the Iraq war ended in 2011 and American troops are withdrawing from Afghanistan, the mental health of children in military families is likely to remain an important issue.
"While many deployed service members return home with minimal reintegration issues, we know that a fair number of folks coming back from deployment aren't doing particularly well," says Cederbaum. "Their children may now be in a home where there's potential traumatic brain injury, mental distress, or substance misuse. That service member or veteran is going through an adjustment and the family has to readjust as well."
Increasing mental health screenings in pediatric and school settings and creating a safe environment for teens of military families to talk about their experiences and feel supported are ways to help identify and reach at-risk youth, Cederbaum says.
http://www.sciencedaily.com/releases/2013/11/131119193439.htm
Higher BMI in adolescence may affect cognitive function in midlife
December 8, 2016
Hebrew University of Jerusalem
Higher Body Mass Index (BMI), if it begins in adolescence, can affect cognitive function in midlife, scientists have found. However, the effect appears to be restricted to adults who had lower socioeconomic position as children.
Overweight and obesity in adolescents have increased substantially in recent decades, and today affect a third of the adolescent population in some developed countries. While the dangers posed by high adult BMI on cognitive function in later life have been documented, the association of adolescent BMI with cognitive function in midlife has not yet been reported. (BMI, or Body Mass Index, is a calculation of a person's weight in kilograms divided by the square of their height in meters.)
To shed light on this issue, scientists at the Hebrew University-Hadassah Braun School of Public Health and Community Medicine set out to determine the association between cumulative life course burden of high-ranked body mass index (BMI), and cognitive function in midlife. The research, which will appear in the Journal of Alzheimer's Disease 55(3), was led by Prof. Jeremy Kark from the Braun School, in the Hebrew University of Jerusalem's Faculty of Medicine, working with colleagues in Israel and the United States.
The researchers used weight and height data from 507 individuals tracked from over 33 years starting at age 17. The participants completed a computerized cognitive assessment at ages 48-52, and their socioeconomic position was assessed by multiple methods. Using mixed models the researchers calculated the life-course burden of BMI from age 17 to midlife, and used multiple regression to assess associations of BMI and height with global cognition and its five component domains.
"In this population-based study of a Jerusalem cohort, followed longitudinally from adolescence for over 33 years, we found that higher BMI in late adolescence and the long-term cumulative burden of BMI predicted poorer cognitive function later in life. Importantly, this study shows that an impact of obesity on cognitive function in midlife may already begin in adolescence, independently of changes in BMI over the adult life course," said the paper's senior author, Prof. Jeremy Kark of the Hebrew University-Hadassah Braun School of Public Health and Community Medicine.
"Our results also show that taller stature was associated with better global cognitive function, independent of childhood and adult socioeconomic position, and that height increase in late adolescence, reflecting late growth, conferred a protective effect, but among women only," added Irit Cohen-Manheim, doctoral candidate at the Braun School and lead author.
The researchers point out that while socioeconomic position may have a particularly important role in the trajectory of a person's lifetime cognitive function, it has rarely been adequately taken into account: "To the best of our knowledge, the association between BMI and cognition as a function of childhood and adult socioeconomic position has not been previously reported. Childhood household socioeconomic position appears to strongly modify the association between adolescent BMI and poorer cognition in midlife, the inverse association being restricted to low childhood socioeconomic position," said Prof. Kark.
"Our results are consistent with the hypothesis that childhood living conditions, as reflected also by height, influence cognitive function later in life; however, our study is unique in showing that an adverse association of higher BMI with cognitive function appears to begin in adolescence and that it appears to be restricted to adults with lower childhood socioeconomic position," said Prof. Kark.
"Evidence for the association between impaired cognitive function in midlife and subsequent dementia supports the clinical relevance of our results. Findings of the relation of BMI in adolescence with poorer midlife cognitive status, particularly in light of the ongoing epidemic of childhood obesity, require confirmation," said Irit Cohen-Manheim.
Science Daily/SOURCE : https://www.sciencedaily.com/releases/2016/12/161208090112.htm
Yoga can have social benefits for children in care
December 13, 2016
Science Daily/University of Nottingham
A certain type of yoga could potentially help to improve the health and psychological wellbeing of children in care, a new study suggests.
The study, 'Kundalini Yoga as Mutual Recovery: A feasibility study including children in care and their carers,' published at The Journal of Children's Services, found that the practice of Kundalini yoga in care homes, when both staff and children are involved, can lead to both individual and social benefits.
