ABSTRACT
This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.
Subject(s)
Narcolepsy , Restless Legs Syndrome , Sleep Wake Disorders , Adolescent , Humans , Child , Child, Preschool , Sleep , Polysomnography , Narcolepsy/therapy , Circadian Rhythm , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/therapyABSTRACT
BACKGROUND: Restless legs syndrome (RLS) may be underdiagnosed in children with autism spectrum disorder (ASD) due to difficulty expressing the symptoms in their own words. In addition, administration of oral iron may be particularly difficult in children with ASD. METHODS: This was a retrospective, open-label case series of children with ASD, restless legs (RL) symptoms, and serum ferritin <30 µg/L, who either had failed or did not tolerate oral iron, and were subsequently treated with intravenous (IV) ferric carboxymaltose (FCM). Patients received a single dose of IV FCM, 15 mg/kg up to a maximum dose of 750 mg. Data collected pre- and eight weeks post-infusion included presenting symptoms, serum ferritin, iron profile, and Clinical Global Impression Scale (CGI-Severity pre- and CGI-Improvement post-infusion). Adverse effects were assessed. RESULTS: Nineteen children, 4-11 years old (12 male, median age 6, interquartile range (IQR 4-11) were included. A definite RLS diagnosis was identified in 6 verbal children (31.6%). RL symptoms (designated probable RLS) in the 13 other children met all RLS diagnostic criteria except "improvement of symptoms with movement," which was not definitively determined. Baseline median values were: ferritin 10 µg/L (IQR 10-16), iron 66.5 µg/dL (IQR 57-96), TIBC 382 µg/dL (IQR 360-411) and transferrin saturation 19% (IQR 14-28). Median CGI-S was 4 (moderate symptoms) (IQR 3-4). At eight weeks after IV FCM, all measures were improved. Median ferritin was 68 µg/L (IQR 62.5-109, p < 0.00045). Median CGI-I was 1 (very much improved) (IQR 1-2). All children meeting definite RLS criteria improved. Three children in the probable RLS group did not improve. Children meeting the full RLS criteria had lower baseline ferritin levels than those with a probable diagnosis (9 µg/L, IQR 9-10 vs. 13 µg/L, IQR 10-16, Mann-Whitney test p < 0.045). Adverse effects included lightheadedness, gastrointestinal discomfort, fever, and headache among others. CONCLUSIONS: The majority of children (84.2%) with ASD, restless legs symptoms, and serum ferritin <30 µg/L had clinical improvement and significantly better serum iron parameters after a single IV FCM infusion. Although larger, randomized trials are needed, IV FCM appears to be a promising treatment for this subset of children with ASD.
Subject(s)
Autism Spectrum Disorder , Restless Legs Syndrome , Child , Child, Preschool , Humans , Male , Autism Spectrum Disorder/drug therapy , Ferric Compounds/adverse effects , Ferritins , Iron , Restless Legs Syndrome/drug therapy , Retrospective Studies , Treatment Outcome , FemaleABSTRACT
Collaborative service delivery models have gained considerable popularity in health care, education, and clinical settings. Despite the unique opportunity that this new popularity provides for the dissemination of applied behavior analysis, the majority of practicing behavior analysts have received little or no formal professional development on how to participate in teams with nonbehavioral colleagues. The purpose of this article is to elucidate the larger movement toward collaborative service delivery with an emphasis on interprofessionalism. The four core competency domains presented by the Interprofessional Education Collaborative (IPEC) Framework are interpreted through a behavior-analytic lens. This article is an initial attempt to operationalize constructs commonly associated with interprofessional educational and collaborative practices including (but not limited to) cultural sensitivity and responsiveness, cultural humility and reciprocity, empathy, and compassion.
ABSTRACT
[This corrects the article DOI: 10.1007/s40617-021-00602-7.].
