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What is neurodiversity?

Neurodiversity describes the idea that people experience and interact with the world around them in many different ways; there is no one “right” way of thinking, learning, and behaving, and differences are not viewed as deficits.

The word neurodiversity refers to the diversity of all people, but it is often used in the context of autism spectrum disorder (ASD), as well as other neurological or developmental conditions such as ADHD or learning disabilities. The neurodiversity movement emerged during the 1990s, aiming to increase acceptance and inclusion of all people while embracing neurological differences. Through online platforms, more and more autistic people were able to connect and form a self-advocacy movement. At the same time, Judy Singer, an Australian sociologist, coined the term neurodiversity to promote equality and inclusion of “neurological minorities.” While it is primarily a social justice movement, neurodiversity research and education is increasingly important in how clinicians view and address certain disabilities and neurological conditions.

Words matter in neurodiversity

Neurodiversity advocates encourage inclusive, nonjudgmental language. While many disability advocacy organizations prefer person-first language (“a person with autism,” “a person with Down syndrome”), some research has found that the majority of the autistic community prefers identity-first language (“an autistic person”). Therefore, rather than making assumptions, it is best to ask directly about a person’s preferred language, and how they want to be addressed. Knowledge about neurodiversity and respectful language is also important for clinicians, so they can address the mental and physical health of people with neurodevelopmental differences.

Neurodiversity and autism spectrum disorder

Autism spectrum disorder (ASD) is associated with differences in communication, learning, and behavior, though it can look different from person to person. People with ASD may have a wide range of strengths, abilities, needs, and challenges. For example, some autistic people are able to communicate verbally, have a normal or above average IQ, and live independently. Others might not be able to communicate their needs or feelings, may struggle with impairing and harmful behaviors that impact their safety and well-being, and may be dependent on support in all areas of their life. Additionally, for some people with autism, differences may not cause any suffering to the person themself. Instead, the suffering may result from the barriers imposed by societal norms, causing social exclusion and inequity.

Medical evaluation and treatment is important for individuals with ASD. For example, establishing a formal diagnosis may enable access to social and medical services if needed. A diagnostic explanation may help the individual or their family understand their differences better and enable community connections. Additionally, neurodevelopmental conditions may also be associated with other health issues that require extra monitoring or treatment. It is important that people who need and desire behavioral supports or interventions to promote communication, social, academic, and daily living skills have access to those services in order to maximize their quality of life and developmental potential. However, approaches to interventions cannot be one-size-fits-all, as all individuals will have different goals, desires, and needs.

Fostering neurodiversity in the workplace

Stigma, a lack of awareness, and lack of appropriate infrastructure (such as office setup or staffing structures) can cause exclusion of people with neurodevelopmental differences. Understanding and embracing neurodiversity in communities, schools, healthcare settings, and workplaces can improve inclusivity for all people. It is important for all of us to foster an environment that is conducive to neurodiversity, and to recognize and emphasize each person’s individual strengths and talents while also providing support for their differences and needs.

How can employers make their workplaces more neurodiversity-friendly?

  • Offer small adjustments to an employee’s workspace to accommodate any sensory needs, such as
    • Sound sensitivity: Offer a quiet break space, communicate expected loud noises (like fire drills), offer noise-cancelling headphones.
    • Tactile: Allow modifications to the usual work uniform.
    • Movements: Allow the use of fidget toys, allow extra movement breaks, offer flexible seating.
  • Use a clear communication style:
    • Avoid sarcasm, euphemisms, and implied messages.
    • Provide concise verbal and written instructions for tasks, and break tasks down into small steps.
  • Inform people about workplace/social etiquette, and don’t assume someone is deliberately breaking the rules or being rude.
  • Try to give advance notice if plans are changing, and provide a reason for the change.
  • Don’t make assumptions — ask a person’s individual preferences, needs, and goals.
  • Be kind, be patient.