Corporate care is far from perfect, with evidence showing that children in care are still among the most vulnerable in society. Research for the Department for Education has also shown that children in care have a higher degree of physical and mental health needs than their not-in-care counterparts, and in comparison to children who are in other forms of care, such as foster care.
'Creative practice as mutual recovery'
This new study was carried out under the belief of 'creative practice as mutual recovery', and looked at the idea that shared creativity, collective experience and mutual benefit can promote resilience in mental health and well-being among communities that have been traditionally divided (e.g. children's home staff and children).
The study was carried out by experts from The University of Nottingham's Institute of Mental Health in conjunction with external collaborators Mark Ball, Edge of Care Hub Manager at Nottingham City Council (Children and Families), Emily Haslam-Jones, Kundalini yoga teacher at Yoganova and David Crepaz-Keay from the Mental Health Foundation.
The experts tested a 20-week Kundalini yoga program in three children's homes situated in the East Midlands. The program was evaluated according to recruitment and retention rates, self-reporting questionnaires from the participants and semi-structured interviews.
The findings show that yoga practice in children's homes, especially when participation is high, has the potential to encourage togetherness and mutuality and improve health and psychological outcomes for children in care, as well as within the workforce.
All the participants reported that the study was personally meaningful and experienced both individual (i.e. feeling more relaxed) and social benefits (e.g. feeling more open and positive).
Far-reaching social benefits
Individuals reported that the yoga sessions helped to show them beneficial exercises that they could use in various contexts, such as before going to bed, or during emotionally challenging times at work as well as at home.
The social benefits were also far-reaching with some participants reporting that they felt more positive, open to others and, as a consequence, had seen an improvement in their social lives and out of work.
Some staff and residents noticed that other people also interacted more positively with them.
Dr Elvira Perez, a Senior Research Fellow at Horizon, member of the Institute of Mental Health, and lead author of the study, says: "The findings are very exciting as they suggest that the practice of Kundalini yoga, involving both staff and children in care, is a plausible intervention that can lead to individual and social benefits. This could have potentially huge, wide-reaching benefits for children in care as well as for all the staff working in residential settings.
"The study has generated a number of valuable guiding principles and recommendations that might underpin the development of any future intervention for children in care and the staff working in these homes."
Science Daily/SOURCE :https://www.sciencedaily.com/releases/2016/12/161213074339.htm
Depressed children respond differently to rewards than other kids
December 15, 2016
Science Daily/Washington University in St. Louis
Adults and teenagers with depression don't respond to rewards in a normal manner. Although depression has been diagnosed in children as young as 3, it hasn't been clear whether their responses to rewards also may be blunted. So researchers studied kids ages 4 to 7 and found that, like adults, when the children were depressed, their brains were less likely to respond to rewards. The researchers say insensitivity to rewards may serve as a "red flag" for depression in young children.
https://images.sciencedaily.com/2016/12/161215124756_1_540x360.jpg
A child wearing a device that measures electrical activity in the brain chooses between doors on a computer screen. Choosing one door wins points while the other results in a loss of points. Washington University researchers have found that the brains of children with depression don't react as robustly to success in the game. Their blunted reward response is a marker of clinical depression.
Credit: Robert Boston
Previous research from the same group of scientists found that a reduced ability to experience joy is a key sign of clinical depression in young children. The findings in the new study could help explain the biological underpinnings of the earlier discovery.
"These findings may show us how the brain processes emotions in young children with depression," said senior investigator Joan L. Luby, MD, director of Washington University's Early Emotional Development Program. "The pleasure we derive from rewards -- such as toys and gifts -- motivates us to succeed and seek more rewards. Dampening the process early in development is a serious concern because it may carry over to how a person will approach rewarding tasks later in life."
The new findings are published in the December 2016 issue of the Journal of the American Academy of Child & Adolescent Psychiatry.
"A blunted response to reward frequently is seen in the brains of depressed adults and adolescents," said first author Andrew C. Belden, PhD, an assistant professor of child psychiatry. "In this study, we were interested in learning whether preschoolers also had that blunted response to reward, and in fact, the brains of children as young as 4 showed very similar responses. That's consistent with other findings in that many neurobehavioral aspects of depression remain consistent throughout the lifespan."
