Researchers from the University of Oklahoma and The University of Tulsa have created a novel structured clinical interview to assess multiple sleep disorders in children simultaneously, potentially streamlining diagnosis and treatment.
A groundbreaking screening tool for paediatric sleep disorders has been developed by researchers at the University of Oklahoma in collaboration with The University of Tulsa. This innovative structured clinical interview, the first of its kind, enables healthcare professionals to evaluate children for multiple sleep issues concurrently, facilitating more rapid assessment and targeted treatment recommendations.
Comprehensive assessment
The research underpinning this new tool was recently published in the journal Behavioral Sleep Medicine [1]. The study details the efficacy of the interview questions across various sleep disorders, which often present with overlapping symptoms but may require distinct therapeutic approaches.
Dr Tara Buck, an associate professor in the OU School of Community Medicine in Tulsa and child and adolescent psychiatrist, explained the significance of the tool: “Sleep problems can be common in kids, but we have not had a means of getting a comprehensive view of what is going on with their sleep. It takes time to go through
all the individual disorders to narrow down what’s going on. This structured clinical interview allows us to screen for the most common sleep problems at once and gain a better idea of how to treat them.”
Development process
The structured clinical interview was developed under the leadership of Dr Mollie Rischard, a post-doctoral fellow in the Department of Psychiatry at the OU School of Community Medicine. The project, which served as her doctoral dissertation at The University of Tulsa, involved adapting the existing adult comprehensive assessment for sleep disorders to suit paediatric populations.
The development process was rigorous, involving multiple iterations, input from clinical experts, and alignment with criteria in the Diagnostic and Statistical Manual. The tool’s effectiveness was subsequently validated through clinical trials.
Addressing diagnostic challenges
While polysomnography remains the gold standard for diagnosing sleep disorders, it is a costly and potentially unnecessary procedure in some cases. Dr Rischard highlighted the importance of preliminary screening: “Sleep apnoea, for example, is a medical problem that must be diagnosed through a sleep study, but before we make costly referrals and ask families to undergo a sleep study, we want to be as sure as we can that it’s necessary. There are a lot of overlapping symptoms among sleep disorders, where a child has difficulty falling asleep and staying asleep, so it’s important to determine what is driving the problems.”
The structured clinical interview aims to provide a more nuanced understanding of a child’s sleep issues, potentially guiding treatment decisions more effectively. Dr Rischard noted that cognitive behavioural therapy can be efficacious for several sleep disorders.
Importance of addressing sleep problems
The researchers emphasised the critical nature of targeting sleep problems in children due to their significant impact on daytime functioning. Dr Rischard explained: “It’s not just excessive daytime sleepiness, but we often see a paradox where kids can appear hyperactive and may be misdiagnosed with something like ADHD. Many sleep disorders are very treatable because we make behavioural changes that can produce quick improvements. And if you start sleeping better, you genuinely feel better.”
Nightmares and mental health
The development of this comprehensive screening tool was partly motivated by a related research collaboration between the University of Oklahoma and The University of Tulsa, focusing on a new cognitive behavioural treatment for youth with nightmares.
Dr Lisa Cromer, a professor of psychology at TU and volunteer child psychiatry faculty member at OU-Tulsa, led the development of this treatment. She highlighted the growing recognition that nightmares should be addressed as a distinct issue rather than merely a symptom of another problem.
“There is growing evidence that nightmares are a signal for very serious mental health problems, in particular suicidal ideation and behaviour,” Dr Cromer said. “Another big risk factor for suicidality is impulsivity, and we know that people are better able to control impulses when they’ve been sleeping well.”
Paradigm shift in nightmare treatment
The cognitive behavioural treatment developed by Dr Cromer incorporates relaxation strategies, stress management, sleep behaviours, and visualisation techniques to alter dream structures. Preliminary data from the ongoing trial indicate a promising reduction in suicidal ideation among children with nightmares following treatment.
Dr Buck commented on the significance of this approach: “In the past, we’ve seen nightmares as a symptom of other conditions, and we thought there wasn’t much we could do. We might try to treat their PTSD or anxiety and hope that the nightmares got better. But now there are treatments to empower kids to reduce or eliminate their nightmares. It’s a paradigm shift for both families and health professionals.”
This new structured clinical interview for paediatric sleep disorders represents a significant advancement in the field of sleep medicine, potentially improving diagnostic accuracy and treatment outcomes for children experiencing sleep-related issues.
Reference:
- Rischard, M., Buck, T., et al. (2024). Construction and Initial Examination of Inter-Rater Reliability of a Structured Clinical Interview for DSM-5-TR Sleep Disorders (SCISD) – Kid. Behavioral Sleep Medicine. https://doi.org/10.1080/15402002.2024.2324035
