The sleep patterns and problems of clinically anxious children

Childhood sleep problems have been associated with a range of adverse cognitive and academic outcomes, as well as increased impulsivity and emotional disorders such as anxiety and depression. The aim of the study was to examine subjective reports of sleep-related problems in children with anxiety disorders during school and weekend nights. Thirty-seven children with clinically-diagnosed anxiety disorders and 26 non-clinical children aged 7-12 years completed an on-line sleep diary to track sleep patterns across school nights and weekend nights. Anxious children reported going to bed significantly later (p = 0.03) and had significantly less sleep (p = 0.006) on school nights compared to non-anxious children. No significant differences in sleep onset latency, number of awakenings or time awake during the night, daytime sleepiness, or fatigue were found between the two groups. On the weekends, anxious children fell asleep quicker and were less awake during the night than on weeknights. School-aged anxiety disordered children showed a sleep pattern that differs from their non-anxious peers. Although the mean 30 min less sleep experienced by anxious children may initially seem small, the potential consequences on daytime performance from an accumulation of such a sleep deficit may be significant, and further investigation is warranted.     

A Systematic Review of Sleep Associations in Parents and Children

This systematic review aimed to examine sleep associations in a) typically developing children and their parents, and b) children with neurodevelopmental disorders and their parents. Literature search was conducted on PubMed, PsycINFO, EMBASE and Scopus databases for articles examining sleep associations between parents and children. Thirty studies were included in the final review. Based on the first aim, sleep associations between parents and typically developing children were observed for sleep quality, sleep duration and sleep efficiency. However, evidence for associations between sleepiness levels in parents and children and sleep schedules related to bedtime or waketime was limited. Based on the second aim, children with neurodevelopmental disorders and their parents reported greater sleep disturbances in comparison to typically developing children and their parents. The review concluded that sleep in parents and children is interrelated across a number of sleep parameters. It also revealed some preliminary evidence on bidirectionality in parent-child sleep, which warrants further examination. The review highlights the need to examine the mediating role of environmental factors on the interactions between parent-child sleep. Rigorous, longitudinal designs should be employed to explore the pathways through which parents may impact their children’s sleep and functioning and vice-versa.

     

父母物质惩罚对儿童睡眠质量的影响：主观幸福感的中介作用及友谊质量的调节作用

摘 要：为探讨父母物质惩罚与儿童睡眠质量的关系及其作用机制,采用问卷法对438名小学生进行调查。结果发现：（1）父母物质惩罚与儿童主观幸福感、睡眠质量之间呈现显著相关;（2）物质惩罚既能直接预测儿童睡眠质量,也能通过主观幸福感的中介作用预测睡眠质量;（3）友谊质量能在物质惩罚对儿童睡眠质量的中介中起到调节,对高友谊质量的儿童来说,物质惩罚对幸福感的作用不显著。研究结果揭示了作为物质型教养行为之一的物质惩罚对儿童睡眠质量的影响及其作用机制,能为提高儿童的幸福感及睡眠质量提供有效启示。     

Behavioral Sleep Problems in Children and Adolescents

Sleep problems in children and adolescents are common, and they impact multiple domains of child and family functioning. Psychologists have a critical role in the assessment and treatment of sleep problems and are integral to interdisciplinary sleep teams. Certain sleep problems may be related to co-morbid psychological or developmental conditions, and others are considered to be primarily medical, yet behavioral approaches may be applicable. There are also sleep problems considered to be behavioral in etiology (e.g. inadequate sleep hygiene, behavioral insomnia of childhood, nightmares/bad dreams/nighttime fears, delayed sleep phase syndrome, and psychophysiological insomnia). In this article, the assessment of behavioral sleep problems, as well as specific behavioral sleep disorders, and their treatments will be discussed.     

Parent-Led Exposure Therapy: A Pilot Study of a Brief Behavioral Treatment for Anxiety in Young Children

Despite prevalence rates as high as 9.4%, few studies have examined the applicability of cognitive-behavioral therapy for treatment of anxiety disorders in very young children (i.e., below the age of 7 years). The present study examined the preliminary efficacy of a parent-led exposure therapy protocol (PLET) designed for young children with anxiety disorders. Twenty-two youth aged 4–7 years and their parents participated in this pilot randomized control trial. Families of youth with significant anxiety concerns were randomized to either PLET (n?=?12), a 10 session/5-week family-based exposure therapy program designed to target anxiety in young children, or treatment as usual (TAU; n?=?10). Children in the PLET condition demonstrated a greater reduction in anxiety symptoms compared to TAU (d?=?3.18), with 90.91% of PLET participants (active condition) being classified as treatment responders at post-treatment as opposed to 0 in the TAU condition. Gains were maintained at 1 month-follow-up. Although pilot in nature, these data suggest in a preliminary fashion that a parent led exposure therapy protocol that is adapted appropriately for developmental age and incorporates an active coaching component for parents may be efficacious for the treatment of young children with anxiety disorders. This clinical trial was registered through clinicaltrials.gov under the following identifier: NCT02051192.     

