Cele Richardson

Insomnia disorder update: the benefits of screening and treatment for this common presentation

Publisher: Wiley

Date: 11-2021

DOI: 10.1111/IMJ.15567

Abstract: Insomnia is a chronic condition and major healthcare problem for Australians across the lifespan. Insomnia's high prevalence and disease burden render it an important target for treatment. Further, and importantly, there exist established bidirectional links between insomnia and a range of health conditions, with insomnia both contributing to risk, maintenance and relapse of comorbid conditions. Recent clinical research demonstrates that treating insomnia in its own right is important for resolution of insomnia and for optimising treatment outcomes for comorbid presenting problems. Due to its effectiveness and favourable side‐effect profile, Cognitive Behaviour Therapy‐Insomnia (CBT‐I) is the recommended first‐line treatment even when comorbid conditions are present. CBT‐I is a brief treatment often delivered in four to eight consultations. In idual, group and online CBT‐I have each demonstrated effectiveness. Outcomes for online CBT‐I are often stronger when in idualised clinician support is provided. Specifically assessing for and treating insomnia in clinical practice may provide an opportunity to optimise treatment outcome in many patients.

Eye-tracking to assess anxiety-related attentional biases among a large sample of preadolescent children

Publisher: Elsevier BV

Date: 06-2022

DOI: 10.1016/J.BRAT.2022.104079

Abstract: A considerable body of research in adults has demonstrated that anxiety disorders are characterised by attentional biases to threat. Findings in children have been inconsistent. The present study examined anxiety-related attention biases using eye tracking methodology in 463 preadolescents between 10 and 12 years of age, of whom 92 met criteria for a DSM-5 anxiety disorder and 371 did not. Preadolescent's gaze was recorded while they viewed adolescent face pairs depicting angry-neutral and happy-neutral expressions with each face pair presented for 5000 ms. No group differences were observed across any eye tracking indices including probability of first fixation direction, latency to first fixation, first fixation duration and dwell time. The s le overall showed faster initial attention towards threat cues, followed by a later broadening of attention away from threat. There is a need to identify the types of threats and the developmental period during which visual attention patterns of anxious and non-anxious youth erge to inform more developmentally sensitive treatments.

Determinants of Sleep Problems in Children with Intellectual Disability

Publisher: Wiley

Date: 24-05-2021

DOI: 10.1111/JSR.13361

Abstract: Children with intellectual disabilities are more likely to experience sleep disorders of insomnia, excessive daytime sleepiness and sleep breathing disorders than typically developing children. The present study examined risk factors for these sleep disorders in 447 children (aged 5–18 years), diagnosed with an intellectual disability and comorbid autism spectrum disorder, cerebral palsy, Down syndrome or Rett syndrome. Primary caregivers reported on their child’s sleep using the Sleep Disturbance Scale for Children (SDSC), as well as medical comorbidities and functional abilities. Multivariate linear and logistic regressions were used to examine the effects of these factors on SDSC t scores and a binary indicator, respectively for the relevant subscales. Receiving operating characteristic curves were generated for each logistic regression model to determine their ability to discriminate between poor and good sleep. Comorbidities rather than functional abilities were associated with poorer sleep. In particular, recurrent pain, frequent seizures, frequent coughing, constipation and prescription of sleep medications were associated with abnormal sleep across the entire s le, but predictors differed between diagnostic groups. The present study suggests that comorbidities are more strongly associated with quality of sleep than functional impairments. The present study provides new information on potential associations between frequent coughing, prescription sleep medications and sleep quality that should be further investigated.

Risk and Protective Factors for Prospective Changes in Adolescent Mental Health during the COVID-19 Pandemic

Publisher: Springer Science and Business Media LLC

Date: 27-10-2020

DOI: 10.1007/S10964-020-01332-9

Cognitive “insomnia” processes in delayed sleep–wake phase disorder: Do they exist and are they responsive to chronobiological treatment?

Publisher: American Psychological Association (APA)

Date: 2019

DOI: 10.1037/CCP0000357

Abstract: To systematically investigate whether cognitive "insomnia" processes are implicated in adolescent Delayed Sleep-Wake Phase Disorder (DSWPD) and to examine whether these processes are responsive to chronobiological treatment. Sixty-three adolescents (M = 15.8 ± 2.2 years, 63.5% f) diagnosed with DSWPD and 40 good sleeping adolescents (M = 15.9 ± 2.4 years, 75% f) completed baseline measures of sleep, daytime functioning and cognitive "insomnia" processes (i.e., repetitive negative thinking, physiological hyperarousal, distress, sleep-related attention and monitoring, sleep misperception). Sixty DSWPD adolescents (M = 15.9 ± 2.2 y, 63% f) entered a treatment trial and received 3 weeks of light therapy. Sleep, daytime functioning, and insomnia were measured again post-treatment and at 3-month follow-up. Adolescents with DSWPD had significantly later sleep timing (d = 0.99-1.50), longer sleep latency (d = 1.14), and shorter total sleep time (d = 0.85) on school nights, compared with the good sleeping adolescents. There was evidence of cognitive "insomnia" symptoms, with the DSWPD group reporting more repetitive negative thinking (d = 0.70-1.02), trait hyperarousal (d = 0.55), distress (d = 2.19), sleep associated monitoring (d = 0.76), and sleep onset misperception (d = 1.29). Across treatment and follow-up, adolescents with DSWPD reported advanced sleep timing (d = 0.54-0.62), reduced sleep latency (d = 0.53), increased total sleep time (d = 0.49), and improved daytime functioning (d = 0.46-1.00). Repetitive negative thinking (d = 0.64-0.96), physiological arousal (d = 0.69), distress (d = 0.87), and sleep onset misperception (d = 0.37) also showed improvement. Cognitive "insomnia" processes may be implicated in the development and maintenance of DSWPD in adolescents. Many of these processes are amendable to chronobiological treatment however, residual symptoms may place adolescents at risk of poor treatment outcome or relapse. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Development of evening sleep homeostatic pressure in early adolescent boys

