Abstract
Anxiety disorders and behavioral sleep-related problems (SRPs) frequently co-occur during childhood. However, few studies have used the recommended method of a sleep-diary. The present study examined parental perceptions of behavioral SRPs in anxious compared to non-anxious children using a sleep-diary. Parents of 22 clinically anxious children and 29 healthy controls (aged 6–13 years) completed a 7-day sleep-diary of their child’s behavioral SRPs. Compared to non-anxious peers, anxious children were rated by parents as more often (a) having a negative mood before bed, (b) delaying bed, (c) requiring parental assistance during the night, especially on weeknights, (d) having difficulty waking on their own the next morning, (e) falling back to sleep after morning waking, and (f) waking in a negative mood. There were no significant group differences in sleep onset latency or sleep duration, and behavioral SRPs of anxious children did not negatively affect their functioning or that of their parents the next day based on parent report. Parents of anxious children are more likely to perceive their children as engaging in behavioral SRPs compared to parents of non-anxious children.
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Notes
A copy of the sleep diary can be obtained from the corresponding author, Professor Allison Waters by email (a.waters@griffith.edu.au).
References
Alfano CA, Beidel DC, Turner SM, Lewin DS (2006) Preliminary evidence for sleep complaints among children referred for anxiety. Sleep Med 7(6):467–473. https://doi.org/10.1016/j.sleep.2006.05.002
Alfano CA, Ginsburg GS, Kingery JN (2007) Sleep-related problems among children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 46(2):224–232. https://doi.org/10.1097/01.chi.0000242233.06011.8e
Alfano CA, Patriquin MA, De Los Reyes A (2015) Subjective–objective sleep comparisons and discrepancies among clinically-anxious and healthy children. J Abnorm Child Psychol 43(7):1343–1353. https://doi.org/10.1007/s10802-015-0018-7
Alfano CA, Pina AA, Zerr AA, Villalta IK (2010) Pre-sleep arousal and sleep problems of anxiety-disordered youth. Child Psychiatry Hum Dev 41(2):156–167. https://doi.org/10.1007/s10578-009-0158-5
Alfano CA, Reynolds K, Scott N, Dahl RE, Mellman TA (2013) Polysomnographic sleep patterns of non-depressed, non-medicated children with generalized anxiety disorder. J Affect Disord 147(1):379–384. https://doi.org/10.1016/j.jad.2012.08.015
Beesdo-Baum K, Knappe S (2012) Developmental epidemiology of anxiety disorders. Child Adolesc Psychiatr Clin 21(3):457–478. https://doi.org/10.1016/j.chc.2012.05.001
Beidel DC, Turner SM (1997) At risk for anxiety: I. Psychopathology in the offspring of anxious parents. J Am Acad Child Adolesc Psychiatry 36(7):918–924. https://doi.org/10.1097/00004583-199707000-00013
Blader JC, Koplewicz HS, Abikoff H, Foley C (1997) Sleep problems of elementary school children: A community survey. Arch Pediatr Adolesc Med 151(5):473–480
Bonuck KA, Goodlin-Jones BL, Schechter C, Owens J (2017) Modified children’s sleep habits questionnaire for behavioral sleep problems: a validation study. Sleep Health 3(3):136–141. https://doi.org/10.1016/j.sleh.2017.03.009
Buysse DJ, Ancoli-Israel S, Edinger JD, Lichstein KL, Morin CM (2006) Recommendations for a standard research assessment of insomnia. Sleep 29(9):1155–1173
Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL, Morin CM (2012) The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep 35(2):287–302. https://doi.org/10.5665/sleep.1642
Chase RM, Pincus DB (2011) Sleep-related problems in children and adolescents with anxiety disorders. Behav Sleep Med 9(4):224–236. https://doi.org/10.1080/15402002.2011.606768
Costello EJ, Egger H, Angold A (2005) 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. J Am Acad Child Adolesc Psychiatry 44(10):972–986. https://doi.org/10.1097/01.chi.0000172552.41596.6f
Cousins JC, Whalen DJ, Dahl RE, Forbes EE, Olino TM, Ryan ND, Silk JS (2011) The bidirectional association between daytime affect and night-time sleep in youth with anxiety and depression. J Pediatr Psychol 36(9):969–979. https://doi.org/10.1093/jpepsy/jsr036
