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Ricketts EJ, Sturm A, McMakin DL, McGuire JF, Tan PZ, Smalberg FB, McCracken JT, Colwell CS, Piacentini J. Changes in Sleep Problems Across Attention-Deficit/Hyperactivity Disorder Treatment: Findings from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder Study. J Child Adolesc Psychopharmacol 2018; 28:690-698. [PMID: 30388029 PMCID: PMC7364298 DOI: 10.1089/cap.2018.0038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: Stimulant medication and behavior therapy are efficacious for youth with attention-deficit/hyperactivity disorder (ADHD). However, research suggests that stimulants may start and/or worsen sleep problems for youth. Further, the impact of behavior therapy for ADHD on sleep is unknown. This study examined the frequency of sleep problems and effects of stimulant medication, behavior therapy, and their combination on sleep problems in youth with ADHD. This study also explored the influence of dimensional baseline ratings of ADHD symptom subtype and psychiatric comorbidity on sleep outcomes. Methods: Participants were 576 children (aged 7-9 years) with ADHD-Combined type from the Multimodal Treatment of ADHD study that compared methylphenidate, behavior therapy, and their combination to community care. Before treatment, parents completed the Child Behavior Checklist used to derive a total sleep problems score. Parents also completed ratings of oppositionality and ADHD symptom severity, whereas youth completed ratings of depression and anxiety. These ratings were readministered after treatment. Results: General linear mixed-effects models were used to assess change in total sleep problems across treatment. The combined group exhibited a statistically significant reduction in total sleep problems (z = -5.81, p < 0.001). Reductions in total sleep problems in methylphenidate (z = -3.11, p = 0.05), behavior therapy (z = -2.99, p = 0.08), or community care (z = -1.59, p > 0.99) did not reach statistical significance. Change in psychiatric symptoms did not significantly moderate change in total sleep problems by treatment assignment. Greater baseline oppositional defiant disorder severity predicted less reduction in total sleep problems, χ2(1) = 3.86, p < 0.05. Conclusions: Findings suggest that combination of methylphenidate and behavior therapy is efficacious for reducing parent-reported sleep problems in young children with ADHD-Combined type relative to community care. However, potential ameliorative effects of monotherapy treatments (i.e., methylphenidate, behavior therapy) should be examined. Future replication is needed to confirm findings.
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Affiliation(s)
- Emily J. Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.,Address correspondence to: Emily J. Ricketts, PhD, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plz, Los Angeles, CA 90024
| | - Alexandra Sturm
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Dana L. McMakin
- Department of Psychology, Florida International University, Miami, Florida.,Department of Neurology, Nicklaus Children's Hospital, Miami, Florida
| | - Joseph F. McGuire
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Patricia Z. Tan
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Fallon B. Smalberg
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - James T. McCracken
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Christopher S. Colwell
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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Iwadare Y, Kamei Y, Usami M, Ushijima H, Tanaka T, Watanabe K, Kodaira M, Saito K. Behavioral symptoms and sleep problems in children with anxiety disorder. Pediatr Int 2015; 57:690-3. [PMID: 25754117 DOI: 10.1111/ped.12620] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 12/24/2014] [Accepted: 01/23/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sleep disorders are frequently associated with childhood behavioral problems and mental illnesses such as anxiety disorder. To identify promising behavioral targets for pediatric anxiety disorder therapy, we investigated the associations between specific sleep and behavioral problems. METHODS We conducted retrospective reviews of 105 patients aged 4-12 years who met the DSM-IV criteria for primary diagnosis of generalized anxiety disorder (n = 33), separation anxiety disorder (n = 23), social phobia (n = 21), or obsessive compulsive disorder (n = 28). Sleep problems were evaluated using the Children's Sleep Habits Questionnaire (CSHQ) and behavioral problems by the Spence Children's Anxiety Scale, Oppositional Defiant Behavior Inventory (ODBI), and Depression Self-Rating Scale for Children. RESULTS Depressive behavior was weakly correlated with CSHQ subscores for sleep onset delay and night waking but not with total sleep disturbance. Anxiety was correlated with bedtime resistance, night waking, and total sleep disturbance score. Oppositional defiance was correlated with bedtime resistance, daytime sleepiness, sleep onset delay, and most strongly with total sleep disturbance. On multiple regression analysis ODBI score had the strongest positive association with total sleep disturbance and the strongest negative association with total sleep duration. CONCLUSIONS Sleep problems in children with anxiety disorders are closely related to anxiety and oppositional defiant symptoms.
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Affiliation(s)
- Yoshitaka Iwadare
- Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
| | - Yuichi Kamei
- Department of Clinical Laboratory, National Center Hopsital, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Masahide Usami
- Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
| | - Hirokage Ushijima
- Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
| | - Tetsuya Tanaka
- Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
| | - Kyota Watanabe
- Department of Child and Adolescent Psychiatry, National Center for Global Health and Medicine, Kohnodai Hospital, Ichikawa, Japan
| | - Masaki Kodaira
- Department of Child and Adolescent Psychiatry, Aiiku Hospital, Minato, Japan
| | - Kazuhiko Saito
- Department of Child and Adolescent Psychiatry, Aiiku Hospital, Minato, Japan
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Willoughby MT, Mills-Koonce WR, Gottfredson NC, Wagner N. Measuring Callous Unemotional Behaviors in Early Childhood: Factor Structure and the Prediction of Stable Aggression in Middle Childhood. J Psychopathol Behav Assess 2014; 36:30-42. [PMID: 24729655 PMCID: PMC3979638 DOI: 10.1007/s10862-013-9379-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study sought to replicate the results of our earlier study, which were published in this Journal (Willoughby et. al 2011), that used mother-reported items from the Achenbach System of Empirically Based Assessment to develop a screening measure of callous unemotional (CU) behaviors for use with preschool-aged children. We further sought to extend those results by exploring the predictive validity of the CU measure with aggression trajectories in early-/mid-childhood. The current study involved secondary data analysis of the NICHD Study of Early Childhood and Youth Development (NICHD-SECCYD) dataset. Factor analyses included N = 1176 children who participated in the age 3 year assessment of the NICHD-SECCYD. Predictive models included N = 1081 children for whom four of the six possible teacher ratings of aggressive behavior were available from annual assessments spanning 1st-6th grades. Consistent with prior work, a three-factor confirmatory factor model, which differentiated CU from oppositional defiant (ODD) and attention deficit/hyperactive-impulsive (ADHD) behaviors, provided the best fit to the data. Among children with disorganized attachment status, the combination of high levels of mother-rated ODD behaviors and CU behaviors, was predictive of stable elevated levels of teacher-rated aggression from 1st-6th grade (predicted probability = .38, compared with a base rate of .07). These results demonstrate that CU behaviors can be reliably measured by parent report in young children and are dissociable from more commonly assessed dimensions of disruptive behavior. Three-year-old children who exhibit elevated levels of ODD and CU behaviors, and who have disorganized attachments, are at increased risk for exhibiting elevated levels of aggression across middle childhood. Results are discussed from the perspective of early assessment and intervention.
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Affiliation(s)
| | | | - Nisha C Gottfredson
- Transdisciplinary Prevention Research Center, Duke University, Durham, NC, USA
| | - Nicholas Wagner
- Center for Developmental Science, UNC-Chapel Hill, Chapel Hill, NC, USA
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