Yoga therapy and autism: OK but "better trials are required to confirm the positive impact"

I approach the findings reported by HM Vidyashree and colleagues [1] with my typical critical eye but perhaps also with a sense of 'receptivity' to the idea that yoga training *might* be useful for some people diagnosed as being on the autism spectrum. My receptivity is there because: (a) "yoga is a safe and effective way to increase physical activity, especially strength, flexibility and balance" according to the NHS guide to yoga, and (b) putting aside any (non-testable) spirituality or the like associated with yoga use, I'd like to think that some of the aims of and techniques used in yoga are similar to that seen with some of the martial arts. As well as being a fan of the martial arts - Shotokan karate is my particular hobby - certain martial arts already have some quite positive 'history' in the context of autism in the peer-reviewed science arena (see here and see here for examples). We'll see what we'll see...

The Vidyashree paper had the aim: "to investigate the effect of yoga intervention on short-term heart rate variability (HRV) in children with ASD [autism spectrum disorder]." HRV is basically what it describes: "a measure of the variation in time between each heartbeat." That variation is controlled by something called the autonomic nervous system (ANS), which basically regulates various bodily functions typically minus conscious input from ourselves. From what I gather, a low HRV is something to be avoided; as people talk about a higher HRV being linked to better cardiovascular fitness as well as increased resilience to stress (whatever that means). You probably won't be surprised to hear that HRV has been previously talked about with autism in mind [2], albeit with a lot more investigation required (see here).

So: "50 children (38 boys and 12 girls) with ASD were recruited from Swabhimaan Trust, Palavakkam, Chennai." All were diagnosed with an autism spectrum disorder (ASD) and "were grouped into ASD with yoga intervention (n = 25) and ASD without yoga intervention group (n = 25) by simple lottery method." HRV was recorded via an ECG (electrocardiogram) on two occasions, before and after intervention/non-intervention. Said yoga intervention - in 40 minute sessions - was apparently delivered "every day in the morning" over 3 months. That's quite a few sessions...

Results: bearing in mind 10 participants and 5 participants from the yoga and non-yoga groups respectively were excluded from the data analysis side of things, a few details were observed. So: "There is a significant reduction in mean HR [heart rate]... in the ASD children after yoga intervention." As a group, the mean baseline HR for the yoga group was around 90 beats per minute. After intervention, this dropped to under 80 beats per minute. At the same time, the non-yoga group showed an increase in their mean heart rate over the same period. Other results, more technical results, are also included in the Vidyashree paper which I believe translate into measuring HRV [3]. I can't pretend to know all the hows-and-whys of those results, but with a cursory reading of the literature in this area, am willing to go along with the authors' conclusions that results: "showed significant improvement" coinciding with the yoga intervention.

Obviously a lot more study is required in this area before any grand claims about yoga or anything else are made in the context of autism. The Vidyashree results were firmly focused on HRV following yoga and said nothing about how yoga may/may not have affected some of the behavioural profiles associated with autism for example. Likewise, all the stuff about lower HRV being linked to greater resilience to something like stress have not been fully analysed in the context of the current results either. All of this comes alongside the methodological issues that accompany the Vidyashree: an open-trial, yoga vs. no yoga, etc.

But I still remain interested in the potential of something like yoga in many contexts including that related to autism...

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[1] Vidyashree HM. et al. Effect of Yoga Intervention on Short-Term Heart Rate Variability in Children with Autism Spectrum Disorder. Int J Yoga. 2019;12(1):73–77.

[2] Daluwatte C. et al. Atypical pupillary light reflex and heart rate variability in children with autism spectrum disorder. J Autism Dev Disord. 2013 Aug;43(8):1910-25.

[3] Shaffer F. & Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5:258. Published 2017 Sep 28.

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"no good evidence that time in front of a screen is "toxic" to health"

BBC News January 4 2019

Quite a few days back the BBC here in Blighty ran the headline "Worry less about children's screen use, parents told" as part of their coverage of the paper by Neza Stiglic & Russell Viner [1]. This paper - "a systematic review of reviews" no less - set out to "systematically examine the evidence of harms and benefits relating to time spent on screens for children and young people’s (CYP) health and well-being, to inform policy."

Informing policy is just what the Stiglic/Viner paper did (see here), as the Royal College of Paediatrics & Child Health (RCPCH) concluded that: "Many of the apparent connections between screen time and adverse effects may be mediated by lost opportunities for positive activities (socialising, exercise, sleep) that are displaced by screen time" but parents shouldn't necessarily get too stressed if their offspring find some enjoyment in their computer/tablet and/or phone in amongst their busy lives. Indeed it was refreshing to see that children and young peoples' voices were being heard on the potential benefits of screen time, with comments such as: "Gives you knowledge" and "Provides you with more opportunities to reach a wider community." All those hours of watching You Tubers fooling around or building whatever on Roblox or similar platforms can actually be intermixed with something approaching gaining knowledge; i.e. learning. Who knew!

The Stiglic/Viner review paper drew on data from 13 reviews reporting "associations between time on screens (screentime; any type) and any health/well-being outcome in CYP [children and young people]." All was not however completely rosy when the reviews were boiled down to a consensus, as we are told that authors found "moderately strong evidence for associations between screentime and greater obesity/adiposity and higher depressive symptoms" and "moderate evidence for an association between screentime and higher energy intake, less healthy diet quality and poorer quality of life." I don't think anyone should really be surprised that more screen time *might* mean an increased tendency towards being overweight or obese. If one subscribes to the idea that energy in - energy out is at least partially related to being overweight or being obese [2] it stands to reason that unless people are running around whilst using their tablets or phones, there is likely to be less 'energy out'.

As for the 'higher depressive symptoms', well let's just say that this is something else that is no stranger to the debate about screen time, as other recent research has similarly observed (see here). Whether it is the actual use of tablets, phones and/or television or the type of material being accessed [3] *correlating* with depression is a question that needs further investigation. I might add that the scenario of when screen time turns into an addiction also needs to be discussed in this context (see here), bearing in mind the limitations of observational studies in relation to discerning cause-and-effect.

Also: "There is weak evidence for association of screentime with behaviour problems, anxiety, hyperactivity and inattention, poorer self-esteem and poorer psychosocial health in young children." Bearing in mind that 'weak evidence' does not mean 'no evidence', this part of the Stiglic/Viner review paper is also important. It means that sweeping conclusions that screen time is somehow playing a major role in the rise of behaviour problems in children (young and old) are not yet necessarily backed up by the scientific evidence. Indeed, as per other topics on this blog, I'd advance the position that certain facets of screen time may actually be advantageous to quite a few children and young people (see here) who are perhaps not for example, the social butterflies that other children are.

