Journal of Pediatric Psychology - recent issues

Treating Oppositional Defiant Disorder in Primary Care: A Comparison of Three Models

2008-05-02

Objective To determine if a nurse-led or psychologist-led parent-training program was more successful than a minimal intervention in treating early childhood Oppositional Defiant Disorder (ODD) in pediatric primary care. Methods Twenty-four practices were randomized to conditions in which parents of 117, 3- to 6.11-year-olds with ODD received the 12-session Webster-Stratton Incredible Years program led by primary care nurses or clinical psychologists, or to a minimal intervention group in which parents received only the companion book to the treatment program. Results There was improvement across posttreatment and 12-month follow-up for all groups, but no overall treatment group effects. There was a dose effect, with a reliable, clinically significant gain after seven sessions on the Eyberg intensity scale, and nine sessions on the Child Behavior Checklist externalizing scale. Conclusions There is little advantage to the therapist-led treatment over bibliotherapy unless parents attend a significant number of sessions.

Predictor and Moderator Effects in the Treatment of Oppositional Defiant Disorder in Pediatric Primary Care

2008-05-02

Objective To examine predictors and moderators of parent-training outcomes for treatment of Oppositional Defiant Disorder (ODD) in pediatric primary care. Methods Parents of 117 children with ODD, ages 3–6 years, seen in primary care received either a minimal intervention bibliotherapy treatment (MIT), or a 12-session parenting program led by a nurse or psychologist. Results More initial total life stress, parenting distress, internalizing problems, functional impairment, and difficult temperament were associated with more improvement, but families scoring lower on those variables had fewer behavior problems at posttreatment and follow-up. Gender was a significant moderator, with more improvement for girls than boys in the nurse-led group but more improvement for boys than girls in the MIT group. Less well-educated mothers treated by psychologists showed the greatest change. Conclusions Predictors and moderators may play a role in deciding, which families receive a particular form of treatment for ODD in primary care.

A Randomized Controlled Trial of a Mother-Infant or Toddler Parenting Program: Demonstrating Effectiveness in Practice

Hayes, L., Matthews, J., Copley, A., Welsh, D. — 2008-05-02

Objective Describes outcomes of an intervention aimed to improve infant or toddler care and reduce parental distress. Methods A randomized controlled trial method was used with 118 mothers. Participants were allocated to an intervention group (n = 65) or an enhanced waitlist group (n = 53). Measures were taken at pre-, post-, and 6-weeks follow-up. Results Results demonstrated that mothers who attended the program reported improvement in depression, anxiety, stress, parental satisfaction, and decreases in problematic child behavior. Improvements were maintained at the 6-week follow up. Intention-to-treat analysis replicated the results, although with smaller effect sizes. Conclusions The results of this study demonstrate that delivery of a 1 day intervention for distressed mothers can contribute to lower levels of parental distress and child problem behavior. Given the importance of early mother–child relationships and the limited number of well-controlled studies on brief interventions this result is of significance to researchers and the service community.

Body Size Stigmatization: An Examination of Attitudes of African American Preschool-Age Children Attending Head Start

Margulies, A. S., Floyd, R. G., Hojnoski, R. L. — 2008-05-02

Objective To assess body size stigmatization attitudes (BSSA), their effect on friendship selection, and controllability beliefs in a sample of African American preschool-age children of low socioeconomic status. Methods Participants included 76 children attending Head Start. Children completed an adjective task, a friendship selection task, and a controllability task. Results On the adjective task, the Overweight figure received significantly more negative mean ratings than the Underweight figure; however, there were no significant differences between the mean ratings for the Overweight and Average figures or the Average and Underweight figures. On the friendship selection task, children preferred the Average or Underweight figures as playmates and friends. On the controllability task, greater control was associated with the Overweight figure than the Underweight figure. Conclusion Results suggest that BSSA may be present in a sample of African American preschool-age children of low socioeconomic status. These attitudes may influence friendship selection and controllability beliefs.

