Exploring the association between perceived excessive daytime sleepiness in children and academic outcomes

Excessive daytime sleepiness (EDS) in children has been associated with a number of problems. In contrast to adults who experience EDS and who may fall asleep or doze when in a monotonous or boring situation, children with EDS may present as hyperactive or poorly behaved. This community-based study aims to identify the prevalence of EDS in children from three perspectives: parent report, self-report, and teacher report. The study also explores the association between EDS and academic outcomes in children. The participants were 365 students (161 males) aged 4-12 years, their parents, and their teachers at a regional school. Academic outcomes were based on each student's school grades at the conclusion of the semester in which the community-based survey was administered. Using a cutoff score of 15 or greater on the PDSS, 113 (31%) students were identified by at least one respondent as displaying or experiencing EDS. EDS as observed by teachers using the PDSS was found to be associated with the student's academic outcomes, higher sleepiness scores being associated with poorer academic outcomes. Our findings suggest that the prevalence of EDS in a community setting may be higher than previously identified

Brief Report: An evaluation of an Australian autism-specific, early intervention programme

There is a relative paucity of evidence examining the effectiveness of early intervention for young children with Autism Spectrum Disorder, in particular those delivered through educationally-based programmes. This study aimed to evaluate the real world effectiveness of a community-based autism-specific early learning and intervention programme in Australia. Children enrolled between February 2010 and May 2013 who had a diagnosis of an Autism Spectrum Disorder was eligible to participate in the study. Fifty-nine children with a mean age of 3.98 years participated. Cognitive ability, language, autistic symptoms, and motor skills were assessed at baseline and follow up (12 months or at programme exit) using standardised measures. Pre- and post-measures were compared using paired sample t-tests. Significant improvements were found in receptive and expressive language, autism symptoms, and overall adaptive behaviour. No significant change was found in motor skills. Children with Autism Spectrum Disorder attending the community-based programme had significant gains particularly in domains of cognition and language. Study limitations are discussed

A case-control genome-wide association study of ADHD discovers a novel association with the tenascin R (TNR) gene

This work has been supported by Project Grant funding from the National Health and Medical Research Council (NHMRC) of Australia to Z.H. (1006573, 1002458 and 1065677) and M.A.B. (569636, 1065677, 1045354, 1002458 and 1006573).It is well-established that there is a strong genetic contribution to the aetiology of attention deficit hyperactivity disorder (ADHD). Here, we employed a hypothesis-free genome-wide association study (GWAS) design in a sample of 480 clinical childhood ADHD cases and 1208 controls to search for novel genetic risk loci for ADHD. DNA was genotyped using Illumina’s Human Infinium PsychArray-24v1.2., and the data were subsequently imputed to the 1000 Genomes reference panel. Rigorous quality control and pruning of genotypes at both individual subject and single nucleotide polymorphism (SNP) levels was performed. Polygenic risk score (PGRS) analysis revealed that ADHD case–control status was explained by genetic risk for ADHD, but no other major psychiatric disorders. Logistic regression analysis was performed genome-wide to test the association between SNPs and ADHD case–control status. We observed a genome-wide significant association (p = 3.15E−08) between ADHD and rs6686722, mapped to the Tenascin R (TNR) gene. Members of this gene family are extracellular matrix glycoproteins that play a role in neural cell adhesion and neurite outgrowth. Suggestive evidence of associations with ADHD was observed for an additional 111 SNPs (⩽9.91E−05). Although intriguing, the association between DNA variation in the TNR gene and ADHD should be viewed as preliminary given the small sample size of this discovery dataset.Publisher PDFPeer reviewe

How Well Do Children Understand the Vocabulary of Sleep?

Sleep surveys, such as the Pediatric Daytime Sleepiness Scale (PDSS), are used to determine a variety of concerns associated with sleep, including excessive daytime sleepiness (hypersomnolence), bedtime sleep behaviors, night awakenings, sleep duration, and sleep-disordered breathing. However, the literacy ability of the patient may not be adequate to ensure comprehension of questions and provision of accurate responses.To assess children's understanding of the sleep-associated vocabulary included in the PDSS.A cross-sectional, open-response survey was developed for use with students age 4 to 12 years. Prior to completing the instrument, each student was asked the meaning of six key sleep-related words used in the PDSS: drowsy, sleepy, alert, awakened, tired, and awake. The parents/caregivers were requested to record their child's definitions of these key words exactly as stated. Identification of words for "suitable" definitions was undertaken through consultation of three online dictionaries. This enabled the qualitative process associated with open-response surveys to be followed: identification of common themes, chunking of information, and criteria for coding responses. The final sample consisted of word definitions from 325 students (152 boys and 173 girls) from a school enrollment of 727 (45%).A high percentage of children provided "suitable" responses for the words sleepy (84%) and tired (75%). The percentage of "suitable" responses for the words drowsy and awakened gradually increased across the age groups. The words alert and awake were challenging for the children to define, with the sleep-associated definition for alert only being provided by 31% of children overall and awake only being provided by 48% overall. In total, 57% of children were able to provide suitable definitions for at least four words.Our findings suggest that the results of many sleep surveys using these terms may not yield results that accurately reflect a child's actual state of daytime sleepiness and sleep/wake behaviors. Prior to administering a sleep survey, physicians need to clearly explain the meanings of sleep-associated words used in the survey and thus gain a more accurate reflection of a child's sleep and daytime behaviors. .Sleep surveys are used to identify problems with sleep. Children with poor health literacy due to age may not understand the questions and may not provide adequate answers. Children's understanding of sleep-associated vocabulary was assessed using six words: drowsy, sleepy, alert, awakened, tired, and awake. Many of these words were found to be difficult for the children to define

Paediatric palliative care and intellectual disability-a unique context

Paediatric palliative care is a nuanced area of practice with additional complexities in the context of intellectual disability. There is currently minimal research to guide clinicians working in this challenging area of care.This study describes the complex care of children with life-limiting conditions and intellectual disability by means of a literature synthesis and commentary with "best-practice" guide.As few articles concerning children with intellectual disability and palliative care needs were identified by formal systematic review, our expert consensus group has drawn from the paediatric palliative, oncology and adult intellectual disability literature to highlight common clinical challenges encountered in the day-to-day care of children with intellectual disability and life-limiting conditions.A longitudinal child- and family-centred approach is key to ensuring best-practice care for families of children with life-limiting conditions and intellectual disability. As highlighted by the great absence of literature addressing this important patient population, further research in this area is urgently required