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Barron-Linnankoski STA, Raaska HK, Reiterä PH, Laasonen MR, Elovainio MJ. Hair cortisol and psychiatric symptomatology in children; outcomes of group CBT. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2024; 20:100263. [PMID: 39328425 PMCID: PMC11425118 DOI: 10.1016/j.cpnec.2024.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 08/30/2024] [Indexed: 09/28/2024] Open
Abstract
The associations between hair cortisol concentration (HCC), a biomarker of chronic stress, and behavior and sleep disturbance symptoms have not been studied in children with psychiatric disorders. While cognitive behavioral therapy (CBT) has proven effective in treating psychiatric symptoms in children, its potential biological implications as determined by HCC have not been investigated. We explored associations between HCC, behavior and sleep disturbance symptoms, and different diagnostic groupings (depression/anxiety, ADHD, or other types of psychiatric disorders) in clinician-diagnosed 6-12-year-old children (n = 100) with mixed psychiatric disorders and comorbidities. In addition, we examined whether group CBT led to changes in HCC, behavior symptoms, and sleep disturbance symptoms and whether any fluctuations in HCC levels were associated with potential symptom change. We collected data on HCC, internalizing and externalizing symptoms (The Spence Children's Anxiety Self-Report, Child Behavior Checklist, and Teacher Report Form), and sleep disturbance symptoms (The Sleep Disturbance Scale for Children) at three time points (baseline, post-treatment, and seven-month follow-up). Baseline HCC was not associated with behavior or sleep disturbance symptoms, whereas behavior and sleep disturbance symptoms were mutually correlated. No changes in HCC levels were observed with group CBT. Moreover, potential variations in HCC levels over the course of the study did not appear to be associated with behavior symptom relief after group CBT. Our findings suggest that HCC may not be a methodologically relevant biomarker of behavior or sleep disturbance symptoms in children with diverse psychiatric disorders.
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Affiliation(s)
- Sarianna T A Barron-Linnankoski
- Child Psychiatry, Children and Adolescents, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna K Raaska
- Child Psychiatry, Children and Adolescents, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- The Social Insurance Institution of Finland, Helsinki, Finland
| | - Paula H Reiterä
- Biostatistics Consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja R Laasonen
- Logopedics, School of Humanities, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Marko J Elovainio
- Department of Psychology/ Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- The Finnish Institute for Health and Welfare, Helsinki, Finland
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2
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Saletin JM, Koopman-Verhoeff ME, Han G, Barker DH, Carskadon MA, Anders TF, Sheinkopf SJ. Sleep Problems and Autism Impairments in a Large Community Sample of Children and Adolescents. Child Psychiatry Hum Dev 2024; 55:1167-1175. [PMID: 36515855 DOI: 10.1007/s10578-022-01470-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 12/15/2022]
Abstract
Sleep problems are common in individuals with autism spectrum disorder (ASD). How sleep problems reflect specific ASD phenotypes is unclear. We studied whether sleep problems indexed functional impairment in a heterogeneous community sample of individuals with ASD. We analyzed 977 probands (233 females; age = 11.27 ± 4.13 years) from the Rhode Island Consortium for Autism Research and Treatment dataset, a unique public-private-academic collaboration involving all major points of service for families in Rhode Island. We found that individuals with a confirmed diagnosis of ASD were more likely to have sleep problems. However, across the whole sample and above and beyond a formal diagnosis, sleep problems were dimensionally associated with worse social impairment and poorer adaptive functioning. By using a large dataset reflective of the diversity of presentations in the community, this study underscores the importance of considering sleep problems in clinical practice to improve adaptive functioning in individuals with ASD.
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Affiliation(s)
- Jared M Saletin
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
- Emma Pendleton Bradley Hospital, East Providence, RI, USA.
- Sleep Research Laboratory, Emma Pendleton Bradley Hospital, Providence, RI, USA.
| | - M Elisabeth Koopman-Verhoeff
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
- Sleep Research Laboratory, Emma Pendleton Bradley Hospital, Providence, RI, USA
| | - Gloria Han
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Anesthesiology, Vanderbilt Medical Center, Nashville, TN, USA
| | - David H Barker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- The Bradley Hasbro Children's Research Center, Providence, RI, USA
| | - Mary A Carskadon
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
- Sleep Research Laboratory, Emma Pendleton Bradley Hospital, Providence, RI, USA
| | - Thomas F Anders
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Stephen J Sheinkopf
- Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, RI, USA
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, USA
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3
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Crowe K, Spiro-Levitt C. Sleep-Related Problems and Pediatric Anxiety Disorders. Psychiatr Clin North Am 2024; 47:213-228. [PMID: 38302208 DOI: 10.1016/j.psc.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sleep-related problems are highly prevalent among childhood and adolescent anxiety disorders. The objective of this review was to summarize the relevant clinical research literature as it pertains to the nature of the association between sleep-related problems and youth anxiety, developmental factors relevant to this association, and intervention efforts to target comorbid sleep challenges and anxiety. Limitations of the literature and future directions are discussed.