The research, involving 84 children, was conducted as part of a larger study of clinical depression in children ages 3 to 7. The principal investigators of that larger study, which includes therapy and functional brain scanning, are Luby and Deanna M. Barch, PhD, chair of Washington University's Department of Psychological & Brain Sciences in Arts & Sciences and the Gregory B. Couch Professor of Psychiatry at the School of Medicine.
The children wore a device that resembles a shower cap but is hooked to wires that measure electrical activity in the brain using an electroencephalogram machine (EEG). Then, the children played a computer game that involved choosing between two doors shown on the screen. Choosing one door won them points, but choosing the other resulted in a loss of points.
Researchers have tested this idea in adults and teens by allowing them to win cash. In this study, however, young children who picked the correct door enough times won a toy that they were able to pick from a basket of figures, balls and plush items they had been shown before the computer session began.
While the brains of clinically depressed children responded similarly to those of nondepressed children when points were lost, the response when the correct door was chosen was blunted.
"The EEG results showed that their brains did not react as robustly from the pleasurable event of choosing the correct door on the screen," Belden said. "It was not that their brains somehow overreacted to making the wrong choice. The brains of both depressed and nondepressed children reacted the same way to making the wrong choice. The differences we observed were specific to the reward response."
Luby and Belden next plan to see whether the blunted response to reward changes after treatment.
"It may or may not normalize," said Luby, the Samuel and Mae S. Ludwig Professor of Child Psychiatry. "But we suspect the reward response will improve."
Luby and Belden said that when a very young child doesn't seem to be excited by rewards, such as toys and gifts, it may be a sign that the child is depressed or prone to depression. If the condition persists, they suggest parents talk to a pediatrician.
"There are clear risk factors," Luby explained. "Decreased ability to enjoy activities and play is a key sign. Kids who feel excessively guilty about wrongdoing and those who experience changes in sleep and appetite also may be at risk. If they're persistently sad, irritable or less motivated, those are markers that may indicate depression, even in kids as young as 3 or 4, and we would recommend that parents get them evaluated."
Science Daily/SOURCE :https://www.sciencedaily.com/releases/2016/12/161215124756.htm
Early intervention with the very young
Since a lot is happening in the brain during the first years of life, van der Meer says that it is easier to promote learning and prevent problems when children are very young.
The term "early intervention" keeps popping up in discussions of kindergartens and schools, teaching and learning. Early intervention is about helping children as early as possible to ensure that as many children as possible succeed in their education and on into adulthood -- precisely because the brain has the greatest ability to change under the influence of the ambient conditions early in life.
"When I talk about early intervention, I'm not thinking of six-year-olds, but even younger children from newborns to age three. Today, 98 per cent of Norwegian children attend kindergarten, so the quality of the time that children spend there is especially important. I believe that kindergarten should be more than just a holding place -- it should be a learning arena -- and by that I mean that play is learning," says van der Meer.
Babies exposed to stimulation get brain boost
January 2, 2017
Science Daily/The Norwegian University of Science and Technology (NTNU)
Many new parents still think that babies should develop at their own pace, and that they shouldn’t be challenged to do things that they’re not yet ready for. Infants should learn to roll around under their own power, without any “helpful” nudges, and they shouldn’t support their weight before they can stand or walk on their own. They mustn’t be potty trained before they are ready for it.
According to neuroscientist Audrey van der Meer, a professor at the Norwegian University of Science and Technology (NTNU) this mindset can be traced back to the early 1900s, when professionals were convinced that our genes determine who we are, and that child development occurred independently of the stimulation that a baby is exposed to. They believed it was harmful to hasten development, because development would and should happen naturally.
Early stimulation in the form of baby gym activities and early potty training play a central role in Asia and Africa. The old development theory also contrasts with modern brain research that shows that early stimulation contributes to brain development gains even in the wee ones among us.
Using the body and senses
Van der Meer is a professor of neuropsychology and has used advanced EEG technology for many years to study the brain activity of hundreds of babies.
The results show that the neurons in the brains of young children quickly increase in both number and specialization as the baby learns new skills and becomes more mobile. Neurons in very young children form up to a thousand new connections per second.
Van der Meer's research also shows that the development of our brain, sensory perception and motor skills happen in sync. She believes that even the smallest babies must be challenged and stimulated at their level from birth onward. They need to engage their entire body and senses by exploring their world and different materials, both indoors and out and in all types of weather. She emphasizes that the experiences must be self-produced; it is not enough for children merely to be carried or pushed in a stroller.