The Stiglic/Viner review and subsequent RCPCH advice does not say that screen time for children is risk-free. It does not say that parents shouldn't be continually asking questions about how long their children spend using screens and/or what material they are accessing. It does however mean that, on the basis of the currently available evidence, parents shouldn't get too stressed about moderate screen use in their offspring. Balance things out with the odd physically active inclined hobby or two (avoiding any tiger parenting notions) by all means, but don't stress too much about their swiping. See the potential positives as well as the potential negatives of screen use, and remember that screen time is an inevitable part of growing up these days...

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[1] Stiglic N. & Viner RM. Effects of screentime on the health and well-being of children and adolescents: a systematic review of reviews. BMJ Open. 2019;9:e023191.

[2] Malhotra A. et al. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. Br J Sports Med 2015;49:967-968.

[3] Kelly Y. et al. Social Media Use and Adolescent Mental Health: Findings From the UK Millennium Cohort Study. EClinical Med. 2019. Jan 4.

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"Children are getting weaker, study finds"

The title of this post - "Children are getting weaker, study finds" - comes from one of the media headlines covering the study findings presented by Gavin Sandercock & Daniel Cohen [1]. In their study, the authors detail results derived from the Chelmsford Children's Fitness and Activity Survey, an initiative that has been monitoring the fitness of local children (local to Chelmsford) for about 20 years. Their results for the most recent cohort (2014) compared with previous study cohorts (2008, 1998) make for worrying reading: children are getting weaker alongside "a decrease in self-reported physical activity concurrent with the accelerated declines in fitness from 2008 to 2014."

So: "We measured; height, weight, standing broad-jump, handgrip, sit-ups and bent-arm hang in 10-year-old boys and girls from Chelmsford, England in: 2014 (n = 306), 2008 (n = 304) and 1998 (n = 310)." Researchers also asked about recent physical activity among their cohort using the Physical Activity Questionnaire for Children/Adolescents (PAQ-C), a self-report questionnaire. The collected results were analysed and among other analyses, authors "compared percentage change per year 1998–2008 with 2008–2014" across the variables being studied.

As per the headline, the results were worrying: "Pairwise comparisons showed muscular fitness of both sexes was significantly lower in 2014 than in 1998." They also observed that self-reported physical activity was lower in the later cohort. Obviously, I need to stress that this was self-reported physical activity information, so not exactly objective actigraphic data for example. Out of the several results reported relating to specific aspects of fitness across the cohorts, the issue of handgrip strength stuck out for me in light of some still emerging research suggesting that handgrip strength might have "prognostic value for mortality" according to some studies. Without wishing to make connection when none might exist, I do wonder whether such data might one day eventually tally with some other quite worrying statistics on longevity recently published?

Another detail discussed by Sandercock & Cohen is their finding that "Ten-year-olds in 2014 were taller and heavier than in 2008 and 1998 but there were no differences in BMI [body mass index]." They authors talk about this more in their media interviews: "As today's ten-year-olds are taller and heavier than the children measured six and 16 years ago we expect them to be stronger and more powerful, but this was not the case." Worrying. And it also appears that the declines in strength were increasing more rapidly in the later cohort than compared with the earlier ones, as the authors mention that from 1998 to 2008, strength (group strength) fell by just over half a percent per year, whereas from 2008 to 2014 this decline increased to 1.6% per year.

So what does this all mean for the health and well being of the next generation, and what can be done to reverse such trends? Well, health in childhood is often a good indicator of what health will look like in adulthood. I say this not only from a physiological point of view but also bearing in mind that habits bred in childhood tend to persist into adulthood. Low levels of physical activity probably also follow that pattern.

The possible reasons to account for the cohort disparities? Minus any sweeping generalisations I don't think it would be out of place to mention that things have changed quite a bit when it comes to hobbies and pastimes for at least some parts of the paediatric population. More time spent playing video games or on the Internet have perhaps replaced previous scenarios when kids would meet (in person), play out, run around, climb trees, play football and the like. I don't say that to demonise such digital pastimes (see here) but rather to point out a shifting pattern in activities that also have been noted in other relevant studies [2]. It's perhaps also worthwhile pointing out that opportunities for physical activity have also perhaps changed as a function of the environment we now live in. Why else would schools have had to implement strategies such as the daily mile for example?

Possible solutions? When I first tweeted about the publication of the Sandercock & Cohen article I added in the idea that physical activity specifically along the lines of strength and conditioning could perhaps be added to the learning curriculum. So, alongside maths and English (here in Blighty), there is also a focus on physical education too. Yes, I know physical ed(ucation) is part of the school agenda, but I actually meant something like getting kids into a gym and doing something akin to circuit training at least a few times a week. I know this is ambitious and I know that not every kid is going to be able to do this. But surely in these days of adaption and flexibility in teaching and learning, there are also ways to make such exercise open to all. And you never know, start children young with the mindset that exercise is fun and good for physical (and mental) health, and it might just serve them for a lifetime...

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[1] Sandercock GRH. & Cohen DD. Temporal trends in muscular fitness of English 10-year-olds 1998–2014: An allometric approach. Journal of Science and Medicine in Sport. 2018. Aug 1.

[2] Walsh JJ. et al. Associations between 24 hour movement behaviours and global cognition in US children: a cross-sectional observational study. The Lancet Child & Adolescent Health. 2018. Set 26.

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Exercise may protect against the development of depression

"Available evidence supports the notion that physical activity can confer protection against the emergence of depression regardless of age and geographical region."

So said the findings reported by Felipe Schuch and colleagues [1] who undertook a review of the existing peer-reviewed research literature looking at whether physical activity a.k.a exercise *might* provide some important protection against the development of depression. Such a review took place in the context that NHS Choices, the go-to place for health and medical information here in Blighty, already has an entry called 'exercise for depression'.

The authors - many of whom are quite recognisable names in the area of science looking at the physical and the mental coexisting together - located almost 50 studies labelled as prospective cohort studies including over a quarter of a million participants residing across the globe. They undertook a meta-analysis - combining all the data from the various studies together and coming up with a sort of consensus finding - and concluded that yes, physical activity does seem to have a positive effect on reducing the risk of depression. The level of the decrease in risk of depression from participation in physical activity seemed to vary slightly according to age, amount of exercise and geographical region, but the trend was most definitely in the protective direction across such variables and remained even after potentially important variables such as body mass index (BMI) and tobacco smoking were taken into account. The authors also reported that: "Although significant publication bias was found, adjusting for this did not change the magnitude of the associations" indicating that although there was a tendency for results 'friendly' to the 'physical activity might reduce depression' hypothesis to be published over less positive results, this did not seemingly affect the findings in any particularly meaningful way.

