Sleep and body mass index in depressed children and healthy controls.

OBJECTIVE: Higher body mass index (BMI) has been associated with more sleep disturbance and depressive symptoms, but the combined effects of depression and BMI on sleep have not been studied in children. This study evaluated the relationship between BMI and polysomnography in children with major depressive disorder (MDD), compared to healthy controls (HCs). METHOD: The sample of 104 subjects included 72 children, 8-17 years old, with MDD and 32 similarly aged HCs with no personal or family history of psychopathology. BMI was adjusted using the CDC formula for percentiles by age. Subjects were categorized as (1) normal weight (5-84th percentile) or (2) high weight, which included at risk of overweight and overweight (> or = 85th percentile). All analyses were adjusted for sex and Tanner maturational stage scores. RESULTS: In the MDD group only, higher BMI was significantly correlated with decreased sleep efficiency, decreased percentage of rapid eye movement sleep (REM%), and higher percentage of time spent awake and moving (TSPAM). In the HC group only, higher BMI correlated with higher total sleep time. Multivariate analyses revealed significant interactions between the BMI and diagnostic groups for several REM sleep parameters, such that high-weight children from the HC and MDD groups had increases and decreases in REM sleep, respectively. TSPAM increased in the high-weight MDD group, but decreased in the high-weight HC group. CONCLUSIONS: Although limited by small sample size, these findings suggest that children and adolescents with MDD and a high BMI have more fragmented sleep than other children. The increased REM sleep patterns observed with MDD in this and other studies normalized in high-weight children with MDD. Prevention and treatment strategies should target both sleep and weight as factors that can potentially influence the development and course of MDD.

Attention training for school-aged children with ADHD: results of an open trial.

OBJECTIVE: The article discusses a feasibility study conducted to examine whether Pay Attention!, an intervention training sustained, selective, alternating, and divided attention, could be utilized in a clinical setting with children diagnosed with ADHD, and whether children who received the intervention made attention and executive functioning gains. METHOD: After a diagnostic and baseline evaluation, 23 school-aged children with ADHD participate in up to 16 sessions of Pay Attention! and the outcomes are evaluated. RESULTS: Results show the intervention is feasible to administer and acceptable to participants. Parents and clinicians rate fewer ADHD symptoms following the intervention and report improvements in executive function. Child performance on neuropsychological tests showed improvements in fluid reasoning and cognitive flexibility and working memory. CONCLUSION: The findings suggest that a randomized clinical trial of Pay Attention! is warranted to investigate its viability as a treatment for attention and executive functioning deficits in ADHD.

Fluoxetine versus placebo in preventing relapse of major depression in children and adolescents.

OBJECTIVE: The authors compared fluoxetine and placebo in continuation treatment to prevent relapse of major depressive disorder in children and adolescents. METHOD: After a detailed evaluation, children and adolescents 7-18 years of age with major depressive disorder were treated openly with fluoxetine. Those who had an adequate response after 12 weeks, as indicated by a Clinical Global Impression improvement score of 1 or 2 and a decrease of at least 50% in Children's Depression Rating Scale-Revised score, were randomly assigned to receive fluoxetine or placebo for an additional 6 months. The primary outcome measures were relapse and time to relapse. Relapse was defined as either a score of 40 or higher on the Children's Depression Rating Scale with a history of 2 weeks of clinical deterioration, or clinical deterioration as judged by the clinician. Additional analyses were conducted with relapse defined only as a score of 40 or higher on the Children's Depression Rating Scale. RESULTS: Of 168 participants enrolled in acute fluoxetine treatment, 102 were randomly assigned to continuation treatment with fluoxetine (N=50) or placebo (N=52). Of these, 21 participants (42.0%) in the fluoxetine group relapsed, compared with 36 (69.2%) in the placebo group, a significant difference. Similarly, under the stricter definition of relapse, fewer participants in the fluoxetine group relapsed (N=11; 22.0%) than in the placebo group (N=25; 48.1%). Time to relapse was significantly shorter in the placebo group. CONCLUSIONS: Continuation treatment with fluoxetine was superior to placebo in preventing relapse and in increasing time to relapse in children and adolescents with major depression.