Unused brain synapses disappear
"Many people believe that children up to three years old only need cuddles and nappy changes, but studies show that rats raised in cages have less dendritic branching in the brain than rats raised in an environment with climbing and hiding places and tunnels. Research also shows that children born into cultures where early stimulation is considered important, develop earlier than Western children do," van der Meer says.
She adds that the brains of young children are very malleable, and can therefore adapt to what is happening around them. If the new synapses that are formed in the brain are not being used, they disappear as the child grows up and the brain loses some of its plasticity.
Van der Meer mentions the fact that Chinese babies hear a difference between the R and L sounds when they are four months old, but not when they get older. Since Chinese children do not need to distinguish between these sounds to learn their mother tongue, the brain synapses that carry this knowledge disappear when they are not used.
Loses the ability to distinguish between sounds
Babies actually manage to distinguish between the sounds of any language in the world when they are four months old, but by the time they are eight months old they have lost this ability, according to van der Meer.
In the 1970s, it was believed that children could only learn one language properly. Foreign parents were advised not to speak their native language to their children, because it could impede the child's language development. Today we think completely differently, and there are examples of children who speak three, four or five languages fluently without suffering language confusion or delays.
Brain research suggests that in these cases the native language area in the brain is activated when children speak the languages. If we study a foreign language after the age of seven, other areas of the brain are used when we speak the language, explains Van der Meer.
She adds that it is important that children learn languages by interacting with real people.
"Research shows that children don't learn language by watching someone talk on a screen, it has to be real people who expose them to the language," says van der Meer.
Early intervention with the very young
Since a lot is happening in the brain during the first years of life, van der Meer says that it is easier to promote learning and prevent problems when children are very young.
The term "early intervention" keeps popping up in discussions of kindergartens and schools, teaching and learning. Early intervention is about helping children as early as possible to ensure that as many children as possible succeed in their education and on into adulthood -- precisely because the brain has the greatest ability to change under the influence of the ambient conditions early in life.
"When I talk about early intervention, I'm not thinking of six-year-olds, but even younger children from newborns to age three. Today, 98 per cent of Norwegian children attend kindergarten, so the quality of the time that children spend there is especially important. I believe that kindergarten should be more than just a holding place -- it should be a learning arena -- and by that I mean that play is learning," says van der Meer.
Too many untrained staff
She adds that a two-year old can easily learn to read or swim, as long as the child has access to letters or water. However, she does not want kindergarten to be a preschool, but rather a place where children can have varied experiences through play.
"This applies to both healthy children and those with different challenges. When it comes to children with motor challenges or children with impaired vision and hearing, we have to really work to bring the world to them," says van der Meer.
"One-year-olds can't be responsible for their own learning, so it's up to the adults to see to it. Today untrained temporary staff tend to be assigned to the infant and toddler rooms, because it's 'less dangerous' with the youngest ones since they only need cuddles and nappy changes. I believe that all children deserve teachers who understand how the brains of young children work. Today, Norway is the only one of 25 surveyed OECD countries where kindergarten teachers do not constitute 50 per cent of kindergarten staffing," she said.
More children with special needs
Lars Adde is a specialist in paediatric physical therapy at St. Olavs Hospital and a researcher at NTNU's Department of Laboratory Medicine, Children's and Women's Health. He works with young children who have special needs, in both his clinical practice and research.
He believes it is important that all children are stimulated and get to explore the world, but this is especially important for children who have special challenges. He points out that a greater proportion of children that are now coming into the world in Norway have special needs.
"This is due to the rapid development in medical technology, which enables us to save many more children -- like extremely premature babies and infants who get cancer. These children would have died 50 years ago, and today they survive -- but often with a number of subsequent difficulties," says Adde.
New knowledge offers better treatment
Adde says that the new understanding of brain development that has been established since the 1970s has given these children far better treatment and care options.
For example, the knowledge that some synapses in the brain are strengthened while others disappear has led to the understanding that we have to work at what we want to be good at -- like walking. According to the old mindset, any general movement would provide good general motor function.
Babies who are born very prematurely at St. Olavs Hospital receive follow-up by an interdisciplinary team at the hospital and a municipal physiotherapist in their early years. Kindergarten staff where the child attends receive training in exactly how this child should be stimulated and challenged at the appropriate level. The follow-up enables a child with developmental delays to catch up quickly, so that measures can be implemented early -- while the child's brain is still very plastic.
