Chapter 13 – health-related and substance-use disorders
History:
Related to emotional factors or psychological factors and physical well-being factors. For centuries,
poorly understood physical symptoms have been misattributed to psychological causes. Today,
pediatric health psychologists study show children’s health-related problems interact with their
psychological well-being and how they and their families adapt in response.
Sleep-wake disorders:
Sleep is the primary activity of the brain during the early years of development. With 2 years the
brain had developed for 90% of its adult size complexity in cognitive skills, language, concept of
self, socioemotional development and physical skills.
With 5 years of age, the child needs more sleep than he is awake, if not it affects physical and mental
health and well-being.
Sleep problems co-occur with many different disorders, like ADHD, depression, anxiety, conduct
problems and developmental disorders. Sleep difficulties are secondary symptoms of a more primary
problem. Sleep problems cause emotional and behavioral problems and may be cause by an
psychological disorder.
Regulatory functions of sleep:
Central nervous system (CNS) restores the balance between sleep and arousal. Giddiness, silliness
and impulsive behaviors children show if sleep-deprived (slaapgebrek) shows impairment in the
prefrontal cortex functions. It decreases the response, concentration, ability to inhibit, control, basic
drives, impulses and emotions. These symptoms are easily confused with those of ADHD. In a specific
sleep stage the CNS is temporary disconnected from other systems.
Maturational (rijpings) changes:
Infants have more night-waking problems, preschoolers have more falling-asleep problems and
younger school-age children have more going-to-bed problems. Adolescents and adults have
difficulty going or staying asleep (insomnia) or not having enough time to sleep.
Features of sleep-wake disorders:
Primary slap-wake disorders are a result of abnormalities in the body’s ability to regulate sleep-wake
mechanisms and the timing of sleep. Are related to mental disorders, medical disorders or the use of
medication, there is a lot of overlap. DSM-5 describes 10 different kinds of sleep-wake disorders.
There are two categories:
1. Dyssomnias: disorders of initiating or maintaining sleep, characterized by difficulty getting
enough sleep, not sleeping when you want to, not feeling refreshed after sleeping
disruptions in sleep process.
o Insomnia disorder: difficulty initiating or maintaining sleep, or sleep that is not
restorative in infants. 25-50% and age 1-3 years. Behavioral treatment and family
guidance.
o Hypersomnolence disorder: excessive sleepiness that is displayed as either prolonged
sleep episodes or daytime sleep episodes. Common among young children. Behavioral
treatment and family guidance.
, o Narcolepsy: irresistible attacks of refreshing sleep occurring daily, accompanied by
brief episodes of loss of muscle tone. 1% of children and adolescents. Structure,
support, psychostimulants and antidepressants for treatment.
o Breathing-related sleep disorder: sleep disruption leading to excessive sleepiness or
insomnia that is caused by sleep-related breathing difficulties. 1-2% of the children,
preschool and elementary ages. Removal of tonsils (amandelen) and adenoids as
treatment.
o Circadian rhythm sleep disorder: persistent or recurrent sleep disruption leading to
excessive sleepiness or insomnia due to a mismatch between the sleep-wake schedule
required by a person’s environment and his or her internal sleep cycle; late sleep
onset, difficulty awakening in morning, sleeping in on weekends, resistance to change.
Prevalence is unknown, 7% of adolescents. Behavioral treatment and chronotherapy.
2. Parasomnias: sleep disorders in which behavioral of physiological events intrude on ongoing
sleep physiological or cognitive arousal at inappropriate times during the sleep-wake
cycle. Include nightmares (during rapid-eye-movement (REM), sleep terrors and
sleepwalking.
o Nightmare disorder: repeated awakenings with detailed recall of extended and
extremely frightening dreams, usually involving threats to survival, security, or self-
esteem; generally occurs during the second half of the sleep period. Common
between ages 3-8. Provide comfort and reduce stress as treatment.
o NREM sleep arousal disorders
Sleep terrors: recurrent episodes of abrupt awakening form sleep, usually
occurring during the first third of the sleep episode and beginning with a
panicky scream, accompanied by autonomic discharge (sweating, heartrate).
Difficult to arouse, inconsolable, disoriented no memories of episode in the
morning. 3% form 18 months till 6 years. Reduce stress and fatigue, add late
afternoon nap as treatment.
Sleep walking: repeated episodes or arising from bed during sleep and
walking about, usually during the first third of the sleep episode; poorly
coordinated, difficult to arouse, disoriented; no memory of episode in
morning. 15% of children have one attack, 1-6% have more attacks per week.
4-12 years old. Rare in adolescence. Take safety precautions, reduce stress
and fatigue, add late afternoon nap as treatment.
DSM-5 diagnostic criteria for all sleep-related disorders emphasize:
1. The presence of distress or impairment in social, occupational or other areas of functioning.
2. Requirement that the sleep disturbance cannot be better accounted for by another mental
disorder, the direct physiological effects of a substance or a general medical condition.
Treatment:
- Reward system for the child going to bed on time/consistent bed-time routine.
- Behavioral interventions to teach parents to attend to the child’s need for comfort and
reassurance.
- Behavioral intervention to eliminate the sleep deprivation and to restore a more normal slap-
wake routine or melatonin supplements circadian rhythm sleep disorders.
Most disappear with maturity, they still may have a negative impact on the child’s daily activity and
adjustment. Effective psychological treatments for most childhood sleep disorders involve the
establishment and regulation of bedtime routines.