Accepting that there is a further scheme of work required on this topic in terms of things like what physical activities might be 'best' for depression or depressive symptoms (see here), how to measure physical activity more objectively (ahem, actigraphy) and what the mechanism(s) of effect might be, these are important results. I can think of many, many different areas that the Schuch results could be pertinent to; several already covered on this blog (see here and see here). Many of those areas / conditions / labels reflect states where either physical activity seems to be reduced by choice (see here) or through necessity (see here) but the net result could be the same in terms of elevated risk of depression.

Still, the general message emerging from the Schuch paper is: if you can, move more, and perhaps not just for the physical benefits that accompany physical activity.

And just in case you need some more reading material on this topic, you could do a lot worse than the paper by Brett Gordon and colleagues [2] who concluded that: "Resistance exercise training significantly reduced depressive symptoms among adults regardless of health status, total prescribed volume of RET, or significant improvements in strength."

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[1] Schuch FB. et al. Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies. Am J Psychiatry. 2018 Apr 25:appiajp201817111194.

[2] Gordon BR. et al. Association of Efficacy of Resistance Exercise Training With Depressive Symptoms. JAMA Psychiatry. 2018. May 9.

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Violent ideation and behavior in relation to serious mental illness: substance abuse counts

I approach the findings reported by Matthew Roché and colleagues [1] in the same way as I would any other peer-reviewed science results covering the topic of violence in relation to a diagnosis / label / condition: cautiously and minus the need for sweeping generalisations (see here), but without shying away from potentially important findings.

Roché et al discuss results based on their analysis of "intake records of 63,572 patients diagnosed with SMIs [serious mental illness] (i.e., schizoaffective disorder, schizophrenia, bipolar disorder, and unipolar depression), substance use disorders, and non-SMI psychiatric disorders" in relation to the risk of violent ideation and behavior (VIB). As well as looking at the frequency of VIB among their cohort, they also looked for other variables outside of a diagnosis of SMI that may impact on VIB.

Results: "patients with SMI conditions had higher rates of VIB than both patients with non-SMI psychopathology and those with substance use disorders only." No, this does not make for great PR for SMIs but is a reality of their observations. Further: "patients with SMI and comorbid substance use pathology were responsible for the majority of VIB within each SMI condition." This equation - SMI plus substance abuse equals greater risk of violence - is something that is becoming rather important based on the peer-reviewed science literature. It follows other independent findings [2] too and might even link into other areas.

Appreciating that those diagnosed with a SMI are also at greater risk of being a victim of crime (see here) including crime with a violent element attached to it, there are some important lessons to be learned from the Roché data. Not least is the potential focus on reducing comorbid substance abuse in the context of a diagnosis of serious mental illness so as to potentially modify the heightened risk of VIB and also, other less than desirable outcomes [3]. This is not something that can be done easily (see here) but does not mean it cannot be attempted at all.

I might also add that violence, as and when it does occur in the context of SMI, is likely to be related to other social and situational factors as well as being influenced by something like substance abuse (disorder). Indeed, in the context that various aspects of life can very much be *altered* by the experience of an SMI (diet, physical activity, etc) I'm minded to direct your attention to other variables potentially important to VIB such as nutritional factors for example (see here and see here). Science might also perhaps look to other diagnoses that potentially complicate the clinical picture in SMI as perhaps also exerting any effect on the risk of VIB (see here) and the [developmental] importance of transitioning risk from one label to another (see here) again, minus any sweeping generalisations. Finally, and minus passing the buck, the findings reported by Patel and colleagues [4] further complicate the clinical picture...

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[1] Roché MW. et al. Prevalence and Risk of Violent Ideation and Behavior in Serious Mental Illnesses: An Analysis of 63,572 Patient Records. J Interpers Violence. 2018 Mar 1:886260518759976.

[2] Fazel S. et al. Schizophrenia, substance abuse, and violent crime. JAMA. 2009 May 20;301(19):2016-23.

[3] Skalisky J. et al. Prevalence and Correlates of Cannabis Use in Outpatients with Serious Mental Illness Receiving Treatment for Alcohol Use Disorders. Cannabis Cannabinoid Res. 2017 Jun 1;2(1):133-138.

[4] Patel RS. et al. Is Cannabis Use Associated With the Worst Inpatient Outcomes in Attention Deficit Hyperactivity Disorder Adolescents? Cureus. 2018 Jan 7;10(1):e2033.

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Is early adolescent physical activity protective against later "chronic disabling fatigue"?

TIE fighter crossing the moon?

One particular detail in the recent paper by Simon Collin and colleagues [1] (open-access available here) talking about higher physical activity potentially being *protective* against subsequent adolescent 'fatigue', immediately caught my attention: "CDF [chronic disabling fatigue], a proxy for clinically diagnosed CFS/ME [chronic fatigue syndrome/myalgic encephalomyelitis]."

This is not the first time that this authorship group have used the term CDF and seen it's use 'merging' into meaning something close to or like CFS/ME (see here) and I doubt that it will be the last. Far be it from me to put myself forward as some sort of expert on diagnosing CFS/ME - I'm not - but CDF as representing a proxy for CFS/ME does not mean that CDF is the same as CFS/ME. And that's also bearing in mind that the issue of diagnosis of CFS/ME is still the topic of lots and lots of (continuing) discussion (see here)...

Keeping all that in mind, I do want to briefly talk about the new paper from Collin et al. The Avon Longitudinal Study of Parents and Children (ALSPAC) was, once again, the data source for their findings, and yet again, this was a study looking at adolescent and young adults. The aim of the study was to: "investigate whether levels and patterns of physical activity at age 11 years are associated with ‘chronic disabling fatigue’... at ages 13 and 16 years."

A strength of the Collin research is that authors looked at more than just subjective 'how much exercise did you do' questionnaire via their use of actigraphy. So: "All ALSPAC children who attended research clinics at age 11 years... were asked to wear an Actigraph AM7164 2.2 accelerometer (Actigraph LLC, Fort Walton Beach, Florida, USA) for 7 days." Further: "Data from children who had worn the accelerometer for at least 10 hours a day for at least 3 days were considered valid" and from such data various calculations were made in terms of sedentary time, total physical activity and the proportion of "moderate-to-vigorous physical activity." Such data was analysed in the context of CDF measurements at ages 13 and 16 using methods previously described in their other research [2].

