Assessment and Treatment of Pediatric Sleep Problems: Knowledge, Skills, Attitudes and Practices in a Group of Community Child Psychiatrists.

Ali Anwar,Ginger Nicol,Ujjwal Ramtekkar,Alicia Zhang,Michael Yingling

doi:10.3390/medsci6010018

Abstract

As part of a university-based quality improvement project, we aimed to evaluate child psychiatrists’ knowledge, skills, attitudes, and practices regarding assessment and treatment of pediatric sleep problems. We developed a nine-question survey of knowledge, skills, attitudes, and practices regarding assessing for and treating sleep complaints in pediatric patients, and administered this survey to child psychiatrists in training and in practice in the state of Missouri. Respondents reported sleep hygiene as the first-line treatment strategy, followed by the use of supplements or over-the-counter remedies. The most common barriers to evidence-based assessment and treatment of sleep problems were the lack of ability to obtain reliable history, and parental preference for medications over behavioral approaches for sleep concerns. These results suggest potential opportunities for enhancing knowledge regarding validated assessment tools and non-pharmacological treatment options for sleep problems. Additional research is needed to further assess the quality and type of sleep education provided in child psychiatry training programs.

Highlights

Sleep problems are a common complaint amongst individuals suffering from psychiatric illness [1,2,3]
The majority of participants (n = 50, 90.9%) reported that they assess for sleep problems in all of their patients, with 78.6% (n = 44) reporting that they assess for sleep problems at every clinical visit
Anticipated non-compliance with recommendations (52.7%, n = 29) and patient/guardian preference for medications (32.7%, n = 18) were the most selected reasons for barriers to using sleep hygiene as a first-line treatment for sleep problems. This is the first study to report on the skills, attitudes, and practices of child psychiatric providers regarding pediatric sleep concerns

Summary

Introduction

Sleep problems are a common complaint amongst individuals suffering from psychiatric illness [1,2,3]. Sleep is part of the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) for numerous major psychiatric conditions, including those first observed in childhood. Even in psychiatric disorders where sleep disruption is not a major symptom marker, sleep is still thought to play a role in the development and maintenance of dysfunctional symptoms. Attention deficit hyperactivity disorder ADHD symptoms are commonly presented complaints in outpatient child psychiatric practices. Children with ADHD can have more bedtime resistance, more issues with initiation of sleep, more nighttime awakenings, difficulties with morning awakenings, sleep-disordered breathing, and daytime sleepiness [7]. Autism spectrum disorder is another condition where sleep is not part of the symptom criteria, but sleep problems are

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