Parent and Adolescent Distribution of Responsibility for Diabetes Self-care: Links to Health Outcomes

Helgeson, V. S., Reynolds, K. A., Siminerio, L., Escobar, O., Becker, D. — 2008-05-02

Objective To examine the relation of adolescent and parent responsibility distribution for diabetes self-care to psychological and physical health. Methods We interviewed children (mean age 12 years) annually for 3 years and asked parents to complete a questionnaire. Both reported how diabetes self-care was distributed in the family. Amount of responsibility held by the child only, the parent only, and shared between child and parent was calculated. Psychological distress, competence, and diabetes outcomes were assessed at each wave. Results In both cross-sectional and longitudinal (lagged) analyses, multilevel modeling showed that shared responsibility was consistently associated with better psychological health, good self-care behavior, and good metabolic control, whereas child and parent responsibility were not. In some cases, links of shared responsibility to health outcomes were stronger among older adolescents. Conclusions These findings highlight the importance of shared responsibility for diabetes self-care through early to middle adolescence.

Mediators of Depressive Symptoms in Children with Type 1 Diabetes and their Mothers

Jaser, S. S., Whittemore, R., Ambrosino, J. M., Lindemann, E., Grey, M. — 2008-05-02

Objective To examine the relationships among maternal and child depressive symptoms and child and family psychosocial factors. Method Secondary analysis of baseline data for a coping skills intervention for school-age children (ages 8–12) with type 1 diabetes (T1D) and their mothers. Children and mothers completed measures of depressive symptoms, coping, quality of life, and family functioning. Results There was a strong relationship between maternal and child depressive symptoms (r = .44, p < .001). Maternal depressive symptoms were negatively related to child quality of life, perceptions of coping, and family functioning. Impact of diabetes on quality of life, finding coping with diabetes upsetting, and family warmth mediated the relationship between maternal and child depressive symptoms. Conclusions Maternal depression may negatively affect child adjustment through its influence on quality of life, coping, and family functioning. Implications for interventions to improve psychosocial adjustment in children with T1D are discussed.

Psychosocial Adjustment, Health-Related Quality of Life, and Psychosexual Development of Boys with Hypospadias: A Systematic Review

Schonbucher, V. B., Weber, D. M., Landolt, M. A. — 2008-05-02

Objective A systematic review of studies on psychosocial adjustment, HRQoL (health-related quality of life), and psychosexual development of boys with hypospadias. Methods Research was conducted on several online bibliographic databases. Articles were selected on the basis of predefined criteria. Methodological quality was assessed by two independent reviewers who applied a standardized checklist. When possible, data analyses were performed by calculating effect sizes. Results Thirteen studies met the criteria for inclusion, whose methodological standard ranged from low to high quality. None of them has focused on HRQoL. Findings with regard to psychosocial and psychosexual adjustment were inconsistent, though they clearly showed that boys with hypospadias suffer from negative genital appraisal and sexual inhibitions. Overall, medical factors exerted a rather small influence. Psychosocial risk factors have hardly been examined so far. Conclusions The identification of psychosocial risk factors in methodologically sound studies is necessary to guarantee a comprehensive treatment for boys with hypospadias.

Factors Related to Changes in Cognitive, Educational and Visual Motor Integration in Children who Undergo Hematopoietic Stem Cell Transplant

Barrera, M., Atenafu, E., Andrews, G. S., Saunders, F. — 2008-05-02

Objectives Investigate cognitive, educational, and perceptual motor skills up to 2 years posttransplant of pediatric hematopoietic progenitor cell transplantation (HPCT) survivors and their correlates. Methods Survivors were assessed at baseline, 12, and 24 months after transplant. Results Performance IQ improved over time and was negatively related to maternal depression. Full IQ and educational outcomes were positively related to child's age and mother's age. Low depression scores were associated with high Verbal IQ one and 2 years post-HPCT, and with high visual motor scores 2 years post-HPCT. Poor educational outcomes were related to increased time since diagnosis. Two years post-HPCT, Performance IQ and Processing Speed were above the norm values whereas arithmetic and motor scores were below. Conclusions Pediatric HPCT survivors do better cognitively than educationally. Maternal age and depression, child's age, and time since diagnosis are critical factors for these outcomes.

