Browsing by Subject "Sleep Initiation and Maintenance Disorders"
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Item Evaluation of Social Stories in Sleep Treatment for Children with Autism Spectrum Disorder: A Feasibility Study(2020-12-01T06:00:00.000Z) Israelsen, Lora Jane; Brown, William David; Germann, Julie; Kao, Yungfei; Bellone, Katherine; Nakonezny, PaulA majority of children with autism spectrum disorders (ASD) experience sleep disturbances which are apt to negatively impact cognition, behavioral functioning, and the general trajectory of psychosocial development. Additionally, pediatric sleep disorders may contribute to disordered sleep in parents and reduced quality of life for family members. While children with ASD often respond positively to general standard of care in pediatric sleep medicine, there are few sleep treatments that address ASD-specific factors that contribute to sleep disturbances. This limitation may be addressed through the development of a treatment that incorporates sleep behavioral strategies in a format developed for children with ASD, such as a social story. This study evaluated the feasibility and acceptability of using a social story on bedtime routine developed for children as a complementary intervention for standard of care in a pediatric sleep clinic. Results from this study indicated social stories are acceptable as a complementary tool to sleep treatment. All participants approached for the study gave consent. Of those enrolled in the treatment group, all participants randomized to the treatment group read the story for at least one week as part of the bedtime routine (100%) with a mean utilization of 19.4 days during the month. Participants reported the social story was easy to implement and well received by the children, though feedback indicated the need for personalization and flexibility in the implementation of social stories. There were no significant differences in pediatric sleep outcomes between treatment groups. There were significant challenges related to the feasibility of the study in terms of gathering follow-up data, partially due to the impact of the COVID-19 worldwide pandemic that occurred during the study. Secondary analyses found no significant differences in parental sleep outcomes or psychosocial functioning between treatment groups. These findings suggest that social stories may be a promising tool in pediatric sleep treatment for children with ASD, but additional research is warranted to clarify its efficacy.Item Prediction by Insomnia to Treatment Outcomes in an Adolescent Suicide Management Program(2019-03-15) Lau, Jenny Wong; Emslie, Graham; Stewart, Sunita M.; Kennard, Beth D.BACKGROUND: Insomnia is the symptom most strongly associated with suicide-related thoughts and behaviors in adolescents and young adults with diverse diagnoses, even after adjusting for psychiatric conditions like depression (Goldstein, 2008). However, there is little empirical evidence that demonstrates prospectively that sleep problems are in fact a risk factor for suicide attempts (Franklin et al. 2017). OBJECTIVE: This study examines the previously unexplored relationship between insomnia and suicidal relapse in youth enrolled in an outpatient suicide prevention program. METHODS: Data were obtained from clinical records of adolescents ages 12-17 enrolled in the Suicide Prevention and Resilience at Children's Intensive Outpatient program (SPARC IOP) from January 1, 2014 through March 1, 2016 (n = 206). Patients completed measures of depressive symptoms, insomnia, and suicide risk at entry and exit. The association between insomnia, exit suicide risk, and 6-month attempts was tested with multiple regression analyses. RESULTS: Patients were mainly female (79.1%; n = 163) with a primary diagnosis of depression (89.8%; n = 185). Depression, suicide risk, and insomnia scores decreased overall. Entry insomnia was associated with exit suicide risk (CHRT) after controlling for entry risk, age, sex, time in the program, and number of previous attempts. Patients with insomnia did not show a different rate of treatment response (β = 0.257, p > .10). Entry insomnia was also associated with suicide attempts within 6 months after exiting the program when controlling for age, sex, and previous attempts. When entry and exit risk were added to the model, the association between entry insomnia and attempts within 6 months lost significance while the association between exit risk and attempts at 6 months became significant. Thus, patients with higher insomnia scores at entry had higher suicide risk scores at exit, which increased the likelihood of a suicide attempt 6 months after the program. CONCLUSION: These findings suggest that insomnia is a distal variable in the pathway to risk for suicide attempts after discharge. Entry insomnia is associated with exit risk, which has a more proximal relationship with 6-month attempts. Direct management of insomnia symptoms could reduce suicide risk at program exit, which could then reduce the probability of a suicide attempt in the 6 months following discharge. These studies could ultimately lead to new therapeutic approaches for reducing suicide attempts by treating insomnia symptoms.Item Treatment Considerations for Comorbid Insomnia and Chronic Pain: A Biopsychosocial Approach to Clinical Care(2016-08-25) Van Ness, Olivia Elizabeth; Robinson, Richard C.; Gatchel, Robert J.; Noe, CarlBACKGROUND: Interdisciplinary pain management programs have proven to be quite effective in alleviating presenting patient symptoms. Sleep is a complex process not well understood and the effects it maintains on subsequent daytime function appear to influence pain and related symptoms. SUBJECTS: 134 qualifying participants were drawn from an interdisciplinary pain management program. The majority of subjects were females of Caucasian race with sample ages ranging from 20 to 86 years. Participants were compensated a small amount for their time. METHOD: Patients were administered computerized testing on measures of pain, mood, and function prior to and upon successful completion of the program. Participants were placed into groups based on their performance on sleep measures to be examined for differences. RESULTS: Time spent in the interdisciplinary program was shown to be effective across all measures administered, including sleep measures. The sleep improvement group showed significantly more change on measures of physical function and social satisfaction. DISCUSSION: This study further strengthens the argument for the use of interdisciplinary pain management by providing an example of global improvement among the sample. Particular attention should be paid to physical function and social satisfaction when observing differences in sleep disturbance and sleep-related impairment.