These parental and wider family issues indicate ways in which a child's psychological and social development can be affected by persistent sleep disturbance. In addition, children can be distressed by their experience of sleep disorder phenomena. Examples include night-time fears which can be intense, alarming hypnagogic imagery, or sleepwalking and night terrors, which can be embarrassing, especially if they occur away from home. Excessive daytime sleepiness often leads to educational problems and can produce extreme reactions such as the denial, aggression, or depression as described in narcolepsy, (11) or accidents and substance abuse.(l2)
In addition to these largely indirect ways in which a child's sleep disorder may have psychological effects, sleep disturbance can produce direct effects on mood, behaviour, and cognitive function. Although not well investigated in children, there is no particular reason to believe that the psychological effects of sleep disturbance is any less than at a later age. Indeed, their developmental consequences might be severe if not arrested at an early age.
Even impairment of physical growth is associated with sleep disturbance. Failure to thrive is a recognized possible consequence of early-onset sleep-related breathing difficulties, although the mechanisms involved remain to be clarified. It has been suggested that 'psychosocial dwarfism' (growth retardation associated with emotional difficulties) may be caused by growth hormone abnormalities linked to sleep disturbance. (13)
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