Treatment for Improving Sleep in Residential Setting

Children with overweight or obesity are more likely to experience sleep disorders, although the role of weight in pediatric insomnia treatment has not been examined. The current study examined the relationships of high body mass with pretreatment insomnia severity and global sleep problems and the potential moderating impact of weight on changes in insomnia severity following insomnia treatment. Participants included 1,133 youth ages 2-18 years clinically referred for insomnia treatment. The Pediatric Insomnia Severity Index was collected at the initial assessment and throughout treatment as part of routine clinical care. Treatment status was coded as no treatment, early termination, and completed treatment. Secondary measures of global sleep problems at the initial assessment included the Adolescent Sleep Wake Scale, Adolescent Sleep Hygiene Scale, and Children's Sleep Habits Questionnaire. Medical chart review of visits within ± 3 months of baseline was used to obtain age-adjusted and sex-adjusted body mass index Z-score. Among adolescents, regression analyses found that higher body mass index Z-score modestly predicted baseline insomnia severity (P = .021) and worse sleep hygiene (P < .001). For children, higher body mass index Z-score was modestly associated with baseline total sleep problems (P = .006) but not insomnia severity (P = .792). Across ages, body mass index Z-score predicted neither treatment status nor insomnia improvement (P > .05). Findings were similar in categorical analyses comparing patients with overweight/obesity to healthy weight. Although there is evidence that children of higher body mass present for insomnia treatment with greater sleep concerns, body mass does not predict treatment completion or insomnia improvement. Data suggest insomnia treatment is effective irrespective of weight status. Duraccio KM, Simmons DM, Beebe DW, Byars KC. Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample. J Clin Sleep Med. 2022;18(4):1083-1091.

Sleep problems in children with fetal alcohol spectrum disorders (FASD) are reportedly common but not well characterized. Objectives were to: (1) assess sleep concerns in children with FASD using a caregiver-report survey, the Children's Sleep Habits Questionnaire (CSHQ); (2) compare CSHQ results with those of previously reported community sample; and (3) describe pilot polysomnography findings in children with FASD. Children with FASD were recruited from a behavioral intervention study, and participating caregivers completed the CSHQ. CSHQ results were compared with the original data from a previously published community sample of similar age. Participants with FASD and elevated CSHQ scores were offered overnight polysomnography. Thirty-three children with FASD (4.1-12.1 years) were enrolled; 85% of children with FASD scored above the clinical cutoff Total Score of 41, reflecting marked sleep disturbance. Elevated subdomain scores occurred primarily in areas concerning for pediatric insomnia. Those with comorbid ADHD had elevated CSHQ on additional subdomains with no difference in Total Scores. Compared with the community sample, children with FASD had higher Total Scores on the CSHQ (52 vs. 39, p < 0.001). Polysomnography, completed in 5 subjects, revealed mild sleep disordered breathing and fragmented sleep with elevated non-respiratory arousal indices. Clinically significant sleep problems are present in children with FASD on both subjective and objective measures. Further investigation is needed to better describe these sleep disturbances and their impact on overall health and daytime neurobehavioral problems in this clinical population.

In this article, we studied whether pathways in substance use disorder (SUD) treatment differ among people admitted to residential versus ambulatory settings. We analyzed a retrospective cohort of 84,755 adults (ages ≥ 18) in Chilean SUD treatment during 2010-2019, creating a comparable sample of 11,226 pairs in ambulatory and residential treatment through cardinality matching. We used a nine-state multistate model, stratifying readmissions by baseline treatment outcome (i.e., completion vs. noncompletion) from admission to the third readmission. We estimated transition probabilities and lengths of stay in states at three-month, one-year, three-year, and five-year follow-ups. Sensitivity analyses tested different model specifications and estimated E-values. Patients in residential settings (vs. ambulatory) had greater treatment completion probabilities (difference at three months; 3.4% [95% CI: 2.9%, 3.9%]), and longer treatment retention (e.g., 1.6 days longer at three months, 95% CI: 0.8, 2.3). Patients in residential vs. ambulatory settings had higher first readmission probabilities regardless of baseline treatment outcome (e.g., three-month difference: 5.7% if completed baseline [95% CI: 4.4%, 7.0%] and 8.0% if did not complete baseline [95% CI: 6.7, 9.3%]). Third readmission probabilities were higher only among patients in residential settings with an incomplete baseline treatment (at least 3.7%; 95% CI: 0.2%, 7.3% at 1-year). Patients in residential settings at baseline were more likely to experience a second treatment and a third readmission among patients with incomplete treatments. Findings underscore the importance of completing initial SUD treatments to reduce readmissions. Residential treatments might require additional strategies to prevent readmissions.