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Affiliation(s)
- Katherine Crowe
- Home for Anxiety, Repetitive Behaviors, OCD, and Related Disorders (HARBOR), 1518 Walnut Street, Suite 1506, Philadelphia, PA 19102, USA.
| | - Carolyn Spiro-Levitt
- Department of Child and Adolescent Psychiatry at Hassenfeld Children's Hospital at New York University (NYU) Langone, 1 Park Avenue, Seventh Floor, New York, NY 10016, USA
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de Lacy N, Ramshaw MJ. Selectively predicting the onset of ADHD, oppositional defiant disorder, and conduct disorder in early adolescence with high accuracy. Front Psychiatry 2023; 14:1280326. [PMID: 38144472 PMCID: PMC10739523 DOI: 10.3389/fpsyt.2023.1280326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/13/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction The externalizing disorders of attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are common in adolescence and are strong predictors of adult psychopathology. While treatable, substantial diagnostic overlap complicates intervention planning. Understanding which factors predict the onset of each disorder and disambiguating their different predictors is of substantial translational interest. Materials and methods We analyzed 5,777 multimodal candidate predictors from children aged 9-10 years and their parents in the ABCD cohort to predict the future onset of ADHD, ODD, and CD at 2-year follow-up. We used deep learning optimized with an innovative AI algorithm to jointly optimize model training, perform automated feature selection, and construct individual-level predictions of illness onset and all prevailing cases at 11-12 years and examined relative predictive performance when candidate predictors were restricted to only neural metrics. Results Multimodal models achieved ~86-97% accuracy, 0.919-0.996 AUROC, and ~82-97% precision and recall in testing in held-out, unseen data. In neural-only models, predictive performance dropped substantially but nonetheless achieved accuracy and AUROC of ~80%. Parent aggressive and externalizing traits uniquely differentiated the onset of ODD, while structural MRI metrics in the limbic system were specific to CD. Psychosocial measures of sleep disorders, parent mental health and behavioral traits, and school performance proved valuable across all disorders. In neural-only models, structural and functional MRI metrics in subcortical regions and cortical-subcortical connectivity were emphasized. Overall, we identified a strong correlation between accuracy and final predictor importance. Conclusion Deep learning optimized with AI can generate highly accurate individual-level predictions of the onset of early adolescent externalizing disorders using multimodal features. While externalizing disorders are frequently co-morbid in adolescents, certain predictors were specific to the onset of ODD or CD vs. ADHD. To our knowledge, this is the first machine learning study to predict the onset of all three major adolescent externalizing disorders with the same design and participant cohort to enable direct comparisons, analyze >200 multimodal features, and include many types of neuroimaging metrics. Future study to test our observations in external validation data will help further test the generalizability of these findings.
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Affiliation(s)
- Nina de Lacy
- Huntsman Mental Health Institute, Salt Lake City, UT, United States
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
| | - Michael J. Ramshaw
- Huntsman Mental Health Institute, Salt Lake City, UT, United States
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
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5
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Clementi MA, Kienzler C, Yonker M, Harmon M, Simon SL. Preliminary exploration of a multidimensional sleep health composite in adolescent females with frequent migraine. Headache 2023; 63:1437-1447. [PMID: 37655667 PMCID: PMC10840896 DOI: 10.1111/head.14626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE This observational study aimed to: (i) describe and explore preliminary psychometric properties of a multidimensional sleep health composite score in adolescent females with frequent migraine; and (ii) examine associations between the composite score, headache characteristics, and emotional health. BACKGROUND Sleep health is a multidimensional construct comprised of various dimensions of sleep and circadian functioning, including Regularity, Satisfaction, Alertness, Timing, Efficiency, and Duration (Ru-SATED framework). The Ru-SATED sleep health composite score may provide a holistic perspective of sleep among adolescents with frequent migraine in the context of neurobiological and psychosocial impacts on sleep unique to this developmental period. METHODS In all, 60 female adolescents (aged 12-18 years) with high-frequency episodic or chronic migraine completed wrist-worn actigraphy for 10 days and concurrent daily electronic surveys assessing headache, sleep, and emotional health. A sleep health composite score was derived from empirically supported "healthy" versus "unhealthy" ratings on the six Ru-SATED sleep dimensions. RESULTS Half of participants (27/54 [50%]) had a composite score ≥4 (i.e., at least four of the six dimensions rated as poor). Convergent validity of the composite score was acceptable (rs = 0.30-0.56, all p < 0.05). Internal consistency among the dimensions was low (α = 0.45). Multivariate multiple regression models indicated that worse sleep health was associated with greater headache-related disability (B = 0.71, p = 0.018) and anxiety (B = 0.59, p = 0.010), and trended toward significance for sadness (B = 0.35, p = 0.052). The composite score was not significantly associated with headache frequency or severity. CONCLUSIONS A multidimensional sleep health composite score may provide an alternative, more comprehensive picture of sleep disturbance among adolescent females with frequent migraine. Larger studies are needed to examine psychometric properties more rigorously and further explore the composite score as a potentially unique predictor of headache outcomes.
