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Background Autism spectrum disorder (ASD) is often seen alongside narcolepsy in childhood; however, little is known about the potential link between the two. Our objective was to identify any similarities or differences between children with narcolepsy who also have ASD and those who do not. Methods A single-centre retrospective records review was undertaken of all children attending narcolepsy clinics as of 1st of August 2021. Data collected included: date and method of narcolepsy diagnosis, severity of narcolepsy at diagnosis, Revised Children’s Anxiety and Depressions Scale (RCADS) scores from parent and child, presence of autistic traits, date of ASD diagnosis and support received by the child’s family. Results Data was collected from 83 sets of patient records. of this sample, 75 (90.4%) had a confirmed diagnosis of narcolepsy, further analysis was conducted on this group only. A total of 21 (28.0%) children were recorded to have autistic traits, 9 (12.0%) had a confirmed diagnosis of ASD; 88% of ASD diagnoses were made before investigation for narcolepsy. Children with and without ASD had similar SOL and REMSOP results on MSLT. When collecting RCADS data, 55.6% of questionnaires from children with ASD were incomplete for both parent and child, compared to 29.6% of questionnaires from cases without, there was greater discrepancy between parent and child scores in the ASD group and higher parent-rated anxiety scores. Children with ASD were also more likely to receive enhanced school support. Discussion Descriptive analysis of this sample has shown that 40% of children with narcolepsy also have and ASD diagnosis or autistic traits. These children were more likely to be rated as anxious by their parents and went on to require enhanced support throughout school. This may suggest that ASD is could act as a clinical indicator to offer enhanced support where possible.

Introduction A child’s activities during the hour before bedtime forms the basis of the assessment for behavioural change interventions for children’s insomnia. The aim of this observational study was to identify patterns of behaviour around bedtime in a cohort of children with severe sleep difficulties and to explore deviations in behaviour from The Sleep Charity’s standard bedtime routine advice. Methods Data were collected by research staff using a questionnaire during a baseline face-to-face visit to the child’s home prior to sleep practitioner support as part of the Sheffield Children’s Sleeping Well study. Children were aged 2-17 years with a diagnosis of ADHD or were identified as a looked-after child. Data was input into NVivo where it was coded to identify common or recurring keywords or phrases in the responses. Results 51 parents were interviewed. Table 1 presents the coded responses to questions relating to sleep behaviours. For 32 children, bedtime routines lasted 30 mins-2 hours; 17 had no routine. Only 13 children were reported to have actively had technology removed within the hour before bedtime. 32 had no planned snack. of the 17 that did, snacks were usually cereal, toast, biscuit, warm milk although some snacks included chocolate, hot chocolate, crisps, burger and chips. Only10 children engaged in calming activities in the hour before bedtime such as reading, colouring, lego and crafts. 28 children were left to self-settle and 22 had a parent laying or sitting next to them in their bedroom in order to fall asleep. Conclusion There was marked variation from the recommended bedtime routine in children with severe behavioural sleep difficulties, accepting that in some, socially desirable responses may have been given to the research staff during the assessment. Further work to explore the important factors in helping a child to self-settle is ongoing.

Objective To determine the inter-observer agreement of a respiratory rate (RR) count on a child when assessed by three independent observers. Design The RR of 169 children (age range: 3 days to 15 years) was measured by three independent observers over a 3-month period. The first RR was taken by different healthcare professionals (HCPs) from within the hospital using their own preferred method of measurement. A further count of RR was then taken by two observers from the research team simultaneously within 30 min of the first measurement, using the WHO-recommended method of measurement. Results 507 RR measurements were taken on 169 children. Median RR showed a 4 beats per minute (bpm) difference between the HCP (median RR 32 bpm) and the researchers (median RR 28 bpm). The 95% limits of agreement between the first measurement and second and third measurements were −10.2 to 17.7 bpm and −11.4 to 18.7 bpm, respectively. For simultaneous measurements, the 95% limits of agreement were −7.1 to 7.0 bpm. 81 children had a RR > 95th centile for their age and an even poorer level of agreement was seen in these children than in those whose RR was within normal range. In only 27 of these 81 children (33%) did all three observers agree on the presence of a raised RR. Conclusions Inter-observer agreement for the measurement of RR in children is poor. The effect that this variation has on the clinical assessment and subsequent management of a child may be significant. These findings highlight the need for a robust review of our current measurement methods and interpretation of an important vital sign.