Sleep disorders in children and adolescents
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Abstract
Up to 30% of children and adolescents suffer from sleep problems (Mindell & Owens, 2009). For many children these problems persist over time and result in adverse daytime consequences (Kataria, Swanson & Trevathan, 1987; Lam, Hiscock, & Wake, 2003; Sadeh, 2007; Wake et al., 2006; Zuckerman, Stevenson & Bailey, 1987). Impaired attention, problems with impulse control, hyperactivity, decrements in working memory, and poor academic performance have each been shown to result from insufficient sleep (see McLaughlin-Crabtree & Witcher, 2008). Potential effects on physical health are similarly deleterious and include cardiovascular risk, compromised immune function, and metabolic changes such as insulin resistance (de la Eva, Baur, Donaghue & Waters, 2002; Gozal & Kheirandish-Gozal, 2008). Sleep disturbances also overlap considerably with child psychopathology (Alfano & Gamble, 2009), and a majority of children presenting with sleep complaints meet criteria for a mental health problem (Ivanenko, Barnes, Crabtree & Gozal, 2004). These collective data provide undeniable evidence of the critical role of sleep in physical, cognitive, and emotional development. The current chapter overviews sleep disorders in childhood, including evidence-based assessment and treatment approaches. We begin with a brief review of the neuroscience of sleep, including description of the two process model of sleep regulation, basic sleep staging, and physiology. Next, we discuss key normative, developmental changes in sleep that occur during the childhood years. Although problems sleeping can manifest at any age, we focus on school-aged youth age 6 and older who have achieved monophasic sleep (i.e., one nighttime sleep period during a 24 hour day). Then, diagnostic classifications of sleep disorders and validated methods for the assessment and diagnosis of these disorders are outlined. We consider several 3 specific sleep disorders common in youth, including those most likely to be encountered by mental health professionals by virtue of their high prevalence and frequent comorbidity with various forms of psychopathology. For each disorder, we provide information on its prevalence, comorbidities, diagnostic considerations, and finally, evidence-based intervention approaches.