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Carson M, Cicalese O, Bhandari E, Stefanovski D, Fiks AG, Mindell JA, Williamson AA. Discrepancies Between Caregiver Reported Early Childhood Sleep Problems and Clinician Documentation and Referral. Acad Pediatr 2023; 23:1234-1241. [PMID: 36764578 PMCID: PMC10409870 DOI: 10.1016/j.acap.2023.02.001] [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] [Received: 10/06/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE The American Academy of Pediatrics recommends routine sleep problem screenings during child well-visits. However, studies suggest a discrepancy between caregiver- and clinician-reported child sleep problems. The present study examines whether caregiver-reported child sleep problems (ie, habitual snoring, insomnia symptoms, poor sleep health) and clinician-documented child sleep problems and management are congruent. METHODS The sample included 170 caregiver-child dyads (child Mage = 3.3 years, range = 2-5 years; 56.5% girls; 64.1% Black, 20.0% non-Latinx White, and 4.1% Latinx; 86.5% maternal caregiver reporter). Caregivers' questionnaire-based reports of habitual snoring, insomnia symptoms, and sleep health behaviors (nighttime electronics, caffeine intake, insufficient sleep) were compared with clinician documentation in the electronic health record. RESULTS About 92.3% of children had at least 1 caregiver-reported sleep problem (66% insomnia symptoms, 64% electronics, 38% insufficient sleep, 21% caffeine, 17% snoring). In contrast, a substantially lower percent of children had a clinician documented sleep problem (20% overall; 10% insomnia symptoms, 7% electronics, 0% insufficient sleep, 3% caffeine, 4% snoring), sleep-related referral (1% overall; 0.6% Otolaryngology, 0.6% polysomnogram, 0% sleep clinic), or recommendation (12% overall; 8% insomnia symptoms, 4% electronics, 0% insufficient sleep, 1% caffeine). CONCLUSIONS There is a vast discrepancy between caregiver-reported child sleep problems and clinician-documented sleep problems and management, with a higher proportion of caregiver reports. To benefit overall child health and well-being, future research and quality improvement initiatives should focus on enhancing screening tools and educational opportunities to improve clinician documentation and enhance family conversations about early childhood sleep problems.
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Affiliation(s)
- Mikayla Carson
- Saint Joseph's University (M Carson and JA Mindell), Philadelphia, Pa
| | - Olivia Cicalese
- Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa
| | - Esha Bhandari
- Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa
| | - Darko Stefanovski
- Veterinary School of Medicine (D Stefanovski), University of Pennsylvania, Philadelphia, Pa
| | - Alexander G Fiks
- Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa; Perelman School of Medicine (AG Fiks, JA Mindell, and AA Williamson), University of Pennsylvania, Philadelphia, Pa
| | - Jodi A Mindell
- Saint Joseph's University (M Carson and JA Mindell), Philadelphia, Pa; Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa; Perelman School of Medicine (AG Fiks, JA Mindell, and AA Williamson), University of Pennsylvania, Philadelphia, Pa
| | - Ariel A Williamson
- Children's Hospital of Philadelphia (O Cicalese, AG Fiks, JA Mindell, E Bhandari, and AA Williamson), Philadelphia, Pa; Perelman School of Medicine (AG Fiks, JA Mindell, and AA Williamson), University of Pennsylvania, Philadelphia, Pa.
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McQuillan ME, Anderson A, Russo KD, Truss A, Honaker SM, Walsh KL. Pediatric behavioral sleep medicine in the era of telemedicine: psychology trainee perspectives. J Clin Sleep Med 2021; 17:1965-1967. [PMID: 33960292 DOI: 10.5664/jcsm.9376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The worldwide coronavirus pandemic in 2020 radically changed the landscape of psychology service provision and training, with rapid rollouts of telemedicine to promote safe access to care. In this perspective article, we share the experiences of 4 psychology trainees, all of whom worked as psychology interns or postdoctoral fellows in pediatric behavioral sleep medicine during the pandemic. With restricted in-person visits and upheaval of children's normative sleep and school schedules, we directly observed growth in both need for psychological care and opportunity to provide this care remotely. Here, we summarize the unique challenges and learning opportunities we faced when trying to learn and implement evidence-based assessment and treatment of child and adolescent sleep difficulties during the pandemic. CITATION McQuillan ME, Anderson A, Russo KD, Truss A, Honaker SM, Walsh KL. Pediatric behavioral sleep medicine in the era of telemedicine: psychology trainee perspectives. J Clin Sleep Med. 2021;17(9):1965-1967.