A Developmental Perspective on Functional Somatic Symptoms

Beck, J. E. — 2008-05-02

Objective To provide a new approach for conceptualizing and studying functional somatic symptoms (FSS) in children and adolescence. Methods A developmental model is proposed based on the synthesis of the extant literature and previous theoretical perspectives of FSS in children and adolescents. Results Multiple risk and protective factors from child, familial, social, and environmental domains, the interactions across risk domains, and potential developmental pathways of FSS are identified. Conclusions This article underscores the necessity of taking a broader, developmental view of FSS. The tenets of developmental psychopathology emphasize the utility of viewing FSS on a continuum of severity rather than as a discrete entity or diagnosis. This article concludes with directions for future research and treatment implications.

Introduction to the Special Issue: Sleep in Children with Neurodevelopmental and Psychiatric Disorders

Owens, J., Palermo, T. — 2008-04-01

The Interplay of Sleep Disturbance, Anxiety, and Depression in Children

Chorney, D. B., Detweiler, M. F., Morris, T. L., Kuhn, B. R. — 2008-04-01

Objective To review and critically evaluate the association between sleep, anxiety, and depression in children and provide recommendations for future research. Methods A literature search was conducted using MEDLINE and PsychINFO computerized databases and bibliographies of relevant articles. Results A surprisingly small but growing research base exists on the relation between sleep disturbance, anxiety, and depression in pediatric populations. Existing research indicates a significant symptom overlap between anxiety, depression, and sleep. This overlap may complicate proper assessment and treatment of children with these disorders. Conclusions Future research should ensure adequate assessment for symptoms of anxiety and depression when examining sleep disturbance in children. Likewise, research on anxiety and depression should include assessment for symptoms of disturbed sleep. Bridging the gap between these literatures should provide further insights into the etiologies of these disorders, increase symptom detection, and improve the clinical care of children and their families.

Web Survey of Sleep Problems Associated with Early-onset Bipolar Spectrum Disorders

Lofthouse, N., Fristad, M., Splaingard, M., Kelleher, K., Hayes, J., Resko, S. — 2008-04-01

Objective As research on sleep difficulties associated with Early-Onset Bipolar Spectrum Disorders (EBSD) is limited, a web-based survey was developed to further explore these problems. Methods 494 parents of 4-to-12 year-olds, identified by parents as being diagnosed with EBSD, completed a web survey about past and current EBSD-related sleep problems. The survey included Children's Sleep Habits Questionnaire (CSHQ) items and sleep problems from the International Classification of Sleep Disorders 2nd edition. Results Nearly all parents reported some type of past or current EBSD-sleep problem. Most occurred during a worst mood period, particularly with mixed manic-depressive symptoms. Symptoms caused impairments at home, school, or with peers in 96.9% of the sample and across all three contexts in 64.0% of children. Sleep problems were also noted after three-day weekends and Spring and Fall Daylight Savings time changes. Conclusions Findings, study limitations, and implications for treatment and etiology are discussed.

Caffeine Consumption, Sleep, and Affect in the Natural Environments of Depressed Youth and Healthy Controls

2008-04-01

Objective Sleep problems are a cardinal symptom of depression in children and adolescents and caffeine use is a prevalent and problematic issue in youth; yet little is known about caffeine use and its effects on sleep in youth with depression. We examined caffeine use and its relation to sleep and affect in youth's natural environments. Methods Thirty youth with major depressive disorder (MDD) and 23 control youth reported on caffeine use, sleep, and affect in their natural environment using ecological momentary assessment at baseline and over 8 weeks, while MDD youth received treatment. Results Youth with MDD reported more caffeine use and sleep problems relative to healthy youth. Youth with MDD reported more anxiety on days they consumed caffeine. Caffeine use among youth with MDD decreased across treatment, but sleep complaints remained elevated. Conclusions Findings suggest that both sleep quality and caffeine use are altered in pediatric depression; that caffeine use, but not sleep problems, improves with treatment; and that caffeine may exacerbate daily anxiety among youth with depression.