Resources to learn more about neurodiversity

Neurodiversity in the Workplace

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Gift giving for family or friends in assisted living

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Have family or friends in assisted living facilities? Finding the right gift can be complicated. Health issues may rule out some gifts: cross off sweets or chocolates for those who need to keep blood sugar under control. There isn’t much space for extra belongings in the apartment or room. In some cases, your giftee’s physical or mental capabilities (or both) are declining.

"Any gift you give will probably be appreciated," says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center. "But it helps if it’s something the person can really use and will enjoy. Tailor it to their particular ailments, needs, and interests." Below is a roundup that can help you select a great gift for the holidays — or any other occasion.

Gifts for social engagement

"Many people feel lonely and isolated in assisted living facilities. Keeping loved ones socially connected combats that, and also helps ward off chronic disease and cognitive decline," Salamon notes. Gifts that may fit the bill include:

  • A simple phone. The easier a phone is to operate, the more likely your loved one will be able to use it. That could be a landline phone with large, easy-to-read numbers ($25 and up), a flip phone ($35 and up), or a smartphone with few buttons and apps ($50 and up). Remember that cell phones come with monthly service costs; prices depend on the carrier.
  • A smart speaker. If phone use is too hard for your loved one, consider a smart speaker ($20 and up) that can be programmed to dial important numbers (like yours). Commands can be said aloud at any time to make a call. Check if your loved has internet service, which is needed for smart speaker use.
  • A photo book. A loose-leaf photo album (less than $20) or easily created photo book ($10 and more) with recent photos of family and friends may be a warm reminder of connections, or can be a gift to share with others in the assisted living facility. That social interaction is important for health. Plus, it will make the person feel good to see all of those photos of people who love them.

Gifts to aid independence

Health problems can make simple activities challenging. These gifts can give your loved one a little independence.

  • Adaptive tools. Your loved one may be able to take back some control of dressing with a long-handled shoehorn, a button hook, or a zipper pull (less than $10 each).
  • A magnifying glass. Especially handy for those with impaired vision (and who hasn’t misplaced reading glasses?), having a magnifying glass ($5 and up) is handy for reading or seeing small objects. For a nice upgrade, make it a lighted magnifying glass ($15).
  • Handwriting aids. Hand arthritis or neurodegenerative conditions (such as Parkinson’s disease) make writing difficult. Ergonomically-shaped adaptive pens ($10 and up) can help your loved one jot down information or thoughts.

Gifts for sharper thinking skills

"Challenging your brain or learning new information promotes new brain cell connections, which help protect and maintain cognition," Dr. Salamon says. Give your loved one something that will make the process easy and fun, such as the following:

  • A daily trivia calendar. (About $15)
  • Large-print nonfiction or fiction books. ($5 and up). Audio selections are enjoyable, too.
  • Large-print books of brain games and puzzles. ($5 and up)
  • A print subscription to a health publication, such as the Harvard Health Letter ($24).

Gifts to ease health issues

A well-chosen gift can bring comfort and help ease health issues. Try addressing someone’s aches and pains with gifts such as:

  • A microwavable heat wrap ($15 and up).
  • A handheld massager ($5 and up).

Or you could address circulatory problems that make people feel cold or increase the risk for blood clots in the legs. Ideas include:

  • A soft fleece blanket ($10 and up).
  • Warm slippers with slip-resistant soles ($20 and up).
  • Brightly patterned compression stockings with fun designs ($15 and up). Be sure to check the size so they aren’t too small for your loved one.

Gifts to track health

Even though assisted living facility staffers monitor residents’ health, your loved one may find it useful to have one of the following gifts:

  • A blood pressure monitor ($30 and up). Look for one with a cuff that goes around the upper arm; inflates automatically; has a lighted background with large numbers; and is certified by the Association for the Advancement of Medical Instrumentation, the British Hypertension Society, or the European Society of Hypertension.
  • A digital "stick" thermometer ($10 and up). The right one will be large and easy to hold, with a lighted background and large numbers.

Not quite right?