Publisher: Elsevier BV

Date: 10-2023

DOI: 10.1016/J.SLEEP.2023.07.019

Paediatric sleep literacy in australian health professionals

Publisher: Elsevier BV

Date: 05-2021

DOI: 10.1016/J.SLEEP.2021.02.035

Sleep in young people: What works now and where to? A meta-review of behavioural and cognitive interventions and lifestyle factors

Publisher: Informa UK Limited

Date: 28-02-2023

DOI: 10.1080/15402002.2023.2182305

Can exercise regulate the circadian system of adolescents? Novel implications for the treatment of delayed sleep-wake phase disorder

Publisher: Elsevier BV

Date: 08-2017

DOI: 10.1016/J.SMRV.2016.06.010

Abstract: Adolescents are vulnerable to inadequate sleep due to a unique constellation of risk factors. In particular, the puberty-related phase delay in the timing of the circadian system postpones the onset of sleep. Resultantly, disordered sleep is common among teenagers and young adults, with the most common sleep problem being delayed sleep wake-phase disorder (DSWPD). Although current treatments for DSWPD show promise, novel ways to improve our youth's sleep are needed. The purpose of this review is to critically evaluate the evidence for the role of exercise as a method to shift and/or regulate circadian timing, and thus improve sleep, in adolescents and young adults. A growing body of evidence suggests that nocturnal exercise can delay circadian timing. However, exercise administered at different times of the 24-h day may result in phase advances, particularly when the timing of exercise is gradually advanced in small daily increments. The implications of these results for young people's sleep health are discussed and suggestions are provided for ways that exercise could be used clinically, to improve the treatment of DSWPD.

Cognitive performance in adolescents with Delayed Sleep-Wake Phase Disorder: Treatment effects and a comparison with good sleepers

Publisher: Wiley

Date: 16-03-2018

DOI: 10.1016/J.ADOLESCENCE.2018.03.002

Abstract: The present study aimed to investigate whether Australian adolescents with Delayed Sleep‐Wake Phase Disorder have impaired cognitive performance and whether chronobiological treatment for Delayed Sleep‐Wake Phase Disorder improves adolescents' sleep, daytime functioning and cognitive performance. Adolescents with Delayed Sleep‐Wake Phase Disorder (mean = 15.68 ± 2.1 y, 62% f) reported significantly later sleep timing ( d = 1.03–1.45), less total sleep time ( d = 0.82) and greater daytime sleepiness ( d = 2.66), fatigue ( d = 0.63) and impairment ( d = 2.41), compared to good sleeping adolescents (mean = 15.9 ± 2.4 y, 75% f). However, there were no significant between‐group differences (all p 0.05) in performance on the Operation Span ( ηp 2 = 0.043), Digit Span (forwards: ηp 2 = 0.002, backwards: ηp 2 = 0.003), Letter Number Sequencing ( ηp 2 0.001) (working memory) and Digit‐Symbol Substitution Tasks ( ηp 2 = 0.010) (processing speed). Adolescents with Delayed Sleep‐Wake Phase Disorder went on to receive 3 weeks of light therapy. At 3 months post‐treatment, adolescents with Delayed Sleep‐Wake Phase Disorder reported significantly advanced sleep timing ( d = 0.56–0.65), greater total sleep time ( d = 0.52) and improved daytime sleepiness ( d = 1.33), fatigue ( d = 0.84) and impairment ( d = 0.78). Performance on the Operation Span ( d = 0.46), Letter Number Sequencing ( d = 0.45) and Digit‐Symbol Substitution tasks ( d = 0.57) also significantly improved.

Mechanisms influencing older adolescents' bedtimes during videogaming: the roles of game difficulty and flow

Publisher: Elsevier BV

Date: 11-2017

DOI: 10.1016/J.SLEEP.2017.09.002

Abstract: A relationship between evening technology use and sleep has been established, and models suggest various mechanisms to explain this relationship. Recent updates to these models also suggest the influence of in idual difference factors, such that the relationship between technology and sleep varies between young people. Flow is an experience of immersion and time distortion that could vary between adolescents when using technology. The aim of the present study was to investigate the effects of flow on the self-selected bedtimes of adolescents when videogaming. Seventeen older adolescent, experienced videogamers (age = 15.9 ± 0.83 years), played a new videogame on two school-night evenings in a sleep laboratory. Game difficulty was set to "hard" one evening (flow condition) and "easy" on the other evening (disrupted flow). Trait and state flow were measured, along with heart rate during videogaming, and bedtime measured objectively with real-time cameras. An interaction effect for heart rate indicated an elevated heart rate in the easy condition after 150 min of gaming (p < 0.02). No significant differences were found in bedtimes between the easy and hard conditions (p = 0.77). Adolescents high on trait flow played for longer and selected significantly later bedtimes than their low trait flow peers but only for the hard (flow) condition (12:22 AM vs. 10:53 PM, p = 0.004). Similarly, adolescents with high state flow went to bed significantly later than those low on state flow (12:24 PM vs. 10:52 PM, p = 0.001), again only in the hard condition. These findings suggest that in idual and situational characteristics may lify the effects of technology use on the "sleep" of adolescents and provides support for the displacement of bedtime hypothesis.

