Clinical trials to determine safety, efficacy would be useful, study concludes

(RxWiki News) A new study from Hasbro Children’s Hospital indicates nearly a quarter of children in mental health treatment are prescribed sleep medication.

The study, conducted by Dr. Judith Owens and published in the August 2010 edition of Sleep Medicine, surveyed child psychiatrists and found in a typical month 96 percent of clinicians recommended at least one prescription medication for sleeplessness and 88 percent recommended an over-the-counter insomnia medication. 

Owens, an associate professor at The Warren Alpert Medical School of Brown University, said the most important rationale among child psychiatrists prescribing sleep medication is “to manage the effects of sleep disruption on daytime functioning.” She said concerns about side effects and the lack of evidence regarding the medications’ effectiveness were cited as significant barriers to their use.

Nearly 1,300 members of the American Academy of Child and Adolescent Psychiatry (AACAP) completed the survey. Most of the respondents see 70 children every month on average, the majority of whom are age 6 or older. The number of patients who identified with insomnia increased with age. Of those treated for mental health, more than 20 percent of preschoolers and nearly one-third of school-aged children and adolescents are indentified with insomnia. 

The medications most often prescribed for sleeplessness in children ranged from antihistamines to sedatives, such as alpha agonists (clonidine), most often used to quell the effects of Attention Deficit-Hyperactivity Disorder (ADHD). Anti-psychotic and anti-convulsive medicines, depending on the psychiatric or behavioral diagnosis of the child, were also prescribed. Sleep medications were most often prescribed for children with mental retardation or developmental delays, ADHD, autism spectrum disorders and mood/anxiety disorders.

While the safety and effectiveness of pharmacotherapy for the treatment of insomnia in children and adolescents is not well documented, multiple studies confirm sleep disturbances are one of the primary indications for prescribed psychotropic medication in children. Relaxation techniques, sleep restriction and cognitive-behavioral therapy, among other behavioral treatments, have proven effective for childhood insomnia.

Owens said that since insomnia and sleep disruption can cause daytime sleepiness and fatigue in children, “child psychiatrists may be potentially more likely than pediatricians to prescribe medication for insomnia.”
Based on their conclusions, researchers in the study recommend clinical trials of sleep medications in children to determine efficacy, dosages, safety and tolerability.

Owens concluded mental health professionals need to establish “an evidence-based understanding of appropriate treatment choices for insomnia.”

“We need a more comprehensive understanding of insomnia in the context of psychiatric disorders in general and the impact on quality of life and long-term prognosis in these patients,” she said.