101
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Price TE, Farrell LJ, Donovan CL, Waters AM. Behavioral Sleep-Related Problems in Clinically Anxious Children: A Parent-Report Diary Study. Child Psychiatry Hum Dev 2019; 50:746-755. [PMID: 30805815 DOI: 10.1007/s10578-019-00878-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anxiety disorders and behavioral sleep-related problems (SRPs) frequently co-occur during childhood. However, few studies have used the recommended method of a sleep-diary. The present study examined parental perceptions of behavioral SRPs in anxious compared to non-anxious children using a sleep-diary. Parents of 22 clinically anxious children and 29 healthy controls (aged 6-13 years) completed a 7-day sleep-diary of their child's behavioral SRPs. Compared to non-anxious peers, anxious children were rated by parents as more often (a) having a negative mood before bed, (b) delaying bed, (c) requiring parental assistance during the night, especially on weeknights, (d) having difficulty waking on their own the next morning, (e) falling back to sleep after morning waking, and (f) waking in a negative mood. There were no significant group differences in sleep onset latency or sleep duration, and behavioral SRPs of anxious children did not negatively affect their functioning or that of their parents the next day based on parent report. Parents of anxious children are more likely to perceive their children as engaging in behavioral SRPs compared to parents of non-anxious children.
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Affiliation(s)
- Therese E Price
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Lara J Farrell
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | | | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia.
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102
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Wheeler AC, Okoniewski KC, Wylie A, DeRamus M, Hiruma LS, Toth D, Christian RB. Anxiety-associated and separation distress-associated behaviours in Angelman syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1234-1247. [PMID: 31134691 DOI: 10.1111/jir.12635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/21/2019] [Accepted: 05/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Anxiety is considered a 'frequent' feature in the clinical criteria for Angelman syndrome; however, the nature and severity of anxiety symptoms have not been well characterised in this population. Anxiety behaviours, especially in response to separation from a preferred caregiver, have been described clinically but have not yet been explored empirically. METHOD This study used a combination of standardised and clinician-derived survey items to assess the frequency, nature and severity of behaviours associated with anxiety and separation distress in 100 individuals with Angelman syndrome. Family (e.g. income and maternal education) and individual (e.g. age, sex, genetic subtype, sleep difficulties and aggressive behaviours) variables were also gathered to assess possible predictors of higher anxiety levels. Approximately half of the sample was seen in clinic and assessed with standardised measures of development and daily functioning, allowing for an additional exploration of the association between anxiety symptoms and extent of cognitive impairment. RESULTS Anxiety concerns were reported in 40% of the sample, almost 70% were reported to have a preferred caregiver and over half displayed distress when separated from that caregiver. Individuals with the deletion subtype and individuals who are younger were less likely to have anxiety behaviours. Sleep difficulties and aggressive behaviour consistently significantly predicted total anxiety, the latter suggesting a need for future studies to tease apart differences between anxiety and aggression or anger in this population. CONCLUSIONS Anxiety concerns, especially separation distress, are common in individuals with Angelman syndrome and represent an area of unmet need for this population.
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Affiliation(s)
- A C Wheeler
- Center for Newborn Screening, Ethics and Disability Studies, RTI International, Durham, NC, USA
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K C Okoniewski
- Center for Newborn Screening, Ethics and Disability Studies, RTI International, Durham, NC, USA
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A Wylie
- Center for Newborn Screening, Ethics and Disability Studies, RTI International, Durham, NC, USA
| | - M DeRamus
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L S Hiruma
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D Toth
- Center for Newborn Screening, Ethics and Disability Studies, RTI International, Durham, NC, USA
| | - R B Christian
- Carolina Institute for Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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103
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Meir P, Alfano CA, Lau S, Hill RM, Palmer CA. Sleep Patterns and Anxiety in Children Interact to Predict Later Suicidal Ideation. CHILDRENS HEALTH CARE 2019; 48:372-393. [PMID: 32675893 PMCID: PMC7365578 DOI: 10.1080/02739615.2019.1630283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Elevated levels of childhood anxiety pose risk for suicide; however, factors that accentuate this risk are unknown. Seventy-one children participated in a longitudinal study investigating anxiety and sleep in childhood (between 7-11 years) and later suicidal ideation (SI; M = 3.3 years later). Sleep was assessed via subjective reports and objective measures (actigraphy and polysomnography). Children with greater anxiety symptoms were at greater risk for later SI when sleep disturbances were present in childhood. Results suggest that sleep disruption may amplify SI risk in anxious children.
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Affiliation(s)
- Priel Meir
- Department of Psychology, University of Houston, Houston, TX 77004
| | | | - Simon Lau
- Department of Psychology, University of Houston, Houston, TX 77004
| | - Ryan M. Hill
- Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030
| | - Cara A. Palmer
- Department of Psychology, Montana State University, Bozeman, MT 59717
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104
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Wilson C, Carpenter J, Hickie I. The Role of the Sleep-Wake Cycle in Adolescent Mental Illness. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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105
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Dockray S, O'Neill S, Jump O. Measuring the Psychobiological Correlates of Daily Experience in Adolescents. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2019; 29:595-612. [PMID: 31573767 DOI: 10.1111/jora.12473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Mapping the psychobiological correlates of social contexts, experiences, and emotional responses of adolescents in their daily lives provides insight into how adolescent well-being shapes, and is shaped by, experience. Measures of these psychobiological correlates are enabled by devices and technologies that must be precise and suitable for adolescent participants. The present report reviews the most often used research measures, and suggests strategies for best practice, drawn from practical experience. The rapid advances in technological methods to collect attuned measures of psychological processes, social context, and biological function indicate the promise for multimodal measures in ecological settings. Attaining these methodological goals will support research to secure comprehensive, quality data, and advance the understanding of psychobiological function in ambulatory settings.
