Sleep Issues and Children with Developmental Disorders
Author: Disabled World
Information regarding affects of childhood sleep disorders on children with developmental disorders as well as the family unit.
Main DigestImpaired sleep quality or quantity may have significant effects on a person's daytime behavior, mood, cognition, general performance and physiology. When sleep disturbance is present in children it impacts not only on the child's daytime functioning, but also on that of the child's parents and their family members in general. Associations between childhood sleep issues and maternal depression, stress, poor marital relationships and even child abuse have been reported.
The negative associations with childhood sleep issues are of specific concern in view of the high prevalence of sleep difficulties. Figures of around 25% of children, 43% of school-age children, and 33% of teenagers are presented and these figures are likely underestimated. The reported rates of sleep disorders in children with developmental disorders are even higher unfortunately. Rates vary, depending upon the criteria used to define a sleep issue; examples reported are:
- 34-86% of children with intellectual disabilities
- 49-89% of children with autistic spectrum disorders
- 25-50% of children with attention deficit hyperactivity disorder
Chart showing percentages of children with developmental disorders who also experience sleep disorders
The sleep issues of children with developmental disorders deserve specific attention, not least because of their prevalence, but also because of their persistence and severity, added stress it may place on carers, the contribution that sleep disturbance may be making to daytime difficulties with cognition and behavior, as well as the ability of the child's parents to cope with these things. Fortunately, the improvements in child and parental functioning that can follow successful treatment are worthwhile.
The sleep disturbances reported may be classified into basic groups. These groups include:
- Physiological sleep disturbances such as rapid eye movement (REM) sleep abnormalities which have been identified across a range of conditions.
- Sleep disorders that are more prevalent in certain groups of children, many times resulting from an underlying condition such as sleep related breathing disorders in children with Down syndrome.
A potential group is possible in which a sleep disorder is contributing to or causing the main condition. A substantial minority of children with ADHD are reported to experience periodic limb movement disorder (PLMD), a condition characterized by stereotypic and repetitive limb movement during sleep accompanied by physiological arousal. Sleep quality in those who experience PLMD is impaired to the degree that it shows in the person's daytime behavioral manifestations of sleep disruption through over-active behavior, poor concentration and impulsivity. After receiving treatment for PLMD, a person's symptoms of ADHD have been reported to diminish or even resolve entirely.
A Lack of Existing Information
Large gaps exist in our knowledge of sleep disturbances in children with developmental disorders. A lack of attention to co-existing conditions such as epilepsy, common in certain groups with developmental disorders, which may affect a person's sleep, is one reason why. Studies have many times been poorly controlled, if they were controlled at all, for factors such as age, current medication and IQ that may impact sleep patterns. The methods for assessing sleep have varied as well, ranging from physiological sleep studies conducted in a sleep laboratory to parent report questionnaires.
While the different methods are useful and taken together provide a more complete understanding, the comparison of results can be hard. Very few studies have done more than describe the symptoms or sleep issues while what is needed is analysis of the sleep disorder that underlies the symptoms. The distinction is important because very different sleep disorders may present with symptoms that are similar and treatment must be based on the disorder. There are broad categories of presenting symptoms:
- Excessive sleepiness
- Episodic disturbances of behavior associated with sleep or, 'parasomnias'
The International Classification of Sleep Disorders; however, lists more than eighty underlying sleep disorders - each of which may produce one or more of these symptoms. As an example; sleeplessness taking the form of difficulty getting to sleep at night may result from disturbance of a person's, 'body clock,' failure to learn appropriate bedtime behavior, or anxiety. The treatments for each of these differ greatly.
The Need for Assistance
When children with developmental disorders experience sleep disturbance they are not certain to receive appropriate treatment. It has been reported that of 124 children with severe forms of intellectual disabilities and current or past sleep issues, only 47% received treatment and the percentage was only slightly higher in 61 children with autism and sleep issues at 54%. The figures say nothing about the success or quality of the treatment they received.