Low-intensity scheduled morning exercise for adolescents with a late chronotype: a novel treatment to advance circadian phase?

Publisher: Oxford University Press (OUP)

Date: 2022

DOI: 10.1093/SLEEPADVANCES/ZPAC021

Abstract: During adolescence, an interplay between biological and environmental factors leads to constrained sleep duration and timing. The high prevalence of sleep deprivation during this developmental period is a public health concern, given the value of restorative sleep for mental, emotional, and physical health. One of the primary contributing factors is the normative delay of the circadian rhythm. Therefore, the present study aimed to evaluate the effect of a gradually advanced morning exercise schedule (30 min shift each day) completed for 45 min on 5 consecutive mornings, on the circadian phase and daytime functioning of adolescents with a late chronotype, compared with a sedentary control group. A total of 18 physically inactive male adolescents aged 15–18 years spent 6 nights at the sleep laboratory. The morning procedure included either 45 min walking on a treadmill or sedentary activities in dim light. Saliva dim light melatonin onset, evening sleepiness, and daytime functioning were assessed during the first and last night of laboratory attendance. The morning exercise group had a significantly advanced (earlier) circadian phase (27.5 min ± 32.0), while sedentary activity resulted in a phase delay (−34.3 min ± 53.2). Morning exercise also led to higher evening sleepiness in the earlier hours of the night, but not at bedtime. Mood measures improved slightly in both study conditions. These findings highlight the phase-advancing effect of low-intensity morning exercise among this population. Future studies are needed to test the transference of these laboratory findings to adolescents’ real life.

Understanding Sleep-Wake Behavior in Late Chronotype Adolescents: The Role of Circadian Phase, Sleep Timing, and Sleep Propensity

Publisher: Frontiers Media SA

Date: 11-03-2022

DOI: 10.3389/FPSYT.2022.785079

Abstract: Adolescents with a late chronotype are at greater risk for mood disorders, risk-taking behaviors, school absenteeism, and lower academic achievement. As there are multiple causes for late chronotype, the field lacks studies on the relationship between mood, circadian phase, and phase angle of entrainment in late chronotype adolescents. Three objectives guide this explorative study: (1) to describe sleep, circadian phase, and phase angle of entrainment in late chronotype adolescents, (2) to explore how different levels of lateness are associated with sleep quality, sleep propensity, and mood, and (3) to investigate the influence of circadian phase on bedtime choice and sleep duration. Baseline data from 19 male adolescents (M = 16.4 ± 1.0 yrs), who were part of a larger intervention trial, were analyzed. Chronotype was measured with the Munich Chronotype Questionnaire, circadian timing via dim light melatonin onset (DLMO), and sleep habits with a 7-day sleep log. Further questionnaires assessed daytime sleepiness, sleep quality, and mood. Evening sleepiness and sustained attention were used as a proxy for evening sleep propensity. On school nights, sleep duration averaged 7.78 h (±1.65), and 9.00 h (±1.42) on weekend nights. Mean DLMO was observed at 23.13 h (± 1.65), with a weekend phase angle of entrainment of 2.48 h. Regression fittings revealed a tendency for shorter phase angles with delayed DLMOs. Further analysis with chronotype subgroups revealed that this was only true for light and moderate late types, whereas extreme late types showed wide phase angles. Even though daytime sleepiness and sleep duration did not differ between subgroups, mood and sleep quality declined as lateness increased. Extreme late chronotypes experienced higher evening sleepiness, while slight late chronotypes showed higher evening attention. Chronotype but not DLMO predicted bedtime on school- and particularly weekend-nights. Our findings suggest that with increasing lateness, the likelihood of experiencing poor sleep quality and mood disorders increases. As DLMO did not predict bedtime, our data indicate that the factors contributing to a late chronotype are versatile and complex, particularly for extreme late types. Further studies involving a larger and gender-balanced s le are needed to confirm findings.

The Development of Insomnia or the Plasticity of Good Sleep? A Preliminary Study of Acute Changes in Sleep and Insomnia Resulting from an Analogue Trauma

Publisher: Informa UK Limited

Date: 14-03-2014

DOI: 10.1080/15402002.2013.829065

Abstract: The present preliminary study aimed to shed light on the mechanisms underlying the development of insomnia. An analogue stressor (i.e., trauma video) was used to prevent presleep cognitive de-arousal. Subsequent changes in nocturnal sleep and sleep-related attentional processing were examined. Thirty-four participants were randomly assigned to either a cognitive arousal (trauma video age: M = 22.9, SD = 4.3, 6 male, 11 female) or control (pleasant video age: M = 23.8, SD = 5.8, 7 male, 10 female) condition. Although no significant differences were found for presleep cognitive de-arousal (p = .39), the cognitive arousal group experienced a significant worsening in sleep latency (p = .048, partial η(2) = .12) and an increase in sleep-related attentional bias (p = .032, d = 0.51) following the manipulation. However, changes in sleep and attentional bias were not maintained. Vulnerability to stress did not significantly account for any change in attentional bias, arousal, or sleep. These findings challenge current conceptualizations of the development of insomnia, yet also supporting the notion that good sleep is a default state that protects in iduals from sleep disturbance.

