Module 13 Autism ADHD Sleeep and Behavioural Disorders Flashcards

Question

Vitamins and ADHD What are common deficiencies?

Answer 1

Folic Acid Thiamin Niacin Vit C Were most commonly found to be low in children who responded to supplementation with measurable improvement. Deficiencies of Vitamin A, E, B12, riboflavin, and of minerals were linked to bad behaviour Improvements couldn't be expected unless all deficiencies were corrected. Iron and ADHD: most common nutrient deficiency in US school aged children. Iron deficiency is associated with decreased attentiveness, narrower attention span, decreased persistence, and lowered activity levels, which respond positively to supplementation. Magnesium- significantly decreased hyperactivity.

Answer 2

-Afferentation sensory processing perception helps with sleep (affects mood/ behaviour) helps digestion Pain reduction There is insufficient evidence to evaluate the efficacy of chiro care for paediatric and adolescent ADHD.

Answer 3

Adjustments Instruct to avoid all food colourings, flavourings and preservatives Reduce sugar intake Use organic foods reduce environmental load Focus intensive treatment during drug free periods (school holidays) Neurofeedback IgG profile to assess for food allergies CDSA Bioscreen medical Test for lead and thyroid function Supplements eg Neuropro (metegenics), zinc, EFA (DHA), magnesium, B vitamins,

Answer 4

50% of children with ADHD function well in adulthood The remaining continue to exhibit symptoms of inattention and impulsivity Deliquent behaviour during teens and later antisocial personality disorder may be evident in as many as 50-80% of those who continue to be affected

Answer 5

Eg abnormal type of sleep eg narcolepsy- regulation of sleep and wake is abnormal) 2. Abnormal behaviour during sleep (eg enuresis or sleep walking) or 3. A pathophysiologic event that occurs during sleep eg obstructive sleep apnoea Sleep-Wake disorders afflict 1/3 of all children

Answer 6

1. Sleep environment (eg crib or parents room) 2. Sleep position (eg prone or supine) 3. Need for sleep aids (eg pacifier, rocking, patting) 4. Time a child goes to bed 5. Time of the final morning awakening 6. Presence of habitual snoring, mouth breathing, sweating 7. gastroesophageal reflux 8. Abnormal behaviour suggestive of seizures and parasomnia 9. Behaviour during the daytime (irritability, hyper-reactivity, sleepiness) 10. Number of daytime naps and their duration 11. medication that may affect sleep- wake function 12. Interventions the parents carry out to improve sleep. 13.

Answer 7

Often results from: 1. Obesity and metabolic syndrome 2. adenotonsillar hypertrophy 3. neuromuscular disease, eg, muscular and myotonic dystrophy, 4. congenital myopathies 5. spinal muscular atrophy 6. craniofacial abnormalities * The presenting problem in children with sleep-disordered breathing depends on the age. * In children younger than 5 years presentation includes 1. snoring is the most common complaint 2. mouth breathing 3. diaphoresis (excessive abnormal sweating) 4. paradoxic chest movement, 5. restlessness 6. frequent awakenings 7. witnessed apneic episodes * Children 5 years and older commonly present with 1. enuresis 2. behavioral problems 3. decreased attention span 4. failure to thrive 5. snoring

Answer 8

Narcolepsy: * Chronic, lifelong disorder characterized by 1. irresistible attacks of daytime sleepiness lasting 15–30 minutes 2. cataplexy (sudden loss of muscle tone in association with emotional stimuli like fright or surprise) 3. sleep paralysis (an inability to move for a few seconds at sleep onset) Kleine-Levin syndrome * The rare Kleine-Levin syndrome typically presents in adolescents. * There is a predominance of males, with a mean age of onset of 15 years. * The episodes of severe hypersomnia and mood disturbance are present in all patients, but variability was observed in the type of mood change, between aggressiveness to decreased psychomotor activity

