Sleep in Children With Psychiatric Disorders

Relationship Between Posttraumatic Stress Disorder, Death Anxiety, and Insomnia in Adults After the Earthquake

This study aimed to determine the relationship between posttraumatic stress disorder, death anxiety, and insomnia in adults after the earthquake. This study, designed in a relational-cross-sectional-descriptive model, was conducted with 624 adult individuals living in a province affected by the earthquake that occurred in Turkey on February 6, 2023. The study data were collected using a personal information form, Posttraumatic Stress Disorder Checklist, Turkish Death Anxiety Scale, and Bergen Insomnia Scale. The analysis of the study data was performed by using SPSS 25.0, AMOS 24.0, and G*Power 3.1 Statistical package software. A significant positive correlation was found between posttraumatic stress disorder and Insomnia and Death Anxiety (p < .05). There was a significant positive correlation between Death Anxiety and Insomnia (p < .05). It was determined that Death Anxiety has a mediating role in the impact of posttraumatic stress disorder on insomnia (95% Confidence Interval: 0.572/1.407) (p < .05). It was determined that the model created in line with the hypotheses was compatible and the model fit indices were within the desired limits, with x2/df = 1.795, RMSEA = 0.03, CFI = 0.95, GFI = 0.946, AGFI = 0.93, IFI = 0.95. It was determined that posttraumatic stress disorder increased death anxiety and insomnia after the earthquake. Conducting longitudinal studies on the post-earthquake period is recommended.

Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents

Insomnia and related sleep disturbances are prevalent among youth and are associated with adverse consequences, including poorer psychiatric functioning. Behavioral sleep interventions, ranging from brief educational interventions to behavioral therapies (cognitive behavior therapy-insomnia), are associated with positive outcomes for pediatric sleep health. In addition, sleep interventions may improve psychiatric health for children and adolescents with neurodevelopmental and internalizing disorders. Additional research is necessary to clarify the efficacy of these interventions over the long-term and across demographic groups; however, evidence suggests incorporating behavioral sleep strategies may prove beneficial to pediatric patients with sleep disturbances and related psychiatric complaints.

Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents

Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.

The relationship between alexithymia, emotion regulation, and sleep problems in school-aged children: A multicentric study

OBJECTIVES

Alexithymia, mood dysregulation, and sleep quality have complicated effects on children's development. The current study aimed to investigate the relationship between alexithymia, emotion regulation, psychiatric problems, and sleep problems among Egyptian school-aged children.

METHODS

A total of 564 Egyptian children, aged 6 to 14, were divided into two groups based on their total Children's Sleep Habits Questionnaire abbreviated score: group 1 (N = 300) with sleep problems and group 2 (N = 264) with non-sleep problems. Their parents completed the Strengths and Difficulties Questionnaire (SDQ) and subjectively assessed the children's emotions using the Children's Alexithymia Measure (CAM) and the Clinical Evaluation of Emotional Regulation-9 (CEER-9).

RESULTS

Males were more proportional in the sleep problems group than others. The sleep problem group was significantly younger and had a longer daily sleep duration than the non-sleep problem group. Alexithymia and emotion dysregulation had the highest mean in the sleep problem group. Furthermore, alexithymia, emotion dysregulation, emotion difficulty, conduct, and prosocial problems were the most significant contributing factors and risk factors for sleep problems in children.

CONCLUSION

Sleep problems in children were associated with younger male children with lengthy daily sleep duration and emotional, behavioural, and prosocial difficulties. Furthermore, alexithymia and emotion dysregulation are significant contributors and risk factors for sleep problems in school-aged children.

Investigation of the Relationship Between Mental Health Status and Sleep Patterns of Children Who Experienced the Kahramanmaraş Earthquake: Data From the Earthquake Region

BACKGROUND

The psychological conditions of children exposed to earthquakes, such as somatization, obsessive-compulsive, hostility, and paranoid thought, have not been adequately studied.

AIM

This study was conducted to examine the relationship between the mental states and sleep patterns of children who experienced the Kahramanmaraş earthquake.

METHOD

This is a descriptive, cross-sectional, and relational study that included 867 children from 11 provinces of Turkey affected by the earthquake that occurred in Kahramanmaraş on February 6th. The Child Follow-up Form, Mental Symptom Screening Scale, and Child Sleep Habits Scale were used to collect data.

