1
|
Cifre AB, Budnick CJ, Bick J, McGlinchey EL, Ripple CH, Wolfson AR, Alfano CA. Sleep Health among Children Adopted from Foster Care: The Moderating Effect of Parent-Child Sleep Interactions. Behav Sleep Med 2024; 22:472-487. [PMID: 38263632 DOI: 10.1080/15402002.2024.2303467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Sleep disruption is prevalent among children placed in foster care, elevating risk for a range of deleterious outcomes. Theoretically, achieving permanency via adoption may have a positive influence on children's sleep via the presence of various factors, but little is known about the sleep health of children adopted from foster care, including predictors and moderators of sleep health. METHOD The current study included 226 parents who adopted a child from foster care in the U.S. (aged 4-11 years) within the past two years and a propensity score matched sample of 379 caregivers of children currently in foster care. Both samples completed online questionnaires about their child's sleep, physical, and mental health. RESULTS Comparatively, children in foster care experienced more nightmares, night terrors, moving to someone else's' bed during the night, and worse overall sleep quality, whereas adopted children were reported to experience significantly more nighttime awakenings. In the adopted sample, a greater number of prior foster placements unexpectedly predicted lower total sleep disturbance scores, but this relationship was moderated by parent-child interactions around sleep. In general, greater parental involvement in children's sleep was associated with lower levels of child sleep disturbance. CONCLUSIONS Findings suggest that while specific sleep problems might remit after children in foster care achieve permanence, nighttime sleep fragmentation often persists. Parent-child interactions surrounding sleep may be pivotal in improving sleep health in this population.
Collapse
Affiliation(s)
- Anthony B Cifre
- Department of Psychology University of Houston, Houston, TX, USA
| | | | - Johanna Bick
- Department of Psychology University of Houston, Houston, TX, USA
| | | | | | - Amy R Wolfson
- Department of Psychology, Loyola University of Maryland, Baltimore, MD, USA
| | - Candice A Alfano
- Department of Psychology University of Houston, Houston, TX, USA
| |
Collapse
|
2
|
Khalid S, Mitchell S, Al-Mateen C. Comparison of alpha-2 agonist versus alpha-1 antagonist for post-traumatic stress disorder-associated nightmares in pediatric patients. Ment Health Clin 2024; 14:199-203. [PMID: 38835814 PMCID: PMC11147653 DOI: 10.9740/mhc.2024.06.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/08/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction Posttraumatic stress disorder (PTSD) in children and adolescents has a high prevalence of accompanying sleep disturbances. Currently, pediatric treatment of PTSD-related nightmares is extrapolated from adult studies. This study aims to determine the effectiveness and safety of clonidine and guanfacine compared with prazosin for the treatment of PTSD-related nightmares. Methods This was a retrospective, single-center, medical record review of patients 5 to 17 years old admitted to an inpatient psychiatric unit from January 2015 to September 2021. Patients with a new initiation of an alpha-2 agonist (clonidine or guanfacine) or an alpha-1 antagonist (prazosin) with a diagnosis of PTSD, other trauma- or stressor-related disorder or unspecified anxiety disorder were included. The primary endpoint was the percentage of patients with a decrease in the frequency of nightmares. Results A total of 59 patients were included in the study: 37 in the alpha-2 agonist group and 22 in the alpha-1 antagonist group. There was no statistically significant difference in reduction of nightmares with both groups having a high percentage of patients showing response (alpha-2 agonist: 91.9%, alpha-1 antagonist: 86.4%). Time to decrease in nightmares was comparable between groups with a relatively quick onset. Within the alpha-2 agonist group, clonidine (1.59 ± 1.06 days) compared with guanfacine (3.18 ± 1.74 days) had a statistically significant faster time to reduction in nightmares (p = .005). Discussion Both pharmacologic classes of medications were effective treatment options for pediatric PTSD-associated nightmares with a low incidence of adverse effects. There was a quick time to onset seen with all agents.
Collapse
Affiliation(s)
- Seher Khalid
- (Corresponding author) Clinical Pharmacy Specialist, Psychiatry, University of North Carolina Health, Chapel Hill, North Carolina; previously, Virginia Commonwealth University Heath System Department of Pharmacy Services, Richmond, Virginia,
| | - Sandra Mitchell
- Clinical Pharmacy Specialist, Child and Adolescent Psychiatry, Virginia Commonwealth University Health System Department, Richmond, Virginia
| | - Cheryl Al-Mateen
- Child and Adolescent Psychiatrist, Virginia Commonwealth University Health System Department of Psychiatry, Division of Child and Adolescent Psychiatry, Richmond, Virginia
| |
Collapse
|
3
|
Mii AE, Coffey HM, McCoy K, Sonnen E, Meidlinger K, Huit TZ, May GC, Flood MF, Hansen DJ. Sleep, Emotional, and Behavioral Problems Among Youth Presenting to Treatment Following Sexual Abuse. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:411-423. [PMID: 38938946 PMCID: PMC11199425 DOI: 10.1007/s40653-023-00590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 06/29/2024]
Abstract
Research indicates that sleep problems are fairly common in childhood. However, the relationship between child sexual abuse (CSA) and sleep problems and how sleep issues influence psychological symptoms in children presenting for treatment remain unclear. The purpose of this study was to examine the presence of sleep problems and the association between sleep problems and psychological symptoms in youth presenting to treatment following CSA. Participants included 276 non-offending caregiver-child dyads at pre-treatment and 106 dyads at post-treatment. Youth were 6 to 19 years old and predominately female (82.9%). Caregivers were 23 to 72 years old and predominately female (87.4%). Youth and caregivers identified as predominately European American (76.6% and 86.0%, respectively). Results indicated that caregiver endorsement of a particular youth sleep problem (as measured by the Child Behavior Checklist sleep items) at pre-treatment ranged between 17.9 and 51.4%. Sleep problems were positively associated with psychological symptoms per caregiver- and youth self-report. Interestingly, a substantial proportion of youth reported decreased sleep problems at the end of treatment even though the treatment did not target sleep issues. This study highlights the commonality of sleep problems in children who experienced sexual abuse. Findings suggest that CSA interventions that do not directly address sleep may be missing a component that can contribute to successful recovery. The results provide preliminary evidence that sleep problems and mental health concerns among youth who experienced CSA are associated, indicating a need for further investigation into the association and potential implications for treatment. Other implications for future research and treatment following CSA are discussed.
Collapse
Affiliation(s)
- Akemi E. Mii
- Department of Psychology Lincoln, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308 USA
| | - Hannah M. Coffey
- Department of Psychology Lincoln, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308 USA
| | - Kelsey McCoy
- Department of Psychology Lincoln, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308 USA
| | - Emily Sonnen
- Department of Psychology Lincoln, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308 USA
| | - Katie Meidlinger
- Department of Psychology Lincoln, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308 USA
| | - T. Zachary Huit
- Department of Psychology Lincoln, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308 USA
| | - Gina C. May
- Department of Psychology Lincoln, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308 USA
| | - Mary Fran Flood
- Department of Psychology Lincoln, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308 USA
| | - David J. Hansen
- Department of Psychology Lincoln, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588-0308 USA
| |
Collapse
|
4
|
Rossouw J, Suliman S, Nothling J, Lombard C, Bröcker E, Hewett M, Simmons C, Shorter GW, Seedat S, Milanak ME, Armour C. A pilot randomised control study to investigate the effect of the South African Adolescence Group Sleep Intervention (SAASI) on adolescent sleep and PTSD. Eur J Psychotraumatol 2024; 15:2350217. [PMID: 38774992 PMCID: PMC11123447 DOI: 10.1080/20008066.2024.2350217] [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] [Received: 11/06/2023] [Accepted: 04/11/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Trauma exposure prevalence and consequent post-traumatic stress disorder among South African adolescents are significant. Sleep disturbances are among the most frequently reported difficulties faced by those dealing with PTSD. The current study examined the feasibility and preliminary efficacy of the South African Adolescence Group Sleep Intervention on PTSD symptom severity and sleep disturbance.Method: Sixty-one adolescents with PTSD diagnoses and sleep disturbance were randomly assigned (1:1) to one individual and four group sessions of a sleep intervention (SAASI) or a control group. Participants completed the Child PTSD symptom scale for DSM5 (CPSS-5) and the Pittsburgh Sleep Quality Index (PSQI) among other sleep and psychiatric measures. The trial was registered on the Pan African Trial Registry (PACTR202208559723690).Results: There was a significant but similar decrease in PSQI scores in both groups over time indicating no overall intervention effect (Wald test = -2.18, p = .029), mean slope = -0.2 (95% CI: -0.37 to -0.02) (p = .583). On the CPSS-5, interaction between groups was also not significant (p = .291). Despite this overall finding, the mean difference in CPSS-SR-5 scores increased over time, with the difference between groups post-treatment -9.10 (95%CI: -18.00 to -0.21), p = .045 and the 1-month follow-up contrast - 11.22 (95%CI: -22.43 to -0.03), p = .049 suggesting that PTSD symptom severity decreased more in the intervention group than the control group. The dropout rate was higher than expected for both the intervention (n = 10; 32%) and control (n = 8; 26.7%) groups. Dropout were mostly school commitments or travel related.Conclusions: Early findings suggest a trend towards dual improvement in sleep quality and PTSD symptom severity in adolescents with a sleep disturbance and PTSD receiving a group sleep intervention (SAASI). Further investigation in a properly powered RCT with detailed retention planning is indicated.
Collapse
Affiliation(s)
- Jaco Rossouw
- Faculty of Medicine and Health Sciences, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Sharain Suliman
- Faculty of Medicine and Health Sciences, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- Faculty of Medicine and Health Sciences, South African Medical Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Jani Nothling
- Faculty of Medicine and Health Sciences, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Carl Lombard
- South African Medical Research Council – Biostatistics Unit, Cape Town, South Africa
| | - Erine Bröcker
- Faculty of Medicine and Health Sciences, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Maryke Hewett
- Faculty of Medicine and Health Sciences, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Candice Simmons
- Faculty of Medicine and Health Sciences, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Gillian W. Shorter
- School of Psychology, David Keir Building, Queen’s University Belfast, Belfast, Northern Ireland
| | - Soraya Seedat
- Faculty of Medicine and Health Sciences, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- Faculty of Medicine and Health Sciences, South African Medical Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Melissa E. Milanak
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Cherie Armour
- Faculty of Medicine and Health Sciences, South African Medical Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
5
|
Chandler-Mather N, Crichton A, Shelton D, Harris K, Donovan C, Dawe S. Carer-reported sleep disturbance and carer- and teacher-rated executive functioning in children with prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder. Child Neuropsychol 2024:1-22. [PMID: 38607688 DOI: 10.1080/09297049.2024.2337715] [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: 10/06/2023] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
Children with prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD) have high rates of sleep disturbance and marked difficulties with executive functioning (EF). Sleep disturbance has been associated with poorer EF across development in typically developing children. The contribution of insomnia symptoms and nightmares to EF difficulties in children with PAE and FASD is unclear. The current study examined whether caregiver-reported insomnia symptoms and nightmares predicted difficulties with EF in children with PAE who were assessed at FASD diagnostic clinics. Archival data on 116 children with PAE assessed at FASD diagnostic clinics were extracted from databases. Children were assigned to a preschool-age group (3.1 to 5.9 years, n = 40) and a school-age group (5.9 to 10.9 years, n = 76). Insomnia symptoms and nightmares were measured using items extracted from the Child Behavior Checklist (CBCL) while EF was measured using the caregiver and teacher Behavior Rating Inventory of Executive Function (BRIEF) rating forms. Bootstrapped regression models were used examine the effects of insomnia symptoms and nightmares on domains of EF in each group while adjusting for potential confounds. For preschool children, insomnia symptoms were associated with greater daytime tiredness while nightmares were associated with greater difficulties with Emergent Metacognition according to their teachers. For school-age children, insomnia symptoms predicted greater EF difficulties across most domains according to their caregivers but not teachers. Sleep disturbance may compound EF impairments in children with PAE and should be screened for as part of FASD diagnostic assessment.
