The Research Topic, investigating vigilance & disruptive behaviors, in context with sleep deprivation, is devoted to the British neurologist Henry Head and German psychiatrist Heinrich Hoffmann. In 1923, Head defined vigilance as the ability of the body “… to respond to an effective stimulus with a more or less appropriate reaction”. Already in 1845, Hoffmann, a general practitioner, depicted the connection of “vigilance” with disruptive behaviors of children and youth in a cartoon book entitled,
“Struwwelpeter - Merry Tales and Funny Pictures”. Each story within this book describes a clinical condition, which has multiple links to affected vigilance and in consequence to disruptive daytime behaviors. The narratives of ADHD (Fidgety Philip), ADD (John Head-in-Air), sensory processing dysfunctions and obsessive compulsive behaviors (Struwwelpeter and Conrad), Eating Disorders (Augustus), oppositional defiant disorder (Flying Robert and Harriet), mobbing and bullying in context with racism (The Inky Boys), and compulsive disorder (Cruel Frederick) are told in the cartoons, and are based on observations and pattern recognition.
Over the decades, Head’s definition of vigilance has been interpreted in various ways, perhaps most commonly as the ability to maintain attention to a task for a sustained period of time, leading to the creation of investigatory paradigms with a focus on test performance. Interestingly, whilst the concept of affected vigilance as the reaction to stimuli with a visible time delay (hypo-arousability in reacting or thinking) has been applied in the context of sleep deprivation, the consequences of this for disruptive wake behaviors has been neglected. This is an omission given that such an approach could frame innovative assessment and management concepts in developmental pediatrics, neuro-psychology, and child and adolescent psychiatry. How can we bridge this gap between sleep deprivation related disruptive daytime behaviors and vigilance in a pragmatic context?
This Research Topic aims to promote understanding of the connections between vigilance and disruptive daytime behavior in the context of sleep deprivation, and to explore how naturalistic observations and pattern recognition can play a role in furthering our understanding of the links. Both disruptive behaviors and impaired vigilance can be observed. Indeed, naturalistic observations are the foundation of clinical history taking, commonly used in communication between clinicians and patients (including parents in the case of child patients). A discourse - to examine the validity of outsourcing a contextual concept into lab settings without capturing and agreeing first on the observed patterns, their epistemic justification, and phenomenology - is overdue. In Hoffmann’s “Struwwelpeter”, translated in more than 35 languages, depicted patterns were discovered as clinical characteristics of disruptive behaviors, approximately 100 years later. In other words, observational concepts may lack phenomenology but as recognized patterns they share ubiquity and exist in many cultures. And yet, they have not been applied in clinical practice!
In consequence, the Research Topic, Vigilance & Disruptive Behaviors is devoted to these ubiquitous, naturalistic observations, and includes a discussion of phenomenology and pattern recognition.Within this research endeavor, vigilance and its use as a clinical outcome measure will be examined from various perspectives:
- What observable patterns connect vigilance and disruptive behaviors? Are facial characteristics of alertness or tiredness related to cognitive processing speed, captured as levels of arousal in reactions or thinking? Theme:
Applicability and limitations of current vigilance concepts and their consequences on diagnosis and treatment regimes.- Is the notion of arousability and tension of the body, connoted with hyper- or hypo- arousability clinically more relevant in the diagnosis of vigilance fluctuations than performing “boring and monotonous vigilance” tasks? Theme:
Vigilance, disruptive behaviors and wellbeing? Affecting factors: Sleep Deprivation, Comfort, Pain, Medications.- Is there a direct connection between vigilance and hyperactive-like behaviors appearing as hyper or hypo arousability and hypermotor-restlessness (all summarized as H-behaviors) in a circadian context? What is the interrelationship between circadian patterns of thermal comfort and levels of activity? Theme:
Databases / Registries - How to develop logic models and integrate machine learning?- Thus, the Research Topic, Vigilance & Disruptive Behaviors is targeted to an interdisciplinary and multi-professional audience for improving applied clinical practice with a trans¬disciplinary understanding, and aims to implement a function based assessment concept
What is the clinical utility of vigilance as a clinical outcome measure? A better understanding of the concept of vigilance related to sleep deprivation and how best to assess this clinical outcome would have implications both in clinical settings and beyond. The most striking example is that sleep deprivation and alcohol intoxication have similar effects on hand-eye coordination which, more generally relates to the concept of vigilance, and ultimately increases the risk of injury. Long term sleep deprivation can, similar to long term use of alcohol, impair cognitive and emotional wellbeing, While the consumption of alcohol is regulated in all countries throughout the world (e.g. alcohol at workplace or driving regulations), sleep deprivation is not regulated and further, measures to assess sleep deprivation for such purposes have been banned in laboratory settings. Despite firm evidence of many of the varied and negative sequelae of sleep deprivation, achieving sleep is still not universally prioritized. As suggested in holy books and beliefs, ‘our Lord never sleeps and protects us’, so the archetypical hero or leader also does not need sleep. This prevailing perception is an excellent example of the connotations of sleep in a historical and cultural context, and possibly affects our clinical application for research and understanding. Paradoxically, whilst recognizable signs of tiredness have not been integrated in medical decision making, the need for sleep is a common problem presented to clinicians and is something we can all perceive (parents/partners send their kids/each other to bed with the phrase, ‘You look tired, your face shows it’).
Therefore, let us begin together this learning journey on structured behavioral observations of vigilance and their association with disruptive behaviors.
Interested authors are welcome to submit reviews, original articles and case reports addressing the following questions:A. How applicable and what are the limitations of current vigilance concepts and their consequences on diagnosis and treatment regimens?
a. How to apply structured behavioral observations to connect vigilance with disruptive behaviors?
b. What are the effects of circadian rhythms on fluctuations in vigilance and associated behavioral patterns and processing speed?
c. What are the consequences of sleep deprivation and/or affected sleep architecture on vigilance and behavioral patterns on processing speed, cognitive functioning and emotional wellbeing?
B. What is the role of medications on vigilance, disruptive behaviours and wellbeing?
a. What are the effects of medications on sleep architecture, wake-behavior and vigilance?
b. Do we capture vigilance, disruptive behaviours and wellbeing together when we medicate? What monitoring concepts are applicable in clinical practice?
c. Do we respect the autonomy of the patient in our monitoring? What are the concepts for ethical prescription practices?
C. How to distinguish vigilance loss from sleepiness, tiredness and/or fatigue and are non-verbal signs of tiredness, fatigue, or sleepiness similar in different cultural contexts?
a. Are facial characteristics and/or behavioral patterns changed by fluctuations of vigilance?
b. What are the limitations and pitfalls of capturing cognitive processing speed and vigilance decrements in clinical practice?
c. How to distinguish between disorders affecting tension, arousability (vigilance) and wellbeing from chronic childhood sleep disorders?
d. Is there evidence for a continuum in hypermotor-restlessness at day and nighttime?
e. Is there a developmental trajectory (of changes in the observable manifestation of loss of vigilance) and in how it is best assessed and represented in its relationship with disruptive behaviours?
D. Can machine learning be integrated into behavioral analysis and recognition of vigilance fluctuations/sleepiness and distinguishing phenotype specific characteristics?