Readiness to change and commitment as predictors of therapy compliance in adolescents with Delayed Sleep-Wake Phase Disorder

Publisher: Elsevier BV

Date: 03-2019

DOI: 10.1016/J.SLEEP.2018.12.002

Abstract: Recent evidence indicates that adolescents' motivation to change sleep-wake patterns is low, despite significant impact of adolescent sleep problems on many areas of daytime functioning. The aim of the present study is to evaluate components of adolescents' motivation, and subsequent changes in behaviour. Fifty-six adolescents, aged 13-23 (M = 15.8 ± 2.3 y 38% m) diagnosed with Delayed Sleep-Wake Phase Disorder (DSWPD) underwent three therapy sessions involving bright light therapy to phase advance sleep patterns. Adolescents were instructed to advance wake-up times by 30-min daily. Motivation ratings of desire, ability, reason, need and commitment to change sleep patterns were taken at baseline. Sleep diaries were taken at the end of treatment session 1, with sequentially earlier wake-up times in 30-min intervals indicating compliance. At the outset of therapy, adolescents indicated strong desire, reasons and need, yet moderate ability and commitment to advance their sleep-wake patterns. Following therapy, sleep-onset times were significantly advanced, total sleep time increased and sleep latency decreased (all p < 0.05). Therapy lasted 6-27 days (M = 13.9 ± 4.5) and clients complied for approximately half the time (between 3 and 15 days M = 8.8 ± 2.7). Commitment was associated with ability (r = 0.66, p 0.05). Adolescents' desire to change (r = 0.30, p = 0.03) and commitment (r = 0.30, p = 0.03) were positively correlated with behaviour change, but their need, ability and reasons were not. A mediation analysis showed that ability and desire were important in predicting behaviour change, by total effects through commitment (ie, indirectly and directly). Our findings suggest that the total effects of ability (ie, confidence) and desire to change are the best predictors of behavioural changes, thus clinicians should focus on these components of the readiness to change model when undertaking treatments with sleep-disordered adolescents.

The meditating role of sleep in the longitudinal associations between peer victimization and internalizing symptoms: A cross-lagged panel analysis

Publisher: Cambridge University Press (CUP)

Date: 03-2023

DOI: 10.1017/S0954579423000159

Abstract: Adolescence is a time of heightened vulnerability for both peer victimization (PV) and internalizing symptoms. While the positive association between them is well established, there is little understanding of the mechanisms underpinning this relationship. To address this gap, the current study aimed to investigate sleep hygiene and school night sleep duration as in idual and sequential mediators of the relationship between PV and both depressive and social anxiety symptoms during pre- to mid-adolescence. The study drew upon a community s le of 528 Australian youth aged 10–12 years at baseline ( M age = 11.19, SD = .55 51.1% boys) and data were collected over five annual measurement occasions. Direct and indirect longitudinal and bidirectional associations were examined using cross-lagged panel analysis. There was no evidence of sequential mediation through both sleep hygiene and sleep duration to depression and social anxiety. Instead, the findings show that sleep hygiene mediated the prospective association between PV and both depressive and social anxiety symptoms, and between PV and sleep duration. Overall, sleep hygiene represents a modifiable transdiagnostic factor that can be targeted to break the cycle of PV, inadequate sleep, and internalizing symptoms.

A randomised controlled trial of bright light therapy and morning activity for adolescents and young adults with Delayed Sleep-Wake Phase Disorder

Publisher: Elsevier BV

Date: 05-2018

DOI: 10.1016/J.SLEEP.2018.02.001

Abstract: A randomised controlled trial evaluated bright light therapy and morning activity for the treatment of Delayed Sleep-Wake Phase Disorder (DSWPD) in young people. 60 adolescents and young adults (range = 13-24 years, mean = 15.9 ± 2.2 y, 63% f) diagnosed with DSWPD were randomised to receive three weeks of post-awakening Green Bright Light Therapy (∼507 nm) and Sedentary Activity (sitting, watching TV), Green Bright Light Therapy and Morning Activity (standing, playing motion-sensing videogame), Red Light Therapy (∼643 nm) and Sedentary Activity or Red Light Therapy and Morning Activity. Sleep (ie sleep onset time, wake up time, sleep onset latency, total sleep time) and daytime functioning (ie morning alertness, daytime sleepiness, fatigue, functional impairment) were measured pre-treatment, post-treatment and at one and three month follow-up. Contrary to predictions, there were no significant differences in outcomes between treatment groups and interaction effects between treatment group and time for all outcome variables were not statistically significant. However, adolescents and young adults in morning activity conditions did not meaningfully increase their objective activity (ie movement frequency). Overall, adolescents reported significantly improved sleep timing (d = 0.30-0.46), sleep onset latency (d = 0.32) and daytime functioning (d = 0.45-0.87) post-treatment. Improvements in sleep timing (d = 0.53-0.61), sleep onset latency (d = 0.57), total sleep time (d = 0.51), and daytime functioning (d = 0.52-1.02) were maintained, or improved upon, at the three month follow-up. However, relapse of symptomology was common and 38% of adolescents and young adults requested further treatment in addition to the three weeks of light therapy. Although there is convincing evidence for the short-term efficacy of chronobiological treatments for DSWPD, long-term treatment outcomes can be improved. To address this gap in our current knowledge, avenues for future research are discussed. Australian & New Zealand Clinical Trials Registry, www.anzctr.org.au, ACTRN12614000308695.