Acute Impact of Immediate Release Methylphenidate Administered Three Times a Day on Sleep in Children with Attention-Deficit/Hyperactivity Disorder

Corkum, P., Panton, R., Ironside, S., MacPherson, M., Williams, T. — 2008-04-01

Objective To determine the impact of immediate release Ritalin, given three times a day, on sleep quality and quantity in medication-naïve, newly diagnosed children with attention-deficit/hyperactivity disorder (ADHD). Methods Children (aged 6–12) rigorously diagnosed with ADHD (n = 21) underwent multiple measurement assessments (i.e., actigraphy, sleep diary, and questionnaires) during a 1-week baseline and then during a 3-week blinded randomized medication trial. Results Although the medication was effective in reducing ADHD symptoms, analyses of actigraphy and sleep diary data found statistically and clinically significant changes in the children's total sleep time and sleep onset latency in the medication compared to the no medication conditions. No effects on sleep were found based on the sleep questionnaire. Conclusions Physicians and parents are encouraged to closely monitor children's sleep when treating ADHD with stimulant medication.

Brief Report: Sleep in Parents of Children with Autism Spectrum Disorders

Meltzer, L. J. — 2008-04-01

Objective To examine sleep quality and sleep–wake patterns in parents of children with autism spectrum disorders (ASDs) and parents of typically developing (TD) children. Methods Thirty-five mothers and 22 fathers completed the Pittsburgh Sleep Quality Index, a 7-day sleep diary, and wore an actigraph for 1 week. Results Parents of children with ASDs reported poorer sleep quality compared to the TD group. In addition, parents of children with ASDs had objectively different sleep patterns, with an earlier wake time and shorter total sleep time than parents of TD children. Finally, regardless of group, fathers had significantly shorter sleep time compared to mothers. Conclusions This study is one of the first to demonstrate poorer sleep quality and shorter sleep quantity in parents of children with ASDs using validated measures of sleep. Future studies should examine the relationship between chronic sleep loss and stress in parents of children with ASDs.

Sleep Quality in Young Adults with Very Low Birth Weight--the Helsinki Study of Very Low Birth Weight Adults

2008-04-01

Objective To assess the relationship between very low birth weight (VLBW; <1,500 g) and quality and amount of sleep in young adults. Methods We compared 89 VLBW and 78 term-born 19- to 26-year-old adults, by actigraphy and the Basic Nordic Sleep Questionnaire. Results There were no group differences in sleep quality or amount (p's >.15), although VLBW adults went to bed on average 36 min earlier (95% confidence interval 6–66 min). Shorter gestational age was related to longer sleep latency both within VLBW (standardized regression coefficient β = –.36, p =.040) and term-born adults (β = –.25, p =.029). Conclusion Adults with VLBW had similar quality and amount of sleep as those born at term, although VLBW adults went to bed earlier, suggesting an advanced sleep phase. Within each group, a lower gestational age was related to a longer sleep onset.

Sleep Difficulties in Infants at Risk for Developmental Delays: A Longitudinal Study

Scher, A., Tse, L., Hayes, V. E., Tardif, M. — 2008-04-01

Objectives We compared the sleep of infants at risk for neuromotor delays to that of infants without such risks, and examined the predictive validity of risk indicators to the development of sleep problems. Methods Conveniently recruited infants (n = 142) were assessed for neuromotor achievements and sleep behaviors at 4–6 months and 10–12 months of age. Assessment tools were the Harris Infant Neuromotor Test and Morrell's Infant Sleep Questionnaire. Based on a cumulative risk index, three groups were defined: higher risk (n = 28), lower risk (n = 42), and no risk (n = 72). Results At both ages, the sleep scores were similar among the groups. In the no risk and lower risk group, sleep difficulties decreased with age, while for infants in the higher risk group, more difficulties were reported over time. Overall, the neuromotor attainments were not related to sleep fragmentation or settling difficulties. Conclusions In a diverse sample of infants, with and without risks for developmental delays, overall, sleep patterns were similar. It appears that the neuromotor achievements are not associated with sleep-wake regulation, as measured by caregivers’ report.

