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Chapter 15 - Sleep Problems

from Part III - Family Intervention for Specific Child and Adolescent Mental Health Problems

Published online by Cambridge University Press:  18 February 2021

By
Gabrielle Rigney ,
Elizabeth Keys ,
Michelle Johnson ,
Jocelyn Paul  and
Penny Corkum
Edited by
Jennifer L. Allen ,
David J. Hawes  and
Cecilia A. Essau
Jennifer L. Allen
Affiliation:
University of Bath
David J. Hawes
Affiliation:
University of Sydney
Cecilia A. Essau
Affiliation:
Roehampton University, London
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Summary

One of the most common concerns for parents is their child’s sleep behaviour. Inadequate sleep can impact cognitive, behavioural and social-emotional functioning. There are predictable developmental changes that occur in sleep behaviour. It is important to know that sleep problems throughout childhood and adolescence are common and that there is a spectrum from sleep problems through to diagnosed sleep disorders. This chapter starts with a brief overview of what sleep is, how it is regulated, steps for assessment and theoretical underpinnings that aid in further understanding treatment principles for behaviourally based sleep problems (e.g., cognitive and behavioural theories and the 4-P model). Then a developmental framework is used to outline common behaviourally based sleep problems experienced across developmental stages and the range of family-based behavioural interventions that can be applied from infancy through to adolescence. Throughout the chapter, the impact of behaviourally based sleep problems on the family is considered. Finally, the role of the therapist in working with children experiencing behaviourally based sleep problems and the importance of implementing a core competencies approach are discussed.

Keywords

sleepbehaviorally-based sleep problemsinsomniasleep across developmenthealthy sleep practicesbehavioral sleep interventions
Type
Chapter
Information
Family-Based Intervention for Child and Adolescent Mental Health
A Core Competencies Approach
 , pp. 191 - 206
Publisher: Cambridge University Press
Print publication year: 2021

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References

Dewald-Kaufmann, J, de Bruin, E, Michael, G. Cognitive behavioral therapy for insomnia (CBT-I) in school-aged children and adolescents. Sleep Medicine Clinics 2019; 14(2):155–65.Google Scholar
Astill, RG, Van der Heijden, KB, Van Ijzendoorn, MH, Van Someren, EJ. Sleep, cognition, and behavioral problems in school-age children: A century of research meta-analyzed. Psychological Bulletin 2012; 138(6):1109–38.CrossRefGoogle ScholarPubMed
Owens, J. Insufficient sleep in adolescents and young adults: An update on causes and consequences. Pediatrics 2014; 134(3):e921.CrossRefGoogle Scholar
Dahl, RE, El-Sheikh, M. Considering sleep in a family context: introduction to the special issue. Journal of Family Psychology 2007; 21(1):1–3.CrossRefGoogle Scholar
Carskadon, M, Dement, W. Monitoring and staging human sleep. In: Kryger, M, Roth, T, Dement, C (eds.), Principles and Practice of Sleep Medicine, 5th ed. St. Louis: Elsevier Saunders, 2011, pp. 16–26.Google Scholar
Dattilo, M, Antunes, HK, Medeiros, A, et al. Sleep and muscle recovery: Endocrinological and molecular basis for a new and promising hypothesis. Medical Hypotheses 2011; 77(2):220–2.CrossRefGoogle ScholarPubMed
Borbely, AA. A two process model of sleep regulation. Human Neurobiology 1982; 1(3):195–204.Google Scholar
Czeisler, C, Duffy, J, Shanahan, T, et al. Stability, precision, and near-24-hour period of the human circadian pacemaker. Science 1999; 284(5423):2177–81.Google Scholar
