Multifactorial Influences, Including Comorbidities, Contributing to Sleep Disturbance in Children with a Neurodevelopmental Disorder

Abstract

The term neurodevelopmental disorder (NDD) implies an impairment of the growth and development of the CNS caused by genetic, metabolic, toxic, or traumatic factors. Childhood neuropsychiatric disorder is a subset of NDD. Sleep disturbance is reported in many children with NDD although the details of this association, including extent and types of sleep disturbance, etiology, and assessment and treatment issues, need to be clarified by further research. This review considers the nature of sleep disturbance in NDD. Emphasis is placed on sleep disorders (i.e., the specific conditions that cause sleep problems) of which many are now recognized in the International Classification of Sleep Disorders (ICSD-3), and also intrinsic pathophysiological factors, physical and psychiatric comorbidities, and pharmacological and parental influences, which might contribute to the sleep disorders in children with NDD. The implications of this complexity for assessment and treatment in such children are then discussed. Appropriate treatment based on precise diagnosis of the causes of sleep disturbance is required to mitigate the harmful developmental effects of disordered sleep on children with NDD and their families.

Neurodevelopmental difficulties in children with idiopathic clubfoot

“…For example, in the conservative treatment of clubfoot, the child is required to sleep with a brace to counteract recurrence. This might cause extraordinary distress, in the case of additional neurodevelopmental challenges, as sleep disturbances can be common in children with neurodevelopmental disorders . Moreover, the poorer quality of life reported in children with neurodevelopmental disorders needs to be considered .…”

“…This might cause extraordinary distress, in the case of additional neurodevelopmental challenges, as sleep disturbances can be common in children with neurodevelopmental disorders. 25 Moreover, the poorer quality of life reported in children with neurodevelopmental disorders needs to be considered. 16 Possible coexisting difficulties encourage a broader intervention approach beyond the traditional and core clubfoot treatment, which may include speech and language therapy, motor training, behavioural interventions, and/or psychopharmacology on a case-to-case basis.…”

Oral melatonin for non‐respiratory sleep disturbance in children with neurodisabilities: systematic review and meta‐analyses

“…[9][10][11] The clinical and research literature uses numerous alternative phrases to describe sleep disorder in terms of its impact on an individual's sleep, such as 'sleep disturbance', 'sleep problems', and 'sleep difficulties'. 12 Such terms have all been used to describe difficulties with falling asleep (i.e. sleep initiation) and staying asleep, as opposed to night wakings or very early waking (i.e.…”

“…Current guidance on the management of sleep disturbance in children advocates that, once clinical or respiratory reasons for sleep disturbance are excluded, parent-directed interventions that seek to change parents' responses to sleeprelated problems should be the 'first port of call' for any child, 13,[19][20][21] with pharmacological intervention (typically melatonin) suggested in cases where such approaches prove ineffective and/or to be used alongside parent-directed approaches. 12,22 However, current practice in prescribing medicines such as melatonin has been described as haphazard. 18 For melatonin, guidance states that it should be considered for improving sleep onset latency (SOL) in children with neurodisabilities of any form whose sleep problems have not resolved after implementation of behavioural interventions.…”

Non‐pharmacological interventions for non‐respiratory sleep disturbance in children with neurodisabilities: a systematic review

“…This guidance is regarded as applicable to children with neurodisability. Pharmacological interventions (such as melatonin) are recommended where such interventions prove ineffective or alongside parent‐directed approaches . Other non‐pharmacological approaches include chronotherapy, phototherapy, dietary interventions, sensory interventions (e.g.…”