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Tools for the Assessment of Pediatric Restless Legs Syndrome
Pamela Hamilton Stubbs1, Arthur S Walters2
1Dr. Hamilton-Stubbs Sleep and Total Wellness Institute, LLC., Richmond, VA, United States.
Insights
Validated instruments for pediatric Restless Legs Syndrome (RLS) are scarce. This review examines existing adult and pediatric RLS tools, recommending specific scales for children and adolescents while highlighting the need for further validation.
Area of Science:
- Pediatric Neurology
- Clinical Assessment Tools
- Sleep Medicine
Background:
- Limited availability of validated diagnostic, severity, and quality of life questionnaires for pediatric Restless Legs Syndrome (RLS).
- Few instruments have been specifically developed for childhood RLS.
Purpose of the Study:
- To review instruments used for adult RLS and assess their applicability to children.
- To review instruments specifically developed for pediatric RLS.
Main Methods:
- Literature review of diagnostic, severity, and quality of life instruments for adult and pediatric RLS.
- Analysis of the validation status and application of these instruments in pediatric populations.
Main Results:
- One adult RLS diagnostic question is validated for adolescents. The Pediatric Emory RLS questionnaire is developed but not validated.
- Adult RLS severity scales (IRLS, CGI, RLS-6) are usable in adolescents. The International Restless Legs Scale (IRLS) has been used in multiple pediatric studies.
- No Quality of Life scales are specific to pediatric RLS, but general pediatric scales (PedsQL, SBQ, PSC) have been utilized.
Conclusions:
- There is a critical need for the development and validation of RLS-specific instruments for children.
- Currently available pediatric RLS instruments are recommended for use.
- Adult scales can be used for adolescent RLS, with caution and parent-child discussion for younger children.
Background:
There are only a few of the questionnaires for the diagnosis, severity and quality of life of adult Restless Legs Syndrome (RLS) that have been utilized in children. Even fewer of these types of instruments have been developed specifically for Pediatric RLS.
Methods:
This article is a review of instruments used in adult RLS, their applicability to children and of instruments specifically developed for childhood RLS.
Results:
A single question for the diagnosis of RLS has been validated for adults and utilized in one epidemiology study of adolescents with RLS. The Pediatric Emory RLS questionnaire has been developed as a diagnostic instrument for childhood RLS, utilized in two studies of RLS in children, but not yet validated. The IRLS (International Restless Legs Scale), the CGI (Clinical Global Impression), and the RLS-6, which have been validated for determining adult RLS severity, were administered without difficulty in one therapeutic study of adolescent RLS. In addition, the IRLS has also been utilized in another 5 studies of childhood and adolescent RLS. The pediatric Restless Legs Syndrome Severity Scale (P-RLS-SS) has been developed for use in children but not yet validated. A modification of the P-RLS-SS based upon rating the severity of the 4 diagnostic criteria for RLS has been developed for children but not yet validated. There are no Quality of Life scales developed for Pediatric RLS. However, 3 separate studies utilized the general Peds Quality of Life Inventory (PedsQL) in RLS children and adolescents and one of these studies also employed the general Sleep Behavior Questionnaire (SBQ) and yet another of these studies also employed the Pediatric Symptom checklist (PSC).
Discussion:
There is a need for the development and validation of instruments specific to Pediatric RLS. Meanwhile, we recommend the use of the Pediatric RLS instruments that have been developed and we recommend use of the adult scales in adolescent RLS where language barriers are not a problem. If adult scales are used in younger children, we recommend that they be administered in conjunction with an ongoing discussion between the parent and the child during the scale administration.
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