Nearly Half of Toddlers Diagnosed with Psychiatric Disorders Have Serious Sleep Problems

Rob Wipond
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In a sample of 183 children aged 19 months to 6 years who were admitted to an early childhood psychiatric day treatment program at Bradley Hospital in Rhode Island, 41% had serious sleep problems, according to a study in Child Psychiatry & Human Development.

The sleep-disordered children “demonstrated longer latency to sleep onset, longer and more frequent night awakenings, less total sleep, and lower sleep efficiency than non-sleep disordered participants,” reported the authors. “Such sleep deprivation is of significant clinical concern, given the associations between sleep disruption and behavioral disturbance, cognitive impairment, and deficits in attentiveness.”

“It is important for families to be aware of how important sleep is to the behavioral adjustment and wellbeing of young children,” said lead author John Boekamp in a press release. “Sleep disorders may be unrecognized and under-diagnosed in young children, particularly when other behavioral or emotional problems are present.”

At the time of their admission to the Bradley Hospital program, 18% of the children were being prescribed one or more psychiatric medications, including stimulants, alpha agonists, antidepressants, and Melatonin. The authors emphasized “the need to assess and treat early childhood sleep problems, even when such problems are not the primary presenting clinical concern.” They did not discuss specific treatments.

Sleep difficulties common among toddlers with psychiatric disorders (Lifespan Press Release on ScienceDaily, October 23, 2014)

(Abstract) Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders (Boekamp, John R. et al. Child Psychiatry & Human Development. October 2014. DOI: 10.1007/s10578-014-0505-z)

15 COMMENTS

  1. As one who wonders if I had sleep apnea at the time I was placed on a cocktail of psych meds, I am so glad to see articles like this one. In my opinion, before anyone is placed on a psych med, it should be the standard practice of care to screen for sleep disorders. To not do so, is criminal.

    • I also found that phrase chilling! No toddler should EVER be diagnosed with a “psychiatric disorder!” Well, really no PERSON should, but it is especially egregious with toddlers, who haven’t even had time to solidify their basic personality. It’s bizarre!

      —- Steve

      • I absolutely agree, Steve. I spent several years working with children who had been horribly traumatized, and even before I began questioning psychiatry, it horrified me that so many of these kids would identify themselves as a psych label. I don’t know why anyone feels the need to tell a child who was abused his whole life and then thrown around between a dozen or more foster homes, group homes, and other institutions that he is not more than entitled to be incredibly distressed about the things that he is dealing with, and instead hands him a bunch of labels and pills. With toddlers, trauma/other life experiences aside, EVERY toddler acts in ways that seem “bipolar” or “ADHD,” because THEY’RE TODDLERS. I mean, are we going to start bringing newborns to psychiatrists because they cry all the time, and are clearly “clinically depressed?”

        I think part of the problem is that psychiatry is primarily ruled by wealthy, white, career-oriented men who appear to have limited experience or awareness of how poverty, abuse, and discrimination impact people and of what normal child development even looks like. Now, I don’t question that some young children may be in intense emotional distress, but I cannot understand why the response would not be to ask what is so wrong in this child’s environment to make things so difficult for him. Or, we can just let the establishment continue to give lip service to preventing child abuse while it continues covering it up by labeling victims as “mentally ill.”

  2. “Madame, I am horribly obliged to inform you that your child has the terrible twos disorder, and will have to be drugged, perhaps for the rest of life. Unfortunately, post-diagnosis prognoses for this type thing aren’t especially good at this particular juncture in time. Sorry, demented life happens.”

    • Even a diagnosis of sleep disorder seems scary if there is no effort to account for an adverse childhood experience that could account for sleeplessness or nightmares. What if the child is a victim of abuse? What if the child is being woken up constantly by the sound of drunken fighting in the next room? Many picture perfect parents may be hiding unfortunate circumstances or ashamed to admit that they are living in poverty, experiencing homelessness, unemployment, addiction, etc.

      No child should ever by diagnosed with a psychiatric disorder because of troubled family dynamics or because they are not getting enough play time to simply be a child.

      My four year old grandson and I play imaginary games all the time. What if someone at his school were to misinterpret his words or actions when he is exercising his imagination, as signs of ‘psychosis?’ Sometimes my grandson crawls like a worm (especially when I am trying to dress him and he doesn’t want to get dressed) or a spider (especially when he wants to surprise or startle me) and uses a spider voice that ranges from complete silence to ‘Scheeeee”. Sometimes its better to simply go with the flow when a child is non compliant but with parents working double shifts to make ends meet, the valuable play time between child and adult is becoming a rare commodity.

      Sometimes, when we go out to the chicken house to get eggs we pick both ‘real’ eggs and ‘pretend’ eggs. We even go so far as to crack the pretend eggs into the skillet along with the real ones, and pretend to eat the pretend eggs along with the real ones! Time to enjoy the nonsensical and the whimsical is not just a luxury; I think its important for a child’s brain development!

      Some parents and teachers may get spooked when children fluidly move between the world of imagination’ and the ‘real’ world because it is not a practical state of mind for a child to be in when he must participate in regimented group or classroom. The terror felt by parents that their children will be left behind in the new economy is like a looming shadow that is affecting them deeply.

      If children are placed in a hostile situation or miss a social cue or fail to act appropriately in every given situation, they are at risk of getting labeled or punished. This is scary!

      Yes, we want children to not be daydreaming when they are crossing the street or riding their bike in traffic. Yes, we want them to learn to be social and have a place in society. Teaching kids how to be safe in a complicated and dangerous world is important but teaching them to be comfortable with the way their unfettered mind was designed to speculate, imagine, and delight in the world around them is important too.

      Kids who are victims of dysfunctional family dynamics, sexually, physically, verbally, or emotionally abused have to grow up abnormally fast and may develop unhealthy coping skills in order to survive. For these kids, play time is essential so that they can step out of themselves for a change and help them remember that they are, after all, children.

      We often give children a disease label and medicate them when they are exercising emotions in an inappropriate way. When a parent seeks the help of a psychiatrist for his/her child, I think the first prescription that a psychiatrist should write is for play therapy, not medications!

      Give a child only 20 minutes of quality play time every and you would not believe how quickly they become attentive, appropriate, and resilient! Works wonders with my grandson!

      • “adverse childhood experience that could account for sleeplessness or nightmares”
        A kid of my parents’ friends had terrible insomia and nightmares after being in a hospital for over a month at a very young age (she was practically separated from her parents). Back in the day it was understood as a result of this experience, today that would be a psychiatric disorder.

  3. I have a question related to insomia: has anyone seen some good data or fora threads suggesting that stimulants not only cause insomia but that persists over a long-term after withdrawal? I know someone who could benefit from such information…

  4. First of all, toddlers do not have “psychiatric disorders!” Second of all, many children have difficulties sleeping because, as one of my friends told me who suffered childhood sexual abuse at a very early age, you don’t go to sleep at night because the “bad things” happen to you in the dark.

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