Effects of White Noise on Off-Task Behavior and Sleep for Elementary-Age Students with ADHD

Abstract

Children with ADHD were administered 75?dB of continuous white noise during independent seat work in the classroom and during bedtime in their homes. Compared to baseline all three students exhibited decreases in off-task behavior. Off-task behavior returned to original baseline levels when white noise was removed and decreased again when reintroduced in classrooms. White noise also decreased bedtime sleep latency and spontaneous night wakings at home. Both sleep latencies and night wakings increased during return-to-baseline conditions. Surprisingly, when white noise was reintroduced only in the classrooms sleep improved a second time. White noise in classrooms with or without simultaneous treatment during sleep at night resulted in lower levels of off-task classroom behavior as well as less disruptive sleep. Results were independent of whether children were on ADHD medication. Children, teachers, and parents all rated white noise favorably.     

Exploring Socioeconomic Differences in Bedtime Behaviours and Sleep Duration in English Preschool Children

Children's sleep is critical for optimal health and development; yet sleep duration has decreased in recent decades, and many children do not have adequate sleep. Certain sleep behaviours (‘sleep hygiene’) are commonly recommended, and there is some evidence that they are associated with longer nighttime sleep. Parents of 84 British 3‐year‐old children were interviewed about their children's sleep and completed five‐night/four‐day sleep diaries documenting their children's sleep, from which daily sleep duration was estimated. Diaries were validated by actigraphy in a subgroup of children. Sleep hygiene behaviours (regular bedtime, reading at bedtime, falling asleep in bed) were associated with each other, and were more common in the high socioeconomic status compared to the low socioeconomic status group. Parents' reasons for not practicing sleep hygiene included difficulty, inability or inconvenience. Sleep hygiene behaviours were associated with significantly longer child sleep at night but not over 24 h. Longer daytime napping compensated for shorter nighttime sleep in children whose parents did not implement sleep hygiene behaviours. Parents may need to be advised that certain behaviours are associated with longer nighttime sleep and given practical advice on how to implement these behaviours. © 2014 The Authors. Infant and Child Development published by John Wiley & Sons, Ltd.     

Learning to sleep through the night: Solution or strain for mothers and young children?

Is the process of helping infants and young children learn to sleep through the night a solution to family sleep problems or does it exacerbate matters for mother and child? Retrospective and current accounts from a nonclinical, convenience sample of 102 mothers of preschool‐aged children provided information on sleep issues from early infancy through preschool age. Child, mother, and parenting characteristics, along with family sleep arrangements, were differentially related to the age at which children learned to sleep through the night and to the extent of difficulty that characterized this experience. Mothers who indicated more difficulty as their children learned to sleep through the night also reported more depressive symptoms and more strain in the mother–child relationship. Later age at sleeping through the night was more common among early bedsharers, but timing of sleeping through the night was not associated with preschool children's reported independence in several nonsleep domains. Sleep arrangements and the importance placed on sleeping through the night were the strongest contributors to variance explained in whether children learned to sleep through the night during infancy or toddlerhood. When advising parents about sleep interventions, practitioners should seek to understand whether families' parenting values fit their nighttime sleep practices.     

Immediate as well as delayed post learning sleep but not wakefulness enhances declarative memory consolidation in children

While there is mounting evidence for the importance of sleep for declarative memory consolidation in adults, so far this issue has not been investigated in children despite considerable differences in sleep duration and sleep architecture between children and adults. Here, 27 children (aged between 9 and 12yr) were examined on two conditions: on the Sleep-Wake condition, subjects learned word pairs in the evening and delayed recall was tested first in the next morning after sleep and then again in the following evening after daytime wakefulness. On the Wake-Sleep condition, learning took place in the morning and delayed recall was tested in the evening of the same day and again in the next morning after sleep. In both conditions retention of declarative memory was significantly increased only after an interval of sleep that either followed immediately after learning (as in the Sleep-Wake condition) or that followed after daytime wakefulness (as in the Wake-Sleep condition), respectively. The results support the hypothesis that sleep plays an active role in declarative memory consolidation even if delayed and further show for the first time the importance of sleep for declarative memory consolidation during childhood.     