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106
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Valshtein TJ, Oettingen G, Gollwitzer PM. Using mental contrasting with implementation intentions to reduce bedtime procrastination: two randomised trials. Psychol Health 2019; 35:275-301. [DOI: 10.1080/08870446.2019.1652753] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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107
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Sleep problems and anxiety from 2 to 8 years and the influence of autistic traits: a longitudinal study. Eur Child Adolesc Psychiatry 2019; 28:1117-1127. [PMID: 30659385 DOI: 10.1007/s00787-019-01275-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/03/2019] [Indexed: 12/28/2022]
Abstract
Whether or not childhood sleep problems and anxiety occur simultaneously, or one precedes the other, and any effect of autistic traits on this relationship remains unclear. We investigated longitudinal associations between sleep and anxiety at 2 years and sleep and anxiety at 8 years controlling for demographic variables. We also examined the additional influence of autistic traits at 2 years on sleep problems and anxiety at 8 years. Participants were from the Western Australian Pregnancy Cohort (Raine) Study, where 2900 pregnant women were recruited between 1989 and 1991 and their children assessed every 2-3 years thereafter. Demographic information was provided at 16-18 weeks gestation. Children's sleep and anxiety at 2 and 8 years and autistic traits at 2 years were measured using the Child Behavior Checklist. Hierarchical multiple regression models tested the prediction of both anxiety and sleep problems at 8 years. Sleep problems at 2 years and 8 years, anxiety at 2 years, and autistic traits at 2 years were significantly associated with anxiety at 8 years. Sleep problems at 2 years and anxiety at 8 years were significantly related to sleep problems at 8 years. Each of these models explained about 20% of variance. Childhood sleep problems, anxiety and autistic traits are interrelated and can occur concurrently in young children, but the best predictor of poor sleep in middle childhood is concurrent anxiety and vice versa. Anxiety and sleep problems may be an early indicator of autism in young children and early autistic traits may also contribute to anxiety problems later in childhood.
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108
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Palmer CA, Clementi MA, Meers JM, Alfano CA. Co-Sleeping among School-Aged Anxious and Non-Anxious Children: Associations with Sleep Variability and Timing. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:1321-1332. [PMID: 29302831 DOI: 10.1007/s10802-017-0387-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Little is known about the co-sleeping behaviors of school-aged children, particularly among anxious youth who commonly present for the treatment of sleep problems. The current study examined the occurrence of co-sleeping in both healthy and clinically anxious children and its associated sleep patterns. A total of 113 children (ages 6-12), 75 with primary generalized anxiety disorder and 38 healthy controls, participated along with their primary caregiver. Families completed structured diagnostic assessments, and parents reported on their child's co-sleeping behaviors and anxiety severity. Children provided reports of anxiety severity and completed one week of wrist-based actigraphy to assess objective sleep patterns. A significantly greater proportion of anxious youth compared to healthy children co-slept, and greater anxiety severity was related to more frequent co-sleeping. Co-sleeping in anxious youth was associated with a delay in sleep timing and with greater sleep variability (i.e., more variable nightly sleep duration). All analyses controlled for child age, race/ethnicity, family income, and parental marital status. Co-sleeping is highly common in anxious school-aged children, with more than 1 in 3 found to co-sleep at least sometimes (2-4 times a week). Co-sleeping was even more common for youth with greater anxiety severity. Increased dependence on others to initiate and maintain sleep may contribute to poorer sleep in this population via shifted schedules and more variable sleep patterns.
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Affiliation(s)
- Cara A Palmer
- Sleep and Anxiety Center of Houston, University of Houston, 4849 Calhoun Road, #373, Houston, TX, 77204, USA.
| | - Michelle A Clementi
- Sleep and Anxiety Center of Houston, University of Houston, 4849 Calhoun Road, #373, Houston, TX, 77204, USA
| | - Jessica M Meers
- Sleep and Anxiety Center of Houston, University of Houston, 4849 Calhoun Road, #373, Houston, TX, 77204, USA
| | - Candice A Alfano
- Sleep and Anxiety Center of Houston, University of Houston, 4849 Calhoun Road, #373, Houston, TX, 77204, USA
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109
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Blake MJ, Latham MD, Blake LM, Allen NB. Adolescent-Sleep-Intervention Research: Current State and Future Directions. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2019. [DOI: 10.1177/0963721419850169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Emerging evidence suggests that cognitive-behavioral interventions should be considered as a first-line treatment for adolescent sleep problems and can also address associated mental health concerns. This article’s aim is to prioritize future directions for this research. Studies are needed that (a) leverage innovative technology, which may allow for a more personalized-medicine approach to care; (b) use alternative research designs, such as treatment-optimization strategies; (c) evaluate mechanisms of therapeutic improvements, including mediators and moderators of change, predictors of treatment adherence, dose–response relationships, and specificity of effects of different treatment components; (d) “scale up” the interventions so that a large proportion of adolescents can access them; and (e) develop flexible approaches to delivery (e.g., online platforms) and stepped-care guidelines. National and international standards of secondary school start times of 8:30 a.m. or later are also needed. The field is now mature enough to take these next steps, which will enhance the effectiveness and public health impact of these interventions.