Sleep research with adults with learning disabilities has been limited. This study considered the sleep problems experienced by adults with learning disabilities in two main sections, a survey and an intervention. The survey assessed the prevalence, nature and range of sleep problems experienced by adults with learning disabilities who live at home with their families, and investigated the relationship between sleep problems and daytime behaviour disturbance. The intervention part of the study considered whether daytime behaviour difficulties reduced following a successful sleep intervention, and whether carer stress was influenced by an improvement in sleep problems. Individuals with learning disabilities who live at home with their families had prevalence figures for sleep problems higher than those experienced by the general population. The relationship between sleep and behaviour problems was highly specific with settling problems predicting hyperactivity, lethargy, irritability and the overall score on behavioural measures. The interventions did not provide substantial evidence that sleep and behaviour were related, with only one of six participants demonstrating a decrease in behaviour problems following an improvement in sleep. Carer stress did not significantly reduce as a result of the intervention. The study has provided prevalence rates of sleep problems for a population which has not been previously studied. It concludes that the relationship between sleep and behaviour definitive conclusions can be drawn. The efficacy of behavioural interventions was demonstrated, and the clinical and theoretical implications of the results were considered.

Introduction This mixed-methods study sought to identify contributors to caregiver-reported child sleep improvements after receiving Sleep Well!, a behavioral sleep intervention for 1-5-year-olds, by examining (1) quantitative data from intervention sessions and (2) qualitative caregiver perceptions at post-intervention. Methods Forty-six caregiver-child dyads (caregivers: 96% mothers, 64% non-Latine Black, 40%≦high school education; children: 40% girls, 67% non-Latine Black) randomized to Sleep Well! completed a 3-session telehealth intervention. Interventionists completed fidelity forms to indicate session content implemented (intervention components, suggested strategies, handouts, homework) and rated family engagement using a Likert scale item. Forty-two caregivers also completed post-intervention ratings of child sleep problems (Brief Child Sleep Questionnaire item, primary trial outcome) and semi-structured qualitative interviews, coded using thematic analysis. Child sleep improvements were dichotomized into “resolved sleep problem” versus “small to severe problem.” Quantitative analyses (chi-square and t-tests) assessed relationships between session content, interventionist-rated engagement, and sleep problem resolution, while qualitative themes were stratified by sleep problem resolution status. Results A total of 64% (n=27) of dyads reported post-intervention sleep problem resolution. Intervention components, suggested strategies, handouts, and homework were not associated with sleep problem resolution. There was a moderate (d=0.69) difference in reporting of a resolved sleep problem based on interventionist-rated engagement, with higher engagement ratings for caregivers reporting a resolved sleep problem, although this did not reach statistical significance, p=.10. Furthermore, qualitative themes of strong intervention-related acceptability, cultural humility, and positive feedback did not differ according to whether the caregiver quantitatively reported a resolved child sleep problem. However, caregivers reporting a resolved child sleep problem qualitatively reported feeling well-equipped with tools from the intervention to manage child sleep, whereas those with an unresolved child sleep problem qualitatively expressed less confidence managing child sleep, citing their child’s behavior as a challenge to sleep improvements. Conclusion Although caregivers reporting an unresolved child sleep problem after Sleep Well! participation qualitatively expressed positive intervention feedback, they also described less confidence in sleep strategies and more challenging child behaviors. Additional research is needed to develop more personalized strategies to address caregiver-reported challenging child behaviors, confidence in intervention strategies, and intervention engagement. Support (if any) K23HD094905 (AAW)

