Clinician Perceptions Around Management of Sleep Problems in Children With Neurodisability

Sleep problems in children with fetal alcohol spectrum disorders (FASD) are reportedly common but not well characterized. Objectives were to: (1) assess sleep concerns in children with FASD using a caregiver-report survey, the Children's Sleep Habits Questionnaire (CSHQ); (2) compare CSHQ results with those of previously reported community sample; and (3) describe pilot polysomnography findings in children with FASD. Children with FASD were recruited from a behavioral intervention study, and participating caregivers completed the CSHQ. CSHQ results were compared with the original data from a previously published community sample of similar age. Participants with FASD and elevated CSHQ scores were offered overnight polysomnography. Thirty-three children with FASD (4.1-12.1 years) were enrolled; 85% of children with FASD scored above the clinical cutoff Total Score of 41, reflecting marked sleep disturbance. Elevated subdomain scores occurred primarily in areas concerning for pediatric insomnia. Those with comorbid ADHD had elevated CSHQ on additional subdomains with no difference in Total Scores. Compared with the community sample, children with FASD had higher Total Scores on the CSHQ (52 vs. 39, p < 0.001). Polysomnography, completed in 5 subjects, revealed mild sleep disordered breathing and fragmented sleep with elevated non-respiratory arousal indices. Clinically significant sleep problems are present in children with FASD on both subjective and objective measures. Further investigation is needed to better describe these sleep disturbances and their impact on overall health and daytime neurobehavioral problems in this clinical population.

IntroductionChildren with attention-deficit/hyperactivity disorder (ADHD) commonly experience behavioural sleep problems, yet these difficulties are not routinely assessed and managed in this group. Presenting with similar symptoms to ADHD itself, sleep...

No Simple Solution To Childhood Insomnia

Research indicates a deleterious effect of sleep disturbances on pain and illness-related functioning across pediatric populations. Sleep problems in youth with functional gastrointestinal disorders (FGIDs) are understudied, despite studies in adult FGIDs indicating sleep disruptions increase pain and symptom severity. This study sought to better characterize sleep problems in school-age children with FGIDs and to assess relationships with demographic characteristics and gastrointestinal symptoms. Sixty-seven children with FGIDs (pediatric Rome IV criteria) and 59 parents completed questionnaires assessing sleep problems, and children completed a 2-week pain/stooling diary. Sleep problems in this sample were compared with published normative samples, and children above and below the clinical cutoff were compared on demographics and FGID symptoms. Of the sample, 61% were above the clinical cutoff for sleep disturbances, with significantly greater bedtime resistance, sleep onset delay, sleep duration, and daytime sleepiness than the comparison group. Children above the clinical cutoff reported greater mean abdominal pain severity and pain interference. Relative to White participants, Black/African-American participants were more likely to be above the clinical cutoff and indicated more frequent night wakening and symptoms of sleep-disordered breathing, but lower maximum and overall mean abdominal pain severity. Sleep problems in children with FGIDs are common and related to greater day-to-day abdominal pain severity and pain interference. Results suggest sleep-pain relationships may differ across racial/ethnic groups. Assessing sleep in children with FGIDs is important, and further research is needed to assess underlying mechanisms and evaluate sleep as a potential treatment target in this population.

The current study examined bidirectional relations between children's sleep problems and parents' relationship satisfaction, coparental cooperation, and global family functioning in a sample of 249 families with 2-3-year-old children. Mothers and fathers were assessed across 5 waves with 2-month lags; the target children (53% female) were 2.8 years old (SD = .62) at baseline. Results of lagged path analyses indicated that children's sleep problems were reciprocally related to lower relationship satisfaction for mothers after accounting for covariates; however, for fathers, only relationship satisfaction predicted residual decreases in children's sleep problems 2 months later. Coparental cooperation also demonstrated reciprocal predictive links with fewer children's sleep problems in mothers; no such effect was found for fathers. Finally, for fathers, family functioning predicted residual decreases in children's sleep problems 2 months later across the 5 waves of the study. Findings build on a growing body of literature addressing reciprocal links between toddlers' sleep problems and adaptive family processes and highlight the importance of examining children's sleep within the context of the larger family system. (PsycINFO Database Record

