Gregory Stores

Sleep patterns and sleep disorders in children with autistic spectrum disorders: insights using parent report and actigraphy

The present study sought to describe the profile of sleep disturbance reported in children with autistic spectrum disorders (ASDs) and to document any sleep disorders underlying reports of sleeplessness. Sixty‐nine children aged 5 to 16 years (mean 9 years 4 months, SD 2 years 7 months; 14 females) with an ASD were assessed by detailed sleep histories taken from parents, the Simonds and Parraga Sleep Questionnaire, a 2‐week sleep diary, and actigraphs worn by the child for five nights. Parent‐reported sleeplessness featured prominently (64%). Sleep disorders underlying the sleeplessness were most commonly behavioural (i.e. to do with inappropriate sleep‐related behaviours), although sleep‐wake cycle disorders and anxiety‐related problems were also seen. In addition, the sleeplessness patterns of a large minority of children could not be classified by conventional diagnostic criteria. Sleep patterns measured objectively did not differ between those children with or without reported sleeplessness, but the sleep quality of all children seemed to be compromised compared with normal values.

A systematic review of treatments for settling problems and night waking in young children.

Abstract Objectives: To assess the efficacy of treatments for settling problems and night waking in young children. Design: A systematic review of randomised controlled trials of interventions for settling problems and night waking in young children. Setting: Electronic bibliographic databases and references on identified papers, hand searches, and personal contact with specialists. Subjects: Children aged 5 years or less who had established settling problems or night waking. Interventions: Interventions had to be described and a placebo, waiting list, or another intervention needed to have been used as a comparison. Interventions comprised drug trials or non-drug trials. Main outcome measures: Number of wakes at night, time to settle, or number of nights in which these problems occurred. Results: Drugs seemed to be effective in treating night waking in the short term, but long term efficacy was questionable. In contrast, specific behavioural interventions showed both short term efficacy and possible longer term effects for dealing with settling problems and night waking. Conclusions: Given the prevalence and persistence of childhood sleep problems and the effects they can have on children and families, treatments that offer long lasting benefits are appealing and these are likely to be behavioural interventions.

School-children with Epilepsy at Risk for Learning and Behaviour Problems

Four preliminary studies have been carried out to try and identify those children among the epileptic population attending ordinary schools who are most at risk from learning and behaviour problems. The findings are briefly reported. Measurement of reading retardation, inattentiveness of various types, dependency and other aspects of disturbed behaviour at school suggest that male sex and the presence of a persistent left temporal lobe spike discharge are consistently associated with these problems. The possibility is raised that the drug phenytoin can adversely affect cognitive function.

Psychological consequences of road traffic accidents for children and their mothers.

BACKGROUND Little is known about the psychological and behavioural consequences of road traffic accidents for children. The study aimed to determine the outcome of road traffic accidents on children and their mothers. METHOD A 1-year cohort study of consecutive child attenders aged 5-16 years at an Accident and Emergency Department. Data were extracted from medical notes and from interview and self-report at baseline, 3 months and 6 months. RESULTS The children had an excellent physical outcome. Fifteen per cent suffered acute stress disorder; 25% suffered post-traumatic stress disorder at 3 months and 18% at 6 months. Travel anxiety was frequent. Post-traumatic consequences for mothers were common. CONCLUSION Psychological outcome was poor for a minority of children and associated with disability, especially for travel. There were significant family consequences. There is a need for changes in clinical care to prevent, identify and treat distressing and disabling problems.

Sleep and psychological disturbance in nocturnal asthma.

Subjective and objective sleep disturbance was studied in children with nocturnal asthma. Relations between such disturbance and daytime psychological function were also explored, including possible changes in learning and behaviour associated with improvements in nocturnal asthma and sleep. Assessments included home polysomnography, parental questionnaires concerning sleep disturbance, behaviour, and mood and cognitive testing. Compared with matched controls, children with asthma had significantly more disturbed sleep, tended to have more psychological problems, and they performed less well on some tests of memory and concentration. In general, improvement of nocturnal asthma symptoms by changes in treatment was followed by improvement in sleep and psychological function in subsequent weeks. The effects of asthma on sleep and the possible psychological consequences are important aspects of overall care. Key messages Sleep disturbance is common in children with asthma, more than is usually supposed. The nature and extent of sleep disruption is only partly apparent from subjective, clinical reporting; physiological sleep recordings might be more informative, showing fragmentation of sleep by brief arousals rather than changes in conventional sleep stages. Disruption of sleep in these ways might affect the child’s daytime cognitive function, mood, and behaviour. Identification and control of nocturnal asthmatic symptoms is important, not only to improve respiratory function but also to promote better quality sleep and psychological well being during the day.

Behavioural effects of anti-epileptic drugs.

There is increasing evidence that various types of behavioural disturbance, other than those described for phenytoin, for example, may occur from the use of anti‐epileptic medication, and it has been suggested that these disturbances may not always be reversible. There are suspicions also that certain groups of patients—especially those with structural brain damage—are particularly susceptible.

Behavioural treatment for sleep problems in children with severe learning disabilities and challenging daytime behaviour: Effect on sleep patterns of mother and child

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 childrens 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.

