Sleep Problems In Youth Research Articles

Prazosin Treatment of Sleep Problems in Youth with PTSD

Post traumatic stress disorder (PTSD) is a condition characterized by reexperiencing symptoms, persistent avoidance, negative alterations in cognition and mood, and changes in arousal and reactivity in response to a traumatic event (American Psychiatric Association, 2013). The pathophysiology of PTSD is not fully understood but likely related to dysregulation of fear‐processing. Currently, the gold standard of treatment is trauma‐focused cognitive behavioral therapy (TF‐CBT). SSRIs are the only FDA‐approved pharmacologic treatments for PTSD in adults and there are no FDA approved medications to treat pediatric PTSD. Unlike studies in adults, double‐blinded randomized control trials (RCTs) did not show any efficacy for SSRIs in pediatric patients diagnosed with PTSD (Hudson et al., 2021). While estimates of pediatric PTSD prevalence varies, the prevalence of PTSD at age 18 is 7.8% (Rolling et al., 2023). Sleep disturbances such as insomnia, night‐time awakenings, and nightmares often persist despite treatment with TF‐CBT or SSRIs. Left untreated, sleep disturbances are predictive of PTSD persistence and comorbid psychiatric complications (Rolling et al., 2023). There is evidence supporting the use of the medication prazosin in alleviating pediatric PTSD sleep disturbances including nightmares and insomnia. Anywhere from 20–80% of children with PTSD report nightmares compared to a prevalence of 10–20% in the general pediatric population (Kovachy et al., 2013). There is a growing need for pharmacologic therapy given the paucity of providers trained in TF‐CBT and a need for symptomatic management. In this review, we will examine sleep disturbances in pediatric PTSD patients and discuss the feasibility of prazosin as an adjunct treatment option.

Sleep well, worry less: A co-design study for the development of the SMILE app.

With the coronavirus disease 2019 pandemic exacerbating mental health concerns, the prevalence rates of anxiety and sleep problems have increased alarmingly among youth. Although 90% of patients with anxiety experience sleep problems, current interventions for anxiety often do not target sleep problems in youth. Given this lack, we designed the SMILE app, an intervention that addresses both anxiety and sleep problems simultaneously. As users' perspectives are essential to ensure app engagement and uptake, the features, designs, and functions of the SMILE app were evaluated using a participatory app design approach. Participants (N = 17) were youth aged 15 to 25 who reported co-morbid anxiety and sleep issues above clinical thresholds. After completing an online screening survey assessing demographics, anxiety, and sleep problems, participants shared app feedback through group-based, semi-structured co-design sessions. Qualitative analyses were conducted to identify common themes from participants' feedback. While participants expressed enthusiasm for the SMILE app's features, particularly the Visualization, Journaling, and Psychoeducation features, and their variety, they criticized the design aspects of the app, such as the font and text amount. Most participants stated they would use the SMILE app or recommend it to a friend. By actively involving the target population in the design process, the SMILE app has the potential to notably improve the mental well-being of youth, though further research and development are required to realize this potential fully.

Executive Functioning, Language, and Behavioral Abilities Related to Obstructive Sleep Apnea in Down Syndrome.

Obstructive sleep apnea (OSA) is highly prevalent among individuals with Down syndrome (DS), and the nonphysiological consequences of OSA require examination to inform treatment planning. This study aimed to investigate the association between OSA and aspects of language, executive functioning, behavioral, social abilities, and sleep problems in youth with DS aged 6 to 17 years. Multivariate analysis of covariance was used to compare 3 groups adjusted for age, participants with DS with untreated OSA (n = 28), participants with DS without OSA (n = 38), and participants with DS with treated OSA (n = 34). To be eligible for the study, participants had to have an estimated mental age of 3 years. No children were excluded based on estimated mental age. After adjusting for age, participants with untreated OSA showed a common pattern of lower estimated marginal mean scores than those with treated OSA and those with no OSA in expressive and receptive vocabulary and higher estimated marginal mean scores with executive functions, everyday memory, attention, internalizing and externalizing behavior, social behavior, and sleep problems. However, only the group differences for executive function (emotional regulation) and internalizing behavior were statistically significant. Study findings corroborate and extend prior findings related to OSA and clinical outcomes for youth with DS. The study highlights the importance of OSA treatment in youth with DS and provides clinical recommendations for this population. Additional studies are necessary to control the effects of health and demographic variables.