Commentary: Comparing Actigraphy and Parental Report as Measures of Children's Sleep

Sadeh, A. — 2008-04-01

Single Parents of Children with Chronic Illness: An Understudied Phenomenon

2008-04-01

Objective To examine the chronic illness literature and evaluate the impact on single parenting and children and adolescents with chronic illness. Methods We conducted literature reviews of relevant research pertaining to single-parent families on PubMed, Medline, and PsychINFO and also surveyed pertinent book chapters and all of the articles from the Journal of Pediatric Psychology since 1987 for articles, specifically examining the potential associations of single (lone) parenting versus two-parent households on children's psychosocial functioning and the impact of the child's illness on caregiver functioning. Results While the literature has examined and discussed the stressors associated with parenting a child with an illness, including the impact of illness on finances, family roles, and caregiver burden, few studies have examined single parents of children and adolescents with chronic illnesses and related stressors stemming from being a lone caregiver. Conclusions There is a dearth of studies examining the association between lone parenting and psychosocial functioning among children and adolescents with chronic illnesses. Specific questions necessitating future investigation are summarized and recommendations are made for future research in this important area of inquiry.

Parental Distress, Family Functioning, and Social Support in Families with and without a Child with Neurofibromatosis 1

2008-04-01

Objective To compare parental adjustment, social support, and family functioning between families of children with neurofibromatosis 1 (NF1) and a group of demographically similar comparison families, and to examine the impact of disease severity. Methods Questionnaires were completed at home by parents of 54 children with NF1 (54 mothers and 42 fathers) and 51 comparison children (49 mothers and 32 fathers). Results Few differences between groups were identified for parental distress, social support, or family environment. Greater neurological impairment in children with NF1 was associated with greater distress, more family conflict, less positive mealtime interactions, and less social support from the perspectives of mothers. Conclusions Overall, parents of children with NF1 appear similar to parents of comparison children. Mothers who have children with NF1 characterized by greater neurological impairment may be at risk for more difficulties. Future work exploring long-term adjustment for these mothers as well as interventions to ameliorate any potential difficulties may be appropriate.

Brief Report: Children's Responses to Trauma- and Nontrauma-related Hospital Admission: A Comparison Study

Murray, B. L., Kenardy, J. A., Spence, S. H. — 2008-04-01

Objective This study aims to investigate and compare psychological responses in children and parents 1 month after trauma- and nontrauma-related hospital admission. Methods Two hundred and five children aged 7–16 years (and their parents) were assessed for posttraumatic stress disorder (PTSD), other psychopathology, and distress 1 month after trauma-related (Trauma Group; n = 101) and nontrauma-related hospital admission (Non-Trauma Group; n = 104). Results Clinically elevated PTSD symptom levels were more prevalent in children admitted for trauma-related (18%) than nontrauma-related reasons (4%). Parents also experienced posttraumatic distress, although rates of clinically elevated symptom levels did not differ between the Trauma (11%) and Non-Trauma (8%) groups. Other pathology and distress in children and parents were comparable across groups. Conclusions Children experienced greater posttraumatic distress following trauma-related hospital admission, while parents’ experience of their child's hospitalization is equally distressing regardless of the reason for admission.

Brief Report: Maintenance of Effects of Motivational Enhancement Therapy to Improve Risk Behaviors and HIV-related Health in a Randomized Controlled Trial of Youth Living with HIV

Naar-King, S., Lam, P., Wang, B., Wright, K., Parsons, J. T., Frey, M. A. — 2008-04-01

Objective To examine the maintenance of effects of Motivational Enhancement Therapy (MET) shown to improve risk behaviors and viral load in youth living with HIV (YLH) immediately posttreatment. Methods Sixty-five youth (ages 16–25 years) were randomized to Healthy Choices or a waitlist control. Frequency of substance use, frequency of unprotected intercourse, and viral load were obtained at baseline, 3, and 6 months after study entry. The waitlist control then received intervention. An additional data collection was obtained at 9 months for follow-up of the original treatment group. Results One-tailed ANOVA showed that the treatment group had greater reductions in viral load and alcohol use from baseline to 6 months. These reductions appeared to be maintained at 9-month follow-up. Improvements in sexual risk were not evident. Conclusions MET showed significant promise in reducing substance use and in improving HIV-related health in YLH immediately posttreatment. These effects were maintained after treatment termination.

