Anxiety in children with attention-deficit/hyperactivity disorder

OBJECTIVES: Although anxiety is common in children with attention-deficit/hyperactivity disorder (ADHD), it is unclear how anxiety influences the lives of these children. This study examined the association between anxiety comorbidities and functioning by comparing children with ADHD and no, 1, or ≥2 anxiety comorbidities. Differential associations were examined by current ADHD presentation (subtype). METHODS: Children with diagnostically confirmed ADHD (N = 392; 5-13 years) were recruited via 21 pediatrician practices across Victoria, Australia. Anxiety was assessed by using the Anxiety Disorders Interview Schedule for Children-IV. Functional measures included parent-reported: quality of life (QoL; Pediatric Quality of Life Inventory 4.0), behavior and peer problems (Strengths and Difficulties Questionnaire), daily functioning (Daily Parent Rating of Evening and Morning Behavior), and school attendance. Teacher-reported behavior and peer problems (Strengths and Difficulties Questionnaire) were also examined. Linear and logistic regression controlled for ADHD severity, medication use, comorbidities, and demographic factors. RESULTS: Children with ≥2 anxiety comorbidities (n = 143; 39%) had poorer QoL (effect size: -0.8) and more difficulties with behavior (effect size: 0.4) and daily functioning (effect size: 0.3) than children without anxiety (n = 132; 36%). Poorer functioning was not observed for children with 1 anxiety comorbidity (n = 95; 26%). Two or more anxiety comorbidities were associated with poorer functioning for children with both ADHD-Inattentive and ADHD-Combined presentation. CONCLUSIONS: Children with ADHD demonstrate poorer QoL, daily functioning and behavior when ≥2 anxiety comorbidities are present. Future research should examine whether treating anxiety in children with ADHD improves functional outcomes.

Classroom standing desks and sedentary behavior: a systematic review

CONTEXT: Reducing sedentary behaviors, or time spent sitting, is an important target for health promotion in children. Standing desks in schools may be a feasible, modifiable, and acceptable environmental strategy to this end. OBJECTIVE: To examine the impact of school-based standing desk interventions on sedentary behavior and physical activity, health-related outcomes, and academic and behavioral outcomes in school-aged children. DATA SOURCES: Ovid Embase, Medline, PsycINFO, Web of Science, Global Health, and CINAHL. STUDY SELECTION: Full-text peer-reviewed journal publications written in English; samples of school-aged youth (5-18 years of age); study designs including the same participants at baseline and follow-up; and use of a standing desk as a component of the intervention. DATA EXTRACTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Eight studies satisfied selection criteria and used quasi-experimental (n = 4), randomized controlled trial (n = 3), and pre-post, no control (n = 1) designs. When examined, time spent standing increased in all studies (effect sizes: 0.38-0.71), while sitting time decreased from a range of 59 to 64 minutes (effect sizes: 0.27-0.49). Some studies reported increased physical activity and energy expenditure and improved classroom behavior. LIMITATIONS: One-half of the studies had nonrandomized designs, and most were pilot or feasibility studies. CONCLUSIONS: This initial evidence supports integrating standing desks into the classroom environment; this strategy has the potential to reduce sitting time and increase standing time among elementary schoolchildren. Additional research is needed to determine the impact of standing desks on academic performance and precursors of chronic disease risk.

Results from New Zealand's 2014 report card on physical activity for children and youth

BACKGROUND: This brief report provides grades for the 2014 New Zealand Report Card on Physical Activity for Children and Youth. The Report Card presents a review of current evidence across 9 key indicators, including physical activity (PA), organized sport and free play, sedentary behavior, and community and government initiatives across New Zealand. METHODS: Nationally representative survey data were collated by researchers at the University of Auckland, New Zealand, between June and December 2013. The grade for each indicator is based on the percentage of children and youth meeting a defined benchmark: A is 81%-100%; B is 61%-80%; C is 41%-60%, D is 21%-40%; F is 0%-20%; INC is incomplete data. RESULTS: Overall PA received a score of B, as did Organized Sport Participation and Active Play. PA participation in School Environment scored slightly less with a score of B-. Sedentary Behaviors, Family and Peers, and Community and Built Environment scored a grade of C. Active transportation received a score of C-. An inconclusive grade was given for the Government indicator due to a lack of established international criteria for assessment. CONCLUSIONS: PA participation in New Zealand is satisfactory, but could improve. However, sedentary behavior is high. Of particular concern is the age-related decline in PA participation, particularly among adolescent females, and the increase in sedentary behavior.