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Affiliation(s)
- Matthew J. Blake
- Melbourne School of Psychological Sciences, The University of Melbourne
| | | | - Laura M. Blake
- Melbourne School of Psychological Sciences, The University of Melbourne
| | - Nicholas B. Allen
- Melbourne School of Psychological Sciences, The University of Melbourne
- Department of Psychology, University of Oregon
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110
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Scott BG, Alfano CA, Russell JD, Weems CF. Heart rate variability and anxious arousal: Unique relations with sleep‐related problems in stress‐exposed adolescents. Dev Psychobiol 2019; 61:1180-1190. [DOI: 10.1002/dev.21883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 02/25/2019] [Accepted: 05/11/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Brandon G. Scott
- Department of Psychology Montana State University Bozeman Montana
| | | | - Justin D. Russell
- Department of Psychiatry University of Wisconsin-Madison Madison Wisconsin
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111
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Alfano CA. (Re)Conceptualizing Sleep Among Children with Anxiety Disorders: Where to Next? Clin Child Fam Psychol Rev 2019; 21:482-499. [PMID: 30136070 DOI: 10.1007/s10567-018-0267-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Children with anxiety disorders (AD) characteristically complain of sleep problems and the extent to which cognitive behavioral treatments (CBT) for childhood anxiety produce sleep-based improvements is a topic of increasing interest. The current paper reviews available evidence for subjective sleep complaints and objective sleep alterations in children and adolescents with AD, including investigations of potential changes in sleep following anxiety-focused CBT. Despite pervasive complaints of poor sleep, the empirical literature provides minimal evidence for actual sleep-wake alterations in this population of youth and evidence for sleep-based changes following treatment for anxiety is minimal. In line with calls for more comprehensive models of the role of sleep in developmental psychopathology, several fundamental gaps in understanding are described and highlighted as essential avenues for clarifying the nature and consequences of poor quality sleep among youth with clinical levels of anxiety. In a second section of the paper, an emerging body of novel, translational research investigating more intricate sleep-anxiety relationships is introduced with potential implications for both etiological models and treatment design and delivery.
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Affiliation(s)
- Candice A Alfano
- Sleep and Anxiety Center of Houston (SACH), Department of Psychology, University of Houston, 126 Heyne Bldg, Houston, TX, 77204, USA.
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112
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Farris SG, Matsko SV, Uebelacker LA, Brown RA, Price LH, Abrantes AM. Anxiety sensitivity and daily cigarette smoking in relation to sleep disturbances in treatment-seeking smokers. Cogn Behav Ther 2019; 49:137-148. [PMID: 30947621 DOI: 10.1080/16506073.2019.1583277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although the association between anxiety and sleep disturbance is well-documented, the underlying mechanisms are less clear. Anxiety sensitivity (AS), the fear of physiological arousal and bodily sensations, is a risk factor for anxiety and poor sleep. Smoking also contributes to poor sleep and may compound the effects of AS on sleep quality. This study evaluated the main and interactive effects of AS and cigarettes/day on sleep quality among smokers. Participants (n = 190) were adult treatment-seeking daily smokers who completed a baseline assessment as part of a larger smoking cessation trial. Sleep quality was self-reported. Results indicated that AS was significantly correlated with greater disturbance in sleep duration, subjective sleep quality, sleep onset latency, sleep disturbance, daytime dysfunction, and sleep medication use. There was a significant interaction between AS and cigarettes/day in terms of sleep onset latency, but not other sleep quality indices. AS was associated with significantly longer sleep onset latency minutes among heavier smokers, but not lighter smokers. Specifically, the association between AS and sleep onset latency was significant for those who smoked ≥ 33 cigarettes/day. AS is a psychological factor that may contribute to poor sleep quality, especially in heavy smokers, and thus may be a promising intervention target.
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Affiliation(s)
- Samantha G Farris
- Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Stephen V Matsko
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital, Providence, RI, USA
| | - Richard A Brown
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Lawrence H Price
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital, Providence, RI, USA
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Butler Hospital, Providence, RI, USA
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113
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Interactions between sleep duration and quality as predictors of adolescents' adjustment. Sleep Health 2019; 5:180-186. [PMID: 30928119 DOI: 10.1016/j.sleh.2018.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/25/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We examined interactions between adolescents' sleep duration and quality as predictors of their internalizing symptoms and externalizing behaviors. As a secondary aim, we assessed adolescent sex, race/ethnicity, and socioeconomic status (SES) as additional moderators of risk (ie, 3-way interactions among sleep duration; quality; and sex, race, or SES). DESIGN The study used a cross-sectional design. SETTING Participants were from small towns and semirural communities in Alabama. PARTICIPANTS The sample consisted of 235 adolescents (Mage = 15.78 years, SD = 9.60 months) and was diverse with respect to sex (54% female), race/ethnicity (32% Black/African American, 67% White), and SES. MEASUREMENTS Sleep duration (actual sleep minutes) was examined with actigraphs for 1 week. Adolescents reported on their subjective sleep quality, internalizing symptoms, and externalizing behavior with psychometrically sound measures. RESULTS Findings revealed interactions between sleep duration and sleep quality as predictors of adolescents' adjustment. Adolescents with both short sleep duration in conjunction with poor sleep quality had the highest levels of internalizing symptoms and aggressive and rule-breaking behavior. SES interacted with sleep duration and sleep quality to predict rule-breaking behavior, and the highest level of problems was observed for adolescents from lower-SES homes who had short sleep duration accompanied by poor sleep quality. CONCLUSIONS Findings identify the conjoint role of sleep duration and quality as predictors of adolescents' socioemotional adjustment and emphasize the importance of examining multiple sleep parameters simultaneously toward a better understanding of adaptation in adolescence.