Keep thinking. A nice, warm fleece sweater ($20 and up)? Extra reading glasses to place in favorite nooks ($15 and up)? If none of these ideas is right, consider giving a healthy treat. A great choice right now is fresh citrus (send a box for $30 and up). "Avoid grapefruit, which can interfere with certain medications," Dr. Salamon advises, "but oranges or tangerines are sweet and rich in vitamin C, which supports a healthy immune system. And that’s a great gift."

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Acupuncture relieves prostatitis symptoms in study

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Prostatitis gets little press, but it’s a common inflammatory condition that accounts for more than two million visits to doctors’ offices in the United States every year. Some cases are caused by bacteria that can be readily detected and treated with antibiotics. But more than 90% of the time, prostatitis symptoms (which can include painful urination and ejaculation, pelvic pain, and sexual dysfunction) have no obvious cause. This is called chronic nonbacterial prostatitis/chronic pelvic pain syndrome, or CP/CPPS. The treatments are varied. Doctors sometimes start with antibiotics if the condition was preceded by a urinary tract infection. They may also recommend anti-inflammatory painkillers, stress-reduction techniques, pelvic floor exercises, and sometimes drugs such as alpha blockers, which relax tight muscles in the prostate and bladder.

Another treatment that can work for some men is acupuncture. A 2018 review article of three published studies found that acupuncture has the potential to reduce CP/CPPS symptoms without the side effects associated with drug treatments.

Now, results from a newly published clinical trial show symptom reductions from acupuncture are long-lasting. Published in the prestigious journal Annals of Internal Medicine, the findings provide encouraging news for CP/CPPS sufferers.

Acupuncture involves inserting single-use needles into “acupoints” at various locations in the body, and then manipulating them manually or with heat or electrical stimulation. During the study, researchers at ten institutions in China assigned 440 men with prostatitis to receive 20 sessions (across eight weeks) of either real acupuncture, or a control sham procedure wherein the needles are inserted away from traditional acupoints.

The researchers were medical doctors, but the treatments were administered by certified acupuncturists with five years of undergraduate education and at least two years of clinical experience. Treatment benefits were assessed using the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), which assigns scores for pain, urinary function, and quality of life. The men were tracked for 24 weeks after the eight weeks of treatment sessions.

By week eight, just over 60% of men in the acupuncture group were reporting significant symptom improvements (with the exception of sexual dysfunction), compared to 37% of the sham-treated men. Importantly, these differences were little changed by week 32, indicating that the benefits of acupuncture were holding steady months after the treatments were initiated.

Precisely how acupuncture relieves prostatitis symptoms is unclear. The authors of the study point to several possibilities, including that stimulation at acupoints promotes the release of naturally occurring opioid-like chemicals (enkephalins, endorphins, and dynorphins) with pain-killing properties. Acupuncture may also have anti-inflammatory effects, and the experience of being treated can also have psychological benefits that result in symptom improvements, the authors speculated.

“The research on prostatitis CPPS has been very sparse and scarce, and often with disappointing results, so this article from practitioners who are also experts in acupuncture is very welcome,” said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, editor of the Harvard Health Publishing Annual Report on Prostate Diseases, and editor in chief of HarvardProstateKnowledge.org. “The possible causes of prostatitis are many and not fully understood. Furthermore, we do not fully understand how and why interventions that may occasionally aid in relieving troublesome symptoms work. If one is to avail themselves of acupuncture, my advice is to make certain that the acupuncturist that you select is well trained and qualified to perform this potentially important intervention.”

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Waiting for motivation to strike? Try rethinking that

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All of us know that motivation is a key ingredient to accomplishing goals in our personal and professional lives. But if you wait for motivation to strike like a sudden lightning storm, you’re a lot less likely to take a single step toward any goal. Even if you have a much-desired goal in mind, it’s all too easy to deplete motivation through feeling overwhelmed, procrastination, or impatience. The steps below can help you increase your motivation to accomplish the goals that matter to you.

