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Autism's Drug Problem

Many people on the spectrum take multiple medications, which can lead to serious side effects and may not even be effective

Connor was diagnosed with autism early — when he was just 18 months old. His condition was already obvious by then. “He was lining things up, switching lights on and off, on and off,” says his mother, Melissa. He was bright, but he didn’t speak much until age 3, and he was easily frustrated. Once he started school, he couldn’t sit still in class, called out answers without raising his hand and got visibly upset when he couldn’t master a math concept or a handwriting task quickly enough. “One time, he rolled himself up into the carpet like a burrito and wouldn’t come out until I got there,” Melissa recalls. (All families in this story are identified by first name only, to protect their privacy.)
Connor was prescribed his first psychiatric drug, methylphenidate (Ritalin), at age 6. That didn’t last long, but when he was 7, his parents tried again. A psychiatrist suggested a low dose of amphetamine and dextroamphetamine (Adderall), a stimulant commonly used to treat attention deficit hyperactivity disorder (ADHD). The drug seemed to improve his time at school: He was able to sit still for longer periods of time and focus on what his teachers were saying. His chicken-scratch handwriting became legible. Then, it became neat. Then perfect. And then it became something Connor began to obsess over.
“We were told that these are the gives and takes; if it’s helping him enough to get through school, you have to decide if it’s worth it,” Melissa says. It was worth it — for a while.
But when the Adderall wore off each day, Connor had a tougher time than ever. He spent afternoons crying and refusing to do much of anything. The stimulant made it difficult for him to fall asleep at night. So after a month or two, his psychiatrist added a second medication — guanfacine (Intuniv), which is commonly prescribed for ADHD, anxiety and hypertension, but can also help with insomnia. The psychiatrist hoped it might both ease Connor’s afternoons and help him sleep.
In some ways, it had the opposite effect. His afternoons did get slightly better, but Connor developed intense mood swings and was so irritable that every evening was a struggle. Rather than simply tossing and turning in bed, he refused to even get under the covers. “He wouldn’t go to bed because he was always angry about something,” Melissa says. “He was getting himself all wound up, carrying on, getting upset at night and crying.”
wound up, carrying on, getting upset at night and crying.” After seven months, his parents declared the combination unsustainable. They swapped guanfacine for over-the-counter melatonin, which helped Connor fall asleep with no noticeable side effects. But within a year, he had acquired a tolerance for Adderall. Connor’s psychiatrist increased his dosage and that, in turn, triggered tics: Connor began jerking his head and snorting. Finally, at his 9-year physical, his doctor discovered that he’d only grown a few inches since age 7. He also hadn’t gained any weight in two years; he’d dropped from the 50th percentile in weight to the 5th. That was the end of all the experiments. His parents took him off all prescription drugs, and today, at almost 13 years old, Connor is still medication-free. His tics have mostly disappeared. Although he has trouble maintaining focus in class, his mother says that the risk-benefit ratio of trying another drug doesn’t seem worth it. “Right now we’re able to handle life without it, so we do.”
(...)
For Connor, eliminating prescription drugs was difficult, but doable. For others, multiple medications may seem indispensable. It’s not unusual for children with autism to take two, three, even four medications at once. Many adults with the condition do so, too. Data are scant in both populations, but what little information there is suggests multiple prescriptions are even more common among adults with autism than in children. Clinicians are particularly concerned about children with the condition because psychiatric medications can have long-lasting effects on their developing brains, and yet are rarely tested in children.
In general, polypharmacy — most often defined as taking more than one prescription medication at once — is commonplace in people with autism. In one study of more than 33,000 people under age 21 with the condition, at least 35 percent had taken two psychotropic medications simultaneously; 15 percent had taken three.
“Psychotropic medications are used pretty extensively in people with autism because there aren’t a lot of treatments available,” says Lisa Croen, director of the Autism Research Program at Kaiser Permanente in Oakland, California. “Is heavy drug use bad? That’s the question. We don’t know; it hasn’t been studied.”