One of the reasons why treatment is not routinely provided is that doctors and psychologists do not have professional training in sleep disorders, or the training they do have is limited in both time and scope. Parents of children with associated conditions might hesitate to seek advice. Among reasons suggested by parents are that sleep issues are long-standing and therefore part of, 'average life,' that parents and professionals view them as an inevitable and insoluble aspect of the underlying condition, and that prior experience has been negative. The offer of hypnotic medication may not have been desired, or behavioral programs may not have been appropriately devised.
Professionals involved in the care of children with sleep disruption must be capable of not only assessing, but recognizing and diagnosing sleep disorders. Their goal must be one of implementing treatment or of guiding parents of children affected to other agencies to receive treatment.
Assessing Sleep Patterns
Chart showing means of investigating sleep patterns
It is important for professionals to keep a careful sleep history of a child, along with their developmental, psychological, medical and family history. A detailed review of the child's 24-hour sleep-wake pattern is recommended to identify factors that are causing or perpetuating sleep issues. Options for further investigation then include:
- Video recordings
- Monitoring of body movements
- Use of sleep diaries, in which parents record information
- Polysomnography, either in a laboratory or in the child's home
- Questionnaires for screening purposes or to provide detailed information about specific aspects of sleep
Objective recordings might be helpful when information is lacking or of doubtful veracity. It may also be useful for assessment of the few sleep disorders where features of the PSG form part of the formal diagnostic requirement; narcolepsy, obstructive sleep apnea etc., are present. Clinical inquiries and systematic sleep diary information; however, will in many instances be sufficient for a basic assessment.
Treatment of Sleep Issues
Treatment for sleep disorders includes adjustment of lifestyle and environmental factors, behavioral techniques to help the child learn positive sleep habits or to unlearn poor ones, cognitive therapy, 'chronotherapy,' or altering sleep timing to re-set the child's body clock, physical measures such as the use of bright light to alter their sleep times, or nasal continuous positive airways pressure to aid breathing during sleep. Surgery to remove the child's tonsils and adenoids might be needed if they are causing an obstruction, and pharmacological approaches such as stimulants, sedatives and melatonin may be used.
A need for further research exists, not only due to deficiencies in information, but also because much of the existing work concentrates on sleeplessness while other types of sleep issues are neglected. Various behavioral treatments and chronotherapy have been reported to be successful across a range of conditions, even where a child's sleep issue is severe and long-standing. A gradual approach, where the new behavior is taught in small steps, might be more practical and acceptable to parents than an acute intervention; particularly in children who experience developmental disorders. The choice of technique should usually be guided by the parent's preference.
Pharmacological management might have a place in the management of some sleep disorders. As an example; imipramine and clonidine have been reported to be useful in children with ADHD and melatonin has been found to be helpful for children with disorders of their sleep-wake cycle, although the concerns and uncertainties surrounding the use of melatonin in children need to be weighed carefully on an individual basis. Generally, sedative medication has a very limited role in the management of children's sleeplessness since the clinical effects are slight and not well maintained. 'Hangover,' daytime effects are common and parents tend to be resistant. An argument for treatment of sleep issues in children with developmental disorders is that the benefits apply not only to the child affected but their family too.
- 1 - Helping People with Seasonal Affective Disorder to Sleep Better : Melissa Carlson - University of Pittsburgh (2013/06/28)
- 2 - Can Eating Foods Such as Cheese Cause Vivid Dreams? : Disabled World (2011/08/08)
- 3 - Throat Reflexes Differ in People with Tetraplegia and Sleep Apnea : The Physiological Society (2018/04/16)
- 4 - Senior Sleep: Sleeping Habits and Napping : Thomas C. Weiss (2015/08/26)
- 5 - Circadian Rhythms and Body Cycles : European College of Neuropsychopharmacology (2010/09/02)
- 6 - Night Sweats: Common Causes, Information and Facts : Thomas C. Weiss (2009/07/25)
- 7 - Non-24-Hour Sleep-Wake Disorder in Blind Individuals : Vanda Pharmaceuticals (2011/07/08)
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