To formulate a rational approach to the pharmacologic treatment of pediatric insomnia, and to develop clinical guidelines regarding indications, target populations, and parameters for the use of these medications, especially by community-based pediatricians. A multidisciplinary task force developed under the auspices of the American Academy of Sleep Medicine, which included experts in pediatric sleep medicine, psychiatry, pharmacology, neurology, and general pediatrics. Review of existing data regarding current use of over-the-counter and prescription medications for pediatric insomnia in the primary care practice setting, and of empirical data on the pharmacology, safety, efficacy, and tolerability of medications commonly used for the treatment of pediatric insomnia. Group consensus definition of pediatric insomnia and clinical guidelines; working group recommendations regarding special populations and future directions. Use of medications for pediatric insomnia should be diagnostically driven, and should be implemented in conjunction with empirically-based behavioral treatment strategies and adequate sleep hygiene. Specific target populations include children with neurodevelopmental disorders, pervasive developmental disorders, chronic medical conditions, and psychiatric disorders. Additional research, including clinical trials, is critically needed to provide an evidence-based approach to the use of these medications in clinical practice.

This study aimed to investigate the prevalence of sleep problems in Chinese children with pervasive developmental disorders (PDD) in Hong Kong and their relationship to parental stress. A cross-sectional survey was conducted in six child assessment centres. All parents of the children with PDD completed the Children's Sleep Habits Questionnaire, the Parenting Stress Index-Short Form, and questions on sleep practice. A total of 210 out of 250 questionnaires (response rate 84%) were returned. Mean age of the children was 3 years 6 months (SD 1 y 4 mo; range 2 y-7 y 7 mo; 168 males, 25 females). The prevalence of parent-defined sleep problems in various sleep domains ranged from 9.3 to 45.6%, with 67.9% of children having significant problems in at least one sleep domain. The most common problems reported were bedtime resistance and parasomnias. Similar sleep problems occurred in all the PDD subgroups. The factor most significantly associated with sleep problems was the occurrence of sleep problems before the age of 2 years. The parents of children with PDD with sleep problems experienced a higher level of stress than those whose children had no sleep problems. A high prevalence of significant sleep problems was reported in Chinese children in Hong Kong with PDD. A higher stress level among the parents of those children with PDD with sleep problems suggests the need for systematic early detection and management of sleep problems in children with PDD.

This study aimed to investigate the prevalence of sleep problems in Chinese children with pervasive developmental disorders (PDD) in Hong Kong and their relationship to parental stress. A cross-sectional survey was conducted in six child assessment centres. All parents of the children with PDD completed the Children's Sleep Habits Questionnaire, the Parenting Stress Index - Short Form, and questions on sleep practice. A total of 210 out of 250 questionnaires (response rate 84%) were returned. Mean age of the children was 3 years 6 months (SD 1y 4mo; range 2y–7y 7mo; 168 males, 25 females). The prevalence of parent-defined sleep problems in various sleep domains ranged from 9.3 to 45.6%, with 67.9% of children having significant problems in at least one sleep domain. The most common problems reported were bedtime resistance and parasomnias. Similar sleep problems occurred in all the PDD subgroups. The factor most significantly associated with sleep problems was the occurrence of sleep problems before the age of 2 years. The parents of children with PDD with sleep problems experienced a higher level of stress than those whose children had no sleep problems. A high prevalence of significant sleep problems was reported in Chinese children in Hong Kong with PDD. A higher stress level among the parents of those children with PDD with sleep problems suggests the need for systematic early detection and management of sleep problems in children with PDD.

