ASSESSMENT AND TREATMENT
Because of the importance of sleep in overall development, systematic assessment of sleep should be undertaken by nurse caring for children with sleep problems. The assessment of sleep history includes exploring factors related to sleep problems, which may
point to the need for further assessment of sleep disturbances. Figure 1 illustrates both the usual and alternative approaches to the psychological assessment of behavioral difficulties, taking into consideration the role of sleep.
The left side of Figure 1 represents the type of assessment usually completed when a patient with behavioral difficulties is referred for services. This Figure represents a child entering the health care system due to behavioral difficulties identified by parents and/or teachers. A health care provider (e.g., doctor, nurse practitioner, mental health professional)
begins the assessment process to determine the nature of the problems. This type of assessment may include a clinical interview and assessment of developmental status, as well as a behavioral assessment, such as the Pediatric Symptom Checklist-35 item or the ADHD Rating Scale-IV (Foy, 2010). The usual approach represented in the Figure includes a thorough assessment of behavior and the need for medications; a therapeutic plan of care is developed. This plan is illustrated by the left side Figure 1.
The right side of Figure 1 adds the consideration of the influence of sleep impairments to the usual assessment, making the sleep history a larger part of the assessment. This information could be a part of the clinical interview performed by the health care provider to gather information regarding when the problem began, how it has been managed to date, and bedtime routine and sleep patterns. Data can be gathered through questions or questionnaires, but the additional input of a sleep diary and use of actigraphy may help the health care provider further understand
the impact of sleep and sleep difficulties on overall daily functioning. Many examples exist of available questionnaires and formats for sleep diaries to help gather this information and determine sleep quality and/or volume (Spruyt & Gozal 2011)