Foreword: Counting Sheep Harsh K. Trivedi. Preface Jess P. Shatkin and Anna Ivanenko

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1 Pediatric Sleep Disorders Foreword: Counting Sheep Harsh K. Trivedi xiii Preface Jess P. Shatkin and Anna Ivanenko xv Normal Sleep in Children and Adolescents 799 Valerie McLaughlin Crabtree and Natalie A. Williams This article reviews the normal development of sleep in infants, children, and adolescents, with specific focus on both the subjective and objective aspects of sleep. Notably, sleep duration decreases substantially from infancy through adolescence with increased consolidation of sleep to the nighttime period only. Sleep architecture exhibits developmental changes with decreases in slow-wave sleep and increases in stage 2 sleep from childhood through adolescence. Although the development of sleep is a dramatic and relatively rapid process during the first decades of life, changes in sleep continue across the life span. The Neurocognitive Effects of Sleep Disruption in Children and Adolescents 813 Louise M. O Brien Sleep problems in children and adolescents are common, and sleep disruption is associated with a wide range of behavioral, cognitive, and mood impairments, including hyperactivity, reduced school grades, and depression. Insufficient or fragmented sleep may induce sleepiness, which is associated with problematic behavior, impaired learning, and/or negative mood. Furthermore, treatment of sleep disruption, by improving sleep hygiene or treating specific sleep disorders, is often associated with improvements in daytime performance, suggesting a common mechanism for the behavioral manifestations. This article reviews the daytime manifestations of sleep disruption. Screening and Evaluation of Sleep Disorders in Children and Adolescents 825 Marsha Luginbuehl and William C. Kohler Most pediatric professionals do not use a systematic screening, identification, or referral process to detect serious sleep problems and disorders in children and adolescents. Therefore, only 2% to 3% of children with sleep disorders are identified and treated. This article presents a screening, referral, and diagnostic process that helps detect and correct sleep

2 viii disorders that impact children s learning, behavioral and emotional functioning, and health. Classification and Epidemiology of Sleep Disorders 839 Anna Ivanenko and Bharath Raj Gururaj Sleep disturbances are common in children and adolescents but still remain underrecognized and undertreated. Several classification systems of sleep disorders are available, including some newer 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, normal children and in children with special medical and neurodevelopmental needs. Sleep disorders are more frequently seen in children and adolescents with psychiatric disorders, making it very important for mental health professionals to be aware of sleep problems and to address them in the context of psychiatric comorbidities. Family and Cultural Influences on Sleep Development 849 Flavia Giannotti and Flavia Cortesi Sleep is a biopsychosocial process that is influenced by the complex interaction of biologic rhythms, including sleep homeostatic mechanisms, chronobiologic factors, parenting, and temperament. However, family structure, culturally specific values, and beliefs are all elements that impact the ecology of a child s sleep. Dramatic demographic changes in many countries have been witnessed in recent years, which have resulted in health professionals and pediatricians being confronted with families of widely differing cultural origins. Attitudes and beliefs on infant sleeping strongly influence whether or not infant sleep behavior is perceived as problematic. Thus, it is advantageous to explore a child s sleep behavior in a multicultural setting. Cultural comparisons are of intrinsic value because they allow not only a better understanding of sleep in different contexts but also an evaluation of the eventual benefits and consequences of different cultural sleep practices. This article provides an overview of some specific sleep-related behaviors and practices highly influenced by different cultural contexts. Sleep Characteristics of Children and Adolescents with Attention Deficit-Hyperactivity Disorder 863 Reut Gruber This article reviews sleep characteristics of children and adolescents who have attention-deficit/hyperactivity disorder (ADHD). Research on sleep disturbances in individuals who have ADHD without comorbid conditions, measured both objectively and subjectively, is first presented. The impact of primary sleep disorders associated with ADHD is then discussed. The effects of psychiatric comorbidities on the sleep patterns of children and