Results: "Children who had CDF at age 13 years had lower levels of physical activity at age 11 years." The authors translated this into various stats including: "For each additional 1% of monitored time spent in moderate-to-vigorous activity, the odds of CDF were reduced by 16%" and "Each additional hour of sedentary time per day was associated with 35% higher odds of CDF."

But just before anyone thinks that pushing children off the sofa and into some moderate-to-vigorous exercise in early adolescence is some kind of magical shield protecting against CDF, a few words of caution from the authors might also be important. Namely: "the lower levels of physical activity at age 11 years [may be] a consequence of chronic fatigue which is already present or developing and which persists until the child is 13 years old." In other words, there could be an alternative explanation for the lower physical activity (PA) levels *causing* chronic disabling fatigue; those who didn't do much PA were already developing and manifesting CDF...

"The main limitation of our study is that children were not assessed by a doctor, which is why we describe our outcome as ‘chronic disabling fatigue’, a proxy for CFS/ME." Yup, no arguments there; also reiterating why one needs to be quite careful about the terminology used around CFS/ME. The suggestions that lower physical activity might show a *correlation* with CDF also needs to be carefully handled given some continuing conversations about 'exercise therapy' in the context of CFS/ME (see here) and in particular, what various patients have been reporting from interventions in this area (see here)...

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[1] Collin SM. et al. Physical activity at age 11 years and chronic disabling fatigue at ages 13 and 16 years in a UK birth cohort. Arch Dis Child. 2018 Jan 30. pii: archdischild-2017-314138.

[2] Norris T. et al. Natural course of chronic fatigue syndrome/myalgic encephalomyelitis in adolescents. Arch Dis Child. 2017 Jun;102(6):522-528.

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Bone health and autism continued

It's been a while since I last wrote about the topic of bone health and autism (see here). On that particular occasion, it was the work by Ann Neumeyer and colleagues [1] that provided the blogging fodder and the observation that: "BMD [bone mineral density] is lower in peripubertal boys with ASD [autism spectrum disorder]." BMD is important because of a possible association between lower BMD and risk of fracture or indeed, something more pathological.

Today I continue with this topic as per further work from Neumeyer and colleagues [2] looking to "examine macro- and micronutrient intakes and self-reported physical activity in boys with ASD compared to TDC [typically developing controls] and the relationship of these variables with BMD."

Based on data from nearly 50 boys aged 8-17 years of age (25 diagnosed with ASD and 24 not-autism controls), researchers once again relied on the technique known as dual-energy x-ray absorptiometry (DXA) for the measurement of bone mineral density. Various measures were taken from various parts of the body -"whole body less head, hip, and spine." Alongside, food diaries provided a rough-and-ready measure of food intake, self-reported physical activity (that's self-reported) did what it said on the tin, and fasting levels of 25(OH) vitamin D and calcium were garnered. I'll come back to some of the pros-and-cons of some of these measures shortly.

Results: consistent with the peer-reviewed data that has come before, BMD z scores at the lumbar spine, femoral neck, total hip, and whole body less head were lower in those with autism compared with control participants. A BMD z score by the way, is basically a comparison of BMD with that of standardised data (i.e. an average person of the same sex and age). Added to such results, authors also observed that less calorie intake was present in the ASD group (again compared with controls) and a "lower proportion of ASD participants were categorized as "very physically active" (27% vs 79%; P<0.001)." Interestingly however: "Body mass index and serum vitamin D and calcium levels were similar."

I was rather intrigued by the Neumeyer results. Not least that vitamin D and calcium levels were 'similar' in the autism and control groups. As I've discussed before on this blog, there have been calls for preferential screening for these biological parameters as and when an autism diagnosis is received (see here) in light of other findings (see here). The Neumeyer observations perhaps reflect a wider need for such screening.

The use of self-report as a measure for physical activity, whilst useful, is slightly outdated in these times of actigraphy. Wearable technology to measure activity and rest cycles is cheap and abundant these days and, as I've mentioned on other occasions, really should be the research industry standard. I'm not saying people might not be accurate in reporting their short-term physical activity but...

I do think there are some additional 'where next?' things to consider when it comes to future work looking at BMD and autism. Noting for example, that both dietary and malabsorptive issues seem to be able to influence BMD [3] there are additional parameters to be looked at. Given previous peer-reviewed reports on lactose issues being present in relation to autism (see here), this could feature in future work. Although still possessing the ability to furrow brows in certain quarters, the observation of issues with intestinal permeability ('leaky gut') in relation to some autism (see here) also could be an additional parameter to examine. I daresay also that some initial chatter about a compound called zonulin potentially serving as a 'biomarker of impaired gut barrier function' in relation to some autism (see here) might also be revealing. And then there is the important issue of epilepsy / seizure disorder often being comorbid with autism (see here), and how certain [important] intervention measures for said issues might affect parameters such as vitamin D (see here) and what that might mean for long-term bone health...

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[1] Neumeyer AM. et al. Bone density in peripubertal boys with autism spectrum disorders. J Autism Dev Disord. 2013 Jul;43(7):1623-9.

[2] Neumeyer AM. et al. Nutrition and Bone Density in Boys with Autism Spectrum Disorder. J Acad Nutr Diet. 2018 Feb 3. pii: S2212-2672(17)31749-5.

[3] Di Stefano M. et al. Lactose malabsorption and intolerance and peak bone mass. Gastroenterology. 2002 Jun;122(7):1793-9.

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Sleep duration and ADHD: a correlation across the years?

"Longer sleep duration (>10 hours per day) was associated with a lower ADHD [attention-deficit hyperactivity disorder] symptom score" was one of the findings reported by Gabriela Peralta and colleagues [1].

They sought to examine whether a particular set of activities (sleeping, physical activity, television watching, etc) might show some *correlation* to "(1) attention-deficit/hyperactivity disorder (ADHD) symptoms and (2) behavior problems, both assessed at 7 years, in ADHD-free children at baseline."

Drawing on a not-insignificant number of children participants (N=817) who were part of a research birth cohort previously discussed on this blog (see here and see here), authors relied on parental report via the Conners' Parent Rating Scales and the Strengths and Difficulties Questionnaire to ascertain ADHD and 'behaviour problem' scores respectively. This was carried out when the child was aged around 7 years old. A few years earlier - when the child was around 4 years old - parents had previously reported on a few other variables: "the time that their children spent sleeping, watching TV, engaging in cognitively stimulating activities, and engaging in physical activity." The two sets of data were married together for analysis.