The meaning of your goal

Before setting a goal, it is critical to clearly identify meaning — that is, why is successfully reaching this goal important to you? What will this achievement mean to you? For example, telling yourself “I want to lose 10 pounds so I have more energy to play with my grandchildren” conveys far more meaning than “I want to lose weight.” Or maybe your goal is to paint a room a different color because you feel that color will bring more joy into your life. That’s very different than setting a goal of “paint room.”

If you set a goal and find yourself procrastinating or not achieving it, revisit the meaning of the goal you have set. Is this a goal that continues to matter to you? If so, consider the meaning behind the procrastination or the difficulties that you are experiencing.

Operationalize your goal

Write out a detailed plan to achieve the goal. Use the SMART acronym to guide this plan:

  • Specific (What exactly do you want to accomplish?)
  • Measurable (How will you know when you have succeeded?)
  • Achievable (Is the goal you have set possible?)
  • Realistic (Does setting this goal make sense for you right now?)
  • Time-bound (What is the specific time frame to accomplish this goal?)

For example, a goal of “exercise more” is too vague, and will not set you up for success. Instead, set a goal of walking 50 steps in the next hour, or taking a 15-minute walk Wednesday morning. This goal is specific, measurable, achievable, realistic, and time-bound.

Set up a to-do list — and tick it off

Once you identify a specific goal, make a to-do list to accomplish it.

  • What resources do you need?
  • What are the steps you’ll take toward your goal? Break down tasks into manageable mini-tasks and write each one down.
  • Set deadlines for each task. Make a schedule to accomplish these tasks, being sure to include regular breaks and realistic time frames.
  • Cross off each mini-task as you complete it. Step by step, you’ll see you’re making progress toward your goals.

If you are having difficulty breaking down your goal into smaller tasks, just begin working toward it. For example, if you set a goal of increasing the number of steps you walk each day, but have difficulty identifying the ideal number of steps as a goal, just start walking. You can figure out that ideal number later.

Include others

Invite a team to help you with your goal. You could join a running club, or ask family and friends to check on your progress in achieving tasks related to your overall goal. Perhaps friends can send email or text message reminders to keep you accountable. Finally, surround yourself by other people who are actively working on their own goals. Their efforts may inspire you, too.

Visualize success

Create an image of yourself achieving this goal. This image could be in your mind, or perhaps you could draw a picture of yourself achieving your goal. Imagine what achieving this goal will mean for you. How will you experience the success? How will it feel for you? Remember these positive emotions as you are completing the tasks on your to-do list to help fuel motivation.

Avoid distractions

Try to choose a space that is organized, free of clutter, and with minimal distractions. Focus on one task at a time, not multitasking. Close email and place your phone on silent. Avoid social media sites that make goals seem very easy to attain.

Track progress and time spent

Decide how often you’ll track progress toward your overall goal through your to-do list. Are you meeting the timeline you initially established? If not, identify stumbling blocks. Revisit the importance and meaning of this goal and how you initially set up your SMART model. If necessary, reconsider challenging aspects of your goal and make changes in your plan.

Think creatively about how to expand available time to work on your goal. Can you make certain tasks more routine in your life? Can you link unenjoyable tasks with more pleasurable activities? For example, if you dread your goal of taking 100 additional steps each day, could you listen to music or a podcast that you enjoy while you are taking these steps?

Embrace empathy

Be kind to yourself when tracking progress toward achieving your goal. Practice self-compassion on occasions when you fall short. Build small rewards into the process, and consider how to celebrate all your accomplishments.

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A new targeted treatment for early-stage breast cancer?

In the US, breast cancer is the most commonly diagnosed cancer in women, and the second leading cause of cancer-related deaths. Each year, an estimated 270,000 women — and a far smaller number of men — are diagnosed with it. When caught in early stages, it’s usually highly treatable.

A promising new form of targeted treatment may expand options available to some women with early-stage breast cancer linked to specific genetic glitches. (Early-stage cancers have not spread to distant organs or tissues in the body.)

The BRCA gene: What does it do?

You may have heard the term BRCA (BReast CAncer) genes, which refers to BRCA1 and BRCA2genes. Normally, BRCA genes help repair damage to our DNA (genetic code) that occurs regularly in cells throughout the human body.