Letter to the Editor: The Effects of Organophosphate Pesticide Exposure on Hispanic Children's Cognitive and Behavioral Functioning

Gresham, C., LoVecchio, F. — 2008-04-01

Response

Sanchez Lizardi, P., O'Rourke, M. K., Morris, R. J. — 2008-04-01

Introduction to the Special Issue: Sleep in Pediatric Medical Populations

Palermo, T. M., Owens, J. — 2008-03-01

Polysomnography and Self-reported Sleep, Pain, Fatigue, and Anxiety in Children with Active and Inactive Juvenile Rheumatoid Arthritis

2008-03-01

Objective To compare polysomnography (PSG) and self-reported sleep, symptoms (pain and fatigue), and anxiety between children with active and inactive juvenile rheumatoid arthritis (JRA) and examine relations among sleep, symptoms, and anxiety. Methods Two consecutive nights of PSG, self-reported sleep, and symptoms were obtained in 70 children 6–11 years of age with active (n = 35) or inactive (n = 35) JRA. Results On the second (study) night, PSG and self-reported sleep variables were not different, but pain and fatigue were significantly higher (both p <.02) in children with active compared to inactive disease. In a stepwise regression, age, medications, disease status, anxiety, evening pain, total sleep time, and arousals explained 36% of the variance in fatigue and age, disease status, and evening pain were significant (all p <.04) predictors of fatigue. All children showed longer sleep latency and reduced sleep efficiency on the first night in the laboratory. Conclusions Sleep was not altered in children with active JRA, however, the "first night effect" suggests that valid laboratory sleep assessments require an adaptation night.

Brief Report: Sleep Disturbances following Mild Traumatic Brain Injury in Childhood

Milroy, G., Dorris, L., McMillan, T. M. — 2008-03-01

Objective To examine objective and subjective reports of sleep disturbance in school-aged children who had sustained mild traumatic brain injury (TBI) at least 6 months prior to the study. Methods Eighteen children aged 7–12 years with a history of mild TBI (GCS 13–15. LOC < 15 min) were compared to 30 children with orthopedic injuries using actigraphy and parental and self-report sleep questionnaires. Results Parents reported greater sleep disturbance in the mild TBI group. No significant differences were found in parental ratings of daytime sleepiness, child-reported sleep difficulties, or objective (actigraph) sleep measures. Conclusions The finding of greater parental reports of sleep disturbance following mild TBI 6 months after injury requires greater exploration and future research with a larger sample followed from the point of injury would seem appropriate.

Prevalence and Predictors of Significant Sleep Disturbances in Children Undergoing Ambulatory Tonsillectomy and Adenoidectomy

MacLaren, J. E., Kain, Z. N. — 2008-03-01

Objective To evaluate children's sleep patterns before and after ambulatory surgery and to identify predictors of sleep decrements following surgery. Methods Participants were 55, 6- to 12-year-old children undergoing tonsillectomy and adenoidectomy. Sleep was assessed using actigraphy for 5 nights prior to and 5 nights following surgery. Parent state and trait anxiety, and child perioperative anxiety and temperament were assessed. Data on postoperative pain and use of analgesics were collected. Results Children had significantly less efficient sleep following surgery than before surgery. Approximately one-third of children demonstrated clinically significant decrements in sleep efficiency. Discriminant function analysis indicated less sociable and more anxious children were more likely to experience these sleep decrements, as were children who experienced greater pain in the postoperative period. Conclusion Children's sleep is an important consideration in recovery from surgery and this article takes a first step toward identifying predictors of the development of clinically significant sleep disruptions following surgery.

Sleep Disturbances in School-age Children with Chronic Pain

Long, A. C., Krishnamurthy, V., Palermo, T. M. — 2008-03-01

Objectives To examine associations between pain, functional outcomes, and sleep disturbances in children with chronic pain, specifically juvenile idiopathic arthritis (JIA), sickle cell disease (SCD), and headache (HA). Sleep disturbances were tested as a risk factor for increased functional disability and decreased health-related quality of life (HRQOL). Methods One hundred children (JIA n = 30, SCD n = 26, HA n = 44; 8–12 years; 56% female) and their caregivers participated. Children completed questionnaires regarding pain, depression, and functional disability. Caregivers completed questionnaires regarding sociodemographics, child sleep habits, functional disability, and HRQOL. Results Levels of overall sleep disturbances were above the clinical cutoff for 53% of children with chronic pain. Sleep disturbances predicted lower physical HRQOL and higher functional disability, according to parent report. Conclusions Sleep disturbances are common and associated with daytime functioning in school-age children with chronic pain, suggesting that assessment and treatment of sleep problems is clinically relevant.

