Sleep Study Terrie McNiffe, Cherie Miller, Dr Sivaramakrishnan, Dr Oliver
Background Sleep problems are common in childhood with up to 43% of children affected at some time. 1,2 The problem is more common in children with developmental problems and disabilities - up to 86% of children are reported to be affected. 3,4,5
Possible aetiologies 6 An increased incidence of issues that interfere with sleep – reflux, constipation, spasms Parents are more concerned or protective about their child with additional needs therefore not following same strategies as with other children People think that the usual behavioural strategies will not work Child with neurodevelopment problems not picking up on the usual cues that indicate that it is coming to bedtime Parents worrying that there might be another reason for their child’s sleep problem
‘Tired all the time’ 7 A report by the Family Fund which looked at the effect of sleep difficulties on households Over 93% of parents are up in the night with their child 49% have health issues due to lack of sleep 22% have relationship problems as a result 15% are concerned about siblings and the wider family’s health
Sleep problems in autism 8 Recent cohort study looking at sleep patterns in children with ASD Found that from 30 months of age children with ASD showed a trend towards reduced total sleep duration (reduction in night-time sleep duration wholly) Children with ASD woke more frequently at night (13% vs 5% cohort at 30 months, 11% vs 0.5% at 81months ) Reason hypothesised is an underlying disturbance in circadian melatonin production.
The Barnsley Sleep Study The aim was to look at the scope and prevalence of sleep problems in the children seen in the neurodevelopmental clinic in Barnsley. Between May and September 2013 an anonymous questionnaire was handed out to parents attending clinic. The questionnaire asked about the problems, if any, encountered and how it affected the family. We also asked whether they would like help with their child’s sleep problem and what help they would find most beneficial.
Demographics 70 questionnaires handed out and 53 responded. 40 males: 13 females Age range from 1 year to 12 years of age
Diagnosis Autism 13 DD 20 Downs syndrome Epilepsy Cerebral palsy 5 ADHD 2 Others 2 2 6 3 Not doc
Does your child have a sleep problem? 16 yes no 37
Reported sleep problem vs. diagnosis 18 16 14 Number of children 12 10 8 yes 6 no 4 2 0 Autism DD Epilepsy ADHD Others Cerebral palsy Not doc Downs syndrome Diagnosis
Problems reported Number reported w 10 15 20 25 a 0 5 k i n g i n n i g h t G o i n g t o b e d E a r l y w a k i n g G o i n g t o b e d o n o w n N o d a y t i m e n a p M s e d i c a l / e q u i p m e n t n e e d s
Sleep problem by diagnosis 40 35 30 Medical/equipment needs 25 No daytime nap Going to sleep on own 20 early waking Going to bed 15 Waking in night 10 5 0 Autism CP Epilepsy Others Not doc DD Downs ADHD
Number of nights affected 18 0 1 to 2 26 3 to 4 >4 5 4
Breakdown of those with >4 nights affected 3 Autism DD 3 Downs Epilepsy 13 CP 2 ADHD 1 Others 1 Not doc 1 2
How is the parent/carer affected? 30 25 20 15 10 5 0 p l p l s h e k a a p n e s r t n c l o e e i a o o i h r s w e l n s i s y t h l o n a h m t o l p a n i t e e t a n r l e a e m p r
Household affected? Partner and other children = 10/37 Partner alone = 8/37 Other children alone = 6/37 No-one = 13/37 Therefore 24/37 of household members affected
Would you like help? Yes = 23 No = 10 Support requested: Medication = 10 Sleep service = 8 Physical help = 6 Respite = 4
Summary 37/53 children were reported to have a sleep problem. 18/20 (90%) of children with a diagnosis of autism had a reported sleep problem. 26 children had more than 4 nights a week affected. Half of these children had autism. 29/37 parents with a child with a sleep problem reported problems themselves – the most common being sleep problems. 24/37 other household members affected 23 parents requested help with sleeping
What the study adds This study adds to what is already known sleep problems are common in children with a neurodevelopmental problem. It is not only the child that is affected when there is a sleep problem The majority of parents want help
Where to go from here? Specialised sleep service? Evidence on Effectiveness of Behavioural Interventions to Help Parents Manage Sleep Problems in Young Disabled Children: A Rapid Review. McDaid, C. and Sloper, P. November 2008 Working Paper No. C4EO 2296 Recently the department invited Cerebra to do a workshop with parents and there is going to be 1-to-1 sessions with parents to identify individual concerns.
References Boyle J, Cropley M., Children’s sleep: 1. Problems and Solutions. Journal of Family Healthcare 2004;14(3):61-3 Blundel et al; Are sleep problems under 2. recognised in general practice? Archives of Disease in Childhood 2004; 89:708-712 3. Bartlett, L.B., Rooney, V. and Spedding, S. (1985) Nocturnal difficulties in a population of mentally handicapped children. British Journal of Mental Subnormality; 31: 54-59
Richdale, AL, Prior, M.R. (1995) The sleep/wake 4. rhythm in children with autism. European Child and Adolescent Psychiatry; 4: 175-286. Wiggs, L., Stores, G. (1996) Sleep problems in 5. children with severe intellectual disabilities: what help is being provided? Journal of Applied Research in Intellectual Disabilities; 9: 159-164. 6. Personal Practice: The management of sleep problems in children with neurodevelopmental problems, including the role of melatonin. Thomas, M. British Academy of Childhood Disability Newsletter, Autumn 2013.
Tired all the time. Family Fund Report 7. Sleep patterns in children with autistic 8. spectrum disorders: a prospective cohort study. Humphreys J. et al, Archives of Disease in Childhood Online September 2013.
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