Screen-time weight-loss intervention targeting children at home (SWITCH): a randomized controlled trial

BACKGROUND: Screen-based activities, such as watching television (TV), playing video games, and using computers, are common sedentary behaviors among young people and have been linked with increased energy intake and overweight. Previous home-based sedentary behaviour interventions have been limited by focusing primarily on the child, small sample sizes, and short follow-up periods. The SWITCH (Screen-Time Weight-loss Intervention Targeting Children at Home) study aimed to determine the effect of a home-based, family-delivered intervention to reduce screen-based sedentary behaviour on body composition, sedentary behaviour, physical activity, and diet over 24 weeks in overweight and obese children.

METHODS: A two-arm, parallel, randomized controlled trial was conducted. Children and their primary caregiver living in Auckland, New Zealand were recruited via schools, community centres, and word of mouth. The intervention, delivered over 20 weeks, consisted of a face-to-face meeting with the parent/caregiver and the child to deliver intervention content, which focused on training and educating them to use a wide range of strategies designed to reduce their child's screen time. Families were given Time Machine TV monitoring devices to assist with allocating screen time, activity packages to promote alternative activities, online support via a website, and monthly newsletters. Control participants were given the intervention material on completion of follow-up. The primary outcome was change in children's BMI z-score from baseline to 24 weeks.

RESULTS: Children (n = 251) aged 9-12 years and their primary caregiver were randomized to receive the SWITCH intervention (n = 127) or no intervention (controls; n = 124). There was no significant difference in change of zBMI between the intervention and control groups, although a favorable trend was observed (-0.016; 95% CI: -0.084, 0.051; p = 0.64). There were also no significant differences on secondary outcomes, except for a trend towards increased children's moderate intensity physical activity in the intervention group (24.3 min/d; 95% CI: -0.94, 49.51; p = 0.06).

CONCLUSIONS: A home-based, family-delivered intervention to reduce all leisure-time screen use had no significant effect on screen-time or on BMI at 24 weeks in overweight and obese children aged 9-12 years.

Presleep activities and time of sleep onset in children

OBJECTIVE: Presleep activities have been implicated in the declining sleep duration of young people. A use-of-time approach may be used to describe the presleep period. The study aims were to describe the activities undertaken 90 minutes before sleep onset and to examine the association between activities and time of sleep onset in New Zealand young people. METHODS: Participants (N = 2017; 5-18 years) self-reported their time use as part of a national survey. All activities reported in the 90 minutes before sleep were extracted. The top 20 activities were grouped into 3 behavioral sets: screen sedentary time, nonscreen sedentary time, and self-care. An adjusted regression model was used to estimate presleep time spent in each behavioral set for 4 distinct categories of sleep onset (very early, early, late, or very late), and the differences between sleep onset categories were tested. RESULTS: In the entire sample, television watching was the most commonly reported activity, and screen sedentary time accounted for ∼30 minutes of the 90-minute presleep period. Participants with a later sleep onset had significantly greater engagement in screen time than those with an earlier sleep onset. Conversely, those with an earlier sleep onset spent significantly greater time in nonscreen sedentary activities and self-care. CONCLUSIONS: Screen sedentary time dominated the presleep period in this sample and was associated with a later sleep onset. The development of interventions to reduce screen-based behaviors in the presleep period may promote earlier sleep onset and ultimately improved sleep duration in young people.

The non-advertising effects of screen-based sedentary activities on acute eating behaviours in children, adolescents, and young adults. A systematic review.