Answer 9

Sleep onset association disorder * Sleep onset association disorder mainly results from poor sleep habits. * Children learn to expect the conditions that are present at sleep onset and become dependent on them to return to sleep after a night waking. * Children who are used to falling asleep in their parents’ arms while being rocked or fed a bottle often need their parents to re- establish these conditions after a night waking and are unintentionally trained by their parents to expect these conditions. * Management consists of  firmly eliminating association with external objects/actions,  placing the infant to sleep in his/her own crib  encouraging the parent to leave the room before the infant falls asleep * Eliminating the daytime naps and postponing bedtime by an hour were also advised as they may make the child sleepier and more prone to fall asleep Limit-setting sleep disorder * Repeated requests for stories, water, or another television show are common, and bedtime is frequently inconsistent. * There is delayed sleep onset due to bedtime resistance, which is defined as requiring more than 20 minutes to fall asleep after going to bed. * The degree of sleep loss depends on the length of time the child requires to fall asleep but is often enough to result in behavior and learning problems during the day. * Management includes appropriate bedtime routines, and a consistent bedtime. * Parents should be encouraged to be firm in their limit setting, both day and night Inadequate sleep hygiene * Inadequate sleep hygiene includes those habits that enhance wakefulness and interrupt the sleep period, leading to a decrease in the quality or quantity of sleep and excessive daytime sleepiness. * Examples of these habits include 1. engaging in stimulating activities near bedtime, 2. using the bed for activities not related to sleep (eg, playing, watching television), 3. consumption of caffeine near bedtime, s 4. leeping in uncomfortable bedroom (eg, too cold, hot, bright, or noisy) * Inconsistent bedtimes and inappropriate napping are also a major contributor to the problem * Advised solution is modification of the sleeping environment to promote restful sleep, and parents may also adopt supportive bedtime routines as storytelling Insufficient sleep syndrome * Insufficient sleep syndrome is the most common cause of excessive daytime sleepiness in children and adolescents. * It arises when the child fails to get an adequate amount of sleep to maintain appropriate wakefulness during the day * Close to 45% of high school students were reported to have expressed a need for more sleep on questionnaire surveys. * Sleep diaries extending over 1–2 weeks and actigraphy can be used to document sleep length. * Management is reported to consist primarily of modifying the daytime schedule in order to obtain more sleep at night

Answer 10

Confusional arousals * Confusional arousals occur in the first 3 hours after sleep onset when the child experiences an abrupt transition from the deepest phases of NREM sleep, ie, stages 3 and 4, to a lighter stage of sleep * The episodes of arousal are commonly brief in duration, usually lasting 2–10 minutes * The child often appears confused and disoriented, with incoherent speech, and will re-enter deep sleep and have no recall of the episode next day * Predisposing factors for confusional arousals which alter stages 3 and 4 NREM sleep include  obstructive sleep apnea,  fatigue,  sleep deprivation, and  irregular wake/sleep schedules * Parents should be reassured that these episodes are harmless, will diminish as the child matures, and that they should not try to awaken their child during the episode Somnambulism * In somnambulism (sleep walking) the child sits up in bed with eyes open but is “unseeing.” * Activity may range from restlessness in bed to walking through the house. * The child does not meaningfully interact with people and is often easily agitated; speech is usually mumbled and slurred, and is rarely intelligible. * Arousal is difficult and, if successful, the child will appear confused, and recollection of the event is rare * Sleep walking is common, occurring in 1%–15% of children, and usually begins at the age of 4– 8 years, is more common in boys than in girls, and is often associated with enuresis. * Because the sleepwalker may try to unlock doors or windows, safety precautions must be taken. * Management includes informing parents that the child is truly asleep and should be gently redirected back to bed without awakening. * This sleep behavior is usually outgrown by adolescence * Bedrooms for sleepwalkers should be on the ground floor of the home, and windows and doors must be secured. * An intervention that proved effective in one study was scheduled awakenings  Waking the child 15 minutes before the sleepwalking had been occurring, making sure the child was fully awake for at least 5 minutes.  With the use of this technique, sleepwalking was quickly extinguished in more than 80% of children * Nocturnal enuresis is one of the most prevalent sleep problems in children and widely regarded as a parasomnia by most sleep researchers because it occurs only during NREM sleep. * The etiology of primary enuresis is likely to be multifactorial. * Achieving continence is maturational, and children who lag developmentally at 1 and 3 years of age are more likely to be enuretic at age 6 years. * Family history of enuresis is often present. * Enuretic children have been reported to have a lower functional bladder capacity, although their true bladder capacity is normal * Management options include  Chiropractic adjustment  Limiting fluid intake in evening  Waking the child  Medications  Bedwetting alarms whatever finished this module

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Module 13 Autism ADHD Sleeep and Behavioural Disorders Flashcards

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