Collapse
Affiliation(s)
| | - Ali Crichton
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
| | - Doug Shelton
- Gold Coast University Hospital, Southport, Australia
| | - Katrina Harris
- Victorian Fetal Alcohol Service, Monash Children's Hospital, Clayton, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Sharon Dawe
- School of Applied Psychology, Griffith University, Brisbane, Australia
| |
Collapse
|
6
|
Bryant BJ. Trauma Exposure in Migrant Children: Impact on Sleep and Acute Treatment Interventions. Child Adolesc Psychiatr Clin N Am 2024; 33:193-205. [PMID: 38395505 DOI: 10.1016/j.chc.2023.08.001] [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: 02/25/2024]
Abstract
Trauma exposure significantly impacts sleep in children. Nightmares are common. Evidence-based therapies are superior to medications but may not always be available in acute settings. No FDA-approved medications exist for the treatment of trauma-related sleep disturbances in youth. The evidence-base for the use of medications is largely based on case reports, retrospective chart reviews, clinical opinion, and adult studies. This evidence is reviewed for a number of medications, including prazosin, trazodone, alpha-2 agonists, quetiapine, and others.
Collapse
Affiliation(s)
- Beverly J Bryant
- Child Psychiatry, Talkiatry, 1400 N Coit Road #302, McKinney, TX 75071, USA.
| |
Collapse
|
7
|
Omidvar Eshkalak Z, Parvizy S, Seyedfatemi N, Haghani H, Nazari H. The effectiveness of web-based training for parents on post-traumatic stress disorder in children. Front Psychol 2024; 15:1325475. [PMID: 38605831 PMCID: PMC11008461 DOI: 10.3389/fpsyg.2024.1325475] [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: 10/21/2023] [Accepted: 02/13/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) after an injury such as accidents is common in children and can affect their overall physical and mental functioning and quality of life. Early intervention can have significant health benefits for children. This study aimed to investigate the effectiveness of web-based training for parents on post-traumatic stress disorder in children. Method This was a quasi-experimental study with intervention and control group. 110 parents of children aged 10-18 years with PTSD after a traumatic event were selected through available sampling and assigned to intervention and control groups. Data was collected by a researcher-made demographic questionnaire and the Child Revised Impact of Events Scale (CRIES-8). Parents in the intervention group received a 4-week training course through a researcher-designed website, but the control group received routine care by the clinical team, which the main focus of care and training was on the physical aspects of the disease, and no intervention was done for PTSD. Two weeks after the intervention, the level of child stress was measured and compared in both groups. Data were analyzed using SPSS V.22. Results The difference between the mean score of total traumatic stress and its subscales before intervention was not statistically significant (p = 0.23). But after intervention, the mean score of total traumatic stress and its subscales decreased in the intervention group and increased in the control group and this difference was statistically significant (p < 0.001). Conclusion E-learning parent training has the potential to support children with PTSD. This available and cost-effective procedure can be recommended to help children with PTSD and possibly increase recovery in these patients.
Collapse
Affiliation(s)
| | - Soroor Parvizy
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Naima Seyedfatemi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Haghani
- Department of Biostatistics, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Hadis Nazari
- Department of Pediatric Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
8
|
Fellman V, Heppell PJ, Rao S. Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents. Psychiatr Clin North Am 2024; 47:229-253. [PMID: 38302209 DOI: 10.1016/j.psc.2023.06.015] [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
Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.
Collapse
Affiliation(s)
- Veronica Fellman
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA.
| | - Patrick J Heppell
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA
| | - Suchet Rao
- Psychiatry and Behavioral Health, NYC Administration for Children's Services, 150 William Street, 11th Floor, New York City, NY 10038, USA
| |
Collapse
|
9
|
Porcheret K, Dyb G, Wentzel-Larsen T, Stensland SØ. Predictors of early adulthood insomnia following exposure to a single mass violence attack during adolescence: 7-13 year follow-up from the Utøya and HUNT studies. Eur J Psychotraumatol 2024; 15:2312750. [PMID: 38386049 PMCID: PMC10885749 DOI: 10.1080/20008066.2024.2312750] [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] [Received: 08/16/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Background: The long-term impact of mass violence attacks is practically unknown, especially in children and adolescents. In a previous study, we found that 8.5 years after a terror attack targeting mainly adolescents, nearly half of the survivors met diagnostic criteria for insomnia.Objectives: The aims of this study were to investigate: (1) whether exposure to a single mass violence event during adolescence increases the risk of insomnia almost a decade later above that expected for a non-exposed population; and (2) whether prior interpersonal violence exposure and early post-traumatic reactions predict later insomnia.Method: Participants were survivors of the 2011 Utøya Island terrorist attack (n = 279) and controls from the HUNT Norwegian general population study (n = 35,664). Early adulthood insomnia was assessed using four items from the Karolinska Sleep Questionnaire 8.5 years after the attack. Participants who had also completed earlier data collection waves for both studies (n = 116 and 2382, respectively) were included in logistic regression models testing the associations between predictors during adolescence and later insomnia.Results: Nearly a decade after the Utøya attack, 38.4% (n = 56) of the survivors reported symptoms of insomnia indicative of probable insomnia compared to 20.5% (n = 5771) of controls. Terror exposure during adolescence was a significant predictor of later insomnia [odds ratio (OR) = 3.18, 95% confidence interval (CI) = 2.05-4.87, p < .001]. Early post-trauma symptoms of anxiety and depression (OR = 1.34, 95% CI = 1.02-1.76, p = .033) and weekly headaches (OR = 1.64, 95% CI = 1.08-2.47, p = .018) were also significant predictors while controlling for background factors and other predictors.Conclusion: Long-term assessment and treatment are needed for survivors of mass violence to improve resilience and recovery.
Collapse
Affiliation(s)
- Kate Porcheret
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Grete Dyb
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern, Norway, Oslo, Norway
| | - Synne Øien Stensland
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
10
|
Robles-Ramamurthy B, Zaki S, Sandoval JF, Dube AR, Hlozek S, Fortuna LR, Williamson AA. Improving adolescent sleep in long-term Juvenile correctional settings: case examples with clinical, research, and policy implications. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae006. [PMID: 38425455 PMCID: PMC10904105 DOI: 10.1093/sleepadvances/zpae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/30/2023] [Indexed: 03/02/2024]
Abstract
Poor sleep during adolescence is a public health concern that may be especially important to address among youth in juvenile correctional facilities, who tend to experience greater mental health challenges, substance use disorders, and traumatic stress exposure. However, evidence for addressing sleep in correctional settings is limited. Using de-identified composite clinical cases, this paper describes challenges and opportunities for addressing sleep disorders (i.e. insomnia) and promoting sleep health (i.e. improving duration, regularity, and behaviors) among adolescents in long-term juvenile correctional facilities. These clinical cases highlight common presenting problems and underscore the need for integrated sleep and mental health interventions as well as adaptations to enhance feasibility and efficacy of behavioral sleep treatment and sleep health promotion in juvenile correctional contexts. We conclude by summarizing clinical, research, and policy implications for addressing adolescent sleep problems and promoting sleep health and well-being in these contexts.
Collapse
Affiliation(s)
- Barbara Robles-Ramamurthy
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Saadia Zaki
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Jessica F Sandoval
- Department of Psychiatry and Behavioral Sciences, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Anish R Dube
- Department of Psychiatry, Charles R. Drew University College of Medicine and Science, Los Angeles, CA, USA
| | - Steven Hlozek
- Department of Internal Medicine, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Lisa R Fortuna
- Department of Psychiatry and Neurosciences, University of California Riverside, School of Medicine, Riverside, CA, USA
| | - Ariel A Williamson
- Ballmer Institute for Children’s Behavioral Health, University of Oregon, Portland, OR, USA
| |
Collapse
|
11
|
Conn BM, Brammer WA, Choi S, Fedorova EV, Ataiants J, Lankenau SE, Wong CF. Mental and Physical Health-Related Cannabis Motives Mediate the Relationship between Childhood Trauma and Problematic Cannabis Use over Time among Emerging Adult Cannabis Users. Subst Use Misuse 2023; 59:193-207. [PMID: 37822106 PMCID: PMC10842029 DOI: 10.1080/10826084.2023.2267111] [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] [Indexed: 10/13/2023]
Abstract
BACKGROUND While growing evidence has identified mental and physical health-related cannabis use motives as significant mechanisms between childhood trauma and problematic cannabis use (PCU) for emerging adults (EA), there is a need to understand the longitudinal stability of these pathways and how they impact PCU as cannabis users age into later adulthood. METHODS The current study extends an analysis examining the impact of childhood trauma (e.g., emotional abuse, sexual abuse) on multiple indicators of PCU through a range of cannabis use motives. 339 medical cannabis patient and non-patient EA users from the Los Angeles area were sampled at baseline (mean age = 21.23; SD = 2.48). The present analysis used four waves of follow-up data collected from 2016 to 2018 (W3, W4) and 2019-2020 (W5, W6). RESULTS Use of cannabis to cope with nausea, sleep, pain, and emotional distress mediated the relationships between some types of childhood abuse and PCU at W4, though most associations attenuated by later adulthood (W6). Specifically, greater emotional distress and nausea motives were associated with greater PCU in models of emotional abuse and neglect and sexual abuse, with emotional distress continuing to mediate at W6. Conversely, sleep and pain motives were associated with lower PCU in models for emotional neglect. CONCLUSIONS Mental and physical health-related motives reflect potential intervenable factors that predict PCU in emerging adulthood among EA cannabis users with histories of childhood trauma. Results highlight the importance of and value for assessing a wide range of motives and PCU outcomes to target and address areas for intervention.
Collapse
Affiliation(s)
- Bridgid M Conn
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Whitney A Brammer
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Susie Choi
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Ekaterina V Fedorova
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Janna Ataiants
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Stephen E Lankenau
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Carolyn F Wong
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| |
Collapse
|
12
|
Pfefferbaum B, Tucker P, Ekambaram V, Van Horn RL. Children's Sleep and Mental Health During the COVID-19 Pandemic. Curr Psychiatry Rep 2023; 25:847-856. [PMID: 37957452 DOI: 10.1007/s11920-023-01475-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic and protracted home confinement required adjustments to schedules and routines generating concern about children's sleep. This review describes general considerations regarding children's sleep, changes and disturbances in their sleep during the pandemic, and the association of sleep measures with health and psychological outcomes in general and in the context of the pandemic. RECENT FINDINGS A number of studies found an increase in the duration of children's sleep with later bedtimes and waketimes for some children. The research also documented sleep disturbances and associations between children's sleep and psychological outcomes. The extent to which increased sleep duration and changed sleep behaviors translated into improved sleep quality and/or a change in sleep disturbances remains unclear. This review suggests the importance of considering children's sleep in other mass trauma situations including, for example, natural and man-made disasters, as well as pandemics.