Inherited BRCA mutations are abnormal changes in these genes that are passed on from a parent to a child. When a person has a BRCA mutation, their body cannot repair routine DNA damage to cells as easily. This accumulating damage to cells may help pave a path leading to cancer. Having a BRCA1 or BRCA2 mutation — or both — puts a person at higher risk for cancer of the breast, ovaries, prostate, or pancreas; or for melanoma. A person’s risk for breast cancer can also be affected by other gene mutations and other factors.

Overall, just 3% to 5% of all women with breast cancer have mutations in BRCAgenes. However, BRCA mutations occur more often in certain groups of people, such as those with triple negative breast cancer (TNBC), Ashkenazi Jewish ancestry, a strong family history of breast and/or ovarian cancer, and younger women with breast cancer.

Inherited BRCA mutations and breast cancer types

Certain types of breast cancer are commonly found in women with BRCA gene mutations.

  • Estrogen receptor-positive, HER2-negative cancer: Women with a BRCA2 mutation usually develop ER+/HER2- breast cancer — that is, cancer cells that are fueled by the hormone estrogen but not by a protein known as HER2 (human epidermal growth factor 2).
  • Triple negative breast cancer: Women with a BRCA1 mutation tend to develop triple negative breast cancer (ER-/PR-/HER2-) — that is, cancer cells that aren’t fueled by the hormones estrogen and progesterone, or by HER2.

Knowing what encourages different types of breast cancer to grow helps scientists develop new treatments, and helps doctors choose available treatments to slow or stop tumor growth. Often this involves a combination of treatments.

A new medicine aimed at early-stage BRCA-related breast cancers

The OlympiA trial enrolled women with early-stage breast cancer and inherited BRCA1/BRCA2 mutations. All were at high risk for breast cancer recurrence despite standard treatments.

Study participants had received standard therapies for breast cancer:

  • surgery (a mastectomy or lumpectomy)
  • chemotherapy (given either before or after surgery)
  • possibly radiation
  • possibly hormone-blocking treatment known as endocrine therapy.

They were randomly assigned to take pills twice a day containing olaparib or a placebo (sugar pills) for one year.

Olaparib belongs to a class of medicines called PARP inhibitors. PARP (poly adenosine diphosphate-ribose polymerase) is an enzyme that normally helps repair DNA damage. Blocking this enzyme in BRCA-mutated cancer cells causes the cells to die from increased DNA damage.

Results from this study were published in the New England Journal of Medicine. Women who received olaparib were less likely to have breast cancer recur or metastasize (spread to distant organs or tissues) than women taking placebo. Follow-up at an average of two and a half years showed that slightly more than 85% of women who had received olaparib were alive and did not have a cancer recurrence, or a new second cancer, compared with 77% of women treated with placebo.

Further, the researchers estimated that at three years:

  • The likelihood that cancer would not spread to distant organs or tissues was nearly 88% with olaparib, compared to 80% with placebo.
  • The likelihood of survival was 92% for the olaparib-treated group and 88% for the placebo group.

The side effects of olaparib include low white cell count, low red cell count, and tiredness. The chances of developing these were low.

The bottom line

Olaparib is already approved by the FDA to treat BRCA-related cancers of the ovaries, pancreas, or prostate, and metastatic breast cancer. FDA approval for early-stage breast cancer that is BRCA-related is expected soon based on this study. These findings suggest taking olaparib for a year after completing standard treatment could be a good option for women who have early-stage breast cancer and an inherited BRCA gene mutation who are at high risk for cancer recurrence and, possibly, its spread.

Follow me on Twitter @NeelamDesai_MD

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Embryo donation: One possible path after IVF

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For decades, in vitro fertilization (IVF) has enabled countless people to have children, often after years of disappointment. It’s a complex process, medically and emotionally. Those embarking on an IVF cycle are often laser-focused on the baby they long for. Most hope a cycle will yield several embryos, because it frequently takes more than one embryo transfer to achieve a successful full-term pregnancy.