Results: it's probably not escaped your notice that (a) parental report is a mainstay of the Peralta data and (b) data for a child at 4 years old and then again at 7 years old represents quite a large time frame during which lots can (and does) happen. With those factors firmly in mind, researchers provided some frequency data on activities at 4 years old. They then added in the data taken at 7 years old where that finding on longer sleep duration (at 4 years) seemed to be linked to lower ADHD scores (at 7 years) came from. Further: "Longer time spent in cognitively stimulating activities (>1 hours per day) was associated with lower scores of both ADHD symptoms... and behavior problems" and also rather interestingly: "Time spent watching TV and engaging in physical activity were not associated with either outcomes."

The quite fuzzy picture emerging from this data - with appropriate caveats - is that sleep and 'keeping the mind active' might be important factors when it comes to the presentation of something like ADHD (symptoms) and other 'behaviour problems' in childhood. The sleep side of things is particularly topical at the moment, given some research chatter about how a sleep intervention might be something to consider for at least some (diagnosed) cases of ADHD (see here). There are also seemingly lots of benefits from ensuring a regular bedtime routine for young children; assuming that is, that poor sleeping patterns are not an early marker for possible ADHD?

The whole 'cognitively stimulating activities' bit is slightly more fluffy in terms of what constitutes such activities and any relationship with ADHD or behavioural issues. I say this on the basis that whilst reading and writing for a 4-year old is likely to be cognitively stimulating, so are lots of other activities such as exploring nature for example or even spending time on the dreaded computer/tablet devices (depending on what activities are being done). Even time spent in front of the gogglebox could be considered cognitively stimulating if they're watching Blue Planet for example, and not just a re-run of Peppa Pig (sorry Peppa). And on the topic of television viewing or at least screen time in the context of ADHD risk, other data have suggested something *correlatively* different from the Peralta findings (see here) just to complicate matters further.

To close, it's been a while but here is some music... Elvin Bishop and a track brought back to life by the Guardians...

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[1] Peralta GP. et al. Sleeping, TV, Cognitively Stimulating Activities, Physical Activity, and ADHD Symptom Incidence in Children: A Prospective Study. J Dev Behav Pediatr. 2017 Dec 18.

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An exercise intervention for autism

"Our results provide support for exercise and physical activity, including basic coordination and strength exercises, as important therapeutic interventions for children with ASD [autism spectrum disorder]."

So said the results published by Chrystiane Toscano and colleagues [1] looking at an important, and sometimes easily overlooked, avenue of intervention with autism in mind: physical activity. I say 'intervention' but as with quite a few other programs/activities described in such terms, it's often more about offering equal access to things that most children (and adults) take for granted. Indeed, to 'intervention-ise' something like exercise in the context of autism kinda follows a pattern where even playing with some well-known connecting blocks is sometimes talked about in 'therapeutic' terms when mentioned alongside autism rather than just being play (see here). One has to be quite careful about the language used...

Anyhow, various parameters were monitored and measured as "a 48-week exercise-based intervention" was put into place looking at the presentation of autism as well as various physical-metabolic variables: "high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and total cholesterol."

Bearing in mind potentially problematic issues such as a lack of blinding - double-blinding - and of course the idea that exercise really needs to make you feel happy in order to keep doing it, researchers reported that many aspects seemed to improve over the quite long study period, more so for the group in receipt of exercise intervention. Not only did physical indicators show improvements, so did autistic features and also "parent-perceived quality of life" too.

Allowing for the fact that there could be 101 different variables impacting on the Toscano results outside of the increase in physical activity, I am happy to see that exercise is a continued focus when it comes to the autism spectrum [2]. There is literally oodles and oodles of research out there talking about how sedentary behaviour(s) do seem to be over-represented in relation to autism (see here for example) and where they could (in part) lead (see here); bearing in mind the sentiment: you can't outrun a bad diet. Anything that gets kids (and adults) up and active has to be a good thing.

Once again, I'm going to draw your attention to one potential exercise option that ticks many boxes when it comes to the autism spectrum and beyond: the martial arts (see here and see here). Physical activity... check. Focus on "basic coordination and strength"... check. Focus on predefined and (sometimes very) repetitive patterns of movement... check. Focus on individual performance set within a social context... check. Regular accomplishment levels - gradings - to boost confidence, pride and self-esteem... check. Something that will make any would-be bullies perhaps think twice or thrice... check.

And of additional importance to any discussions on exercise and physical activity, the data from Flygare Wallén and colleagues [3] highlight the important physiological reason(s) why getting those on the autism spectrum moving more is so damn important...

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[1] Toscano CVA. et al. Exercise Effects for Children With Autism Spectrum Disorder: Metabolic Health, Autistic Traits, and Quality of Life. Percept Mot Skills. 2017 Jan 1:31512517743823.

[2] Najafabadi MG. et al. The Effect of SPARK on Social and Motor Skills of Children with Autism. Pediatrics & Neonatology. 2018. Jan 6.

[3] Flygare Wallén E. et al. High prevalence of diabetes mellitus, hypertension and obesity among persons with a recorded diagnosis of intellectual disability or autism spectrum disorder. J Intellect Disabil Res. 2017 Dec 26.

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Severe mental illness translates into "more sedentary behavior and significantly less physical activity"

The title of this post reflects the findings reported by Davy Vancampfort and colleagues [1] (open-access) who concluded that various diagnoses - "schizophrenia, bipolar disorder or major depressive disorder" - under the label of severe mental illness were associated with decreased physical activity and increased sedentary behaviour(s).

Under the auspice of a "global systematic review and meta-analysis", authors settled on some 70-odd studies that met their search criteria comprising over 35,000 people diagnosed with one of the conditions described and nearly 3000 asymptomatic (asymptomatic for severe mental illness) controls. Vancampfort et al describe assessing for "co-primary outcomes" that "were the mean time (min) per day that people with severe mental illness and healthy controls (in case-control studies) engaged in physical activity, or were sedentary." They found "23 study estimates of physical activity were based on objective measures, three utilized objective and subjective measures and 57 were based on self-report questionnaires"; something important in the context of the technology available to measure activity these days.

