Sleep Onset Problems in Two Children with Mild Intellectual Disability and Epilepsy: Assessment and Treatment in the Home Setting
Maas, A. P. H. M., Didden, R., de Moor, J. M. H., Renier, W. O., Curfs, L. M. G., The International Journal of Behavioral Consultation and Therapy
Sleep problems such as bedtime difficulties, frequent night waking and excessive daytime sleepiness are prevalent in children with epilepsy. In the present study, functional assessment of sleep onset problems in two young children with epilepsy was performed. Effects of bedtime fading and antipsychotic medication (pipamperon) in a 6-year-old boy, and melatonin in an 8-year-old girl were assessed on sleep latency. Treatment resulted in a marked decrease in sleep latency in both cases and effects were maintained after three months.
Keywords: Sleep problems, epilepsy, developmental disabilities, bedtime fading, melatonin, anti-psychotic medication.
Children with developmental disabilities are at increased risk for developing sleep problems. Several studies have shown that sleep problems are much more prevalent in children with developmental disabilities than in their nondisabled peers. An important risk factor for developing sleep problems is the presence of a seizure disorder. An association between sleep problems and epilepsy has been found in correlational (see e.g., Didden, Korzilius, Van Aperlo, Van Overloop, & De Vries, 2002; Quine, 1991) and quasi-experimental studies (see e.g., Stores, Wiggs, & Campling, 1998). Stores et al. compared sleep behaviors of 79 children with mild forms of epilepsy with healthy children from the general population matched for age and gender. They found that, compared to their controls, children with epilepsy showed significant higher rates of sleep disorder symptoms, especially those suggesting poor sleep quality and sleep-related anxieties. More recently, in a sample of 66 children with different types of epilepsy De Moor, Didden, Korzilius & Renier (in preparation) found that: (a) children with epilepsy have more sleep problems than those in a control group, (b) type of epilepsy was related to sleep problems (e.g. children with maligne epilepsy showed more sleep fragmentation than those with other types of epilepsy), and (c) sleep problems were positively related to severity of epileptic attacks. Furthermore, they found that both the severity of epilepsy and daytime problem behaviors were positively associated with sleep problems.
Results of the above studies show that children with epilepsy are at increased risk for developing sleep problems. In most, if not all cases, both the presence of sleep problems and epilepsy have detrimental effects on the well-being of the child and his or her parent(s). Children may show daytime fatigue, irritability and hyperactivity and noncompliance. Furthermore, sleep problems, and especially sleep deprivation is associated with decreased cognitive functioning and learning during academic tasks. Many parents report fatigue and symptoms of depression as a result of longstanding sleep problems in their child.
Given the adverse consequences of sleep problems, assessment and treatment are warranted. Undoubtedly, scientific knowledge about the treatment of sleep problems in children with developmental disabilities has increased during the past decades. Chronic sleep problems in children with developmental disabilities are usually complex, in that such problems may be caused by psychological and/or medical factors. Treatment of sleep problems includes various behavioral methods, such as stimulus control and sleep hygiene, extinction, sleep restriction, bedtime fading and chronotherapy. Medically oriented treatment include treatment of physical cause of sleep problems (e.g., reflux, pain), surgery (e.g., removal tonsils and adenoids in case they cause airway obstruction) and pharmacological approaches (e.g., melatonin, sedative medication) (for a review, see Didden & Sigafoos, 2001). It is recommended that a functional assessment of the sleep problems be conducted to identify possible relationships between disruptive sleep behaviors and parental management techniques (Didden, Curfs, Van Driel, & De Moor, 2002). …