Use of pharmacotherapy for insomnia in child psychiatry practice: A national survey.
OBJECTIVE
To examine clinical practice patterns regarding non-prescription and prescription medication use for insomnia by child and adolescent psychiatrists.


METHODS
Survey mailed to 6018 members of the American Academy of Child and Adolescent Psychiatry.


RESULTS
The final sample (N=1273) reported that insomnia was a major problem in almost a third of their school-aged and adolescent patients and endorsed using medication to treat the insomnia in at least a quarter of these patients. Overall, 96% of respondents recommended at least one of the listed prescription medications in a typical month, and 88% recommended an over-the-counter medication. Alpha agonists were the most commonly prescribed insomnia medication for ADHD (81%), significantly higher than in MR/DD (67%), mood (40%), or anxiety disorders (31%). Trazodone was the most commonly prescribed insomnia medication for children with mood (78%) and anxiety disorders (72%). Antidepressants as a class were also commonly used for children in these diagnostic groups. Atypical antipsychotics, anticonvulsants, and short-acting hypnotics were also more likely to be used in children with mood disorders. Melatonin was recommended by more than one-third of respondents. Mitigation of the effects of sleep disruption on daytime functioning was endorsed as an important rationale for the use of sleep medication; concerns about side effects and the lack of empirical support regarding efficacy were cited as significant barriers to their use.


CONCLUSIONS
Insomnia is a significant clinical problem in children treated by child psychiatrists for a variety of behavioral, neurodevelopmental, and psychiatric conditions. Management with a broad array of psychotropic medications is common and indicates a highly variable clinical approach to insomnia in this pediatric population.
Owens
Judith A
JA
Brown Medical School, Rhode Island Hospital, 593 Eddy St., Potter Bldg., Suite 200 Providence, RI 02903, USA. Owensleep@gmail.com
Rosen
Carol L
CL
Mindell
Jodi A
JA
Kirchner
Hal L
HL
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D001291:Attitude of Health Personnel; D002648:Child; D002665:Child Psychiatry / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D029001:Herbal Medicine / Q000706:statistics & numerical data; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008550:Melatonin / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D011795:Surveys and Questionnaires
D006633:Histamine Antagonists; D006993:Hypnotics and Sedatives; D008550:Melatonin