Research conducted at the University of Oklahoma in collaboration with the University of Tulsa has led to a new method for investigating sleep disorders in children. The tool, the first of its kind, enables healthcare professionals to screen children for multiple sleep problems simultaneously, resulting in faster assessment and more targeted treatment recommendations. The research that led to this tool, called a structured clinical interview, was published in the journal Behavioral Sleep Medicine. The publication details the effectiveness of the interview questions for different types of sleep disorders, which often have overlapping symptoms but may require different treatments.

Gold Standard for Diagnosing Sleep Disorders

“Sleep problems can be common in children, but until now we haven’t had a way to get a comprehensive picture of what’s going on with their sleep,” said child and adolescent psychiatrist Dr. Tara Buck, associate professor at the OU School of Community Medicine in Tulsa. “It takes time to go through all the individual disorders to figure out exactly what’s going on. This structured clinical interview allows us to examine the most common sleep problems at once and get a better idea of how they can be treated.” The development of the structured clinical interview was led by Dr. Mollie Rischard, a postdoctoral fellow in the Department of Psychiatry at the OU School of Community Medicine. The project also served as the topic of her doctoral dissertation at the University of Tulsa. She started with the existing comprehensive assessment of sleep disorders in adults and set about the painstaking work of adapting it for children. After several iterations, input from clinical experts, and ensuring it aligned with the criteria in the Diagnostic and Statistical Manual (the authoritative guide for diagnosing mental disorders), it was tested in a clinical trial. The results showed that it is an effective tool.

The gold standard for diagnosing sleep disorders is a sleep study, in which a child spends the night in a sleep lab connected to sensors that measure sleep quality. However, sleep studies are expensive and may not be necessary in every case, according to Rischard. “Sleep apnea, for example, is a medical problem that needs to be diagnosed by a sleep study, but before we make costly referrals and ask families to undergo a sleep study, we want to be as sure as possible that it is necessary,” she said. There are many overlapping symptoms in sleep disorders where a child has difficulty falling asleep and staying asleep. Therefore, it is important to determine what is causing the problems. They may be suffering from restless legs syndrome or a disruption in their circadian rhythm. A better understanding gives us a better idea of how to treat the problem. Cognitive behavioral therapy can be effective for several sleep disorders.

Identifying Children With Nightmare Disorders and Counteracting Them

“We advocate addressing sleep problems specifically, as children who do not sleep well are highly impaired during the day,” Rischard added. “It’s not just excessive daytime sleepiness; we often see a paradox where children appear hyperactive and may be misdiagnosed with something like ADHD. Many sleep disorders are very treatable, as we make behavioral changes that can lead to rapid improvements. And when you start sleeping better, you really feel better.” The need for a comprehensive structured clinical interview for pediatric sleep disorders arose from a related research collaboration between OU and TU: a clinical trial investigating a new cognitive behavioral therapy for adolescents with nightmares. Lisa Cromer, Ph.D., professor of psychology at TU and adjunct professor of child psychiatry at OU-Tulsa, led the development of the treatment, as there is growing recognition in the field that nightmares should be treated as a problem in their own right, rather than a symptom of another problem. The new structured clinical interview helps identify children with nightmare disorders.

“There is growing evidence that nightmares are a signal for very serious mental health problems, particularly suicidal thoughts and behavior,” Cromer said. “Another major risk factor for suicidality is impulsivity, and we know that people are better able to control their impulses when they have slept well.” Cromer’s cognitive behavioral therapy includes relaxation strategies, stress management, sleep behavior, and visualization to change the structure of dreams. Parents are also involved in the treatment process. These measures are designed to help children reduce or eliminate their nightmares. This is a paradigm shift for both families and healthcare professionals.