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114
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Sleep and adjustment in adolescence: physical activity as a moderator of risk. Sleep Health 2019; 5:266-272. [PMID: 30928497 DOI: 10.1016/j.sleh.2019.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 01/30/2019] [Accepted: 02/14/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We investigated physical activity as a moderator of relations between sleep duration and quality and adolescents' internalizing and externalizing problems. DESIGN The study used a cross-sectional design. SETTING Participants were recruited from small towns and semi-urban communities in Alabama. PARTICIPANTS The sample was comprised of 235 adolescents (Mage = 15.78 years, SD = 9.60 months) who were diverse in sex (53% female), race/ethnicity (34% Black/African American, 66% White), and socioeconomic status. MEASUREMENTS Sleep duration (actual sleep minutes), efficiency (minutes/total sleep period), and latency (minutes from sleep attempt to onset) were examined with actigraphs for 1 week. Youth reported on their physical activity levels and internalizing and externalizing problems. RESULTS Interactions between sleep and physical activity emerged in the prediction of adolescents' internalizing and externalizing problems. Supportive of moderation effects, adolescents with shorter or poorer-quality sleep in conjunction with less physical activity showed the highest levels of internalizing and externalizing problems. Demonstrative of protective effects, adolescents with more physical activity had lower levels of internalizing and externalizing problems regardless of their sleep duration or quality. CONCLUSIONS Findings illustrate that not all youth are at equal risk for adjustment problems when they experience short or poor-quality sleep, suggesting the importance of examining both bioregulatory and environmental factors in understanding adolescent adjustment.
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115
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Cliffe B, Croker A, Denne M, Stallard P. Supported Web-Based Guided Self-Help for Insomnia for Young People Attending Child and Adolescent Mental Health Services: Protocol for a Feasibility Assessment. JMIR Res Protoc 2018; 7:e11324. [PMID: 30545814 PMCID: PMC6315243 DOI: 10.2196/11324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 01/16/2023] Open
Abstract
Background Sleep disturbance in adolescents is common, with up to one-third reporting significant symptoms of insomnia. Research with adults has demonstrated that Web-based cognitive behavioral therapy for insomnia (CBTi) can improve both sleep and mental health. However, research with adolescents is lacking, and we know little about whether CBTi would have similar effects on this younger population. Objective This paper summarizes the protocol of a study to assess the feasibility of adding supported Web-based CBTi to the usual care of young people aged 14-17 years attending specialist Child and Adolescent Mental Health Services (CAMHS). Methods This is an open trial where we will recruit young people (N=50) aged 14-17 years attending specialist CAMHS with primary or comorbid symptoms of insomnia. In addition to their usual care, young people will be provided with Sleepio, a 6-session, Web-based CBTi self-help program for insomnia. Sleepio teaches a range of techniques including sleep hygiene, relaxation training, stimulus control, sleep restriction, and cognitive techniques that participants will be helped to apply through brief, weekly telephone support calls. Questionnaires and interviews will be completed at baseline and postintervention (8-10 weeks) and will assess sleep, symptoms of depression and anxiety, and acceptability of Sleepio and telephone support. Results Recruitment started in May 2018 and continued until the end of October 2018. Conclusions This study will provide preliminary evidence about whether supported Web-based CBTi is acceptable to young people with mental health problems and about the postintervention effects on sleep and symptoms of anxiety and depression. This information will determine whether a randomized trial to determine the effectiveness of Sleepio should be undertaken. International Registered Report Identifier (IRRID) DERR1-10.2196/11324
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Affiliation(s)
- Bethany Cliffe
- Department for Health, University of Bath, Bath, United Kingdom
| | - Abigail Croker
- Child and Family Service, Oxford Health National Health Services Foundation Trust, Keynsham, United Kingdom
| | - Megan Denne
- Child and Family Service, Oxford Health National Health Services Foundation Trust, Keynsham, United Kingdom
| | - Paul Stallard
- Department for Health, University of Bath, Bath, United Kingdom
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116
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Ricketts EJ, Price RB, Siegle GJ, Silk JS, Forbes EE, Ladouceur CD, Harvey AG, Ryan ND, Dahl RE, McMakin DL. Vigilant attention to threat, sleep patterns, and anxiety in peripubertal youth. J Child Psychol Psychiatry 2018; 59:1309-1322. [PMID: 29718535 PMCID: PMC6214801 DOI: 10.1111/jcpp.12923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Vigilant attention to threat is commonly observed in anxiety, undergoes developmental changes in early adolescence, and has been proposed to interfere with sleep initiation and maintenance. We present one of the first studies to use objective measures to examine associations between vigilant attention to threat and difficulties initiating and maintaining sleep in an early adolescent anxious sample. We also explore the moderating role of development (age, puberty) and sex. METHODS Participants were 66 peripubertal youth (ages 9-14) with a primary anxiety disorder and 24 healthy control subjects. A dot-probe task was used to assess attentional bias to fearful relative to neutral face stimuli. Eye-tracking indexed selective attentional bias to threat, and reaction time bias indexed action readiness to threat. Sleep was assessed via actigraphy (e.g. sleep onset delay, wake after sleep onset, etc.), parent report (Children's Sleep Habits Questionnaire), and child report (Sleep Self-Report). The Pediatric Anxiety Rating Scale assessed anxiety severity. RESULTS Eye-tracking initial threat fixation bias (β = .33, p = .001) and threat dwell time bias (β = .22, p = .041) were positively associated with sleep onset latency. Reaction time bias was positively associated with wake after sleep onset (β = .24, p = .026) and parent-reported sleep disturbance (β = .25, p = .019). Anxiety (severity, diagnosis) was not associated with these outcomes. Sex (β = -.32, p = .036) moderated the relation between initial threat fixation bias and sleep onset latency, with a positive association for males (p = .005), but not for females (p = .289). Age and pubertal status did not moderate effects. CONCLUSIONS Vigilant attention to threat is related to longer sleep onset and reduced sleep maintenance. These associations are not stronger in early adolescents with anxiety. Implications for early intervention or prevention that targets vigilant attention to threat to impact sleep disturbance, and vice versa, are discussed.