A child may, for example, have a small brain injury that causes him to use his arms differently. Now we know that the brain connections that govern this arm become weaker when it is used less, which reinforces the reduced function.
"Parents may then be asked to put a sock on the "good" hand when their child uses his hands to play. Then the child is stimulated and the brain is challenged to start using the other arm," says Adde.
Shouldn't always rush development
Adde stresses that it is not always advisable to speed up the development of children with special needs who initially struggle with their motor skills.
A one-year old learning to walk first has to learn to find her balance. If the child is helped to standing position, she will eventually learn to stand -- but before she has learned how to sit down again. If the child loses her balance, she'll fall like a stiff cane, which can be both scary and counterproductive.
In that situation, "we might then ask the parents to instead help their child up to kneeling position while it holds onto something. Then the child will learn to stand up on its own. If the child falls, it will bend in the legs and tumble on its bum. Healthy children figure this out on their own, but children with special challenges don't necessarily do this," says Adde.
Science Daily/SOURCE :https://www.sciencedaily.com/releases/2017/01/170102143458.htm
One in five young people lose sleep over social media
January 16, 2017
Science Daily/Taylor & Francis
One in five young people regularly wake up in the night to send or check messages on social media, according to new research. This night-time activity is making teenagers three times more likely to feel constantly tired at school than their peers who do not log on at night, and could be affecting their happiness and wellbeing.
https://images.sciencedaily.com/2017/01/170116091419_1_540x360.jpg
The study findings support growing concerns about young people's night-time use of social media.
Credit: © fresnel6 / Fotolia
Over 900 pupils, aged between 12-15 years, were recruited and asked to complete a questionnaire about how often they woke up at night to use social media and times of going to bed and waking. They were also asked about how happy they were with various aspects of their life including school life, friendships and appearance.
1 in 5 reported 'almost always' waking up to log on, with girls much more likely to access their social media accounts during the night than boys. Those who woke up to use social media nearly every night, or who didn't wake up at a regular time in the morning, were around three times as likely to say they were constantly tired at school compared to their peers who never log on at night or wake up at the same time every day. Moreover, pupils who said they were always tired at school were, on average, significantly less happy than other young people.
"Our research shows that a small but significant number of children and young people say that they often go to school feeling tired -- and these are the same young people who also have the lowest levels of wellbeing. One in five young people questioned woke up every night and over one third wake-up at least once a week to check for messages. Use of social media appears to be invading the 'sanctuary' of the bedroom." Said author Professor Sally Power, Co-Director (Cardiff) Wales Institute for Social & Economic Research, Data & Methods (WISERD).
The study findings support growing concerns about young people's night-time use of social media. However, because of the complex range of possible explanations for tiredness at school, further larger studies will be needed before any firm conclusions can be made about the social causes and consequences of sleep deprivation among today's youth.
Science Daily/SOURCE :https://www.sciencedaily.com/releases/2017/01/170116091419.htm
Autism symptoms improve after fecal transplant, small study finds
Parents report fewer behavioral and gastrointestinal problems; gut microbiome changes
January 23, 2017
Science Daily/Ohio State University
Children with autism may benefit from fecal transplants -- a method of introducing donated healthy microbes into people with gastrointestinal disease to rebalance the gut. Behavioral symptoms of autism and gastrointestinal distress often go hand-in-hand, and both improved when a small group of children with the disorder underwent fecal transplant and subsequent treatment.
Behavioral symptoms of autism and gastrointestinal distress often go hand-in-hand, and both improved when a small group of children with the disorder underwent fecal transplant and subsequent treatment.
In the study of 18 children with autism and moderate to severe gastrointestinal problems, parents and doctors said they saw positive changes that lasted at least eight weeks after the treatment. Children without autism were included for comparison of bacterial and viral gut composition prior to the study.
"Transplants are working for people with other gastrointestinal problems. And, with autism, gastrointestinal symptoms are often severe, so we thought this could be potentially valuable," said Ann Gregory, one of the study's lead authors and a microbiology graduate student at The Ohio State University.
"Following treatment, we found a positive change in GI symptoms and neurological symptoms overall," she said.
The study, which appears in the journal Microbiome, was conducted while Gregory and her adviser and co-author, Matthew Sullivan, were at the University of Arizona. Other lead researchers on the project are from Arizona State University and Northern Arizona University.
