Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians

Abstract

There is a complex relationship between sleep disorders and childhood neurodevelopmental, emotional, behavioral and intellectual disorders (NDEBID). NDEBID include several conditions such as attention deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, epilepsy and learning (intellectual) disorders. Up to 75% of children and young people (CYP) with NDEBID are known to experience different types of insomnia, compared to 3% to 36% in normally developing population. Sleep disorders affect 15% to 19% of adolescents with no disability, in comparison with 26% to 36% among CYP with moderate learning disability (LD) and 44% among those with severe LD. Chronic sleep deprivation is associated with significant risks of behavioural problems, impaired cognitive development and learning abilities, poor memory, mood disorders and school problems. It also increases the risk of other health outcomes, such as obesity and metabolic consequences, significantly impacting on the wellbeing of other family members. This narrative review of the extant literature provides a brief overview of sleep physiology, aetiology, classification and prevalence of sleep disorders among CYP with NDEBIDs. It outlines various strategies for the management, including parenting training/psychoeducation, use of cognitive-behavioral strategies and pharmacotherapy. Practical management including assessment, investigations, care plan formulation and follow-up are outlined in a flow chart.

Keywords: Sleep; Emotional; Behavioural difficulties; Neurodevelopmental disorders; Pharmacotherapy; Non-pharmacologic interventions; Cognitive therapy; Melatonin; Adolescents; Psychoeducation

Core Tip: Up to 75% of children and young people with neurodevelopmental, emotional, behavioural and intellectual disorders (NDEBID) are known to experience different types of insomnia, associated with significant behavioral, emotional, cognitive and academic impairments, as well as negative impact on the wellbeing of other family members. This paper provides a brief overview of sleep physiology, aetiology, classification and prevalence of sleep disorders among children and adolescents with NDEBIDs. It outlines different strategies for the management of sleep disorders, including parenting training/psychoeducation, the use of cognitive-behavioural strategies and pharmacotherapy. Practical management including clinical assessment, investigations, care plan formulation and follow-up are outlined.