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Affiliation(s)
- Michelle A Clementi
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Caitlin Kienzler
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA
| | - Marcy Yonker
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michelle Harmon
- Department of Psychology, University of Colorado Denver, Denver, Colorado, USA
| | - Stacey L Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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6
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Levenson JC, Williamson AA. Bridging the gap: leveraging implementation science to advance pediatric behavioral sleep interventions. J Clin Sleep Med 2023; 19:1321-1336. [PMID: 36722616 PMCID: PMC10315605 DOI: 10.5664/jcsm.10476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVES This review synthesizes the pediatric behavioral sleep intervention (BSI) evidence base, summarizes challenges in translating BSIs from research to practice, and provides recommendations for integrating implementation science methods to advance pediatric BSI research. METHODS We briefly review the common behavioral sleep disturbances among youth, discuss the pediatric BSIs with well-established evidence, and identify gaps in pediatric BSI research. We then identify contributors to the dearth of research evaluating pediatric BSIs in accessible settings and present a model for applying implementation science strategies to address identified gaps across the continuum of translational research. RESULTS Relatively few BSI trials include older children and adolescents. Similarly, there is limited research evaluating BSIs among racially and ethnically minoritized children and families and/or those of lower socioeconomic status backgrounds. Access to scalable and easily disseminable tools to treat pediatric sleep disturbances early in their development is crucial for promoting positive child outcomes. To address these gaps, researchers should apply implementation science theories, models, and frameworks to design new interventions for implementation, adapt existing interventions with end users and settings in mind, conduct hybrid effectiveness-implementation trials, and test implementation strategies. CONCLUSIONS Given the prevalence and consequences of poor sleep across developmental periods, pediatric BSIs must be effective as well as adaptable, scalable, and easily disseminable. Implementation science theories, models, and frameworks can enhance access to, engagement in, and the implementation and dissemination of scalable BSIs across diverse pediatric care settings and heterogeneous populations. CITATION Levenson JC, Williamson AA. Bridging the gap: leveraging implementation science to advance pediatric behavioral sleep interventions. J Clin Sleep Med. 2023;19(7):1321-1336.
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Affiliation(s)
- Jessica C. Levenson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ariel A. Williamson
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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7
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Sollenberger NA, Sequeira S, Forbes EE, Siegle GJ, Silk JS, Ladouceur CD, Ryan ND, Dahl RE, Mattfeld AT, McMakin DL. More time awake after sleep onset is linked to reduced ventral striatum response to rewards in youth with anxiety. J Child Psychol Psychiatry 2023; 64:83-90. [PMID: 35817759 PMCID: PMC9771920 DOI: 10.1111/jcpp.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Poor sleep and anxiety disorders are highly comorbid in youth, and each predicts altered ventral striatum (VS) response to rewards, which may impact mental health risk. Contrasting evidence suggests previously reported negative associations between sleep health and VS response may be stronger or weaker in youth with anxiety, indicating sensitivity to win/loss information or blunted reward processing, respectively. We cross-sectionally examined the role of sleep in VS response to rewards among youth with anxiety versus a no-psychiatric-diagnosis comparison (ND) group. We expected a group*sleep interaction on VS response to rewards but did not hypothesize directionality. METHODS As part of the pretreatment battery for a randomized clinical trial, 74 youth with anxiety and 31 ND youth (ages 9-14 years; n = 55 female) completed a monetary reward task during fMRI. During the same pretreatment window, actigraphy and diary-estimated sleep were collected over 5 days, and participants and their parents each reported participants' total sleep problems. We examined group*sleep interactions on VS response to monetary rewards versus losses via three mixed linear models corresponding to actigraphy, diary, and questionnaires, respectively. RESULTS Each model indicated group*sleep interactions on VS response to rewards. Actigraphy and diary-estimated time awake after sleep onset predicted reduced VS response in youth with anxiety but not ND youth. Parent-reported sleep problems similarly interacted with group, but simple slopes were nonsignificant. CONCLUSIONS Wake after sleep onset was associated with blunted reward response in youth with anxiety. These data suggest a potential pathway through which sleep could contribute to perturbed reward function and reward-related psychopathology (e.g., depression) in youth with anxiety.