Using big data to explore worldwide trends in objective sleep in the transition to adulthood

Publisher: Elsevier BV

Date: 10-2019

DOI: 10.1016/J.SLEEP.2019.07.024

Abstract: Development induces changes in sleep, and its duration has been reported to change as a function of aging. Additionally, sleep timing is a marker of pubertal maturation, where during adolescence, the circadian rhythm shifts later. Typically, this is manifested in a later sleep onset in the evening and later awakening in the morning. These changes across development seem to be universal around the world but are unlikely to persist into adulthood. This study utilized accelerometer data from 17,355 participants aged 16-30 years (56% female) measured by validated Polar wearables over a 14-day period. We compared sleep duration, chronotype (sleep midpoint) and weekend catch-up (ie, social jetlag) sleep across ages and regions over 242,948 nights. The data indicate a decline in sleep duration as well as a dramatic shift in sleep onset times throughout adolescence. This continues well into early adulthood and stabilizes nearer age 30. Differences in sleep duration across ages were significant, and ranged from 7:53 h at age 16 to 7:29 h at age 30 in the s le. Additionally, there was a clear difference between females and males throughout adolescence and young adulthood: girls had longer sleep duration and earlier timed sleep in the current study. Differences in sleep were found between regions across the world, and across European areas. Both sleep duration and sleep timing go through a clear developmental pattern, particularly in early adulthood. Females had an earlier sleep midpoint and obtained more sleep. Regional differences in sleep occurred across the world.

Are cognitive “insomnia” processes involved in the development and maintenance of delayed sleep wake phase disorder?

Publisher: Elsevier BV

Date: 04-2016

DOI: 10.1016/J.SMRV.2015.05.001

Abstract: Although in iduals with delayed sleep wake phase disorder (DSWPD) and chronic insomnia disorder (CID) share many of the same phenomenological experiences, theories relating to the development and maintenance of these disorders are distinct in focus. Unlike CID, theory relating to DSWPD is primarily physiologically based and assumes almost no cognitive pathway. However, recent research findings suggest that in iduals with DSWPD also display many of the sleep-disordered cognitive processes that were previously assumed to be unique to the insomnia experience. As such, this review aims to summarise current research findings to address the question "Could cognitive processes be involved in the development and maintenance of DSWPD?" In particular, the presence of cognitive and physiological pre-sleep arousal, sleep-related attentional bias, distorted perception of sleep and daytime functioning, dysfunctional beliefs and safety behaviours will be investigated. As this emerging area of research requires a stronger evidence base, we highlight suggestions for future investigation and provide preliminary practice points for clinicians assessing and treating "insomnia" in patients with DSWPD.

Investigating longitudinal and bidirectional relationships between parental factors and time spent on social media during early adolescence

Publisher: SAGE Publications

Date: 08-02-2022

DOI: 10.1177/14614448221076155

Abstract: This three-wave panel study examined the prospective and bidirectional relationships between parental control of social media use, and parents’ and adolescents’ perceived time spent on social media over a 2-year period. Adolescents (52% males, T1: M age = 12.19, SD = 0.52) and one of their parents (96% mothers, T1: M age = 45.26, SD = 4.28) completed annual surveys (T1: N = 498, T2: N = 477 and T3: N = 440). Data were analysed using cross-lagged panel models. More adolescent time spent on social media predicted small decreases in parental control 1 year later, but parental control did not predict adolescent time on social media. More parental time spent on social media predicted small increases in adolescent time spent on social media 1 year later, but adolescent use did not predict parent use. Examining factors related to parental use, rather than restriction, may be more effective to reduce adolescents’ social media use.

Pediatric sleep: current knowledge, gaps, and opportunities for the future

Publisher: Oxford University Press (OUP)

Date: 06-03-2023

DOI: 10.1093/SLEEP/ZSAD060

Abstract: This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society’s Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For ex le, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

Measuring repetitive negative thinking: Development and validation of the Persistent and Intrusive Negative Thoughts Scale (PINTS).

Publisher: American Psychological Association (APA)

Date: 11-2019

DOI: 10.1037/PAS0000755

Abstract: Repetitive negative thinking (RNT) is a key risk and maintenance factor for many psychological disorders and is considered a transdiagnostic process. However, there are few disorder-neutral measures that assess RNT in adults, only 1 of moderate length considered suitable for children, and none that are validated for both children and adults. This study aimed to address this gap by developing a brief measure of RNT that can be used with both children and adults and can be quickly administered in research and clinical contexts. In Study 1, we administered the new 5-item Persistent and Intrusive Negative Thoughts Scale (PINTS) to 527 children (50.3% boys

Examining the Prospective Bidirectional Associations between Subjective and Objective Attractiveness and Adolescent Internalizing Symptoms and Life Satisfaction

Publisher: Springer Science and Business Media LLC

Date: 12-11-2022

DOI: 10.1007/S10964-022-01700-7

Abstract: Research has consistently shown that more physically attractive in iduals are perceived by others to be happier and better psychologically adjusted than those perceived as less attractive. However, due to the lack of longitudinal research in adolescents, it is still unclear whether poor mental health predicts or is predicted by either objective or subjective attractiveness during this critical developmental period. The purpose of the current study was to examine prospective bidirectional associations between both subjective and objective ratings of attractiveness, life satisfaction and symptoms of social anxiety, depression and eating disorders (i.e., internalizing symptoms) from early to mid-adolescence. Participants (T1: N = 528, 49.9% girls M age = 11.19 SD = 0.55) were followed annually over four time points. The cross-lagged panel model results revealed evidence of prospective associations between both forms of attractiveness and life satisfaction and internalizing symptoms, which were driven more by changes in the mental health outcomes than by changes in the subjective and objective attractiveness ratings. The results also indicated that the pattern, strength, and direction of the associations tested were robust across boys and girls, and white and non-white ethnic groups. Overall, the findings suggest that it is important to find effective ways of educating adolescents who are unhappy with their appearance that making changes to improve their mental health, rather than focusing on their physical appearance, will have benefits not only for how they perceive themselves but also for how they are perceived by others.