3 ix adolescents who have ADHD are then reviewed, and sleep alterations associated with medications used to treat ADHD and comorbid conditions are addressed. Safe Enough to Sleep: Sleep Disruptions Associated withtrauma, Posttraumatic Stress, and Anxiety in Children and Adolescents 877 Anthony Charuvastra and Marylene Cloitre Sleep disturbance is an essential symptom of posttraumatic stress disorder, and recent evidence suggests that disrupted sleep may play an important role in the development of posttraumatic stress disorder following traumatic stress. The authors review several aspects of sleep as it relates to posttraumatic stress disorder. First, there is an association between traumatic stress and different components of disrupted sleep in children and adolescents. Second, sleep disruption appears to be a core feature of other pediatric anxiety disorders, and the authors consider if this preexisting sleep vulnerability may explain in part why preexisting anxiety disorders are a risk factor for developing posttraumatic stress disorder following a traumatic event. Third, the authors consider attachment theory and the social context of trauma and sleep disruption. This article concludes with a consideration of the therapeutic implications of these findings. Mood-related Sleep Problems in Children and Adolescents 893 Nicholas Lofthouse, Richard Gilchrist, and Mark Splaingard Sleep problems are an essential part of the current diagnostic criteria for depressive and bipolar disorders in children and adolescents. Whereas many studies have reported subjective sleep problems in youth with depression or bipolar disorder, except for reduced rapid eye movement latency associated with depression, few objective mood-related sleep abnormalities have been consistently identified. Recent technologic advances, such as spectral EEG and actigraphy, hold promise for revealing additional objective disturbances. There are presently few evidence-based published practice recommendations for mood-related sleep problems in youth. In this article, the authors chronologically review research on the phenomenology and treatment of sleep difficulties in youth with depressive and bipolar disorders and present research-based and clinically guided recommendations for the assessment and treatment of these problems. Sleep Patterns in Autism Spectrum Disorders 917 Kyle P. Johnson, Flavia Giannotti, and Flavia Cortesi Like children with other developmental disabilities, children with autism spectrum disorders suffer from sleep problems at a greater rate than typically developing children. It is increasingly recognized that addressing these sleep problems may improve daytime functioning and decrease family stress. The sleep problems experienced by children with autism spectrum disorders are presented in this article.

4 x Sleep and Substance Use and Abuse in Adolescents 929 Irina Gromov and Dmitriy Gromov Substance use disorders and sleep disorders are among the most common psychiatric problems in children and adolescents. They often cooccur and have a significant negative effect upon normal development. This article provides a review of the most recent literature on the relationship between these disorders, along with recommendations on how to recognize and clinically address these disorders in children and adolescents. Parasomnias and Movement Disorders in Children and Adolescents 947 Elana R. Bloomfield and Jess P. Shatkin Childhood parasomnias and movement disorders arise from a variety of etiologic factors. For some children, psychopathology plays a causal role in sleep disorders; in other cases, recurrent parasomnia episodes induce psychopathology. Current research reveals complex interconnections between sleep and mental health. As such, it is important that clinicians consider the impact psychiatric disorders have on childhood parasomnias. This article describes common parasomnias and movement disorders in children and adolescents, with emphasis on psychologic and behavioral comorbidities. Hypersomnia in Children: Interface with Psychiatric Disorders 967 Suresh Kotagal Patients being evaluated in child psychiatry clinics for behavior and mood disturbances frequently exhibit daytime sleepiness. Conversely, patients being evaluated for hypersomnia by sleep specialists may have depressed mood or hyperactive and aggressive behavior. The etiology of daytime sleepiness in children and adolescents is diverse and includes inadequate sleep hygiene, obstructive sleep apnea, delayed sleep phase syndrome, idiopathic hypersomnia, periodic hypersomnia, narcolepsy, and mood disorders per se. Treatment of a sleep disorder can have a favorable impact on alertness and quality of life. A high index of suspicion for sleep problems should be maintained in children and adolescents with psychiatric disorders. Insomnias of Childhood and Adolescence 979 G.J. Reid, E.D. Huntley, and Daniel S. Lewin Childhood insomnias (CI) are a diverse group of sleep-related problems that present across the first 2 decades of life, ranging widely in severity. Little is understood about the origins of CI which are likely heterogeneous. Nevertheless, effective treatments for younger children have been shown to be efficacious. Defined within a development framework, this article reviews common correlates and causes of CI during the first two decades. A practical approach to the evaluation and treatment of insomnias among children and youth is presented.

5 xi Pharmacologic Treatment of Pediatric Insomnia 1001 Judith A. Owens and Sricharan Moturi Pediatric insomnia is common in children and adolescents, particularly in children who have comorbid medical, psychiatric, and neurodevelopmental disorders, and may be associated with cognitive, emotional, and psychosocial impairments that often result in significant caregiver burden. Although several behavioral interventions for pediatric insomnia are effective, there is a relative paucity of empiric evidence supporting the use of pharmacologic treatment. Sedative/hypnotic drugs are frequently used in clinical practice to treat pediatric insomnia, and guidelines for the use of these medications in general as well as for specific medications have been developed. This review presents expert consensus guidelines for the use of these medications in clinical practice, with a focus on the different classes of pharmacologic agents that are most commonly prescribed. Emerging Medicolegal Issues in the Practice of Pediatric Sleep Medicine 1017 Ramesh C. Sachdeva and Lynn A. D Andrea With the rapid growth in the field of pediatric sleep medicine, health care providers need to be aware of several emerging legal issues that have the potential of impacting their clinical practice. This article provides an overview of emerging legal areas that might impact the practice of pediatric sleep medicine, and discusses civil liability emerging from medical malpractice, issues that health care providers must be aware of including issues related to providing care for minors, and newer areas that relate to legal prosecution for health care fraud as it may relate to violations of quality of care. Erratum 1027 Index 1029