Background Childhood sleep problems have been associated with adjustment difficulties; furthermore, early-onset sleep problems may persist over the life course. Exposure to stress during pregnancy may be a risk factor for developing sleep problems in childhood due to its effect on the stress reactivity in the child. In the current study, we examined the association between prenatal stressful life events (SLE) and childhood sleep problems, paying attention to their trajectory over time. Methods Data were obtained from the European Longitudinal Cohort Study of Pregnancy and Childhood (ELSPAC-CZ; N = 4,371 mother-child dyads). Mothers reported SLE during pregnancy using an inventory of 42 life events and the number of child sleep problems at the child's age of 18 months and 3, 5, 7, and 11 years. The association between prenatal SLE and the developmental course of sleep problems was examined using a Poisson latent growth model. The model was adjusted for maternal and family demographics, birth characteristics, and maternal depression. Results At 18 months, mothers reported on average 2.01 sleep problems (range 0-7, p &amp;lt; 0.001). The rate of sleep problems decreased linearly by 0.89 (p &amp;lt; 0.001) per year. A higher number of prenatal SLE was associated with a higher rate of sleep problems at 18 months (rate ratio [RR]=1.02, 95% confidence interval [CI]=1.01-1.02, p &amp;lt; 0.001), and significantly reduced rate of decrease in sleep problems from 18 months to 11 years (p &amp;lt; 0.001). Conclusions Exposure to prenatal SLE was associated with a higher number of sleep problems in early childhood and with their persistence over time. Thus, experiencing prenatal stress may serve as a predisposing factor for the development of sleep problems later in life. Key messages Children of mothers who experienced stressful life events in pregnancy had more sleep problems during childhood. Prenatal exposure to stress may predispose individuals to sleep problems later in life.

Maternal emotions during the pre/postnatal periods and children's sleep behaviors: The mediating role of children's behavior

Previous studies of sleep patterns, as well as rates and correlates of perceived problems in early childhood, indicate variation by neighborhood-level socioeconomic indicators. The purpose of this study was to examine variation in (1) sleep patterns, behaviors, and problems by family-based socioeconomic indicators (income-to-needs ratio and caregiver education level) and (2) sociodemographic and sleep correlates of a caregiver-endorsed child sleep problem across and within socioeconomic indicator groups in a diverse sample. Two hundred eighty-three caregiver-child dyads (ages 1-5 years) completed the Brief Child Sleep Questionnaire. Family-level socioeconomic indicators included income-to-needs ratio and caregiver educational level. Sleep patterns varied based on income-to-needs ratio, with children living in poverty experiencing the longest sleep onset latencies and night awakening durations and shortest nighttime sleep durations. Rates of an endorsed child sleep problem were similar across income-to-needs groups. Although sleep patterns did not vary by caregiver education level, caregivers with an education beyond high school were more likely to endorse a child sleep problem; later bedtimes, more frequent night awakenings, and greater bedtime difficulties were the strongest correlates of a perceived sleep problem in this subgroup. No specific correlates of a child sleep problem emerged for those with a high school education or less. Sleep patterns may be more robustly linked to family income-to-needs ratio, whereas perceptions of a child sleep problem may be more linked to caregiver education level. Clinicians should consider expanding sleep screening questions to include specific sleep outcomes to effectively assess child sleep and guide intervention.

Children with sleep problems present serious management problems to their parents. Such children are also more likely to have additional problems, behavioural disturbance being particularly common. This randomized controlled trial of behavioural interventions for the children's sleep problems was conducted to explore the efficacy and mechanisms of treatment in children with the most extreme forms of problems: severe learning disabilities, severe sleep problems and severe daytime challenging behaviour. Fifteen index families received behavioural advice for the child's sleep problem and compared with 15 matched controls who received no such advice. Repeat assessments of the children's and mothers' sleep were made by parental report as well as actometry. Objective changes in the children's sleep quality and quantity were not seen after treatment. However, mothers in the treatment group reported improvements in the children's sleep problems and had an increased sleeping time themselves following treatment. The results indicate that sleep problems can be successfully treated in this group of children, although the mechanisms of treatment may not be as direct as supposed. This has implications for understanding of sleep problems in children with learning disabilities and also for clinical practice, when considering ways of offering help to these highly 'challenged' families.