Disponível em: <https://www.scientificamerican.com/article/autisms-drug-problem/>. Texto adaptado.

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Can you learn in your sleep?

Sleep is known to be crucial for learning and memory formation. What's more, scientists have even managed to pick out specific memories and consolidate them during sleep. However, the exact mechanisms behind this were unknown — until now.

Those among us who grew up with the popular cartoon "Dexter's Laboratory" might remember the famous episode wherein Dexter's trying to learn French overnight. He creates a device that helps him to learn in his sleep by playing French phrases to him. Of course, since the show is a comedy, Dexter's record gets stuck on the phrase "Omelette du fromage" and the next day he's incapable of saying anything else. This is, of course, a problem that puts him through a series of hilarious situations.

The idea that we can learn in our sleep has captivated the minds of artists and scientists alike; the possibility that one day we could all drastically improve our productivity by learning in our sleep is very appealing. But could such a scenario ever become a reality?

New research seems to suggest so, and scientists in general are moving closer to understanding precisely what goes on in the brain when we sleep and how the restful state affects learning and memory formation.

For instance, previous studies have shown that non-rapid eye movement (non-REM) sleep — or dreamless sleep — is crucial for consolidating memories. It has also been shown that sleep spindles, or sudden spikes in oscillatory brain activity that canbe seen on an electroencephalogram (EEG) during the second stage of non-REM sleep, are key for this memory consolidation. Scientists were also able to specifically target certain memories and reactivate, or strengthen, them by using auditory cues.

However, the mechanism behind such achievements remained mysterious until now. Researchers were also unaware if such mechanisms would help with memorizing new information.

Therefore, a team of researchers set out to investigate. Scott Cairney, from the University of York in the United Kingdom, co-led the research with Bernhard Staresina, who works at the University of Birmingham, also in the U.K. Their findings were published in the journal Current Biology.

Cairney explains the motivation for the research, saying, "We are quite certain that memories are reactivated in the brain during sleep, but we don't know the neural processes that underpin this phenomenon." "Sleep spindles," he continues, "have been linked to the benefits of sleep for memory in previous research, so we wanted to investigate whether these brain waves mediate reactivation. If they support memory reactivation, we further reasoned that it could be possible to decipher memory signals at the time that these spindles took place."

To test their hypotheses, Cairney and his colleagues asked 46 participants "to learn associations between words and pictures of objects or scenes before a nap." Afterward, some of the participants took a 90-minute nap, whereas others stayed awake. To those who napped, "Half of the words were [...] replayed during the nap to trigger the reactivation of the newly learned picture memories," explains Cairney.

"When the participants woke after a good period of sleep," he says, "we presented them again with the words and asked them to recall the object and scene pictures. We found that their memory was better for the pictures that were connected to the words that were presented in sleep, compared to those words that weren't," Cairney reports.

Using an EEG machine, the researchers were also able to see that playing the associated words to reactivate memories triggered sleep spindles in the participants' brains. More specifically, the EEG sleep spindle patterns "told" the researchers whether the participants were processing memories related to objects or memories related to scenes.

"Our data suggest that spindles facilitate processing of relevant memory features during sleep and that this process boosts memory consolidation," says Staresina. "While it has been shown previously," he continues, "that targeted memory reactivation can boost memory consolidation during sleep, we now show that sleep spindles might represent the key underlying mechanism."

Cairney adds, "When you are awake you learn new things, but when you are asleep you refine them, making it easier to retrieve them and apply them correctly when you need them the most. This is important for how we learn but also for how we might help retain healthy brain functions."

Staresina suggests that this newly gained knowledge could lead to effective strategies for boosting memory while sleeping.

So, though learning things from scratch à la "Dexter's Lab" may take a while to become a reality, we can safely say that our brains continue to learn while we sleep, and that researchers just got a lot closer to understanding why this happens.

From: https://www.medicalnewstoday.com/articles/Mar/2018