Results: Those diagnosed with a severe mental illness (SMI) were "more sedentary than age- and gender-matched controls from the general population, spending a mean of 476 min per day (or almost 8 hours) during waking hours in sedentary behavior." Further: "people with severe mental illness are significantly less physically active and spend only an average of 38.4 min per day in moderate or vigorous physical activity." When tweeting about this article, one of the authors - Brendon Stubbs - also linked to another important paper [2] published on the same day as their own, observing that: "Increasing physical activity is a simple, widely applicable, low cost global strategy that could reduce deaths and CVD [cardiovascular disease] in middle age." It's not difficult to see the connection(s) between the two findings.

"Our data documented that higher body mass index, lower cardiorespiratory fitness, and antidepressant or antipsychotic prescription might constitute barriers for engaging in physical activity." One of the value-added bits to the Vancampfort data were the discussions on some of the barriers to engaging in physical activity in those with SMI. Combined with observations such as: "Those who are single or unemployed, those with a low educational level and men are less physically active" it's not too difficult to see what areas might need to be 'tackled' if physical activity levels are to be improved. Indeed, other data (see here) has even talked about what types of exercise might be best suited to what labels (minus any sweeping generalisations).

And since I've mentioned the topic of depression in this post, I might also draw your attention to another paper recently published by Joseph Firth and colleagues [3] - one of the authors on the Vancampfort paper - talking about how technology might provide a useful backdrop to intervention for depressive symptoms. Specifically how the delivery of smartphone apps might be something useful to consider in the context of depression. Indeed, if one assumes that physical activity levels might also be lower in relation to something like depression, one could forsee a time when one or more smartphone apps might either prompt the need for more physical activity or even potentially offer a tailor-made physical activity schedule complementary to other intervention options...

Music to close and Sammy singing Mr Bojangles...

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[1] Vancampfort D. et al. Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry. 2017. Sept 21.

[2] Lear SA. et al. The effect of physical activity on mortality and cardiovascular disease in 130 000 people from 17 high-income, middle-income, and low-income countries: the PURE study. Lancet. 2017. Sept 21.

[3] Firth J. et al. The efficacy of smartphone-based mental health interventions for depressive symptoms: a meta-analysis of randomized controlled trials. World Psychiatry. 2017 Oct;16(3):287-298.

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Obesity and overweight in autism meta-analysed

So: "The meta-analysis showed a significant association between obesity and ASD [autism spectrum disorder]. However, no significant association was identified between overweight and ASD."

Those were the conclusions reached by Zhen Zheng and colleagues [1] (open-access) who surveyed the pertinent peer-reviewed science literature up to November 2016 on the topic of the prevalence of overweight and obesity in relation to the autism spectrum (see here).

Including some 15 studies in their meta-analysis mix "encompassing 49,937,078 participants and 1,045,538 individuals with ASD" authors observed a connection between obesity and autism (a body mass index - BMI - between 30 and 39 for obesity and 40 and over for severely obese) but not being overweight. Among the many analyses undertaken by the authors, we are told that "the sensitivity analysis showed that removing any study did not change the final results, suggesting that our findings were robust."

Zheng et al have covered many bases when it comes to the interpretation of their findings. Feeding and eating issues potentially making "healthy dietary interventions less effective"... check (see here). Physical activity levels and 'sedentary activities'... check (see here). Potential side-effects of medication - antipsychotic medication in particular - check (see here). Also: "some individuals with ASD have been reported to have 16p11.2 or 11p14.1 microdeletions, which encompass genes related to obesity susceptibility." Yup, some genetic conditions that manifest autism also place that person at a greater risk for weight issues, either directly or peripherally.

Minus any sweeping generalisations, there are some obvious implications from such results. Obesity places a person at some heightened risk for various adverse health outcomes and potentially, early mortality outside of other, more socially-defined adversities. Prevention and treatment are key. Yes, facets of autism may make intervention slightly more complicated than perhaps noted in not-autism populations but that does not mean that one should not try to impact on the variables that lead someone down a pathway to obesity. And such intervention should be multi-faceted and perhaps also take into account a role for comorbidity that seemingly follows autism (see here)...

Oh, and probably relevant to today's posting, the scientific support for the old "healthy at every size" notion is dwindling...

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[1] Zheng Z. et al. Association among obesity, overweight and autism spectrum disorder: a systematic review and meta-analysis. Sci Rep. 2017 Sep 15;7(1):11697.

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Should anyone be concerned about pathological video game use in relation to autism?

"... the risk for pathological game use appears larger in adults with ASD [autism spectrum disorder] compared with TD [typically developing] adults. These findings point to pathological game use as a potentially important focus of clinical attention in adults with ASD."

So concluded the paper by Christopher Engelhardt and colleagues [1] (open-access) looking at an interesting issue - "whether adults with autism spectrum disorder (ASD) are at higher risk for pathological game use than typically developing (TD) adults" - based on reports from some 120 participants with and without a diagnosis of autism. Including one Micah Mazurek on the authorship list (who has previously talked about the effects of screen time and autism), researchers delved into self-reported time spent playing video games based on data collected from a cohort "participating in a larger study on violent video game effects" [2]. The average age of participants (with and without a diagnosis of autism) was round about the 20 years old mark.

Results: both on weekdays and weekends, the typical hours of game play were different between the groups of those with autism and those without. Interestingly, authors used a slightly different statistical approach to the traditional "null hypothesis significance tests and 95% confidence intervals" via their use of "Bayes factors to state evidence for or against our predictions" to analyse their data. Bayes and Bayesian teachings provide an alternative to the 'frequentist' considerations in treating data. Alongside asking about game play time, researchers also asked participants to complete a questionnaire on "pathological video game use" that was based on "another behavioral addiction (pathological gambling)" and covered various aspects: "salience, euphoria or relief, tolerance, withdrawal, conflict, relapse and reinstatement."

"The results indicated that adults with ASD endorsed more symptoms of video game pathology than did TD adults. This relationship was strong, enjoying 300,000-to-1 odds in Bayesian model comparison." Such sentences kinda say it all. Risk of pathological video game use was quite a bit more likely in those with autism than those without, and 'escapism' was also reported to be an important reason for such extended use.

I do want to be a little careful in this post not to (a) demonise - pathologise - video game playing and/or (b) isolate those on the autism spectrum as being 'unique' in their video gaming habits. Personally, I don't see an issue if people want to spend large sections of their days playing video games as opposed to watching television or sitting down reading a book (reading in particular, is another fine example of escapism) or doing anything else. This was a study of adults doing what many millions of people do every day, so they should have the right to do as they please in this context. With the wonders of modern technology, gaming today is also not necessarily a socially-isolated pastime so one has to be quite careful about making any sweeping generalisations in that respect too.