Collapse
Affiliation(s)
- Betty Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP 3217, P.O. Box 26901, Oklahoma City, OK, 73126-0901, USA.
| | - Phebe Tucker
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, c/o 15509 Claremont Blvd, Edmond, OK, 73013, USA
| | - Vijayabharathi Ekambaram
- Department of Psychiatry, HCA Florida West Hospital, 8383 N. Davis Highway, Pensacola, FL, 32514, USA
| | - Richard L Van Horn
- University of Oklahoma, 920 Stanton L. Young Boulevard, WP 3217, P.O. Box 26901, Oklahoma City, OK, 73126-0901, USA
| |
Collapse
|
13
|
Palmer CA, Bahn A, Deutchman D, Bower JL, Weems CF, Alfano CA. Sleep Disturbances and Delayed Sleep Timing are Associated with Greater Post-Traumatic Stress Symptoms in Youth Following Hurricane Harvey. Child Psychiatry Hum Dev 2023; 54:1534-1545. [PMID: 35435538 DOI: 10.1007/s10578-022-01359-y] [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: 03/27/2022] [Indexed: 11/03/2022]
Abstract
Sleep patterns following a natural disaster are associated with mental health difficulties, but research in youth samples has been limited to subjective reports of sleep. Participants (N = 68, 8-17 years old) completed an assessment 6-9 months after Hurricane Harvey, which included subjective measures of sleep, chronotype, hurricane-related post-traumatic stress symptoms, and one week of actigraphy. Prior to the hurricane, parents provided reports on emotional symptoms. Controlling for age, sex, socioeconomic status, participation time, and pre-hurricane emotional symptoms, subjective sleep disturbances and an eveningness chronotype were associated with greater post-traumatic stress, with the strongest effects observed for re-experiencing, negative cognitions/mood, and arousal/reactivity symptoms. Later sleep timing as measured by actigraphy was associated with greater arousal/reactivity symptoms and shorter sleep duration was associated with greater avoidance symptoms. As extreme weather-related events are expected to become more frequent and severe, these findings contribute to models of youth risk and resilience.
Collapse
Affiliation(s)
- Cara A Palmer
- Department of Psychology, Montana State University, 319 Traphagen Hall, Bozeman, MT, 59717, USA.
| | - Alexis Bahn
- Psychology Neurosciences Department, Maastricht University, 6229 ER, Maastricht, Netherlands
| | - Dagny Deutchman
- Department of Psychology, Montana State University, 319 Traphagen Hall, Bozeman, MT, 59717, USA
| | - Joanne L Bower
- School of Psychology, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Carl F Weems
- Department of Human Development and Family Studies, Iowa State University, Ames, IA, 50011, USA
| | - Candice A Alfano
- Department of Psychology, University of Houston, Houston, TX, 77204, USA
| |
Collapse
|
14
|
Zeghari R, Gindt M, Guivarch J, Auby P, Robert P, Rolling J, Schröder C, Valo P, Askenazy F, Fernandez A. July 14th 2016 Nice Terrorist Attack Court Trial: A Protocol on Sleep Quality and Somatic Symptoms as Markers of Risk for Traumatic Reactivation in Adolescents Exposed to This Attack. Healthcare (Basel) 2023; 11:2953. [PMID: 37998445 PMCID: PMC10671086 DOI: 10.3390/healthcare11222953] [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: 09/17/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
The court trial of the 14th of July 2016 terrorist attack in Nice (France) opened in September 2022 and ended in December 2022. Engaging in court proceedings, whether as a victim or a witness, can lead to a significant risk of traumatic reactivation (i.e., the re-emergence of post-traumatic stress symptoms). The present protocol aimed to improve knowledge of the pathophysiology of traumatic reactivation due to the media coverage of the trial by assessing sleep disturbances and somatic symptoms that could reappear if there is a traumatic reactivation. Method and Analysis: This is a monocentric longitudinal study, with recruitment solely planned at the Nice Pediatric Psychotrauma Center (NPPC). We intended to include 100 adolescents aged 12 to 17 years who were directly or indirectly exposed to the attack and included in the "14-7" program). Assessments began one month before the trial, in August 2022, and were scheduled once a month until the end of the trial. A smartwatch recorded sleep activity. Somatic and PTSD symptoms and sleep were assessed through validated questionnaires. The main analyses comprised the variance and regression analyses of predictors of clinical evolution over time. Ethics and Dissemination: The National Ethics Committee "NORD OUEST III" approved the "14-7" program protocol (number 2017-A02212-51). The specific amendment for this research was approved in April 2022 by the same national ethical committee. Inclusions started in August 2022.
Collapse
Affiliation(s)
- Radia Zeghari
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Morgane Gindt
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Jokthan Guivarch
- Department of Child Psychiatry, APHM, 13009 Marseille, France;
- CANOP Institut de Neurosciences de la Timone, UMR 7289, CNRS, Aix Marseille University, 13005 Marseille, France
- Faculty of Medicine, Aix-Marseille University, 13005 Marseille, France
| | - Philippe Auby
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Philippe Robert
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Julie Rolling
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, 67000 Strasbourg, France
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, 67000 Strasbourg, France
- CNRS UPR3212-Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, 67000 Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, 67091 Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, 67091 Strasbourg, France
| | - Carmen Schröder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, 67000 Strasbourg, France
- CNRS UPR3212-Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, 67000 Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, 67091 Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, 67091 Strasbourg, France
- Expert Centre for High-Functioning Autism, Fondation FondaMental, 67000 Strasbourg, France
| | - Petri Valo
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Florence Askenazy
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| | - Arnaud Fernandez
- Nice Pediatric Psychotrauma Center (NPPC), Child and Adolescent Psychiatry Department, Hôpitaux Pédiatriques Universitaires Lenval, 06200 Nice, France
- CoBTeK (Cognition-Behaviour-Technology) Lab, Université Cote d’Azur, 06000 Nice, France
| |
Collapse
|
15
|
Rolling J, Rabot J, Reynaud E, Kolb O, Bourgin P, Schroder CM. Nightmares and Sleep Disturbances in Children with PTSD: A Polysomnographic and Actigraphy Approach Evaluation. J Clin Med 2023; 12:6570. [PMID: 37892709 PMCID: PMC10607571 DOI: 10.3390/jcm12206570] [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: 07/21/2023] [Revised: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
RATIONALE Sleep disturbances (insomnia and nightmare symptoms) are the most sensitive and persistent symptoms of pediatric post-traumatic stress disorder (PTSD). Untreated, these sleep disturbances (SD) associated with PTSD are predictive of PTSD persistence and increased psychiatric complications. The aim of this study was to evaluate sleep and circadian rhythms in children with PTSD under both laboratory and ecological conditions in comparison with a control population and to test for the first time the hypothesis that SD and circadian rhythms are positively correlated with PTSD severity and its comorbidities. METHOD This prospective pilot study evaluated PTSD, SD (insomnia, nightmares), and sleep-wake rhythms in 11 children with PTSD (aged 3-18), compared with the age and sex-matched control groups. Assessment of PTSD and subjective and objective measures of sleep and sleep-wake rhythms (questionnaires, 24-h in-laboratory video-polysomnography, 15-day at-home actigraphy recording) were performed between 1 and 6 months after the traumatic event. RESULTS Children with PTSD had higher sleep fragmentation (increased wake-after-sleep onset, increased number of sleep stage changes) compared to controls, with a change in sleep microarchitecture (micro-arousal index at 14.8 versus 8.2, p = 0.039). Sleep fragmentation parameters correlated with PTSD symptomatology, insomnia, and post-traumatic nightmare severity. The within-group comparison revealed a better sleep architecture in the controlled (sleep laboratory) than in the ecological condition (at home) (total sleep time 586 versus 464 min, p = 0.018). CONCLUSIONS Sleep and rhythm disturbances are strongly associated with PTSD in children. The assessment of SD in children with PTSD should be carried out systematically and preferentially under ecological conditions, and management of SD should integrate the environment (environmental design, psycho-education for the children and their parents) more fully into therapy focused on sleep and trauma.
Collapse
Affiliation(s)
- Julie Rolling
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, 67091 Strasbourg, France
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Juliette Rabot
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
- Center for Research, Integrated University Health and Social Services Center (CIUSSS) Nord-de-l’Île-de-Montréal, Montréal, QC H2M 2W1, Canada
- Department of Psychiatry & Addictology, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Eve Reynaud
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
- CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, Forgetting, Université Claude Bernard Lyon 1, 69500 Bron, France
| | - Oriane Kolb
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Patrice Bourgin
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| | - Carmen M. Schroder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospital, 67091 Strasbourg, France; (J.R.); (O.K.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospital, 67091 Strasbourg, France; (E.R.); (P.B.)
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, 67081 Strasbourg, France
| |
Collapse
|
16
|
Kangaslampi S, Zijlmans J. MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02310-9. [PMID: 37814082 DOI: 10.1007/s00787-023-02310-9] [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] [Received: 07/01/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.
Collapse
Affiliation(s)
- Samuli Kangaslampi
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland.
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Josjan Zijlmans
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam University Medical Center, Mental Health, Amsterdam, The Netherlands
| |
Collapse
|
17
|
Zhao X, Lukito S, Huang X, Qiu C, Tang W. Longitudinal associations between pandemic post-traumatic stress symptoms and subsequent non-suicidal self-injury in adolescents: A multiple mediation model. J Affect Disord 2023; 323:707-715. [PMID: 36529405 DOI: 10.1016/j.jad.2022.12.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/06/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUNDS PTSD is one of the most common conditions after people have experienced trauma. While previous studies have found a link between PTSD and non-suicidal self-injury, (NSSI), few studies have longitudinally explored this relationship and the underlying mechanisms. AIMS This study explored adolescent NSSI frequency after COVID-19 lockdown experiences, the relationship with early PTSD symptoms, and the mediating role of depression and sleep problems. METHODS A cohort of 1609 adolescents completed two surveys during and after the national lockdown in China; one month into the lockdown and six months later; which assessed demographic and pandemic-related exposure variables; PTSD, depression, sleep, and NSSI. Mediation analyses and hierarchical regression were employed to examine the relationships and the paths between these variables. RESULTS The NSSI rate was found to be 31.9 % after the three-month lockdown, with 20.6 % of adolescent participants reporting sleeping disorders, and 33.9 % indicating probable depression. Adolescents who had earlier PTSD symptoms, often smoked and/or drank, and had current depression and sleep disorders reported greater NSSI. Early PTSD symptoms were found to predict later NSSI and were mediated by sleep problems and depressive symptoms. Specifically, PTSD avoidance and numbing symptoms were significantly associated with NSSI above and beyond the depressive symptoms, sleeping problems, and the other covariables. CONCLUSION It is necessary to be vigilant about the increased risk of NSSI in adolescents who have experienced extended pandemic lockdowns. Preventing early adolescent PTSD symptoms, especially avoidance and numbness, and helping teenagers quit smoking and drinking could reduce the risk of sleep disorders, depression, and NSSI.
