Many of us wish we could get a better night’s sleep. Wouldn’t it be great if it was as easy as a mocktail before bed?

That’s what the latest viral trend might have us believe. The “Sleepy Girl Mocktail” is a mix of tart cherry juice, powdered magnesium supplement and soda water. TikTok videos featuring the concoction have garnered hundreds of thousands of views. But, what does the science say? Do these ingredients actually help us sleep?

Tart cherry juice

There is research to show including tart cherry juice in your diet improves overall sleep. Clinical trials show tart cherry juice increases sleep quality and quantity, as well as a lessening insomnia symptoms (compared to a placebo). This could be due to the presence of melatonin, a sleep-promoting hormone, in cherries.

Tart cherry varieties such as Jerte Valley or Montmorency have the highest concentration of melatonin (approximately 0.135 micrograms of melatonin per 100g of cherry juice). Over the counter melatonin supplements can range from 0.5 milligram to over 100 milligrams, with research suggesting those beginning to take melatonin start with a dose of 0.5–2 milligrams to see an improvement in sleep.

Melatonin naturally occurs in our bodies. Our body clock promotes the release of melatonin in the evening to help us sleep, specifically in the two hours before our natural bedtime.

If we want to increase our melatonin intake with external sources, such as cherries, then we should be timing our intake with our natural increase in melatonin. Supplementing melatonin too close to bed will mean we may not get the sleep-promoting benefits in time to get off to sleep easily. Taking melatonin too late may even harm our long-term sleep health by sending the message to our body clock to delay the release of melatonin until later in the evening.

Magnesium – but how much?

Magnesium also works to promote melatonin, and magnesium supplements have been shown to improve sleep outcomes.

However, results vary depending on the amount of magnesium people take. And we don’t yet have the answers on the best dose of magnesium for sleep benefits.

We do know magnesium plays a vital role in energy production and bone development, making it an important daily nutrient for our diets. Foods rich in magnesium include wheat cereal or bread, almonds, cashews, pumpkin seeds, spinach, artichokes, green beans, soy milk and dark chocolate.

Bubbly water

Soda water serves as the base of the drink, rather than a pathway to better sleep. And bubbly water may make the mix more palatable. It is important to keep in mind that drinking fluids close to bedtime can be disruptive to our sleep as it might lead to waking during the night to urinate.

Healthy sleep recommendations include avoiding water intake in the two hours before bed. Having carbonated beverages too close to bed can also trigger digestive symptoms such as bloating, gassiness and reflux during the night.

Bottoms up?

Overall, there is evidence to support trying out the Sleepy Girl Mocktail to see if it improves sleep, however there are some key things to remember:

• timing: to get the benefits of this drink, avoid having it too close to bed. Aim to have it two hours before your usual bedtime and avoid fluids after this time

• consistency: no drink is going to be an immediate cure for poor sleep. However, this recipe could help promote sleep if used strategically (at the right time) and consistently as part of a balanced diet. It may also introduce a calming evening routine that helps your brain relax and signals it’s time for bed

• maximum magnesium: be mindful of the amount of magnesium you are consuming. While there are many health benefits to magnesium, the recommended daily maximum amounts are 420mg for adult males and 320mg for adult females. Exceeding the maximum can lead to low blood pressure, respiratory distress, stomach problems, muscle weakness and mood problems
  

• sugar: in some of the TikTok recipes sugar (as flavoured sodas, syrups or lollies) is added to the drink. While this may help hide the taste of the tart cherry juice, the consumption of sugar too close to bed may make it more difficult to get to sleep. And sugar in the evening raises blood sugar levels at a time when our body is not primed to be processing sugar. Long term, this can increase our risk of diabetes

• sleep environment: follow good sleep hygiene practices including keeping a consistent bedtime and wake time, a wind-down routine before bed, avoiding electronic device use like phones or laptops in bed, and avoiding bright light in the evening. Bright light works to suppress our melatonin levels in the evening and make us more alert.

What about other drinks?

Other common evening beverages include herbal tisanes or teas, hot chocolate, or warm milk.

Milk can be especially beneficial for sleep, as it contains the amino acid tryptophan, which can promote melatonin production. Again, it is important to also consider the timing of these drinks and to avoid any caffeine in tea and too much chocolate too close to bedtime, as this can make us more alert rather than sleepy.

Getting enough sleep is crucial to our health and wellbeing. If you have tried multiple strategies to improve your sleep and things are not getting better, it may be time to seek professional advice, such as from a GP.

Charlotte Gupta, Postdoctoral research fellow, CQUniversity Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

“Charlie” is an eight-year-old child with autism. Her parents are worried because she often responds to requests with insults, aggression and refusal. Simple demands, such as being asked to get dressed, can trigger an intense need to control the situation, fights and meltdowns.

Charlie’s parents find themselves in a constant cycle of conflict, trying to manage her and their own reactions, often unsuccessfully. Their attempts to provide structure and consequences are met with more resistance.

What’s going on? What makes Charlie’s behaviour – that some are calling “pathological demand avoidance” – different to the defiance most children show their parents or carers from time-to-time?