Research indicates a deleterious effect of sleep disturbances on pain and illness-related functioning across pediatric populations. Sleep problems in youth with functional gastrointestinal disorders (FGIDs) are understudied, despite studies in adult FGIDs indicating sleep disruptions increase pain and symptom severity. This study sought to better characterize sleep problems in school-age children with FGIDs and to assess relationships with demographic characteristics and gastrointestinal symptoms. Sixty-seven children with FGIDs (pediatric Rome IV criteria) and 59 parents completed questionnaires assessing sleep problems, and children completed a 2-week pain/stooling diary. Sleep problems in this sample were compared with published normative samples, and children above and below the clinical cutoff were compared on demographics and FGID symptoms. Of the sample, 61% were above the clinical cutoff for sleep disturbances, with significantly greater bedtime resistance, sleep onset delay, sleep duration, and daytime sleepiness than the comparison group. Children above the clinical cutoff reported greater mean abdominal pain severity and pain interference. Relative to White participants, Black/African-American participants were more likely to be above the clinical cutoff and indicated more frequent night wakening and symptoms of sleep-disordered breathing, but lower maximum and overall mean abdominal pain severity. Sleep problems in children with FGIDs are common and related to greater day-to-day abdominal pain severity and pain interference. Results suggest sleep-pain relationships may differ across racial/ethnic groups. Assessing sleep in children with FGIDs is important, and further research is needed to assess underlying mechanisms and evaluate sleep as a potential treatment target in this population.

Behavioural interventions are frequently used to address sleep problems in people with intellectual disabilities (ID). The current study aimed to systematically review evidence on the efficacy of behavioural interventions for children and adults with ID and sleep problems. Electronic and hand searches identified seven studies for inclusion (N = 169). Standardised mean difference effect sizes (d) were calculated for group studies (N = 4). Non-overlap effect sizes (Tau-U) were calculated for single case experimental design studies (SCEDs; N = 3). A large effect size (weighted d = 0.923, confidence interval: 0.705 to 1.151) across group studies indicated large improvements in sleep problems following behavioural intervention. Effect size across SCEDs (weighted Tau-U: 0.528, confidence interval: 0.351 to 0.705) indicated a 53% improvement compared with baseline. Sleep initiation and sleep maintenance problems showed significant improvements post-intervention. Follow-up effects were less consistent across study designs and suggested that some sleep problems maintain gains better than others. Meta-analytic evidence from group and SCEDs can provide complementary information about efficacy. Findings propose that behavioural interventions are a promising evidence-based practice for improving sleep problems in people with ID.

Increasing resilience through promotion of healthy sleep among service members.

Impairment of vision is associated with a loss of function in activities of daily living. Avoidance of physical activity and consequent reduced functional capacity is common in older people with visual impairment and an important risk factor for falls. Indeed, the rate of falls and fractures is higher in older people with visual impairment than age-matched visually normal older people. Depression and anxiety is common in older people with vision impairment and leads to further restriction of activity, reduced social contact and reduced quality of life. Possible mechanisms to reduce activity restriction and therefore improve mobility and activity include environmental and behavioural interventions delivered by a number of health professionals, including occupational therapists. The objective of this review was to assess the effectiveness of environmental and behavioural interventions in reducing activity limitation and improving quality of life amongst visually impaired older people. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to November 2012), EMBASE (January 1980 to November 2012), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (January 1937 to November 2012), Allied and Complementary Medicine Database (AMED) (January 1985 to November 2012), OT Seeker (inception to November 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 9 November 2012. Randomised controlled trials (RCTs) and quasi-randomised controlled trials (Q-RCTs) that compared environmental interventions, behavioural interventions or both, versus control (placebo control or no intervention or usual care), and trials comparing different types of environmental or behavioural interventions, in older people (aged 60 and over) with irreversible visual impairment living independently or in residential settings. To be eligible for inclusion the primary aim of studies must be reducing physical activity limitation and must include a measure of physical activity. Secondary outcome measures included falls, fear of falling, quality of life. Two authors independently read abstracts retrieved by the search to identify eligibility and study quality. We contacted study authors for additional information. Our searches found no RCTs or Q-RCTs that met the eligibility criteria for this review. We are unable to reach any conclusion about the effectiveness of environmental or behavioural interventions for reducing physical activity limitation in community-dwelling visually impaired older people, as no eligible studies were found. However a number of studies reviewed included only the secondary outcome measures of this review. Although behavioural interventions delivered by occupational therapists have been shown to reduce the rate of falls, we are unable to conclude if this is due to reduced activity restriction (increased mobility) or reduced activity (lessening exposure to risk). There are inconclusive and conflicting results from trials evaluating the effectiveness of behavioural and environmental interventions aimed at improving quality of life. Further research is necessary (such as ongoing Dutch and UK trials considering the effectiveness of orientation and mobility training on activity restriction, physical activity, falls, fear of falling and quality of life in older adults with low vision, and the effect of an occupational therapist delivering home safety modification, coping strategies and exercise with older people with low vision) before any conclusions can be reached.