A cross‐syndrome study of the differential effects of sleep on declarative memory consolidation in children with neurodevelopmental disorders

Sleep plays an active role in memory consolidation. Because children with Down syndrome (DS) and Williams syndrome (WS) experience significant problems with sleep and also with learning, we predicted that sleep‐dependent memory consolidation would be impaired in these children when compared to typically developing (TD) children. This is the first study to provide a cross‐syndrome comparison of sleep‐dependent learning in school‐aged children. Children with DS (n = 20) and WS (n = 22) and TD children (n = 33) were trained on the novel Animal Names task where they were taught pseudo‐words as the personal names of ten farm and domestic animals, e.g. Basco the cat, with the aid of animal picture flashcards. They were retested following counterbalanced retention intervals of wake and sleep. Overall, TD children remembered significantly more words than both the DS and WS groups. In addition, their performance improved following night‐time sleep, whereas performance over the wake retention interval remained stable, indicating an active role of sleep for memory consolidation. Task performance of children with DS did not significantly change following wake or sleep periods. However, children with DS who were initially trained in the morning continued to improve on the task at the following retests, so that performance on the final test was greater for children who had initially trained in the morning than those who trained in the evening. Children with WS improved on the task between training and the first retest, regardless of whether sleep or wake occurred during the retention interval. This suggests time‐dependent rather than sleep‐dependent learning in children with WS, or tiredness at the end of the first session and better performance once refreshed at the start of the second session, irrespective of the time of day. Contrary to expectations, sleep‐dependent learning was not related to baseline level of performance. The findings have significant implications for educational strategies, and suggest that children with DS should be taught more important or difficult information in the morning when they are better able to learn, whilst children with WS should be allowed a time delay between learning phases to allow for time‐dependent memory consolidation, and frequent breaks from learning so that they are refreshed and able to perform at their best.     

Severity of sleep problems in children with severe learning difficulties: Description and correlates

In this study we have examined the percentage occurrence of settling and waking problems and of sleeping in the parents' bed in a sample of children with sleep problems. We found that about two-thirds had settling problems, nearly nine-tenths had waking problems, and one-third slept regularly in their parents' bed. Parents of children with sleep problems were more likely to experience a range of family problems than were parents of children without problems, and they were more likely to report a range of symptoms of stress. Most children with settling problems took at least two hours to settle to sleep at night. This behaviour was mainly tolerated or accepted by the parents. Parents gave a variety of suggestions as to triggers for settling problems, from being upset during the day to fears, illness and alterations in routine. Most parents thought the underlying explanation was the child's intellectual impairment. Over half the children with waking problems woke up every night, while 85% woke up at least three nights a week. One-third woke up three or more times a night. About two-thirds took up to half an hour to resettle, with one-third taking up to an hour. Parents (mainly mothers) tended to get up to attend to the waking child. About half of the children were thought to need attention because of physical disabilities. Illness, alteration in routine, becoming ‘overtired’ and ‘upset’ were thought to trigger waking problems. Intellectual impairment was again seen as the more general underlying reason for waking problems. Very few children were receiving treatment for their problems—7% were receiving medication and one was receiving a behavioural programme. Few parents had a systematic bedtime routine for their child and few had a consistent agreed response to settling or waking problems. When we examined the relationship between certain family variables and severity of sleep problems a number of relationships were found. Sleep problem severity was related to maternal responsiveness, maternal stress, impact of the child on the family, maternal behaviour towards the child, maternal attitudes towards the child and marital satisfaction. Severity of sleep problems was also related to certain child characteristics. Children with more severe problems tended to present more problems in their daytime behaviour. Sleep problem severity was also found to be related to child communication skills. These findings, together with those from other pilot studies, suggest that using behavioural methods of managing sleep problems might prove a promising way forward.     