Collapse
Affiliation(s)
- Xingkui Zhao
- School of Teacher Education, Yangtze Normal University, Chongqing, China; Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Steve Lukito
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Xia Huang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Changjian Qiu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wanjie Tang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| |
Collapse
|
18
|
Actigraphic sleep monitoring in patients with post-traumatic stress disorder (PTSD): A meta-analysis. J Affect Disord 2023; 320:450-460. [PMID: 36174789 DOI: 10.1016/j.jad.2022.09.045] [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] [Received: 11/21/2021] [Revised: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Sleep disruption is a common complaint among patients with post-traumatic stress disorder (PTSD). Modern technology of activity monitoring (actigraphy) enables extended, objective, unobtrusive recording and measuring of daytime and nighttime activity. We conducted a meta-analysis to investigate the actigraphic sleep patterns in PTSD compared with healthy controls. METHODS We searched through seven electronic databases from inception to July 2022. Only case-control studies comparing rest-activity variables measured by actigraphy devices between clinically diagnosed PTSD patients and healthy individuals were included. RESULTS We identified 12 eligible studies comparing 323 PTSD patients and 416 healthy controls. Using a random-effects model, we showed that PTSD patients have significantly lower sleep efficiency (SMD: -0.26, 95 % CI = -0.51 to -0.004, p < .05, I2 = 29.31 %), more fragmented sleep (SMD: 0.52, 95 % CI = 0.17 to 0.87, p < .01, I2 = 0 %), and longer time in bed (SMD: 0.41, 95 % CI = 0.07 to 0.74, p < .05, I2 = 0 %) compared to healthy controls. LIMITATIONS This study included a limited number of studies. Publication bias was not examined on all variables, which could lead to an overestimation of effect size. Four studies involved veterans, which likely differ from civilians regarding traumatic exposure. CONCLUSION This meta-analytic review highlighted a pattern of sleep disturbances in PTSD patients compared with non-PTSD individuals. High-quality, large-scale studies are necessary to draw a definitive conclusion regarding the distinctive sleep profile in PTSD. Future research can pay attention to sleep-specific mechanisms underlying PTSD and explore the momentary interactions between sleep-wake variables.
Collapse
|
19
|
Traumatic Brain Injury Characteristics Predictive of Subsequent Sleep-Wake Disturbances in Pediatric Patients. BIOLOGY 2022; 11:biology11040600. [PMID: 35453799 PMCID: PMC9030185 DOI: 10.3390/biology11040600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 12/02/2022]
Abstract
Simple Summary Traumatic brain injury is a leading cause of death and disabilities in children and adolescents. Poor sleep after brain injury can slow recovery and worsen outcomes. We investigated clinical sleep problems following pediatric brain injury. We examined characteristics of the injury and details about the patients that may be risk factors for developing sleep problems. The number of patients that developed problems with their sleep after a brain injury was similar between genders. The probability of insomnia increased with increasing patient age. The probability of ‘difficulty sleeping’ was highest in 7–9 year-old brain-injured patients. Older patients had a shorter time between brain injury and sleep problems compared to younger patients. Patients with severe brain injury had the shortest time between brain injury and development of sleep problems, whereas patients with mild or moderate brain injury had comparable times between brain injury and the onset of poor sleep. Multiple characteristics of brain injury and patient details were identified as risk factors for developing sleep problems following a brain injury in children. Untreated sleep problems after a brain injury can worsen symptoms, lengthen hospital stays, and delay return to school. Identifying risk factors could improve the diagnosis, management, and treatment of sleep problems in survivors of pediatric brain injury. Abstract The objective of this study was to determine the prevalence of sleep-wake disturbances (SWD) following pediatric traumatic brain injury (TBI), and to examine characteristics of TBI and patient demographics that might be predictive of subsequent SWD development. This single-institution retrospective study included patients diagnosed with a TBI during 2008–2019 who also had a subsequent diagnosis of an SWD. Data were collected using ICD-9/10 codes for 207 patients and included the following: age at initial TBI, gender, TBI severity, number of TBIs diagnosed prior to SWD diagnosis, type of SWD, and time from initial TBI to SWD diagnosis. Multinomial logit and negative-binomial models were fit to investigate whether the multiple types of SWD and the time to onset of SWD following TBI could be predicted by patient variables. Distributions of SWD diagnosed after TBI were similar between genders. The probability of insomnia increased with increasing patient age. The probability of ‘difficulty sleeping’ was highest in 7–9 year-old TBI patients. Older TBI patients had shorter time to SWD onset than younger patients. Patients with severe TBI had the shortest time to SWD onset, whereas patients with mild or moderate TBI had comparable times to SWD onset. Multiple TBI characteristics and patient demographics were predictive of a subsequent SWD diagnosis in the pediatric population. This is an important step toward increasing education among providers, parents, and patients about the risk of developing SWD following TBI.
Collapse
|
20
|
Sexual abuse and sleep in children and adolescents: a systematic review. Sleep Med Rev 2022; 64:101628. [DOI: 10.1016/j.smrv.2022.101628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/12/2022] [Accepted: 03/14/2022] [Indexed: 12/30/2022]
|
21
|
Gindt M, Fernandez A, Zeghari R, Ménard ML, Nachon O, Richez A, Auby P, Battista M, Askenazy F. A 3-year retrospective study of 866 children and adolescent outpatients followed in the Nice Pediatric Psychotrauma Center created after the 2016 mass terror attack. Front Psychiatry 2022; 13:1010957. [PMID: 36569628 PMCID: PMC9772007 DOI: 10.3389/fpsyt.2022.1010957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The mass terrorist attack in Nice, France, in July 2016 caused deaths and injuries in a local population, including children and adolescents. The Nice Pediatric Psychotrauma Center (NPPC) was opened to provide mental health care to the pediatric population (0-18 years) who experienced traumatic events. OBJECTIVES This study describes the specificity of the care pathway for young trauma victims, with an explanation of how the NPPC works during the first three years. METHODS In this retrospective study, we conducted quantitative and qualitative data collection about new and follow-up consultations, primary and comorbid diagnoses, and the kind of trauma (terrorist attack versus other kinds of trauma). Ethics approval was obtained from the local Ethics committee. RESULTS 866 children and adolescents were followed in the NPPC. We found a high rate of Post-Traumatic Stress Disorder (PTSD; 71%) in this population with a high rate of comorbidities (67%), mainly sleep disorders (34.7%) and mood and anxiety disorders (16.2%). A high number of children and adolescents impacted by the terrorist attack required follow-up consultations after exposure to the mass terrorist attack, the first care-seeking requests continued to occur three years later, although at a slower rate than in the first and second years. New consultations for other kinds of trauma were observed over time. DISCUSSION This study supports previous findings on the significant impact of mass trauma in the pediatric population showing even a higher level of PTSD and a high rate of comorbidities. This may be explained by the brutality of the traumatic event, particularly for this age group. The findings of this study have implications for early interventions and long-term care for children and adolescents to prevent the development of chronic PTSD into adulthood.
Collapse
Affiliation(s)
- Morgane Gindt
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Arnaud Fernandez
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Radia Zeghari
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Marie-Line Ménard
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Ophelie Nachon
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Aurélien Richez
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Philippe Auby
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France
| | - Michele Battista
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Florence Askenazy
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| |
Collapse
|
22
|
Goddard A, Janicek E, Etcher L. Trauma-informed care for the pediatric nurse. J Pediatr Nurs 2022; 62:1-9. [PMID: 34798581 PMCID: PMC9757999 DOI: 10.1016/j.pedn.2021.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trauma is not limited to medical trauma and includes chronic stressors, toxic stress, adverse childhood events, abuse, and now the COVID-19 pandemic. Principles of trauma-informed care and resiliency guide pediatric nursing care across the life span from birth to adolescence. Trauma-informed care principles are pertinent to the nursing care needs of healthy and ill children from infancy to adolescence across care settings. METHODS The purpose of this integrative literature review (IRL) is to elucidate evidence-based practices for pediatric nurses specific to trauma, trauma-informed principles, and the integration of these principles to care. Using Whittemore and Knafl's (2005) methodology, this IRL presents empirical literature to operationalize trauma-informed care for the pediatric nurse through 1) identification of the problem; 2) literature search; 3) data evaluation; 4) data analysis; 5) result presentation. FINDINGS Results are presented in a contemporary framework by the Substance Abuse and Mental Health Services Administration (2018) of trauma-awareness for the pediatric nurse, trauma-informed principles, and the integration of these principles to care. Pediatric nurses are in a unique position to offer trauma-informed care by recognizing and managing trauma to include chronic stressors, toxic stress, adverse childhood experiences, and abuse. DISCUSSION Pediatric nurses today are caring for patients in a complex and diverse healthcare climate amid the world's worst public health pandemic in living memory. Awareness of trauma, assessment of trauma in pediatrics, and health and resiliency promotion are critical in moving forward post-pandemic. The overview of trauma-informed care provides a guide for the pediatric nurse.
Collapse
Affiliation(s)
- Anna Goddard
- Quality, Research, & Evaluation, School-Based Health Alliance, United States of America; Sacred Heart University, Davis & Henley College of Nursing, United States of America; Child and Family Agency of Southeastern Connecticut, United States of America.
| | - Erin Janicek
- Child and Family Agency of Southeastern Connecticut, United States of America.
| | - LuAnn Etcher
- Sacred Heart University, Davis & Henley College of Nursing, United States of America.
| |
Collapse
|
23
|
Roche L, McLay L, Sigafoos J, Whitcombe‐Dobbs S. A review of behavioral treatments for sleep disturbances in civilians who have experienced trauma. BEHAVIORAL INTERVENTIONS 2021. [DOI: 10.1002/bin.1853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Laura Roche
- School of Education University of Newcastle Newcastle New South Wales Australia
| | - Laurie McLay
- School of Health Sciences University of Canterbury Christchurch New Zealand
| | - Jeff Sigafoos
- School of Education Victoria University of Wellington Wellington New Zealand
| | | |
Collapse
|
24
|
Mesman GR, John SG, Dougherty EH, Edge NA, Pemberton JL, Vanderzee KL, McKelvey LM. Sleep as a Moderator of Young Children's Traumatic Stress and Behavior Problems: a Treatment-Referred Sample. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:311-319. [PMID: 34471450 PMCID: PMC8357896 DOI: 10.1007/s40653-020-00318-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/21/2020] [Indexed: 06/03/2023]
Abstract
Empirical evidence suggests young children who have experienced trauma are at risk of developing sleep problems and behavior difficulties, but it is unclear of the specific relation between these behavioral health concerns. The primary purpose of the study is to determine whether sleep problems moderate the relation between traumatic stress and behavior problems in a sample of young children referred for treatment. A secondary purpose is to explore if sleep problems also moderate the relation between specific domains of traumatic stress (i.e., intrusion, avoidance, arousal) and behavior problems. Data from 170 preschoolers ages 3 through 5 referred for treatment were gathered at intake and utilized in this study. Results indicate sleep problems moderate the effect of overall traumatic stress on behavior problems. This statistical finding also was found with intrusive symptoms, and the moderation analyses approached significance with avoidance and arousal. Our findings highlight the importance for clinicians to assess for sleep problems when young children who have experienced trauma are referred to them for treatment, particularly if a low level of overall traumatic stress is present.
Collapse
Affiliation(s)
- Glenn R. Mesman
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St., #554, Little Rock, AR 72205-7199 USA
| | - Sufna G. John
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St., #554, Little Rock, AR 72205-7199 USA
| | - Elissa H. Dougherty
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St., #554, Little Rock, AR 72205-7199 USA
| | - Nicola A. Edge
- Department of Family and Preventative Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., #530, Little Rock, AR USA
| | - Joy L. Pemberton
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St., #554, Little Rock, AR 72205-7199 USA
| | - Karin L. Vanderzee
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St., #554, Little Rock, AR 72205-7199 USA
| | - Lorraine M. McKelvey
- Department of Family and Preventative Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., #530, Little Rock, AR USA
| |
Collapse
|
25
|
Berg KA, Francis MW, Ross K, Spilsbury JC. Opportunities to improve sleep of children exposed to interpersonal violence: A social-ecological perspective. CHILDREN AND YOUTH SERVICES REVIEW 2021; 127:106082. [PMID: 36090582 PMCID: PMC9455662 DOI: 10.1016/j.childyouth.2021.106082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Over 25% of U.S. children are witness to traumatic intrafamilial or community violence each year, and sleep medicine and developmental research jointly suggest that trauma-exposed youth experience more sleep disturbance than their non-exposed counterparts. Sleep medicine literature emphasizes physical and social environmental factors affecting sleep, and trauma literature underscores children's seeking out physically and emotionally safe and predictable environments during trauma recovery. This study employed a hermeneutic phenomenological framing to explore the lived experiences of 65 violence-exposed children and families, and to examine how youths' social and physical sleep environments facilitated or impeded sleep in the aftermath of trauma. Children's sleep experiences following violence exposure shared two primary essences of experience: a) navigating external threats that agitated sleep after trauma; and b) exercising agency over sleep and related environments to restabilize emotional security. Clinicians and social services coordinators working with children and families are uniquely positioned to indicate sleep assessments as part of treatment following trauma, and to also facilitate identification of tangible, sleep-supportive and changeable factors in sleep environments.