RESULTS

The psychological symptoms (anxiety, depression, somatization, anger-hostility, obsessive-compulsive symptoms, interpersonal sensitivity, phobic anxiety, paranoid ideation, psychotic symptoms, and other issues) experienced by children after the earthquake explained 96.9% of their sleep disturbance. Some of the demographic characteristics, such as age, the status of experiencing loss in the earthquake, the survival status of their mother and father, the survival status of their siblings, the total number of losses after the earthquake, the total number of losses in the nuclear family, total hours spent under the rubble, the hours children waited for their father, mother, and siblings to come out of the rubble, accounted for 77.9% of the mental symptoms (SCL-90).

CONCLUSIONS

These results showed the importance of early recognition and treatment of sleep disturbances to prevent possible psychiatric disorders after children have been exposed to natural disasters. It is of great importance to evaluate the mental states of children after the earthquake and to apply appropriate psychiatric interventions.

Sleep Problems in Pediatric Disorders of Gut-Brain Interaction: A Systematic Review

OBJECTIVE

Disorders of gut-brain interaction (DGBIs) are common, and findings are mixed on rates of sleep problems (e.g., sleep quality) in pediatric populations. A clear understanding of sleep problems in pediatric DGBIs is needed as sleep challenges might negatively impact symptoms and prognoses. The aims of this systematic review are to (1) describe the prevalence and types of sleep problems in pediatric patients with DGBIs and examine differences by DGBI diagnosis and (2) examine the relationship among sleep problems and pain, mood, and functional outcomes in pediatric patients with DGBIs.

METHODS

We searched PubMed, PsycInfo, CINAHL, and Medline in June 2022; articles were included if they enrolled ≤19 years old with a DGBI, used a quantitative assessment of sleep problems, and were available in English. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was used to assess study quality. We used a protocol to systematically pull and tabulate data across articles with quality assessment ratings.

RESULTS

Twenty-four articles with 110,864 participants across 9 countries were included, with most studies being of moderate to weak quality. Patients with DGBIs reported more sleep problems than healthy peers, and some research reviewed found that patients with IBS had more sleep problems than other DGBI diagnoses. Sleep problems in DGBIs were related to worse mood, pain, and functional outcomes.

CONCLUSION

Pediatric patients with DGBIs are experiencing sleep problems that can impact outcomes. Screening for sleep problems and targeted treatment is needed to best support these patients.

Frequency of antidepressant use and clinical characteristics of children and adolescents undergoing polysomnography: an observational study

BACKGROUND

Antidepressants are increasingly used in children for various psychiatric disorders but also for sleep disorders such as insomnia; however, it is currently unknown how many children undergoing polysomnography (PSG) are taking anti-depressants. The aims were: to determine the frequency of use of antidepressants in paediatric patients referred for PSG, to identify the most common antidepressants used, to investigate the reasons for their use, and to analyse the PSG parameters found in children taking antidepressants.

METHOD

An observational cross-sectional retrospective chart review of all children undergoing PSG at Seattle Children's Hospital from 6/14/2020 to 12/8/2022 was carried out. Clinical features (such as diagnosis, especially psychiatric), sleep disorders (such as insomnia and restless sleep), and class of antidepressant used [selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCA), or atypical antidepressants], and PSG parameters were collected for further analysis.

RESULTS

Among 3,371 patients who underwent PSG during the study, 367 children were selected who were taking one antidepressant only (154 boys and 213 girls, mean age was 13.7 ± years 3.69). A significantly decreased sleep stage N3 was found in girls, who were older than boys. Children with insomnia had longer sleep latency than children without, but more N3. There was a prolonged rapid eye movement (REM) sleep latency in children with attention-deficit/hyperactivity disorder and children with autism. REM latency was longer and REM percentage smaller in children taking SNRIs. Periodic leg movement index ≥ 5/hour was found in a higher number of children taking SSRIs or SNRIs (24.9%) than in subjects taking TCA or atypical antidepressants (13.3%) (chi-square 5.29, p = 0.013).

CONCLUSIONS

Child and adolescent psychiatrists should question about the effects on sleep (both positive and negative) after initiating therapy with antidepressant medications.