What is pathological demand avoidance?

British developmental psychologist Elizabeth Newson coined the term “pathological demand avoidance” (commonly shortened to PDA) in the 1980s after studying groups of children in her practice.

A 2021 systematic review noted features of PDA include resistance to everyday requests and strong emotional and behavioural reactions.

Children with PDA might show obsessive behaviour, struggle with persistence, and seek to control situations. They may struggle with attention and impulsivity, alongside motor and coordination difficulties, language delay and a tendency to retreat into role play or fantasy worlds.

PDA is also known as “extreme demand avoidance” and is often described as a subtype of autism. Some people prefer the term persistent drive for autonomy or pervasive drive for autonomy.

What does the evidence say?

Every clinician working with children and families recognises the behavioural profile described by PDA. The challenging question is why these behaviours emerge.

PDA is not currently listed in the two diagnostic manuals used in psychiatry and psychology to diagnose mental health and developmental conditions, the current Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the World Health Organization’s International Classification of Diseases (ICD-11).

Researchers have reported concerns about the science behind PDA. There are no clear theories or explanations of why or how the profile of symptoms develop, and little inclusion of children or adults with lived experience of PDA symptoms in the studies. Environmental, family or other contextual factors that may contribute to behaviour have not been systematically studied.

A major limitation of existing PDA research and case studies is a lack of consideration of overlapping symptoms with other conditions, such as autism, attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, anxiety disorder, selective mutism and other developmental disorders. Diagnostic labels can have positive and negative consequences and so need to be thoroughly investigated before they are used in practice.

Classifying a “new” condition requires consistency across seven clinical and research aspects: epidemiological data, long-term patient follow-up, family inheritance, laboratory findings, exclusion from other conditions, response to treatment, and distinct predictors of outcome. At this stage, these domains have not been established for PDA. It is not clear whether PDA is different from other formal diagnoses or developmental differences.

Finding the why

Debates over classification don’t relieve distress for a child or those close to them. If a child is “intentionally” engaged in antisocial behaviour, the question is then “why?”

Beneath the behaviour is almost always developmental difference, genuine distress and difficulty coping. A broad and deep understanding of developmental processes is required.

Interestingly, while girls are “under-represented” in autism research, they are equally represented in studies characterising PDA. But if a child’s behaviour is only understood through a “pathologising” or diagnostic lens, there is a risk their agency may be reduced. Underlying experiences of distress, sensory overload, social confusion and feelings of isolation may be missed.

So, what can be done to help?

There are no empirical studies to date regarding PDA treatment strategies or their effectiveness. Clinical advice and case studies suggest strategies that may help include:

• reducing demands
• giving multiple options
• minimising expectations to avoid triggering avoidance
• engaging with interests to support regulation.

Early intervention in the preschool and primary years benefits children with complex developmental differences. Clinical care that involves a range of medical and allied health clinicians and considers the whole person is needed to ensure children and families get the support they need.

It is important to recognise these children often feel as frustrated and helpless as their caregivers. Both find themselves stuck in a repetitive cycle of distress, frustration and lack of progress. A personalised approach can take into account the child’s unique social, sensory and cognitive sensitivities.

In the preschool and early primary years, children have limited ability to manage their impulses or learn techniques for managing their emotions, relationships or environments. Careful watching for potential triggers and then working on timetables and routines, sleep, environments, tasks, and relationships can help.

As children move into later primary school and adolescence, they are more likely to want to influence others and be able to have more self control. As their autonomy and ability to collaborate increases, the problematic behaviours tend to reduce.

Strategies that build self-determination are crucial. They include opportunities for developing confidence, communication and more options to choose from when facing challenges. This therapeutic work with children and families takes time and needs to be revisited at different developmental stages. Support to engage in school and community activities is also needed. Each small step brings more capacity and more effective ways for a child to understand and manage themselves and their worlds.

What about Charlie?

The current scope to explain and manage PDA is limited. Future research must include the voices and views of children and adults with PDA symptoms.

Such emotional and behavioural difficulties are distressing and difficult for children and families. They need compassion and practical help.

For a child like Charlie, this could look like a series of sessions where she and her parents meet with clinicians to explore Charlie’s perspective, experiences and triggers. The family might come to understand that, in addition to autism, Charlie has complex developmental strengths and challenges, anxiety, and some difficulties with adjustment related to stress at home and school. This means Charlie experiences a fight, flight, freeze response that looks like aggression, avoidance or shutting down.

With carefully planned supports at home and school, Charlie’s options can broaden and her distress and avoidance can soften. Outside the clinic room, Charlie and her family can be supported to join an inclusive local community sporting or creative activity. Gradually she can spend more time engaged at home, school and in the community.

Nicole Rinehart, Professor, Child and Adolescent Psychology, Director, Krongold Clinic (Research), Monash University; David Moseley, Senior Research Fellow, Deputy Director (Clinical), Monash Krongold Clinic, Monash University, and Michael Gordon, Associate Professor, Psychiatry, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.