History:
Related to emotional factors or psychological factors and physical well-being factors. For centuries,
poorly understood physical symptoms have been misattributed to psychological causes. Today,
pediatric health psychologists study show children’s health-related problems interact with their
psychological well-being and how they and their families adapt in response.
Sleep-wake disorders:
Sleep is the primary activity of the brain during the early years of development. With 2 years the
brain had developed for 90% of its adult size complexity in cognitive skills, language, concept of
self, socioemotional development and physical skills.
With 5 years of age, the child needs more sleep than he is awake, if not it affects physical and mental
health and well-being.
Sleep problems co-occur with many different disorders, like ADHD, depression, anxiety, conduct
problems and developmental disorders. Sleep difficulties are secondary symptoms of a more primary
problem. Sleep problems cause emotional and behavioral problems and may be cause by an
psychological disorder.
Regulatory functions of sleep:
Central nervous system (CNS) restores the balance between sleep and arousal. Giddiness, silliness
and impulsive behaviors children show if sleep-deprived (slaapgebrek) shows impairment in the
prefrontal cortex functions. It decreases the response, concentration, ability to inhibit, control, basic
drives, impulses and emotions. These symptoms are easily confused with those of ADHD. In a specific
sleep stage the CNS is temporary disconnected from other systems.
Maturational (rijpings) changes:
Infants have more night-waking problems, preschoolers have more falling-asleep problems and
younger school-age children have more going-to-bed problems. Adolescents and adults have
difficulty going or staying asleep (insomnia) or not having enough time to sleep.
Features of sleep-wake disorders:
Primary slap-wake disorders are a result of abnormalities in the body’s ability to regulate sleep-wake
mechanisms and the timing of sleep. Are related to mental disorders, medical disorders or the use of
medication, there is a lot of overlap. DSM-5 describes 10 different kinds of sleep-wake disorders.
There are two categories:
1. Dyssomnias: disorders of initiating or maintaining sleep, characterized by difficulty getting
enough sleep, not sleeping when you want to, not feeling refreshed after sleeping
disruptions in sleep process.
o Insomnia disorder: difficulty initiating or maintaining sleep, or sleep that is not
restorative in infants. 25-50% and age 1-3 years. Behavioral treatment and family
guidance.
o Hypersomnolence disorder: excessive sleepiness that is displayed as either prolonged
sleep episodes or daytime sleep episodes. Common among young children. Behavioral
treatment and family guidance.
, o Narcolepsy: irresistible attacks of refreshing sleep occurring daily, accompanied by
brief episodes of loss of muscle tone. 1% of children and adolescents. Structure,
support, psychostimulants and antidepressants for treatment.
o Breathing-related sleep disorder: sleep disruption leading to excessive sleepiness or
insomnia that is caused by sleep-related breathing difficulties. 1-2% of the children,
preschool and elementary ages. Removal of tonsils (amandelen) and adenoids as
treatment.
o Circadian rhythm sleep disorder: persistent or recurrent sleep disruption leading to
excessive sleepiness or insomnia due to a mismatch between the sleep-wake schedule
required by a person’s environment and his or her internal sleep cycle; late sleep
onset, difficulty awakening in morning, sleeping in on weekends, resistance to change.
Prevalence is unknown, 7% of adolescents. Behavioral treatment and chronotherapy.
2. Parasomnias: sleep disorders in which behavioral of physiological events intrude on ongoing
sleep physiological or cognitive arousal at inappropriate times during the sleep-wake
cycle. Include nightmares (during rapid-eye-movement (REM), sleep terrors and
sleepwalking.
o Nightmare disorder: repeated awakenings with detailed recall of extended and
extremely frightening dreams, usually involving threats to survival, security, or self-
esteem; generally occurs during the second half of the sleep period. Common
between ages 3-8. Provide comfort and reduce stress as treatment.
o NREM sleep arousal disorders
Sleep terrors: recurrent episodes of abrupt awakening form sleep, usually
occurring during the first third of the sleep episode and beginning with a
panicky scream, accompanied by autonomic discharge (sweating, heartrate).
Difficult to arouse, inconsolable, disoriented no memories of episode in the
morning. 3% form 18 months till 6 years. Reduce stress and fatigue, add late
afternoon nap as treatment.
Sleep walking: repeated episodes or arising from bed during sleep and
walking about, usually during the first third of the sleep episode; poorly
coordinated, difficult to arouse, disoriented; no memory of episode in
morning. 15% of children have one attack, 1-6% have more attacks per week.
4-12 years old. Rare in adolescence. Take safety precautions, reduce stress
and fatigue, add late afternoon nap as treatment.
DSM-5 diagnostic criteria for all sleep-related disorders emphasize:
1. The presence of distress or impairment in social, occupational or other areas of functioning.
2. Requirement that the sleep disturbance cannot be better accounted for by another mental
disorder, the direct physiological effects of a substance or a general medical condition.
Treatment:
- Reward system for the child going to bed on time/consistent bed-time routine.
- Behavioral interventions to teach parents to attend to the child’s need for comfort and
reassurance.
- Behavioral intervention to eliminate the sleep deprivation and to restore a more normal slap-
wake routine or melatonin supplements circadian rhythm sleep disorders.
Most disappear with maturity, they still may have a negative impact on the child’s daily activity and
adjustment. Effective psychological treatments for most childhood sleep disorders involve the
establishment and regulation of bedtime routines.
