Another Restless Night or Something More?: Five Signs of Sleep Disorders in School-Age Children with Special Needs

From the Kennedy Krieger Institute:

While sleep disturbances are common in all children at some point during childhood, the National Association of School Psychologists estimates that as many as 30 percent of children have restless nights serious enough to be diagnosed with a sleep disorder. For children with special needs, the likelihood of sleep disorders is even higher, due to factors such as physical and behavioral differences, and even side-effects from medication.

Left untreated, sleep disorders can exacerbate existing conditions or cause additional health problems. While not all children with special needs who experience sleep disturbances will be diagnosed with a sleep disorder, experts point to early detection of common signs as the key to improving sleep.

According to Dr. Jennifer Accardo, director of the Sleep Disorders Clinic and Lab at the Kennedy Krieger Institute in Baltimore, Md., parents know their child’s sleep patterns best and are often able to spot a more serious problem if they know the signs.

Signs of Sleep Problems in Children with Special Needs

1. Snoring. Children who struggle to breathe or who noisily pause, gasp or choke in their nighttime breathing are at risk for obstructive sleep apnea. This treatable condition prevents a child from achieving deep, restful sleep and often results in daytime attention and behavior problems.
2. Difficulty falling or staying asleep. Everyone has problems now and then, but chronic difficulty falling or staying asleep can make it hard for children to stay alert and focused during the day. Even children can have insomnia, and those with disabilities tend to struggle the most.
3. Sleepwalking, night terrors and other nighttime activities. At some point, many children walk, talk or cry out in their sleep. Doctors call these occurrences parasomnias and if they happen often or over a long period of time, parents should seek help to find potential triggers.
4. Sleeping too much. Children who have trouble waking up in the morning, getting to school on time or falling asleep during class have clear signs of a sleep problem.
5. Needing parents to be in the room to fall asleep. If children are unable to fall asleep without their parents in the room, then it may be time to seek guidance.

“While a good night’s sleep is important for all children, it is especially critical for children with special needs,” says Dr. Accardo. “Parents can make small changes at home to help their child get a better night’s sleep and improve their performance in daytime activities, therapies and social interactions.”

Tips to Improve Sleep Patterns

1. Make sleep a priority. Without a good night’s sleep, children may have difficulty participating fully in activities such as homework, sports and therapies.
2. Develop a bedtime routine. Everyone needs this, even adults! A short set of calming activities helps children “wind down” to be ready for sleep.
3. Keep schedules consistent between weekdays and weekends.Kids who stay up later and sleep in on weekends may find it hard to return to their regular schedules during the school week.
4. In fact, keep schedules consistent every day! Going to bed and waking up around the same time daily trains your brain to account for the hours you need for other regular activities.
5. Make the bedroom a restful place. TV and video games are not only distracting in the bedroom, but they also produce bright light that signals the brain to wake up.
6. Sleep in the same place every night. Children who sleep on the couch, on the floor or in different beds have more trouble developing good sleep habits.
7. Avoid caffeine. Caffeine in sodas, teas and coffees can keep children and adults awake.
8. Put your child to bed when they are sleepy, but not yet fully asleep. Self-soothing is a fundamental skill for children. Putting children to bed before they are completely asleep gives them an opportunity to develop this skill.
9. Address anxiety. Anxiety commonly affects children with disabilities, and makes sleep difficulties worse.
10. Take note of sleep problem signs. Tracking patterns and signs can help your pediatrician or a sleep expert to more quickly identify the problem and offer solutions.

“If parents are concerned about their child’s sleep patterns and behaviors, they should consult with their pediatrician or a sleep expert,” says Dr. Accardo. “Sleep evaluations can be extremely beneficial in identifying causes and ultimately improving sleep for the entire family.”

For more information on sleep disorders in children with specific diagnoses, see this overview on sleep disorders I wrote in 2009, and find other helpful information and tips in the Sleep Disorders section of the main site, www.tourettesyndrome.net.

School re-opens soon – is your child ready?

This is a re-post of links to back-to-school tips published previously on this blog:

I know that in some parts of the country, the school year has already started, but if you are in New York like I am, there are still a few more weeks.  I thought this might be a good time to remind parents of some back-to-school tips:

• Back to School Tip #1: Is the teacher ready for your child?
• Back to School Tip #2: Re-establish wake-up time and routines
• Back to School Tip #3: Structure and routine boost homework compliance
• Back to School Tip #4: Can they manage their clothes? Their lunch?
• Back to School Tip #5: Lost at School – Literally?
• Back to School Tip #6: Medication

Summer heat poses special risks for individuals with neuropsychiatric challenges

A new study on Bipolar Disorder reminds me that this might be a good time to raise some safety issues  for parents about summer heat. But let’s start with the study. Mark Cowen writes:

Results from a Taiwanese study suggest that high daily temperatures are associated with increased hospitalization rates for mood symptoms among patients with bipolar disorder, particularly women.