While sleep problems in people with intellectual disabilities (ID) living in residential settings are very common, scant attention is paid to them. This study examined how to improve the knowledge and understanding of sleep quality and sleep problems in people with ID among care staff at a residential facility and, consequently, to reduce extrinsic sleep problems. Using a variation on a crossover design with two groups, sleep efficiency and sleep latency in people with ID (not suspected of having sleep problems) were measured four times. One group (Group A) of staff was offered a lecture after the first measurement and a workshop after the second one. A second group (Group B) of staff was only offered a lecture, between the second and third measurements. In both groups, sleep efficiency rose significantly. The time spent in bed by residents overseen by Group A was reduced significantly, and there was a significant reduction of daily napping time among group A's residents. In Group B, there was a significant increase of daily napping time and in the number of naps. The application of educational techniques, such as lectures and workshops, provided to staff can lead to significant improvements in residents' sleep efficiency.

Sleep problems such as bedtime difficulties, frequent night waking and excessive daytime sleepiness are prevalent in children with epilepsy. In the present study, functional assessment of sleep onset problems in two young children with epilepsy was performed. Effects of bedtime fading and antipsychotic medication (pipamperon) in a 6-year-old boy, and melatonin in an 8-year-old girl were assessed on sleep latency. Treatment resulted in a marked decrease in sleep latency in both cases and effects were maintained after three months. Keywords: Sleep problems, epilepsy, developmental disabilities, bedtime fading, melatonin, anti-psychotic medication. Introduction Children with developmental disabilities are at increased risk for developing sleep problems. Several studies have shown that sleep problems are much more prevalent in children with developmental disabilities than in their nondisabled peers. An important risk factor for developing sleep problems is the presence of a seizure disorder. An association between sleep problems and epilepsy has been found in correlational (see e.g., Didden, Korzilius, Van Aperlo, Van Overloop, & De Vries, 2002; Quine, 1991) and quasi-experimental studies (see e.g., Stores, Wiggs, & Campling, 1998). Stores et al. compared sleep behaviors of 79 children with mild forms of epilepsy with healthy children from the general population matched for age and gender. They found that, compared to their controls, children with epilepsy showed significant higher rates of sleep disorder symptoms, especially those suggesting poor sleep quality and sleep-related anxieties. More recently, in a sample of 66 children with different types of epilepsy De Moor, Didden, Korzilius & Renier (in preparation) found that: (a) children with epilepsy have more sleep problems than those in a control group, (b) type of epilepsy was related to sleep problems (e.g. children with maligne epilepsy showed more sleep fragmentation than those with other types of epilepsy), and (c) sleep problems were positively related to severity of epileptic attacks. Furthermore, they found that both the severity of epilepsy and daytime problem behaviors were positively associated with sleep problems. Results of the above studies show that children with epilepsy are at increased risk for developing sleep problems. In most, if not all cases, both the presence of sleep problems and epilepsy have detrimental effects on the well-being of the child and his or her parent(s). Children may show daytime fatigue, irritability and hyperactivity and noncompliance. Furthermore, sleep problems, and especially sleep deprivation is associated with decreased cognitive functioning and learning during academic tasks. Many parents report fatigue and symptoms of depression as a result of longstanding sleep problems in their child. Given the adverse consequences of sleep problems, assessment and treatment are warranted. Undoubtedly, scientific knowledge about the treatment of sleep problems in children with developmental disabilities has increased during the past decades. Chronic sleep problems in children with developmental disabilities are usually complex, in that such problems may be caused by psychological and/or medical factors. Treatment of sleep problems includes various behavioral methods, such as stimulus control and sleep hygiene, extinction, sleep restriction, bedtime fading and chronotherapy. Medically oriented treatment include treatment of physical cause of sleep problems (e.g., reflux, pain), surgery (e.g., removal tonsils and adenoids in case they cause airway obstruction) and pharmacological approaches (e.g., melatonin, sedative medication) (for a review, see Didden & Sigafoos, 2001). It is recommended that a functional assessment of the sleep problems be conducted to identify possible relationships between disruptive sleep behaviors and parental management techniques (Didden, Curfs, Van Driel, & De Moor, 2002). …

