Behavioural insomnia and circadian rhythm disorders — structured clinical encounter

Station brief (candidate)

You are the paediatric registrar in a general clinic. A 15-year-old boy is referred with worsening school lateness and absence over six months. He describes lying awake until about 2am despite trying to sleep earlier, being impossible to rouse for school, and feeling sleepy and irritable through the morning that improves by the afternoon. At weekends and in holidays he sleeps from around 2am to 11am and wakes refreshed. His mother asks whether he is depressed or just lazy. The team asks you to establish the diagnosis, assess him, exclude organic and mood disorder, and plan treatment. You have 12 minutes with the family and 5 minutes for examiner discussion. ^{[8] [9]}