Perfectionism and insomnia in adolescents: The role of vulnerability to stress and gender

Publisher: Wiley

Date: 15-10-2020

DOI: 10.1016/J.ADOLESCENCE.2020.10.003

Abstract: Perfectionism is an often overlooked yet consistent construct related to insomnia in the scientific literature. Perfectionism and insomnia are both highly prevalent in adolescence. However, there is a dearth of research examining mechanisms linking perfectionism with insomnia, particularly in young people. The current study aimed to investigate whether vulnerability to stress, a factor common to both constructs, accounts for the relationship between perfectionism and insomnia symptoms in a s le of adolescents. 281 Australian participants (M age = 16.53, SD = 1.91, range = 13–19 years, 78% female) completed questionnaires assessing perfectionism, vulnerability to stress and insomnia on one occasion. Vulnerability to stress accounted for the relationship between self‐oriented striving perfectionism, self‐oriented critical perfectionism and insomnia symptom severity in females, but not males. Females reported higher self‐oriented critical perfectionism, vulnerability to stress and insomnia severity, with a stronger relationship between vulnerability to stress and insomnia symptoms observed for females. These results may partly explain the preponderance of insomnia in adolescent females. Possible implications for the prevention and treatment of insomnia in young people are discussed.

Risk for social anxiety in early adolescence: Longitudinal impact of pubertal development, appearance comparisons, and peer connections.

Publisher: Elsevier BV

Date: 07-2022

DOI: 10.1016/J.BRAT.2022.104126

Abstract: The aims of this study were to determine the impact of adolescent-relevant risk factors on changes in social anxiety symptoms from pre-to early-adolescence. From 2016 to 2018, 528 youth (51% boys) were tested in three annual waves across grades 6, 7, and 8 (M ages 11.2, 12.7, 13.7 years). Through online surveys youth reported on peer relationships that were combined into two latent factors: 1) appearance comparisons, comprising youth reports of appearance comparisons relative to others in general and while using social media, along with perceived attractiveness and 2) positive peer connections, comprising youth reports of group affiliation, school belonging, and peer victimisation. Youth and their parents also reported on the youth's level of pubertal development as well as the youth's level of social anxiety using previously validated questionnaires. Social anxiety was also assessed with structured diagnostic interview. Separate cross-lagged panel models were used to model longitudinal associations between all risk factors and youth, parent, and interviewer-reported measures of social anxiety. Of the associations tested, only appearance comparisons directly predicted increases in social anxiety symptoms 12 months later across all models. More advanced pubertal development was associated with increased appearance comparisons the following year. On the other hand, higher levels of social anxiety predicted subsequent reductions in positive peer connections in parent and interviewer models. These results highlight the important and interconnected impact of pubertal development and appearance comparisons on both the development of social anxiety symptoms during early adolescence, as well as the social consequences of social anxiety.

The Moderating Role of Sleep in the Relationship Between Social Isolation and Internalising Problems in Early Adolescence

Publisher: Springer Science and Business Media LLC

Date: 31-05-2019

DOI: 10.1007/S10578-019-00901-9

Abstract: Social isolation may be a unique risk factor for depression and anxiety in early adolescence. However, optimal sleep may protect adolescents from the emotional sequela of social isolation. The present study aimed to investigate whether sleep moderates the relationship between social isolation and symptoms of anxiety and depression in early adolescence. Five hundred and twenty eight early adolescents (M = 11.18 years, SD = 0.56, range 10-12 years, 51% male) completed online questionnaires assessing social isolation, sleep duration, daytime sleepiness and symptoms of generalised anxiety, social anxiety, separation anxiety and depression. Sleep duration moderated the effect of social isolation on symptoms of generalised anxiety, social anxiety and depression, but not separation anxiety. Daytime sleepiness emerged as an additional sleep-related risk factor in the relationship between social isolation and depressive symptoms. Therefore, sleep may be an important modifiable risk or protective factor to target, in the prevention of depression and anxiety in adolescence.

Sleep’s role in the development and resolution of adolescent depression

Publisher: Springer Science and Business Media LLC

Date: 20-06-2022

DOI: 10.1038/S44159-022-00074-8

A longitudinal investigation of sleep hygiene as a mediator linking parental warmth with adolescent sleep

Publisher: Oxford University Press (OUP)