Sleep Problems in Youth During COVID-19: A Narrative Review

Sleep Problems in Youth During COVID-19: A Narrative Review

3.6 Trauma and Sleep

The objectives are to: 1) describe the epidemiology of sleep problems in youth who have experienced acute and chronic trauma; 2) identify the proposed pathophysiology of insomnia and nightmares experienced by trauma survivors; and 3) outline the data supporting nonpharmacologic and pharmacologic treatments of nightmares and trauma-related insomnia.

0646 Sleep Disorders and Sleep Medication Use in Youth with Persistent Tic Disorders

Abstract Introduction Sleep disturbance is present in 80% of youth with persistent tic disorders (PTD). However, studies examining rates of sleep disorders in youth with PTD are limited, and reports on sleep medication use in this population are lacking. Such knowledge would inform understanding of assessment and treatment needs of youth with PTD. Therefore, the present study examined rates of sleep disorders and sleep medication use among youth with PTD, and their associations with tic severity and ADHD symptoms. Methods Participants were 52 parents of youth with PTD who responded to an internet survey evaluating sleep-wake patterns. Youth were predominantly male (n = 37, 72.5%); and 88.5% (n = 46) were reported to have Tourette’s disorder and 11.5% (n = 6) were reported to have persistent motor tic disorder. Parents provided demographics and medical history, including lifetime sleep disorder diagnosis by a health professional and current prescription or over-the-counter sleep medication use. Parents rated youth tic severity (Parent Tic Questionnaire) and ADHD symptom severity (Swanson, Nolan, and Pelham-IV Parent Rating Scale). Results Descriptive statistics and independent samples t-tests were performed. Per parent report, 39.2% (n = 20) of youth with PTD had one or more lifetime sleep disorders. Insomnia (n = 9, 17.3%), nightmares (n = 9, 15.7%), sleep walking (n = 5, 10.0%), bruxism (n = 5, 10.0%), and restless leg syndrome (n = 5, 10.0%) were most commonly endorsed. Fifty percent of parents of youth with PTD endorsed youth sleep medication use. The most commonly endorsed sleep medications were melatonin (n = 23, 44.2%), valerian (n = 6, 11.5%), and diphenhydramine (n = 5, 9.6%). There were no significant group differences in tic severity or ADHD symptom severity. Conclusion Findings highlight the presence of disorders of sleep initiation and maintenance, parasomnias, and sleep-related movement disorders in youth with PTD. Results indicate that sleep medication use, particularly melatonin, is common in this population. Future research is needed to test the efficacy of melatonin use for addressing sleep problems in youth with PTDs. Support (If Any) NIMH K23 MH113884 funding to Dr. Ricketts.

Improving Sleep in Youth With Mental Health Disorders: A Quality Improvement Project.

Sleep problems are prevalent among youth with mental health disorders. Consistent with national statistics, sleep problems were present in approximately 80% of the patients attending a children's hospital psychiatric partial hospitalization program in the Midwestern United States. The aim of this quality improvement (QI) project was to decrease sleep problems in youth with mental health disorders. The Pittsburgh Sleep Quality Index (PSQI) was administered to patients ages 12-18 with mental health disorders to screen for sleep problems. Patients identified by the PSQI as having a sleep problem, and their parents, were given verbal and written education on sleep hygiene practices and stimulus control. Each patient participated in a cognitive behavioral therapy group that included relaxation therapy. Evidence-based interventions used to improve sleep were reinforced daily by providers. Self-reported sleep quality, as measured by the PSQI, was improved in 95% of the patients participating in this QI project. Adequately screening for and treating sleep problems in youth with mental health disorders can lead to improved outcomes.

Predictors of Sleep-Problem Trajectories Across Adolescence.

Stress and sleep problems are significantly correlated in adolescents. Few longitudinal studies, however, have evaluated possible correlates and predictors of sleep problems at multiple points across adolescence. The current study examined the relation between stress and sleep problems across four years in a sample of adolescents who varied in risk for psychopathology. Participants included 223 adolescents (55% female) and 223 mothers (77% with a history of a mood disorder during their child's life). Youth were evaluated in grade 7 (M = 12.69years, SD = 0.61) and again in grades 8, 9, and 11. Sleep problems were assessed as part of a clinical interview, and weekly stressful events were measured with the Life Events Interview for Adolescents. Multi-group latent growth curve analyses were conducted. Among youth whose mothers had a history of depression (high-risk), sleep problems significantly increased over time (p < .001). Second, among high-risk youth, at each time point, higher stress levels during the prior three months significantly predicted higher levels of sleep problems (p < .001). Finally, across the entire sample, at each time point a greater level of sleep problems predicted higher stress ratings a year later (p ≤ .001). Thus, stress was a significant predictor of sleep problems across multiple years of adolescence, particularly among offspring of mothers with a history of depression. Results highlight targets for preventive interventions for sleep problems in youth.