I have however, always been a little worried about this and other research on screen time use in the context of autism and what detrimental effects it might have for a person's physical health. Everyone is prone to a degree of 'couch-potatoing' (i.e. loafing of the sofa for hours on end) but when people are talking about nearly 3 hours every day gaming, presumably sat on a couch/sofa, this really can't be doing anyone any good in terms of their long-term physical health. We're all being told to move more (see here) and given the data emerging when it comes to the physical activity patterns of rather a lot of people on the autism spectrum (see here), there are some good grounds for encouraging more movement and more physical activity minus any nanny-stating. I appreciate that sports and exercise is not everyone's cup of tea and in particular, more needs to be done in making physical activity more attractive to many groups of people including those on the autism spectrum (see here). Efforts should continue to ensure a balance is struck between times of sedentary behaviours typically associated with gaming and times of engaging in physical activity; as far as I can see, Engelhardt et al did not ask about physical activities or other related pastimes on this research occasion. Indeed, although I am still a little apprehensive about the use of exergaming, I do wonder if this could be a good bridging point on the road to balance...

Music to close: Shape of You by Ed for one of my brood who seems to be looking forward to becoming a kumite specialist (when she graduates from Ippon kumite).

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[1] Engelhardt CR. et al. Pathological game use in adults with and without Autism Spectrum Disorder. PeerJ. 2017. e3393.

[2] Engelhardt CR. et al. Effects of Violent-Video-Game Exposure on Aggressive Behavior, Aggressive-Thought Accessibility, and Aggressive Affect Among Adults With and Without Autism Spectrum Disorder. Psychol Sci. 2015 Aug;26(8):1187-200.

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Who'd have thunk it: physical activity inversely associated with BMI and body fat percentage

"In this sample of middle-aged adults, drawn from the general population, physical activity was inversely associated with BMI [body mass index] and body fat percentage. For people with the same BMI, those who were more active had a lower body fat percentage."

Those were the conclusions made by Kathryn Bradbury and colleagues [1] (open-access) drawing on data derived from "cross-sectional analysis of participants recruited into UK Biobank in 2006–2010." Said results continue a research theme where physical activity figures in the aforementioned dataset.

So: "119 230 men and 140 578 women aged 40–69 years, with complete physical activity information, and without a self-reported long-term illness, disability or infirmity" were included for study - not an under-powered study by any means. Height and weight of participants were measured by trained staff "using standardised techniques." Physical activity estimates were gathered via self-report; specifically the use of 'touchscreens' as information gatherers regarding "walking, moderate physical activity and vigorous physical activity" and how often in a typical week participants "did each of the activities for 10 min or more" then onward for how many minutes during a day. Such data was number-crunched to provide something called "excess metabolic equivalent (MET)-hours/week of physical activity during work and leisure time." The authors also report on some efforts to off-set the potential unreliability of self-reported physical activity and several other variables (whether occupation involved primarily sitting or standing, tobacco smoking status, alcohol consumption, etc) were also thrown into the statistical mixer.

Results: well, who'd have thunk it? Those reporting higher levels of physical activity (via questionnaire responses) tended to have a lower BMI and a lower body fat percentage. They were also likely to eat more fruit and vegetables that those with low levels of physical activity. Diet, occupation type and education level did not however seem to affect the primary findings.

Accepting again that self-reported physical activity is not a great substitute for more objective measures and that BMI, whilst a good rough-and-ready indication of weight status, tends not to differentiate between fat and muscle, these are important results. They imply that far from not being able to outrun a bad diet (see here) physical activity still has an important place in maintaining a sensible weight and thus reducing the risk of a myriad of adverse health outcomes. Added to other findings indicating that we all really need to move quite a bit more (see here), the message seems to be that the human body was made for moving so move it. And the latest figures on obesity and physical activity highlight the challenges being faced in this area.

And so to close,  a song to help with that 'move it' sentiment...

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[1] Bradbury KE. et al. Association between physical activity and body fat percentage, with adjustment for BMI: a large cross-sectional analysis of UK Biobank. BMJ Open 2017; 7: e011843.

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Bradbury, K., Guo, W., Cairns, B., Armstrong, M., & Key, T. (2017). Association between physical activity and body fat percentage, with adjustment for BMI: a large cross-sectional analysis of UK Biobank BMJ Open, 7 (3) DOI: 10.1136/bmjopen-2016-011843

I would walk 500 miles... or maybe just 8 miles (a day).

"Desk-bound workers should ‘walk EIGHT miles a day’ to slash risk of heart attacks or stroke" went one headline talking about the findings reported by William Tigbe and colleagues [1]. Drawing on data from over 110 postal workers - "(55 office-workers, 5 women, and 56 walking/delivery-workers, 10 women)" - who wore "activPAL physical activity monitors for seven days", researchers observed some potentially important trends.

Alongside wearing their activity monitors, participants were also assessed on the basis of weight, height, and blood pressure; also providing blood samples pertinent to analyses for cholesterol and triglycerides. Such collected data were used to assess cardiovascular risk based on the PROCAM risk calculator.

Results: those who were described as office workers and had a 'desk job' were generally larger at the waist and showed a slightly larger body mass index (BMI) score. They were also deemed to have an elevated risk of cardiovascular disease (over 10 years) compared with the walking/delivery workers. These observations were discussed in terms of the sedentary behaviours associated with their desk job. By contrast, those who delivered post (i.e. were active for large parts of the day) fared quite a bit better than their desk-bound colleagues, bearing in mind that all study participants were fairly healthy to begin with in terms of being non-smokers for example and not being in current receipt of blood pressure or glucose lowering medicines at time of study.

The 'walk 8 miles a day' headline that followed the Tigbe study was derived from the observation(s) that: "Those with no metabolic syndrome features walked >15 000 steps/day, or spent >7 h/day upright." Metabolic syndrome refers to a collection of symptoms - "a combination of diabetes, high blood pressure and obesity" - that increases the risk of adverse events associated with cardiovascular (dys)function. It seems that being active, or at least not being sedentary, is important for our health - a shocker indeed!

I've covered some of the other research in this area before (see here and see here for examples) and so the Tigbe results really don't come as a surprise. The strengths of the study are multiple in terms of objective measuring of activity (not reliant on the 'how much activity/exercise did you do today' type questionnaires) and all those biochemical measurements taken for participants to complement such findings. Yes, the sample size is OK but not particularly large and yes, these were pretty healthy participants to start with, but the results are nonetheless important.

