It is estimated that 25% of children and adolescents suffer from a sleep problem at some point before entering adulthood. Research shows that over 95% of child and adolescent psychiatrists prescribe at least one sleep medication monthly, yet numerous studies show that CBT-Insomnia (CBT-I) works just as well as medication, is extremely cost effective and has longer-lasting benefits. Unfortunately, however, most child and adolescent psychiatrists are not trained in CBT-I. This Extended Workshop will teach participants when and for whom CBT-I is an appropriate treatment intervention, the 6 primary components of CBT-I, and how to design CBT-I treatment plans for a variety of child, adolescent, and young adult patients diagnosed with insomnia.

Sleep disturbances are common in children and adolescents but still remain unrecognized and undertreated. Several classification systems of sleep disorders are available, which include recent attempts to develop more specific nosologic categories that reflect developmental aspects of sleep. The prevalence of sleep disorders has been studied across various samples of healthy, typically developing children and those with special medical, psychiatric, and neurodevelopmental needs. Sleep disorders are highly prevalent in children and adolescents with psychiatric disorders, making it important for mental health professionals to be aware of sleep problems and to address them in the context of psychiatric comorbidities.

It is estimated that 25% of children and adolescents suffer from a sleep problem at some point prior to entering adulthood. Research shows that over 95% of child and adolescent psychiatrists prescribe at least 1 sleep medication monthly, yet numerous studies show that CBT for insomnia (CBT-I) works just as well as medication, is extremely cost-effective, and has longer-lasting benefits. Unfortunately, however, most child and adolescent psychiatrists are not trained in CBT-I. This Workshop will teach participants the following: when and for whom CBT-I is an appropriate treatment intervention; the 6 primary components of CBT-I; and how to design CBT-I treatment plans for a variety of adolescent and young adult patients diagnosed with insomnia. This Workshop will be based upon a comprehensive literature review and the clinical expertise of the instructors. In advance of the Workshop, registered participants will be sent a variety of standardized rating scales so that they may begin to assess their patient's (and their own) sleep in preparation for learning how to improve the sleep of their patients. CBT-I consists of an easily taught series of evidence-based skills that are portable, and time- and cost-effective. The goals of CBT-I are to alter the factors that perpetuate insomnia and include: 1) behavioral training in stimulus control, sleep restriction, and sleep hygiene; 2) cognitive training in managing dysfunctional thoughts and maladaptive behaviors related to sleep, such as unrealistic expectations and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. This Workshop will provide instruction in the use of CBT-I for adolescents and adults, and practitioners will be guided through a series of applied exercises to enhance their therapeutic skills.

Study Objectives To characterize children and youth newly diagnosed with insomnia and to describe their use of sleep and other related prescription medications.Methods Within a commercial claims database (January 1, 2016-December 31, 2021), we identified children and youth (2-24 years) with a newly recorded insomnia diagnosis (G47.0x; F51.0x) and examined psychiatric diagnoses in the prior 6 months. We evaluated sleep and related prescription medications dispensed in the week after new insomnia diagnoses (i.e. trazodone, other antidepressants, hydroxyzine, alpha-agonists, benzodiazepines, non-benzodiazepine hypnotics "z-drugs," antipsychotics, and others). Analyses were stratified by age and psychiatric comorbidities.Results Among 68 698 children and 108 118 older youth (18-24 years) with a new insomnia diagnosis, three-quarters had a diagnosed comorbid psychiatric condition; anxiety disorders, depression, and ADHD were the most common. Among those without comorbid psychiatric diagnoses, 20.2% of children and 37.4% of older youth had a sleep or related medication dispensed in the following week. In children without a comorbid psychiatric diagnosis, alpha-agonists, hydroxyzine, and trazodone were the most common medications; in older youth, trazodone was the most common medication followed by hydroxyzine, z-drugs, and SSRIs. Sleep and related prescription medications were more commonly dispensed to those with psychiatric comorbidities. From 2017 to 2021, there was an increase in hydroxyzine prescriptions following a new insomnia diagnosis and decline in z-drug and benzodiazepine prescriptions.Conclusions Our findings from a nationwide sample of young people with insomnia highlight the high prevalence of psychiatric comorbidities and variety of sleep and related medications they receive. Characterizing prescribing tendencies informs guideline development and future research. Graphical Abstract

