Salvatore Ottaviano

Circadian preference, sleep and daytime behaviour in adolescence.

The aim of this study was to determine the relationship between circadian preferences, regularity of sleep patterns, sleep problems, daytime sleepiness and daytime behaviour. As a part of an epidemiological survey on sleep in a representative sample of Italian high‐school students, a total of 6631 adolescents, aged 14.1–18.6 years, completed the School Sleep Habits Survey, a comprehensive questionnaire including items regarding sleep, sleepiness, substance use, anxiety and depressed mood, use of sleeping pills, school attendance and a morningness/eveningness scale. The sample consisted of 742 evening‐types (315 males and 427 females; mean age 17.1 years) and 1005 morning‐types (451 males and 554 females; mean age 16.8 years). No significant sex differences were found for morningness/eveningness score. Eveningness was associated with later bedtime and wake‐up time, especially on weekends, shorter time in bed during the week, longer weekend time in bed, irregular sleep–wake schedule, subjective poor sleep. Moreover, evening types used to nap more frequently during school days, complained of daytime sleepiness, referred more attention problems, poor school achievement, more injuries and were more emotionally upset than the other chronotype. They referred also greater caffeine‐containing beverages and substances to promote sleep consumption. Our results suggest that circadian preference might be related not only to sleep pattern, but also to other adolescent behaviours.

The Sleep Disturbance Scale for Children (SDSC) Construct ion and validation of an instrument to evaluate sleep disturbances in childhood and adolescence

SUMMARY To attempt a categorization of sleep disorders in children, we developed a 27 item Likert‐type rating scale (Sleep Disturbance Scale for Children: SDSC) and assessed the psychometric properties was developed. The scale was distributed to the mothers of 1304 children (1157 controls, mean age 9.8y; 147 sleep disorder subjects, mean age 9.2y, composed of four clinical groups: Insomnia 39 subjects, Hypersomnia 12 subjects, Respiratory disturbances during sleep 25 subjects and Parasomnias 71 subjects). The internal consistency was high in controls (0.79) and remained at a satisfactory level in sleep disorder subjects (0.71); the test/retest reliability was adequate for the total (r = 0.71) and single item scores. The factor analysis (variance explained 44.21%) yielded six factors which represented the most common areas of sleep disorders in childhood and adolescence. Enuresis was the only item with a factor loading lower than 0.40 and with a low inter‐item correlation and was therefore eliminated, resulting in a final scale of 26 items. The re‐evaluation of the sample, using the factor scores, supported the validity and the discriminating capacity of the scales between controls and the four clinical groups. The correlation between factor scores corroborated the hypothesis that childhood sleep disturbances are not independent entities nor do they cluster into different groupings related to each other. The SDSC appears to be a useful tool in evaluating the sleep disturbances of school‐age children in clinical and non‐clinical populations.

Sleep Problems and Daytime Behavior in Childhood Idiopathic Epilepsy

Summary: Purpose: To evaluate the presence of sleep problems and their association with behavioral and adjustment problems in children with idiopathic epilepsy.

Flunarizine and Migraine in Childhood: An Evaluation of Endocrine Function

Flunarizine was tested for prophylactic efficacy and for side effects in 10- to 13-year-old patients with severe migraine (> 2 attacks per month). The 13 preadolescents received a single 5-mg dose at night for 2 months. The attack frequency decreased significantly, and the effect was maintained over time. The endocrine status, investigated before and after treatment, showed no significant interference with pituitary, beta-pancreatic, or gonadal function.

Childhood headache risk: warning signs and symptoms present during the first six months of life*

In the history of children suffering from non-organic headache, the presence of periodic syndromes can often be found. In previous observations we ascertained that periodic syndromes are a common finding in children showing physical and behavioural characteristics of “hyperreactivity” in the first months of their lives. We have tried to verify, through a prospective study, whether children with “hyperreactivity” in the first months of life are particularly prone to develop periodic syndromes and/or non-organic headache. We have developed an appropriate test for the assessment of hyperreactivity in the first 6 months of life. We have isolated 183 hyperreactive subjects; 102 of them have been followed-up to an average age of 10.8 years, together with a control group of 80 subjects followed-up to an average age of 10.2 years. Of the 102 hyperreactive infants, 54 (52.9%) suffered from common migraine, versus 12 (15%) of the control group; 66 (64.5%) hyperreactive infants suffered from periodic syndrome, versus 10 (12.5%) of the control group. There was frequently a co-existence of migraine and periodic syndrome. It is thus possible to identify infants who are particularly prone to develop periodic syndromes and headache.

Laterality of arm movement in full-term newborn

We have investigated 20 healthy full-term newborns between the 4th and the 6th day of life in standard conditions for laterality of arm movements, before and after introduction of a target. The durations of recording were: (a) 5 min continuously before target introduction; (b) five 1-min units during target presentation. The movements studied were extension, flexion, movement with semiflexed arm with hand half-open or open toward the midline of the body, and total movements. Each of these items were counted separately and the counts were compared within and between sides. Spontaneous movements showed no side preference whereas in the presence of the target, movements toward the midline (target directed movements) showed a significant right-hand preference.

The effect of niaprazine on some common sleep disorders in children

A placebo-controlled double-blind clinical trial on the effect of niaprazine on children with some common sleep disorders was carried out. Niaprazine at a daily dosage of 1 mg/kg body weight or placebo at random was administered to a selected group of 36 children (aged from 6 months to 6 years) suffering from frequent nighttime waking or inability to fall asleep. The effect of niaprazine (or placebo) on sleep disorders was studied by means of continuous home-videorecorded sleep before and after the trial. A reliable positive effect of niaprazine on the sleep disorders considered was found. No adverse side effects were observed. We conclude that niaprazine seems to reprensent an effective and safe drug for the therapy of frequent nighttime waking and inability to fall asleep.

The utilization of the Rorschach test in a case-controlled study

The Rorschach test was administered to 58 children of normal intelligence aged 7–14 years with a history of common migraine of at least 12 months and to a group of controls matched for age, sex, and IO. The Rorschach test was scored blindly. The migraine group was characterized by marked intellectual inhibition with poor school performance and low response rates; inhibition of psychomotor activity and aggressiveness, shown by content analysis and by the presence of kinesthetic shock; inhibition of affect (ratio M/sum C); ineffective use of mechanisms of defence against anxiety (F-); prevalence of phobic features and massive use of repression, indicated by the high rejection rate and shock at red colour. The differences from the controls were significant at the 0.01 level with regard to all items in the preadolescent age group and with regard to all items except kinesthetic shock in the migraine group as a whole. There was thus a definite difference between the migraine group and the controls, a difference that might depend on impairment of ego function and on recurrent experience of pain.

Personality Inventory for Children and Childhood Migraine: A Case-Controlled Study

The personality inventory for children (PIC), which is similar in structure to the MMPI and hence free from subjective interpretation, is applicable to children from 6 to 16 years of age. We used it in 40 children with common migraine aged 8 to 14 years and in 40 controls comparable in age, sex, and socioeconomic status. Although the migraine subjects did not emerge as globally different from the controls, they presented significantly higher scores on the Somatic concern, Depression, and Anxiety scales, irrespective of sex. These results underline the value of PIC in the diagnostic assessment of childhood migraine.