Date: 08-11-2022

DOI: 10.1093/SLEEP/ZSAC267

Abstract: Parental warmth in adolescence protects sleep in early adulthood, yet the nature, directions, and mechanisms of this association across adolescence are unknown. This study examined parental warmth, adolescent sleep hygiene and sleep outcomes (morning/eveningness, school night sleep duration, and daytime sleepiness) across five annual waves, spanning four years, using a cross-lagged panel design. Adolescents and one primary caregiver (96% mothers) completed questionnaires assessing parental warmth (child- and parent-report) and adolescent sleep hygiene and sleep (child-report), across five annual waves: Wave 1 (N = 531, Mage = 11.18, SD = 0.56, 51% male), Wave 2 (N = 504, Mage = 12.19, SD = 0.53, 52% male), Wave 3 (N = 478, Mage = 13.19, SD = 0.53, 52% male), Wave 4 (N = 440, Mage = 14.76, SD = 0.47, 51% male), and Wave 5 (N = 422, Mage = 15.75, SD = 0.49, 51% male). Greater child-reported parental warmth was indirectly associated with better adolescent sleep (greater morningness, longer school night sleep duration, less sleepiness) through healthier sleep hygiene. The inverse was also often observed. Warmth had a direct relationship with sleep duration and sleepiness, independent of sleep hygiene. Parent-reported parental warmth did not predict, nor was predicted by child-reported adolescent sleep. Parental warmth may protect against developmental changes in adolescent sleep, partially by improving sleep hygiene practices. Similarly, inadequate adolescent sleep may negatively impact parental warmth via deteriorating sleep hygiene. Sleep hygiene emerged as a key mechanism for protecting adolescent sleep and parent-child relationships.

Chronotype, circadian rhythms and mood

Publisher: Elsevier BV

Date: 08-2020

DOI: 10.1016/J.COPSYC.2019.09.002

Abstract: Growing evidence shows a link between mood and chronotype. The majority of studies measure chronotype as a preference for morning/evening activities, rather than actual sleep behaviour (i.e. midsleep) or biological markers of sleep timing (e.g. dim light melatonin onset). Most studies show an association between chronotype and mood and identify eveningness as a potential risk for depression, but the directionality is unclear. Some evidence shows a stronger association between misalignment with the biological clock and depressive symptoms. This review provides a snapshot of recent research on chronotype and unipolar depression. We conclude that future studies should strive to integrate different measures of chronotype. This will give a clearer picture of the association between early/late chronotype and mood, which will in turn better inform clinical practice.

Depressed mood and repetitive negative thinking in Delayed Sleep–Wake Phase Disorder: Treatment effects and a comparison with good sleepers

Publisher: Wiley

Date: 04-08-2021

DOI: 10.1111/JSR.13452

Abstract: Circadian dysregulation and depressed mood commonly co‐occur in young people, yet mechanisms linking Delayed Sleep–Wake Phase disorder (DSWPD) with depression are poorly understood. The present study aimed to examine the role of repetitive negative thinking (RNT), by comparing sleep, RNT and depressive symptomology between 40 ‘good’ sleeping young people and 63 with DSWPD, with ( n = 30) and without ( n = 33) self‐reported doctor‐diagnosed depression. Secondary analysis from a randomised controlled trial was also undertaken to observe changes in depressive symptoms and RNT as a result of treatment for DSWPD. The 60 young people with DSWPD (mean [ SD ] age of 15.9 [2.2] years, 63% female) received either short (green) or long (red) wavelength bright light therapy (BLT) over 3 weeks. Cross‐sectional baseline comparisons revealed an escalating pattern of worse sleep, more RNT and higher depressed mood scores in the DSWPD young people compared to good sleepers. Across all participants, RNT accounted for the associations between sleep‐onset difficulties and depressed mood at baseline. Symptoms of depression, RNT and sleep onset difficulties in DSWPD in iduals significantly improved after treatment ( d = 0.47–0.65) and at the 1‐ ( d = 0.43–1.00) and 3‐month follow‐up ( d = 0.39–1.38), yet there were no differences between short‐ and long‐wavelength BLT. Results provide preliminary evidence that RNT may link delayed sleep phase with depression. BLT conferred sleep benefits, but also improvements in depressed mood and RNT, and thus represents a potentially cost‐effective strategy for young people experiencing delayed sleep phase and low mood.

CBT-I Cannot Rest Until the Sleepy Teen Can

Publisher: Oxford University Press (OUP)

Date: 12-2015

DOI: 10.5665/SLEEP.5220

The role of parenting behaviors in the bidirectional and intergenerational transmission of depression and anxiety between parents and early adolescent youth

Publisher: Hindawi Limited

Date: 13-07-2021

DOI: 10.1002/DA.23197

Abstract: Parenting is a modifiable factor proposed to underpin the transmission of anxiety and depression from parents to children. This study examined the role of parenting in the intergenerational transmission of anxiety and depression across pre- and early adolescence. Participants were 531 youth (M Results suggest bidirectional associations over time between parent and child depression, and parental rejection and child depression. Parental rejection and low warmth were associated with increases in child depression, but did not mediate depression transmission. Parental anxiety was associated with increases in child anxiety and depression, but there was no bidirectional association from child psychopathology to parental anxiety. There was little evidence that parenting predicted changes in child anxiety over time. Child anxiety and depression were associated with subsequent increases in parental depression. Parental depression, rejection and low warmth are independent risk factors for child depression. Parental rejection may also be a consequence of parenting a depressed youth. Parenting did not account for the apparent transmission of parental anxiety to increased child anxiety and depression. Child psychopathology increases risk of parental depression. Parental rejection may be an important modifiable risk factor for youth depression in early adolescence, and may also reduce later risk of parent depression.

