Sleep Patterns In Children Research Articles

Actigraphic and Parent Reports of Sleep Patterns and Sleep Disorders in Children With Subtypes of Attention-Deficit Hyperactivity Disorder

To describe parent-reported and actigraphically assessed sleep patterns and sleep disorders in stimulant-medication-free children with attention-deficit/hyperactivity disorder (ADHD), divided according to ADHD subtype. Seventy-one stimulant-medication-free children with a clinical diagnosis of ADHD (8 girls; mean 8.8 years (SD 2.6), range 3-15 years) recruited from child psychiatry clinics. ADHD: ADHD Rating Scale DSM IV- Home Version to subdivide children into those with predominantly attention deficit, mainly hyperactivity, and those with both aspects equally. Sleep: Parent-completed sleep diary, clinical history, and 5 nights of actigraphy. Parents reported a wide range of frequently occurring sleep disturbances in their children. However, the objective sleep patterns were not abnormal and did not differ between the ADHD subtypes, and objective sleep patterns did not predict ADHD severity. There was poor correspondence between parent report and actigraphy. Careful clinical consideration of each case suggested that sleep disorders may be widespread in this group of children; only 8 of the 71 children had no discernable likely sleep disorder. Symptoms of sleep-disordered breathing, sleeplessness and reports of restless legs featured prominently. Parents of children with ADHD may not be accurate reporters of their children's sleep pattern and/or the sleep disturbances that come to parents' attention are not best detected by actigraphy. Results highlight the prominence of parent-reported sleep disturbance in children with ADHD and the need for clinicians to routinely screen for the presence of sleep disorders and assess detailed sleep physiology where indicated.

Sleep disturbances in children with epilepsy compared with their nearest-aged siblings

The aim of the study was to compare sleep patterns in children with epilepsy with those of their non-epileptic siblings and to determine which epilepsy-specific factors predict greater sleep disturbance. We conducted a case-control study of 55 children with epilepsy (mean age 10y, range 4 to 16y; 27 males, 28 females) and their nearest-aged non-epileptic sibling (mean age 10y, range 4 to 18y; 26 males, 29 females). Epilepsy was idiopathic generalized in eight children (15%), symptomatic generalized in seven (13%), and focal in 40 (73%); the mean duration was 5 years 8 months. Parents or caregivers completed the Sleep Behavior Questionnaire (SBQ) and Child Behavior Checklist (CBCL) for patients and controls, and the Quality of Life in Childhood Epilepsy (QOLCE) for patients. Patients had a higher (more adverse) Total Sleep score (p<0.001) and scored worse than controls on nearly all subscales of the SBQ. In patients, higher Total Sleep scores were correlated with higher scores on the Withdrawn, Somatic complaints, Social problems, and Attention subscales of the CBCL, and significantly lower Total Quality of Life Scores. Refractory epilepsy, mental retardation, and remote symptomatic etiology predicted greater sleep problems in those with epilepsy. We conclude that children with epilepsy in this current study had significantly greater sleep problems than their non-epileptic siblings.

The ADHD and Sleep Conundrum

The relationship between attention-deficit hyperactivity disorder (ADHD) and sleep is a complex one that poses many challenges in clinical practice. Recent studies have helped to elucidate the nature of the brain mechanisms and neuromodulator systems underlying the theoretical associations among sleepiness, arousal, and attention. Studies of sleep disturbances in children with academic and behavioral problems have also underscored the role that primary sleep disorders such as obstructive sleep apnea hypopnea syndrome play in the clinical presentation of symptoms of inattention and behavioral dysregulation. In addition, new methodologies used in examining sleep and sleep patterns in children diagnosed with ADHD have shed further light on the prevalence, type, risk factors for, and impact of sleep disturbances in these children. The following discussion of the multilevel relationships among sleep quality and quantity, neurobehavioral functioning, and the clinical syndrome of ADHD expands on previous reviews of the literature and synthesizes what is currently known about the interaction of sleep and attention/arousal in children to propose possible underlying mechanisms, integrate more recent findings, and highlight important areas for future study. In addition, guidelines are provided for a clinical approach to evaluation and management of children with ADHD and sleep problems.