Obviously one has to be a little careful so as not to imply that being active is the only thing that leads to good health and wellbeing. Science has already heard about how 'you can't outrun a bad diet' [2] and for some people, walking 15,000 steps every day or even standing up for 7 hours a day is going to be a big ask. But as part of a package of 'interventions' to potentially ward off metabolic syndrome or related issues [3], the idea that we should all be quite a bit more active is one that really should be given a lot more consideration...

Music to close, and with the title to this post, what else could I offer?

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[1] Tigbe WW. et al. Time spent in sedentary posture is associated with waist circumference and cardiovascular risk. Int J Obes (Lond). 2017 Jan 31.

[2] Malhotra A. et al. It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. Br J Sports Med. 2015 Aug;49(15):967-8.

[3] Alexander DD. et al. A Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies of Eicosapentaenoic and Docosahexaenoic Long-Chain Omega-3 Fatty Acids and Coronary Heart Disease Risk. Mayo Clinic Proceedings. 2017; 92: 15-29.

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Tigbe WW, Granat MH, Sattar N, & Lean ME (2017). Time spent in sedentary posture is associated with waist circumference and cardiovascular risk. International journal of obesity (2005) PMID: 28138134

Physical activity levels and autism (again)

"Adolescents with ASD [autism spectrum disorder] spent less time in MVPA [moderate and vigorous physical activity] compared to TD [typically developing] adolescents (29 min/day vs. 50 min/day, p < 0.001) and fewer met the Physical Activity Guidelines for Americans (14 vs. 29%, p > 0.05)."

So said the study results published by Heidi Stanish and colleagues [1] adding yet more to another growth autism research area - physical activity and exercise - a topic also fast becoming a repetitive blogging issue for me.

It's not necessarily new news that physical activity and exercise levels are not what they could or should be for many people on the autism spectrum (see here) but rather that the use of objective measures such as accelerometers for data collection are starting to put some scientific flesh on previous 'what exercise did you do' type questionnaire studies. And the trend that is being revealed really is quite a disturbing one if one assumes that physical activity is a significant gateway to rude health and well-being, particularly in the context of ever-increasing waistlines and onward longitudinal effects. I might even point you in the direction of some new research hinting that MVPA in childhood might predict "fewer symptoms of major depressive disorders" later on; something that could be particularly relevant to autism in light of those over-represented comorbidities that I keep going on about (see here).

Stanish et al have been mentioned before on this blog in the context of physical activity / exercise and autism and particularly the ways that said activity could be made more attractive to teens diagnosed on the autism spectrum (see here). Small steps and finding the right activity were some of the routes offered in that previous paper [2].

Before I go I do want to briefly mention one point raised in the latest Stanish paper: "Walking/hiking and active video gaming were among the top activities for both groups." Both groups refers to adolescents with autism (n=35) and those described as typically developing (n=60) who were included for study (although much like the term 'neurotypical' I'm still at a loss as to the precise meaning of 'typically developing'). Walking/hiking... great, really worthwhile encouraging (see here) including exposing people to the great outdoors and that yellow thing usually high in the sky. 'Active videogaming' is something I'm a little less sure of at the moment and indeed, some people have talked about such 'exergaming' as being a poor substitute for the real thing [3]. I don't doubt that one can build up a sweat on something like those new-fangled 'watch my movement' games consoles that abound these days, but might such exergaming just further feed into the 'screen time' narrative that typically accompanies sedentary behaviours?

And of the multiple correlates potentially attached to low levels of physical activity, one might also count bone health [4] among them as being relevant to at least some autism...

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[1] Stanish HI. et al. Physical Activity Levels, Frequency, and Type Among Adolescents with and Without Autism Spectrum Disorder. J Autism Dev Disorders. 2017. Jan 9.

[2] Stanish H. et al. Enjoyment, Barriers, and Beliefs About Physical Activity in Adolescents With and Without Autism Spectrum Disorder. Adapt Phys Activ Q. 2015 Oct;32(4):302-17.

[3] Daley AJ. Can Exergaming Contribute to Improving Physical Activity Levels and Health Outcomes in Children? Pediatrics. 2009; 124: 2.

[4] Neumeyer AM. et al. Bone microarchitecture in adolescent boys with autism spectrum disorder. Bone. 2017 Jan 11. pii: S8756-3282(17)30009-1.

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Stanish, H., Curtin, C., Must, A., Phillips, S., Maslin, M., & Bandini, L. (2017). Physical Activity Levels, Frequency, and Type Among Adolescents with and Without Autism Spectrum Disorder Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-016-3001-4

A (bleedin' obvious) guide to happiness

Happy New Year!

Welcome back to Questioning Answers in 2017. While we wait to see just what this year will offer in [autism research] blogging terms, I open proceedings with the answer to happiness. Yes, you heard me right, I can officially unveil the Questioning Answers guide to happiness...

Drum roll please... and "Mental health and relationships 'key to happiness'."

As I unclutch my hands from my face and those opening 'bleedin' obvious' words included in the title of this post resonate once more alongside the question: 'how much did this research cost?' I direct you to some further discussion about the Origins of Happiness study (see here) from where results were derived.

Taken from: http://voxeu.org/article/origins-happiness

"So in short. If your suffering from depression your not very happy. Dontcha just love the intellectual elite" and "So in a nutshell, have the report's authors found that people not suffering with depression are generally happier than those that are suffering with it? How much are these geniuses paid?" are just two of the comments following that BBC coverage of the study results. With all due respect to the study authors and their introduction of new watchwords like 'wellbeing creation' over wealth creation, I am kinda reeling from the idea that we actually needed a study/report like this given the lack of surprising outcomes noted.

As per Figure 1 and the 'determinants of adult life satisfaction' is anyone really that surprised that having an education, a job, an income, being in rude health, having a special someone or even special 'some people', not being incarcerated or exposed to criminality and not suffering from depression and/or anxiety actually makes people more satisfied with their lives? No, and neither should you be.

I've little more to say on this topic aside from mentioning that (a) happiness is perhaps a relative term and something that includes both short-term and long-term elements to it and (b) the focus on treating mental health issues such as depression and anxiety with 'psychological therapies' (made by the author(s)) should not necessarily be to the exclusion of other well-validated treatment measures. Indeed, I might advance the position of a greater 'correlation' between physical health and mental health in light of other research findings (see here).

So: Be Happy! (I promise that my blogging this year will get better).

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