Linking adolescent sleep, brain maturation, and behavior

Sleep duration and perceptions of sleep quality in British Army recruits during basic training - an observational analysis

Introduction

Sleep is critical to the health, wellbeing and performance of military personnel during basic training. This two-part study evaluated sleep-wake patterns and sleep disturbances in junior soldiers (JS) and infantry recruits in Autumn 2021 (study 1), and non-infantry recruits in spring 2022 (study 2).

Methods

During studies 1 and 2, validated wearable technology combined with a sleep diary was used to quantify sleep-wake indices, sleep disturbances and perceptions of sleep quality. Sleep diary data was analysed descriptively. A series of repeated-measures ANOVAs examined differences in objective sleep-wake indices. Correlation analysis determined associations between time in bed (TIB) and total sleep time (TST).

Results

Significant (p < 0.05) differences in most sleep-wake indices were observed between weeks of basic training for all cohorts. Strong positive correlations between TIB and TST were observed for each cohort across basic training (r = 0.681 - 0.970, p < 0.001), with longer TST associated with greater TIB. The mean±SD sleep duration (hours and mins [hm]) for JS (06:22 ± 00:27hm), non-infantry (05:41 ± 00:47hm) and infantry (05:46 ± 00:34hm) recruits across basic training was consistently below national recommendations. The mean±SD bed and wake times for JS (bedtime: 23:01 ± 00:32hm; awake: 05:34 ± 00:10hm), non-infantry (bedtime: 23:38 ± 01:09hm; awake: 04:47 ± 00:58hm), and infantry (bedtime: 23:13 ± 00:29hm; awake: 05:38 ± 00:26hm) recruits varied across weeks of basic training, with over 80% reporting "fairly bad" or "very bad" sleep quality and frequent periods of "dozing off" during daytime activity. The most commonly reported sleep disturbing factors identified during basic training involved: late-night military admin (e.g., ironing, boot cleaning, kit set up etc), early morning wake times, extraneous noise, light and hot room temperatures within the primary sleeping environment, bed/mattress discomfort, muscle soreness and feelings of stress and anxiety.

Discussion/Conclusion

Our findings contribute to the existing evidence that long-term sleep loss is pervasive during initial military training programmes. The average sleep durations indicate chronic and unrecoverable sleep loss which would be expected to significantly impair physical and cognitive military performance, and increase the risk of injury, illness and attrition rates during basic training. Changes in the design and scheduling of basic training programmes to enable, at the least, minimum sleep recommendations to be met, and to improve sleep hygiene in the primary sleeping environment are warranted.

European Academy of Paediatric consensus statement on successful transition from paediatric to adult care for adolescents with chronic conditions

Around one in ten adolescents suffer from chronic conditions and disabilities, and the transition from paediatric to adult care can be particularly challenging. Unplanned transfers can complicate education, work and health and result in patients being lost to follow-up, poor treatment adherence and more frequent hospitalisation. The Adolescent Health and Medicine Working Group of the European Academy of Paediatrics has developed a consensus statement for a successful transition.

CONCLUSION

This statement will help paediatricians, adult care specialists, policymakers and other stakeholders to handle chronic care transitions so that they meet the expectations and needs of adolescents and their families.

Reframing the Teenage Wasteland: Adolescent Microbiota-Gut-Brain Axis

Human adolescence is arguably one of the most challenging periods of development. The young adult is exposed to a variety of stressors and environmental stimuli on a backdrop of significant physiological change and development, which is especially apparent in the brain. It is therefore unsurprising that many psychiatric disorders are first observable during this time. The human intestine is inhabited by trillions of microorganisms, and evidence from both preclinical and clinical research focusing on the established microbiota-gut-brain axis suggests that the etiology and pathophysiology of psychiatric disorders may be influenced by intestinal dysbiosis. Provocatively, many if not all of the challenges faced by the developing teen have a documented impact on these intestinal commensal microbiota. In this review, we briefly summarize what is known about the developing adolescent brain and intestinal microbiota, discuss recent research investigating the microbiota-gut-brain axis during puberty, and propose that pre- and probiotics may prove useful in both the prevention and treatment of psychiatric disorders specifically benefitting the young adult.

Men, Masculinities, and Hemophilia

Hemophilia is a congenital bleeding disorder that predominantly affects men. Home intravenous replacement of missing clotting factor is the most effective treatment; however, the uptake of preventative treatment (also known as prophylaxis) varies among men with hemophilia. The purpose of the current qualitative study was to describe the connections between masculinities and men's (n = 11) experiences of hemophilia across varying age groups. The inductively derived findings revealed bleed-related joint pain as the primary prompt for men to treat or seek medical help. Many men reported experiencing a high number of bleed-related injuries in adolescence, particularly in high school, oftentimes as a result of engaging in idealized masculine physical activities. Though the limitations imposed by hemophilia were contested by most men early on in their lives, as men grow older more conservative approaches were employed both in terms of treatment and activity to reduce the potential for residual bleed-related disabilities. Overall, the results indicate that men with hemophilia may benefit from peer and professional education about recognition, prevention, and optimal treatment of bleeds. Furthermore, masculine ideals act as important context in which men navigate hemophilia management practices and may facilitate contesting or conceding behaviors. Masculine ideals of strength and control may be garnered to facilitate optimal hemophilia management practices.