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Affiliation(s)
- Nathan A. Sollenberger
- Psychology Department, Florida International University, Miami, Florida
- Center for Children and Families, Florida International University, Miami, Florida
| | | | | | | | | | | | - Neal D. Ryan
- Department of Psychiatry, University of Pittsburgh, PA
| | - Ronald E. Dahl
- School of Public Health, University of California, Berkeley, CA
| | - Aaron T. Mattfeld
- Psychology Department, Florida International University, Miami, Florida
- Center for Children and Families, Florida International University, Miami, Florida
| | - Dana L. McMakin
- Psychology Department, Florida International University, Miami, Florida
- Center for Children and Families, Florida International University, Miami, Florida
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8
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Tan WJ, Ng MSL, Poon SH, Lee TS. Treatment Implications of Sleep-Related Problems in Pediatric Anxiety Disorders: A Narrative Review of the Literature. Child Psychiatry Hum Dev 2021; 54:659-664. [PMID: 34724133 DOI: 10.1007/s10578-021-01277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
Pediatric anxiety disorders and sleep-related problems (SRPs) are highly prevalent and are associated with serious health or psychopathological consequences. This narrative review aims to provide an overview of the current evidence of the associations between anxiety disorders and SRPs, to examine how this relationship may affect treatment, and to evaluate future directions for the field. Despite their strong bi-directional relationship, SRPs are often neglected in pediatric anxiety literature. There is little consensus on the conceptualization and related measurements of SRPs, which has led to methodological limitations and difficulties. Furthermore, available research suggests that anxiety treatment alone may be inadequate as clinically impairing SRPs were still present post-treatment, which may, in turn, diminish effects of therapy. Understanding the implications of the relationship between anxiety and SRPs on treatment outcomes may be helpful in recognizing opportunities for high impact and enduring interventions.
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Affiliation(s)
- Wan Jie Tan
- Duke-NUS Medical School, Neuroscience and Behavioral Disorders Program, 8 College Rd, Singapore, 169857, Singapore.
| | - Melissa S L Ng
- Duke-NUS Medical School, Neuroscience and Behavioral Disorders Program, 8 College Rd, Singapore, 169857, Singapore
| | - Shi Hui Poon
- Duke-NUS Medical School, Neuroscience and Behavioral Disorders Program, 8 College Rd, Singapore, 169857, Singapore
| | - Tih Shih Lee
- Duke-NUS Medical School, Neuroscience and Behavioral Disorders Program, 8 College Rd, Singapore, 169857, Singapore
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9
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Bilsky SA, Luber MJ, Cloutier RM, Dietch JR, Taylor DJ, Friedman HP. Cigarette use, anxiety, and insomnia from adolescence to early adulthood: A longitudinal indirect effects test. Addict Behav 2021; 120:106981. [PMID: 33993036 DOI: 10.1016/j.addbeh.2021.106981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cigarette use during adolescence has been linked to increased risk for insomnia symptoms, but limited work has examined factors that may account for this association. Adolescent cigarette use and anxiety symptoms characterized by physiological hyperarousal evidence bidirectional associations, as do anxiety symptoms and insomnia symptoms. This suggests that adolescent cigarette use, anxiety symptoms characterized by physiological hyperarousal, and insomnia symptoms may increase and maintain one another. The current study tests physiological hyperarousal anxiety symptoms as a potential indirect effect in the cigarette-insomnia symptoms link across adolescence and young adulthood. METHODS We examined data from adolescents and young adults from Waves 1, 2, 3 and 4 of the National Longitudinal Study of Adolescent to Adult Health (N = 2,432 with full data). Insomnia symptoms were assessed at baseline (ages 12-16 years), 1 year later (13-17 years), and 14 years after baseline (26 - 30 years) among a nationally representative sample of adolescents. Cigarette use was assessed at baseline, 1 year later, 6 years after baseline, and 14 years after baseline. Anxiety symptoms were assessed at baseline and 1 year later. RESULTS Structural equation models indicated that anxiety symptoms exerted an indirect effect on the longitudinal associations between adolescent cigarette use and adult insomnia symptoms. Anxiety symptoms and cigarette use evidenced bidirectional associations during adolescence. CONCLUSIONS These results suggest that increases in anxiety symptoms characterized by physiological hyperarousal may be one mechanism whereby cigarette use during adolescence is associated with increased insomnia symptoms during early adulthood. Prevention efforts aimed at reducing cigarette use during adolescence may have long term additional benefits for anxiety symptoms and insomnia symptoms.
