Function-Based Behavioral Interventions for Sleep Problems in Children and Adolescents with Autism: Summary of 41 Clinical Cases

Objective. A series of studies were conducted to investigate pediatricians' training, knowledge, and practices regarding sleep and sleep disorders in children and adolescents. Method and results. Study 1, a national survey of 156 pediatric residency programs, found that pediatricians receive a mean of 4.8 hours of instruction on sleep and sleep disorders, although the mode and median hours of instruction is 0 hours. In Study 2, 88 pediatricians completing a questionnaire concerning general knowledge about sleep disorders in children and adolescents received a mean score of 71.8% (range, 40% to 93%). Pediatricians appear to know the most about developmental issues and sleep hygiene and the least about specific disorders such as narcolepsy and parasomnias. In the third study, 183 pediatricians were surveyed about their actual beliefs and practices regarding young children's sleep problems. Together, those surveyed reported that approximately 25% of their patients experience some type of sleep problem. Most pediatricians recommend behavioral interventions, although 14.8% of pediatricians report prescribing pharmacological treatments, and 48.9% inform parents that their child is likely to outgrow the problem. Conclusions. The results of these studies support the need for more education in sleep and sleep disorders in children and adolescents within medical schools, pediatric residency programs, and the practicing pediatric community.

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Subjective and Electroencephalographic Sleep Parameters in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10173893 ◽

2021 ◽

Vol 10 (17) ◽

pp. 3893

Author(s):

Maria Giuseppina Petruzzelli ◽

Emilia Matera ◽

Donatella Giambersio ◽

Lucia Marzulli ◽

Alessandra Gabellone ◽

...

Keyword(s):

Systematic Review ◽

Autism Spectrum Disorder ◽

Children And Adolescents ◽

Sleep Problems ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Subjective Sleep ◽

Adolescents With Autism ◽

Sleep Parameters ◽

Sleep Abnormalities

Background: Sleep problems have commonly manifested in children and adolescents with autism spectrum disorder (ASD) with a complex and multifactorial interaction between clinical and etiological components. These disorders are associated with functional impairment, and provoke significant physical and mental affliction. The purpose of this study is to update the existing literature about objective and subjective sleep parameters in children and adolescents with ASD, extrapolating information from polysomnography or sleep electroencephalography, and sleep related questionnaires. Methods: We have conducted a systematic review of case-control studies on this topic, performing a web-based search on PubMed, Scopus and the Web of Science databases according to the Preferred Reporting items for Systematic Review and Meta-analyses (PRISMA) guidelines. Results: Data collected from 20 survey result reports showed that children and adolescents with ASD experienced a higher rate of sleep abnormalities than in typically developing children. The macrostructural sleep parameters that were consistent with subjective parent reported measures unveil a greater percentage of nighttime signs of insomnia. Sleep microstructure patterns, in addition, pointed towards the bidirectional relationship between brain dysfunctions and sleep problems in children with ASD. Conclusions: Today’s literature acknowledges that objective and subjective sleep difficulties are more often recognized in individuals with ASD, so clinicians should assess sleep quality in the ASD clinical population, taking into consideration the potential implications on treatment strategies. It would be worthwhile in future studies to examine how factors, such as age, cognitive level or ASD severity could be related to ASD sleep abnormalities. Future research should directly assess whether sleep alterations could represent a specific marker for atypical brain development in ASD.

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BEHAVIORAL SLEEP PROBLEMS IN CHILDREN (BEHAVIORAL INSOMNIA) AND EFFECTIVE METHODS OF THEIR MANAGEMENT

EXPERIMENTAL & CLINICAL MEDICINE GEORGIA ◽

10.52340/jecmj.2021.389 ◽

2021 ◽

Author(s):

GVANTSA ARVELADZE ◽

TEIMURAZ MIKELADZE

Keyword(s):

Children And Adolescents ◽

Behavioral Interventions ◽

Sleep Problems ◽

Behavioral Therapy ◽

Sleep Onset ◽

Pharmacologic Therapy ◽

Poor Sleep ◽

Older Children ◽

Falling Asleep ◽

Sleep Schedule

Sleep problems with behavioral origins occur in 20 to 30 percent of children and are especially common in children with medical, neurodevelopmental, or psychiatric disorders. Insomnia related to learned sleep onset associations is most common in infants and toddlers and is characterized by prolonged night waking, requiring parental intervention to restore sleep. It occurs when the child learns to associate falling asleep with specific experiences, such as being rocked or fed. Insomnia related to inadequate limit-setting is a disorder most common in children who are preschool-aged and older and is characterized by active resistance, verbal protests, and repeated demands at bedtime. Guidance to parents about healthy sleep practices helps to prevent sleep problems and is also an important first step in treatment. An integral part of the bedtime routine is the institution of a bedtime and sleep schedule that ensures a developmentally appropriate amount of sleep. A consistent nightly bedtime will help to set the circadian clock and enable the child to fall asleep more easily. Treatment of primary insomnia in older children and adolescents usually involves behavioral interventions that resemble those used in adults. Establishing a consistent sleep schedule is also important for older children and adolescents for whom poor sleep hygiene is a common cause of sleep problems. Pharmacologic therapy for the treatment of childhood insomnia is not a first-line treatment and should always be combined with behavioral therapy.

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