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Affiliation(s)
- Maureen E McQuillan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adrienne Anderson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Autumn Truss
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah M Honaker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kate Lyn Walsh
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Meltzer LJ, Williamson AA, Mindell JA. Pediatric sleep health: It matters, and so does how we define it. Sleep Med Rev 2021; 57:101425. [PMID: 33601324 DOI: 10.1016/j.smrv.2021.101425] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/16/2022]
Abstract
In 2014, Buysse published a novel definition of sleep health, raising awareness for the importance of this construct for individuals, populations, clinical care, and research. However, the original definition focused on adults, with the recommendation that it should be adapted for children and adolescents. As children live within a complex and dynamic system, and may not always have control over their own sleep, this theoretical review will examine and apply Buysse's five dimensions of sleep health within the context of pediatrics. In addition, using examples from the pediatric sleep literature we introduce a modified definition that takes into consideration the influence of the socio-ecological system within which children live, and the sleep-related behaviors that are critical in supporting or hindering sleep health. Finally, we discuss how the proposed theoretical framework, Peds B-SATED, can be applied to clinical practice, research, and training in the field of pediatric sleep.
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Affiliation(s)
| | - Ariel A Williamson
- Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Center for Sleep and Circadian Neurobiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jodi A Mindell
- Sleep Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Psychology, Saint Joseph's University, Philadelphia, PA, USA
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Sevecke JR, Meadows TJ. It Takes a Village: Multidisciplinary Approach to Screening and Prevention of Pediatric Sleep Issues. Med Sci (Basel) 2018; 6:E77. [PMID: 30223505 PMCID: PMC6163437 DOI: 10.3390/medsci6030077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 08/29/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022] Open
Abstract
Sleep is essential to human development. Poor sleep can have significant effects on cognition, learning and memory, physical and behavioral health, and social-emotional well-being. This paper highlights the prevalence of common pediatric sleep problems and posits that a multidisciplinary approach to the assessment and intervention of sleep problems is ideal. Primary care providers are often the first professionals to discuss sleep issues with youth and families. However, dentists, otolaryngologists, childcare providers, school personnel, and behavioral health providers have a vital role in screening and prevention, providing intervention, and monitoring the progress of daily functioning. The strengths of this approach include better provider-to-provider and provider-to-family communication, streamlined assessment and intervention, earlier identification of sleep issues with more efficient referral, and longer-term monitoring of progress and impact on daily functioning. Barriers to this approach include difficulty initiating and maintaining collaboration among providers, limited provider time to obtain the necessary patient permission to collaborate among all multidisciplinary providers, lack of financial support for consultation and collaboration outside of seeing patients face-to-face, geographic location, and limited resources within communities. Research investigating the utility of this model and the overall impact on pediatric patient sleep issues is warranted and strongly encouraged.
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Affiliation(s)
- Jessica R Sevecke
- Department of Psychiatry, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17821, USA.
| | - Tawnya J Meadows
- Department of Psychiatry, Geisinger Health System, 100 North Academy Avenue, Danville, PA 17821, USA.
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Mindell JA, Owens JA, Babcock D, Crabtree VM, Ingram D. Child Sleep Coaches: Current State and Future Directions. Clin Pediatr (Phila) 2017; 56:5-12. [PMID: 27872359 DOI: 10.1177/0009922816678977] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Given the genuine gaps in the availability of clinical sleep services for children, sleep coaching as a field has emerged and appears to be significantly increasing. Sleep coaches are typically individuals who provide individualized services, often via the Internet or phone, to families of infants and young children (and increasingly to older children, adolescents, and adults as well) with sleep problems. At this time, there is no universally accepted definition of sleep coach, nor are there clear guidelines regarding educational background, training requirements, scope of practice, or credentialing. To start to address the needs of families seeking the services of a sleep coach, educational materials were developed for parents and health care providers regarding issues to consider. Furthermore, there is a need going forward that (1) the designation sleep coach or consultant be clear and well defined, with a clear standard of care and scope of practice; (2) there is a standard core body of knowledge included in all training programs; (3) a certification process is developed for sleep coaches that is reputable and has recognizable and clear standards; and (4) that care for sleep problems in infants and young children are available to diverse populations, irrespective of socioeconomic status.
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Affiliation(s)
- Jodi A Mindell
- 1 Saint Joseph's University and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | | | | | - David Ingram
- 5 Children's Mercy Hospital, Kansas City, MO, USA
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Rubens SL, Patrick KE, Williamson AA, Moore M, Mindell JA. Individual and socio-demographic factors related to presenting problem and diagnostic impressions at a pediatric sleep clinic. Sleep Med 2016; 25:67-72. [DOI: 10.1016/j.sleep.2016.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/11/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
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Meltzer LJ, Avis KT, Biggs S, Reynolds AC, Crabtree VM, Bevans KB. The Children's Report of Sleep Patterns (CRSP): a self-report measure of sleep for school-aged children. J Clin Sleep Med 2013; 9:235-45. [PMID: 23493949 DOI: 10.5664/jcsm.2486] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES (1) Present preliminary psychometrics for the Children's Report of Sleep Patterns (CRSP), a three-module measure of Sleep Patterns, Sleep Hygiene, and Sleep Disturbance; and (2) explore whether the CRSP provides information about a child's sleep above and beyond parental report. METHODS A multi-method, multi-reporter approach was used to validate the CRSP with 456 children aged 8-12 years (inclusive). Participants were recruited from pediatricians' offices, sleep clinics/laboratories, children's hospitals, schools, and the general population. Participants completed measures of sleep habits, sleep hygiene, anxiety, and sleepiness, with actigraphy and polysomnography used to provide objective measures of child sleep. RESULTS The CRSP demonstrated good reliability and validity. Differences in sleep hygiene and sleep disturbances were found for children presenting to a sleep clinic/laboratory (vs. community population); for younger children (vs. older children); and for children who slept less than 8 hours or had a sleep onset later than 22:00 on actigraphy. Further, significant associations were found between the CRSP and child-reported anxiety or sleepiness. Notably, approximately 40% of parents were not aware of child reported difficulties with sleep onset latency, night wakings, or poor sleep quality. CONCLUSIONS The three modules of the CRSP can be used together or independently, providing a reliable and valid self-report measure of sleep patterns, sleep hygiene, and sleep disturbances for children ages 8-12 years. Children not only provide valid information about their sleep, but may provide information that would not be otherwise captured in both clinical and research settings if relying solely on parental report.