Reading Skills of Children with Generalised or Focal Epilepsy Attending Ordinary School

Results of laboratory investigations have suggested that children with recurrent bursts of generalised seizure discharge, including those apparently unassociated with clinical manifestations (‘subclinical seizure discharge’), might be especially disadvantaged educationally because of impaired attentiveness and other learning difficulties. This possibility was explored by comparing a group of 17 children who consistently showed these electroence‐phalographic features with a matched group of children with persistent focal spike abnormalities. Each epileptic child was paired with a non‐epileptic child in the same class at school, of the same sex, similar age and, as far as possible, similar general behaviour. All children in the study were attending ordinary school. School progress was assessed in terms of the relationship between actual reading skills and those predicted for each child on the basis of chronological age and over‐all intelligence.

The psychosocial problems of children with narcolepsy and those with excessive daytime sleepiness of uncertain origin.

BACKGROUND. Narcolepsy is a predominantly rapid eye movement sleep disorder with onset usually in the second decade but often in earlier childhood. Classically it is characterized by combinations of excessive sleepiness especially sleep attacks, cataplexy, hypnagogic hallucinations, and sleep paralysis. The psychosocial effects of this lifelong condition are not well documented, especially in children. This study aims to describe the psychosocial profile of a large group of children with narcolepsy compared with other excessively sleepy children and controls. METHODS. We used an international cross-sectional questionnaire survey of children aged from 4 to 18 years who had received from a physician a diagnosis of narcolepsy compared with age- and gender-matched controls. Assessments were made of behavior, mood, quality of life, and educational aspects. RESULTS. Recruited children were separated into those who met conventional criteria for narcolepsy (n = 42) and those whose primary complaint was excessive daytime sleepiness without definite additional features of narcolepsy (excessive daytime sleepiness group; n = 18). Compared with controls, children with narcolepsy and also those with excessive daytime sleepiness alone showed significantly higher rates of behavioral problems and depression. Again, to a significant extent, their quality of life was poorer and they had more educational problems. The children with narcolepsy and the excessive daytime sleepiness group were indistinguishable from each other on these measures. CONCLUSIONS. A range of psychosocial problems can be identified in children with narcolepsy. The origins of these problems are unclear. The similar profiles of difficulties in the narcolepsy and excessive daytime sleepiness groups suggest that excessive sleepiness is the main cause. Clinicians and others responsible for the care of such children need to be mindful of the importance of early detection, intervention, and, ideally, the prevention of these problems.

Children's sleep disorders: modern approaches, developmental effects, and children at special risk.

thinking20,21. Starting school early in the morning, thus causing persistent sleep deprivation, has been linked with both complaints and objective evidence of daytime sleepiness as well as poor concentration at school in teenagers22,23. In a high proportion (18%) of children in the general population with poor academic performance, upper-airway obstruction by enlarged tonsils and adenoids was reported to be the cause, with improvement in academic performance only apparent in those who had adenotonsillectomy24. This is in keeping with other preliminary reports of psychological improvements after surgical intervention25,26. EFFECTS ON EMOTIONAL STATE AND BEHAVIOUR A recent metaanalysis of research findings in adults indicated that the mean level of psychological functioning in sleepdeprived subjects is equivalent to only the 9th centile of subjects not deprived of sleep. However, mood was more affected than cognitive performance; irritability and depression were common27. From studies of children with Down syndrome, there are indications that, of the various types of sleep problem encountered in children, those in which there is a reduction in the duration and continuity of overnight sleep are particularly linked with daytime psychological disturbance28. Poor quality of sleep has also been associated with a range of mood and behavioural problems in children with OSA or asthma, with some evidence of psychological improvement after successful treatment of these conditions26,29. The signs of sleepiness can be very different in adults compared with children. Instead of activity level being reduced, it may well increase in young children, producing the symptoms of attention-deficit–hyperactivity disorder (ADHD). Indeed, there is some reason to believe that in a subgroup of children with ADHD the primary problem is a sleep disorder, the treatment of which improves behaviour30. In addition to these more direct ways in which sleep disturbance can cause psychological disturbance, children can be emotionally distressed indirectly by their sleep problems. Some sleep-disorder phenomena are frightening, such as intense hypnagogic imagery; others are embarrassing, such as sleepwalking or sleep terrors, especially if they occur when children are away from home. Some reactions are extreme as in the denial, aggression, or depression described in children with narcolepsy31. Serious psychosocial problems (including alcohol and drug abuse, as well as driving offences) have been described as a consequence of sleep disturbance in adolescents32. The child’s emotional development and behaviour may also be harmed by the effect of the sleep disturbance on other family members, especially parents. Mothers of children with a learning disability and severe sleep problems are reported to be less affectionate towards their children and to use more physical punishment than mothers of such children without sleep problems33. There are preliminary indications that these effects on parenting ability (and other aspects of family function) can be improved by successful treatment of the sleep disorder34. 570 Developmental Medicine & Child Neurology 1999, 41: 568–573 Table III: Typical total hours of sleep at different ages Age Length of sleep (h)