Faculty Bibliography

Dr. Monique LeBourgeois, a sleep scientist at the University of Colorado at Boulder, and her colleagues have just conducted the first study on how napping affects the cortisol awakening response, a burst of hormone secretion known to take place shortly after morning awakening. They showed that children produce this response after short naps in the morning and afternoon, though not in the evening, and it may be adaptive in helping children respond to the stresses of the day. By experimentally restricting sleep in young children, and then analyzing their behavior putting puzzles together, Dr. LeBourgeois's group also is quantifying how napping -- or the lack of it -- affects the ways that children respond to their worlds. 'Sleepy children are not able to cope with day-to-day challenges in their worlds,' she said. When children skip even a single nap, 'We get less positivity, more negativity and decreased cognitive engagement.' The 'circadian process,' which has been localized to a very particular place in the brain, works a little like a clock, tying our sleep to schedules and to cycles of light and dark, regardless of how much we have or haven't slept. This interacts with the 'homeostatic process,' which works differently, pushing us harder toward sleep the longer we stay awake and building up sleep pressure, which can be measured via EEG recordings.

[...] researchers are learning that it is not so simple: napping in children actually is a complex behavior, a mix of individual biology, including neurologic and hormonal development, cultural expectations and family dynamics. Napping happens 'because children have a much faster sleep homeostasis -- they build up sleep pressure more quickly, they are not so tolerant toward longer waking periods,' said Dr. Oskar Jenni, a pediatrician who is director of the child development project at the University Children's Hospital Zurich

'The data definitely did surprise me,' said Dr. Joachim Hallmayer, the lead author of the study and an associate professor of psychiatry and behavioral sciences at Stanford University. Dr. Miodovnik points out that potentially toxic substances are ubiquitous and cannot be completely avoided, but suggests that prospective parents try to avoid pesticides, don't microwave plastics that may contain endocrine disruptors, and consider choosing fragrance-free personal products (phthalates are used in many fragrances)

In the 1950s, autism famously was blamed on bad parenting and emotionally remote 'refrigerator mothers.' As the research advanced, including early important twin studies, the inherited basis of the disorder became clear. In a 2010 article published in an American Psychiatric Association journal, autism spectrum disorder is described as 'among the most heritable of psychiatric disorders.' 'environment' is a tricky word. To many scientists studying autism, it means 'everything that's not the inherited DNA,' said Irva Hertz-Picciotto, a professor of epidemiology at the University of California, Davis, MIND Institute. An environmental influence might be a chemical the fetus is exposed to via the placenta, or it might refer to aspects of nutrition, maternal health, stress -- or perhaps exposure to a microbe. Phthalates, chemicals found in many consumer products, are so-called endocrine disruptors, hormonally active substances that can interfere with a variety of developmental processes, including brain development. Yet these data don't demonstrate cause and effect, Dr. [Amir Miodovnik] said, 'only that these substances are associated with symptoms found in autism.' Conversely, taking prenatal vitamins around the time of conception has been associated with a lower risk of autism in a recent study

The law varies state by state, but many, including New York, allow minors to consent by themselves to medical care involving such sensitive needs as contraception, pregnancy, sexually transmitted diseases and mental health. 'In the vast majority of cases when we're working with a student who has some sort of medical or mental health news, they want their parents involved and we are able to communicate freely,' said Dr. Sarah Van Orman, executive director of University Health Services at the University of Wisconsin, Madison, and vice president of the board of directors of the American College Health Association

Dr. Debra Lotstein, assistant professor of pediatrics at the University of California, Los Angeles, studies this transition in adolescents and young adults with chronic medical conditions -- problems which can range from asthma and diabetes to developmental conditions like autism to complex and rare syndromes. As they move out of the pediatrician's office, Dr. Lotstein and her colleagues have found, gaps in care occur for as many as two-thirds of these young adults. Even for young adults with insurance, the lines between pediatric care and adult care are growing blurrier. Pregnancy, for instance: get pregnant, and it used to be that you graduated to the women's clinic. Now a reproductive issue no longer marks the end of pediatric care. While some young women start seeing gynecologists during adolescence, many are getting that care from their pediatricians. Conversely, adult specialists are struggling to learn how to handle adults with a range of problems once limited to pediatric practices. When I was doing my residency during the 1980s, we took care of adolescents with cystic fibrosis, knowing that many were unlikely to live past their 20s -- it was a pediatric disease, and the experts were pediatricians. Not that long ago, there were relatively few grown-up survivors of complex congenital heart disease, for example, or childhood cancer, or congenital H.I.V. infection

Dr. Debra Lotstein, assistant professor of pediatrics at the University of California, Los Angeles, studies this transition in adolescents and young adults with chronic medical conditions -- problems which can range from asthma and diabetes to developmental conditions like autism to complex and rare syndromes

'We're not looking for a gene for handedness or a gene for schizophrenia,' he said. 'We're looking for subtle relationships.' The gene affects the ways that neurons communicate with one another, he said, but its mechanisms still need to be studied. 'Handedness has a genetic basis, but like other complex traits - height, weight - it is complex,' he said. 'It's not a single gene that leads to it. There's a strong environmental component, too. It's a very tricky problem.' 'I can hold the pencil properly in my left hand, but I don't have the co-ordination to write,' he told me. 'It looks like I'm holding the pencil properly, but I am unable to make any letters.'

'We're not looking for a gene for handedness or a gene for schizophrenia,' he said. 'We're looking for subtle relationships.' The gene affects the ways that neurons communicate with one another, he said, but its mechanisms still need to be studied. 'Handedness has a genetic basis, but like other complex traits - height, weight - it is complex,' he said. 'It's not a single gene that leads to it. There's a strong environmental component, too. It's a very tricky problem.' A colleague's husband, Anthony Gentile, told me that though he was always left-handed, he was taught to write with his right hand - though he can form the letters, he could never learn to hold the pencil correctly in that hand. 'I can hold the pencil properly in my left hand, but I don't have the co-ordination to write,' he told me. 'It looks like I'm holding the pencil properly, but I am unable to make any letters.'

[...] I got so worried the child was dehydrated that I told her to go to the emergency room. [...] when she got there, she told them she was scared because the child had a high fever. [...] fever does not harm the brain or the body, though it does increase the need for fluids.