Insomnia Diagnosed Almost 30% of Time by Child Psychs

Major Finding: Child psychiatrists report that insomnia is a major problem for 28% of the patients they see in a typical month. In a typical month, 96% of respondents recommended a prescription medication, and 88% recommended an over-the-counter medication.

Data Source: Surveys completed by 1,273 child psychiatrists during a 6-month period beginning in the fall of 2003.

Disclosures: The study was supported by an unrestricted grant from Sanofi-Aventis. The investigators disclosed that none of them received a salary or other compensation for this work.

Child psychiatrists report that nearly a third of the children they see in a typical month have insomnia as a major problem, according to a survey completed by 1,273 members of the American Academy of Child and Adolescent Psychiatry.

Virtually all (96.4%) of the respondents said that they prescribed at least one type of prescription drug for insomnia during a typical month, and 88.3% reported recommending at least one over-the-counter medication, wrote Dr. Judith A. Owens of Brown University in Providence, R.I., and her colleagues.

The study was published online (Sleep Med. 2010 [doi:10.1016/j.sleep.2009.11.015

Psychiatrists estimated that they treated insomnia with medications for 29% of the 13- to 18-year-old patients, 25% of the 6- to 12-year-olds, 17% of the 3- to 5-year-olds, and 3.5% of those aged 2 years and younger.

The relationship between medication use for insomnia and the child's age was statistically significant.

Among nonprescription medications, antihistamines were the most commonly recommended, followed by melatonin, herbals such as chamomile tea, and pain-reliever combinations such as Tylenol PM.

This order of preference was the same regardless of the patient's diagnosis.

Among prescription medications, on the other hand, significant differences were found in medication preferences depending on the patient's diagnosis. For children with attention-deficit/hyperactivity disorder (ADHD), 81% of psychiatrists prescribed an alpha-agonist such as clonidine, compared with 67% who prescribed an alpha-agonist for mental retardation/developmental delay (MR/DD) and autism spectrum disorders, 40% who prescribed a drug in this class for anxiety disorders, and 31% who prescribed it for mood disorders. The differences were statistically significant.

Child psychiatrists frequently used antidepressants–particularly sedating antidepressants–for insomnia, especially in patients with anxiety and mood disorders. Among the respondents, 85% said they used sedating antidepressants for insomnia in children with mood disorders, 82% used them in anxiety disorders, 76% in MR/DD and autism, and 71% in ADHD.

Slightly more than half of child psychiatrists (51%-52%) used atypical antipsychotics for insomnia in children with mood disorders or with MR/DD and autism. In contrast, only 33%-34% used atypical antipsychotics in children with ADHD or anxiety disorders.

Short-acting hypnotics were the choice of 42% of child psychiatrists treating children with mood disorders and 41% of those treating children with anxiety disorders. Child psychiatrists were significantly less likely to use short-acting hypnotics for children with MR/DD and autism (21%) or ADHD (18%).

Investigators sent the eight-page survey to 6,091 listed members of the American Academy of Child and Adolescent Psychiatry in the fall of 2003, with a reminder 1 month later to nonrespondents. In all, 1,601 surveys (26.3%) were returned, but only 1,273 (20.9%) were usable.

Psychiatrists with a greater number of years in practice were significantly less likely than their less experienced colleagues to prescribe medication for insomnia for patients in most categories.

Similarly, psychiatrists with an academic appointment at a medical school were significantly less likely to recommend medication than were psychiatrists in community settings.

The investigators noted that few well-designed, controlled studies have been published on the use of medications for insomnia in children.

This lack of information on efficacy, tolerability, dosing, and safety in children, “significantly hampers the rational clinical use of these medications in child psychiatry clinical practice,” they wrote.

“Clinical trials of these drugs are needed to establish effective dosing ranges, to address safety and tolerability issues, to assess withdrawal and discontinuation effects, and to determine the relative efficacy in terms of sleep induction and maintenance.”

Major Finding: Child psychiatrists report that insomnia is a major problem for 28% of the patients they see in a typical month. In a typical month, 96% of respondents recommended a prescription medication, and 88% recommended an over-the-counter medication.

Data Source: Surveys completed by 1,273 child psychiatrists during a 6-month period beginning in the fall of 2003.

Disclosures: The study was supported by an unrestricted grant from Sanofi-Aventis. The investigators disclosed that none of them received a salary or other compensation for this work.

Child psychiatrists report that nearly a third of the children they see in a typical month have insomnia as a major problem, according to a survey completed by 1,273 members of the American Academy of Child and Adolescent Psychiatry.

Virtually all (96.4%) of the respondents said that they prescribed at least one type of prescription drug for insomnia during a typical month, and 88.3% reported recommending at least one over-the-counter medication, wrote Dr. Judith A. Owens of Brown University in Providence, R.I., and her colleagues.

The study was published online (Sleep Med. 2010 [doi:10.1016/j.sleep.2009.11.015

Psychiatrists estimated that they treated insomnia with medications for 29% of the 13- to 18-year-old patients, 25% of the 6- to 12-year-olds, 17% of the 3- to 5-year-olds, and 3.5% of those aged 2 years and younger.

The relationship between medication use for insomnia and the child's age was statistically significant.

Among nonprescription medications, antihistamines were the most commonly recommended, followed by melatonin, herbals such as chamomile tea, and pain-reliever combinations such as Tylenol PM.

This order of preference was the same regardless of the patient's diagnosis.

Among prescription medications, on the other hand, significant differences were found in medication preferences depending on the patient's diagnosis. For children with attention-deficit/hyperactivity disorder (ADHD), 81% of psychiatrists prescribed an alpha-agonist such as clonidine, compared with 67% who prescribed an alpha-agonist for mental retardation/developmental delay (MR/DD) and autism spectrum disorders, 40% who prescribed a drug in this class for anxiety disorders, and 31% who prescribed it for mood disorders. The differences were statistically significant.