Sleep disturbances are highly prevalent, especially among patients with psychiatric disorders. This year, we propose 2 clinical sessions on sleep to provide the practicing mental health professional with pragmatic, advanced knowledge of pharmacological and behavioral treatments of sleep disorders in children, adolescents, and young adults. A comprehensive literature review and case-based presentations will be provided. 1)Sleep terrors and sleepwalking are 2 of the most common parasomnias in childhood. Argelinda Baroni, MD, will present on evaluation, pathogenesis, and treatment of sleep terrors and sleepwalking with a focus on clinical applications. 2) Judith Owens, MD, will provide an update on the complex relationships between primary sleep disorders and ADHD in children and adolescents. Updated evidence-based behavioral and pharmacologic interventions, including melatonin, for ADHD-related insomnia will be reviewed. 3) Kyle Johnson, MD, will describe the current status of knowledge regarding sleep and ASD. A practical approach to addressing sleep problems in children with ASD using a systematic, evidence-based approach will be presented. 4) Jess Shatkin, MD, MPH, will describe the bidirectional relationship between sleep and cannabis. His presentation will describe the typical neurocognitive and behavioral effects of the best-known bioactive components of cannabis (cannabidiol [CBD] and tetrahydrocannabinol [THC]) upon sleep, in addition to prevention strategies and treatment approaches for those dependent upon cannabis for sleep. 5) Reut Gruber, PhD, will complete the session by integrating individual presentations and summarizing their clinical implications. This session will emphasize the importance of a sleep assessment and will provide participants with a guide to gold-standard behavioral and pharmacological treatments for youth with sleep disorders that frequently present in psychiatric practice. Participants will leave with updated knowledge on the recognition and management of sleep disorders, which will significantly improve treatment outcomes and quality of life for their patients.

The objective of this session is to provide clinicians with information that will enable them to better appreciate and address the impact of poor sleep on brain development and neurobehavioral functioning in vulnerable youth.

It is estimated that 25% of children and adolescents suffer from a sleep problem at some point prior to entering adulthood. Research shows that over 95% of child and adolescent psychiatrists prescribe at least 1 sleep medication monthly, yet numerous studies show that CBT for insomnia (CBT-I) works just as well as medication, is extremely cost-effective, and has longer-lasting benefits. Unfortunately, however, most child and adolescent psychiatrists are not trained in CBT-I. This Workshop will teach participants when and for whom CBT-I is an appropriate treatment intervention, the 6 primary components of CBT-I, and how to design CBT-I treatment plans for a variety of adolescent and young adult patients diagnosed with insomnia. This Workshop will be based upon a comprehensive literature review and the clinical expertise of the instructors. In advance of the Workshop, registered participants will be sent a variety of standardized rating scales so that they may begin to assess their patients’ (and their own) sleep in preparation for learning how to improve the sleep of their patients. CBT-I consists of an easily taught series of evidence-based skills that are portable, and time- and cost-effective. The goals of CBT-I are to alter the factors that perpetuate insomnia and include: 1) behavioral training in stimulus control, sleep restriction, and sleep hygiene; 2) cognitive training in managing dysfunctional thoughts and maladaptive behaviors related to sleep, such as unrealistic expectations and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. This Workshop will provide instruction in the use of CBT-I for adolescents and adults, and practitioners will be guided through a series of applied exercises to enhance their therapeutic skills.