The Role of Comorbid Symptoms in Perceived Stress and Sleep Problems in Adolescent ADHD

We examined perceived stress and sleep problems in adolescent ADHD and whether this varies as a function of ADHD presentation and sex. Further, we mapped structural associations between ADHD symptoms, comorbid symptoms, perceived stress, and sleep problems. Participants were 306 adolescents aged 13-19 years (66.8% females, 193 had an ADHD diagnosis, 113 were controls). Parents rated ADHD symptoms, all other constructs were self-rated. Adolescents with ADHD had elevated levels of perceived stress and sleep problems. Girls with ADHD reported the highest levels of perceived stress. Emotional symptoms mediated the effect of inattention whereas conduct problems mediated the effect of hyperactivity/impulsivity on stress and sleep. Perceived stress and sleep problems should be considered when mapping ADHD-related problems. Comorbid symptoms are potential intervention targets that may increase treatment response.

Association of accelerometer-derived sleep measures with lifetime psychiatric diagnoses: A cross-sectional study of 89,205 participants from the UK Biobank

BACKGROUND

Sleep problems are both symptoms of and modifiable risk factors for many psychiatric disorders. Wrist-worn accelerometers enable objective measurement of sleep at scale. Here, we aimed to examine the association of accelerometer-derived sleep measures with psychiatric diagnoses and polygenic risk scores in a large community-based cohort.

METHODS AND FINDINGS

In this post hoc cross-sectional analysis of the UK Biobank cohort, 10 interpretable sleep measures-bedtime, wake-up time, sleep duration, wake after sleep onset, sleep efficiency, number of awakenings, duration of longest sleep bout, number of naps, and variability in bedtime and sleep duration-were derived from 7-day accelerometry recordings across 89,205 participants (aged 43 to 79, 56% female, 97% self-reported white) taken between 2013 and 2015. These measures were examined for association with lifetime inpatient diagnoses of major depressive disorder, anxiety disorders, bipolar disorder/mania, and schizophrenia spectrum disorders from any time before the date of accelerometry, as well as polygenic risk scores for major depression, bipolar disorder, and schizophrenia. Covariates consisted of age and season at the time of the accelerometry recording, sex, Townsend deprivation index (an indicator of socioeconomic status), and the top 10 genotype principal components. We found that sleep pattern differences were ubiquitous across diagnoses: each diagnosis was associated with a median of 8.5 of the 10 accelerometer-derived sleep measures, with measures of sleep quality (for instance, sleep efficiency) generally more affected than mere sleep duration. Effect sizes were generally small: for instance, the largest magnitude effect size across the 4 diagnoses was β = -0.11 (95% confidence interval -0.13 to -0.10, p = 3 × 10-56, FDR = 6 × 10-55) for the association between lifetime inpatient major depressive disorder diagnosis and sleep efficiency. Associations largely replicated across ancestries and sexes, and accelerometry-derived measures were concordant with self-reported sleep properties. Limitations include the use of accelerometer-based sleep measurement and the time lag between psychiatric diagnoses and accelerometry.

CONCLUSIONS

In this study, we observed that sleep pattern differences are a transdiagnostic feature of individuals with lifetime mental illness, suggesting that they should be considered regardless of diagnosis. Accelerometry provides a scalable way to objectively measure sleep properties in psychiatric clinical research and practice, even across tens of thousands of individuals.

Association between sleep habits/disorders and emotional/behavioral problems among Japanese children

Actual sleep status and the association between sleep habits/disorders and emotional/behavioral problems among children in the development stage have not been fully clarified. A questionnaire survey was conducted on the sleep habits/disorders (Brief Child Sleep Questionnaire; BCSQ) and emotional/behavioral problems (Strengths and Difficulties Questionnaire; SDQ) of 87,548 children enrolled in ordinary classes in nine grade levels from the first grade of elementary school to the third grade of junior high school from December 2009 to April 2010. As school grade increased, children's bedtimes were delayed and sleep duration was reduced by 2.0 h over the nine grade levels. Based on the BCSQ, 18.3% of children were judged to have some type of sleep disorder, and about 30% to 40% of children had sleep symptoms at bedtime, during sleep, and at wake time. Multiple regression analysis showed that emotional and behavioral problems were associated with presence of any sleep symptom, longer sleep latency, and longer awake time after sleep onset, whereas total sleep time was not. Sleep symptoms at wake time were most strongly associated with emotional and behavioral problems. Status of sleep habits/disorders should be considered when interpreting emotional/behavioral problems in school-age children.

Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents

Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.

Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents

Insomnia and related sleep disturbances are prevalent among youth and are associated with adverse consequences, including poorer psychiatric functioning. Behavioral sleep interventions, ranging from brief educational interventions to behavioral therapies (cognitive behavior therapy-insomnia), are associated with positive outcomes for pediatric sleep health. In addition, sleep interventions may improve psychiatric health for children and adolescents with neurodevelopmental and internalizing disorders. Additional research is necessary to clarify the efficacy of these interventions over the long-term and across demographic groups; however, evidence suggests incorporating behavioral sleep strategies may prove beneficial to pediatric patients with sleep disturbances and related psychiatric complaints.

Integrative Management of Metabolic Syndrome in Youth Prescribed Second-Generation Antipsychotics

Weight gain and metabolic syndrome are common side effects of second-generation antipsychotics and carry significant health consequences both in childhood and into adulthood. This review highlights evidence-based, non-pharmacologic interventions to assist in the management of these side effects. Such intervention categories include dietary, physical activity, sleep, stress management, and nutritional supplementation. Interventions with the highest quality evidence include increasing the consumption of fruits, vegetables, and whole grains, increasing physical activity, improving sleep, and fish oil supplementation. We suggest that clinicians work with patients on managing metabolic side effects in a patient-centered way, incorporating principles of motivational interviewing, to reduce the risk of metabolic syndrome.

The Use of Sleep Medication in Youth Residential Care

Objectives: To investigate the use of sleep medication and concomitant psychotropic medication in children and adolescents placed under residential care (RC). Methods: Participants were youth 0-20 years of age placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of sleep medication in RC with the general child population (GenPop) and how it covaried with gender, age, reasons for RC placement, and concomitant use of other psychotropic medications (antidepressants, anxiolytics, antipsychotics, and psychostimulants). Results: A total of 2171 youths were identified in RC at mean age 14 years (82% ≥ 13 years). Seventeen percent (371/2171) used sleep medications (melatonin 11%, alimemazine 7%, and benzodiazepines/z-hypnotics 2%) significantly more than the 2.3% who used in GenPop. The girl/boy ratio for medication use in RC was 1.8 (95% confidence interval [CI] = 1.5-2.2), not significantly different from the corresponding ratio in GenPop (1.4; 95% CI = 1.3-1.5). The use of sleep medication increased with age. When comparing reasons for placement in RC, medication use was particularly low among unaccompanied minor asylum seekers (2%). About half of the youths used concomitant psychotropic medication, with clear gender differences; girls used about twice as much antidepressants, anxiolytics, and antipsychotics, whereas boys used 1.3 times more psychostimulants. Conclusion: Youths in RC used more sleep medication and concomitant psychotropic medication than the GenPop, most likely reflecting the increased psychosocial strain and mental disorders reported in this population. Further studies of prevalence, assessment, and treatment of sleep problems in RC populations are warranted.

Prevalence and impact of insomnia in children and adolescents with body dysmorphic disorder undergoing multimodal specialist treatment

Pediatric body dysmorphic disorder (BDD) is challenging to treat. This study aimed to establish the prevalence of insomnia in youth with BDD and explore its impact on clinical outcomes. Sixty-six children and adolescents with BDD consecutively referred to a specialist clinic completed a range of clinical measures, including the Yale-Brown Obsessive-Compulsive Scale Modified for BDD-Adolescent Version (BDD-YBOCS-A), and the Insomnia Severity Index (ISI). Patients with clinical insomnia (ISI score ≥ 9) were compared to the rest of the sample on socio-demographic and clinical features. Fifty-six patients who received multimodal treatment were re-assessed post-treatment. A mixed-model ANOVA was performed to compare treatment outcomes between the insomnia vs. no insomnia groups, and Chi-squared tests were used to compare response and remission rates. According to the ISI, 48% of the sample qualified as having insomnia at baseline. These participants showed significantly higher self-reported BDD symptom severity, more depressive symptoms, and more functional impairment in daily activities. Patients with insomnia improved less on the BDD-YBOCS-A than those without insomnia, although the difference did not reach statistical significance. The rates of responders and remitters were lower in the insomnia group, compared to the non-insomnia group. Insomnia is prevalent in pediatric BDD, and is associated with more severe psychopathology and worse functioning in daily activities. Furthermore, youth experiencing BDD and insomnia may benefit from multimodal treatment to a lesser extent than those without insomnia. If these results are replicated in larger samples, treatment refinements for pediatric BDD could include specific modules to directly target insomnia.