Hospitalization of Children with Cystic Fibrosis Adversely Affects Mothers’ Physical Activity,Sleep Quality,and Psychological Status

Having a child with a chronic disease can cause anxiety and depression, which may impair the sleep quality of mothers. The aim of this study was to compare physical activity level, sleep quality, anxiety and depression in mothers of hospitalized cystic fibrosis patients, cystic fibrosis outpatients and healthy controls. Twenty-three of the patients were hospitalized and 38 were outpatients and 37 age-matched healthy children served as controls. The mothers’ fatigue levels, sleep disturbances, stress levels and perceptions of their child’s disease severity were assessed with a Visual Analog Scale. The International Physical Activity Questionnaire, Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale were administered to the mothers of children. Mothers of hospitalized and outpatient cystic fibrosis children had significantly higher fatigue severity, sleep disturbance, and stress level according to Visual Analog Scale than mothers of healthy controls. All of International Physical Activity Questionnaire scores were significantly lower in cystic fibrosis patients’ mothers than healthy controls’. Hospital Anxiety and Depression Scale depression score, Pittsburgh Sleep Quality Index subdomains and total scores of hospitalized patients’ mothers were higher than those of the other two groups (p?<?0.05). Chronic illness in children with cystic fibrosis may impair the physical activity level, sleep quality and psychological state of their mothers, especially during hospitalization period.     

The role of physiological attention-focusing in the relaxation treatment of sleep disturbance,general tension,and specific stress reaction

Three experiments comparing the effects of muscle tension-release relaxation with vs without physiological attention-focusing and no-treatment on (a) sleep disturbance, (b) general tension, and (c) a variety of time estimation, heart rate perception, and stress reaction measures, are reported. The two relaxation conditions produced equivalent reductions in latency to sleep onset reports, suggesting the importance of tension-release in the relaxation treatment of sleep disturbance. Relaxation without physiological attention-focusing was unexpectedly superior to the other relaxation condition in reducing reported daily tension, supporting Denny's (1976) hypothesis that pervasive anxiety may be a function of anxiety conditioned to relaxation-produced cues. Sleep disturbed subjects over-estimated elapsed time, and relaxation training improved accuracy of time estimation. Several additional differences between sleep and tension subjects and among the three treatment conditions on physiological activity during stress are reported and discussed.     

Age attenuates noise and increases symmetry of head movements during sleep resting-state fMRI in healthy neonates,infants, and toddlers

Newborns produce spontaneous movements during sleep that are functionally important for their future development. This nuance has been previously studied using animal models and more recently using movement data from sleep resting-state fMRI (rs-fMRI) scans. Age-related trajectory of statistical features of spontaneous movements of the head is under-examined. This study quantitatively mapped a developmental trajectory of spontaneous head movements during an rs-fMRI scan acquired during natural sleep in 91 datasets from healthy children from ∼birth to 3 years old, using the Open Science Infancy Research upcycling protocol. The youngest participants studied, 2–3 week-old neonates, showed increased noise-to-signal levels as well as lower symmetry features of their movements; noise-to-signal levels were attenuated and symmetry was increased in the older infants and toddlers (all Spearman's rank-order correlations, P < 0.05). Thus, statistical features of spontaneous head movements become more symmetrical and less noisy from birth to ∼3 years in children. Because spontaneous movements during sleep in early life may trigger new neuronal activity in the cortex, the key outstanding question for in vivo, non-invasive neuroimaging studies in young children is not “How can we correct head movement better?” but rather: How can we represent all important sources of neuronal activity that shape functional connections in the still-developing human central nervous system?     

Sleep disturbance and neuropsychological function in young children with ADHD

Sleep disturbance, common among children with ADHD, can contribute to cognitive and behavioral dysfunction. It is therefore challenging to determine whether neurobehavioral dysfunction should be attributed to ADHD symptoms, sleep disturbance, or both. The present study examined parent-reported sleep problems (Children’s Sleep Habits Questionnaire) and their relationship to neuropsychological function in 64 children, aged 4–7 years, with and without ADHD. Compared to typically developing controls, children with ADHD were reported by parents to have significantly greater sleep disturbance—including sleep onset delay, sleep anxiety, night awakenings, and daytime sleepiness—(all p ≤ .01), and significantly poorer performance on tasks of attention, executive control, processing speed, and working memory (all p < .01). Within the ADHD group, total parent-reported sleep disturbance was significantly associated with deficits in attention and executive control skills (all p ≤ .01); however, significant group differences (relative to controls) on these measures remained (p < .01) even after controlling for total sleep disturbance. While sleep problems are common among young children with ADHD, these findings suggest that inattention and executive dysfunction appear to be attributable to symptoms of ADHD rather than to sleep disturbance. The relationships among sleep, ADHD symptoms, and neurobehavioral function in older children may show different patterns as a function of the chronicity of disordered sleep.     

