Effect of sleep counseling and parental education for management of sleep-related problems in special need children: A case study

Meenakshi Khorana Saha; Anjan Bhattacharya

doi:10.4103/am.am_24_18

CASE REPORT

Year : 2018 | Volume : 15 | Issue : 2 | Page : 104-106

Effect of sleep counseling and parental education for management of sleep-related problems in special need children: A case study

Meenakshi Khorana Saha, Anjan Bhattacharya
Child Development Centre, Apollo Gleneagles Hospital, Kolkata, West Bengal, India

Date of Web Publication

5-Jul-2018

Correspondence Address:
Anjan Bhattacharya
Child Development Center, Apollo Gleneagle Hospital, 58, Canal Circular Road, Kolkata - 700 054, West Bengal
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/am.am_24_18

Abstract

The aim of this case study is to describe how parental sleep counseling and education can help to manage children from developing sleep disorder and improve the quality of sleep. In this case study, semi-structured behavioral intervention has been used. Children and parents of children with special needs and sleep-related difficulties were picked up from detailed developmental history taken in our center as a routine and were referred to the developmental psychologist for sleep counseling by the developmental pediatrician. The child already had a diagnosis of Cornelia de Lange Syndrome, autism spectrum disorder (ASD), profound global developmental delay, and attention deficit hyperactivity disorder (ADHD). Sleep disorders are commonly associated with Cornelia de Lange Syndrome, ASD, and ADHD. Parents were given a semi-structured sleep counseling session and were advised to sit for a review after 2 weeks post the intervention/counseling. The major disturbances in sleep were significantly reduced along with that parents reported child's behavioral issues have improved and are more attentive now. Our case study highlights that even though a single parental education and counseling session, many of the sleep-related problems can be managed successfully enough preventing downward spiraling. This is important knowledge since sleep disorders are common in neurodevelopmental disorders described, and our simple intervention strategy seems to alleviate a number of these problems. Thus, the role of parental education and counseling can be a potentially useful tool in the management of children with special needs, some of which may be even in the form of a single semi-structured session only.

Keywords: Behavioral intervention, parent education, sleep counseling, sleep disorder

How to cite this article:
Saha MK, Bhattacharya A. Effect of sleep counseling and parental education for management of sleep-related problems in special need children: A case study. Apollo Med 2018;15:104-6

How to cite this URL:
Saha MK, Bhattacharya A. Effect of sleep counseling and parental education for management of sleep-related problems in special need children: A case study. Apollo Med [serial online] 2018 [cited 2022 Dec 1];15:104-6. Available from: https://apollomedicine.org/text.asp?2018/15/2/104/235993

Introduction

Sleep is naturally recurring state of mind and body characterized by altered consciousness, relatively inhibited sensory activity, inhibition of nearly all voluntary muscles, and reduced interactions with surroundings.^[1]

Sleep is essential for a person's health and well-being, according to the National Sleep Foundation. “Researchers have also shown that after people sleep, they tend to retain information and perform better on memory tasks. Our bodies all require long periods of sleep in order to restore and rejuvenate, to grow muscles, repair tissues, and synthesize hormones.”^[2]

As understood the importance of sleep, sleep deprivation may cause a number of risks such as:^[3]

Short attention span ^[4]
Increased risk for accidents
Poor work/school performance
Weak immune system
Depression ^[5]
Anger
Anxiety
Delayed reaction time
Difficulty making decision, solving problems ^[6],[7]
Impaired moral judgment ^[8]
Hallucination
Impulsivity
Irritability
Attention deficit hyperactivity disorder (ADHD)
Suicidal ideation
High blood pressure
Heart diseases
Growth suppression
Decreased temperature.

The paper by Touchette et al.^[9] provided a very important contribution, which is relevant to this critical area. There are several notable strengths in Touchett's study: It used a longitudinal design with a large sample of children where they examined the total amount of night sleep and also the pattern of change in sleep times over development. They utilized behavioral measure and cognitive tasks at school entry for the study; the findings showed that short sleep duration in the first 3 years of life was associated with hyperactivity/impulsivity, and lower cognitive performance on neurodevelopmental tests at the age of 6. It is provocative and potentially very important. These findings appear to be consistent with the previous evidence of the short-term effect of sleep loss.

A recent study has also found preliminary evidence for the role of sleep in infants in learning.^[10] Another exciting body of work is the evidence that sleep homeostasis is involved in basic aspects of neural plasticity.^[11] These issues represent a major frontier in developmental neuroscience.

Chapter Five-Sleep in Neurodevelopmental Disorders explains individual with Intellectual and Developmental Disabilities experiences sleep problems at higher rates than the general population. The study was done by Dimitriou et al.^[12] shows that the contribution of sleep to procedural learning in typically developing children. Sleep disturbances are very common in children with special needs.^[13] It is important to consider that sleep disturbances are common in children with neurodevelopmental disorders such as Autism, ADHD, Down syndrome, and William Syndrome.^[13] Therefore, it is possible that sleep disturbances contribute to some of the cognitive difficulties/impairments in these children, which could be improved if treatment of sleep problems is done effectively.

Behavioral interventions should be the main focus of treatment of pediatric insomnia and should be offered as an initial treatment or in conjunction with medications to parents and children.^[14] Behavioral interventions aim to help children initiate and maintain sleep independently resulting in increased total time of sleep, and improved quality of sleep as stated by the article Assessment and treatment of common pediatric sleep disorders by Sricharan Motari. Thus, the importance of “Behavioral interventions for pediatric sleep problems (e.g., graduated extinction, parent education, and positive bedtime routines), especially in young children, have been shown to produce clinically significant improvements.”^[14]

A recent review published by the American Academy of Sleep Medicine ^[15] found that behavioral interventions produce both reliable and lasting improvements in bedtime problems and night wakings in infants and young children.

