ABSTRACT
Mental health specialists can contribute to improvements in children's school experience when they work with administrators to incorporate up-to-date mental health knowledge into educational practice. Effective consultation is not simply a knowledge dissemination exercise. The impact of the consultant's input is determined by how responsive the consultation process is to the needs and assets of faculty, students, and the broader community.
Subject(s)
Administrative Personnel , Adolescent Psychiatry/methods , Child Psychiatry/methods , Consultants , School Health Services/organization & administration , Adolescent , Child , Health Plan Implementation , HumansABSTRACT
OBJECTIVE: To examine the prevalence, co-occurrence, and correlates of sleep problems among elementary school children. DESIGN: Survey. SETTING: General community. PARTICIPANTS: The parents of 987 children aged 5 to 12 years completed an anonymous survey distributed in their children's schools. MAIN OUTCOME MEASURES: The survey form asked about background characteristics, children's sleep environment, sleep habits, adult interventions, sleep history, and specific sleep problems. RESULTS: Bedtime resistance was the most prevalent sleep problem (27%). Sleep-onset delays (11.3%), night waking (6.5%), morning wake-up problems (17%), and fatigue complaints (17%) were also common. Among children with sleep-onset problems, 80% displayed bedtime resistance, while 34% of bedtime resisters had onset problems. Onset problems correlated with more fears, night waking, psychiatric and medical conditions, the need for reassurance and caregiver proximity, and history of sleep problems. Bedtime resistance was associated with an inconsistent bedtime and falling asleep away from bed. Those who display delayed sleep onset and bedtime resistance also wake later, suggesting that sleep-phase delays may maintain these problems. CONCLUSIONS: The results confirm bedtime resistance as parents principal sleep-related complaint for this age group but reveal a subgroup more prone to insomnia, night waking, and anxiety-related features. Phase delay findings suggest the importance of limits around wake-up time as well as bedtime. The results highlight the importance of distinctly evaluating bedtime resistance, sleep onset, sleep maintenance, waking, and emotional adjustment.
Subject(s)
Sleep Wake Disorders/epidemiology , Child , Child Behavior , Child, Preschool , Data Collection , Dreams , Enuresis/epidemiology , Female , Humans , Male , New York/epidemiology , Prevalence , Sleep Wake Disorders/psychologyABSTRACT
OBJECTIVE: This study evaluated the effects on behavior and sleep of methylphenidate (MPH) administered at 4 PM to children with attention-deficit hyperactivity disorder (ADHD). METHODOLOGY: Twelve children admitted to a child psychiatric inpatient service with ADHD participated in a double-blind, crossover study in which they received a 4 PM dose of either 15 mg of MPH, 10 mg of MPH, or a placebo in random order for 12 consecutive days. Ratings of behavior, including ADHD symptoms, pertaining to the period from dose administration until sleep onset, were supplied nightly by hospital staff. Sleep latency and sleep adequacy were also assessed for each night. RESULTS: MPH resulted in markedly improved behavioral control compared with placebo; there was no difference between 15-mg and 10-mg MPH doses. MPH did not alter sleep latencies observed with the placebo. Children were more often rated as less tired on awakening after nights that they received 10 mg of MPH compared with 15 mg of MPH and the placebo. Weight loss was apparent among 83% of the patients, but dinner intake did not vary with third-dose condition. CONCLUSIONS: Morning and noon administration of stimulants to children with ADHD is a near-universal practice, but many clinicians avoid a third, late-afternoon administration for fear of inducing insomnia. This study's findings show that children with ADHD derive substantial symptom reduction from MPH administered in late afternoon, with no untoward effects on sleep. Therefore, three-times-a-day dosing should be considered for those children exhibiting ADHD symptoms in the evening. Adverse effects on sleep latency were not apparent in the sample overall. Nonetheless, monitoring for possible aggravation of sleep problems and weight loss remains sound treatment practice.
Subject(s)
Attention Deficit Disorder with Hyperactivity/drug therapy , Child Behavior/drug effects , Methylphenidate/therapeutic use , Sleep/drug effects , Attention Deficit Disorder with Hyperactivity/psychology , Child , Child, Preschool , Cross-Over Studies , Double-Blind Method , Drug Administration Schedule , Eating , Fatigue/prevention & control , Female , Humans , Male , Methylphenidate/administration & dosage , Placebos , Sleep Stages/drug effects , Wakefulness/drug effects , Weight LossABSTRACT
Behavioral patterns over time were assessed during the first 24 days of hospitalization for 98 child psychiatric inpatients. Staff completed daily behavioral monitoring and ratings. Patients were categorized as improved, unchanged or deteriorated during this time. Thirty-four percent of patients initially exhibited well-controlled behavior, but then significantly worsened after a period averaging 6.8 days. This result empirically supports the "honeymoon" phenomenon. Other patients showed either improvement during the initial period (15%), no change (30%), or could not be reliably classified (21%). Therefore, many child inpatients show rapid symptom stabilization after admission, but a large number then worsen. Clinical, scientific and administrative implications of these results are discussed.