School start times for adolescents

The American Academy of Pediatrics recognizes insufficient sleep in adolescents as an important public health issue that significantly affects the health and safety, as well as the academic success, of our nation's middle and high school students. Although a number of factors, including biological changes in sleep associated with puberty, lifestyle choices, and academic demands, negatively affect middle and high school students' ability to obtain sufficient sleep, the evidence strongly implicates earlier school start times (ie, before 8:30 am) as a key modifiable contributor to insufficient sleep, as well as circadian rhythm disruption, in this population. Furthermore, a substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep (8.5-9.5 hours) and to improve physical (eg, reduced obesity risk) and mental (eg, lower rates of depression) health, safety (eg, drowsy driving crashes), academic performance, and quality of life.

A substance use decision aid for medically at-risk adolescents: results of a randomized controlled trial for cancer-surviving adolescents

BACKGROUND

Adolescent survivors of childhood cancer engage in risky behaviors.

OBJECTIVE

This study tested a decision aid for cancer-surviving adolescents aimed at difficult decisions related to engaging in substance use behaviors.

METHODS

This randomized controlled trial recruited 243 teen survivors at 3 cancer centers. The cognitive-behavioral skills program focused on decision making and substance use within the context of past treatment. Effects at 6 and 12 months were examined for decision making, risk motivation, and substance use behaviors using linear regression models.

RESULTS

The majority of the teen cancer survivors (90%) rated the program as positive. There was an intermediate effect at 6 months for change in risk motivation for low riskers, but this effect was not sustained at 12 months. For quality decision making, there was no significant effect between treatment groups for either time point.

CONCLUSIONS

The overall program effects were modest. Once teen survivors are in the program and learn what quality decision making is, their written reports indicated adjustment in their perception of their decision-making ability; thus, a more diagnostic baseline decision-making measure and a more intensive intervention are needed in the last 6 months. With 2 of 3 teen participants dealing with cognitive difficulties, the data suggest that this type of intervention will continue to be challenging, especially when 90% of their household members and 56% of their close friends model substance use.

IMPLICATIONS FOR PRACTICE

This effectiveness trial using late-effects clinics provides recommendations for further program development for medically at-risk adolescents, particularly ones with cognitive difficulties.

Making long-term memories in minutes: a spaced learning pattern from memory research in education

Memory systems select from environmental stimuli those to encode permanently. Repeated stimuli separated by timed spaces without stimuli can initiate Long-Term Potentiation (LTP) and long-term memory (LTM) encoding. These processes occur in time scales of minutes, and have been demonstrated in many species. This study reports on using a specific timed pattern of three repeated stimuli separated by 10 min spaces drawn from both behavioral and laboratory studies of LTP and LTM encoding. A technique was developed based on this pattern to test whether encoding complex information into LTM in students was possible using the pattern within a very short time scale. In an educational context, stimuli were periods of highly compressed instruction, and spaces were created through 10 min distractor activities. Spaced Learning in this form was used as the only means of instruction for a national curriculum Biology course, and led to very rapid LTM encoding as measured by the high-stakes test for the course. Remarkably, learning at a greatly increased speed and in a pattern that included deliberate distraction produced significantly higher scores than random answers (p < 0.00001) and scores were not significantly different for experimental groups (one hour spaced learning) and control groups (four months teaching). Thus learning per hour of instruction, as measured by the test, was significantly higher for the spaced learning groups (p < 0.00001). In a third condition, spaced learning was used to replace the end of course review for one of two examinations. Results showed significantly higher outcomes for the course using spaced learning (p < 0.0005). The implications of these findings and further areas for research are briefly considered.

