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Non-pharmacological management of problematic sleeping in children with developmental disabilities

DEV MED CHILD NEUROL , 2015, vol. 57, n° 2, p. 120-136
Doc n°: 172589
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.1111/dmcn.12623

Sleep is important for underlying neural plasticity, and children with
developmental disabilities suffer behavioural, emotional, cognitive, and
sensory-motor issues that affect their wake and sleep states. Problematic
sleeping can be hypothesized to have adverse effects on both of these areas in
children with developmental disabilities. With this review, we aim to provide a
benchmark in managing problematic sleeping in children with developmental
disabilities. METHOD: A literature search was conducted and data on the study
descriptives, patient characteristics, study design, study-related factors,
criteria applied to operationalize sleep and developmental disability, and sleep
'management' were collected. Each management strategy was tabulated and analysed.
RESULTS: We identified 90 studies involving 1460 children with developmental
disabilities, of whom 61.6% were male. The highest proportion of studies, almost
half, were in children with syndromes (44.4%), followed by studies in children
with intellectual disabilities (18.9%). Non-pharmacological sleep management was
primarily aimed at improving sleep quality (86.7%), followed by sleep-wake
schedules and, to a certain extent, sleep regularity (42.2%). About 56.7% of the
studies reported more than one approach. Studies mostly focused on disorders of
initiating and maintaining sleep through a diversity of strategies and relied
heavily on subjective measures to identify and monitor problematic sleeping.
Sleep management approaches were primarily delivered at the level of the
individual in the home setting. The number of management approaches per study was
unrelated to the number of sleep problems discussed. INTERPRETATION: Modifying
sleep management strategies to meet the specific needs of children with
developmental disabilities is encouraged, and studies that look beyond sleep
quality or sleep quantity are required. It is also advocated that modifications
to sleep hygiene, sleep regularity, and sleep ecology in a population with
developmental disabilities are rigorously investigated. Finally, daytime
somnolence should not be overlooked when aiming to optimize sleep in children
with developmental disabilities across the ages and stages of their lives. There
were several limitations in the research findings of problematic sleep in
children with developmental disabilities. In general, the sleep problems and the
developmental disabilities investigated were multicomponent in nature. It is
likely that management approaches impacted those problems on multiple levels or
through diverse 'therapeutic' pathways. There is a need for randomized controlled
trials and more objective measures that quantify improved sleep or wake states.
CI - (c) 2014 Mac Keith Press.

Langue : ANGLAIS

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