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Byars KC, Yeomans-Maldonado G, Noll JG. Parental functioning and pediatric sleep disturbance: An examination of factors associated with parenting stress in children clinically referred for evaluation of insomnia. Sleep Med 2011; 12:898-905. [DOI: 10.1016/j.sleep.2011.05.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 05/19/2011] [Accepted: 05/23/2011] [Indexed: 01/28/2023]
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Moore M. Bedtime problems and night wakings: treatment of behavioral insomnia of childhood. J Clin Psychol 2011; 66:1195-204. [PMID: 20865768 DOI: 10.1002/jclp.20731] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bedtime problems and frequent night wakings are common sleep problems in infants and toddlers, affecting 20 to 30% of young children. Such problems, categorized as behavioral insomnia of childhood (BIC), lead to insufficient sleep, which contributes to multiple domains of child dysfunction. Behavioral treatments of BIC, such as extinction and positive routines are introduced, and supporting evidence is reviewed. Critical factors in developing a successful treatment plan include conducting a detailed assessment, collaboratively developing a plan that starts where the family is, and providing support between sessions. A case of a 3-year-old girl with BIC illustrates how treatment helped her to develop healthy sleep habits and taught her to sleep independently via graduated and standard extinction.
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Affiliation(s)
- Melisa Moore
- Melisa Moore, Sleep Center, The Children's Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA 19104, USA.
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McCrae CS, Taylor DJ, Smith MT, Perlis ML. The future of behavioral sleep medicine: a report on the presentations given at the Ponte Vedra Behavioral Sleep Medicine Consensus Conference, March 27-29, 2009. Behav Sleep Med 2010; 8:74-89. [PMID: 20352544 DOI: 10.1080/15402001003622792] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A major goal of the Behavioral Sleep Medicine Consensus Conference held in Ponte Vedra, Florida on March 27 through 29, 2009 was to have 15 key opinion leaders provide the latest information on their areas of expertise. Those leaders represented the breadth of the behavioral sleep medicine field (pediatrics, adults, insomnia, PAP adherence, and circadian rhythm disorders) and included clinicians and researchers from a variety of settings (academia, private practice, the military, and primary care). The presentations highlighted the milestones already achieved by the field (critical mass, solid empirical base, 30+ training programs, certification, dedicated journal, and dedicated textbook), as well as important future directions (more clinical research, public relations campaigns, training, and reimbursement).
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Affiliation(s)
- Christina S McCrae
- Department of Clinical and Health Psychology, University of Florida, 101 S. Newell Drive, Gainesville, FL 32610-0165, USA.
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Meltzer LJ, Phillips C, Mindell JA. Clinical psychology training in sleep and sleep disorders. J Clin Psychol 2009; 65:305-18. [PMID: 19132641 DOI: 10.1002/jclp.20545] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
There is growing evidence to suggest that clinical psychologists would benefit from more training in sleep and sleep disorders. Sleep disturbances are commonly comorbid with mental health disorders and this relationship is often bidirectional. In addition, psychologists have become integral members of multidisciplinary sleep medicine teams and there are not enough qualified psychologists to meet the clinical demand. The purpose of this study was to evaluate the current education on sleep and sleep disorders provided to clinical psychology predoctoral students and interns. Directors of graduate programs and internships (N=212) completed a brief online survey on sleep education in their program. Only 6% of programs offers formal didactic courses in sleep, with 31% of programs offering training in the treatment of sleep disorders. There are few programs with sleep faculty (16%), and most reported that their institutions were ineffective in providing sleep education. Thirty-nine percent of training directors reported they would implement a standard curriculum on sleep, if available. The findings from this study suggest that more opportunities are needed for trainees in clinical psychology to gain didactic and clinical experience with sleep and sleep disorders.
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Affiliation(s)
- Lisa J Meltzer
- The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA 19104, USA.
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