Assessing and Treating Sleep Difficulties in Anxious Children and Adolescents

Anna Swan, PhD, and Johanna Carpenter, PhD

Citation

Swan, A., & Carpenter, J. (2018). Assessing and treating sleep difficulties in anxious children and adolescents. Journal of Health Service Psychology, 44, 7–13.

Abstract

Ten percent of children experience anxiety disorders, and the majority of them also have sleep-related problems. A multi-step process is recommended to help children and adolescents with anxiety achieve independent and sufficient sleep, which includes 1) establishing good sleep hygiene to set the stage for quality sleep, 2) using cognitive behavioral therapy with exposures to help children and adolescents learn to manage anxiety that interferes with sleep, 3) using behavioral sleep interventions to address poor sleep onset associations and other sleep specific concerns, and 4) tailoring interventions throughout treatment to match caregiver and child needs. Parent guidance and training is essential to help change maladaptive sleeping patterns.

References

Alfano, C. A., Ginsburg, G. S., & Kingery, J. N. (2007). Sleep-Related Problems Among Children and Adolescents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 46(2), 224–232. https://doi.org/10.1097/01.chi.0000242233.06011.8e

Brand, S., Gerber, M., Beck, J., Hatzinger, M., P?hse, U., & Holsboer-Trachsler, E. (2010). High Exercise Levels Are Related to Favorable Sleep Patterns and Psychological Functioning in Adolescents: A Comparison of Athletes and Controls. Journal of Adolescent Health, 46(2), 133–141. https://doi.org/10.1016/j.jadohealth.2009.06.018

Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Lichstein, K. L., & Morin, C. M. (2006). Recommendations for a Standard Research Assessment of Insomnia. Sleep, 29(9), 1155–1173. https://doi.org/10.1093/sleep/29.9.1155

Caporino, N. E., Read, K. L., Shiffrin, N., Settipani, C., Kendall, P. C., Compton, S. N., … Albano, A. M. (2015). Sleep-Related Problems and the Effects of Anxiety Treatment in Children and Adolescents. Journal of Clinical Child & Adolescent Psychology, 1–11. https://doi.org/10.1080/15374416.2015.1063429

Chase, R. M., & Pincus, D. B. (2011). Sleep-Related Problems in Children and Adolescents With Anxiety Disorders. Behavioral Sleep Medicine, 9(4), 224–236. https://doi.org/10.1080/15402002.2011.606768

Costello, J., Egger, H. & Angold, A. (2005). The Developmental Epidemiology of Anxiety Disorders: Phenomenology, Prevalence, and Comorbidity. Child and Adolescent Psychiatric Clinics of North America, 14(4), 631–648.

Figueiro, M. (2016). Delayed sleep phase disorder: clinical perspective with a focus on light therapy. Nature and Science of Sleep, 91. https://doi.org/10.2147/NSS.S85849

Figueiro, M., & Overington, D. (2016). Self-luminous devices and melatonin suppression in adolescents. Lighting Research & Technology, 48(8), 966–975. https://doi.org/10.1177/1477153515584979

Hale, L., & Guan, S. (2015). Screen time and sleep among school-aged children and adolescents: A systematic literature review. Sleep Medicine Reviews, 21, 50–58. https://doi.org/10.1016/j.smrv.2014.07.007

Harsh, J. R., Easley, A., & LeBourgeois, M. K. (2002). A  measure  of  sleep  hygiene. Sleep, 25, A316–A317.

Hollon, S. & Beck, A. (2013). Cognitive and Cognitive-Behavioral Therapies. In Handbook of Psychotherapy and Behavior Change(M. J. Lambert, pp. 393–443). Hoboken, NJ, USA: John Wiley & Sons.

Huebner, D. (2008). What to Do when You Dread Your Bed: A Kids Guide to Overcoming

Problems with Sleep. Magination Press.

March, J. S. (1997). Manual for the multidimensional anxiety scale for children (MASC). Toronto: Multi-Health Systems.

March, J. S., Parker, J. D. A., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional Anxiety Scale for Children (MASC): Factor Structure, Reliability, and Validity. Journal of the American Academy of Child & Adolescent Psychiatry, 36(4), 554–565. https://doi.org/10.1097/00004583-199704000-00019

Meltzer, L. J., & Crabtree, V. M. (2015). Pediatric sleep problems: A clinician’s guide to behavioral interventions. Washington, DC: American Psychological Association.

Mindell, J. A., & Owens, J. A. (2015). A clinical guide to pediatric sleep: diagnosis and

management of sleep problems. Lippincott Williams & Wilkins.

Mindell, J. A., Telofski, L. S., Wiegand, B., & Kurtz, E. S. (2009). A Nightly Bedtime Routine: Impact on Sleep in Young Children and Maternal Mood. Sleep, 32(5), 599–606. https://doi.org/10.1093/sleep/32.5.599

Owens, J., Spirito, A., & McGuinn, M. (2000). The  Children’s  Sleep  Habits Questionnaire  (CSHQ):  Psychometric  properties  of  a  survey  instrument  for school-aged  children. SLEEP-NEW YORK, 23(8), 1043–1052.

Paine, S., & Gradisar, M. (2011). A randomised controlled trial of cognitive-behaviour therapy for behavioural insomnia of childhood in school-aged children. Behaviour Research and Therapy, 49(6-7), 379–388. https://doi.org/10.1016/j.brat.2011.03.008

Paruthi, S., Brooks, L. J., Ambrosio, C. D’, Hall, W. A., Kotagal, S., Lloyd, R. M., … Wise, M. S. (2016). Consensus Statement of the American Academy of Sleep Medicine on the Recommended Amount of Sleep for Healthy Children: Methodology and Discussion. Journal of Clinical Sleep Medicine, 12(11), 1549–1561. https://doi.org/10.5664/jcsm.6288

Peterman, J. S., Carper, M. M., Elkins, R. M., Comer, J. S., Pincus, D. B., & Kendall, P. C. (2016). The effects of cognitive-behavioral therapy for youth anxiety on sleep problems. Journal of Anxiety Disorders, 37, 78–88. https://doi.org/10.1016/j.janxdis.2015.11.006

Pincus, D. B., Weiner, C. L., & Friedman, A. G. (2012). Differential Efficacy of Home Monitoring and Cognitive-Behavioral Treatment for Decreasing Children’s Maladaptive Nighttime Fears. Child & Family Behavior Therapy, 34(1), 1–19. https://doi.org/10.1080/07317107.2012.654426

Silverman, W. K., & Albano, A. M. (1996). Silverman WK, Albano AM (1996), The Anxiety Disorders Interview Schedule for Children for DSM-IV: (Child and Parent Versions). San Antonio, TX: Psychological Corporation.

Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36(5), 545–566.

Spence, S. H., Barrett, P. M., & Turner, C. M. (2003). Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. Journal of Anxiety Disorders, 17(6), 605–625. https://doi.org/10.1016/S0887-6185(02)00236-0

Spence, S. H., & Rapee, R. M. (1999). Preschool anxiety scale (parent report). University of Queensland.

Swan, A. J., & Kendall, P. C. (2016). Fear and Missing Out: Youth Anxiety and Functional Outcomes. Clinical Psychology: Science and Practice, 23(4), 417–435. https://doi.org/10.1111/cpsp.12169

Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., … Kendall, P. C. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359, 2753–2766. http://doi.org/10.1056/NEJMoa0804633