Collapse
Affiliation(s)
- Kristen A. Berg
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, United States
| | - Meredith W. Francis
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, United States
| | - Kristie Ross
- School of Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, United States
| | - James C. Spilsbury
- School of Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, United States
| |
Collapse
|
26
|
Hu T, Wang Y, Lin L, Tang W. The mediating role of daytime sleepiness between problematic smartphone use and post-traumatic symptoms in COVID-19 home-refined adolescents. CHILDREN AND YOUTH SERVICES REVIEW 2021; 126:106012. [PMID: 33846662 PMCID: PMC8028598 DOI: 10.1016/j.childyouth.2021.106012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/23/2021] [Accepted: 04/06/2021] [Indexed: 02/08/2023]
Abstract
Background COVID-19 was first recognized in late 2019 in China, at which time school closures forced most students to isolate at home or maintain social distance, both of which increased smartphone use, daytime sleepiness and post traumatic disorder (PTSD) risks. However, to date, no research has fully explored these behavioral risks or the consequences. Methods Two thousand and ninety home-confined students from two Chinese high schools participated in an online-based questionnaire battery that assessed their sociodemographic characteristics, COVID-19 related exposures, daytime sleepiness, problematic smartphone use, and PTSD. The subsequent data were subjected to mediation analysis, and structural equation models (SEM) were employed to explore the variable relationships. Results The problematic smartphone use, daytime sleepiness and PTSD prevalence were respectively 16.4%, 20.2% and 6.9%. The number of COVID-19 related exposure was directly associated with problematic smartphone use and PTSD symptoms. Problematic smartphone use was found to be a mediator between COVID-19 related exposure and PTSD symptoms, and daytime sleepiness was found to partially mediate the associations between problematic smartphone use and PTSD. Conclusions The more exposure associated with the pandemic, the more psychological and behavioral problems the adolescents had. The relatively high rate of problematic smartphone use in home isolated adolescents possibly increased the risk of daytime sleepiness and psychological problems. Therefore, targeted improvements are needed to reduce the risk of psychological problems and daytime sleepiness in adolescents.
Collapse
Affiliation(s)
- Tao Hu
- Department of Psychology, Chengdu Normal University, Chengdu, China
| | - Ying Wang
- Department of Psychology, Chengdu Normal University, Chengdu, China
| | - Ling Lin
- Department of Psychology, Chengdu Normal University, Chengdu, China
| | - Wanjie Tang
- Centre for Educational and Health Psychology, Sichuan University, Chengdu, China.,Mental Health Center, State Key Lab of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
27
|
Hudson N, Burghart S, Reynoldson J, Grauer D. Evaluation of low dose prazosin for PTSD-associated nightmares in children and adolescents. Ment Health Clin 2021; 11:45-49. [PMID: 33850681 PMCID: PMC8019540 DOI: 10.9740/mhc.2021.03.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Knowledge about fundamental sleep disorders and dysregulation that occurs in children with PTSD is limited. Prazosin is an alpha-1 receptor antagonist often used off label for the treatment of PTSD-associated nightmares in adults; however, evaluation of its use in pediatrics and adolescents is limited. The primary objective of this study was to assess the impact of prazosin on nightmares associated with PTSD in this population. Secondary objectives included assessing side effects, changes in blood pressure, and 30-day readmission rates. Methods This was a retrospective, single-center chart review of inpatients diagnosed with PTSD nightmares from January 1, 2017, to July 31, 2019. Patients 4 to 18 years old with a PTSD diagnosis, experiencing nightmares, and initiating any dose of prazosin were assessed to determine efficacy and tolerance. Results Forty-two patients were evaluated to determine symptom improvement after initiation of prazosin for PTSD nightmares in children and adolescents. Of the 42 patients, 24 (57.1%) reported improvement in nightmares (average dose 1.05 mg). For secondary results, 38 (90.5%) patients continued prazosin at discharge, and 2 (5%) were readmitted within 30 days for reasons other than PTSD-associated nightmares. Thirty-four (81%) reported having no adverse effects to prazosin. There was no significant difference in systolic (P = .1883) or diastolic (P = .2777) blood pressure preinitiation and postinitiation of prazosin. Discussion Despite the limitations of this retrospective study, the data suggests that prazosin may be associated with an improvement in nightmares in children and adolescents with PTSD. Adverse events were rarely reported, and there was no significant change in blood pressure with initiation of prazosin.
Collapse
Affiliation(s)
- Nancy Hudson
- PGY-1 Pharmacy Practice Resident, The University of Kansas Health System, Kansas City, Kansas,
| | - Steven Burghart
- Clinical Pharmacist, The University of Kansas Health System, Kansas City, Kansas
| | - Jill Reynoldson
- Pharmacy Manager, Psychiatry, The University of Kansas Health System, Kansas City, Kansas
| | - Dennis Grauer
- Associate Professor, Vice Chair of Research, The University of Kansas School of Pharmacy, Lawrence, Kansas
| |
Collapse
|
28
|
Adverse Childhood Experiences and Trauma-Informed Care. J Pediatr Health Care 2021; 35:145-155. [PMID: 33129624 DOI: 10.1016/j.pedhc.2020.09.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/25/2020] [Accepted: 09/07/2020] [Indexed: 11/21/2022]
Abstract
Adverse childhood experiences (ACEs) refer to the abuse, neglect, and traumatic experiences in childhood that directly affect long-term adolescent and adult health. Understanding the ACE Pyramid and the physiological stress response has guided research toward a better understanding of the long-term mental and physical health consequences from psychological impacts early in life. Trauma-informed care becomes critical for pediatric clinicians to operationalize in practice. The four R's approach-realize, recognize, respond, and resist re-traumatization-can be used by pediatric providers as guidance. The trauma-informed care approach includes the realization of how ACEs affect health, the recognition of pediatric clinical symptom presentation and screening protocols for ACEs, and the health care provider's ability to respond and not re-traumatize patients when delivering evidence-based care. As recent events have triggered worldwide mental and emotional trauma in youth, clinicians must start operationalizing trauma-informed care into practice, as future presentations of trauma are expected.
Collapse
|
29
|
Giannakopoulos G, Kolaitis G. Sleep problems in children and adolescents following traumatic life events. World J Psychiatry 2021; 11:27-34. [PMID: 33643859 PMCID: PMC7896245 DOI: 10.5498/wjp.v11.i2.27] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
Rates of childhood trauma exposure are extremely high, with approximately 70% of children and adolescents experiencing at least one traumatic event. Among the most common non-specific consequences of stress and trauma are disruptions of sleep. Sleep problems, such as shorter sleep duration, difficulty falling asleep, frequent awakenings, nightmares, sleepless nights, and early-morning wakefulness appear to have a higher prevalence among children and adolescents following traumatic events. This review will illustrate the role of sleep problems in traumatized children and adolescents, and emphasize the need to consider a wide range of etiological mechanisms for these symptoms. However, the relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research. Moreover, in view of the adverse consequences of long-term disrupted sleep on mental health outcomes following trauma, the need to effectively address sleep disturbances in traumatized children and adolescents is crucial.
Collapse
Affiliation(s)
- George Giannakopoulos
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| | - Gerasimos Kolaitis
- Department of Child Psychiatry, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, Athens 11527, Greece
| |
Collapse
|
30
|
Blum K, McLaughlin T, Modestino EJ, Baron D, Bowirrat A, Brewer R, Steinberg B, Roy AK, Febo M, Badgaiyan RD, Gold MS. Epigenetic Repair of Terrifying Lucid Dreams by Enhanced Brain Reward Functional Connectivity and Induction of Dopaminergic Homeostatic Signaling. ACTA ACUST UNITED AC 2021; 10. [PMID: 34707968 DOI: 10.2174/2211556010666210215153513] [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] [Indexed: 11/22/2022]
Abstract
During Lucid Dreams, the dreamer is aware, experiences the dream as if fully awake, and may control the dream content. The dreamer can start, stop, and restart dreaming, depending on the nature and pleasantness of the dream. For patients with Reward Deficiency Syndrome (RDS) behaviors, like Attention Deficit Hyperactivity Disorder (ADHD), Tourette's- Syndrome, and Posttraumatic Stress Disorder (PTSD), the dream content may be pleasant, unpleasant, or terrifying. A sample of psychiatric center patients identified as having RDS reported the effectiveness of a neuronutrient, dopamine agonist, KB200Z, in combating terrifying, lucid dreaming. These reports motivated the study of eight clinical cases with known histories of substance abuse, childhood abuse, and PTSD. The administration of KB200Z, associated with eliminating unpleasant or terrifying lucid dreams in 87.5% of the cases. Subsequently, other published cases have further established the possibility of the long-term elimination of terrifying dreams in PTSD and ADHD patients. Induction of dopamine homeostasis may mitigate the effects of neurogenetic and epigenetic changes in neuroplasticity, identified in the pathogenesis of PTSD and ADHD. The article explores how relief of terrifying lucid dreams may benefit from modulation of dopaminergic signaling activated by the administration of a neuronutrient. Recently, precision formulations of the KB220 neuronutrient guided by Genetic Addiction Risk Score (GARS) test results have been used to repair inheritable deficiencies within the brain reward circuitry. The proposition is that improved dopamine transmodulational signaling may stimulate positive cognitive recall and subsequently attenuate the harmful epigenetic insults from trauma.
