The Vienna Proposal on Children’s Right to Sleep
The goal of the CR2S-Vienna Conference is to position pediatric and adolescent sleep in clinical care. We analyzed the differences between adult and pediatric medicine and adapted the Austrian recommendations for action (7 Handlungsempfehlungen 2024) from the perspective of pediatric and adolescent sleep medicine/psychology.
Sleep & ADHD
Phenotyping Sleep Disturbances in ADHD and Identifying Harmonized Outcome Measures. A Precision Medicine Approach to Disruptive Behaviours
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Attention deficit hyperactivity disorder (ADHD) is a widespread neurodevelopmental disorder. Currently, the diagnosis and treatment of ADHD is primarily centred on school performance and daytime functioning, although disrupted and restless sleep have been frequently reported in youth with ADHD. However, it has been recognized that sleep disorders, along with an individual’s lifestyle, not only intensify existing ADHD symptoms, but also mimic characteristic symptoms in children and adolescents with primary sleep disorders, which may present as challenging or disruptive. Under the title ‘The blind spot: sleep as a child’s right issue?’, professionals from diverse disciplines, including medicine, social sciences, and individuals with an interest in ADHD and sleep medicine, including laypeople, have initiated a discourse. The objective of this discourse is to address gaps in our understanding of the diagnosis and treatment of disruptive behaviours and to aim for personalised precision medicine. Research has shown that existing categorical diagnoses of behavioural disabilities do not include the enormous abundance of their phenotypic expressions, affecting diagnostic accuracy and precision in the evaluation of therapeutic attempts. New strategies for clinical phenotyping and the exploration of patient reported behaviours are necessary to expand our understanding and conduct personalised precision medicine. In this position paper, we outline the initial gaps in the clinical care of ADHD and related sleep disturbances, review strategies for closing these gaps to meet the needs of individuals with ADHD, and suggest a roadmap for escaping the catch-22 situation.
Children with Medical Complexity
Children and adolescents with complex chronic care conditions are at high-risk for developing disrupted sleep triggering daytime behavioural co-morbidities such as inattention, hyperactivity, and cognitive and emotional impairments and/or deficits. However, such symptoms though most probably caused by sleep disturbances or sleep disorders, are mainly associated with neurodevelopmental diagnoses, such as attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) and treated with medications. While conventional medicine facilitates a repertoire of categorical diagnoses that are applied based on training culture, symptoms that are not in alignment with the standard repertoire (e.g., hyper-motor restless sleep) are not recognized and possible underlying disorders (e.g., restless legs syndrome, periodic limb movements or sleep-disordered breathing) are missed.
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As causes of sleep disturbances can be diverse and complex, our team developed a visual logic model for capturing the possible causes of common paediatric sleep disturbances and mapped these to a grid for approaching potential root causes and functional diagnoses with medication-and non-medication-based first line intervention options, allowing all involved clinicians to share a common evidence-based framework. Our goal is to expand this grid and support individualization of this logic model for each patient.
This framework exceeds the current clinical practice of categorical sleep and/or wake diagnoses and the predominantly daytime-focused explanatory models in developmental and general paediatrics, and child and adolescent psychiatry. Thus, we invite all involved parties, including patients, advocacy groups, and service teams to approach disrupted sleep in a joint transdisciplinary and transdiagnostic approach using a stepped care model.
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Coming soon!