Social-ecological considerations informing a universal screening strategy for sleep health in the community

“Poor sleep health” (PSH), defined as reduced amount of sleep and non-restorative sleep, affects cognitive, social and emotional development. Evidence suggests an association of sleep deprivation and mental health problems; however, there are no universal concepts allowing a first-tier screening of PSH at a community level. The focus of this narrative review is to highlight the cultural context of the current medicalized approach to PSH and to suggest social ecological strategies informing new and holistic community-based screening concepts. We present two conceptual screening frameworks; a “medical” and a merged “social emotional wellbeing framework” and combine them utilizing the concept of “ecologies.” The first framework proposes the incorporation of “sleep” in the interpretation of “vigilance” and “inappropriate” labeled behaviors. In the first framework, we provide a logic model for screening the myriad of presentations and possible root causes of sleep disturbances as a tool to assess daytime behaviors in context with PSH. In the second framework, we provide evidence that informs screening for “social emotional wellbeing” in the context of predictive factors, perpetuating factors and predispositions through different cultural perspectives. The distinct goals of both frameworks are to overcome training-biased unidirectional thinking and a priori medicalization of challenging, disruptive and/or disobedient behaviors. The latter has been explicitly informed by the critical discourse on colonization and its consequences, spearheaded by First Nations. Our “transcultural, transdisciplinary and transdiagnostic screening framework” may serve as a starting point from which adaptations of medical models could be developed to suit the purposes of holistic screening, diagnosis, and treatment of complex childhood presentations in different cultural contexts

Editorial: Sleep, vigilance & disruptive behaviors

The Frontiers in Psychiatry Research Theme of Sleep, vigilance, and disruptive behaviors has two aims: first, to promote the understanding of the connections between vigilance and disruptive daytime behavior in the context of sleep deprivation and, second, to explore how naturalistic observations and pattern recognition can play a role in furthering our understanding of these connections. . .

Sleep Health Issues for Children with FASD: Clinical Considerations

This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD) focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders. The sleep promotion techniques used for typical children are less suitable for children with FASD who need individually designed interventions. The types, causes, and adverse effects of sleep disorders, the modification of environment, scheduling and preparation for sleep, and sleep health for their caregivers are discussed. It is our hope that parents and also researchers, who are interested in the sleep disorders of children with FASD, will benefit from this presentation and that this discussion will stimulate much needed evidence-based research

Children\u27s Sleep during COVID-19: How Sleep Influences Surviving and Thriving in Families

Objective The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents and children s needs to support sleep during the pandemic. Methods Eighty-five Canadian parents with children aged 4 14 years participated in this explanatory sequential, mixed-methods study using an online survey of children s and parents sleep, with a subset of 16 parents, selected based on changes in their children s sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. Results While some parents perceived their child s sleep quality improved during the COVID-19 pandemic (14.1%, n 12), many parents perceived their child s sleep had worsened (40.0%, n 34). Parents attributed children s worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children s and parents sleep. Conclusions The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children s sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges

Applying ethnographic methodologies & ecology to unveil dimensions of sleep problems in children & youth with neurodevelopmental conditions

Willis Ekbom disease/restless legs syndrome is a relatively well-known neurological disorder in adult and paediatric medicine; however, the possibility of its presentation as familial early onset chronic intractable insomnia has not yet been recognized. I investigated the possible causes of intractable insomnia in children and youth with neurodevelopmental conditions. Through my studies of medical anthropology and educational psychology, I learned to apply qualitative methodologies in my clinical explorations, namely: a) ethnographic exploration of the ecology of paediatric intractable insomnia; b) the operationalization of this ethnographic exploration as a therapeutic emplotment concept in clinical practice, and c) the creation of new methodological tests and tools for structured behavioural observations as further development of the therapeutic emplotment concept. Application of these concepts led to the development of a functional sleep and wake-behaviours assessment model. This model exceeds the current clinical practice of categorical sleep and/or wake diagnoses and the predominantly daytime-focused explanatory models of developmental paediatrics, child psychiatry and mental health. My research has privileged me with becoming the first physician to identify Willis Ekbom disease/restless legs syndrome in children with neurodevelopmental conditions, who suffer from early onset chronic intractable insomnia, in a methodologically reproducible way. This research also enabled me to demonstrate that unrecognized Willis Ekbom disease/restless legs syndrome leads to cascades of medical diagnoses and medication prescriptions causing iatrogenic harm. Weaning children off medications and increasing their wellbeing and performance after addressing their sleep problems became the proof of concept. The Willis Ekbom disease/restless legs syndrome story in children with neurodevelopmental conditions is a modern parable, illustrating how conventional categorical diagnoses with overemphasis on daytime behaviours can produce systemic gaps in healthcare. While conventional medicine facilitates a spectrum of diagnoses that are applied based on training culture, symptoms that are not in alignment with the standard repertoire are not recognized and diagnoses are missed. Understanding this parable and finding applicable answers for how such systemic errors can be avoided in mainstream medicine in the future has taken me seven years, and is still a work in progress.Graduate and Postdoctoral StudiesGraduat

Diagnosis by behavioral observationHome-Videosomnography – A Rigorous Ethnographic Approach to Sleep of Children with Neurodevelopmental Conditions

Introduction Advanced video technology is available for sleep-laboratories. However, low-cost equipment for screening in the home setting has not been identified and tested, nor has a methodology for analysis of video recordings been suggested.MethodsWe investigated different combinations of hardware /software for home-videosomnography (HVS) and established a process for qualitative and quantitative analysis of HVS-recordings. A case vignette (HVS analysis for a 5.5-year-old girl with major insomnia and several co-morbidities) demonstrates how methodological considerations were addressed and how HVS added value to clinical assessment.ResultsWe suggest an ‘ideal set of hardware/software’ that is reliable, affordable (~$500) and portable (= 2.8kg) to conduct non-invasive HVS, which allows time-lapse analyses. The equipment consists of a net-book, a camera with infra-red optics, and a video capture device. (1) We present an HVS-analysis protocol consisting of 3 steps of analysis at varying replay speeds: (a) basic overview and classification at 16x normal speed; (b) 2nd viewing and detailed descriptions at 4-8x normal speed, and (c) viewing, listening, and in-depth descriptions at real-time speed. (2) We also present a custom software program that facilitates video analysis and note-taking (Annotator©), and Optical Flow software that automatically quantifies movement for internal quality control of the HVS-recording.The case vignette demonstrates how the HVS-recordings revealed the dimension of insomnia caused by Restless Legs Syndrome, and illustrated the cascade of symptoms, challenging behaviors and resulting medications.ConclusionThe strategy of using HVS, although requiring validation and reliability testing, opens the floor for a new ‘observational sleep medicine’, which has been useful in describing discomfort-related behavioral movement patterns in patients with communication difficulties presenting with challenging/disruptive sleep/wake behaviors

Overview of ADHD association studies.

Pediatric/adolescent studies: Age 19 years or less; adult studies: Age 19 years or greater.</p