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Affiliation(s)
| | | | | | | | | | | | | | - Neal D. Ryan
- Department of Psychiatry, University of Pittsburgh
| | - Ronald E. Dahl
- School of Public Health, University of California, Berkeley, USA
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117
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Åslund L, Arnberg F, Kanstrup M, Lekander M. Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis. J Clin Sleep Med 2018; 14:1937-1947. [PMID: 30373682 DOI: 10.5664/jcsm.7498] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 08/23/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Sleep problems are common in children and adolescents and can aggravate comorbid disorders. This meta-analysis examined the effect of cognitive and behavioral sleep interventions (with four or more treatment sessions) from randomized controlled trials on school-age children and adolescents. METHODS In a systematic literature search, six randomized controlled trials were identified (n = 528; mean age = 14.6 years; female = 63%) that reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset, and daytime sleepiness from ratings and actigraphy. RESULTS After intervention, no effect was seen on self-reported TST, but when measured with actigraphy, an effect favoring the intervention group was observed (+11.47 minutes, P = .05). SOL decreased in the intervention group compared to the control group after intervention as measured by both sleep diaries (-9.31 minutes, P = .007) and actigraphy (-19.48 minutes, P < .0001). Effect sizes ranged from small to large. No effect was found for wake after sleep onset or daytime sleepiness. Short-term (4 to 8 weeks) follow-up data from four studies indicated maintained positive effects on SOL: sleep diaries -15.85 minutes (P = .01) and actigraphy -23.67 minutes (P < .0001). At follow-up, the effects on wake after sleep onset from ratings (-14.41 minutes, P = .001) and actigraphy (-7.54 minutes, P = .01) were significant, favoring the intervention group (moderate to large effect sizes). No effect on TST was indicated. CONCLUSIONS Cognitive and behavioral sleep interventions are indicated to improve sleep in school-age children and adolescents. However, because treatment protocols were heterogeneous and risk of bias high, results should be interpreted with caution. Large and rigorous trials are needed.
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Affiliation(s)
- Lie Åslund
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Filip Arnberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Marie Kanstrup
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Functional Area Medical Psychology, Functional Unit Behavior Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
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118
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Gittins S, Steel D, Brunklaus A, Newsom-Davis I, Hawkins C, Aylett SE. Autism spectrum disorder, social communication difficulties, and developmental comorbidities in Sturge-Weber syndrome. Epilepsy Behav 2018; 88:1-4. [PMID: 30195931 DOI: 10.1016/j.yebeh.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/05/2018] [Accepted: 08/06/2018] [Indexed: 11/18/2022]
Abstract
Sturge-Weber syndrome (SWS) is a neurocutaneous disorder characterized by the combination of a facial naevus flammeus and pial angioma, often associated with learning difficulties and/or epilepsy. Here, we report on the neuropsychological characteristics of a cohort of 92 children with SWS seen at a national referral center between 2002 and 2015. Almost a quarter (24%) had a diagnosis of autism spectrum disorder (ASD), with 45% overall having evidence of social communication difficulties (SCD). Autism spectrum disorder was more commonly seen in those individuals with bilateral angioma (p = 0.021). Significant behavioral difficulties were reported in 50% while 26% had difficulties with sleep. Difficulties with social communication, behavior, and sleep were closely associated with one another. They were not, however, significantly associated with markers of epilepsy severity and were noted to occur even in children without epilepsy. The prevalence of ASD/SCD, sleep difficulties, and behavioral disorders seen in SWS is high and reflects the complex needs of this group.
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Affiliation(s)
- Samuel Gittins
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; University College London Medical School, London, UK
| | - Dora Steel
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Andreas Brunklaus
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Imogen Newsom-Davis
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Developmental Neurosciences Programme of the UCL Institute of Child Health, London, UK
| | - Christina Hawkins
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Sarah E Aylett
- Neurosciences Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK; Developmental Neurosciences Programme of the UCL Institute of Child Health, London, UK.
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119
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The Role of Sleep Quality in Associations between Peer Victimization and Internalizing Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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120
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Geng F, Liu X, Liang Y, Shi X, Chen S, Fan F. Prospective associations between sleep problems and subtypes of anxiety symptoms among disaster-exposed adolescents. Sleep Med 2018; 50:7-13. [DOI: 10.1016/j.sleep.2018.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
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121
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Insomnia in Adolescence. Med Sci (Basel) 2018; 6:medsci6030072. [PMID: 30200388 PMCID: PMC6164454 DOI: 10.3390/medsci6030072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/16/2022] Open
Abstract
Adolescent insomnia is a common condition that negatively impacts a developing young adult's mental and physical health. While the treatment of adult insomnia has been standardized, the treatment of pediatric insomnia is very practitioner-dependent and few large-scale studies are available to determine a standard recommended practice. There is great hope that as the adolescent medicine and sleep medicine fields flourish, larger cohort analyses will be performed to determine the prevalence and precipitating factors of adolescent insomnia, allowing for standardized treatment recommendations and systematic efforts to make these recommendations available to all adolescents.
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122
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McMakin DL, Ricketts EJ, Forbes EE, Silk JS, Ladouceur CD, Siegle GJ, Milbert M, Trubnick L, Cousins JC, Ryan ND, Harvey AG, Dahl RE. Anxiety Treatment and Targeted Sleep Enhancement to Address Sleep Disturbance in Pre/Early Adolescents with Anxiety. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:S284-S297. [PMID: 29873503 DOI: 10.1080/15374416.2018.1463534] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep disturbance is prevalent in anxious youth and prospectively predicts poor emotional adjustment in adolescence. Study 1 examined whether anxiety treatment improves subjective and objective sleep disturbance in anxious youth. Study 2 examined whether a sleep intervention called Sleeping TIGERS can further improve sleep following anxiety treatment. Study 1 examined 133 youth (ages 9-14; 56% female; 11% ethnic/racial minority) with generalized, social, or separation anxiety over the course of anxiety treatment (cognitive behavioral treatment or client-centered treatment). Sleep-related problems (parent-, child-report) and subjective (diary) and objective (actigraphy) sleep patterns were assessed across treatment in an open trial design. Study 2 included 50 youth (ages 9-14; 68% female; 10% ethnic/racial minority) who continued to report sleep-related problems after anxiety treatment and enrolled in an open trial of Sleeping TIGERS. Pre- and postassessments duplicated Study 1 and included the Focal Interview of Sleep to assess sleep disturbance. Study 1 demonstrated small reductions in sleep problems and improvements in subjective sleep patterns (diary) across anxiety treatment, but outcomes were not deemed clinically significant, and 75% of youth stayed above clinical cutoff. Study 2 showed clinically significant, large reductions in sleep problems and small changes in some subjective sleep patterns (diary). Anxiety treatment improves, but does not resolve, sleep disturbance in peri-pubertal youth, which may portend risk for poor emotional adjustment and mental health. The open trial provides preliminary support that Sleeping TIGERS can improve sleep in anxious youth to a clinically significant degree.