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10
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Lewis KM, Rafihi-Ferreira RE, Freitag GF, Coffman M, Ollendick TH. A 25-Year Review of Nighttime Fears in Children: Past, Present, and Future. Clin Child Fam Psychol Rev 2021; 24:391-413. [PMID: 34125354 DOI: 10.1007/s10567-021-00354-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Nighttime fears in children are common, interfere with daily functioning, and result in considerable disruption in the family. The aim of the present review was to examine empirical literature from the past 25 years that investigated the assessment of nighttime fears in young children and the efficacy and effectiveness of psychosocial treatments for children's nighttime fears. The last review of this literature was in 1997 and examined studies conducted in and prior to 1995 (King et al. in Clin Psychol Rev 17:431-443, 1997). Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review of the literature aimed at providing a synthesis of the Randomized Control Trials (RCTs) and controlled single-case multiple baseline design studies (MBLs) on the treatment of nighttime fears in children. A search of the literature identified 12 articles, with nine studies utilizing a between-group randomized controlled trial design and three studies utilizing a multiple baseline design. Results demonstrated significant improvements in children's nighttime fears and reductions in disruptive nighttime behaviors using behavioral interventions and cognitive-behavioral strategies. This review provides a commentary on the effectiveness and limitations of the assessment and treatment approaches for nighttime fears in children and suggests directions for future research.
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Affiliation(s)
- Krystal M Lewis
- National Institute of Mental Health, 9000 Rockville Pike, 10 Center Drive, Bldg.10 RM B1D43S, Bethesda, MD, 20814, USA.
| | - Renatha El Rafihi-Ferreira
- Institute of Psychiatry, Hospital da Clinicas - Faculty of Medicine, University of Sao Paulo, 785 Ovídio Pires de Campos, São Paulo, SP, 05403903, Brazil
| | - Gabrielle F Freitag
- Department of Psychology, Center for Children and Families, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | | | - Thomas H Ollendick
- Department of Psychology, Child Study Center, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24060, USA
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Williamson AA, Zendarski N, Lange K, Quach J, Molloy C, Clifford SA, Mulraney M. Sleep problems, internalizing and externalizing symptoms, and domains of health-related quality of life: bidirectional associations from early childhood to early adolescence. Sleep 2021; 44:5874179. [PMID: 32691073 DOI: 10.1093/sleep/zsaa139] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/15/2020] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES To examine longitudinal, bidirectional associations among behavioral sleep problems, internalizing and externalizing symptoms, and domains of health-related quality of life (HRQoL) from early childhood to adolescence in a population sample of Australian children. METHOD Data were drawn from the Longitudinal Study of Australian Children, a national prospective cohort study with 4983 children participating in the Kindergarten cohort. Data were collected when children were aged 4-5, 6-7, 8-9, 10-11, and 12-13 years. At each study wave, the primary parent (97% mothers) reported on behavioral child sleep problems, internalizing and externalizing symptoms, and HRQoL domains (psychosocial and physical). Cross-lagged structural equation models were used to evaluate bidirectional associations. RESULTS At nearly every age, behavioral sleep problems were associated with worse subsequent psychosocial and physical HRQoL. Despite bidirectional associations between mental health and HRQoL at many waves, HRQoL domains more strongly predicted later internalizing symptoms, while externalizing symptoms more strongly predicted later HRQoL. Many of the bidirectional associations among sleep, mental health, and HRQoL were found earlier in childhood. CONCLUSIONS Behavioral sleep problems may forecast later HRQoL psychosocial and physical impairments. Attending to both sleep problems and HRQoL could prevent the progression of internalizing conditions, while a focus on externalizing concerns could prevent the worsening of these symptoms, sleep problems, and HRQoL, particularly during the transition to school.
