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Sleep Problem Detection and Documentation in Children With Autism Spectrum Disorder and
Dana C Won1, Heidi M Feldman, Lynne C Huffman
1Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.
Insights
Developmental-behavioral pediatricians under-documented sleep problems in children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). This highlights a need for clearer care plans to ensure sleep issues are monitored by clinicians.
Area of Science:
- Pediatric Medicine
- Neurodevelopmental Disorders
- Sleep Medicine
Background:
- Sleep problems are common in children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD).
- Accurate documentation of sleep issues by developmental-behavioral pediatricians is crucial for appropriate care.
- Previous research indicates a potential gap between the prevalence of sleep problems and their documented identification in clinical settings.
Purpose of the Study:
- To quantify the percentage of sleep problem documentation for children with ASD, ADHD, or combined ASD + ADHD.
- To identify factors predicting sleep problem documentation by developmental-behavioral pediatricians.
- To compare documented sleep problems with their known prevalence in these pediatric populations.
Main Methods:
- Retrospective chart review of encounter forms from 12 US academic medical centers within the Developmental-Behavioral Pediatrics Research Network (DBPNet).
- Analysis of sociodemographic, medical, clinician, and visit factors.
- Four models were used to define sleep problem documentation, incorporating codes for sleep disorders, polysomnograms, sleep medications, and clonidine.
Main Results:
- Sleep problem documentation ranged from 14.1% to 19.7% across the four models, significantly lower than the reported prevalence.
- Predictors for documentation (Model 4) included patient age group, ethnicity, medical insurance type, and the specific DBPNet site.
- Substantial variation in documentation rates was observed among the participating DBPNet sites.
Conclusions:
- Developmental-behavioral pediatricians in the DBPNet network under-report sleep problems in children with ASD and ADHD.
- Significant variability exists in sleep problem documentation across different clinical sites.
- Care plans for children with ASD and ADHD should explicitly designate clinicians responsible for monitoring sleep issues.
Objective:
To determine the percentage of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and combined ASD + ADHD who had sleep problems documented by developmental-behavioral pediatricians at diagnostic and follow-up visits at 12 US academic medical centers comprising the Developmental-Behavioral Pediatrics Research Network (DBPNet) and to identify the predictors of sleep problem documentation.
Methods:
Developmental-behavioral pediatricians completed encounter forms that covered sociodemographic, medical, clinician, and visit factors. There was 1 dependent variable, sleep problem documentation, for which 4 definitions were developed (Model 1 = Sleep Disorder coded; Model 2 = Sleep Disorder or polysomnogram coded; Model 3 = Sleep Disorder, polysomnogram, or sleep medication coded; and Model 4 = Sleep Disorder, polysomnogram, sleep medication, or clonidine coded).
Results:
Sleep problem documentation was 14.1% for Model 1, 15.2% for Model 2, 17.3% for Model 3, and 19.7% for Model 4. All values were lower (p < 0.001) than the reported prevalence of sleep problems in these conditions. For Model 4, predictors of sleep problem documentation were age group, ethnicity, medical insurance type, and DBPNet site.
Conclusion:
Developmental-behavioral pediatricians in DBPNet under-reported sleep problems in children with ASD and ADHD. Variation among sites was substantial. Care plans for children with ASD and ADHD should specify which treating clinician(s) monitors sleep issues.
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