A survey of sleep problems in autism, Asperger's disorder and typically developing children

Sleep problems are common in typically developing (TD) children and in children with autism, however, less is known about the sleep of children with Asperger's disorder (AD). The aim of this study was to compare sleep patterns of children with autism and AD to a TD group of children. Sixty-six parents of TD children, 53 parents of children with autism, and 52 parents of children with AD completed a survey on their child's sleep patterns, the nature and severity of any sleep problems and success of any treatment attempted. The results showed high prevalence of sleep problems with significantly more problems reported in the autism and AD groups (TD = 50%, autism = 73%, AD = 73%), with no significant differences between groups on severity or type of sleep problem. Children with AD were significantly more likely to be sluggish and disoriented after waking and had a higher Behavioral Evaluation of Disorders of Sleep (BEDS) total score compared to the other two groups. The autism and AD groups reported significantly better treatment success for medication compared to the TD group. The autism group reported significantly better success for behavioural treatment compared to the AD group. In conclusion, children with AD may have more symptoms of sleep disturbance, and different types of sleep problems than children with autism. As this is the first study to compare autism and AD and to survey treatment outcomes, further research is needed to validate these findings.

Sleeping habits in Italian children and adolescents

Sleep characteristics in children vary not only with age but also with ethnic and socio-cultural influences. Lifestyle issues as well as cultural beliefs and family values might influence sleep too. This review points out a high incidence of parental involvement at bedtime associated with longer sleep latency, a higher incidence of night wakings and a reduction of night-time sleep in preschoolers. We found also in school-aged children a high incidence of bedtime resistance, parental presence at bedtime, all-night cosleeping and TV use as a sleep aid in 30% of them. An irregular sleep schedule was found in 19% of adolescents; however, we found that Italian adolescents reported much better sleep hygiene than US teens. In Italy subjective, parental, and medical knowledge on sleep patterns in childhood and adolescence are limited and sometimes distorted. The results of our studies were more or less in line with those reported by studies carried out in other countries. However, some interesting differences in sleeping habits, probably culturally determined, were reported too. To better understand such differences in the future it would be desiderable to plan international sleep studies which embrace many cultures and languages, conducted in the same period with identical measures and administration procedures. These studies for their cross-national nature might provide the added opportunity to adopt common strategies for prevention of sleep problems in children and adolescents in different cultures.

Behavioral approaches to the treatment of sleep problems in children with developmental disorders: What is the state of the art?

This paper reviews behavioral treatments for sleep problems in children with a developmental disorder (DD). Sleep problems are common in children with a DD and children’s sleep problems may be associated with adverse consequences including behaviour problems, compromised daytime functioning and family stress. However, the sleep intervention literature for these children is seriously lacking, with only extinction and graduated extinction approaches meeting criteria for a probably efficacious treatment for common sleeplessness problems. The investigation of behavioral treatments for other sleep difficulties remains in its infancy. The impact of sleep problems and successful treatment is largely unexplored, while professional awareness regarding sleep problems and their treatment appears poor. Sleep disturbances are one of the most frequently reported behaviour problems affecting children from the general population, with estimated prevalence rates of about 30% (Richman, 1981; Owens, Spirito, McGuinn, & Nobile, 2000). For children with developmental disorders (DDs), sleep disturbance is even more widespread and problems are typically more severe and persistent. Amongst children with intellectual disabilities (IDs) up to 86% of children aged less than six years were reported by parents to have ‘sleep problems’ (Bartlett, Rooney, & Spedding, 1985) with similar high rates (77%) even for children aged 12-16 years. Problems of sleeplessness (i.e., difficulty getting off to sleep, night waking, or early waking) appear to be the most commonly reported problems (Quine, 1991; Wiggs & Stores, 1996a). Prevalence data for aetiologically discrete samples is limited but studies have suggested that between 44% and 89% of children with autistic spectrum disorders (ASD) may have sleep difficulties, again with sleeplessness featuring prominently (Richdale, 1999; Wiggs & Stores, 2004). Interestingly, amongst ASD samples, high rates of sleep problems appear to occur independently of the presence of co-existing ID (Richdale & Prior, 1995; Patzold, Richdale & Tonge, 1998). True prevalence rates are difficult to assess and likely to vary depending on the age and nature of the group of children studied and the types of sleep disturbances investigated but it seems clear that perhaps the majority of children with DDs suffer from some form of sleep disturbance. There are over 80 different sleep disorders listed in the International Classification of Sleep Disorders (American Sleep Disorders Association [ASDA], 2001) but there are three main types of presenting sleep problems: sleeplessness, excessive sleepiness and episodes which are associated with/intrude into sleep (i.e., parasomnias). Most of the literature concerning sleep patterns of children with DDs does not make the distinction between ‘sleep problems’ and ‘sleep disorders’, with research largely describing presenting symptoms (e.g., “difficulty getting off to sleep”) based upon parents report. This is a limitation because management decisions need to be based upon correcting the underlying disorder and different sleep disorders can present with similar symptoms. For example, sleeplessness, taking the form of a difficulty getting to sleep at night, may amongst other things, result from disorders of the body clock, failure to learn appropriate bedtime behaviour or anxiety. Treatment for each of these causes, or underlying disorders, would be very different. The Significance of Sleep Disturbance The widespread problem of persistent sleep disturbance in children with DDs is especially concerning in view of the fact that sleep disturbance is associated with far-reaching and serious effects (Stores, 1996; 2001; Pilcher & Huffcutt, 1996; Fallone, Owens, & Deane 2002), likely to further compromise daytime functioning in children whose daytime functioning is already impaired by virtue