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Affiliation(s)
- Ariel A Williamson
- Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nardia Zendarski
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Katherine Lange
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Jon Quach
- Melbourne Graduate School of Education, University of Melbourne, Carlton, Victoria, Australia
| | - Carly Molloy
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Susan A Clifford
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Melissa Mulraney
- Population Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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12
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Kathrin B, Michael A H, Ines W, Kerstin H. The relation between sigma power and internalizing problems across development. J Psychiatr Res 2021; 135:302-310. [PMID: 33524677 DOI: 10.1016/j.jpsychires.2021.01.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/15/2021] [Accepted: 01/18/2021] [Indexed: 11/30/2022]
Abstract
Internalizing problems are characterized by deficits in emotion processing and regulation. They are among the most common problems in children and adolescents and mark an increased risk for depressive and anxiety disorders in later life. First evidence suggests that sleep alterations are related to the development and/or persistence of mood and anxiety disorders in children, adolescents, and adults. Most recently, data from clinical samples showed that brain activity in the sigma frequency band (9-16 Hz, i.e. sleep spindle frequency) is associated with internalizing problems in children and adolescents. However, less is known about the association between sigma power and internalizing problems in healthy participants within this age group. Here, we re-analyzed longitudinal data (25 healthy subjects (18 females) at two time points (T1: childhood mean age: 9.52 ± 0.77; T2: adolescence mean age: 16.08 ± 0.91) by correlating sigma power with measures for internalizing problems. Moreover, we calculated sigma power ratios (frontal/central, frontal/parietal, frontal/occipital) to examine whether these measures would reflect developmental changes more accurately. We found that higher values of internalizing problems at T1 were related to a lower decrease in sigma power from T1 to T2 at frontal and central derivations. Furthermore, higher values of internalizing problems at T1 as well as at T2 were related to higher sigma power ratios at T2. We suggest that sigma power may reflect maturational processes (e.g. network efficiency, integrity) related to the development of internalizing problems. In particular, a stronger decrease in frontal sigma power from childhood to adolescence may indicate a healthier development. Thus, our results emphasize the role of sigma power as a useful marker for internalizing problems during adolescence.
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Affiliation(s)
- Bothe Kathrin
- Laboratory for Sleep, Cognition and Consciousness Research, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
| | - Hahn Michael A
- Laboratory for Sleep, Cognition and Consciousness Research, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
| | - Wilhelm Ines
- Translational Psychiatry Unit (TPU), Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.
| | - Hoedlmoser Kerstin
- Laboratory for Sleep, Cognition and Consciousness Research, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria.
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13
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Abstract
Sleep-related problems are highly prevalent among childhood and adolescent anxiety disorders. The objective of this review was to summarize the relevant clinical research literature as it pertains to the nature of the association between sleep-related problems and youth anxiety, developmental factors relevant to this association, and intervention efforts to target comorbid sleep challenges and anxiety. Limitations of the literature and future directions are discussed.
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Affiliation(s)
- Katherine Crowe
- Home for Anxiety, Repetitive Behaviors, OCD, and Related Disorders (HARBOR), 1518 Walnut Street, Suite 1506, Philadelphia, PA 19102, USA.
| | - Carolyn Spiro-Levitt
- Department of Child and Adolescent Psychiatry at Hassenfeld Children's Hospital at New York University (NYU) Langone, 1 Park Avenue, Seventh Floor, New York, NY 10016, USA
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14
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Williamson AA, Mindell JA, Hiscock H, Quach J. Longitudinal sleep problem trajectories are associated with multiple impairments in child well-being. J Child Psychol Psychiatry 2020; 61:1092-1103. [PMID: 32713013 PMCID: PMC7530051 DOI: 10.1111/jcpp.13303] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study examined whether distinct sleep problem trajectories from infancy through middle childhood were associated with multiple aspects of child well-being at ages 10-11 years. METHODS Data were from the first six waves of the Longitudinal Study of Australian Children - Birth Cohort (5,107 children recruited at birth). Caregivers reported on child sleep problems at each time point. A combination of caregiver-reported, teacher-reported and child-completed tasks were used to index child well-being outcomes at ages 10-11 years including emotional/behavioural functioning (internalizing and externalizing symptoms; self-control), health-related quality of life, cognitive skills and academic achievement. RESULTS Latent class analysis identified five distinct sleep problem trajectories over time: persistent sleep problems through middle childhood (7.7% of the sample), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%) and no sleep problems (51.9%). Compared to those with no sleep problems, children with persistent sleep problems had the greatest impairments across all outcomes except cognitive skills (perceptual reasoning), with moderate to large effect sizes. Children with increased middle childhood sleep problems similarly experienced greater internalizing and externalizing symptoms and worse quality of life, but few academic impairments. Both the limited infant/preschool sleep problems and mild increases over time trajectories also showed internalizing concerns and worse caregiver-reported quality of life, although effects were smaller than the other sleep trajectories. CONCLUSIONS The linkages between sleep problems and negative child outcomes across domains underscore the importance of early identification and targeted intervention to address sleep problems and promote child well-being.