Jenni, OG, Carskadon, MA. Sleep behavior and sleep regulation from infancy through adolescence: Normative aspects. Sleep Medicine Clinics 2007; 2(3):321–9.Google Scholar
Sadeh, A. Cognitive-behavioral treatment for childhood sleep disorders. Clinical Psychology Review 2005; 25(5):612–28.Google Scholar
Peterman, JS, Carper, MM, Elkins, RM, et al. The effects of cognitive-behavioral therapy for youth anxiety on sleep problems. Journal of Anxiety Disorders 2016; 37:78–88.Google Scholar
Meltzer, LJ, Mindell, JA. Systematic review and meta-analysis of behavioral interventions for pediatric insomnia. Journal of Pediatric Psychology 2014; 39(8):932–48.Google Scholar
Tikotzky, L, Sadeh, A. The role of cognitive-behavioral therapy in behavioral childhood insomnia. Sleep Medicine 2010; 11(7):686–91.CrossRefGoogle ScholarPubMed
Badin, E, Haddad, C, Shatkin, JP. Insomnia: The sleeping giant of pediatric public health. Current Psychiatry Reports 2016; 18(5):47–55.CrossRefGoogle ScholarPubMed
Blake, MJ, Sheeber, LB, Youssef, GJ, et al. Systematic review and meta-analysis of adolescent cognitive-behavioral sleep interventions. Clinical Child and Family Psychology Review 2017; 20(3):227–49.Google Scholar
Lane, JM, Jones, SE, Dashti, HS, et al. Biological and clinical insights from genetics of insomnia symptoms. Nature Genetics 2019; 51(3):387–93.Google Scholar
Oniszczenko, W, Rzeszutek, M, Stanislawiak, E. Affective temperaments, mood, and insomnia symptoms in a nonclinical sample. Behavioral Sleep Medicine 2019; 17(3):355–63.CrossRefGoogle Scholar
Palagini, L, Petri, E, Novi, M, et al. Adult insecure attachment plays a role in hyperarousal and emotion dysregulation in insomnia disorder. Psychiatry Research 2018; 262:162–7.Google Scholar
Giannotti, F, Cortesi, F, Sebastiani, T, Ottaviano, S. Circadian preference, sleep and daytime behaviour in adolescence. Journal of Sleep Research 2002; 11(3):191–9.CrossRefGoogle ScholarPubMed
Lemola, S, Perkinson-Gloor, N, Brand, S, et al. Adolescents’ electronic media use at night, sleep disturbance, and depressive symptoms in the smartphone age. Journal of Youth and Adolescence 2015; 44(2):405–18.Google Scholar
Wolfson, AR, Carskadon, MA. Understanding adolescent’s sleep patterns and school performance: A critical appraisal. Sleep Medicine Reviews 2003; 7(6):491–506.Google Scholar
Li, SX, Chan, NY, Man Yu, MW, et al. Eveningness chronotype, insomnia symptoms, and emotional and behavioural problems in adolescents. Sleep Medicine 2018; 47:93–9.Google Scholar
Sidani, S, Ibrahim, S, Lok, J, et al. Comparing the experience of and factors perpetuating chronic insomnia severity among young, middle-aged, and older adults. Clinical Nursing Research 2018; 10(15):1–24.Google Scholar
Bartel, KA, Gradisar, M, Williamson, P. Protective and risk factors for adolescent sleep: A meta-analytic review. Sleep Medicine Review 2015; 21:72–85.Google Scholar
Yen, CF, Ko, CH, Yen, JY, Cheng, CP. The multidimensional correlates associated with short nocturnal sleep duration and subjective insomnia among Taiwanese adolescents. Sleep 2008; 31(11):1515–25.CrossRefGoogle ScholarPubMed
Morgenthaler, T, Owens, J, Alessi, C, et al. Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep 2006; 29(10):1277–81.Google Scholar
Taylor, D, Roane, B. Treatment of insomnia in adults and children: A practice-friendly review of research. Journal of Clinical Psychology 2010; 66(11):1137–47.Google Scholar
Allen, SL, Howlett, MD, Coulombe, JA, Corkum, PV. ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations. Sleep Medicine Review 2016; 29:1–14.Google Scholar