Symptoms of Sleep Apnea and Polysomnography as Predictors of Poor Quality of Life in Overweight Children and Adolescents

2008-03-01

Objective The goal of this study was to examine the relationship between quality of life (QOL) and symptoms of obstructive sleep apnea (OSA) as well as objectively measured severity of OSA using polysomnography (PSG) in a cohort of overweight and at risk for overweight children and adolescents. Methods One hundred and fifty-one overweight subjects [90 males, average ages of 12.52, mean body mass index (BMI) Z-score of 2.27) and their parent/guardian completed surveys assessing QOL and symptoms of OSA syndrome. The subjects also underwent overnight PSG. Results Overweight patients reported poor QOL. Polysomnographic variables did not correlate with QOL. However, symptoms of OSA as reported on the Pediatric Sleep Questionnaire significantly correlated with QOL from both the parent and the subject. Conclusions Overweight youth with symptoms of OSA have a lower QOL both by their report and parental report. Interestingly, objective measures of OSA did not correlate with QOL.

Sleep Disruptions in Parents of Children and Adolescents with Chronic Illnesses: Prevalence, Causes, and Consequences

Meltzer, L. J., Moore, M. — 2008-03-01

Objective Provide a comprehensive review of the existing literature on the prevalence, causes, and consequences of sleep disruptions in parents of youth with chronic illnesses. Methods A comprehensive literature search of PsychInfo, MEDLINE, and CINAHL for articles related to sleep in parents of youth with chronic illnesses yielded 59 potential articles, with 19 meeting inclusion criteria. Results Parents of children with eczema were the most commonly studied group. The prevalence of sleep disruptions was 15–86%. Potential causes of parent sleep disruptions included nighttime caregiving, monitoring of the child's illness, and stress related to the child's illness. Consequences included poor sleep quality, depression, and anxiety. Conclusions Parents of youth with chronic illnesses experience sleep disruptions, providing a potential mechanism to explain elevated rates of negative daytime functioning found in previous studies. To provide interventions and support for these parents, additional research is needed to address the limitations of the existing literature.

Practices and Provisions for Parents Sleeping Overnight with a Hospitalized Child

Stremler, R., Wong, L., Parshuram, C. — 2008-03-01

Objective To describe practices affecting parents’ overnight stays, provisions for parents sleeping overnight and parents’ involvement in overnight care of their hospitalized child. Methods A cross-sectional telephone survey of Canadian and American hospitals with more or equal to 50 acute pediatric beds and more or equal to two pediatric wards was conducted. Results Surveys were completed by 135 hospitals (77% response rate). All general pediatric units allowed parents to sleep at the bedside overnight; higher acuity units limited parental stays. The majority of hospitals limited overnight visitors at the bedside to one parent, and few hospitals routinely allowed siblings to sleep overnight. One hundred and thirty-three (99%) hospitals reported parental involvement in their child's care at night, with 52 (39%) stating this was an expectation. Conclusions In general, parents are given the opportunity to stay at the bedside overnight, but barriers exist that limit opportunities for sleep during their child's hospitalization, and serve to separate families who have a hospitalized child.

Gender Differences in Sleep, Fatigue, and Daytime Activity in a Pediatric Oncology Sample Receiving Dexamethasone

2008-03-01

Objective To examine gender differences in sleep, fatigue, and daytime activity in a sample of children with acute lymphoblastic leukemia (ALL). Methods Participants included 88 children in maintenance treatment for ALL (34 girls; 54 boys). Participants wore an actigraph for 10 consecutive days (5 days pre-dexamethasone and 5 days during dexamethasone administration). Fatigue instruments were also administered. Results Girls napped more and had less fragmented night sleep than boys did. Wake time after sleep onset was sensitive to dexamethasone administration, revealing a differential direction of response for girls and boys. No gender differences were observed for subjective fatigue or daytime activity in the total sample. Conclusions Our preliminary findings support gender differences in the sleep of children with cancer after controlling for differences in age, treatment, and risk group. Future research that focuses on the etiology of gender differences and developing interventions will help clarify the clinical application of our findings.

