Isa Corcoran

7/5/18

Dr. McAuliffe

PSY 472-S

Case Study # 2

Background

Owen Phillips is a 6-year-old European-American male in the first grade who suffers

from Sleep Terrors. He is one of two boys in the Phillips family and he is the youngest of the

two. Owen is an active little boy who excels academically and is a very happy child. Owen has

many friends and spends his days at school, enjoying recess and interacting with his peers. He is

a very calm little boy but sometimes gets nervous about new experiences and the unknown. His

mother, Meredith Phillips, is a high-strung, Type A woman who works in finance. Meredith

spends as much time as possible with her two sons and her husband Tom, but she is incredibly

career-driven. Meredith is a patient woman (to an extent), but easily becomes frustrated and

dismissive, especially when Owen has one of his episodes. Tom Phillips, Owen’s father, is also

in finance. He is a successful investment banker who does not spend that much time with his

children because of his demanding work schedule, but he spends quality time interacting with

Owen and Timmy when he can. Owen’s older brother, Timmy Phillips, is a 12-year-old middle

schooler. Overall, Timmy has a positive relationship with his little brother Owen, but Timmy

becomes frustrated and lashes out at Owen when he wakes up the family with his piercing

screams. Although Timmy never had any parasomnia or dyssomnia issues, both Mr. and Mrs.

Phillips suffered from nightmares as children.

 Owen’s sleep terrors are disruptive to the entire family and the Phillips family dog,

Buster. He has had five episodes over a period of three months and are almost exactly the same

every time. He wakes up his family with a shrill, bone-chilling scream but is completely unaware

of the entire event the next day. His mother has become increasingly agitated with Owen and

makes snippy comments in regards to him bothering the family. Owen’s father is a bit more

understanding but still gets annoyed when his sleep schedule is interrupted. The biggest issue is

that Timmy becomes angry and makes mean comments to Owen about how he “is so annoying”

and “is such a baby” for waking the family up with his “dumb nightmares”. Although the

situation is somewhat out of Owen’s control, these comments have started to take a toll on his

self-esteem and make him feel like his family does not really love him.

Symptoms

Although Owen has experienced several isolated episodes (meaning that days pass in

between each episode), he has had five violent episodes over a span of three months. The

episodes occur almost the same way every time. They start at roughly 2:00 or 2:30 am and he sits

upright in his bed and begins to scream uncontrollably. It is a blood-curdling scream that wakes

up the whole house. Once his parents hear him scream, they run to his room and in the past they

have attempted to wake him, but are unable to do so successfully. Meredith and Tom noticed that

Owen sweats profusely and occasionally shivers during his violent episodes due to the sheer

force that he exerts while screaming. He remains seated in his bed, but his posture is stiff and it

is a physiological response that expresses the sheer psychological terror he feels. After 30-60

seconds of his piercing scream, Owen will lay back down and sleep until about 7:00 or 7:30 am,

depending on his school schedule. In the morning, his mother or Timmy usually makes a
comment about how their sleep was disrupted by Owen’s screams and on the days right after the

episode, Owen is noticeably more quiet and withdrawn from his peers and his family. This is a

direct result of the embarrassment and shame he feels around not remembering his violent

outbursts and not being able to control his sleep terrors.

Although Owen is not directly harming himself or others when the sleep terrors occur, he

disrupts his family member’s sleep cycles and the after effects of his family’s frustration with

him and his uncontrollable screaming are beginning to take a toll on his self-esteem and make

him feel nervous about sleeping and making his family angry with him. Children who suffer

from sleep terrors typically grow out of them as they get older, but in this particular case,

Owen’s sleep terrors greatly affect the dynamics of his family system and foster a breeding

ground for growing feelings of shame, insecurity, and inadequacy around his inability to control

his outbursts.

Assessment

In order to come up with an accurate diagnosis and an effective treatment plan for Owen,

it would be prudent to conduct clinical interviews with Owen, his parents, his brother, and his

teacher(s). This would allow the psychologist or psychiatrist to get as much information as

possible about Owen and how he behaves in his everyday life in order to come up with an

accurate patient profile. The interviews would also help determine if there are any underlying

subconscious issues that have triggered Owen’s night terrors. Determining the root of the issue

would allow the psychologist or psychiatrist to either proceed with behavioral interventions to

modify Owen’s behavior and cognitions in order to prevent future sleep terror episodes from

occurring. It would also help determine the severity of Owen’s disorder and address the question
about possibly prescribing an antidepressant to target any underlying psychological factors that

contribute to his violent episodes.