Sleep Patterns and Sleep Problems Among Schoolchildren in the United States and China

Sleep patterns and sleep problems in children are not only influenced by a large number of biological and psychologic factors but also by cultural and social factors. Little is known about similarities and differences in sleep patterns and sleep problems among children across countries. We attempted to compare sleep patterns and sleep problems among schoolchildren from 2 countries with distinctive cultural contexts: the United States and China. The data come from 2 cross-sectional surveys in 3 elementary schools of Jinan City, People's Republic of China, and 3 elementary schools from a suburban school district in southeastern New England, United States. The Chinese sample consisted of 517 elementary school children (grades 1 to 5), and the US sample consisted of 494 elementary school children (grades kindergarten through 4). We used the Children's Sleep Habits Questionnaire (CSHQ) to assess children's sleep patterns and sleep problems as reported by parents. Parents of the Chinese sample completed a Chinese version of the CSHQ. For children in both the US and Chinese samples, reported bedtime was delayed and sleep duration decreased with increasing age. Compared with the US children (grades 1-4), Chinese children went to bed approximately half an hour later (9:02 vs 8:27 pm) and woke up half an hour earlier (6:28 vs 6:55 am), resulting in an average sleep duration that was 1 hour less (9.25 vs 10.15 hours). Chinese children were rated significantly higher than the US children on almost all CSHQ scales, indicating more sleep problems in Chinese children. Common sleep problems observed for all children were difficulty falling asleep, having a fear of sleeping in the dark, sleep talking, restless sleep, teeth grinding during sleep, and daytime sleepiness. Shorter daily sleep duration was associated with difficulty falling asleep, struggling at bedtime, and trouble sleeping away for the US children, and with going to bed at different times and having a fear of sleeping alone for Chinese children. Short sleep duration was a main predictor of daytime sleepiness for Chinese children, whereas restless sleep and snoring predicted daytime sleepiness for the US children. As reported by parents, children in China went to bed later and woke up earlier and their sleep duration was 1 hour shorter than the US children. Chinese children were reported to have more sleep problems than their US counterparts. Daytime sleepiness was determined by sleep duration only for those who slept insufficiently. Unique school schedules and sleep practices may contribute to the differences in the sleep patterns and sleep problems of children from the United States and China.

Reducing Bedtime Disturbance and Night Waking Using Positive Bedtime Routines and Sleep Restriction

The purpose of this study Was to investigate behavioral interventions designed to reduce sleep difficulties in four young children With developmental disorders. Positive bedtime routines and sleep restriction Were successful in eliminating bedtime disturbances and nighttime aWakenings in four children With significant sleep problems. Positive bedtime routines included activities such as taking a bath, changing into pajamas, and reading a story. Sleep restriction involved reducing the number of hours each child slept While maintaining a consistent bedtime and Wake-up time. Positive bedtime routines and sleep restriction also resulted in improved parental satisfaction With the child's behavior at bedtime, the child's sleep pattern, and the time it takes to put the child to bed at night.

Is attachment security related to sleep–wake regulation?: Mothers’ reports and objective sleep recordings

This study set out to examine the links between infants’ sleep–wake regulation and attachment security. Subjects were 57 healthy, Israeli infant–mother dyads. Mother–child relationship was assessed at 12 months with the Attachment Q-Set (AQS) (Waters & Deane, 1985). Sleep was measured, objectively, with an activity monitor, as well as through maternal reports. The objective sleep records were not associated with either the security or the dependency score. In contrast, mothers’ descriptions of the child's sleep problems were associated with the child's dependency placement. This result is in line with the premise that dependency, more than security, modulates the child's transitions to sleep. Since temperament was implicated in both the dependency placement and in the child's sleep pattern, a further disentangling of sleep-attachment-temperament is in order. Future studies of sleep regulation and attachment should address these constructs longitudinally, and include observational measures of attachment and of nighttime parenting, in different child-rearing contexts.