Insomnia in pediatric obsessive-compulsive disorder: prevalence and association with multimodal treatment outcomes in a naturalistic clinical setting

OBJECTIVE

Little is known about the prevalence and impact of insomnia on clinical outcomes in youth with obsessive-compulsive disorder (OCD). This study aimed to investigate this subject.

PATIENTS/METHODS

A total of 193 patients from a specialist pediatric OCD clinic completed a range of diagnostic and clinical measures, including the Insomnia Severity Index (ISI). Patients scoring above a previously validated cut-off on the ISI (score ≥9) were compared to the rest of the sample on sociodemographic and clinical characteristics. In a subsample of 143 (from the initial 193) patients who were treated at the clinic, a mixed-model analysis of variance (ANOVA) was used to compare the outcomes of multimodal OCD treatment in the insomnia (N = 60) vs no insomnia (N = 83) groups. The primary outcome measure was the clinician-administered Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) at post-treatment and at three-month follow-up.

RESULTS

The psychometric properties of the ISI in our sample were excellent. At baseline, 42% (81/193) of the sample scored above the ISI cut-off for clinical insomnia. These participants had significantly higher OCD severity, higher rates of psychiatric comorbidities, more severe depressive symptoms, poorer general functioning, and were more likely to take sleep medications, compared to those who scored below the ISI cut-off. In the treated subsample, while the insomnia group remained more severely affected through the three time-points, both groups improved similarly on the CY-BOCS at post-treatment and at three-month follow-up.

CONCLUSION

Insomnia is relatively common in pediatric OCD and is associated with more severe psychopathology. However, with adequate multimodal, evidence-based treatment, these patients can improve as much as those without insomnia.

An epidemiologic study of self-reported sleep problems in a large sample of adolescent earthquake survivors: The effects of age, gender, exposure, and psychopathology

BACKGROUND

This study investigated the prevalence of sleep problems and their associated risk factors in child and adolescent survivors three years after the 2013 Ya'an earthquake.

METHODS

A total of 6132 adolescent survivors aged 9-18 years were invited to complete the Pittsburgh Sleep Quality Index, Children's Revised Impact of Event Scale-13, Short Mood and Feelings Questionnaire, and Screen for Child Anxiety-Related Emotional Disorders. Logistic analysis was used to identify possible relationships of sleep disturbance scores with earthquake exposures, mental health and demographic characteristics.

RESULTS

More than a quarter of the sample showed sleep problems of some kind, with 23.1% sleeping fewer than 7 h per night, 32.5% having difficulty falling asleep, 24.2% having difficulty remaining asleep, 25.3% having poor sleep quality, 17.4% having nightmares and 44.6% having difficulty functioning during daytime hours. Older participants were at a significantly higher risk of sleep issues than younger children (OR 2.89), and the subjects had significantly elevated risks of probable anxiety (OR 3.47), probable depression (OR 2.45), and probable posttraumatic stress disorder (OR 1.89). Other risk factors for sleep problems were earthquake exposure variables, including being injured (OR 1.42), having a parent injured (OR 1.27), witnessing death (OR 1.32) or feeling extremely scared (OR 1.22) in the Ya'an earthquake.

CONCLUSIONS

Sleep disturbances are common in adolescent earthquake survivors, and they are associated with age, gender, psychiatric symptoms and factors related to earthquake exposure. These results highlight the importance of development- and gender-specific interventions to prevent sleep disturbances after a major earthquake.

Relationship between Sleep and Psychosis in the Pediatric Population: A Brief Review

Sleep disorders are common in several psychiatric disorders, including schizophrenia. In the pediatric population, the relationship between sleep and psychosis is not completely understood due to limited research studies investigating the link. Insomnia is noted to be a predictor of psychosis, especially in ultrahigh risk adolescents. Sleep difficulties are also associated with a two to three-fold increase in paranoid thinking. Biological factors, such as decrease in thalamic volume, have been observed in children with schizophrenia and ultrahigh risk adolescents with associated sleep impairment. Objective studies have indicated possible actigraphy base measures to be the predictor of psychosis after a one year follow-up. The studies using polysomnography have rare and inconsistent results. In this brief review, we provide an overview of existing literature. We also posit that future research will be beneficial in understanding the initiation, course and progression of sleep disturbance in the high risk pediatric population with the goal of implementing interventions to alter the development of psychosis.