Any remaining embryos may offer the hope of future pregnancies and additional children. Yet remaining embryos also bring difficult decisions to the fore — if not immediately, then in subsequent years. The decisions one person, or a couple, makes might be divided into five paths. One path — donating embryos to another person or couple hoping for children — carries with it many questions. This path, and those questions, are the subject of this post.

A decision pathway for people who became parents through IVF

If you became a parent through IVF and have remaining embryos, you are not alone. Estimates vary on the number of cryopreserved embryos in the United States, but it’s likely to be in the hundreds of thousands.

You may be among the many people or couples who plan to use their embryos, or among those whose family feels complete. And you may be starting to figure out what to do with your embryos, or you may be putting the decision on hold, paying for annual embryo storage and feeling no urgency to make a decision, since embryos can remain safely frozen for many years. Having “extras” in deep freeze may offer comfort, kind of a psychological insurance policy after years of disappointment and loss.

Sooner or later, though, most people find themselves at a decision point, considering these options:

  • You can discard your remaining embryos. This may feel harder than you anticipated but absolutely doable. You see these embryos as part of the IVF process that enabled you to have your cherished child or children. The word “discard” sounds harsh, but you are not prepared to parent another child and do not see donating them to others as an option.
  • You can decide to have an additional child. A larger family wasn’t what you’d planned on or hoped for, but you see extra embryos as part of IVF, and a new child as meant to be. You look at the family you have and decide it is worth undergoing at least one more embryo transfer before making a final decision to discard.
  • You can decide to donate your embryos to science. Unfortunately, if you begin to explore this, you’ll discover there is no easy route for it. Perhaps you will choose to explore other possible pathways, or decide to focus on one of the other options.
  • You can donate your embryos to another person or couple. For some, this feels natural: you have been given the gift of children and you want to pay it forward to others longing for pregnancy and parenthood. However, for many the decision to donate does not feel easy or natural. Rather, it poses a huge dilemma: you want to honor the embryos and offer them a chance at life, but you have unsettled feelings when you think of your genetic offspring being raised by another family.
  • Not to decide is to decide. In listing options, it is important to acknowledge that some of your fellow IVF parents are deciding not to decide. They are among the many who have “abandoned” their embryos (the term clinics use for families that avoid contact). They stop paying their storage fees; they fail to respond to outreach calls and letters.

What questions arise if you choose to donate embryos to another family?

Writing in TheNew York Times about facing her own decision about unused embryos, author Anna Hecker said, “For me this far surpasses discomfort. I see it as a life-or-death decision, which makes it nearly impossible to make.”Having worked with couples making this decision, I can attest that this sense of the “nearly impossible” passes over time, as people grapple with their choice and come to a place of clarity and peace.

Below are some — though not all — questions you are likely to confront as you think about donating embryos. If you are part of a couple, you can sort through these questions with your partner. (If you are single, the decision is yours to make.)

  • How would we feel about another family raising a child created with our genes?
  • Would it feel okay if we knew the family we donate to, or could that make it harder, seeing what might have been our child growing up with others as parents?
  • Is this fair to the children involved? How will our children feel knowing they have full genetic siblings in another family? What will they make of the fact that it was the random choice of an embryologist who determined which embryo would land in our family and which in another?
  • How will children who come from our donation feel? Will they feel displaced, like they landed in the wrong family? Will they, perhaps, feel a bit like a science-fiction project?
  • How will we feel about possible challenges in the future: our child gets sick, the family we donate to gets divorced, we fervently disagree with the parenting style and values of the other family?
  • If we decide to donate, how should we go about finding a family? Does geography or demographics matter — for example, will it feel good or more complicated to have them nearby? Should we donate to a same-sex couple, an older single woman, or others?
  • Do we want to tell family members and friends of our decision to donate our embryos? If so, how much do we share of this information?
  • If there are several embryos, do we donate all to the same family or divide them? For those who feel strongly about not wanting to discard embryos, it may be important to ensure that none are discarded when the receiving family feels complete.
  • If our embryos were created with the help of donor eggs and/or sperm, should we seek permission or approval from the donor? How do we go about this if we do not have access to the donor?

