Review: Identification and Management of Circadian Rhythm Sleep Disorders as a Transdiagnostic Feature in Child and Adolescent Psychiatry

CRDs are prevalent in child and adolescent populations, including in children with neurodevelopmental disorders such as ADHD, mood disorders and ASD, and impact on daily functioning including attention, working memory, mood and externalizing behaviors. For the diagnosis, assessment and prevention of CRDs, questionnaires and subjective instruments are important but may be augmented by objective measures via actigraphy devices or biological measures such as DLMO. The impact of social and school schedules, modern media and lighting sources in concert with a trend for children to spend less time outside (reduced sunlight exposure) may contribute to CRDs and should be carefully assessed in young people presenting with potential CRDs. Simple management measures that target such factors include sleep hygiene and psychoeducation for patients and their carers, increasing morning light by simple means such as change of transport to school to walking or cycling, reducing unnecessary blue light in the evening by blue light blocking features in devices or with blue light blocking glasses in the evening. When such preventative measures have not helped sufficiently, chronotherapeutic approaches should be tried, such as timed bright light therapy in the morning (30 min. of 10.000 lux at 20-40 cm of the eyes, or light glasses104), behavioral interventions such as a structured sleep –wake schedule105, or melatonin, where it is important that melatonin dosing and timing is implemented appropr...
Source: Journal of the American Academy of Child and Adolescent Psychiatry - Category: Psychiatry Authors: Tags: Review Source Type: research