Relationship of overweight and obesity to insomnia severity, sleep quality, and insomnia improvement in a clinically referred pediatric sample.

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.

Longitudinal Associations Between Parenting Practices and Youth Sleep Problems.

Sleep problems among youth are highly prevalent and associated with adjustment difficulties. When considering influences on youth's sleep, bidirectional links between youth's sleep health and family functioning have been suggested. Parenting practices are among the many familial factors that could be transactionally related to poor sleep in youth; however, research is lacking on potential longitudinal associations between parenting practices and sleep problems in youth. In addition, sensitive periods for this link are mostly unknown. The current study examined longitudinal relations between constellations of parenting practices and youth sleep health to identify profiles of parenting practices that are predictive of sleep problems in youth across different developmental stages. Participants were 292 parents (M = 36.51, SD = 7.3) of children between the ages of 3 and 14 years (M = 8.4, SD = 3.6). A person-centered approach was used to create profiles across traditionally labeled positive and negative parenting practices, as well as supportive and unsupportive parental emotion socialization strategies. Parenting profiles were then examined as longitudinal predictors of youth sleep problems. Findings revealed 3 distinct parenting profiles, which were differentially associated with sleep problems in youth, with the first profile predicting the lowest levels of sleep problems and the third profile predicting the highest levels of sleep problems, particularly among peripubertal youth. This study extends previous findings by elucidating distinct constellations of parenting practices that are differentially predictive of youth sleep problems and highlighting parenting among the various family processes that can longitudinally contribute to youth's sleep health.

Sleep disturbances in children with functional gastrointestinal disorders: demographic and clinical characteristics.

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.

Who sleeps better? Sleep patterns and sleep disturbances in adolescents with recurrent abdominal pain or inflammatory bowel disease and healthy controls

Background: Sleep difficulties play an important role in the maintenance and course of chronic abdominal pain disorders (RAP and IBD). Particularly among adolescents with inflammatory bowel diseases (IBD) or recurrent abdominal pain (RAP), adequate sleep seems to be important, as the diseases self and the associated symptoms can cause distress and impair daytime functioning. Hence it seems adequate to take a closer look concerning the sleep difficulties within the different conditions of abdominal pain especially in comparison to a healthy control. To our knowledge no former study compared sleep problems in youths with RAP and IBD as well as healthy controls. Thus the aim of the present study was to 1) evaluate sleep problems in the RAP and IBD and 2) compare the sleep problems of these abdominal pain diseases with a healthy control group. Methods: 129 adolescents (14-25 years) took part in the online survey, with 58 suffering from IBD, 23 had RAP and 48 healthy controls. Adolescents completed sleep questionnaires as PSQI, SDSC or NEQ. Data was analysed by conducting MANOVAs to test differences between the three groups followed by a post-hoc analyses. Results: Significant differences between both patient groups and healthy controls regarding sleep quality as well as sleep disturbances were found. Results indicate that especially young IBD patients suffered more often from poor sleep quality, sleep disturbances as well as daily effects of nightmares than the control group. The comparison of adolescents with RAP and healthy controls showed elevated scores concerning sleep disturbances for RAP patients. However, IBD and RAP adolescents did not differ significantly concerning most sleep measurements. Discussion: The study at hand was the first to compare adolescents with IBD and RAP regarding sleep difficulties. Adolescents with IBD and RAP have an impaired sleep quality as well as a higher rate of sleep disturbances and suffer from daily effects of nightmares than the control group. Therefore sleep disturbances should be also addressed when treating IBD and RAP patients to prevent further impairments.