Sleep patterns in children and adolescents with functional recurrent abdominal pain: objective versus subjective assessment

To document objective sleep patterns of children and adolescents with functional recurrent abdominal pain (RAP), and to compare them with subjective sleep assessments and sleep patterns of healthy controls. Subjective sleep reports and sleep habit assessments were obtained from 25 adolescents with functional RAP and from 15 age- and gender-matched healthy volunteers, and were compared with continuous movement monitoring using the Actigraph for 7 consecutive days. Abdominal pain before falling asleep was a unanimous complaint in the RAP group, with 29% reporting awakening from sleep by the pain. Only 25% of RAP patients assessed their sleep quality as good, compared with 87% of the control group. Objective sleep patterns measurements of the RAP patients were similar to those of the control group as well as to measurements observed in a large population of school-aged children and adolescents. This study of a small group of children and adolescents with functional RAP provides objective evidence that their sleep patterns do not differ from those of normal peers, despite their subjective complaints.

Sleep patterns in children and adolescents with functional recurrent abdominal pain: objective versus subjective assessment

Sleep patterns in children and adolescents with functional recurrent abdominal pain: objective versus subjective assessment

Is there a specific polysomnographic sleep pattern in children with attention deficit/hyperactivity disorder?

The aim of the study was to characterize the sleep pattern in children with attention deficit/hyperactivity disorder (ADHD). By means of polysomnography (PSG), sleep patterns were studied in 17 unmedicated preadolescent boys rigorously diagnosed with ADHD and 17 control boys precisely matched for age and intelligence. Although ADHD children did not display a general sleep alteration, major PSG data showed a significant increase in the duration of the absolute rapid eye movement (REM) sleep and the number of sleep cycles in ADHD group when compared with controls. In addition, REM sleep latency tended to be shorter in ADHD children. These results suggest that in ADHD children, a forced REM sleep initiation may produce a higher incidence of sleep cycles and may also contribute to an increased duration of the absolute REM sleep. The overall pattern of the findings implies that a forced ultradian cycling appears characteristic for the sleep in ADHD children, which may be related to alterations of brain monoamines and cortical inhibitory control accompanying the ADHD psychopathology.

A Comment on Honomichl R. D. et al. (2002). Sleep patterns of children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 32(6), 553–561

A Comment on Honomichl R. D. et al. (2002). Sleep patterns of children with pervasive developmental disorders. Journal of Autism and Developmental Disorders, 32(6), 553–561

Sleep-wake patterns in children with intrauterine growth retardation.

The purpose of this study was to characterize the sleep patterns of children with intrauterine growth retardation, known to be at risk for neurodevelopmental disorders, and seek a possible correlation with behavior, concentration, and attention problems. The sleep patterns of 26 children with intrauterine growth retardation aged 4 to 7 years were compared with those of 47 control children using activity monitors (actigraphs). In addition, data were collected from the parents regarding sleep habits, behavior, concentration, and attention. Children with intrauterine growth retardation aged 4 to 7 years were found to have a tendency toward poorer quality of sleep than their matched controls. This inclination was statistically significant only for one sleep measure, the true sleep time. A tendency toward increased fragmentation of sleep, prolonged waking, and decreased sleep efficiency, although not statistically significant in this study, was demonstrated. Our results showed that 58% of the children with intrauterine growth retardation, compared with 40% of the children in the control group, could be defined as "poor sleepers" (sleep efficiency lower than 90% or three or more waking episodes per night). This disturbed sleep profile is probably an integral part of the neurodevelopmental profile typical of these at-risk children. No significant correlations were found between sleep quality and behavior, concentration, and attention problems.

Sleep-Wake Patterns in Children With Intrauterine Growth Retardation

The purpose of this study was to characterize the sleep patterns of children with intrauterine growth retardation, known to be at risk for neurodevelopmental disorders, and seek a possible correlation with behavior, concentration, and attention problems. The sleep patterns of 26 children with intrauterine growth retardation aged 4 to 7 years were compared with those of 47 control children using activity monitors (actigraphs). In addition, data were collected from the parents regarding sleep habits, behavior, concentration, and attention. Children with intrauterine growth retardation aged 4 to 7 years were found to have a tendency toward poorer quality of sleep than their matched controls. This inclination was statistically significant only for one sleep measure, the true sleep time. A tendency toward increased fragmentation of sleep, prolonged waking, and decreased sleep efficiency, although not statistically significant in this study, was demonstrated. Our results showed that 58% of the children with intrauterine growth retardation, compared with 40% of the children in the control group, could be defined as “poor sleepers” (sleep efficiency lower than 90% or three or more waking episodes per night). This disturbed sleep profile is probably an integral part of the neurodevelopmental profile typical of these at-risk children. No significant correlations were found between sleep quality and behavior, concentration, and attention problems. ( J Child Neurol 2002;17:872—876).