Brief Report: Actigraphic Sleep and Daytime Naps in Adolescent Girls with Chronic Musculoskeletal Pain

2008-03-01

Objectives A descriptive pilot study to examine sleep and daytime naps in adolescent girls with chronic musculoskeletal (MSK) pain. Methods Seventeen girls (14.9 ± 2.0 years) completed questionnaires on anxiety and depressive symptoms during their clinic visit, and maintained a sleep diary and wore an actigraph for 7 days. Parents completed a daily diary of their teen's medications and approaches used to ease pain. Results Average nighttime sleep was 7.2 hr by actigraphy. All participants had mean sleep efficiency <90%. In diaries, 76.5% of the girls reported daytime naps; five girls reported more than three days with naps and more naps were associated with lower sleep efficiency and total nighttime sleep. Conclusions Adolescent girls with chronic MSK pain may sleep fewer hours at night than is recommended and nap in the daytime to compensate for insufficient nighttime sleep.

Brief Report: The Temporal Relationships Between Sleep, Cortisol, and Lung Functioning in Youth with Asthma

Hanson, M. D., Chen, E. — 2008-03-01

Objectives This study tested the directionality of the association between sleep and health outcomes in youth with asthma. Method Thirty-eight youth with asthma (aged 9–19) completed a daily diary study on sleep, asthma symptoms, peak expiratory flow (PEF) measures, and salivary cortisol samples. Results Greater quantity of sleep predicted lower PEF% [β(32) = –.33, p =.02], and lower daily cortisol output [β(33) = –.31, p =.07] the following day. Additionally, poorer self-reported sleep quality predicted more severe symptoms the next day [β(33) =.27, p =.05]. In contrast, PEF%, cortisol, and asthma symptoms did not significantly predict self-reported sleep quantity or quality the next night. Conclusions Results suggest that sleep may affect subsequent health outcomes, rather than asthma impacting subsequent sleep, indicating the potential benefits of targeting sleep behaviors in youth with asthma.

Brief Report: Daily Mood as a Mediator or Moderator of the Pain-Sleep Relationship in Children with Sickle Cell Disease

Valrie, C. R., Gil, K. M., Redding-Lallinger, R., Daeschner, C. — 2008-03-01

Objective To investigate mood as a mediator or moderator of the pain-sleep relationship in children with sickle cell disease (SCD). Method Children with SCD (n = 20; aged 8–12 years) completed daily diaries assessing mood, sleep, and pain for up to 2 months. Data was analyzed using multilevel modeling. Results Results indicate that negative mood partially mediates the relationship between high daily pain and poor sleep that night as well the relationship between poor sleep and high daily pain the following day. The impact of poor sleep on high pain the following day was weakened at increasing levels of positive mood. Conclusion Research is needed to fully explore the ways positive and negative mood may relate to pain and sleep characteristics. This information may be beneficial for developing more effective pain management and sleep interventions.

Nocturnal Awakenings and Pediatric Injury Risk

Schwebel, D. C., Brezausek, C. M. — 2008-03-01

Objective This study was designed to examine relations between nocturnal awakenings and unintentional injury risk among toddlers. Methods A nationally representative sample of 799 children was followed longitudinally from birth through 36 months. Patterns of nocturnal awakening were assessed by parent-report at ages 6, 15, 24 and 36 months, and injury events were reported at quarterly intervals over the same time period. A range of external covariates, including positive and negative affect and externalizing behavior; maternal stress, maternal depression, and parenting style; and family socioeconomic status were measured. Results A persistent pattern of very mild nocturnal awakening was related to increased risk of injury during the toddler years, and that relation held after controlling for a range of potential covariates. Conclusions A pattern of persistent nocturnal awakening appears to be related to unintentional injury risk in toddlers.

Commentary: The Importance of Sleep in Pediatric Chronic Pain--A Wake-up Call for Pediatric Psychologists

Chambers, C. T., Corkum, P. V., Rusak, B. — 2008-03-01