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Help our Wildcats Sleep and Develop...Must Reads for all Parents!

Illinois School Board Journal Looks into Students and their Sleep

Sleep science sets the snooze
By Theresa Kelly Gegen

Theresa Kelly Gegen is editor of The Illinois School Board Journal 

In 2014, the American Academy of Pediatrics released a policy statement based on studies of adolescent sleep requirements, which alarmed parents, awakened a discussion in school districts, and created a rousing chorus of “I told-you-so” from current and former teenagers. 

Starting with studies that show that the average adolescent is “chronically sleep-deprived,” and that 87 percent of high school students did not get the recommended 8-10 hours of sleep at night, the AAP examined factors that could relieve “pathological sleepiness.” 

In its policy, the AAP concluded that “adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores, and an overall better quality of life.” 

So, they should just go to bed earlier, right? Wrong. 

Sleep science has determined what almost any teen can tell you: Early bedtimes are not practicable in the adolescent and teenage world. 

Two factors determine when people are likely to sleep: Sleep-wake balance (how long it has been since you last slept) and your internal body clock, which determines the circadian rhythm that makes an individual feel wakeful or sleepy at the same time each day. 

Circadian rhythms are biological processes that naturally occur in a 24-hour cycle. They affect body temperature and daily hormonal changes, but are best known for how they impact an individual’s patterns of sleep and wakefulness. Circadian rhythms underlie human sleep habits, from an infant’s developing sleep patterns to an adult’s jet lag. 

 Most teens experience a “sleep phase delay” as they go through puberty. This is a natural shift in circadian rhythms by two hours — it’s not that they won’t fall asleep at 8 or 9 p.m. — they can’t. These natural sleep cycles of teens, combined with homework, extracurricular activities, after-school jobs, modern technology — not to mention their social lives — make early bedtimes an impracticable solution. The AAP also said, “Napping, extending sleep on weekends, and caffeine consumption can temporarily counteract sleepiness, but they do not restore optimal alertness and are not a substitute for regular, sufficient sleep.” 

In addition to physical and mental impacts, the list of academic impacts of chronic sleep loss on children and teens includes impairments in executive function, attention, and memory; deficits in abstract thinking and verbal creativity; and ultimately lower academic achievement, poor school attendance, and increased dropout rates. 

After examining the impacts, the conversation drifted towards “identifying potentially modifiable factors,” which led to the later school start times. The AAP’s recommendation: 

“… 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 …” 

Sleep science and application to school start times are not a recent development, and most studies acknowledge teen and adolescent habits are partially responsible for performance-hindering lack of sleep. A 1998 study, “Sleep Schedules and Daytime Functioning in Adolescents” by Amy R. Wolfson and Mary A. Carskadon, noted that a child’s sleep needs do not change from childhood to adolescence, but the timing of natural sleep rhythms do change. Adding “environmental constraints,” specifically early school start times, the result is that “for most teens waking up to go to school is neither spontaneous nor negotiable.” 

In 1999, U.S. Representative Zoe Lofgren (D- Calif.), began an effort that continues today, to encourage school districts to consider sleep needs when determining morning start times. Known as “ ZZZs to As,” the effort encourages school districts to move school start times to no earlier than 8:30 a.m., to improve academic outcomes. Lofgren worked with the National Sleep Foundation, which stated in a 2000 report on adolescent sleep that “Scientists hypothesize that … sleep-related problems are due largely to conflicts between physiologically-driven sleep needs and patterns, and behavioral and psychosocial factors that influence sleep habits.” 

A 2002 Maryland-based study recognized the problem of diminished sleep time but declared that because of “significant costs and impact other activities of families and communities,” later school start times were not warranted without further study. A 2004 article entitled “Sleep Wars: Research and Opinion” burrowed into the public policy discussion. More studies followed, covering circadian rhythms, perceptions of healthy sleep, and the causes and consequences of sleepiness in teens. This led to 2014, when the AAP’s report reawakened the discussion and brought sleep and school start times into mainstream discussion. 