The researchers found that the risk for hospitalization began to increase when the daily temperature rose above 24.0°C, and continued to increase with higher daily temperatures.

The results support “our hypothesis that environmental factors influenced bipolar disorder hospitalizations,” comment Huey-Jen Su and team from National Cheng Kung University in Tainan.

[...]

The researchers found that there was a significant positive association between increasing ambient temperature over 24.0°C and hospital admissions for bipolar disorder the following day.

Specifically, compared with a daily mean temperature ranging from 19.8 to 24.0°C, the relative risk for bipolar disorder admission increased 10%, 15%, 34%, and 51% when the daily mean temperature was over 24.0°C, 27.2°C, 29.0°C, and 30.7°C, respectively.

Read more on News-Medical.net

For those of us used to Fahrenheit:
24.0°C = 75.2°F
27.2°C = 80.96°F
29.0°C = 84.2°F
30.7°C = 87.26°F

Keep in mind that Taiwan’s average annual temperature is around 71.6°F, whereas there is more variability in the U.S., depending on where you live.

The finding that environmental temperature and climatic factors can influence neuropsychiatric disorders is certainly not new, and the relationship between mood disorders and seasonal changes is well documented. But’s not just Bipolar Disorder or mood disorder that’s susceptible to seasonal variations or climate effects. Back in the 1970′s, when I was conducting my doctoral dissertation, I had even noted the correlation between measures and specific environmental factors such as temperature, relative humidity, and barometric pressure in some patients who had been diagnosed with migraine headaches and/or Raynaud’s Syndrome, and individuals with other disorders may also experience impact from temperature or other climatic factors.

So how can you use this information?

First, if you are parenting a child with a neuropsychiatric disorder, remember to keep your child cool and well-hydrated and avoid over-exertion if it’s very hot out.

Second, learn the warning signs of heat exhaustion and heat stroke.

Third, be aware that some medications can make your child even more susceptible to heat stroke.

These concerns and precautions do not just apply to the current heat wave or summer or to kids or teens diagnosed with a mood disorder. In September, some of you will be sending your children back into hot school environments. Make sure you have appropriate accommodations and alerts in place to protect their safety.

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Written Expression Problems in Students with ADHD

Reuters had an article about some new research that confirms what many of us already knew – that written expression is a huge problem for students with ADHD:

Kids with attention-deficit hyperactivity disorder are more likely to have writing problems such as poor spelling and grammar than their peers, suggests a new study. And the difference may be especially conspicuous in girls with ADHD.

Reading and math problems often raise red flags for teachers and parents, but “written-language disorder is kind of overlooked,” said study author Dr. Slavica Katusic, from the Mayo Clinic in Rochester, Minnesota.

[...]

Writing problems were much more common in both boys and girls with ADHD. Close to two-thirds of boys with ADHD had trouble with writing, compared to one in six boys without ADHD.

For girls, 57 percent with ADHD had a writing problem, compared to less than 10 percent without ADHD. And girls with ADHD were almost ten times more likely to have a combination of writing and reading disorders compared to girls without the condition.

Memory and planning problems in kids with ADHD may affect the writing process, the authors explain, and ADHD has been linked to learning disorders in the past.

Annette Majnemer, who has studied handwriting in kids with ADHD at McGill University in Montreal, Canada, said that many with the disorder seem to have difficulty with that component of writing.

“It might be partially the fact that they’re inattentive and distractable and hyperactive,” she told Reuters Health. It’s also possible that motor skills and coordination problems are partly to blame, said Majnemer, who was not involved in the new research.

[...]

“Clinicians and the teachers have to emphasize that the testing has to be done for everything, every kind of learning disability,” Katusic said. “It has to be identified early and the treatment has to start early.”

Read more on Reuters.

As the article suggests, there are a number of factors that contribute to difficulties in written expression and a comprehensive assessment that includes handwriting, memory, and executive functions is crucial. Once the various challenges are identified, appropriate accommodations and remediation can be designed. The good news is that we do have accommodations and techniques that can help – but only if the school recognizes and assesses the problem.

If your child is extremely frustrated every time they have to write more than one sentence or have to elaborate on their thoughts – if their written work gives you a headache because it seems out of order and poorly organized or prioritized — if they act as if you are killing them because you ask them to edit their work or insert necessary capitalization, punctuation, and correct their spelling – contact the school to request an assessment.

School re-opens soon – is your child ready?

I know that in some parts of the country, the school year has already started, but if you are in New York like I am, there are still a few more weeks.  I thought this might be a good time to remind parents of some back-to-school tips I had previously shared:

• Back to School Tip #1: Is the teacher ready for your child?
• Back to School Tip #2: Re-establish wake-up time and routines
• Back to School Tip #3: Structure and routine boost homework compliance
• Back to School Tip #4: Can they manage their clothes? Their lunch?
• Back to School Tip #5: Lost at School – Literally?
• Back to School Tip #6: Medication

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