Case Report

Parent of Z. D. B, age: 7 years 3 months, male have been diagnosed with Cornelia de Lange Syndrome,^[1] autism spectrum disorder, profound global developmental delay, and ADHD in the Child Development Centre, Apollo Gleneagles Hospital (CDC, AGH), Kolkata. He was referred for sleep counseling with sleep difficulties to the developmental psychologist by the developmental pediatrician for (1) difficulty to fall asleep, (2) late onset of sleep, (3) Fidgety in sleep, (4) awakening in the midnight, (5) difficulty in waking up in the morning, and (6) bedwetting (Enuresis) apart from all these, parents also reported (7) lack of attention.

Methods

Management/intervention

A semi-structured behavioral intervention was done with the parents of the child having the seven sleep-related difficulties, mentioned above, was picked up from the detailed developmental history taken in CDC, AGH and was referred to the developmental psychologist for sleep counseling and parental education by the developmental pediatrician.

A detailed sleep history was taken by the psychologist, with an initial screening called BEARS ^[16] was done with the parents. Along with that, detailed sleep counseling was provided. Parents were educated how to maintain a sleep diary and to revisit the developmental psychologist for a review session after 2 weeks [Figure 1], where the outcome was discussed along with that reassessment of the BEARS was done. After the review, the patient was referred back to the developmental pediatrician for further assessments. A Review log was maintained. 2nd and 6th week's review were taken. Both had positive and consistent feedback.

Figure 1: A specimen of sleep diary maintained by the parents of the particular patient being discussed

Click here to view

Outcome

After the first counseling session, parents came for the review session; most of their sleep-related difficulties of their child were significantly reduced. Parents maintained a sleep diary that logged the daily routine and sleep-wake phase activity which showed significant improvement regarding behaviorally managing the problems. Parents further reported that the child's attention problems has also reduced and is paying more attention in his daily activities after improvement of his overall sleep quality.

Discussion

Single-step sleep counseling in a prepared set of parents seems to result in significant positive results in alleviating sleep-related problems in children with special needs; though, a future proposal for research with two groups: one taking sleep counseling and another which did not take the service can be considered.

The benefit reported may be short-term in the current difficult case; however, our experience in similar children shows long-lasting benefits as well, using this method. We aspire to report a case series on such children soon.

Conclusion

Our case study highlights that through sleep counseling and parent education, many of the sleep-related problems of children with special needs can be managed satisfactorily.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	“Brain Basics: Understanding Sleep”. Office of Communications and Public Liaison, National Institute of Neurological Disorders and Stroke. Bethesda, MD: US National Institutes of Health; 2017.
2.	Available from: http://www.sleepfoundation.org. [Last accessed on 2018 Feb 17].
3.	Available from: https://www.webmd.com. [Last accessed on 2018 Feb 17].
4.	Lim J, Dinges DF. Sleep deprivation and vigilant attention. Ann N Y Acad Sci 2008;1129:305-22.
5.	Riemann D, Berger M, Voderholzer U. Sleep and depression – Results from psychobiological studies: An overview. Biol Psychol 2001;57:67-103.
6.	Harrison Y, Horne JA. One night of sleep loss impairs innovative thinking and flexible decision making. Organ Behav Hum Decis Process 1999;78:128-45.
7.	Harrison Y, Horne JA. The impact of sleep deprivation on decision making: A review. J Exp Psychol Appl 2000;6:236-49.
8.	Killgore WD, Killgore DB, Day LM, Li C, Kamimori GH, Balkin TJ, et al. The effects of 53 hours of sleep deprivation on moral judgment. Sleep 2007;30:345-52.
9.	Touchette E, Petit D, Séguin JR, Boivin M, Tremblay RE, Montplaisir JY, et al. Associations between sleep duration patterns and behavioral/cognitive functioning at school entry. Sleep 2007;30:1213-9.
10.	Gómez RL, Bootzin RR, Nadel L. Naps promote abstraction in language-learning infants. Psychol Sci 2006;17:670-4.
11.	Tononi G, Cirelli C. Sleep function and synaptic homeostasis. Sleep Med Rev 2006;10:49-62.
12.	Dimitriou D, Karmiloff-Smith A, Ashworth A, Hill CM. Impaired sleep-related learning in children with Williams syndrome, short title: Sleep and learning in Williams syndrome. Pediat Res Int J 2013;2013:10. [DOI: 10.5171/2013.662275].
13.	Ashworth A, Hill CM, Karmiloff-Smith A, Dimitriou D. The importance of sleep: Attentional problems in school-aged children with down syndrome and Williams syndrome. Behav Sleep Med 2015;13:455-71.
14.	Moturi S, Avis K. Assessment and treatment of common pediatric sleep disorders. Psychiatry (Edgmont) 2010;7:24-37.
15.	Mindell JA, Kuhn B, Lewin DS, Meltzer LJ, Sadeh A; American Academy of Sleep Medicine, et al. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep 2006;29:1263-76.
16.	Judith M, Owens A, editors. A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems by Jodi A. Philadelphia, Pennsylvania, United States: Lippincott Williams & Wilkins; 2003.