Since then, school districts across the country have examined school start times in light of sleep science. And sleep science — such as UCLA’s Sleep Disorders Center patient education page — offers advice on creating better sleep for kids, no matter what time the bell rings: 

• Parents should create a calm atmosphere in the home at bedtime. 
• Teens should have a regular, relaxing routine just before bedtime. They often have busy, hectic schedules. They need a chance to unwind at night. 
• To help them relax, teens should avoid activities that will excite their senses late in the evening. They should find another time for computer games, action movies, intense reading, or heavy studying. 
• They should not have anything with caffeine (including soda and chocolate) after 4 p.m. 
• They should also avoid smoking and drinking. Along with hurting their health, nicotine and alcohol will disturb their sleep. 
• A regular exercise routine and a healthy diet will help them sleep better at night. 
• Keep the lights dim in the evening. Open the curtains or blinds to let in bright light in the morning. This helps keep their body clocks set at the right time. 
• If they must take a nap, they should keep it to under an hour. 
• It can be hard for teens to get enough sleep during the week. They may need to wake up later on weekends. But they should not wake up more than two hours later than the time when they normally rise on a weekday. Sleeping in longer than that will severely disrupt a teen’s body clock. This will make it even harder to wake up on time when Monday morning arrives. 

Finally, it should be noted that most of the research is assessing start times as early as 7 a.m. (and/or transportation times making for still earlier mornings). The AAP recommends changes for middle school and high school start times to “no earlier than 8:30 a.m.” 

Resources:
Policy Statement: School Start Times for Adolescents, Judith A. Owens, MD, MPH, FAAP, et al. The American Association of Pediatrics, Adolescent Sleep Working Group and Committee on Adolescence, and Council on School Health, August 2014. 

Schedules and Daytime Functioning in Adolescents, Amy R. Wolfson and Mary A. Carskadon. Child Development, August 1998. 

Association of Sleep and Academic Performance, by Arne Eliasson, Anders Eliasson, Joseph King, Ben Gould, and Arn Eliasson, Association of Sleep and Academic Performance, Thieme Medical Publishers, January 2002. 

Sleep wars: research and opinion. Susan Riter and Laurel Wills, Pediatric Clinics of North America, 2004. 

Adolescent Sleep Needs and Patterns, research report and resources guide, The National Sleep Foundation, Sleep and Teens Task Force, 2000. 

Sleep and Teens. UCLA Sleep Disorders Center , Health Patient Education.

Toddlers’ screen time linked to slower speech development, study finds

BY NSIKAN AKPAN  May 4, 2017 at 6:20 PM EDT, PBIS News Hour

A new study found children who spent more time with hand-held screens were more likely to exhibit a delay in expressive speech. Photo by triloks/via Getty Images

Hand-held screens might delay a child’s ability to form words, based on new research being presented this week at the annual Pediatric Academic Societies Meeting in San Francisco. This preliminary study is the first to show how mobile devices impact speech development in children, raising a question that fills the minds of many parents: How much time should my child spend with a mobile device? 

But for parents who see mobile devices as an education tool, don’t immediately lock away your smartphone or tablet. Here’s what you should know about the risk.

Express yourself

Studies on media usage and child development are notoriously difficult to conduct. Doctors can’t exactly split up a bunch of babies and say, “you kids spend a lot of time with your iPads, while the rest of you don’t. Let’s see what happens.”

Each additional 30 minutes of hand-held screen time was linked to a 49 percent increased risk in expressive speech delay.

So Catherine Birken, a pediatrician and scientist at the Hospital for Sick Children in Toronto, relied on well-child visits, regular checkups that assess a child’s growth, health and development. From 2011 to 2015, she asked the parents of to estimate how much time their children spent each day with hand-held screens, like smartphones, tablets and electronic games. Meanwhile, Birken and her team assessed each child with the Infant Toddler Checklist — a screening tool that looks for signs of delayed communication development. 