Bessey, M, Aimee Coulombe, J, Corkum, P. Sleep hygiene in children with ADHD: Findings and recommendations. ADHD Report 2013; 21:1–7.Google Scholar
Owens, JA, Moturi, S. Pharmacologic treatment of pediatric insomnia. Child and Adolescent Psychiatric Clinics of North America 2009; 18(4):1001–16.CrossRefGoogle ScholarPubMed
Dias, C, Figeriredo, B, Rocha, M, Field, T. Reference values and changes in infant sleep-wake behaviour during the first 12 months of life: A systematic review. Journal of Sleep Research 2018; 27(5):e12654.Google Scholar
Tham, E, Schneider, N, Broekman, B. Infant sleep and its relation with cognition and growth: A narrative review. Nature and Science of Sleep 2017; 9:135–49.Google Scholar
Cook, F, Giallo, R, Hiscock, H, et al. Infant regulation and child mental health concerns: A longitudinal study. Pediatrics 2019; 143(3):e20180977.Google Scholar
Williams, K, Nicholson, J, Walker, S, Bethelsen, D. Early childhood profiles of sleep problems and self-regulation predict later school adjustment. British Journal of Educational Psychology 2016; 86(2):331–50.Google Scholar
Winsper, C, Wolke, D. Infant and toddler crying, sleeping and feeding problems and trajectories of dysregulated behavior across childhood. Journal of Abnormal Child Psychology 2014; 42(5):831–43.CrossRefGoogle ScholarPubMed
Chaput, JP, Gray, CE, Poitras, VJ, et al. Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Applied physiology, nutrition, and metabolism 2016; 41(6), S266–S282.Google Scholar
Cook, F, Mensah, F, Bayer, J, Hiscock, H. Prevalence, comorbidity and factors associated with sleeping, crying and feeding problems at 1 month of age: A community-based survey. Journal of Paediatrics and Child Health 2019; 55(6):644–51.CrossRefGoogle ScholarPubMed
Voltaire, S, Teti, D. Early nighttime parental interventions and infant sleep regulation across the first year. Sleep Medicine 2018; 52:107–15.CrossRefGoogle ScholarPubMed
Guillory, S. Predictors of infant sleep problems: Maternal psychosocial contributions. PhD dissertation, Mills College, Ann Arbor, MI, 2013.Google Scholar
Morrell, J. The role of maternal cognitions in infant sleep problems as assessed by a new instrument, the Maternal Cognitions About Infant Sleep Questionnaire. Journal of Child Psychology and Psychiatry 1999; 40(2):247–58.Google Scholar
Reader, J, Teti, D, Cleveland, M. Cognitions about infant sleep: Interparental differences, trajectories across the first year, and coparenting quality. Journal of Family Psychology 2017; 31(4):453–63.Google Scholar
Sadeh, A, Flint-Ofir, E, Tirosh, T, Tikotzky, L. Infant sleep and parental sleep-related cognitions. Journal of Family Psychology 2007; 21(1):74–87.Google Scholar
Tikotzky, L, Sadeh, A. Maternal sleep-related cognitions and infant sleep: A longitudinal study from pregnancy through the 1st year. Child Development 2009; 80(3):860–74.CrossRefGoogle ScholarPubMed
Sadeh, A, Juda-Hanael, M, Livne-Karp, E, et al. Low parental tolerance for infant crying: An underlying factor in infant sleep problems? Journal of Sleep Research 2016; 25(5):501–7.Google Scholar
Morales-Munoz, I, Partonen, T, Saarenpaa-Heikkila, O, et al. The role of parental circadian preference in the onset of sleep difficulties in early childhood. Sleep Medicine 2019; 54:223–30.Google Scholar
Millikovsky-Ayalon, M, Atzaba-Poria, N, Meiri, G. The role of the father in child sleep disturbance: Child, parent, and parent-child relationship. Infant Mental Health Journal 2015; 36(1):114–27.Google Scholar
Tikotzky, L, Sadeh, A, Glickman-Gavrieli, T. Infant sleep and paternal involvement in infant caregiving during the first 6 months of life. Journal of Pediatric Psychology 2011; 36(1):36–46.Google Scholar
