Review: Identification and Management of Circadian Rhythm Sleep Disorders as a Transdiagnostic Feature in Child and Adolescent Psychiatry

OBJECTIVE: Sleep disturbances are highly frequent features in a range of child and adolescent psychiatric conditions. However, it is commonly not clear if such sleep problems represent symptomatic features, co-morbidities or risk factors for these conditions. It is believed that underlying dysfunction in the daily biological (circadian) clock may play important roles in the etiology of many sleep disorders, and circadian rhythm changes are also reported in a number of neuropsychiatric conditions. Here we explore the key identifying features of circadian rhythm disorders in child and adolescent psychiatry, and address how such disorders may be managed in the clinic.

METHOD: A narrative review of the extant literature of circadian rhythm disorders in children and adolescents with psychiatric conditions.

RESULTS: We identify key biological and social factors that contribute to circadian rhythm disorders in children and adolescents, as well as outlining the cognitive and neurobehavioral consequences resulting from insufficient sleep. We outline the roles of melatonin and other chronotherapeutic and behavioral interventions for the management of circadian rhythm disorders. Further, we highlight the importance of careful investigation of circadian rhythm abnormalities in shaping the most effective treatment plan according to chronobiological principles.

CONCLUSION: Circadian rhythm disorders are common in children and adolescents with psychiatric conditions, and arise out of complex interactions between biological and social factors. Careful clinical attention to, and management of, circadian rhythm disorders in child and adolescent psychiatry has the potential for significant benefit not only in the domain of sleep but also in a range of cognitive, affective and behavioral outcomes.