“It isn’t a definitive diagnosis,” Birken said, but it does assess whether a child is at-risk and needs to be referred for further evaluation. In total, Birken’s team recruited and examined nearly 900 toddlers, aged 6 to 24 months, for the study. 

By the time they reached their 18-month checkups, 20 percent of the children used mobile devices for 28 minutes on average each day. They found children who spent more time with hand-held screens were more likely to exhibit signs of a delay in expressive speech — how children use their sounds and words, and how they put their words together to communicate. 

“Parents should be wary of educational apps marketed for children 24 months or younger,” pediatrician Jenny Radesky said, because “the science on this says quite clearly that [these] children just don’t symbolically understand what they’re seeing on a two-dimensional screen.” Photo by Tim Clayton/Corbis via Getty Images

Each additional 30 minutes of hand-held screen time was linked to a 49 percent increased risk in expressive speech delay. Other forms of communication — gestures, emotions, social eye-gazing — were unaffected. 

Birken emphasized that the findings, at this stage, don’t prove cause and effect. That would require a clinical trial where children are randomly selected and tracked throughout childhood.

Birken emphasized that the findings, at this stage, don’t prove cause and effect. That would require a clinical trial where children are randomly selected and tracked throughout childhood. 

But this study highlights what could be a life-altering trend for children exposed to too much hand-held screen time because of the value of expressive speech.

“When kids can’t express themselves they get really frustrated,” said Jenny Radesky, a University of Michigan developmental pediatrician who wasn’t involved in the study. “They are more likely to act out more or to use their bodies to try to communicate or use attention-seeking behaviors.”

In the short term, an expressive speech delay can influence a child’s ability to conceptualize words or define their emotions. Though some children who are behind at 18 months or 24 months can eventually catch up, over time, these language delays can impede literacy skills in grade school. 

“Early language delays have been linked with later academic problems or not finishing high school,” Radesky said. 

Hold the phone — and interact with it too

Last autumn, Radesky’s lab reported that families fret over hand-held screen time for conflicting reasons. They worry their children will miss out on educational opportunities or lack digital literacy without the devices, but wonder if fast-moving technology stifles creativity or displaces family time. 

But Radesky, who co-authored the American Academy of Pediatrics’ recent guidelines for children’s media use, said the problem lies less with mobile devices, and more with how we use them.

“Kids can start to learn language from media, if they’re watching with a parent who then uses the media as a teaching tool,” Radesky said. “Help the child apply it to the rest of the world around them — the way parents often do with a book.”

If parents are introducing young children to mobile technology, they should try and do it in a way that teaches the child to use the device as a tool rather than purely for entertainment. Photo by Tang Ming Tung

Radesky said that’s tricky because media designers sometimes forget to build content that’s interactive for both a parent and a child. She offered Daniel’s Tiger as a counterexample that hits the mark for teaching social, emotional and language skills with parent-child interactions.

Also, parents should be wary of educational apps marketed for children 24 months or younger, she said, because “the science on this says quite clearly that [these] children just don’t symbolically understand what they’re seeing on a two-dimensional screen.”

Birken’s study didn’t distinguish between whether educational or entertainment media influences the risk of expressive delay, but the trend did hold regardless of income level and maternal education. Her future studies could also look into how parents’ mental health, literacy legacy within a family and access to other caretakers like grandparents factor into the hand-held device usage and language development.

“One of the challenges is the pace of technology is outstripping the pace of research,” Birken said. “It’s a big challenge.”

But Radesky recognizes the allure of passing back a smartphone in a car to placate a child, but if they’re introducing young children to the technology, they should try and do it in a way that teaches the child to use the device as a tool rather than purely for entertainment. Kids can become tech savvy by learning how to find whether their grandma is online on Skype or by taking and sharing funny pictures.

“If they really want to promote some sort of language learning or developmental stimulation, that is always still done best through interpersonal interaction,” Radesky said.