A randomised controlled dismantling trial of sleep restriction therapies for chronic insomnia disorder in middle childhood: effects on sleep and anxiety, and possible contraindications

Publisher: Wiley

Date: 17-06-2022

DOI: 10.1111/JSR.13658

Abstract: Sleep restriction therapies likely drive improvement in insomnia in middle childhood via increases in homeostatic sleep pressure (e.g., evening sleepiness). Increased evening sleepiness may also d en comorbid anxiety symptoms and reduced wakefulness in bed may reduce worry. However, sleep restriction therapies have never been evaluated as a standalone intervention in this population. The mechanism of action needs testing, as do effects on anxiety, and cognitive performance and parasomnias (possible contraindications). This randomised controlled trial evaluated the efficacy of two “doses” of sleep restriction therapy (sleep restriction therapy, bedtime restriction therapy), compared to a control condition (time in bed regularisation). A total of 61 children (mean [SD, range] age 9.1 [2.1, 6–14] years 54% female) with chronic insomnia disorder received two weekly 60‐min treatment sessions with a psychologist. Sleep, sleepiness, anxiety, worry, cognitive performance, and parasomnias were measured pre‐treatment, across treatment, and at 4‐weeks post‐treatment. Both the sleep and bedtime restriction groups experienced reductions in total sleep time ( d = 1.38–2.27) and increases in evening sleepiness ( d = 1.01–1.47) during the 2‐week treatment, and improvements in insomnia (i.e., sleep onset latency d = 1.10–1.21), relative to the control group. All groups reported improved anxiety and worry, yet there were no differences between the control and restriction groups (all p 0.658). Time in bed increased at the 1‐month follow‐up, and benefits to sleep and insomnia were maintained. There were no adverse effects on cognitive functioning (all p 0.259), nor parasomnia occurrence (all p 0.740). These results suggest that sleep restriction therapies are brief, yet effective, standalone interventions for insomnia in middle childhood, and improvements are likely due to increased sleepiness, not sleep regularisation.

Testing a concurrent model of social anxiety in preadolescence

Publisher: SAGE Publications

Date: 25-03-2020

DOI: 10.1177/0165025420912014

Abstract: Social anxiety is a common mental disorder with an average age of onset in early adolescence. Current theories focus largely on risk factors that are present from early in life, but reasons for onset of the disorder as youth move into adolescence are rarely discussed. We recently proposed a model of the onset of certain mental disorders during the adolescent years based on characteristics of adolescent development. While this model will require longitudinal testing, the current article establishes concurrent associations between relevant variables in a cohort of 528 preadolescents ( M age = 11.2 years) at baseline. Youth with social anxiety disorder differed significantly from other youth on measures of social comparison (including physical appearance comparisons, self-rated attractiveness, and negative peer comparisons on social media) as well as positive peer connections (including self-reported school belonging, number of friends, victimization, and peer affiliation). A structural equation model showed that symptom levels of social anxiety were directly related to social comparisons and peer connections, as well as indirectly associated with pubertal development and social comparisons. This pattern was not moderated by sex of youth.

The role of rumination in the relationship between symptoms of insomnia and depression in adolescents

Publisher: Wiley

Date: 17-05-2023

DOI: 10.1111/JSR.13932

Abstract: There is a strong relationship between the symptoms of insomnia and depression, however, little is understood about the factors that mediate this relationship. An understanding of these underlying mechanisms may inform the advancement of existing treatments to optimise reductions in insomnia and depression when they co‐occur. This study examined rumination and unhelpful beliefs about sleep as mediators between symptoms of insomnia and depression. It also evaluated the effect of cognitive behavioural therapy for insomnia (CBT‐I) on rumination and unhelpful beliefs about sleep, and whether these factors mediated the effect of CBT‐I on depressive symptoms. A series of mediation analyses and linear mixed modelling were conducted on data from 264 adolescents (12–16 years) who participated in a two‐arm (intervention vs. control) randomised controlled trial of Sleep Ninja®, a CBT‐I smartphone app for adolescents. Rumination, but not unhelpful beliefs about sleep, was a significant mediator between symptoms of insomnia and depression at baseline. CBT‐I led to reductions in unhelpful beliefs about sleep, but not in rumination. At the between‐group level, neither rumination, nor unhelpful beliefs about sleep emerged as mechanisms underlying improvement in depression symptoms, however, rumination mediated within‐subject improvements following CBT‐I. The findings suggest rumination links symptoms of insomnia and depression and provide preliminary evidence that reductions in depression following CBT‐I occurs via improvements in rumination. Targeting rumination may improve current therapeutic approaches.

Adolescent development and risk for the onset of social-emotional disorders: A review and conceptual model

Publisher: Elsevier BV

Date: 12-2019

DOI: 10.1016/J.BRAT.2019.103501

Abstract: The adolescent developmental stage appears to be a sensitive period for the onset of several particular forms of mental disorder that are characterised by heightened emotionality and social sensitivity and are more common in females than males. We refer to these disorders (social anxiety disorder, generalised anxiety disorder, eating disorders, major depression) collectively as the social-emotional disorders. The aim of this paper is to address an important question in the understanding of social-emotional disorders - why do these disorders commonly begin during adolescence? We present a conceptual model that describes some of the key changes that occur during adolescence and that addresses some hypothesised ways in which these changes might increase risk for the development of social-emotional disorders. An overview of the extant empirical literature and some possible directions for future research are suggested. The model points to interesting links between psycho-social risk factors that should highlight potentially fruitful directions for both psychopathology research and early intervention programs.

Longitudinal Associations between Coping Strategies and Psychopathology in Pre-adolescence

Publisher: Springer Science and Business Media LLC

Date: 29-10-2020

DOI: 10.1007/S10964-020-01330-X

Flinders University School Of Psychology

Location: Australia

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Flinders University

Location: Australia

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University Of Western Australia

Location: Australia

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Macquarie University

Location: Australia

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Discovery Projects - Grant ID: DP0346777

Start Date: 02-2003

End Date: 12-2006

Amount: $212,000.00

Funder: Australian Research Council