Sleep problems are a commonly reported complaint for individuals with an intellectual or developmental disability (DD), with prevalence generally exceeding that reported for individuals in the general population. Nevertheless, while there has been an increase in interest in sleep problems in children with autism spectrum disorder (ASD), sleep research in very young children and older adolescents and adults with ASD and sleep research in other DDs remains sparse. This review examines articles investigating sleep in DDs, including behavioural and melatonin interventions, published during 2012 and most of 2013, evaluating their contribution. Overall, the majority of publications concern sleep in ASD, and there remains a lack of research examining aetiology, impact and intervention for sleep difficulties in populations of individuals with other DDs. This is disappointing, given the high prevalence of sleep difficulties in DD populations and the negative impact they are known to have on individuals and their families.

School psychology arguably began in the 1880s in the University of Pennsylvania laboratory of Lightner Witmer (Noell & Witt, 1996). Through the next 100 years, school psychology grew larger in scope, becoming recognized within the American Psychological Association (APA) and founding its own organization, the National Association of School Psychologists in 1969. As the need for school psychologist grew, so did the need for an effective, efficient service delivery model. Bergan's, Behavioral Consultation (BC) model became the widely accepted, indirect service delivery model used in public school settings. Interestingly, the model has undergone few changes since its unification in the late 1970s (see Bergan, 1977). Noell & Witt (1996) argued that the model has undergone few changes because it was primarily a model to deliver scientifically derived interventions and therefore the empirical evidence was specific to intervention, not to consultation. Thus, the emphasis was on the client (i.e., student) and not the consultee (i.e., staff). To be sure, this emphasis places the locus of control for behavior change (i.e., response-to-intervention) within the student, not the student's environment. As such, Witt, Noell, LaFleur & Mortenson (1997) began a line of investigation that focused BC directly on consultee behavior and considered the consultee as the instrument for behavior change in the client. With the addition of Performance Feedback, Witt et. al. (1997) added intervention implementation fidelity to the BC model and shifted the locus of control for behavior change, to the student's environment. Performance Feedback (PFB) has been described as Information provided to individuals about the quantity or quality of their past performance (Prue & Fairbank, 1981). Witt et. al. (1997) modified PFB procedures derived from Organizational Psychology to school settings and intervention implementation fidelity of evidence-based interventions. In that study, the authors developed academic interventions that included an end-of-intervention assessments that functioned as evidence that the interventions were completed (i.e., permanent products). A task analysis with checklist was included in the intervention packet. The teacher was asked to check off which intervention components were completed each day the intervention was implemented. The task list and the end-of-intervention assessment were indications of intervention fidelity adherence. These two permanent products were then used to graph the number of steps completed by the total number of steps in the prescribed intervention (task analysis checklist) and graph the student end-of-intervention assessment data. Then, the authors met with the teachers on a daily basis to present the graphs, provided positive statements when the interventions were completed, and discuss how implementation fidelity could be achieved when implementation adherence was low. Follow-up studies investigated the use of PFB when the intervention used peer tutors (Noell, Witt, LaFleur, Mortenson, Ranier, & LeVelle, 1997), when PFB was delivered on a weekly basis (Mortenson and Witt, 1998), with behavioral interventions (Noell, Duhon, Gatti, & Connell, 2002) in residential settings (Jones, Wickstrom & Friman, 1997) and with direct-care staff (Reedy, Luiselli & Thibedeau, 2001), in comparison to other consultation models (Noell, et., al., 2005), within a response-to-intervention pre-referral meeting (Duhon et. al. 2009), and in autistic support classrooms (Pellecciah et. al., 2010). However, investigating the use of PFB in home settings where the barriers to implementing the procedures derived from the studies above are unknown. Program fidelity is greatly needed in home settings because many parents/guardians are confronted with significant concurrent responsibilities and demands and stay-at-home caregivers have far less support than school-based staff. …