A growing body of research is drawing connections between the bacteria and viruses that inhabit the gut and problems in the brain, and it is possible the two are tied together in an important way in autism, she said.
Previous research has established that children with autism typically have fewer types of some important bacteria in their guts and less bacterial diversity overall -- a difference that held true in this study. That could be because many of them are prescribed a lot of antibiotics in the first three years of life, the research team wrote in the study.
Parents of the children not only reported a decrease in gut woes including diarrhea and stomach pain in the eight weeks following the end of treatment: They also said they saw significant changes for the better when it came to behavioral autism symptoms in their sons and daughters, who ranged from 7 to 16 years old.
The researchers collected this information from parents through established, standardized questionnaires to assess social skills, irritability, hyperactivity, communication and other measures. One of those tools showed the average developmental age increased by 1.4 years after treatment.
The average score on a scale for ranking gastrointestinal symptoms dropped 82 percent from the beginning to the end of treatment. And when the researchers asked parents to give feedback on 17 autism-related symptoms, they saw overall improvement that was sustained two months after the final treatment.
The researchers also asked the children's doctors to complete a diagnostic evaluation before the experimental treatment, at the end of treatment and eight weeks after that. Those results pointed to lasting benefits.
Doctor-reported symptoms (from the Childhood Autism Rating Scale) decreased by 22 percent at the end of treatment and 24 percent eight weeks after treatment ended compared with ratings at the start of the study.
Researchers also were able to document a rebalancing of the gut following treatment. At the end of the study, the bacterial diversity in the children with autism was indistinguishable from their healthy peers. The study also included a unique viral analysis by Ohio State scientists, made possible because of previous work in the world's oceans.
Gregory, who is particularly interested in the interplay between viruses and bacteria, used genetic testing to examine the viral diversity in the guts of the treated children. It rebounded quickly, and became more similar to the donor's microbiome.
"Those donor viruses seemed to help," she said.
Fecal transplantation is done by processing donor feces and screening it for disease-causing viruses and bacteria before introducing it into another person's gastrointestinal tract.
In this study, the researchers used a method called microbiota transfer therapy, which started with the children receiving a two-week course of antibiotics to wipe out much of their existing gut flora. Then, doctors gave them an initial high-dose fecal transplant in liquid form. In the seven to eight weeks that followed, the children drank smoothies blended with a lower-dose powder.
There currently exists no approved pharmaceutical treatment for autism.
James Adams, one of the study's lead authors and an Arizona State University professor who specializes in autism, called the results compelling, but cautioned that larger, more rigorous studies confirming benefits must be done before the approach could be used widely.
Limitations of this study include its small size. The children and their parents also knew they were receiving the experimental treatment (neither the researchers nor the subjects were blinded to that) and the researchers relied heavily on parents' observations, both of which open the door for false perceived benefits.
"We have to be mindful of the placebo effect and we have to take it with a grain of salt," said Sullivan, an associate professor of microbiology at Ohio State. "But it does give us hope."
The research team is seeking additional funding for a larger clinical trial.
Scientists are trying to work out the cellular-level details of why patients who undergo fecal transplants for various conditions, such as C. diff infection, see improvement, Gregory said.
"Doctors know it works, just not how," she said.
And they're interested in uncovering the precise types of bacteria and viruses that make a difference -- those types of discoveries could lead to lab-engineered treatments tailored to specific diseases, Sullivan said.
Sullivan said the team originally planned to study the use of probiotics in autism, but shifted gears when fecal transplantation began to show benefits for those with other conditions.
The research team cautioned that families should not try to replicate the experimental treatment on their own, as it could harm children if done improperly.
Science Daily/SOURCE :https://www.sciencedaily.com/releases/2017/01/170123094638.htm
Physically active children are less depressed
Children, like adults, reap physical and mental benefits from being active
January 31, 2017
Science Daily/Norwegian University of Science and Technology
Being active, getting sweaty and roughhousing offer more than just physical health benefits for young children. A new study shows this kind of physical activity also protects against depression.
Previous studies have shown that adults and young people who are physically active have a lower risk of developing depression. But the same effect has not been studied in children -- until now.
Results from a new study are showing that children receive the same beneficial effect from being active. We're talking about moderate to vigorous physical activity that leaves kids sweaty or out of breath.
Researchers at the Norwegian University of Science and Technology (NTNU) and NTNU Social Research have followed hundreds of children over four years to see if they could find a correlation between physical activity and symptoms of depression.