Tikotzky, L, Sadeh, A, Volkovich, E, et al. Infant sleep development from 3 to 6 months postpartum: Links with maternal sleep and paternal involvement. Monographs of the Society for Research in Child Development 2015; 80(1):107–24.Google Scholar
Jian, N, Teti, D. Emotional availability at bedtime, infant temperament, and infant sleep development from one to six months. Sleep Medicine 2016; 23(Supp C):49–58.Google Scholar
Kim, B, Teti, D. Maternal emotional availability during infant bedtime: An ecological framework. Journal of Family Psychology 2014; 28(1):1–11.CrossRefGoogle ScholarPubMed
Teti, D, Kim, B, Mayer, G, Countermine, M. Maternal emotional availability at bedtime predicts infant sleep quality. Journal of Family Psychology 2010; 24(3):307–15.Google Scholar
Smith, J, Hardy, S, Hale, L, Gazmararian, J. Racial disparities and sleep among preschool aged children: A systematic review. Sleep Health 2019; 5(1):49–57.Google Scholar
Bryanton, J, Beck, C, Montelpare, W. Postnatal parental education for optimizing infant general health and parent-infant relationships. Cochrane Database of Systematic Reviews 2013; 11:CD004068.Google Scholar
Galland, B, Sayers, R, Cameron, S, et al. Anticipatory guidance to prevent infant sleep problems within a randomised controlled trial: Infant, maternal and partner outcomes at 6 months of age. BMJ Open 2017; 7:e014908.CrossRefGoogle Scholar
Hiscock, H, Cook, F, Bayer, J, et al. Preventing early infant sleep and crying problems and postnatal depression: A randomized trial. Pediatrics 2014; 133(2):e346–54.Google Scholar
Nikolopoulo, M, St James-Roberts, I. Preventing sleeping problems in infants who are at rise of developing them. Archives of Disease in Childhood 2003; 88(2):108–11.Google Scholar
Stremler, R, Hodnett, E, Lee, K, et al. A behavioral-educational intervention to promote maternal and infant sleep: A pilot randomized, controlled trial. Sleep 2006; 29(12):1609–15.Google Scholar
Stremler, R, Hodnett, E, Kenton, L, et al. Effect of behavioural-educational intervention on sleep for primiparous women and their infants in early postpartum: Multisite randomised controlled trial. British Medical Journal 2013; 346:1164.Google Scholar
Covington, L, Rogers, V, Armstrong, B, et al. Toddler bedtime routines and associations with nighttime sleep duration and maternal and household factors. Journal of Clinical Sleep Medicine 2019; 15(6):865–71.CrossRefGoogle ScholarPubMed
Mindell, J, Lee, C, Leichman, E, Rotella, K. Massage-based bedtime routine: Impact of sleep and mood in infants and mothers. Sleep Medicine 2018; 41:51–57.Google Scholar
Mindell, J, Telofski, L, Wiegand, B, Kurtz, E. A nightly bedtime routine: Impact on sleep in young children and maternal mood. Sleep 2009; 32(5):599–606.Google Scholar
Staples, A, Bates, J, Peterson, I. Bedtime routines in early childhood: Prevalence, consistency, and associations with nighttime sleep. Monographs of the Society for Research in Child Development 2015; 80(1):141–59.Google Scholar
Mindell, J, Leichman, E, Lee, C, et al. Implementation of a nightly bedtime routine: How quickly do things improve?. Infant Behavior and Development 2017; 49:220–7.Google Scholar
Kempler, L, Sharpe, L, Miller, CB, Bartlett, DJ. Do psychosocial sleep interventions improve infant sleep or maternal mood in the postnatal period? A systematic review and meta-analysis of randomised controlled trials. Sleep Medicine Reviews 2016; 29:15–22.Google Scholar
Hatch, B, Galland, B, Gray, A, et al. Consistent use of bedtime parenting strategies mediates the effects of sleep education of child sleep: Secondary findings from an early-life randomized controlled trial. Sleep Health 2019; 5(5):433–43.Google Scholar