Collapse
Affiliation(s)
- Kenneth Blum
- Western University Health Sciences, Pomona, CA., USA.,Department Psychiatry, Wright University, Boonshoff School of Medicine, Dayton, OH., USA.,Division of Neuroscience & Addiction Research Therapy, Pathway Healthcare, Birmingham, AL., USA.,Division of Nutrigenomics, Geneus Genomic Testing Center, Geneus Health, LLC., San Antonio, TX., USA.,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | | | | | - David Baron
- Department Psychiatry, Wright University, Boonshoff School of Medicine, Dayton, OH., USA
| | - Abdalla Bowirrat
- Department of Neuroscience and Genetics, Interdisciplinary Center Herzliya, Israel
| | - Raymond Brewer
- Division of Nutrigenomics, Geneus Genomic Testing Center, Geneus Health, LLC., San Antonio, TX., USA
| | | | - A Kenison Roy
- Department of Psychiatry, School of Medicine, University of Tulane, New Orleans, LA., USA
| | - Marcello Febo
- Department of Psychiatry, McKnight Brain Institute, University of Florida, School of Medicine, Gainesville, FL.USA
| | - Rajendra D Badgaiyan
- Department of Psychiatry, Ichan School of Medicine, Mount Sinai Hospital, New York, NY.& Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, San Antonio, TX, Long School of Medicine, University of Texas Medical Center, San Antonio, TX, USA
| | - Marks S Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Mo. USA
| |
Collapse
|
31
|
Jones S, Castelnovo A, Riedner B, Flaherty B, Prehn-Kristensen A, Benca R, Tononi G, Herringa R. Sleep and emotion processing in paediatric posttraumatic stress disorder: A pilot investigation. J Sleep Res 2021; 30:e13261. [PMID: 33442931 PMCID: PMC8365752 DOI: 10.1111/jsr.13261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
Emotion processing abnormalities and sleep pathology are central to the phenomenology of paediatric posttraumatic stress disorder, and sleep disturbance has been linked to the development, maintenance and severity of the disorder. Given emerging evidence indicating a role for sleep in emotional brain function, it has been proposed that dysfunctional processing of emotional experiences during sleep may play a significant role in affective disorders, including posttraumatic stress disorder. Here we sought to examine the relationship between sleep and emotion processing in typically developing youth, and youth with a diagnosis of posttraumatic stress disorder . We use high-density electroencephalogram to compare baseline sleep with sleep following performance on a task designed to assess both memory for and reactivity to negative and neutral imagery in 10 youths with posttraumatic stress disorder, and 10 age- and sex-matched non-traumatized typically developing youths. Subjective ratings of arousal to negative imagery (ΔArousal = post-sleep minus pre-sleep arousal ratings) remain unchanged in youth with posttraumatic stress disorder following sleep (mean increase 0.15, CI -0.28 to +0.58), but decreased in TD youth (mean decrease -1.0, 95% CI -1.44 to -0.58). ΔArousal, or affective habituation, was negatively correlated with global change in slow-wave activity power (ρ = -0.58, p = .008). When considered topographically, the correlation between Δslow-wave activity power and affective habituation was most significant in a frontal cluster of 27 electrodes (Spearman, ρ = -0.51, p = .021). Our results highlight the importance of slow-wave sleep for adaptive emotional processing in youth, and have implications for symptom persistence in paediatric posttraumatic stress disorder. Impairments in slow-wave activity may represent a modifiable risk factor in paediatric posttraumatic stress disorder.
Collapse
Affiliation(s)
- Stephanie Jones
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Anna Castelnovo
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Brady Riedner
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Bethany Flaherty
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ruth Benca
- Department of Psychiatry & Human Behavior, School of Medicine, University of California-Irvine, Irvine, CA, USA
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Ryan Herringa
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
32
|
Schultz JH, Forsberg JT, Harb G, Alisic E. Prevalence and Characteristics of Posttraumatic Nightmares in War- and Conflict-Affected Students. Nat Sci Sleep 2021; 13:423-433. [PMID: 33776500 PMCID: PMC7989377 DOI: 10.2147/nss.s282967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/03/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Recurrent nightmares, frequently associated with traumatic experiences, may impair quality of life and daily functioning. However, there have been few studies of posttraumatic nightmares occurring among children and youth, in particular for trauma-exposed populations in conflict zones. METHODS Using two quantitative data sets, this study investigates the prevalence and characteristics of recurrent nightmares among conflict-exposed young people in the Gaza Strip (N = 300) and examines the characteristics of posttraumatic nightmares and their association with academic functioning among treatment-seeking students in Gaza (N = 1093). RESULTS Among 300 students (10-12 years old) who lived in the ongoing conflict area in Gaza, nightmares were often mentioned, with 56% reporting recurrent nightmares with an average weekly frequency of 4.20 nights in the past week (SD = 1.94) and a mean duration of 2.48 years (SD = 2.01). Similarly, the large sample of 1093 students (6-17 years of age) who sought help for nightmares and sleep disturbance reported recurrent traumatic nightmares on average 4.57 nights per week, with an average duration of 2.82 years. Their self-reported academic functioning was negatively affected by whether they experienced nightmares but was not associated with nightmare frequency or intensity. DISCUSSION Given the high prevalence of nightmares and the relation between nightmares and academic functioning, students in conflict-affected areas appear to be a particularly vulnerable group. This study proposes screening and treating conflict-affected students for recurrent posttraumatic nightmares.
Collapse
Affiliation(s)
- Jon-Håkon Schultz
- Department of Education, UiT, The Arctic University of Norway, Tromsø, Norway
| | | | - Gerlinde Harb
- Department of Education, UiT, The Arctic University of Norway, Tromsø, Norway.,Philadelphia VA Medical Center, Philadelphia, PA, USA
| | - Eva Alisic
- University of Melbourne, Melbourne, Australia
| |
Collapse
|
33
|
Fellman V, Heppell PJ, Rao S. Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2021; 30:225-249. [PMID: 33223064 DOI: 10.1016/j.chc.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.
Collapse
Affiliation(s)
- Veronica Fellman
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA.
| | - Patrick J Heppell
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, Child Study Center, One Park Avenue, 7th Floor, New York City, NY 10016, USA
| | - Suchet Rao
- Psychiatry and Behavioral Health, NYC Administration for Children's Services, 150 William Street, 11th Floor, New York City, NY 10038, USA
| |
Collapse
|
34
|
Harb GC, Schultz JH. The nature of posttraumatic nightmares and school functioning in war-affected youth. PLoS One 2020; 15:e0242414. [PMID: 33237929 PMCID: PMC7688112 DOI: 10.1371/journal.pone.0242414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
Children and adolescents who have experienced traumatic events demonstrate a variety of posttraumatic symptoms, including recurrent nightmares, as well as adverse reactions in the school setting. The current study examined nightmare symptoms, posttraumatic stress, sleep disturbance, and self- and teacher-reported school functioning of 64 youths in the Gaza Strip, ages 12 to 16, who have lived through three wars and experience ongoing conflict and political insecurity. Students were treatment-seeking for sleep-problems and reported, on average, five nightmares per week for an average of three years, with concomitant disrupted sleep, fear of going to sleep, and not feeling rested in the morning. Both teachers and students reported that participants exhibited impaired academic functioning and daytime sleepiness. The content of the students’ nightmares demonstrated frightening themes of being under attack and loss of self-efficacy/control; threat levels were high, and almost 60% included the threat of death. Approximately half of the nightmares included surreal elements in addition to more realistic scenes of violence. Participants in the study demonstrated substantial posttraumatic sleep problems with intensely distressing, frequent and chronic nightmares, andnightmare symptoms were associated with impairment in school functioning. Given the disruptive and distressing nature of these students’ nightmare disturbance, we suggest that increasing self-efficacy in relation to the experience of recurrent nightmares may be a good point of intervention with these recurrently traumatized youth. Thus, increasing the understanding of students’ nightmare symptoms may lead to ameliorating the suffering of youths in war zones and may have positive effects on their school functioning.
Collapse
Affiliation(s)
- Gerlinde C. Harb
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States of America
- Arctic University of Norway, Tromsø, Norway
- * E-mail:
| | | |
Collapse
|
35
|
Lai BS, La Greca AM, Colgan CA, Herge W, Chan S, Medzhitova J, Short M, Auslander B. Sleep Problems and Posttraumatic Stress: Children Exposed to a Natural Disaster. J Pediatr Psychol 2020; 45:1016-1026. [PMID: 32885231 DOI: 10.1093/jpepsy/jsaa061] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Sleep plays a critical role in children's growth and development. This study examined the frequency and persistence of children's sleep problems following a natural disaster, risk factors for children's sleep problems, and the bidirectional relationship between children's sleep problems and posttraumatic stress symptoms (PTSS) over time. METHODS This study assessed 269 children (53% female, M = 8.70 years, SD = 0.95) exposed to Hurricane Ike at 8 months (Time 1) and 15 months (Time 2) post-disaster. Children completed measures of hurricane exposure and related stressors, stressful life events, sleep problems, and PTSS. RESULTS Children's sleep problems were significantly correlated from Time 1 to Time 2 (r = .28, p < .001). Risk factors for sleep problems at Time 2 were younger age, sleep problems at Time 1, and PTSS, not including sleep items, at Time 1. Examinations of the bidirectional relationship between sleep problems and PTSS indicated that PTSS significantly predicted later sleep problems, but sleep problems did not significantly predict later PTSS. CONCLUSIONS Findings demonstrate that PTSS may contribute to the development and course of children's sleep problems post-disaster.
Collapse
Affiliation(s)
- Betty S Lai
- Department of Counseling, Developmental, and Educational Psychology, Lynch School of Education and Human Development, Boston College
| | | | - Courtney A Colgan
- Department of Counseling, Developmental, and Educational Psychology, Lynch School of Education and Human Development, Boston College
| | - Whitney Herge
- Psychology Department, Texas Scottish Rite Hospital for Children
| | - Sherilynn Chan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, College of Medicine, University of Cincinnati
| | - Julia Medzhitova
- Department of Counseling, Developmental, and Educational Psychology, Lynch School of Education and Human Development, Boston College
| | - Mary Short
- Clinical, Health and Applied Sciences, College of Human Sciences and Humanities, University of Houston-Clear Lake
| | - Beth Auslander
- Department of Pediatrics, University of Texas Medical Branch
| |
Collapse
|
36
|
Nelson S, Burns M, McEwen B, Borsook D. Stressful experiences in youth: "Set-up" for diminished resilience to chronic pain. Brain Behav Immun Health 2020; 5:100095. [PMID: 34589863 PMCID: PMC8474662 DOI: 10.1016/j.bbih.2020.100095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 01/01/2023] Open
Abstract
Chronic pain in youth is common, with prevalence rates in some reports exceeding 50%. Given the plasticity of brain systems in youth and their general level of activity, the underlying processes relating to the evolution of chronic pain may be different from that observed in adults. One aspect that affects brain development is childhood stress. Preliminary research indicates that maladaptive responses to stressful events that induce biological and psychological inability to adapt may be related to pain chronicity in youth. This relationship is particularly notable given the high rates of exposure to stressful events in pediatric pain populations. A review of the literature was performed in the areas of biological, cognitive, psychological and social processes associated with chronic pain and psychological stress and trauma in youth and adult populations. The current review presents a theoretical framework, adapted from McEwen's model (1998) on stress and allostatic load, which aims to outline the potential connection between exposure to stressful events and pediatric chronic pain. Avenues for future investigation are also identified.
Collapse
Affiliation(s)
- Sarah Nelson
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Maureen Burns
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
| | | | - David Borsook
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
- Department of Anesthesia, Harvard Medical School, USA
| |
Collapse
|
37
|
Hall Brown T, Garcia E. Trauma-related sleep disturbance in youth. Curr Opin Psychol 2020; 34:128-132. [PMID: 32229429 DOI: 10.1016/j.copsyc.2020.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 12/30/2022]
Abstract
As the occurrence of traumatic events has increased in mainstream media the study of Trauma-Related Sleep Disturbance (TRSD) has gained more traction within the field of sleep health. TRSD is prevalent in youth and can have deleterious outcomes that impact function, yet empirical data that examine this topic are limited. This review seeks to highlight the extant literature focusing on TRSD and to identify critical areas of future research.
