1. Child Psychopathology Sleep Disorders Elimination Problems Reading: Chapter 12

3. Normal course of sleep n How many hours per day do you sleep on average? n How many hours per day did sleep when 15 yrs.? n What happens when you do not have enough sleep? n Sleep deprivation impairs pre-frontal cortex, decreases concentration, loss of inhibition of emotions and basic drives n How many hours do newborns sleep? The elderly? n Developmentally, sleep becomes more organized and nocturnal n Problems arise in toddlerhood (nighttime awakening), preschoolers (getting to sleep), elementary-school- age (bedtime rituals)

4. Sleep Disorders: Dyssomnias n Protodyssomnia –problems initiating and maintaining sleep n Hypersomnia –excessive sleepiness n Narcolepsy –bouts of REM sleep during wakefulness –inherited, neurological disorder n Breathing related sleep disorder –Sleep apnea: loss/ disruption of breathing

5. Sleep Disorders: Parasomnias n Nightmares n Occur during REM n Common (up to 50% of children) n Can recall if awakened n Movement and vocals inhibited n No ANS arousal n Anytime n Night Terrors n Non-REM sleep n Uncommon n Cannot remember n Ambulatory, vocal n Cannot be awakened n ANS arousal n Early in evening

6. Sleep Disorders Incidence and treatment of nightmares, night terrors, and somnambulism (sleep walking) Table 12.2 of text

7. Normal bedwetting behavior

8. Enuresis: Diagnostic criteria n Involuntary discharge of urine during the day or night n At least twice a week for three consecutive months n Significant distress or impairment n At least age 5 years or MA of 5 n Not accounted for by medical condition or physiological effects of a substance (diuretic) n Specify nocturnal or diurnal, primary or secondary

9. Treatment for enuresis n Behavioral approaches –Bell & pad (Classical Conditioning) –Overcorrection (Operant, punishment) –Sticker charts (Reinforcement) n Drugs: Imipramine n Family-based interventions –Bathroom before bed, awakening n Dietary manipulations –restrict fluids, caffeine (e.g., COKE)

10. Bowel movements and encopresis

11. Encopresis: Diagnostic criteria n Passage of feces into inappropriate places n once per month for 3 months n child at least 4 years-old or MA of 4 n not accounted for by medical condition or physiological effects of a substance n Specify: With or without constipation and overflow incontinence

12. Treatment for encopresis n Behavioral approaches –Reinforcement for appropriate tioleting –Regular scheduling of tioleting n Drugs, laxatives, enemas, mineral oil (goal: empty large intestine) n Family-based interventions –Guilt, shame associated with tioleting, pressure to produce n Dietary manipulations: Fibre, non- binders, increase natural motility