These questions are complicated, best made over time and with care. While you may want to make the decision soon so that you can feel closure and move on as a family, I have found this is one instance in life when moving slowly, visiting and revisiting a decision, accepting doubt and the need to take pauses, all contribute to you eventually feeling the rightness of your decision.

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Naps: Make the most of them and know when to stop them

During the first year of life, naps are crucial for babies (who simply cannot stay awake for more than a couple of hours at a time), and crucial for parents and caregivers, who need breaks from the hard work of caring for an infant.

But as children become toddlers and preschoolers, naps aren’t always straightforward. Children often fight them (following the “you snooze you lose” philosophy), and they can conflict with daily tasks (such as school pick-up when there are older siblings) or lead to late bedtimes.

Here are some tips for making naps work for you and your child — and for knowing when they aren’t needed anymore.

Making naps work for your baby

Most infants will take at least two naps during the day, and early in toddlerhood most children will still take both a morning nap and an afternoon nap. Naps are important not just for physical rest and better moods, but also for learning: sleep allows us to consolidate new information. As children get older, they usually drop one of the naps, most commonly the morning nap.

Every child is different when it comes to napping. Some need long naps, some do fine with catnaps, some will give up naps earlier than others. Even within the same family, children can be different. A big part of making naps work is listening to and learning about your child’s temperament and needs. Otherwise, you can end up fighting losing battles.

The needs of a parent or caregiver are also important: everyone needs a break. Sometimes those breaks are particularly useful at specific times of the day (like meal prep time). While you can’t always make a child be sleepy at the most convenient time for you, it’s worth a try — which leads me to the first tip:

Schedule the naps. Instead of waiting for a child to literally drop and fall asleep, have a regular naptime. We all do better when our sleep routines are regular, even adults. If you can, put the child down awake (or partially awake). Learning to fall asleep without a bottle or a breast, or without being held, is a helpful skill for children to learn and can lead to better sleep habits as they grow.

A couple of scheduling notes:

  • If you need a child to fall asleep earlier or later than they seem to do naturally, try to adjust the previous sleep time. For example, if you need an earlier morning nap, wake the child up earlier in the morning. It may not work, but it’s worth a try.
  • Naps later in the afternoon often mean that a child won’t be sleepy until later in the evening. That may not be a problem, but for parents who get tired early or need to get up early, it can be. Try to move the nap earlier, or wake the child earlier. If the problematic afternoon nap is in daycare, talk to the daycare provider about moving or shortening it.

Create a space that’s conducive to sleep. Some children can sleep anywhere and through anything, but most do best with a space that is quiet and dark. A white noise machine (or even just a fan) can also be helpful.

Don’t use screens before naptime or bedtime. The blue light emitted by computers, tablets, and phones can wake up the brain and make it harder for children to fall asleep.

When is it time to give up naps?

Most children give up naps between the ages of 3 and 5. If a child can stay up and be pleasant and engaged throughout the afternoon, they are likely ready to stop. Some crankiness in the late afternoon and early evening is okay; you can always just get them to bed earlier.

One way to figure it out, and ease the transition, is to keep having “quiet time” in the afternoon. Have the child go to bed, but don’t insist on sleep; let them look at books or play quietly. If they stay awake, that’s a sign that they are ready to stop. If they fall asleep but then end up staying up very late, that’s another sign that the afternoon nap needs to go.

Whether or not your child naps, having some quiet time without screens every afternoon is a good habit to get into. It gives your child and everyone else a chance to relax and unwind, and sets a placeholder not just for homework but also for general downtime as children grow — and just like naps for babies, downtime for big kids is crucial.