Do children and adolescents have differential response rates in placebo-controlled trials of fluoxetine?

OBJECTIVE: Recent acute efficacy trials of antidepressants in youth have suggested that high placebo-response rates in children (< 12 years of age) indicate that children may be more responsive to non-specific treatment interventions. Yet, these studies generally have not presented age-specific outcome data. The objective of this study was to compare the efficacy outcomes for children (< 12 years of age) and adolescents (> or = 12 years of age) using the combined data from two previously published double-blind, placebo-controlled trials of fluoxetine. METHODS: Children (< 12 years of age) and adolescents (> or = 12 years of age) with major depressive disorder were randomized to fluoxetine or placebo for 8-9 weeks of treatment. Outcome was assessed using the Children's Depression Rating Scale-Revised (CDRS-R) and Clinical Global Impressions scale. RESULTS: Random regression of the CDRS-R showed a treatment group by age group interaction (F(1,338)=4.10, P=.044), indicating that the treatment effect was significantly more pronounced in children than adolescents. Within children, response at exit to fluoxetine was significantly better than placebo (56.9% vs 33.3%; P=.009). Adolescent response rates at exit were not significantly different between the groups (51.1% vs 38.6%; P=.128). Remission rates were low for both groups. CONCLUSION: In the combined fluoxetine trials, drug-placebo difference was greater in children compared with adolescents. Contrary to expectations, the placebo-response rate was lower in the children than the adolescents.

Sex and age differences in sleep macroarchitecture in childhood and adolescent depression.

SUBJECT OBJECTIVE: To evaluate age and sex differences in sleep macroarchitecture in children and adolescents with major depressive disorder. DESIGN: Ninety-seven (50 F, 47 M) symptomatic unmedicated depressed outpatients were compared with 76 healthy controls (42 F, 34 M) matched for age and sex. SETTING: Participants spent 2 consecutive nights in the sleep laboratory. PARTICIPANTS: One hundred seventy-three children and adolescents, aged 8 to 18 years. MEASUREMENTS AND RESULTS: Significant group-by-age-by-sex interactions were evident for total sleep period, percentage of Stage 1 sleep, percentage of Stage 2, percentage of slow-wave sleep, and rapid eye movement (REM) sleep latency. The depressed adolescent boys had the greatest sleep disturbance with the highest amount of percentage of Stage 1 sleep, the shortest REM latency, and the least percentage of slow-wave sleep and number of minutes of slow-wave sleep in the first non-REM period. There were minimal age differences in sleep parameters between depressed children and adolescent girls. Within age groups, the sex differences were minimal in the healthy controls. The sex differences within the depressed group were substantially larger than controls. CONCLUSIONS: These findings suggest a differential developmental influence on sleep in early-onset depression that is heavily dependent on sex. Sex differences are substantially smaller in healthy individuals compared with those with depression, in agreement with previous studies in depressed adults.

Sleep microarchitecture in childhood and adolescent depression: temporal coherence.

Previous work has indicated that low temporal coherence of ultradian sleep EEG rhythms is characteristic of depressed patients and women in particular. It may also be evident in depressed children and adolescents, although most published studies are limited in sample size. The present study evaluated temporal coherence of sleep EEG rhythms in 173 children and adolescents 8-17 years of age, including 97 who met criteria for major depressive disorder (MDD) and were symptomatic but unmedicated at the time of study and 76 healthy controls. Temporal coherence of all-night sleep EEG rhythms was evaluated on the second of two nights in the laboratory. Data were coded for diagnostic group, gender and age and subjected to MANOVAs. Temporal coherence was significantly lower in adolescents with MDD, compared to healthy controls. Findings were most robust for coherence between left and right beta and between delta and beta in both hemispheres. Both gender and age strongly influenced between-group differences, with the lowest temporal coherence among MDD girls, even in those under 13 years of age. In conclusion, early onset depression is associated with a reduction in synchronization of sleep EEG rhythms that shows a differential maturational course in boys and girls.