Child psychiatrists frequently used antidepressants–particularly sedating antidepressants–for insomnia, especially in patients with anxiety and mood disorders. Among the respondents, 85% said they used sedating antidepressants for insomnia in children with mood disorders, 82% used them in anxiety disorders, 76% in MR/DD and autism, and 71% in ADHD.

Slightly more than half of child psychiatrists (51%-52%) used atypical antipsychotics for insomnia in children with mood disorders or with MR/DD and autism. In contrast, only 33%-34% used atypical antipsychotics in children with ADHD or anxiety disorders.

Short-acting hypnotics were the choice of 42% of child psychiatrists treating children with mood disorders and 41% of those treating children with anxiety disorders. Child psychiatrists were significantly less likely to use short-acting hypnotics for children with MR/DD and autism (21%) or ADHD (18%).

Investigators sent the eight-page survey to 6,091 listed members of the American Academy of Child and Adolescent Psychiatry in the fall of 2003, with a reminder 1 month later to nonrespondents. In all, 1,601 surveys (26.3%) were returned, but only 1,273 (20.9%) were usable.

Psychiatrists with a greater number of years in practice were significantly less likely than their less experienced colleagues to prescribe medication for insomnia for patients in most categories.

Similarly, psychiatrists with an academic appointment at a medical school were significantly less likely to recommend medication than were psychiatrists in community settings.

The investigators noted that few well-designed, controlled studies have been published on the use of medications for insomnia in children.

This lack of information on efficacy, tolerability, dosing, and safety in children, “significantly hampers the rational clinical use of these medications in child psychiatry clinical practice,” they wrote.

“Clinical trials of these drugs are needed to establish effective dosing ranges, to address safety and tolerability issues, to assess withdrawal and discontinuation effects, and to determine the relative efficacy in terms of sleep induction and maintenance.”

Major Finding: Child psychiatrists report that insomnia is a major problem for 28% of the patients they see in a typical month. In a typical month, 96% of respondents recommended a prescription medication, and 88% recommended an over-the-counter medication.

Data Source: Surveys completed by 1,273 child psychiatrists during a 6-month period beginning in the fall of 2003.

Disclosures: The study was supported by an unrestricted grant from Sanofi-Aventis. The investigators disclosed that none of them received a salary or other compensation for this work.

Child psychiatrists report that nearly a third of the children they see in a typical month have insomnia as a major problem, according to a survey completed by 1,273 members of the American Academy of Child and Adolescent Psychiatry.

Virtually all (96.4%) of the respondents said that they prescribed at least one type of prescription drug for insomnia during a typical month, and 88.3% reported recommending at least one over-the-counter medication, wrote Dr. Judith A. Owens of Brown University in Providence, R.I., and her colleagues.

The study was published online (Sleep Med. 2010 [doi:10.1016/j.sleep.2009.11.015

Psychiatrists estimated that they treated insomnia with medications for 29% of the 13- to 18-year-old patients, 25% of the 6- to 12-year-olds, 17% of the 3- to 5-year-olds, and 3.5% of those aged 2 years and younger.

The relationship between medication use for insomnia and the child's age was statistically significant.

Among nonprescription medications, antihistamines were the most commonly recommended, followed by melatonin, herbals such as chamomile tea, and pain-reliever combinations such as Tylenol PM.

This order of preference was the same regardless of the patient's diagnosis.

Among prescription medications, on the other hand, significant differences were found in medication preferences depending on the patient's diagnosis. For children with attention-deficit/hyperactivity disorder (ADHD), 81% of psychiatrists prescribed an alpha-agonist such as clonidine, compared with 67% who prescribed an alpha-agonist for mental retardation/developmental delay (MR/DD) and autism spectrum disorders, 40% who prescribed a drug in this class for anxiety disorders, and 31% who prescribed it for mood disorders. The differences were statistically significant.

Child psychiatrists frequently used antidepressants–particularly sedating antidepressants–for insomnia, especially in patients with anxiety and mood disorders. Among the respondents, 85% said they used sedating antidepressants for insomnia in children with mood disorders, 82% used them in anxiety disorders, 76% in MR/DD and autism, and 71% in ADHD.

Slightly more than half of child psychiatrists (51%-52%) used atypical antipsychotics for insomnia in children with mood disorders or with MR/DD and autism. In contrast, only 33%-34% used atypical antipsychotics in children with ADHD or anxiety disorders.

Short-acting hypnotics were the choice of 42% of child psychiatrists treating children with mood disorders and 41% of those treating children with anxiety disorders. Child psychiatrists were significantly less likely to use short-acting hypnotics for children with MR/DD and autism (21%) or ADHD (18%).

Investigators sent the eight-page survey to 6,091 listed members of the American Academy of Child and Adolescent Psychiatry in the fall of 2003, with a reminder 1 month later to nonrespondents. In all, 1,601 surveys (26.3%) were returned, but only 1,273 (20.9%) were usable.

Psychiatrists with a greater number of years in practice were significantly less likely than their less experienced colleagues to prescribe medication for insomnia for patients in most categories.

Similarly, psychiatrists with an academic appointment at a medical school were significantly less likely to recommend medication than were psychiatrists in community settings.

The investigators noted that few well-designed, controlled studies have been published on the use of medications for insomnia in children.

This lack of information on efficacy, tolerability, dosing, and safety in children, “significantly hampers the rational clinical use of these medications in child psychiatry clinical practice,” they wrote.

“Clinical trials of these drugs are needed to establish effective dosing ranges, to address safety and tolerability issues, to assess withdrawal and discontinuation effects, and to determine the relative efficacy in terms of sleep induction and maintenance.”