Daniel AE (1983) Power, privilege and prestige. Longman Cheshire, Melbourne
Donovan C, Spence S, March S (2017) Does an online CBT program for anxiety impact upon sleep problems in anxious youth? J Clin Child Adolesc Psychol 46(2):211–221
Farrell LJ, Mathieu SL, Lavell CH (2018) Obsessive–compulsive and related disorders. In: Ollendick TH, White SW, White BA (eds), The Oxford handbook of clinical child and adolescent psychology. OUP, Oxford, p 309
Fielding J, Young S, Martin PR, Waters AM (2016) Incidence of headache symptoms consistent with migraine and tension-type headaches in children with anxiety disorders. J Anxiety Disord 40:67–74
Fletcher FE, Conduit R, Foster-Owens MD, Rinehart NJ, Rajaratnam SMW, Cornish KM (2018) The association between anxiety symptoms and sleep in school-aged children: a combined insight from the Children’s Sleep Habits Questionnaire and Actigraphy. Behav Sleep Med 16:169–184
Forbes EE, Bertocci MA, Gregory AM, Ryan ND, Axelson DA, Birmaher B, Dahl RE (2008) Objective sleep in pediatric anxiety disorders and major depressive disorder. J Am Acad Child Adolesc Psychiatry 47(2):148–155. https://doi.org/10.1097/chi.0b013e31815cd9bc
Garber J, Weersing VR (2010) Comorbidity of anxiety and depression in youth: Implications for treatment and prevention. Clinical Psychology 17:293–306. https://doi.org/10.1111/j.1468-2850.2010.01221.x
Grant BF, Saha TD, Ruan WJ, Goldstein RB, Chou SP, Jung J et al (2016) Epidemiology of DSM-5 drug use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions–III. JAMA Psychiatry 73(1):39–47
Gregory AM, Van der Ende J, Willis TA, Verhulst FC (2008) Parent-reported sleep problems during development and self-reported anxiety/depression, attention problems, and aggressive behavior later in life. Arch Pediatr Adolesc Med 162(4):330–335. https://doi.org/10.1001/archpedi.162.4.330
Gregory AM, O’Connor TG (2002) Sleep problems in childhood: a longitudinal study of developmental change and association with behavioral problems. J Am Acad Child Adolesc Psychiatry 41(8):964–971. https://doi.org/10.1097/00004583-200208000-00015
Gregory AM, Eley TC, O’Connor TG, Plomin R (2004) Etiologies of associations between childhood sleep and behavioral problems in a large twin sample. J Am Acad Child Adolesc Psychiatry 43(6):744–751. https://doi.org/10.1097/01.chi/0000122798.47863.a5
Hansen BH, Skirbekk B, Oerbeck B, Richter J, Kristensen H (2011) Comparison of sleep problems in children with anxiety and attention deficit/hyperactivity disorders. Eur Child Adolesc Psychiatry 20(6):321. https://doi.org/10.1007/s00787-011-0179-z
Harvey AG, Murray G, Chandler RA, Soehner A (2011) Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clin Psychol Rev 31(2):225–235. https://doi.org/10.1016/j.cpr.2010.04.003
Hudson JL, Gradisar M, Gamble A, Schniering CA, Rebelo I (2009) The sleep patterns and problems of clinically anxious children. Behav Res Ther 47(4):339–344. https://doi.org/10.1016/j.brat.2009.01.006
Hudson JL, Rapee RM (2001) Parent-child interactions and anxiety disorders: An observational study. Behav Res Ther 39(12):1411–1427
Kendall PC, Compton SN, Walkup JT, Birmaher B, Albano AM, Sherrill J et al (2010) Clinical characteristics of anxiety disordered youth. J Anxiety Disord 24(3):360–365. https://doi.org/10.1016/j.janxdis.2010.01.009
Kendall PC, Safford S, Flannery-Schroeder E, Webb A (2004) Child anxiety treatment: Outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up. J Consult Clin Psychol 72(2):276. https://doi.org/10.1037/0022-006X.72.2.276
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602. https://doi.org/10.1001/archpsyc.62.6.593
Lyneham HJ, Abbott MJ, Rapee RM (2007) Interrater reliability of the Anxiety Disorders Interview Schedule for DSM-IV: child and parent version. J Am Acad Child Adolesc Psychiatry 46(6):731–736. https://doi.org/10.1097/chi.0b013e3180465a09
McLaughlin-Crabtree V, Witcher L (2008) Impact of sleep loss on children and adolescents. In: Ivanenko A (ed) Sleep and psychiatric disorders in children and adolescents. Informa Healthcare, New York, pp 139–148
