Children with chronic sleep problems may develop mental health disorders later in life

Clinical research center provides low-cost evaluation, treatment for children and adolescents

Children who have chronic sleep problems may be much more likely to develop mental health disorders as adolescents and adults, according to Candice Alfano, associate professor in clinical psychology at the University of Houston (UH) and director of the new Sleep and Anxiety Center for Kids (SACK).

To address this problem and further research in the area, Alfano opened SACK, a clinical research center at UH that provides low-cost, empirically based evaluation and treatment services for children and adolescents who struggle with anxiety and/or sleep disorders. "Several research studies also are being conducted at SACK, which means that many of the families calling (on behalf of their children) will qualify to participate in a study where they will get top-of-the-line treatment at no cost," Alfano said.

"We know from previous research that anxiety and sleep problems are among the most common in kids, affecting up to 30 percent of youth," she said. "Despite their high prevalence, there is little research taking place to teach us how exactly sleep and mental health disorders are related. What we do know is that this relationship is much more complex than simply saying these problems co-occur. If we can identify the kids who are most likely to be anxious or depressed, perhaps based on the earlier emergence of sleep problems, then we can intervene before these disorders take hold."

In addition to the possibility of developing mental health problems later, chronically insufficient sleep in children has been found to have negative effects on performance in school, extracurricular activities and social functioning. Inadequate sleep may interfere with a child's ability to concentrate and follow directions, and is continually linked with behavior problems, irritability, accidents and injuries, and conflict in relationships with family and friends.

"There are some kids who have a tough time 'shutting off' at night and blocking out different types of stimuli in the environment," Alfano said. "Sleep masks and earplugs are a good way to help some kids settle into sleep. Other kids, however, need more help."

"We teach families about the importance of sleep and that it should be made a priority, the same way eating right and exercising are important. We teach children about sleep hygiene, which includes things like keeping the same bedtime and wake time every day, not having caffeinated drinks after lunch, and sleeping in your own bed every night. We also teach kids self-imagery and relaxation skills to deal with intrusive thoughts and feelings of restlessness when trying to fall asleep."

As a recipient of a Mentored Career Development Award from the National Institute of Mental Health (NIMH), Alfano enters year four of a five-year research study that is examining sleep disturbances in children with generalized anxiety disorder (GAD). "We are studying a total of 80 children, ages 7 to 11 years, based on several measures of sleep," Alfano said. She completed the first half of recruitment for the project previously at the Children's National Medical Center in Washington, D.C., and will be completing data collection over the next two years in Houston.

"We in the process of submitting preliminary findings from the study for publication," Alfano said. "What is exciting is that we are finding the same objective sleep patterns in children with GAD that we see in depressed adults. This is particularly intriguing because we know that having GAD as a child is a huge risk factor for developing depression later on, but we don't yet understand exactly why this is. This data suggests it's more than just a co-occurring problem, sleep abnormalities could be a mechanism through which anxiety and depression develop."

Alfano uses a range of methods to assess children's sleep, including clinical interviews with parents and children, polysomnography and actigraphy. An actigraph is a watch-like device worn on the wrist to measure sleep patterns. "It collects data continuously for up to two weeks," she said. "A computer-generated algorithm is then used to score sleep and wake periods. It's a nice, non-invasive way to get a picture of what's going on with a child's sleep without having them sleep in a laboratory with electrodes and wires all over them."

For more detailed questions about sleep (e.g., sleep stages including rapid eye movement sleep) she uses polysomnography, a comprehensive recording of the complex, internal changes in the brain and body that occur during sleep. Polysomnography is often used to diagnose or rule out sleep disorders such as narcolepsy, periodic limb movement disorder and obstructive sleep apnea.

The type of award Alfano received, the Career Development Award from NIMH, requires mentorship and led her to collaborate with Dr. Daniel Glaze, a neurologist and chief of the Texas Children's Sleep Center at Texas Children's Hospital.

"It's a great situation to work with Dr. Glaze and the Texas Children's Sleep Center, one of the few accredited centers in the country specializing in pediatric sleep disorders," Alfano said. "I look forward to a long and productive relationship working with Dr. Glaze and other sleep experts as Texas Children's Hospital."