Adolescents presenting to a sleep center with a chief complaint of insomnia may suffer from an underlying attention deficit, mood, learning or pragmatic disorder. This study evaluated the presence of these dual diagnoses, and the effectiveness of patient-based therapeutic programs to improve the insomnia and comorbid diagnoses.
This study included 13 adolescents aged 10-17 who presented to a nationally accredited sleep center for evaluation of an insomnia condition. Diagnoses of attention deficit disorder, Asperger’s syndrome, non-verbal learning disorder, anxiety, and depression were established by prior neuropsychological and psychiatric assessments. A patient centered learning program was structured to address specific attention and learning deficits and build compensatory strategies for long term acquisition and memory and learning skills development. Treatment of insomnia included non-pharmacological interventions (sleep hygiene, sleep restriction, relaxation therapies) and pharmacological interventions (hypnotics, benzodiazapines). Treatment for morning sleepiness and attention deficit included, when indicated, a wake-promoting agent, and interventions by a speech language pathologist and professional doctoral level education specialist with appropriate modifications of the academic environment.
Attention deficit disorder was found in 7 adolescents; Asperger’s syndrome and non-verbal learning disorder in 3; obsessive compulsive disorder, Tourette’s syndrome or an anxiety disordre in 3 patients; depression in 3 patients; and leraning disorder in 1 patient. (Some adolescents carried dual diagnoses.) Treatment interventions were effective in 6 patients treated by us with respect to an improvement in sleep structure and efficiency, and in improved alertness and attentiveness, and knowledge acquisition.
Adolescents presenting with insomnia may suffer from significant disordres of attention deficit, pragmatic and specific learning impairments, or anxiety and mood disorders. Diagnoses and design of a therapeutic intervention may improve the sleep disorder and their daytime attention and wakefulness impairments, and academic performance.
Physicians and parents should be attentive to sleep disorder evaluations in the treatment of the adolescent with a primary diagnosis of an attention, learning or mood disorder, and a comorbid diagnosis of either insomnia or delayed phase sleep disorder.
Clifford Risk, None.