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Affiliation(s)
| | - Emily J Ricketts
- b Department of Psychiatry , University of California , Los Angeles
| | | | | | | | - Greg J Siegle
- a Department of Psychiatry , University of Pittsburgh
| | | | | | | | - Neal D Ryan
- a Department of Psychiatry , University of Pittsburgh
| | - Allison G Harvey
- d Department of Psychology , University of California , Berkeley
| | - Ronald E Dahl
- e School of Public Health , University of California , Berkeley
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123
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Blake MJ, Blake LM, Schwartz O, Raniti M, Waloszek JM, Murray G, Simmons JG, Landau E, Dahl RE, McMakin DL, Dudgeon P, Trinder J, Allen NB. Who benefits from adolescent sleep interventions? Moderators of treatment efficacy in a randomized controlled trial of a cognitive-behavioral and mindfulness-based group sleep intervention for at-risk adolescents. J Child Psychol Psychiatry 2018; 59:637-649. [PMID: 29164609 DOI: 10.1111/jcpp.12842] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to test moderators of therapeutic improvement in an adolescent cognitive-behavioral and mindfulness-based group sleep intervention. Specifically, we examined whether the effects of the program on postintervention sleep outcomes were dependent on participant gender and/or measures of sleep duration, anxiety, depression, and self-efficacy prior to the interventions. METHOD Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 59.34%; mean age = 14.48 years, range 12.04-16.31 years) who had elevated levels of sleep problems and anxiety symptoms. Participants were randomized into either a group sleep improvement intervention (n = 63) or group active control 'study skills' intervention (n = 60). The sleep intervention ('Sleep SENSE') was cognitive behavioral in approach, incorporating sleep education, sleep hygiene, stimulus control, and cognitive restructuring, but also had added anxiety-reducing, mindfulness, and motivational interviewing elements. Components of the active control intervention ('Study SENSE') included personal organization, persuasive writing, critical reading, referencing, memorization, and note taking. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Center for Epidemiologic Studies Depression Scale (CES-D), and General Self-Efficacy Scale (GSE) and wore an actigraph and completed a sleep diary for five school nights prior to the interventions. Sleep assessments were repeated at postintervention. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001177842; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12612001177842&isBasic=True). RESULTS The results showed that compared with the active control intervention, the effect of the sleep intervention on self-reported sleep quality (PSQI global score) at postintervention was statistically significant among adolescents with relatively moderate to high SCAS, CES-D, and GSE prior to the intervention, but not among adolescents with relatively low SCAS, CES-D, and GSE prior to the intervention. The results were consistent across genders. However, the effects of the sleep intervention on actigraphy-measured sleep onset latency and sleep diary-measured sleep efficiency at postintervention were not dependent on actigraphy-measured total sleep time, SCAS, CES-D, or GSE prior to the intervention. CONCLUSIONS This study provides evidence that some sleep benefits of adolescent cognitive-behavioral sleep interventions are greatest among those with higher levels of anxiety and depressive symptoms, suggesting that this may be an especially propitious group to whom intervention efforts could be targeted. Furthermore, adolescents with lower levels of self-efficacy may need further targeted support (e.g. additional motivational interviewing) to help them reach treatment goals.
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Affiliation(s)
- Matthew J Blake
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Laura M Blake
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Orli Schwartz
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Monika Raniti
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Joanna M Waloszek
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Greg Murray
- Department Psychological Sciences, Swinburne University of Technology, Hawthorn, Vic., Australia
| | - Julian G Simmons
- Department of Psychiatry, The University of Melbourne, Melbourne, Vic., Australia
| | - Elizabeth Landau
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Ronald E Dahl
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Dana L McMakin
- Department of Psychology, Florida International University, Miami, FL, USA.,Psychology Division, Nicklaus Children's Hospital, Miami, FL, USA
| | - Paul Dudgeon
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - John Trinder
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic., Australia.,Department of Psychology, University of Oregon, Eugene, OR, USA
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124
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Poznanski B, Cornacchio D, Coxe S, Pincus DB, McMakin DL, Comer JS. The Link Between Anxiety Severity and Irritability Among Anxious Youth: Evaluating the Mediating Role of Sleep Problems. Child Psychiatry Hum Dev 2018; 49:352-359. [PMID: 29222620 DOI: 10.1007/s10578-017-0769-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although recent studies have linked pediatric anxiety to irritability, research has yet to examine the mechanisms through which youth anxiety may be associated with irritability. Importantly, sleep related problems (SRPs) have been associated with both child anxiety and irritability, but research has not considered whether the link between youth anxiety and irritability may be accounted for by SRPs. The present study investigated whether SRPs mediated the relationship between anxiety severity and irritability in a large sample of treatment-seeking anxious youth (N = 435; ages 7-19 years, M = 12.7; 55.1% female). Anxiety severity, SRPs and irritability showed significant pairwise associations, and the indirect effect of youth anxiety severity on irritability, via SRPs, was positive and significant. The present analysis is the first to examine youth anxiety, irritability, and SPRs in a single model in a sample of anxious youth, and provides preliminary evidence that SRPs partially mediate links between child anxiety and irritability.