Follow me on Twitter @drClaire

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Yoga for weight loss: Benefits beyond burning calories

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If you have trouble losing weight despite your best efforts, this is because obesity is a complex disease with many causes. A family history of weight issues can make it more likely that you’ll have the same issues managing your weight. A diet high in ultra-processed foods, sugar, and fat and being sedentary also contribute to weight gain. Stress and struggles with mental health, including medications to treat certain mental health conditions, poor sleep, and hormonal changes, are all factors that further contribute to weight gain.

There are many ways to combat excess weight, but there is no single solution. If you are trying to lose or maintain your weight, you may want to try yoga. There is good research that yoga may help you manage stress, improve your mood, curb emotional eating, and create a community of support, all of which can help with weight loss and maintenance.

Yoga can also help you burn calories, as well as increase your muscle mass and tone. Yoga may reduce joint pain, which in turn allows you to exercise more and increase your daily activities. These are only some of the many benefits of yoga.

Yoga can help you manage stress that can impact weight gain

Yoga is derived from the Sanskrit word yuj, which means to unite the body, mind, and emotions. It is a holistic mind-body practice that improves many of the causes of weight gain.

Some people may experience stress as physical pain or sleep deprivation, or it may be psychological and cause feelings of anxiety and agitation. Stress leads to an increase in the hormone cortisol. Cortisol increases abdominal fat, decreases muscle mass, causes cravings for fat and sugar-rich food, and thus can lead to obesity.

Yoga can decrease stress and cortisol levels, enhance mood, decrease anxiety and depression, improve sleep, and improve chronic conditions such as hypertension and diabetes, reducing the need for medications that can cause weight gain.

Yoga is not a band-aid for excess weight, but it may work on the underlying causes. Its benefits extend beyond the calories-in-versus-calories-out equation.

Yoga can improve mindfulness related to eating behaviors

Most of us who crave ice cream after 9 pm or can’t stop eating potato chips know that these behaviors hurt our chances of losing weight. We all know that eating vegetables, whole grains, lean protein, etc. is good for our health and weight. While this knowledge is necessary, it seems insufficient to help us stick to our healthy eating plans.

One of yoga’s benefits is that it improves mindfulness of the body and awareness of body sensations. This is why yoga is called “moving meditation.” Research shows that you don’t have to do any formal sitting meditation to get the mindfulness benefits of yoga.

By improving mindfulness, yoga decreases emotional eating, stress eating, and binge eating. These habits sabotage our weight loss efforts and can cause a negative spiral of guilt and shame, which often leads to giving up.

A study published in 2015 showed that practicing yoga led to healthier eating, including lower fat intake and an increase in vegetables and whole grains.

The bottom line: the best diet plan is the one that you can stick with over the long term, and by improving mindfulness, yoga can help you make healthier food choices.

A yoga community can provide acceptance and support

Going to a gym can be intimidating, and may provoke feelings of not belonging for some people with larger bodies. By contrast, yoga culture embodies kindness, support, and self-acceptance.

Yoga teachers and advanced practitioners can serve as role models and inspire newer students to live a healthier lifestyle. Research shows that social networks influence behaviors that affect weight. The yoga network encourages positive health behaviors, and being a part of such a community can make a meaningful difference for weight loss. This type of community can be hard to find with other types of exercise.

Practitioners should look for a safe, comfortable environment. A welcoming yoga group may help you improve your self-esteem and confidence. Find a local studio that feels nurturing and not overwhelming, with other practitioners at your level. Teachers can help beginners or those with physical limitations by modifying poses. You might have to try a few different classes before you find an instructor or a class that you like. Don’t give up after the first one!

If you can’t find a local studio, there are always online options on YouTube and Instagram, with classes at all levels. There are instructors who understand what it is like to be a larger size, and having an inclusive, body-affirming attitude shows that yoga is not just for “skinny people.” Some share inspirational stories of how yoga helped them overcome their own weight struggles, depression, and binge eating. If you are a beginner, consider signing up for a short challenge to get committed to the practice.

The benefits of yoga are universal — no matter what your shape or size. It can take weeks or months to establish a yoga practice, and frequent practice is key for long-lasting benefits.

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