The provision of analgesia and sedation in the PICU: current practice and recent advances

The provision of analgesia and sedation in the PICU: current practice and recent advances

Sleep patterns of children with pervasive developmental disorders.

Data on sleep behavior were gathered on 100 children with pervasive developmental disorders (PDD), ages 2-11 years, using sleep diaries, the Children's Sleep Habits Questionnaire (CSHQ), and the Parenting Events Questionnaire. Two time periods were sampled to assess short-term stability of sleep-wake patterns. Before data collection, slightly more than half of the parents, when queried, reported a sleep problem in their child. Subsequent diary and CSHQ reports confirmed more fragmented sleep in those children who were described by their parents as having a sleep problem compared to those without a designated problem. Interestingly, regardless of parental perception of problematic sleep, all children with PDD exhibited longer sleep onset times and greater fragmentation of sleep than that reported for age-matched community norms. The results demonstrate that sleep problems identified by the parent, as well as fragmentation of sleep patterns obtained from sleep diary and CSHQ data, exist in a significant proportion of children with PDD.

Sleep and adjustment in preschool children: sleep diary reports by mothers relate to behavior reports by teachers.

Prior literature suggests that there may be relations between children's sleep disorders or inadequate amounts of sleep and behavioral adjustment. Most relevant studies concern clinical populations, however, and relatively few concern community populations. Moreover, previous studies have not addressed empirically the possible role of family functioning as a factor in the relation between children's sleep and adjustment. The present study, conducted in a predominantly low-income, community sample (N = 202), measured 4- to 5-year-old children's sleep patterns through daily logs kept by mothers, and measured family stress and parenting practices through detailed, multifaceted interviews and incidental observations of parent-child interactions. Children's adjustment, both positive and negative, was measured through preschool teacher reports on multiple occasions. A structural equation model showed that disrupted child sleep patterns (variability in reported amount of sleep, variability in bedtime, and lateness of bedtime) predicted less optimal adjustment in preschool, even after considering the roles of family stress and family management practices.

Bedsharing, temperament, and sleep disturbance in early childhood.

Temperament was explored as a factor in both night-waking and bedsharing in preschool-aged children. Bedsharers and solitary sleepers were categorized based on the frequency of current bedsharing. MANOVA was used to examine associations among temperament and sleep measures. Two preschools affiliated with a rural university in the Northeast United States. Participants. 67 children between 2.4-5.6 years of age from two University-affiliated preschools were studied. Child temperament was rated by parents and teachers using the Carey Temperament Scale and compared to night-waking, current sleep habits, and the circumstances in which bedsharing occurred Parents and preschool teachers completed the Carey Temperament Scale for 3-7 year olds. Parents also scored the Sleep Habits Inventory and the Sleeping Arrangements Inventory, which provided a current and retrospective history of the child's sleep location and sleep patterns. Parents' ratings showed that bedsharers have less regular bedtimes; difficulty with sleep onset; more night-waking; and seek out the parents following awakening during the night. Temperamentally, bedsharers were found to be more intense and exhibit less adaptability and rhythmicity. However, teachers' temperament ratings did not predict bedsharing and were not concordant with parental ratings. These findings suggest that bedsharing at preschool age is a complex phenomenon related to parents' ratings of child temperament, sleep habits, and disturbances such as night waking. Implications for the clinical assessment of sleep disorders are discussed.

Attachment and sleep: A study of night waking in 12‐month‐old infants

Sleep regulation was examined from a mother-child relational perspective. Although the link between sleep and attachment has been previously discussed, empirical support is rather limited. This report, which is a part of a longitudinal investigation of sleep in infancy, examines the association between the child's sleep pattern and mother-infant attachment in 94 mother-infant dyads. At 12 months each dyad participated in the Strange Situation procedure; 77% were securely attached. Mothers' description of the infant's fussiness was not found to predict the attachment pattern, but was associated with the sleep habits. It was found that 55% of the secure and 60% of the ambivalent children were described as night wakers. To a sub-group of 37 infants, a sleep monitor (actigraph) was provided for two nights' recordings. The frequency of the objective awakenings was higher than what mothers reported but similar for the secure and insecure infants. The findings confirm that night waking at the end of the first year is a common developmental phenomenon. Among this group of non-risk infants, sleep characteristics were only marginally associated with the quality of the child's attachment relationship.