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Affiliation(s)
- Bridget Poznanski
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Danielle Cornacchio
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Stefany Coxe
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Donna B Pincus
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Studies, Boston University, 648 Beacon Street, 6th Floor, Boston, MA, 02215, USA
| | - Dana L McMakin
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Jonathan S Comer
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA. .,Department of Psychology, The Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA.
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125
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Blake MJ, Trinder JA, Allen NB. Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions. Clin Psychol Rev 2018; 63:25-40. [PMID: 29879564 DOI: 10.1016/j.cpr.2018.05.006] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/05/2018] [Accepted: 05/26/2018] [Indexed: 11/27/2022]
Abstract
There is robust evidence of an association between insomnia, anxiety, and depression in adolescence. The aim of this review is to describe and synthesize potential mechanisms underlying this association and explore implications for the design of adolescent behavioral sleep interventions. Specifically, we examine whether insomnia symptoms are a mechanism for the development of internalizing symptoms in adolescence and whether sleep interventions are an effective treatment for both insomnia and internalizing symptoms in adolescence because they target the shared mechanisms underlying these disorders. Research using different methodologies points to the role of sequential, parallel, and interacting mechanisms. In this paper, we review a wide range of relevant biological (i.e., polymorphisms and dysregulation in serotonin, dopamine, and circadian clock genes; alterations in corticolimbic and mesolimbic brain circuits; cortisol reactivity to stress; inflammatory cytokine dysregulation; biased memory consolidation; changes in sleep architecture), psychological (i.e., cognitive inflexibility, interpretational biases, judgment biases, negative attribution styles, worry, rumination, biased attention to threat, dysfunctional beliefs and attitudes about sleep, misperception of sleep deficit), and social mechanisms (i.e., reduced and impaired social interactions, unhelpful parenting behaviors, family stress) and propose an integrative multilevel model of how these phenomena may interact to increase vulnerability to both insomnia and internalizing disorders. Several 'biopsychosocial' mechanisms hold promise as viable treatment targets for adolescent behavioral sleep interventions, which may reduce both insomnia and internalizing symptoms.
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Affiliation(s)
- Matthew J Blake
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia.
| | - John A Trinder
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia.
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia; Department of Psychology, University of Oregon, Eugene, OR 97403-1227, USA.
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126
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Raniti MB, Waloszek JM, Schwartz O, Allen NB, Trinder J. Factor structure and psychometric properties of the Pittsburgh Sleep Quality Index in community-based adolescents. Sleep 2018; 41:4955794. [DOI: 10.1093/sleep/zsy066] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Monika B Raniti
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Joanna M Waloszek
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Orli Schwartz
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
- Department of Psychology, University of Oregon, Eugene, OR
- Melbourne School of Psychological Sciences, University of Melbourne, Australia
| | - John Trinder
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
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127
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Palmer CA, Oosterhoff B, Bower JL, Kaplow JB, Alfano CA. Associations among adolescent sleep problems, emotion regulation, and affective disorders: Findings from a nationally representative sample. J Psychiatr Res 2018; 96:1-8. [PMID: 28941378 DOI: 10.1016/j.jpsychires.2017.09.015] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 12/12/2022]
Abstract
Sleep problems in youth reliably forecast the development of anxiety and mood disorders, presumably due to increased emotional difficulties. However, precise emotional mechanisms have yet to be delineated. The current study investigated how sleep problems in adolescence are associated with different emotion regulation strategies, and how sleep and psychiatric risk may be indirectly associated via poor emotion regulation. This study utilized data from the National Comorbidity Survey-Adolescent Supplement, a nationally representative sample from the United States (N = 10,148; age range 13-18 years). A diagnostic interview determined if adolescents qualified for a mood or anxiety disorder within the past year. Participants provided reports of their sleep, emotion regulation, and current life stress. Adolescents who reported greater sleep problems were more likely to qualify for a mood or anxiety disorder and generally reported poorer emotion regulation strategy use, even when accounting for demographic characteristics and current stress. Specifically, adolescents with greater sleep problems reported less problem solving, and greater avoidance, suppression, rumination, and acceptance. Sleep problems were indirectly associated with anxiety disorders through greater suppression and rumination, and indirectly associated with mood disorders through greater rumination and lower problem solving. Although cross-sectional, this study extends current research by suggesting that certain emotion regulation strategies may be more difficult for youth struggling with sleep problems, and provides initial evidence that poor emotion regulation may be one factor contributing to sleep-based psychiatric risk. These findings can inform more efficacious intervention efforts.
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Affiliation(s)
- Cara A Palmer
- Department of Psychology, University of Houston, Houston, TX, United States.