Repeated mild traumatic brain injury: mechanisms of cerebral vulnerability

Among the 3.5 million annual new head injury cases is a subpopulation of children and young adults who experience repeated traumatic brain injury (TBI). The duration of vulnerability after a single TBI remains unknown, and biomarkers have yet to be determined. Decreases in glucose metabolism (cerebral metabolic rate of glucose [CMRglc]) are consistently observed after experimental and human TBI. In the current study, it is hypothesized that the duration of vulnerability is related to the duration of decreased CMRglc and that a single mild TBI (mTBI) increases the brain's vulnerability to a second insult for a period, during which a subsequent mTBI will worsen the outcome. Postnatal day 35 rats were given sham, single mTBI, or two mTBI at 24-h or 120-h intervals. (14)C-2-deoxy-D-glucose autoradiography was conducted at 1 or 3 days post-injury to calculate CMRglc. At 24 h after a single mTBI, CMRglc is decreased by 19% in both the parietal cortex and hippocampus, but approached sham levels by 3 days post-injury. When a second mTBI is introduced during the CMRglc depression of the first injury, the consequent CMRglc is depressed (36.5%) at 24 h and remains depressed (25%) at 3 days. In contrast, when the second mTBI is introduced after the metabolic recovery of the first injury, the consequent CMRglc depression is similar to that seen with a single injury. Results suggest that the duration of metabolic depression reflects the time-course of vulnerability to second injury in the juvenile brain and could serve as a valuable biomarker in establishing window of vulnerability guidelines.

Frontal lobe bioenergetic metabolism in depressed adolescents with bipolar disorder: a phosphorus-31 magnetic resonance spectroscopy study

OBJECTIVES

To compare the concentrations of high-energy phosphorus metabolites associated with mitochondrial function in the frontal lobe of depressed adolescents with bipolar disorder (BD) and healthy controls (HC).

METHODS

We used in vivo phosphorus-31 magnetic resonance spectroscopy ((31) P-MRS) at 3 Tesla to measure phosphocreatine (PCr), beta-nucleoside triphosphate (β-NTP), inorganic phosphate (Pi), and other neurometabolites in the frontal lobe of eight unmedicated and six medicated adolescents with bipolar depression and 24 adolescent HCs.

RESULTS

Analysis of covariance, including age as a covariate, revealed differences in PCr (p=0.037), Pi (p=0.017), and PCr/Pi (p=0.002) between participant groups. Percentage neurochemical differences were calculated with respect to mean metabolite concentrations in the HC group. Post-hoc Tukey-Kramer analysis showed that unmedicated BD participants had decreased Pi compared with both HC (17%; p=0.038) and medicated BD (24%; p=0.022). The unmedicated BD group had increased PCr compared with medicated BD (11%; p=0.032). The PCr/Pi ratio was increased in unmedicated BD compared with HC (24%; p=0.013) and with medicated BD (39%; p=0.002). No differences in β-NTP or pH were observed.

CONCLUSIONS

Our results support the view that frontal lobe mitochondrial function is altered in adolescent BD and may have implications for the use of Pi as a biomarker. These findings join volumetric studies of the amygdala, and proton MRS studies of n-acetyl aspartate in pointing to potential differences in neurobiology between pediatric and adult BD.

Trauma in early childhood: Empirical evidence and clinical implications

Children in the birth to 5 age range are disproportionately exposed to traumatic events relative to older children, but they are underrepresented in the trauma research literature as well as in the development and implementation of effective clinical treatments and in public policy initiatives to protect maltreated children. Children from ethnic minority groups and those living in poverty are particularly affected. This paper discusses the urgent need to address the needs of traumatized young children and their families through systematic research, clinical, and public policy initiatives, with specific attention to underserved groups. The paper reviews research findings on early childhood maltreatment and trauma, including the role of parental functioning, the intergenerational transmission of trauma and psychopathology, and protective contextual factors in young children's response to trauma exposure. We describe the therapeutic usefulness of a simultaneous treatment focus on current traumatic experiences and on the intergenerational transmission of relational patterns from parent to child. We conclude with a discussion of the implications of current knowledge about trauma exposure for clinical practice and public policy and with recommendations for future research.

Shortridge academy: positive youth development in action within a therapeutic community

This chapter presents a case example of the implementation of Positive Youth Development (PYD) at a therapeutic boarding school including the theoretical, conceptual, and empirical information about PYD, adolescent brain development, authoritative communities, and youth-adult partnerships that guided this work. Specific examples demonstrate how key concepts and underlying principles of PYD were put into practice. The chapter provides information about parents' perceptions of the school's effectiveness and explains a theory of change approach used to develop the program evaluation. The chapter concludes with a discussion of challenges and opportunities experienced in the development and implementation of the program.

Clinical implications of traumatic stress from birth to age five

Children aged birth to five years are exposed to a disproportionately increased amount of potentially traumatic events compared to older children. This review examines the prevalence of traumatic exposure in the birth-to-five age range, the indicators and diagnostic criteria of early traumatic stress, and the contextual issues associated with the experience of early trauma. The article also selectively reviews the impact of trauma on the biological, emotional, social, and cognitive functioning of young children's development along with some promising clinical treatment and service interventions that target the parent-child relationship as a vehicle of trauma recovery. Despite extensive documentation of the negative impact of trauma on the normal development of young children, research, clinical, and policy efforts to address the psychological repercussions of early victimization remain remarkably limited. Future directions in research and clinical practice as well as implications for policy are discussed.