Increased Incidence of Obstructive Sleep Apnea in Hospitalized Children After Enterovirus Infection: A Nationwide Population-based Cohort Study

BACKGROUND

We report the first nationwide population-based cohort study using Taiwan's National Health Insurance Research Database on the association between enterovirus (EV) infection and the incidence of sleep disorders in a pediatric population.

METHODS

Two matched groups of children under 18 years of age were included in the analyses for nonapneic sleep disorder and obstructive sleep apnea (OSA). Among them, 316 subjects were diagnosed with OSA during the surveillance period, including 182 in the EV infection group and 134 in the non-EV infection group.

RESULTS

Hospitalization because of EV infection was associated with OSA after adjusting for age, sex, urbanization atopic disease and perinatal complications (adjusted hazard ratio: 1.62, 95% confidence interval: 1.18-2.21; P = 0.003). An additional factor significantly associated with sleep apnea was allergic rhinitis (hazard ratio: 4.82, 95% confidence interval: 3.45-6.72).

CONCLUSIONS

Children with severe EV infection (ie, requiring hospitalization) carry a significantly higher risk of developing OSA, particularly in those with allergic rhinitis. As pediatric obstructive sleep apnea is a treatable sleep disorder, we emphasize regular follow-up and early detection in children with EV infection.

Sleep Disturbances in Child and Adolescent Mental Health Disorders: A Review of the Variability of Objective Sleep Markers

Sleep disturbances are often observed in child and adolescent mental health disorders. Although previous research has identified consistent subjective reports of sleep disturbances, specific objective sleep markers have not yet been identified. We evaluated the current research on subjective and objective sleep markers in relation to attention deficit hyperactivity disorders, autism spectrum disorders, anxiety and depressive disorders. Subjective sleep markers are more consistent than objective markers of actigraphy, polysomnography, and circadian measures. We discuss the causes of variability in objective sleep findings and suggest future directions for research.

Association of sleep with emotional and behavioral problems among abused children and adolescents admitted to residential care facilities in Japan

BACKGROUND

The psychological care of abused children in the child protection system is an urgent issue in Japan. Child abuse has a serious impact on children's emotion and behavior, but there is virtually no evidence about how child abuse affects sleep, which is closely related to behavioral and emotional control. In this study, we sought to identify sleep habits and suspected sleep disorders among abused children and adolescents admitted to residential care facilities in Japan and to investigate their association with emotional and behavioral problems.

METHODS

The study targeted 273 abused children and adolescents (age range: 4 to 15 years) who had been admitted to a residential care facility in Japan. They were assessed by physicians and other personnel at facilities with expertise in childcare and abuse. Respondents completed a brief sleep questionnaire on the incidence of problematic sleep habits and suspected sleep disorders as well as a questionnaire on emotional and behavioral issues.

RESULTS

Approximately 40% of the abused children and adolescents had some sleep-related symptoms at bedtime and waking, and 19% had suspected sleep disorder. Abused children with emotional and behavioral problems had a significantly higher incidence of suspected sleep disorders than abused children without such problems, and this incidence was particularly high among those with antisocial behavior and depressive behavior. Our predictive model also showed that antisocial behavior and depressive behavior were significant predictors of suspected sleep disorders.

CONCLUSION

Careful assessment and appropriate therapeutic intervention for sleep disorders are required in abused children and adolescents with emotional and behavioral problems.

Assessment and Treatment of Pediatric Sleep Problems: Knowledge, Skills, Attitudes and Practices in a Group of Community Child Psychiatrists

As part of a university-based quality improvement project, we aimed to evaluate child psychiatrists’ knowledge, skills, attitudes, and practices regarding assessment and treatment of pediatric sleep problems. We developed a nine-question survey of knowledge, skills, attitudes, and practices regarding assessing for and treating sleep complaints in pediatric patients, and administered this survey to child psychiatrists in training and in practice in the state of Missouri. Respondents reported sleep hygiene as the first-line treatment strategy, followed by the use of supplements or over-the-counter remedies. The most common barriers to evidence-based assessment and treatment of sleep problems were the lack of ability to obtain reliable history, and parental preference for medications over behavioral approaches for sleep concerns. These results suggest potential opportunities for enhancing knowledge regarding validated assessment tools and non-pharmacological treatment options for sleep problems. Additional research is needed to further assess the quality and type of sleep education provided in child psychiatry training programs.