McMakin DL, Alfano CA (2015) Sleep in late childhood and early adolescence. Curr Opin Psychiatry 28:483–489
Meijer AM, Habekothé HT, Van Den Wittenboer GLH (2000) Time in bed, quality of sleep and school functioning of children. J Sleep Res 9:145–153
Meltzer LJ, Mindell JA (2008) Behavioral sleep disorders in children and adolescents. Sleep Med Clin 3(2):269–279
Mindell JA, Meltzer LJ (2008) Behavioural sleep disorders in children and adolescents. Ann Acad Med Singap 37(8):722–728
Nabinger de Diaz N, Farrell LJ, Waters AM, Donovan CL, McConnell H (2018) Sleep-related problems in pediatric obsessive-compulsive disorder and intensive exposure therapy. Behav Ther. https://doi.org/10.1016/j.beth.2018.09.008
Nauta MH, Scholing A, Rapee RM, Abbott M, Spence SH, Waters A (2004) A parent-report measure of children’s anxiety: psychometric properties and comparison with child-report in a clinic and normal sample. Behav Res Ther 42(7):813–839. https://doi.org/10.1016/S0005-7967(03)00200-6
Oka Y, Suzuki S, Inoue Y (2008) Bedtime activities, sleep environment, and sleep/wake patterns of Japanese elementary school children. Behav Sleep Med 6(4):220–233. https://doi.org/10.1080/15402000802371338
Peterman JS, Carper MM, Kendall PC (2015) Anxiety disorders and comorbid sleep problems in school-aged youth: review and future research directions. Child Psychiatry Hum Dev 46(3):376–392. https://doi.org/10.1007/s10578-014-0478-y
Pine DS, Cohen P, Gurley D, Brook J, Ma Y (1998) The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 55(1):56–64. https://doi.org/10.1001/archpsyc.55.1.56
Rapee RM, Schniering CA, Hudson JL (2009) Anxiety disorders during childhood and adolescence: origins and treatment. Annu Rev Clin Psychol 5:311–341
Reynolds KC, Alfano CA (2016) Things that go bump in the night: frequency and predictors of nightmares in anxious and non-anxious children. Behav Sleep Med 14(4):442–456. https://doi.org/10.1080/15402002.2015.1017099
Rockhill C, Kodish I, DiBattisto C, Macias M, Varley C, Ryan S (2010) Anxiety disorders in children and adolescents. Curr Prob Pediatr Adolesc Health Care 40(4):66–99. https://doi.org/10.1016/j.cppeds.2010.02.002
Silverman WK, Albano A (1996) The Anxiety Disorders Interview Schedule for children–IV (child and parent versions). Psychological Corporation, San Antonio
Silverman WK, Saavedra LM, Pina AA (2001) Test-retest reliability of anxiety symptoms and diagnoses with the Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 40(8):937–944. https://doi.org/10.1097/00004583-200108000-00016
Smaldone A, Honig JC, Byrne MW (2007) Sleepless in America: Inadequate sleep and relationships to health and well-being of our nation’s children. Pediatrics. https://doi.org/10.1542/peds.2006-2089F
Spence SH (1998) A measure of anxiety symptoms among children. Behav Res Ther 36(5):545–566. https://doi.org/10.1016/S0005-7967(98)00034-5
Spence SH, Barrett PM, Turner CM (2003) Psychometric properties of the Spence Children’s Anxiety Scale with young adolescents. J Anxiety Disord 17(6):605–625. https://doi.org/10.1016/S0887-6185(02)00236-0
Thompson-Hollands J, Kerns CE, Pincus DB, Comer JS (2014) Parental accommodation of child anxiety and related symptoms: range, impact, and correlates. J Anxiety Disord 28:765–773
Vorspan F, Mehtelli W, Dupuy G, Bloch V, Lépine JP (2015) Anxiety and substance use disorders: co-occurrence and clinical issues. Curr Psychiatry Rep 17(2):4
Waters AM, Schilpzand E, Bell C, Walker LS, Barber K (2013) Functional gastrointestinal symptoms in anxious children. J Abnorm Child Psychol 41:151–163
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The authors thank Natalie Marshall for assistance with some of the data collection.
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Price, T.E., Farrell, L.J., Donovan, C.L. et al. Behavioral Sleep-Related Problems in Clinically Anxious Children: A Parent-Report Diary Study. Child Psychiatry Hum Dev 50, 746–755 (2019). https://doi.org/10.1007/s10578-019-00878-5
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DOI: https://doi.org/10.1007/s10578-019-00878-5