Collapse
Affiliation(s)
- Tyish Hall Brown
- Department of Psychiatry & Behavioral Sciences Howard University College of Medicine, United States.
| | - E'leyna Garcia
- Department of Psychology Howard University, United States
| |
Collapse
|
38
|
Wang B, Eastwood PR, Becker A, Isensee C, Wong JWY, Huang RC, Runions KC, Stewart RM, Meyer T, Brüni LG, Rothenberger A, Zepf FD. Concurrent developmental course of sleep problems and emotional/behavioral problems in childhood and adolescence as reflected by the dysregulation profile. Sleep 2020; 42:5231982. [PMID: 30521022 DOI: 10.1093/sleep/zsy243] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/04/2018] [Accepted: 12/03/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Longitudinal data on the course and relationship of concurrent psychopathology in youth are scarce but are of need for better practical patient care and prevention. This study explores the course of (and relationships over time) between sleep problems and concurrent dimensional difficulties relating to anxiety/depression, attention deficiency, and aggressive behaviors in childhood and adolescence. The latter three may jointly form a broad syndrome, the dysregulation profile. METHODS Young people from the Raine Study, a large community cohort sample (N = 1625) were followed from age 5 to 17 years. Developmental courses of sleep problems and its concurrent regulatory difficulties were estimated separately and jointly. RESULTS The majority of adolescents reported low levels of problems and which appeared to be stable over time, while a small group (rates between 7.8% and 10.1%) reported enduring problematic developmental courses. Sleep problems and regulatory difficulties shared a strong association in their development over time (individual's probabilities of having the same courses, i.e. low-low and high-high, were between 89.8% and 92.3%). Furthermore, having persistent sleep problems over time was associated with an increased risk of having regulatory difficulties by approximately 10 times, and vice versa. CONCLUSION Findings from this study provide empirical evidence for a strong mutual association in the development of sleep problems and difficulties of dysregulation with emotion, cognition, and aggression. It may be suggested that a positive screening of one such psychopathological dimension should lead to a careful assessment, not only to reduce the problem in question but also to prevent the youth from further problems.
Collapse
Affiliation(s)
- Biyao Wang
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Peter R Eastwood
- Centre for Sleep Science, School of Human Sciences, University of Western Australia, Perth, WA, Australia
| | - Andreas Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Corinna Isensee
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Janice W Y Wong
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Specialised Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia
| | | | - Kevin C Runions
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - Richard M Stewart
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, German Centre for Cardiovascular Research, University of Goettingen, Goettingen, Germany
| | - L G Brüni
- Child and Adolescent Psychiatry, Psychiatry Services Thurgau, Weinfelden, Switzerland
| | - Aribert Rothenberger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of Goettingen, Goettingen, Germany
| | - Florian D Zepf
- Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia.,Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Germany
| |
Collapse
|
39
|
Sleep disturbance underlies the co-occurrence of trauma and pediatric chronic pain: a longitudinal examination. Pain 2020; 161:821-830. [DOI: 10.1097/j.pain.0000000000001769] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
40
|
Ferrafiat V, Soleimani M, Chaumette B, Martinez A, Guilé JM, Keeshin B, Gerardin P. Use of Prazosin for Pediatric Post-Traumatic Stress Disorder With Nightmares and/or Sleep Disorder: Case Series of 18 Patients Prospectively Assessed. Front Psychiatry 2020; 11:724. [PMID: 32774309 PMCID: PMC7388897 DOI: 10.3389/fpsyt.2020.00724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/09/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Few studies have investigated pharmacologic treatment for pediatric post-traumatic stress disorder (PTSD). Prazosin, an alpha-1 adrenergic receptor antagonist, has been studied and demonstrated to be efficacious in an adult population for PTSD related sleep disturbances; however, in the pediatric population, data is limited to case reports and retrospective case series. This study prospectively assessed the safety and effects of Prazosin on PTSD symptoms in a pediatric sample. METHODS Since 2016, 18 patients with PSTD under the age of 15 admitted in a child and adolescent psychiatric unit were challenged with prazosin as part of a treatment protocol. PTSD symptoms and adverse effects were collected weekly and prospectively assessed each month with validated clinical scales. All data were retrospectively analyzed. This treatment protocol and the evaluation of clinical data were approved by our Ethical committee for research on preexisting data at the University Teaching Hospital of Rouen. RESULTS Among the 18 patients (10 girls and 8 boys), 13 (72%) had experienced sexual abuse and 5 (28%) family violence. After 1 month of treatment with a mean prazosin dose of 2.16 ( ± 0.6) mg/day, the CGI-S score significantly decreased from 5.3 ( ± 0.9) to 2.9 ( ± 0.7) (improvement of 43%). The mean total UCLA-PTSD-RI score significantly decreased 11.4 points ( ± 5.4) during the first week and 37.9 ( ± 16) during the first month, leading to an improvement of 20% and 67%, respectively. The improvement was significant irrespective of trauma exposure or sex. No adverse effects were reported except for one patient (hypotension). CONCLUSION Consistent with prior case reports and retrospective reviews, our retrospective analysis of data prospectively and systematically assessed among 18 patients suggests that prazosin is well-tolerated and associated with improvement in symptoms for pediatric PTSD.
Collapse
Affiliation(s)
- Vladimir Ferrafiat
- Child and Adolescent Psychiatric Unit, URHEA, CHSR Sotteville les Rouen, Rouen, France.,Child and Adolescent Psychiatric Department, CHU Charles Nicolle, Rouen, France
| | - Maryam Soleimani
- Child and Adolescent Psychiatric Unit, URHEA, CHSR Sotteville les Rouen, Rouen, France.,Child and Adolescent Psychiatric Department, CHU Charles Nicolle, Rouen, France
| | - Boris Chaumette
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Audrey Martinez
- Child and Adolescent Psychiatric Department, CHU Charles Nicolle, Rouen, France
| | - Jean-Marc Guilé
- Child and Adolescent Psychiatry Services, Amiens University Hospital, Picardie Jules Verne University, Amiens, France.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,INSERM U1105 Research Group for Analysis of the Multimodal Cerebral Function, University of Picardie-Jules Verne (UPJV), Amiens, France
| | - Brooks Keeshin
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Priscille Gerardin
- Child and Adolescent Psychiatric Unit, URHEA, CHSR Sotteville les Rouen, Rouen, France.,Child and Adolescent Psychiatric Department, CHU Charles Nicolle, Rouen, France
| |
Collapse
|
41
|
Rischard ME, Cromer LD. The Role of Executive Function in Predicting Children's Outcomes in a Cognitive Behavioral Treatment for Trauma-Related Nightmares and Secondary Sleep Disturbances. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:501-513. [PMID: 32318219 PMCID: PMC7163803 DOI: 10.1007/s40653-019-00252-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Predictors of children's outcomes in trauma-focused interventions are well documented. However, little is known about the role of higher-order cognitive processes, specifically executive function (EF) abilities, in determining children's responses to treatments specifically for trauma-related sleep disturbances. EF is independently related to PTSD reactions, sleep deficits, and nightmares. Furthermore, well-developed EF can be protective; thus, we sought to examine whether higher EF predicted better treatment outcomes for trauma-related sleep disturbances. Twenty-three children aged 5 to 17 presenting with post-traumatic nightmares (PTNs) participated in a cognitive behavioral therapy to address their trauma-related nightmares (CBT-NC). Pre- and post-treatment data were used in analyses. Findings from discriminant function analyses revealed that EF was not a statistically significant predictor of treatment outcomes across indices of nightmare frequency and distress, sleep quality, and PTSD symptomology. However, effect sizes suggested that EF was a moderate predictor of sleep quality outcomes, which has clinical implications. Treatment duration for sleep problems could be related to EF with briefer interventions being more suitable for children with high EF, whereas children with low EF may benefit from longer treatment protocols.
Collapse
Affiliation(s)
- Mollie E. Rischard
- Department of Psychology, The University of Tulsa, University of Tulsa Institute of Trauma, Adversity, & iNjustice (TITAN), 800 South Tucker Drive, Tulsa, OK 74104 USA
| | - Lisa D. Cromer
- Department of Psychology, The University of Tulsa, University of Tulsa Institute of Trauma, Adversity, & iNjustice (TITAN), 800 South Tucker Drive, Tulsa, OK 74104 USA
| |
Collapse
|
42
|
Fischer JT, Hannay HJ, Alfano CA, Swank PR, Ewing-Cobbs L. Sleep disturbances and internalizing behavior problems following pediatric traumatic injury. Neuropsychology 2019. [PMID: 29528681 DOI: 10.1037/neu0000420] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This prospective longitudinal study investigated sleep disturbance (SD) and internalizing problems after traumatic injury, including traumatic brain injury (TBI) or extracranial/bodily injury (EI) in children and adolescents, relative to typically developing (TD) children. We also examined longitudinal relations between SD and internalizing problems postinjury. METHOD Participants (N = 87) ages 8-15 included youth with TBI, EI, and TD children. Injury groups were recruited from a Level 1 trauma center after sustaining vehicle-related injuries. Parent-reported SD and internalizing problems were assessed at preinjury/baseline, and 6 and 12 months postinjury. Linear mixed models evaluated the relation of group and time of assessment on outcomes. RESULTS Controlling for age, the combined traumatic injury group experienced significantly higher postinjury levels of SD (p = .042) and internalizing problems (p = .024) than TD children; however, TBI and EI injury groups did not differ from each other. Injury severity was positively associated with SD in the EI group only, but in both groups SD was associated with additional postinjury sequelae, including fatigue and externalizing behavior problems. Internalizing problems predicted subsequent development of SD but not vice versa. The relation between injury and SD 1 year later was consistent with mediation by internalizing problems at 6 months postinjury. CONCLUSIONS Children with both types of traumatic injury demonstrated higher SD and internalizing problems than healthy children. Internalizing problems occurring either prior to or following pediatric injury may be a risk factor for posttraumatic SD. Consequently, internalizing problems may be a promising target of intervention to improve both SD and related adjustment concerns. (PsycINFO Database Record
Collapse
Affiliation(s)
| | - H Julia Hannay
- Texas Institute For Measurement, Evaluation, And Statistics, University of Houston
| | | | - Paul R Swank
- School of Public Health, University of Texas Health Science Center at Houston
| | | |
Collapse
|
43
|
Keeshin BR, Berkowitz SJ, Pynoos RS. Pediatrician's Practical Approach to Sleep Disturbances in Children Who Have Experienced Trauma. Pediatr Ann 2019; 48:e280-e285. [PMID: 31305946 DOI: 10.3928/19382359-20190610-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep difficulties are a common challenge among children who have experienced trauma. Pediatricians are best positioned to work with families to address sleep challenges after traumatic events and help families return to healthy sleep patterns. In this article, we review the underlying concepts that connect trauma to disturbed sleep, types of sleep difficulties seen in children exposed to trauma, and explore ways in which pediatricians can support families as they help their child return to a normal sleep cycle, including the identification of co-occurring conditions and the use of medications. [Pediatr Ann. 2019;48(7):e280-e285.].
Collapse
|
44
|
Wamser-Nanney R, Chesher RE. Presence of Sleep Disturbances Among Child Trauma Survivors: Comparison of Caregiver and Child Reports. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2018; 11:391-399. [PMID: 32318163 PMCID: PMC7163801 DOI: 10.1007/s40653-017-0198-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A significant body of research has been devoted to demonstrating high rates of sleep impairment, and the subsequent adverse implications of sleep difficulties, among adult trauma survivors, particularly those diagnosed with posttraumatic stress disorder (PTSD). Yet considerably less work has been focused on sleep disturbances among trauma-exposed children, especially preschoolers. Pediatric research is paramount in light of the numerous developmental and functional implications that may result from sleep impairment. Prior studies have also documented disagreement between caregiver's and children's reports of trauma-related symptoms; however, the level of concordance rates regarding sleep difficulties is unknown in this population. The present study investigated the rates of multiple types of sleep disturbances using caregiver's and children's reports as well as caregiver-child concordance rates regarding these difficulties. Three hundred and forty-two treatment-seeking children ages of 3-18 years (M = 9.68, SD = 4.00; 61.1% female, 60.4% Black) and their caregivers were included in the study. Sleep disturbances were common in this sample, and children endorsed higher levels of sleep symptoms (range 46-72%) than their caregivers (range 14-51%). Nearly half (47%) of preschool children evinced significant sleep impairment per their caregiver. Inter-rater agreement between caregiver's and children's reports for all sleep symptoms were below acceptable levels (range κ = 0.01-.13), indicating that the concordance rate for caregiver-child trauma-related sleep problems is quite low. Findings illustrate the relevance of sleep disturbances among trauma-exposed children and point to the need to assess both caregiver's and children's symptoms regarding sleep impairment.