Diagnosis

According to Fleetham (2014), “Sleep terrors… commence with the sleeper sitting up in

bed, emitting a loud scream and showing the typical autonomic manifestations of intense fear”

(p. 276). In regards to Owen’s symptoms, this corroborates the evidence that he is most likely

suffering from sleep terrors because of his violent screaming and his controlled, upright, tense

posture while sitting down. His physiological responses to the sleep terrors are quite evident and

are indicative of immense amounts or fear and stress that are clearly expressed through his

violent screaming, rigid, seated posture, sweating, and labored breathing. Although he does not

present symptoms of any anxiety disorders, Obsessive Compulsive Disorder, or mood disorders,

it is important for the psychologist or psychiatrist to rule those out when considering treatments

options to treat his sleep terrors.

Risk Factors

One of the biggest risk factors for Owen is that his parents suffered from nightmares

when they were children. Most parasomnia or dyssomnia disorders are hereditary, so although

his brother Timmy never had any sleeping issues, both of his parents’ childhood sleeping issues

would provide an explanation as to why Owen is at a higher risk for having the same issues.

Another big risk factor that affects Owen is the comorbidity of sleep disorders with anxiety

disorders, so it would be important to test Owen for any undiagnosed issues that may influence

the occurrence of sleep terrors.

Etiology

Although there do not seem to be any underlying issues that may cause Owen’s sleep

terrors, it can be traced back to both his parent’s chronic nightmares from their youth.

Parasomnias and dyssomnias are heritable from parent to offspring, so although there is no

definite cause or catalyst that prompted Owen’s sleep terrors, he is more susceptible to suffering

from a sleep disorder because his parents had them. At the moment, it is not clear if there is an

undiagnosed psychological issue that would have triggered the onset of the sleep terrors, but

during a clinical interview or psychological testing, a professional would be able to rule that out

in coming up with an accurate diagnosis for Owen.

Treatment

According to Maski (2016), “the management of arousal parasomnias should first include

reassurance and education of the family regarding the benign and self-limited nature of the

disorder” (p. 1174). In order to create a more supportive environment for Owen to address and

prevent future episodes, Mr. and Mrs. Phillips must first learn all they can about sleep terrors.

Unfortunately, it is difficult to predict when Owen will have another episode, but in learning

more about the disorder, Mr. and Mrs. Phillips can create a plan of action in order to keep Owen

safe and more relaxed so he has less of the episodes. In Owen’s case, since he is so young,

behavioral interventions would be the most appropriate course of action. Some patients benefit

from scheduled awakenings in order to regulate their sleeping schedules, so in the initial stages

of treatment, it would benefit Owen greatly to be woken up every 30 to 45 minutes based on his

REM sleep cycle. Once the scheduled awakenings start to help regulate his sleep cycle, Mr. and
Mrs. Phillips can slowly reduce the amount of times they wake up Owen per night and this

would allow Owen to retrain himself to sleep in a more regulated, scheduled way.

Another helpful step that would benefit Owen in overcoming sleep terrors would be to

create a relaxing evening routine. This could entail a series of activities ranging from running

outside, reading for a substantial amount of time before bed, watching a calming movie, or

working on a series of yoga and mindfulness exercises to help regulate his breathing and thought

patterns to keep them as stable and calming as possible.

 References

Bloomfied, E. R., & Shatkin, J. P. (2009). Parasomnias and Movement Disorders in Children and
Adolescents. Child and Adolescent Psychiatric Clinics of North America,18(4), 947-965.
Retrieved July 6, 2018, from
https://www.clinicalkey.com/service/content/pdf/watermarked/1-s2.0
S105649930900042X.pdf?locale=en_US.

Durand, V. M., & Mindell, J. A. (1999). Behavioral Intervention for Childhood Sleep
Terrors. Behavior Therapy,30(4), 705-715. doi:10.1016/s0005-7894(99)80034-3

Fleetham, J. A., & Fleming, J. A. E. (2014). Parasomnias. CMAJ : Canadian Medical

Association Journal, 186(8), E273–E280. http://doi.org/10.1503/cmaj.120808

Maski, K., & Owens, J. A. (2016). Insomnia, Parasomnias, and Narcolepsy in Children: Clinical
Features, Diagnosis, and Management. The Lancet Neurology,15(11), 1170-1181.
Retrieved July 7, 2018, from
https://www.clinicalkey.com/service/content/pdf/watermarked/1-s2.0
1474442216302046.pdf?locale=en_US.