BackgroundTo delineate sleep habits and problems in children with 22q11.2 deletion syndrome (22q11DS).MethodsThirty children, age 1–15 (mean 6.8) years, participated in the study, which was an internet‐based anonymous survey of parents of children with 22q11DS administered via the 22q11.2 Foundation. The main outcome was the Childhood Sleep Habits Questionnaire (CSHQ).ResultsScores on the CSHQ demonstrated clinically significant sleep problems in 29 of the 30 children. When compared with previously reported normative values for typically developing children of the same age, children with 22q11DS had significantly greater sleep problems. Only 30% of children had previously undergone sleep study. While about half of children had tried a medication for sleep, it usually was not felt to be helpful. In contrast, parents reported that behavioral interventions, such as consistent bedtime routine and appropriate sleep environment, were helpful. This is one of the first studies to specifically address sleep problems other than obstructive sleep apnea in children with 22q11DS.ConclusionsThe findings suggest children with 22q11DS may have a higher risk of experiencing clinical sleep problems, compared to typically developing children. Consideration of additional screening and treatment of sleep disorders in children with 22q11DS is warranted.

Behavioural sleep problems are common in children with autism spectrum disorder (ASD); however, evidence for the efficacy of behavioural sleep interventions is limited. This study examined the efficacy of a brief behavioural sleep intervention in autistic children. It was hypothesised that the intervention would reduce overall child sleep problems (primary outcome), in addition to improvements in children's social, emotional, cognitive, academic functioning, and quality of life, and parent/caregivers' stress, quality of life, and mental health (secondary outcomes). A randomised controlled trial was conducted with participants randomised via a computer-generated sequence to the sleeping sound intervention (n = 123) or treatment as usual (n = 122) group. Participants comprised 245 children with an ASD diagnosis. Inclusion criteria were as follows: confirmation of DSM IV or DSM-5 diagnosis of ASD, participants aged between 5 and 13 years and parent/caregiver report of moderate-severe sleep problems. Exclusion criteria were as follows: parent/caregiver intellectual disability or lacking sufficient English to complete questionnaires; and child participant with co-occurring medical conditions known to impact sleep. The intervention group received the sleeping sound intervention (2 × 50-min face-to-face sessions plus follow-up phone call) by a trained clinician. Change in children's sleep problems was measured by the Children's Sleep Habits Questionnaire (CSHQ) at 3 months post randomisation. Parents/caregivers of children in the intervention group reported a reduction in child sleep problems at 3 months post randomisation (effect size: E.S -0.7). There were also small effects in a number of child (internalising symptoms, emotional behavioural disturbance and quality of life) and parent/caregiver (mental health, parenting stress and quality of life) outcomes; however, these did not remain significant when controlling for multiple comparisons. The sleeping sound ASD intervention is an efficacious and practical way to reduce sleep problems for autistic children. This brief behavioural intervention has the potential to be embedded easily into the Australian healthcare system.