The Prevalence of Sleep Disturbance and Its Socio-demographic and Clinical Correlates in First-episode Individuals With Schizophrenia in Rural China

PURPOSE

This study aimed to determine the prevalence and the socio-demographic and clinical correlates of sleep disturbance in first-episode individuals with schizophrenia in rural China and the factors that impact sleep among individuals with schizophrenia.

DESIGN AND METHODS

A total of 104 first-episode individuals with schizophrenia were randomly selected in rural areas in Ningxia, China, in 2015 as the study sample.

FINDINGS

In first-episode individuals with schizophrenia, the prevalence of sleep disturbance was 78.8% (82/104). Sleep disturbance was significantly associated with economic status, living situation, educational level, depressive symptoms, and anxiety symptoms.

PRACTICE IMPLICATIONS

Sleep disturbance is common in first-episode individuals with schizophrenia in rural China and more attention should be paid in clinical practice to improve the sleep quality for individuals with schizophrenia.

DSM-5 Changes in Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder: Implications for Comorbid Sleep Issues

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are the most common neurodevelopmental disorders. Despite significant comorbidity, the previous diagnostic criteria prohibited the simultaneous diagnosis of both disorders. Sleep problems are highly prevalent in both disorders; however, these have been studied independently for ADHD and ASD. In the context of revised criteria in the Diagnostic Statistical Manual of Mental Disorders 5th edition (DSM-5) that allows combined diagnosis of ADHD and ASD, this short review presents an overview of relationship between sleep problems, ADHD and ASD, as well as conceptualizing the shared pathophysiology. The practical considerations for clinical management of sleep problems in combination with ADHD and ASD are also discussed.

Sleep problems in children and adolescents with epilepsy: Associations with psychiatric comorbidity

Sleep problems are common in pediatric epilepsy and may influence seizure control, daytime functioning, and overall quality of life. Knowledge of factors contributing to sleep problems is likely to improve treatment. The aim of this study was to investigate associations between psychiatric comorbidity and parent-reported and self-reported sleep problems in a sample of children and adolescents with epilepsy. Participants were children and adolescents (N=94), aged 10-19years, with generalized or focal epilepsy who had been referred to a tertiary epilepsy treatment center in Norway. Participants underwent a thorough clinical assessment and 24h of EEG registration. Information on sleep problems was obtained from parents using the Children's Sleep Habit Questionnaire (CSHQ) and from self-reporting using the Sleep Self-Report (SSR) questionnaire. Psychiatric diagnoses were established using the semistructured psychiatric interview Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (Kiddie-SADS-PL). Both the total and subdomain CSHQ and SSR scores were high in comparison with scores from population-based samples. Having one or more psychiatric disorder(s) was significantly associated with elevated scores on both the CSHQ and the SSR. With the exception of parent-reported parasomnias, associations between sleep problems and psychiatric disorders remained significant after adjusting for relevant epilepsy variables. Psychiatric comorbidity explained about one-third of the variance of the reported sleep problems in children and adolescents with epilepsy.

Psychiatric comorbidities among adolescents with and without anxiety disorders: a community study

ABSTRACT Objective To evaluate, in a community sample of adolescents, the presence of comorbidities in different anxiety disorders. Methods This is a cross-sectional study, initially composed of 2,457 adolescents, aged between 10-17 years old, from public schools of the area covered by the Basic Health Unit of a university hospital. We applied the Screen for Child Anxiety Related Emotional Disorders (SCARED) to assess for anxiety disorders. Then, 138 positive cases in the screening were assessed for mental disorders through the Schedule for Affective Disorder and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL). Results Patients with anxiety disorders had more association with other anxiety disorders, as well as depression, and enuresis. The most common comorbidity described in our study was between generalized anxiety disorder and separation anxiety disorder (OR = 4.21, 95% CI 1.88, 9.58). Significant association was observed between other disorders such as enuresis and separation anxiety disorder (OR = 3.81, 95% CI 1.16, 12.49), as well as depression and generalized anxiety disorder (OR = 3.40; 95% CI 1.52, 7.61). Conclusion Our study showed a relevant presence of comorbidities adolescents with anxiety disorders, selected from a community sample, especially regarding other anxiety disorders. Nevertheless, further studies are needed to confirm our findings.