MOTIVATING AUTISTIC CHILDREN THROUGH STIMULUS VARIATION

This study evaluated the differential effectiveness of two methods of presenting discrimination tasks when teaching autistic children. In a constant task condition, the common method of presenting a single task throughout a session was used. In a varied task condition, the same task was interspersed with a variety of other tasks from the children's clinic curricula. Results showed declining trends in correct responding during the constant task condition, with substantially improved and stable responding during the varied task condition. In addition, naive observers judged the children to be more enthusiastic, interested, happier, and better behaved during the varied task sessions. These results suggest that “boredom” may be a particularly important variable to control in the treatment of autistic children, and that particular care may be necessary when defining criteria for task acquisition. The results are discussed in relation to the literature on increased responsivity to stimulus novelty and variation.     

Parenting and toddler self-regulation in low-income families: What does sleep have to do with it?

Toddlerhood is a sensitive period in the development of self-regulation, a set of adaptive skills that are fundamental to mental health and partly shaped by parenting. Healthy sleep is known to be critical for self-regulation; yet, the degree to which child sleep alters interactive child–parent processes remains understudied. This study examines associations between observed parenting and toddler self-regulation, with toddler sleep as a moderator of this association. Toddlers in low-income families (N = 171) and their mothers were videotaped during free play and a self-regulation challenge task; videos were coded for mothers’ behavior and affect (free play) and toddlers’ self-regulation (challenge task). Mothers reported their child's nighttime sleep duration via questionnaire. Results revealed significant Sleep × Maternal Negative Affect and Sleep × Maternal Negative Control interactions. Children who did not experience negative parenting had good self-regulation regardless of their nighttime sleep duration. For children who did experience negative parenting, self-regulation was intact among those who obtained more nighttime sleep, but significantly poorer among children who were getting less nighttime sleep. Thus, among children who were reported to obtain less nighttime sleep, there were more robust associations between negative parenting and poorer self-regulation than among toddlers who were reported to obtain more sleep.     

The auditory sensory memory trace decays rapidly in newborns

The present study investigated the temporal dynamics of auditory sensory memory in newborns as reflected by the mismatch negativity (MMN), a preattentive electric change-detection response. MMN was obtained from 24 full-term healthy newborns who were either awake or asleep (quiet or active sleep) during the experiments. Stimuli were 1,000 Hz tones (standards) that were occasionally replaced by 1,100 Hz tones (deviants). The constant stimulus onset asynchrony (SOA) was, in separate blocks, either 450, 800, or 1,500 ms. A prominent MMN was obtained at the 800 ms SOA in all three sleep or waking states, whereas no MMN occurred at 450 and 1,500 ms SOAs. In view of the fact that in adults MMN is elicited even with a 10s SOA, these results imply that the time span of auditory memory is considerably shorter in neonates than in adults and 8-12-year-old children.     

Spontaneously Hypertensive Rats: Possible Animal Model of Sleep-Related Movement Disorders

Clinical experience suggests that restless legs syndrome (RLS), periodic leg movement (PLM), and attention-deficit hyperactivity disorder (ADHD) may co-occur in both children and adults. The purpose of the present study was to provide an electrocorticography and electromyography evaluation of the spontaneously hypertensive rat (SHR) to investigate the potential of this rat strain as an animal model of RLS–PLM. Initial work focused on evaluating sleep patterns and limb movements during sleep in SHR, having normotensive Wistar rats (NWR) as control, followed by comparison of two treatments (pharmacological–dopaminergic agonist treatment and nonpharmacological–chronic physical exercise), known to be clinically beneficial for sleep-related movement disorders. The captured data strengthen the association between SHR and RLS–PLM, revealing a significant reduction on sleep efficiency and slow wave sleep and an increase on wakefulness and limb movements for the SHR group during the dark period, as compared to the NWR group, effects that have characteristics that are strikingly consistent with RLS–PLM. The pharmacological and nonpharmacological manipulations validated these results. The present findings suggest that the SHR may be a useful putative animal model to study sleep-related movement disorders mechanisms.     

What drives sleep-dependent memory consolidation: Greater gain or less loss?

When memory is tested after a delay, performance is typically better if the retention interval includes sleep. However, it is unclear what accounts for this well-established effect. It is possible that sleep enhances the retrieval of information, but it is also possible that sleep protects against memory loss that normally occurs during waking activity. We developed a new research approach to investigate these possibilities. Participants learned a list of paired-associate items and were tested on the items after a 12-h interval that included waking or sleep. We analyzed the number of items gained versus the number of items lost across time. The sleep condition showed more items gained and fewer items lost than did the wake condition. Furthermore, the difference between the conditions (favoring sleep) in lost items was greater than the difference in gain, suggesting that loss prevention may primarily account for the effect of sleep on declarative memory consolidation. This finding may serve as an empirical constraint on theories of memory consolidation.