Collapse
Affiliation(s)
- Rachel Wamser-Nanney
- Psychological Sciences, University of Missouri- St. Louis, St. Louis, MO 63121 USA
| | - Rebecca E. Chesher
- Psychological Sciences, University of Missouri- St. Louis, St. Louis, MO 63121 USA
| |
Collapse
|
45
|
Stover CS, Keeshin B. Research domain criteria and the study of trauma in children: Implications for assessment and treatment research. Clin Psychol Rev 2018; 64:77-86. [PMID: 27863803 PMCID: PMC5423862 DOI: 10.1016/j.cpr.2016.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 05/07/2015] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
By definition, the Diagnostic and Statistical Manual (DSM) diagnosis of posttraumatic stress disorder (PTSD) requires exposure to a traumatic event. Yet, the DSM diagnostic requirements for children and adolescents for PTSD may fail to capture traumatized youth with significant distress and functional impairment. Many important studies have utilized PTSD diagnosis as a mechanism for grouping individuals for comparative studies examining brain functioning, neuroendocrinology, genetics, attachment, and cognition; however, focusing only on those with the diagnosis of PTSD can miss the spectrum of symptoms and difficulties that impact children who experience trauma and subsequent impairment. Some studying child trauma have focused on examining brain and biology of those with exposure and potential impairment rather than only those with PTSD. This line of inquiry, complementary to PTSD specific studies, has aided our understanding of some of the changes in brain structure and neuroregulatory systems at different developmental periods following traumatic exposure. Application of the Research Domain Criteria (RDoC) framework proposed by NIMH to the study of child trauma exposure and subsequent impairment is an opportunity to examine domains of function and how they are impacted by trauma. Research to date has focused largely in the areas of negative valence, regulatory, and cognitive systems, however those studying complex or developmental trauma have identified an array of domains that are impacted which map onto many of the RDoC categories. This paper will review the relevant literature associated with child trauma as it relates to the RDoC domains, outline areas of needed research, and describe their implications for treatment and the advancement of the field.
Collapse
Affiliation(s)
- Carla Smith Stover
- University of South Florida, 13301 Bruce B. Downs Blvd., Tampa, FL 33647, Salt Lake City, Utah, United States.
| | | |
Collapse
|
46
|
Abstract
PURPOSE OF REVIEW Sleep-wake disorders occur in 10% to 28% of children and differ somewhat in pathophysiology and management from sleep-wake disorders in adults. This article discusses the diagnosis and management of key childhood sleep disorders. RECENT FINDINGS The role of sleep in memory consolidation and in the facilitation of learning has been increasingly recognized, even at the toddler stage. Cataplexy, a key feature of narcolepsy type 1, may be subtle in childhood and characterized by transient muscle weakness isolated to the face. Children with obstructive sleep apnea and restless legs syndrome display prominent neurobehavioral symptoms such as daytime inattentiveness and hyperactivity, so it is important to elicit a sleep history when these symptoms are encountered. Systemic iron deficiency occurs in about two-thirds of children with restless legs syndrome and is easily treatable. Parasomnias arising out of non-rapid eye movement (REM) sleep, such as confusional arousals and sleepwalking, may be difficult to distinguish from nocturnal seizures, and, in many cases, video-EEG polysomnography is required to differentiate between causes. SUMMARY Clinicians should routinely integrate the assessment of sleep-wake function into their practices of neurology and child neurology because of the opportunity to improve the quality of life of their patients.
Collapse
|
47
|
Abajobir AA, Kisely S, Williams G, Strathearn L, Najman JM. Childhood maltreatment and adulthood poor sleep quality: a longitudinal study. Intern Med J 2018; 47:879-888. [PMID: 28422454 DOI: 10.1111/imj.13459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 04/06/2017] [Accepted: 04/12/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Available evidence from cross-sectional studies suggests that childhood maltreatment may be associated with a range of sleep disorders. However, these studies have not controlled for potential individual-, familial- and environmental-level confounders. AIM To determine the association between childhood maltreatment and lower sleep quality after adjusting for potential confounders. METHODS Data for the present study were obtained from a pre-birth cohort study of 3778 young adults (52.6% female) of the Mater Hospital-University of Queensland Study of Pregnancy follow up at a mean age of 20.6 years. The Mater Hospital-University of Queensland Study of Pregnancy is a prospective Australian pre-birth cohort study of mothers consecutively recruited during their first obstetric clinic visit at Brisbane's Mater Hospital in 1981-1983. Participants completed the Pittsburgh Sleep Quality Index at the 21-year follow up. We linked this dataset to agency-recorded substantiated cases of childhood maltreatment. A series of separate logistic regression models was used to test whether childhood maltreatment predicted lower sleep quality after adjustment for selected confounders. RESULTS Substantiated physical abuse significantly predicted lower sleep quality in males. Single and multiple forms of childhood maltreatment, including age of maltreatment and number of substantiations, did not predict lower sleep quality in either gender in both crude and adjusted models. Not being married, living in a residential problem area, cigarette smoking and internalising were significantly associated with lower sleep quality in a fully adjusted model for the male-female combined sample. CONCLUSIONS Childhood maltreatment does not appear to predict young adult poor sleep quality, with the exception of physical abuse for males. While childhood maltreatment has been found to predict a range of mental health problems, childhood maltreatment does not appear to predict sleep problems occurring in young adults. Poor sleep quality was accounted for by concurrent social disadvantage, cigarette smoking and internalising.
Collapse
Affiliation(s)
- Amanuel A Abajobir
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Steve Kisely
- Faculty of Medicine, School of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, Department of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Gail Williams
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Lane Strathearn
- Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Iowa, Iowa City, Iowa, USA.,Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Jake M Najman
- Faculty of Medicine, School of Public Health, University of Queensland, Brisbane, Queensland, Australia.,Faculty of Humanities and Social Sciences, School of Social Sciences, University of Queensland, Brisbane, Queensland, Australia.,Queensland Alcohol and Drug Research and Education Centre, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
48
|
Morse AM, Garner DR. Traumatic Brain Injury, Sleep Disorders, and Psychiatric Disorders: An Underrecognized Relationship. Med Sci (Basel) 2018; 6:E15. [PMID: 29462866 PMCID: PMC5872172 DOI: 10.3390/medsci6010015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 12/28/2022] Open
Abstract
Traumatic brain injury (TBI) is commonplace among pediatric patients and has a complex, but intimate relationship with psychiatric disease and disordered sleep. Understanding the factors that influence the risk for the development of TBI in pediatrics is a critical component of beginning to address the consequences of TBI. Features that may increase risk for experiencing TBI sometimes overlap with factors that influence the development of post-concussive syndrome (PCS) and recovery course. Post-concussive syndrome includes physical, psychological, cognitive and sleep-wake dysfunction. The comorbid presence of sleep-wake dysfunction and psychiatric symptoms can lead to a more protracted recovery and deleterious outcomes. Therefore, a multidisciplinary evaluation following TBI is necessary. Treatment is generally symptom specific and mainly based on adult studies. Further research is necessary to enhance diagnostic and therapeutic approaches, as well as improve the understanding of contributing pathophysiology for the shared development of psychiatric disease and sleep-wake dysfunction following TBI.
Collapse
Affiliation(s)
- Anne M Morse
- Janet Weis Children's Hospital, Department of Pediatric Neurology and Sleep Medicine, Geisinger Medical Center, MC 14-12, 100 N Academy Blvd, Danville, PA 17822, USA.
| | - David R Garner
- Department of Pediatrics, Geisinger Medical Center, Danville, PA 17822, USA.
| |
Collapse
|
49
|
Wamser-Nanney R, Chesher RE. Trauma characteristics and sleep impairment among trauma-exposed children. CHILD ABUSE & NEGLECT 2018; 76:469-479. [PMID: 29268207 DOI: 10.1016/j.chiabu.2017.11.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/20/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Abstract
Trauma-related sleep difficulties are quite common and their functional and clinical importance are increasingly recognized. High rates of sleep problems have been documented among trauma-exposed adults, particularly those diagnosed with posttraumatic stress disorder (PTSD); however, research with trauma-exposed children is relatively limited. Research specifically with child samples is critical due to the numerous developmental and functional implications that may result from sleep impairment. Characteristics of the traumatic event may play a key role in understanding sleep difficulties, yet, these associations are not well understood among trauma-exposed children. The current study therefore investigated whether aspects of the traumatic event (i.e., type, nature, chronicity, age of onset, removal from home, and complex trauma) were related to higher levels of sleep disturbances among 276 treatment-seeking children ages 6-18 years (M = 10.88, SD = 3.39; 63.4% female; 62.7% Black). Sleep problems were common in this sample. Domestic and community violence exposure were associated with higher levels of select sleep difficulties, as were interpersonal trauma, chronic trauma, a trauma that began early in life, and complex trauma. Nonetheless, type of trauma and characteristics of the traumatic event were largely unrelated to sleep problems on either caregiver's or children's reports. Removal from the home was not linked with sleep impairment. Although findings signify the relevance of sleep disturbances among trauma-exposed children, trauma characteristics may have limited influence on sleep problems.
Collapse
Affiliation(s)
- Rachel Wamser-Nanney
- Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO 63121, United States.
| | - Rebecca E Chesher
- Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO 63121, United States
| |
Collapse
|
50
|
Hambrick EP, Rubens SL, Brawner TW, Taussig HN. Do sleep problems mediate the link between adverse childhood experiences and delinquency in preadolescent children in foster care? J Child Psychol Psychiatry 2018; 59:140-149. [PMID: 28862324 PMCID: PMC5775045 DOI: 10.1111/jcpp.12802] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are associated with multiple mental and physical health problems. Yet, mechanisms by which ACEs confer risk for specific problems are largely unknown. Children in foster care typically have multiple ACEs and high rates of negative sequelae, including delinquent behaviors. Mechanisms explaining this link have not been explored in this population. Impaired sleep has been identified as a potential mechanism by which ACEs lead to delinquency in adolescents, because inadequate sleep may lead to poor executive function and cognitive control - known risk factors for delinquency. METHODS Interviews were conducted with 516 maltreated children in foster care, ages 9-11 years, and their caregivers regarding child exposure to ACEs, sleep problems, engagement in delinquent acts, symptoms of posttraumatic stress disorder, and current psychotropic medication use. ACEs data were also obtained from child welfare case records. RESULTS After controlling for age, gender, race/ethnicity, placement type (residential, kin, foster), length of time in placement, posttraumatic stress symptoms, and current psychotropic medication use, sleep partially mediated the association between ACEs and delinquency. CONCLUSIONS Although delinquency is likely multiply determined in this population, improving sleep may be one important strategy to reduce delinquency.
Collapse
Affiliation(s)
- Erin P. Hambrick
- Department of Psychology, University of Missouri–Kansas City,The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine
| | | | | | - Heather N. Taussig
- The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine,Graduate School of Social Work, University of Denver
| |
Collapse
|