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Affiliation(s)
- Ariel A. Williamson
- Division of Pulmonary Medicine, Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA;,Department of Child & Adolescent Psychiatry & Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA;,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jodi A. Mindell
- Division of Pulmonary Medicine, Sleep Center, Children’s Hospital of Philadelphia, Philadelphia, PA, USA;,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;,Department of Psychology, Saint Joseph’s University, Philadelphia, PA, USA
| | - Harriet Hiscock
- Health Services Research Unit, Royal Children’s Hospital, Melbourne, Vic., Australia;,Centre for Community Child Health, Murdoch Children’s Research Institute, Parkville, Vic., Australia;,Department of Pediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Jon Quach
- Melbourne Graduate School of Education, University of Melbourne, Carlton, Vic., Australia;,Policy, Equity and Translation, Murdoch Children’s Research Institute, Parkville, Vic., Australia
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15
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Alfano CA, Bower JL, Harvey AG, Beidel DC, Sharp C, Palmer CA. Sleep restriction alters children's positive emotional responses, but effects are moderated by anxiety. J Child Psychol Psychiatry 2020; 61:1150-1159. [PMID: 32621796 DOI: 10.1111/jcpp.13287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/22/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND An abundance of cross-sectional research links inadequate sleep with poor emotional health, but experimental studies in children are rare. Further, the impact of sleep loss is not uniform across individuals and pre-existing anxiety might potentiate the effects of poor sleep on children's emotional functioning. METHODS A sample of 53 children (7-11 years, M = 9.0; 56% female) completed multimodal, assessments in the laboratory when rested and after two nights of sleep restriction (7 and 6 hr in bed, respectively). Sleep was monitored with polysomnography and actigraphy. Subjective reports of affect and arousal, psychophysiological reactivity and regulation, and objective emotional expression were examined during two emotional processing tasks, including one where children were asked to suppress their emotional responses. RESULTS After sleep restriction, deleterious alterations were observed in children's affect, emotional arousal, facial expressions, and emotion regulation. These effects were primarily detected in response to positive emotional stimuli. The presence of anxiety symptoms moderated most alterations in emotional processing observed after sleep restriction. CONCLUSIONS Results suggest inadequate sleep preferentially impacts positive compared to negative emotion in prepubertal children and that pre-existing anxiety symptoms amplify these effects. Implications for children's everyday socioemotional lives and long-term affective risk are highlighted.
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Affiliation(s)
- Candice A Alfano
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Joanne L Bower
- Department of Psychology, University of East Anglia, Norwich, UK
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Deborah C Beidel
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Cara A Palmer
- Department of Psychology, Montana State University, Bozeman, MT, USA
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16
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Newton AT, Honaker SM, Reid GJ. Risk and protective factors and processes for behavioral sleep problems among preschool and early school-aged children: A systematic review. Sleep Med Rev 2020; 52:101303. [DOI: 10.1016/j.smrv.2020.101303] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022]
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17
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Yip T, Cham H, Wang Y, El-Sheikh M. Discrimination and Sleep Mediate Ethnic/Racial Identity and Adolescent Adjustment: Uncovering Change Processes With Slope-as-Mediator Mediation. Child Dev 2020; 91:1021-1043. [PMID: 31317537 PMCID: PMC6980173 DOI: 10.1111/cdev.13276] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study employs slope-as-mediator techniques to explore how the daily association between ethnic/racial discrimination and sleep disturbances serves as an intermediary link between ethnic/racial identity (ERI) and psychological adjustment. In a diverse sample of 264 adolescents (Mage = 14.3 years old, 70% female, 76% United States born, 25% African American, 32% Asian American, 43% Latinx), discrimination was associated with sleep disturbance. Furthermore, ERI commitment buffered the impact of discrimination on sleep, whereas ERI exploration exacerbated the impact of discrimination. Finally, the daily level association between discrimination and sleep (i.e., daily slope) mediated the association between ERI and adolescent adjustment. Substantive links between discrimination and sleep are discussed as well as broader applications of slope-as-mediator techniques.
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18
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Meers J, Ferri R, Bruni O, Alfano CA. Sleep spindle density is associated with worry in children with generalized anxiety disorder and healthy controls. J Affect Disord 2020; 260:418-425. [PMID: 31539675 PMCID: PMC6880871 DOI: 10.1016/j.jad.2019.09.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Childhood generalized anxiety disorder (GAD), characterized by uncontrollable worry, is associated with long-term psychopathology risk, yet understanding of developmental trajectories is limited. Despite common complaints about sleep, 'macro' sleep abnormalities have not been identified. Emerging findings suggest micro-architectural features of sleep, including sleep spindles, differentiate various psychiatric populations. The current study investigated sleep spindle density during non-rapid eye movement (NREM) sleep among youth with GAD and healthy controls, including relationships with anxiety, worry, global functioning, and subjective sleep quality. METHODS 58 pre-pubertal children, n = 26 with GAD and n = 32 matched healthy controls, aged 7-11 years (M = 8.86, SD=1.47), completed diagnostic assessments and a week of actigraphy monitoring prior to a night of polysomnography (PSG) either at home or in a sleep laboratory. NREM spindle activity was detected in frontal and central regions. RESULTS Sleep spindle activity did not differ based on diagnostic group or sex. Sleep spindles were unassociated with anxiety and sleep quality but showed a significant positive association with worry in all youth. Among youth with GAD, global functioning was negatively associated with spindle density in frontal regions during NREM stage 3. Spindle density was significantly greater during in-lab compared to at-home PSG. LIMITATIONS The small sample size and reliance on only one night of PSG necessitate additional studies. CONCLUSIONS The identified link between spindle activity and worry in pre-pubertal children highlights a need for investigations on transdiagnostic features of child psychopathology rather than specific disorders. Longitudinal studies are needed to explore spindle characteristics and affective risk across development.