To determine the prevalence of sleep problems in children with attention-deficit/hyperactivity disorder (ADHD) and their associations with child quality of life (QOL), daily functioning, and school attendance; caregiver mental health and work attendance; and family functioning. Cross-sectional survey. Pediatric hospital outpatient clinic, private pediatricians' offices, and ADHD support groups in Victoria, Australia. Schoolchildren with ADHD. Main Exposure Attention-deficit/hyperactivity disorder. Primary measure was caregivers' reports of their children's sleep problems (none, mild, or moderate or severe). Secondary outcomes were (1) child QOL (Pediatric Quality of Life Inventory), daily functioning (Daily Parent Rating of Evening and Morning Behavior scale), and school attendance, (2) caregiver mental health (Depression Anxiety Stress Scale) and work attendance, and (3) family functioning (Child Health Questionnaire subscales). Caregivers also reported on how their pediatrician treated their children's sleep problems. Two hundred thirty-nine of 330 (74%) eligible families completed the survey. Child sleep problems were common (mild, 28.5%; moderate or severe, 44.8%). Moderate or severe sleep problems were associated with poorer child psychosocial QOL, child daily functioning, caregiver mental health, and family functioning. After adjusting for confounders, all associations held except for family impacts. Compared with children without sleep problems, those with sleep problems were more likely to miss or be late for school, and their caregivers were more likely to be late to work. Forty-five percent of caregivers reported that their pediatricians had asked about their children's sleep and, of these, 60% reported receiving treatment advice. Sleep problems in children with ADHD are common and associated with poorer child, caregiver, and family outcomes. Future research needs to determine whether management of sleep problems can reduce adverse outcomes.

Pain disrupts sleep in children and youth with intellectual and developmental disabilities

Amaç: Bu araştırmanın amacı, otizm spektrum bozukluğu (OSB) olan çocuklarda uyku ve gastrointestinal sorunları ve bunların birbirleriyle, otizm şiddeti ve problemli davranışlarla olan ilişkisini incelemektir.Gereç ve Yöntemler: Hastanemizde 3 aylık bir sure içinde çocuk psikiyatrisi polikliniklerine başvuran ve DSM-5’e göre OSB tanısı alan çocuklar çalışmaya alındı. Ebeveynler tarafından Sorun Davranış Kontrol Listesi (SDKL), PediatrikGastrointestinal Semptomlar Ölçeği- Ebeveyn Rapor Formu, Çocuk Uyku Alışkanlıkları Anketi (ÇUAA), Otizm Davranış Kontrol Listesi (ODKL) ve sosyodemografik veri formu dolduruldu. Klinisyen tarafından Çocukluk Otizm Derecelendirme Ölçeği (ÇODÖ) uygulandı.Bulgular: Çalışmaya 97 OSB hastası dahil edildi. Pediatrik Gastrointestinal Semptomlar Ölçeği- Ebeveyn Rapor Formuna göre vakaların %38.1’inde olası fonksiyonel gastrointestinal problem saptandı. Bunlardan %26.8’i (n=26) fonksiyonel konstipasyon, %8.2’si (n=8) retansif olmayan fekal inkontinans, %2.1’i (n=2) aerofaji, %3.1’i (n=3) ruminasyon sendromu, %4.1’i (n=4) irritabl bağırsak sendromu, %1’i (n=1) fonksiyonel karın ağrısı sendromu, %1’i (n=1) fonksiyonel dispepsi, %3.1’i (n=3) fonksiyonel karın ağrısı, %1’i siklik kusma ve %1’i (n=1) abdominal migrendi. ÇUAA’ya göre vakaların %58.8’inde uyku problemi vardı. Fonksiyonel gastrointestinal problemi olan OSB hastalarının, fonksiyonel gastrointestinal problemi olmayan hastalara göre ÇUAA, ODKL ve SDKL toplam puanları daha yüksek saptandı.Sonuç: Bulgularımız OSB’li çocuklara gastrointestinal ve uyku sorunlarının sıkça eşlik ettiğini göstermiştir. Özellikle davranış sorunları eşlik eden OSB’li hastaların, altta yatan gastrointestinal ve uyku sorunları açısından değerlendirilmesi önemli görünmektedir. Gastrointestinal hastalıkları ve uyku problemlerini tedavi etmek, OSB’ye sık eşlik eden davranış sorunlarını azaltabilir.