Healthy to roughhouse
Researchers examined just under 800 children when they were six years old, and conducted follow-up examinations with about 700 of them when they were eight and ten years old. Physical activity was measured with accelerometers, which served as a kind of advanced pedometer, and parents were interviewed about their children's mental health.
"Being active, getting sweaty and roughhousing offer more than just physical health benefits. They also protect against depression," says Tonje Zahl, a PhD candidate at NTNU. She is first author of the article on the study findings, which was recently published in the February 2017 issue of Pediatrics.
The work was conducted as part of Tidlig Trygg i Trondheim, a multi-year study of child development and mental health.
Fewer symptoms
Physically active six- and eight-year-olds showed fewer symptoms of depression when they were examined two years later. Physical activity thus seems to protect against the development of depression.
"This is important to know, because it may suggest that physical activity can be used to prevent and treat depression already in childhood," says Silje Steinsbekk, associate professor in NTNU's Department of Psychology. Steinsbekk and Professor Lars Wichstrøm are Zahl's mentors and coauthors.
Steinsbekk stresses that these results should now be tested in randomized studies where researchers increase children's physical activity and examine whether those who participate in these measures have fewer symptoms of depression over time than those who do not participate.
"We also studied whether children who have symptoms of depression are less physically active over time, but didn't find that to be the case," she says.
Facilitate activity for children
Previous findings in adolescents and adults showed that sedentary lifestyles -- like watching television and computer gaming -- are associated with depression, but the NTNU children's study found no correlation between depression and a sedentary lifestyle.
Depressive symptoms did not lead to greater inactivity and a sedentary lifestyle did not increase the risk of depression.
So the message to parents and health professionals is: Facilitate physical activity, which means that children get a little sweaty and breathless. Try a bike ride or outdoor play. Limiting children's TV or iPad screen time is not enough. Children need actual increased physical activity.
Science Daily/SOURCE :https://www.sciencedaily.com/releases/2017/01/170131075131.htm
Harnessing ADHD for business success
Attention deficit hyperactivity disorder (ADHD) promotes entrepreneurial skills
March 9, 2017
Science Daily/Technical University of Munich (TUM)
The symptoms of ADHD foster important traits associated with entrepreneurship. That conclusion was reached in a study conducted by an international team of economists, who found that entrepreneurs with ADHD embrace new experiences and demonstrate passion and persistence. Their intuitive decision making in situations involving uncertainty was seen by the researchers as a reason for reassessing existing economic models.
Poor concentration, hyperactivity, a lack of self-regulation -- at first glance, the symptoms of ADHD would seem to lower performance. On the other hand, successful entrepreneurs are frequently reported to have ADHD. "We noticed sometime that some symptoms of ADHD resemble behaviors commonly associated with entrepreneurship -- in a positive sense," says Prof. Holger Patzelt of the Entrepreneurship Research Institute at the Technical University of Munich (TUM).
In cooperation with Johan Wiklund, professor at the Syracuse University, and Dimo Dimov, professor at the University of Bath, Patzelt asked 14 self-employed people with ADHD about their diagnoses, their careers and their personal background. The study shows that important symptoms of ADHD had a decisive impact on the subjects' decision to go into business and on their entrepreneurial approach:
Impulsiveness
People with ADHD are quick to lose their patience. Several of the participants in the study cited boredom in their previous jobs as a reason for setting up their own company, where they could follow up on their own ideas whenever they wanted. One woman reported that she had introduced 250 new products within just a few years. In situations that would be highly stressful for others, such as difficult meetings with important customers, many of those surveyed felt at ease and stimulated. "Their impulsiveness, resulting from ADHD, gives them the advantage of being able to act under unforeseen circumstances without falling into anxiety and paralysis," says Patzelt.
Most of those surveyed act without thinking, even when making far-reaching decisions. One of the entrepreneurs described buying a friend's company over lunch. He only learned of the friend's plan to retire during the meal. Other participants reported that they make investments with no strategy and commit large sums of money to projects with highly uncertain outcomes. Some entrepreneurs believe that this kind of quick decision making is the only way to be productive, and are willing to live with setbacks as a result. Some have difficulty coping with structured activities.
