20 Co-occurring behaviours of concern and sleep problems in children with neurodevelopmental disorders

Abstract

Abstract Background Many children with neurodevelopmental disorders (NDDs) have behaviours of concern (BoC). These behaviours, such as aggression and self-injury, can impair functioning, cause distress to the child and caregivers, and threaten physical safety. This population also commonly experiences chronic and frequent sleep problems including issues falling asleep and staying asleep. Studies in sub-populations of NDDs suggest insufficient sleep is related to worsening BoC. Therefore, sleep may be a modifiable risk factor in children with NDDs and BoC. However, no studies have systematically characterized co-occurring behaviour and sleep problems in the general NDD population. To our knowledge this is the first study to take a transdiagnostic approach in assessing the co-occurrence of sleep problems and BoC in children with NDDs, and systematically characterizing BoC and sleep problems by their type and severity. Objectives To assess the co-occurrence of BoC and sleep problems in a population of children with diverse NDDs and systematically characterize both BoC and sleep problems. Design/Methods A literature review and clinical experience informed the creation of a REDCap database. Medical information, the nature, frequency, and severity of BoC and sleep problems, and other relevant information (e.g., demographics, medications) were included. Charts from children ages 2-18 years who visited the Child Development Centre for consultation from May – October 2022 and had confirmation of an NDD diagnosis were manually reviewed. Results 241 children met eligibility criteria. Of children with data available for both sleep and behaviour, 55% had co-occurring behaviour and sleep problems. These children displayed aggression (75%) and self-injury (49%) more frequently than children who had behaviours but no sleep problems (66% and 34%, respectively). Children with co-occurring behaviours and sleep problems were more likely to have severe BoC, including severe aggression (48%) and self-injury (45%), compared to children who had behavioural concerns but no sleep problems (21% and 20%, respectively). Conclusion The majority of children with NDDs have co-occurring BoC and sleep problems. This co-occurrence was related to increased frequency and severity of BoC in children with NDDs. Addressing sleep problems may represent a previously underrecognized therapeutic target to address BoC in this population.