Sleep disturbances are highly prevalent among children and adolescents with mood disorders. Increased sleep onset latency is a most consistent finding in youth with depressive disorders with reduced need for sleep being more pathognomonic for manic episodes. There is a relationship between sleep disturbances and increased risk of suicide in adolescents. Sleep evaluation should be an integral part of comprehensive evaluation of children and adolescents with mood disorders.

This presentation will: 1) review the currently available pharmacological treatment options for pediatric insomnia; 2) discuss the safety and efficacy of medications for insomnia, narcolepsy, restless legs syndrome, and parasomnias; and 3) outline practical guidelines to using medications for children with sleep disorders.

The objectives are to: 1) describe how to evaluate sleep disorders in children and adolescents utilizing clinician and patient rating scales, validated sleep questionnaires, actigraphy, and polysomnography; 2) discuss the utility and validity of commercially available and popular fitness and health wearables, such as Fitbit trackers and Apple watches; and 3) determine when to make an appropriate referral to a sleep specialist and/or sleep center.

Back to table of contents previous chapternext chapter No AccessChapter 22.Sleep-Wake DisordersEdited by:https://doi.org/10.1176/appi.books.9781615374809.md22AboutSectionsView chapterExcerptView Full Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View chapterSectionsEpidemiology | Classification of Sleep Disorders | Evaluation | Insomnia Disorder | Narcolepsy and Hypersomnolence Disorder | Restless Legs Syndrome and Periodic Limb Movement Disorder | Breathing-Related Sleep Disorders: Obstructive Sleep Apnea | Parasomnias | Circadian Rhythm Sleep-Wake Disorders | Sleep Problems in Children With Psychiatric Disorders | ReferencesExcerptChild and adolescent mental health care clinicians are on the front line of recognizing sleep disorders in children and adolescents, given that so many children assessed by clinicians have sleep symptoms. These sleep problems may represent sleep issues associated with a psychiatric condition such as depression or anxiety or other sleep disorder such as obstructive sleep apnea (OSA), restless legs syndrome, or narcolepsy. Mental health care professionals must keep sleep disorders in mind when assessing children with neurocognitive, emotional, behavioral, and motivational problems because chronic sleep disruption can cause these difficulties. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Dulcan’s Textbook of Child and Adolescent Psychiatry Information©American Psychiatric Association Publishing History Published online 9 January 2022 Published in print 8 October 2021

Sleep disturbances are highly prevalent, especially among patients with mental health disorders. This year we propose 2 clinical sessions on sleep to provide the practicing mental health professional with pragmatic, advanced knowledge of pharmacological and behavioral treatments of sleep disorders in children, adolescents, and young adults. Pharmacological and behavioral treatments will be our primary focus, with the emphasis on children and adolescents with mental health morbidities.

Objectives: To describe and quantify the nature and severity of sleep disruptions in young people with Dravet syndrome (DS) based upon parent report. Methods: Qualitative review of available pediatric sleep instruments with parent members of the Dravet syndrome Foundation led to the design of a series of questions customized to DS and other severe epilepsies. The questionnaire was administered as part of an on-line survey that reflected specific sleep-related concerns of parents of children with severe epilepsy. Results: 76 parent-respondents completed the survey for their children-participants. Children's median age was 7.5 years (IQR 4.7-15.3); 41 (54 %) were female. The majority of parents (70/76, 93 %) used some method to monitor children while sleeping; co-sleeping was the most common method (45/76, 59 %). Seizures disrupted sleep in 40/76 (53 %); 19(48 %) reported nocturnal seizures 3 or more nights per week. In addition, 58/76 (76 %) also reported non-seizure-related nocturnal awakenings with 30 reporting awakenings 3 or more nights affected per week. Significance: Young people with Dravet syndrome have frequently disrupted sleep secondary to seizures and other factors. Co-sleeping practices, medication effects, enuresis during seizures and other factors are not considered on standard sleep questionnaires. Current findings highlight the frequency of epilepsy-specific concerns and lay groundwork for sleep measures more appropriate for this population.