Sleep as a mediator in the context of emotional problems in adolescents with IBD: A pilot study

Background: Sleep has an impact on daily life. Particularly among adolescents with IBD, adequate sleep seems to be important, as the disease itself and the associated symptoms can cause distress and impair daytime functioning. However, often parental and youth reports differ regarding perceived sleep problems of adolescents. Besides sleep problems, depression and anxiety are often prominent in young IBD patients. To date, the interplay between sleep, anxiety/depression symptoms and IBD is not fully understood. Therefore, the aim of this study was to (1) evaluate sleep problems in adolescents suffering from IBD, (2) compare adolescents’ sleep quality and impairments according to self- and parental reports, and (3) investigate the interaction between IBD symptomatology, emotional problems and sleep disturbances. Methods: 29 adolescents (age 10 - 22; M = 14.44 , SD = 1.78 ) with IBD and their parents took part in the study. Adolescents and parents completed questionnaires concerning sleep, emotional problems, and IBD symptomatology. Results: Especially overtiredness, insomnia symptoms, and nightmares play a prominent role regarding sleep problems in youths. Self-rated sleep problems and parental ratings were inconsistent, particularly for nightmares (Z = -2.12; p = .034). However, other ratings concerning emotional problems and sleep, especially anxiety and nightmares, were significantly related(r = .426, p = .034), even though we found no mediation effect for the association between IBD, nightmares and anxiety. Discussion: The present study revealed the importance of sleep and emotional well-being for adolescents suffering from IBD. Moreover, it became clear that the role of anxiety in youths suffering from IBD and sleep problems is not sufficiently answered yet. Not only emotional behavior but also sleep should be addressed when diagnosing IBD or during treatment of IBD. In addition, these results show the need for further investigation regarding the differences between parental and self-reports concerning sleep problems in young IBD patients.

Reciprocal Relationships Between Exposure to Community Violence and Sleep Problems Across Adolescence

Urban adolescents experience high rates of exposure to community violence, which is associated with sleep problems. However, less is known about the prospective relationships between community violence exposure and sleep problems across adolescence. This study investigated reciprocal relationships between community violence exposure and sleep problems across early, middle, and late adolescence. Participants included 84 urban adolescents (50% females, 95% African Americans) who reported on their community violence exposure and sleep problems at mean ages 13, 16, and 17. Results from an autoregressive latent trajectory model with structured residuals showed that exposure to community violence at age 13 predicted more sleep problems at age 16, but violence exposure at age 16 did not predict sleep problems at age 17. Sleep problems did not predict community violence exposure over time. These results point to early adolescence as a vulnerable period for the development of sleep problems in youth exposed to community violence.

Short communication: Self-reported sleep-wake disturbances preceding onset of full-threshold mood and/or psychotic syndromes in community residing adolescents and young adults

BackgroundInsomnia may predict onset of mental disorders in adults. However, it is unclear whether the same directional relationship exists during the peak age range for the onset of major mental disorders and/or whether other types of sleep-wake disturbance, such as hypersomnia, show similar associations. MethodsLongitudinal follow-up of >1800 community residing twins and non-twin siblings (mean age ~26; 57% female). Adjusted relative risk ratios and 95% confidence intervals (Adj RR and 95% CI) were estimated for onset of depression, hypomania and psychosis in individuals with prior self-reported exposure to Insomnia and/or Hypersomnia or proxies for insomnia disorder (Insomnia and Daytime Impairment) and atypical symptom profile (Hypersomnia and Anergia). ResultsRisk of onset differed somewhat according to type of syndrome and the nature of sleep-wake disturbance (e.g. Insomnia alone increased risk of first onset of psychosis). Overall, the risk for onset of any syndrome was best identified using composite measures (Adj RR were ~1.5–2.5) such as Insomnia and Hypersomnia, Insomnia and Daytime Impairment, or Hypersomnia and Anergia, rather than singular items describing night-time disruption only. ConclusionsThe magnitude of risk of onset of major mental health problems and the availability of effective, low-cost, individual and population-based interventions for sleep-wake disturbances, suggest that it is justifiable to introduce screening for and strategies to overcome sleep problems in youth.

Changes in Sleep Problems Across Attention-Deficit/Hyperactivity Disorder Treatment: Findings from the Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder Study.

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.