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Affiliation(s)
| | | | - Oliviero Bruni
- Sapienza University of Rome, Department of Developmental and Social Psychology
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19
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Higson-Sweeney N, Loades ME, Hiller R, Read R. Addressing sleep problems and fatigue within child and adolescent mental health services: A qualitative study. Clin Child Psychol Psychiatry 2020; 25:200-212. [PMID: 30957529 PMCID: PMC7100015 DOI: 10.1177/1359104519838573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both fatigue and sleep difficulties are common symptoms of mental health presentations such as depression and anxiety. Despite this, little is known about how psychologists in Child and Adolescent Mental Health Services (CAMHS) assess and treat these common symptoms. METHOD Qualitative interviews with nine psychologists working in CAMHS analysed using thematic analysis. RESULTS Fatigue and sleep problems do not tend to be the focus of assessment because they are seen to be part of other presentations and not accorded priority. Psychologists struggled to differentiate fatigue from sleep problems, with greater clarity about sleep problems, which appear to be more routinely assessed. A number of barriers to addressing fatigue and sleep problems were identified, including lack of motivation from young people to make behavioural changes to address fatigue and/or sleep difficulties. Psychologists wished for more training, access to information for young people and families and more service integration with paediatric physical health settings. CONCLUSION Sleep problems and fatigue may not be thoroughly assessed and addressed in CAMHS and are often conflated, with the focus on enquiring about sleep, not fatigue. Further research is required to elucidate whether the themes identified are more pervasive. Potential interventions include training and information provision.
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Affiliation(s)
| | - Maria Elizabeth Loades
- Department of Psychology, University of Bath, UK
- Bristol Medical School, University of Bristol, UK
| | | | - Rebecca Read
- Department of Psychology, University of Bath, UK
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20
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Bai S, Ricketts EJ, Thamrin H, Piacentini J, Albano AM, Compton SN, Ginsburg GS, Sakolsky D, Keeton CP, Kendall PC, Peris TS. Longitudinal Study of Sleep and Internalizing Problems in Youth Treated for Pediatric Anxiety Disorders. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:67-77. [PMID: 31506757 PMCID: PMC6925631 DOI: 10.1007/s10802-019-00582-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The current study examined prospective bidirectional links between dysregulated sleep, and anxiety and depression severity across 4 years, among youth with a history of anxiety disorder. Participants were 319 youth (age 11-26 years), who previously participated in a large multisite randomized controlled trial for the treatment of pediatric anxiety disorders, Child/Adolescent Anxiety Multimodal Study (CAMS), and subsequently enrolled in a naturalistic follow-up, Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), an average of 6.5 years later. They participated in four annual visits that included self-report items of dysregulated sleep and semi-structured multi-informant interviews of anxiety and depression. Dysregulated sleep was bidirectionally associated with clinician-rated anxiety and depression symptom severity across adolescence and young adulthood. However, these bidirectional relationships were attributable to youth mean levels of dysregulated sleep, and anxiety and depression severity over the 4 years. Elevations in dysregulated sleep at each visit, relative to mean levels, did not predict worse anxiety or depression severity 1 year later. Likewise visit-specific elevations in anxiety and depression severity, as opposed to average levels, did not predict higher levels of dysregulated sleep at the next visit. Having higher levels of dysregulated sleep or more severe internalizing problems across the four-year period, as opposed to reporting a relative increase in symptom severity at a particular visit, posed greater risk for poor mental health. Interventions should continue to assess and treat persistent sleep problems alongside anxiety and depression.
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Affiliation(s)
- Sunhye Bai
- Human Development and Family Studies, The Pennsylvania State University, 216 Health and Human Development, University Park, PA, 16802, USA.
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
| | - Emily J Ricketts
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Hardian Thamrin
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | | | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Courtney P Keeton
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tara S Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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21
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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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