"A marked willingness to try out new things and take risks is an important entrepreneurial trait," says Patzelt. However, the respondents' impulsive actions led to success only when they focused on activities essential to the development of their businesses. One disadvantage of their impulsiveness was mentioned by all of them: problems with routine tasks such as bookkeeping.
Hyperfocus
When people with ADHD have a strong interest in a task, they display an unusual level of concentration known as hyperfocus. One entrepreneur reported that he often becomes completely absorbed in crafting customer solutions. Another constantly keeps up with the new technologies in his industry to the point that he is now much in demand as an expert. "With their passion and persistence, and the expertise they acquire as a result, entrepreneurs can gain a substantial competitive advantage," says Patzelt.
High activity level
Many of the entrepreneurs in the study work day and night without taking time off. That is due to the their hyperfocus, but also to the physical restlessness associated with ADHD. The entrepreneurs use this to fuel their workload. As their energy levels are not constant throughout the day, an advantage in running their own businesses is that they can set their own hours.
"Logic of people with ADHD symptoms is better attuned to entrepreneurial action."
Summing up the results, Patzelt says, "ADHD was a key factor in their decision to go into business for themselves and decisively impacted important entrepreneurial traits: risk taking, passion, persistence and time commitment. Impulsiveness has a special role to play. For People with ADHD it is okay to make intuitive decisions even if the results are bad."
Although one third of those surveyed failed in their business ventures or had little success, Patzelt sees the results of the study as vital for prompting a reassessment of prevailing assumptions in entrepreneurship research: "The way we evaluate entrepreneurial decisions is largely based on rationality and good outcomes. In view of the multitude of uncertainties, however, can such decisions always be rational? People with ADHD show us a different logic that is perhaps better suited to entrepreneurship."
https://www.sciencedaily.com/releases/2017/03/170309132303.htm
Poor sleep in early childhood may lead to cognitive, behavioral problems in later years
March 9, 2017
Science Daily/Massachusetts General Hospital
A new study finds that children ages 3 to 7 who don't get enough sleep are more likely to have problems with attention, emotional control and peer relationships in mid-childhood.
"We found that children who get an insufficient amount of sleep in their preschool and early school-age years have a higher risk of poor neurobehavioral function at around age 7," says Elsie Taveras, MD, MPH, chief of General Pediatrics at MassGeneral Hospital for Children , who led the study. "The associations between insufficient sleep and poorer functioning persisted even after adjusting for several factors that could influence the relationship."
As in previous studies from this group examining the role of sleep in several areas of child health, the current study analyzed data from Project Viva, a long-term investigation of the health impacts of several factors during pregnancy and after birth. Information used in this study was gathered from mothers at in-person interviews when their children were around 6 months, 3 years and 7 years old, and from questionnaires completed when the children were ages 1, 2, 4, 5 and 6. In addition, mothers and teachers were sent survey instruments evaluating each child's executive function and behavioral issues -- including emotional symptoms and problems with conduct or peer relationships, when children were around 7.
Among 1,046 children enrolled in Project Viva, the study team determined which children were not receiving the recommended amount of sleep at specific age categories -- 12 hours or longer at ages 6 months to 2 years, 11 hours or longer at ages 3 to 4 years, and 10 hours or longer at 5 to 7 years. Children living in homes with lower household incomes and whose mothers had lower education levels were more likely to sleep less than nine hours at ages 5 to 7. Other factors associated with insufficient sleep include more television viewing, a higher body mass index, and being African American.
The reports from both mothers and teachers regarding the neurobehavioral function of enrolled children found similar associations between poor functioning and not receiving sufficient sleep, with teachers reporting even greater problems. Although no association was observed between insufficient sleep during infancy -- ages 6 months to 2 years -- and reduced neurobehavioral functioning in mid-childhood, Taveras notes that sleep levels during infancy often predict levels at later ages, supporting the importance of promoting a good quantity and quality of sleep from the youngest ages.
"Our previous studies have examined the role of insufficient sleep on chronic health problems -- including obesity -- in both mothers and children," explains Taveras, who is a professor of Pediatrics at Harvard Medical School (HMS). "The results of this new study indicate that one way in which poor sleep may lead to these chronic disease outcomes is by its effects on inhibition, impulsivity and other behaviors that may lead to excess consumption of high-calorie foods. It will be important to study the longer-term effects of poor sleep on health and development as children enter adolescence, which is already underway through Project Viva."
Science Daily/SOURCE :https://www.sciencedaily.com/releases/2017/03/170309171109.htm