Vriend, J, Corkum, P. Clinical management of behavioral insomnia of childhood. Psychology Research and Behavior Management 2011; 4:69–79.Google Scholar
Hirshkowitz, M, Whiton, K, Albert, SM, et al. National Sleep Foundation’s sleep time duration recommendations: Methodology and results summary. Sleep Health 2015; 1(1):40–43.Google Scholar
ParticipACTION. 2018. Available at www.participaction.com/en-ca.Google Scholar
Galland, BC, Short, MA, Terrill, P, et al. Establishing normal values for pediatric nighttime sleep measured by actigraphy: A systematic review and meta-analysis. Sleep 2018; 41(4):10.1093/sleep/zsy017.Google Scholar
Galland, BC, Taylor, BJ, Elder, DE, Herbison, P. Normal sleep patterns in infants and children: A systematic review of observational studies. Sleep Medicine Reviews 2012; 16(3):213–22.Google Scholar
Segura-Jiménez, V, Carbonell-Baeza, A, Keating, XD, et al. Association of sleep patterns with psychological positive health and health complaints in children and adolescents. Quality of Life Research 2015; 24(4):885–95.Google Scholar
Liu, X, Liu, L, Owens, JA, Kaplan, DL. Sleep patterns and sleep problems among schoolchildren in the United States and China. Pediatrics 2005; 115(Suppl 1):241–9.Google Scholar
Crabtree, V, Williams, N. Normal sleep in children and adolescents. Child and Adolescent Psychiatric Clinics of North America 2009; 14(4):799–811.Google Scholar
Liu, Y, Zhang, J, Li, SX, et al. Excessive daytime sleepiness among children and adolescents: Prevalence, correlates, and pubertal effects. Sleep Medicine 2019; 53:1–8.CrossRefGoogle ScholarPubMed
Simola, P, Laitalainen, E, Liukkonen, K, et al. Sleep disturbances in a community sample from preschool to school age. Child: Care, Health and Development 2012; 38(4):572–80.Google Scholar
Astill, RG, Van der Heijden, KB, Van Ijzendoorn, MH, Van Someren, EJ. Sleep, cognition, and behavioral problems in school-age children: A century of research meta-analyzed. Psychological Bulletin 2012; 138(6):1109–38.Google Scholar
Vriend, J, Davidson, F, Rusak, B, Corkum, P. Emotional and cognitive impact of sleep restriction in children. Sleep Medicine Clinics 2015; 10(2):107–15.Google Scholar
Davidson, F, Rusak, B, Chambers, C, Corkum, P. The impact of sleep restriction on daytime functioning in school-age children with and without ADHD: A narrative review of the literature. Canadian Journal of School Psychology 2018; 34(3):188–214.Google Scholar
Berger, RH, Diaz, A, Valiente, C, et al. The association between home chaos and academic achievement: The moderating role of sleep. Journal of Family Psychology 2019; 33(8):975–81.Google Scholar
Tampke, EC, Blossom, JB, Fite, PJ. The role of sleep quality in associations between peer victimization and internalizing symptoms. Journal of Psychopathology and Behavioral Assessment 2019; 41(1):25–35.Google Scholar
El-Sheikh, M, Kelly, RJ. Sleep in Children: Links with Marital Conflict and Child Development. New York: Oxford University Press, 2011, pp. 3–28.Google Scholar
Fuligni, AJ, Arruda, EH, Krull, JL, Gonzales, NA. Adolescent sleep duration, variability, and peak levels of achievement and mental health. Child Development 2018; 89(2):e18–28.Google Scholar
Chaput, JP, Janssen, I. Sleep duration estimates of Canadian children and adolescents. Journal of Sleep Research 2016; 25(5):541–8.Google Scholar
Tarokh, L, Saletin, JM, Carskadon, MA. Sleep in adolescence: Physiology, cognition and mental health. Neuroscience and Biobehavioral Reviews 2016; 70:182–8.Google Scholar