| | - Benjamin Oosterhoff
- Department of Psychiatry and Behavioral Sciences, University of Texas, Health Science Center at Houston, Houston, TX, United States
| | - Joanne L Bower
- Department of Psychology, University of Houston, Houston, TX, United States
| | - Julie B Kaplow
- Department of Psychiatry and Behavioral Sciences, University of Texas, Health Science Center at Houston, Houston, TX, United States
| | - Candice A Alfano
- Department of Psychology, University of Houston, Houston, TX, United States
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128
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Blake MJ, Snoep L, Raniti M, Schwartz O, Waloszek JM, Simmons JG, Murray G, Blake L, Landau ER, Dahl RE, Bootzin R, McMakin DL, Dudgeon P, Trinder J, Allen NB. A cognitive-behavioral and mindfulness-based group sleep intervention improves behavior problems in at-risk adolescents by improving perceived sleep quality. Behav Res Ther 2017; 99:147-156. [DOI: 10.1016/j.brat.2017.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/10/2017] [Indexed: 11/24/2022]
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129
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Brown WJ, Wilkerson AK, Boyd SJ, Dewey D, Mesa F, Bunnell BE. A review of sleep disturbance in children and adolescents with anxiety. J Sleep Res 2017; 27:e12635. [DOI: 10.1111/jsr.12635] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Wilson J. Brown
- Pennsylvania State University; The Behrend College; Erie PA USA
| | | | | | - Daniel Dewey
- Medical University of South Carolina; Charleston SC USA
- Ralph H. Johnson VA Medical Center; Charleston SC USA
| | | | - Brian E. Bunnell
- Medical University of South Carolina; Charleston SC USA
- Ralph H. Johnson VA Medical Center; Charleston SC USA
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130
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Mullin BC, Simon SL. Managing Insomnia Symptoms Among Adolescents With Anxiety Disorders. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23794925.2017.1359704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Benjamin C. Mullin
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stacey L. Simon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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131
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Blake M, Schwartz O, Waloszek JM, Raniti M, Simmons JG, Murray G, Blake L, Dahl RE, Bootzin R, McMakin DL, Dudgeon P, Trinder J, Allen NB. The SENSE Study: Treatment Mechanisms of a Cognitive Behavioral and Mindfulness-Based Group Sleep Improvement Intervention for At-Risk Adolescents. Sleep 2017; 40:3738768. [DOI: 10.1093/sleep/zsx061] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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132
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Systematic Review and Meta-analysis of Adolescent Cognitive–Behavioral Sleep Interventions. Clin Child Fam Psychol Rev 2017; 20:227-249. [DOI: 10.1007/s10567-017-0234-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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133
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Wallace ML, McMakin DL, Tan PZ, Rosen D, Forbes EE, Ladouceur CD, Ryan ND, Siegle GJ, Dahl RE, Kendall PC, Mannarino A, Silk JS. The role of day-to-day emotions, sleep, and social interactions in pediatric anxiety treatment. Behav Res Ther 2016; 90:87-95. [PMID: 28013054 DOI: 10.1016/j.brat.2016.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 11/22/2016] [Accepted: 12/16/2016] [Indexed: 01/23/2023]
Abstract
Do day-to-day emotions, social interactions, and sleep play a role in determining which anxious youth respond to supportive child-centered therapy (CCT) versus cognitive behavioral therapy (CBT)? We explored whether measures of day-to-day functioning (captured through ecological momentary assessment, sleep diary, and actigraphy), along with clinical and demographic measures, were predictors or moderators of treatment outcome in 114 anxious youth randomized to CCT or CBT. We statistically combined individual moderators into a single, optimal composite moderator to characterize subgroups for which CCT or CBT may be preferable. The strongest predictors of better outcome included: (a) experiencing higher positive affect when with one's mother and (b) fewer self-reported problems with sleep duration. The composite moderator indicated that youth for whom CBT was indicated had: (a) more day-to-day sleep problems related to sleep quality, efficiency, and waking, (b) day-to-day negative events related to interpersonal concerns, (c) more DSM-IV anxiety diagnoses, and (d) college-educated parents. These findings illustrate the value of both day-to-day functioning characteristics and more traditional sociodemographic and clinical characteristics in identifying optimal anxiety treatment assignment. Future studies will need to enhance the practicality of real-time measures for use in clinical decision making and evaluate additional anxiety treatments.
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Affiliation(s)
- Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA; Department of Statistics, University of Pittsburgh, 230 South Bouquet Street, Pittsburgh, PA 15260, USA.
| | - Dana L McMakin
- Department of Psychology, Florida International University, 11200 S. W. 8th Street, Miami, FL 33199, USA.
| | - Patricia Z Tan
- Department of Psychiatry, University of California, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Dana Rosen
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA 15260, USA.
| | - Erika E Forbes
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA.
| | - Cecile D Ladouceur
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA.
| | - Neal D Ryan
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA.
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA.
| | - Ronald E Dahl
- School of Public Health, University of California, 50 University Hall, Berkeley, CA 94720, USA.
| | - Philip C Kendall
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA.
| | - Anthony Mannarino
- Allegheny General Hospital, Four Allegheny Center, Pittsburgh, PA 15212, USA.
| | - Jennifer S Silk
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA 15260, USA.
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134
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Palmer CA, Alfano CA. Sleep Architecture Relates to Daytime Affect and Somatic Complaints in Clinically Anxious but Not Healthy Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:175-187. [PMID: 27610927 DOI: 10.1080/15374416.2016.1188704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It is increasingly clear that seminal sleep-affective relationships begin to take root in childhood, yet studies exploring how nighttime sleep characteristics relate to daytime affective symptoms, both in clinical and healthy populations of children, are lacking. The current study sought to explore these relationships by investigating whether trait-like and/or daily reports of affective and somatic symptoms of children with generalized anxiety disorder and matched controls relate to sleep architecture. Sixty-six children (ages 7-11; 54.4% female; 56.1% Caucasian; 18.2% biracial; 6.1% African American; 3% Asian; 16.7% Hispanic) participated including 29 with primary generalized anxiety disorder (without comorbid depression) and 37 healthy controls matched on age and race/ethnicity. Participants underwent structured diagnostic assessments including child-report measures and subsequently reported on their negative affect and somatic symptoms over the course of 1 week. Children also completed 1 night of polysomnography. Among children with generalized anxiety disorder only, greater amounts of slow wave sleep corresponded with less negative affect, and greater amounts of rapid eye movement sleep was related to more somatic complaints across the week. Similarly, for trait-like measures, more rapid eye movement sleep and shorter latency to rapid eye movement sleep were related to greater depressive symptoms in the anxious group only. The current findings suggest that physiologic sleep characteristics may contribute in direct ways to the symptom profiles of clinically anxious children. The functional relevance of such findings (e.g., how specific sleep characteristics serve to either increase or reduce long-term risk) is a vital direction for future research.
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Affiliation(s)
- Cara A Palmer
- a Sleep and Anxiety Center of Houston , University of Houston
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