Sedentary screen time may be an important determinant of childhood obesity. A number of potential mechanisms to explain the link between screen time and increased bodyweight have been proposed; however, the relationship appears to be best explained by the effects on dietary intake, which is attributed to either food advertising or effects independent of food advertising. Technological advances have allowed for greater accessibility and exposure to advertisement-free screen-based media. This review was conducted to systematically synthesise the evidence from laboratory based studies which have investigated the non-advertising effects of screen time (TV viewing, sedentary video games, and computer use) on dietary intake in children, adolescents, and young adults. MEDLINE, PubMed, PsychInfo, CINAHL, and Embase were searched from inception through 5 July 2013. Ten trials met the inclusion criteria and were included in the review. Risk of study bias was judged to range from low to high. Screen time in the absence of food advertising was consistently found to be associated with increased dietary intake compared with non-screen behaviours. Suggested explanations for this relationship included: distraction, interruption of physiologic food regulation, screen time as a conditioned cue to eat, disruption of memory formation, and the effects of the stress-induced reward system. Due to the limited number of high-quality studies available for this review, our findings are preliminary. More work is required to better establish the link between dietary intake and advertisement-free screen time and assess whether differences exist between the different screen-based activities.

Physical activity of children: a global matrix of grades comparing 15 countries

The Active Healthy Kids Canada (AHKC) Report Card on Physical Activity for Children and Youth has been effective in poweringthe movement to get kids moving by influencing priorities, policies, and practice in Canada. The AHKC Report Card process wasreplicated in 14 additional countries from 5 continents using 9 common indicators (Overall Physical Activity, Organized SportParticipation, Active Play, Active Transportation, Sedentary Behavior, Family and Peers, School, Community and Built Environment,and Government Strategies and Investments), a harmonized process and a standardized grading framework. The 15 ReportCards were presented at the Global Summit on the Physical Activity of Children in Toronto on May 20, 2014. The consolidatedfindings are summarized here in the form of a global matrix of grades. There is a large spread in grades across countries for mostindicators. Countries that lead in certain indicators lag in others. Overall, the grades for indicators of physical activity (PA) aroundthe world are low/poor. Many countries have insufficient information to assign a grade, particularly for the Active Play and Familyand Peers indicators. Grades for Sedentary Behaviors are, in general, better in low income countries. The Community and BuiltEnvironment indicator received high grades in high income countries and notably lower grades in low income countries. There wasa pattern of higher PA and lower sedentary behavior in countries reporting poorer infrastructure, and lower PA and higher sedentarybehavior in countries reporting better infrastructure, which presents an interesting paradox. Many surveillance and researchgaps and weaknesses were apparent. International cooperation and cross-fertilization is encouraged to tackle existing challenges,understand underlying mechanisms, derive innovative solutions, and overcome the expanding childhood inactivity crisis.

Screen-time weight-loss intervention targeting children at home (SWITCH): a randomized controlled trial study protocol

BACKGROUND: Approximately one third of New Zealand children and young people are overweight or obese. A similar proportion (33%) do not meet recommendations for physical activity, and 70% do not meet recommendations for screen time. Increased time being sedentary is positively associated with being overweight. There are few family-based interventions aimed at reducing sedentary behavior in children. The aim of this trial is to determine the effects of a 24 week home-based, family oriented intervention to reduce sedentary screen time on children's body composition, sedentary behavior, physical activity, and diet.

METHODS/DESIGN: The study design is a pragmatic two-arm parallel randomized controlled trial. Two hundred and seventy overweight children aged 9-12 years and primary caregivers are being recruited. Participants are randomized to intervention (family-based screen time intervention) or control (no change). At the end of the study, the control group is offered the intervention content. Data collection is undertaken at baseline and 24 weeks. The primary trial outcome is child body mass index (BMI) and standardized body mass index (zBMI). Secondary outcomes are change from baseline to 24 weeks in child percentage body fat; waist circumference; self-reported average daily time spent in physical and sedentary activities; dietary intake; and enjoyment of physical activity and sedentary behavior. Secondary outcomes for the primary caregiver include change in BMI and self-reported physical activity.

DISCUSSION: This study provides an excellent example of a theory-based, pragmatic, community-based trial targeting sedentary behavior in overweight children. The study has been specifically designed to allow for estimation of the consistency of effects on body composition for Māori (indigenous), Pacific and non-Māori/non-Pacific ethnic groups. If effective, this intervention is imminently scalable and could be integrated within existing weight management programs..