Hart, LC, Maslow, G. The medical transition from pediatric to adult-oriented care: Considerations for child and adolescent psychiatrists. Child and Adolescent Psychiatric Clinics of North America 2018; 27(1):125–32.Google Scholar
van Staa, AL, Jedeloo, S, van Meeteren, J, Latour, JM. Crossing the transition chasm: Experiences and recommendations for improving transitional care of young adults, parents and providers. Child: Care, Health and Development 2019; 37(6):821–32.Google Scholar
Honaker, SM, Meltzer, LJ. Sleep in pediatric primary care: A review of the literature. Sleep Medicine Review 2016; 25:31–9.Google Scholar
Boreman, CD, Thomasgard, MC, Fernandez, SA, Coury, DL. Resident training in developmental/behavioral pediatrics: Where do we stand? Clinical Pediatrics (Philadelphia) 2007; 46(2):135–45.CrossRefGoogle ScholarPubMed
Boerner, KE, Coulombe, JA, Corkum, P. Core competencies for health professionals’ training in pediatric behavioral sleep care: A Delphi study. Behavioral Sleep Medicine 2015; 13(4):265–84.Google Scholar
Sburlati, E, Schniering, C, Lyneham, H, Rapee, R. A model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders. Clinical Child and Family Psychology Review 2011; 14:89–109.Google Scholar
Saddichha, S. Diagnosis and treatment of chronic insomnia. Annals of Indian Academy of Neurology 2010; 13(2):94–102.Google Scholar
Meltzer, LJ, Mindell, JA. Systematic review and meta-analysis of behavioral interventions for pediatric insomnia. Journal of Pediatric Psychology 2014; 39(8):932–48.Google Scholar
Corkum, P, Weiss, S, Hall, W, et al. Assessment and treatment of behavioral sleep disorders in Canada. Sleep Medicine 2019; 56:29–37.Google Scholar
Rigney, G, Ali, NS, Corkum, PV, et al. A systematic review to explore the feasibility of a behavioural sleep intervention for insomnia in children with neurodevelopmental disorders: A transdiagnostic approach. Sleep Medicine Reviews 2018; 41:244–54.Google Scholar
Wantland, DJ, Portillo, CJ, Holzemer, WL, et al. The effectiveness of web-based vs. non-web-based interventions: A meta-analysis of behavioral change outcomes. Journal of Medical Internet Research 2004; 6(4):e40.Google Scholar
Zachariae, R, Lyby, MS, Ritterband, LM, O’Toole, MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia: A systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews 2016; 30:1–10.Google Scholar
Werner-Seidler, A, Wong, Q, Johnston, L, et al. Pilot evaluation of the Sleep Ninja: A smartphone application for adolescent insomnia symptoms. BMJ Open 2019; 9(5):e026502.Google Scholar
de Bruin, E, Bogels, F, Oort, F, Meijer, A. Improvements of adolescent psychopathology after insomnia treatment: Results from a randomized controlled trial over 1 year. Journal of Child Psychology and Psychiatry 2018; 59(5):509–22.Google Scholar
Corkum, PV, Reid, GJ, Hall, WA, et al. Evaluation of an internet-based behavioral intervention to improve psychosocial health outcomes in children with insomnia (Better Nights, Better Days): Protocol for a randomized controlled trial. JMIR Research Protocols 2018;7(3):e76.Google Scholar
Ali, N, Rigney, G, Weiss, SK, et al. Optimizing an eHealth insomnia intervention for children with neurodevelopmental disorders: A Delphi study. Sleep Health 2018; 4(2):224–34.Google Scholar
Sadeh, A, Mindell, J, Luedtke, K, Wiegand, B. Sleep and sleep ecology in the first 3 years: A web-based study. Journal of Sleep Research 2009; 18:60–73.Google Scholar
Iglowstein, I, Jenni, O, Molinari, L, Largo, R. Sleep duration from infancy to adolescence: Reference values and generational trends. Pediatrics 2003; 111(2):302–7.Google Scholar

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