Associations among adolescent sleep problems, emotion regulation, and affective disorders: Findings from a nationally representative sample

Sleep problems in youth reliably forecast the development of anxiety and mood disorders, presumably due to increased emotional difficulties. However, precise emotional mechanisms have yet to be delineated. The current study investigated how sleep problems in adolescence are associated with different emotion regulation strategies, and how sleep and psychiatric risk may be indirectly associated via poor emotion regulation. This study utilized data from the National Comorbidity Survey-Adolescent Supplement, a nationally representative sample from the United States (N = 10,148; age range 13–18 years). A diagnostic interview determined if adolescents qualified for a mood or anxiety disorder within the past year. Participants provided reports of their sleep, emotion regulation, and current life stress. Adolescents who reported greater sleep problems were more likely to qualify for a mood or anxiety disorder and generally reported poorer emotion regulation strategy use, even when accounting for demographic characteristics and current stress. Specifically, adolescents with greater sleep problems reported less problem solving, and greater avoidance, suppression, rumination, and acceptance. Sleep problems were indirectly associated with anxiety disorders through greater suppression and rumination, and indirectly associated with mood disorders through greater rumination and lower problem solving. Although cross-sectional, this study extends current research by suggesting that certain emotion regulation strategies may be more difficult for youth struggling with sleep problems, and provides initial evidence that poor emotion regulation may be one factor contributing to sleep-based psychiatric risk. These findings can inform more efficacious intervention efforts.

The Effects of Sleep Problems on the Trajectory of Antisocial Behavior from Adolescence through Early Adulthood in Taiwan: Family Functioning as a Moderator.

To examine the longitudinal relationship between sleep problems and development of antisocial behavior from adolescence through young adulthood, and to investigate whether family functioning moderates the association being examined. Potential sex differences were also explored. A total of 2,491 adolescents participated in a prospective study spanning 2009 through 2014 in northern Taiwan. Measures included sleep problems, family functioning (parental support, family interaction, and family conflict), antisocial behavior, and other individual characteristics (sex, age, parental education, family economic stress, depressive symptoms, and stressful life events). Random coefficient growth models were used to test study hypotheses. Sleep problems were significantly and positively associated with antisocial behavior (B = 0.088 and 0.038 for males and females, respectively). Sex differences further emerged in the moderating effects of family functioning. Among males, those with high family interaction had a weaker association between sleep problems and antisocial behavior; among females, the examined association was weaker in those with high parental support. For both sexes, the association between sleep problems and antisocial behavior was stronger for those with high family conflict. Our findings highlight the robust link between sleep problems and adolescent antisocial behavior over time. We also show for the first time that the association depends on family functioning. Prevention methods and treatment of sleep problems in youths that incorporate family functioning may yield significant benefits for decreasing antisocial behavior. Sex-specific intervention and prevention approaches should also be considered.

Sleep Problems in Children with Attention Deficit/Hyperactivity Disorder: Current Status of Knowledge and Appropriate Management.

Attention deficit hyperactivity disorder (ADHD) affects approximately 5% of children and adolescents, and sleep problems are common in these patients. There is growing evidence informing the significant importance of sleep problems in youth with ADHD. The sleep problems in children with ADHD include specific sleep disorders and sleep disturbances due to comorbid psychiatric disorders or ADHD medications. The specific sleep disorders of ADHD children include behaviorally based insomnia, sleep-disordered breathing, and restless legs syndrome/periodic limb movement disorder. Current practices on the management of sleep problems for ADHD children are based mostly on expert consensus, whereas more evidence-based literature can be found only recently. Assessment of the sleep conditions in ADHD children before initiation of pharmacotherapy is the currently recommended guideline, and good sleep hygiene can be considered as the first-line treatment option. In addition to modifying the dose regimens, formulation, or alternative stimulants when sleep problems are encountered in ADHD children, atomoxetine, once daily guanfacine extended release, and melatonin are potential choices for ADHD children with more severe sleep problems. In this review, we aimed to provide the most updated information, preferably based on meta-analyses, systemic review, and randomized controlled trials published in the latest 3years, in order to be clinically useful for practitioners and clinicians.

Parent psychopathology as a mediator of the relationship between anxiety and sleep problems in children.

Sleep problems exert a negative impact on youths and their families. Parent and child mental health represent 2 posited, yet understudied, risk factors for sleep problems in youths. As such, this study sought to examine the role that parental psychopathology may play in mediating the relationship between child anxiety and sleep problems utilizing Internet sampling procedures. Parents (n = 83; 90.4% female) answered questions about their own mental health, and about their child's (n = 83; 77.1% female) anxiety and sleep. Analyses found that parent anxiety and stress mediated the relationship between child anxiety and sleep problems. This is the first study to examine the joint roles of parent psychopathology and child anxiety in explaining sleep problems in youths. Limitations notwithstanding, these results suggest that both parent- and child-level variables are important for developing a more comprehensive understanding of child sleep problems. Future areas of research are discussed.