J. Aimée Coulombe

Concurrent Associations among Sleep Problems, Indicators of Inadequate Sleep, Psychopathology, and Shared Risk Factors in a Population-based Sample of Healthy Ontario Children

OBJECTIVES Examine the contribution of sleep problems and indicators of inadequate sleep to psychopathology among children after accounting for shared risk and comorbid psychopathology. METHODS Secondary analyses of cross-sectional data on 4- to 11-year-old (N = 1,550) children without chronic illness or developmental delay or disability. Parents provided information about sleep problems, indicators of inadequate sleep, symptoms of psychopathology, and risk factors for psychopathology. Teachers provided information about indicators of inadequate sleep and symptoms of psychopathology. RESULTS Adjusting for risk factors and comorbid psychopathology, sleeping more than other children was related to parent-rated aggression. Nightmares and trouble sleeping were related to parent-rated anxious/depressed mood. Sleep problems were not related to attention problems. Being overtired was related to parent- and teacher-rated psychopathology. CONCLUSIONS Relations among sleep problems, indicators of inadequate sleep, and psychopathology are complex; accounting for potential confounding variables and considering sleep variables separately may clarify these relations.

ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations

The ABCs of SLEEPING mnemonic was developed to serve as an organizing framework for common pediatric sleep recommendations. The mnemonic stands for 1) age appropriate bedtimes and wake-times with consistency, 2) schedules and routines, 3) location, 4) exercise and diet, 5) no electronics in the bedroom or before bed, 6) positivity 7) independence when falling asleep and 8) needs of child met during the day, 9) equal great sleep. This review examines the empirical evidence behind the practices and recommendations captured by the ABCs of SLEEPING mnemonic for children aged 1 to 12. A search was conducted of key electronic databases (PubMed, PsycINFO, CINAHL, & EMBASE) to identify English articles that included the concepts of sleep, insomnia, and/or bedtime. 77 articles were eligible for inclusion and were coded to extract key details and findings regarding the relations between sleep practices identified in the ABCs of SLEEPING mnemonic and sleep outcomes. Findings provided preliminary support for many of the recommendations that are commonly made to families regarding healthy sleep practices. However, more robust investigations are needed to better understand the causal contributions of healthy sleep practices to the onset and maintenance of childrens sleep problems.

Barriers and Facilitators of Evidence-Based Practice in Pediatric Behavioral Sleep Care: Qualitative Analysis of the Perspectives of Health Professionals

Behavioral sleep problems are highly prevalent among young and school-aged children. Despite strong evidence for effective interventions, few children receive evidence-based care. In this study, 124 Canadian health professionals answered open-ended questions regarding barriers and facilitators of their provision of evidence-based behavioral sleep-related care, and responses were analyzed for content. Responses represented issues at an individual practice level, as well as broader systemic issues. The most frequently reported barrier and facilitator related to knowledge, training, and education. Other barriers included lack of time and institutional support, and facilitators included supportive sleep attitudes and beliefs. This study may inform the design of education programs for health professionals, and provides support for broader systems-level initiatives targeted at increasing evidence-based practice.

Core Competencies for Health Professionals' Training in Pediatric Behavioral Sleep Care: A Delphi Study

The need to train non-sleep-specialist health professionals in evidence-based pediatric behavioral sleep care is well established. The objective of the present study was to develop a list of core competencies for training health professionals in assisting families of 1- to 10-year old children with behavioral insomnia of childhood. A modified Delphi methodology was employed, involving iterative rounds of surveys that were administered to 46 experts to obtain consensus on a core competency list. The final list captured areas relevant to the identification and treatment of pediatric behavioral sleep problems. This work has the potential to contribute to the development of training materials to prepare non-sleep-specialist health professionals to identify and treat pediatric behavioral sleep problems, ideally within stepped-care frameworks.

Agreement With Night-Waking Strategies Among Community Mothers of Preschool-Aged Children

OBJECTIVE To explore the night-waking schemas of mothers of preschool-aged children, using a new measure of agreement with night-waking strategies (Night-waking Vignettes Scale; NVS). METHOD A community sample of 203 mothers (M age = 32 years, SD = 5.1) of 2- to 5-year-olds (M age = 3.4 years, SD = 1.0) provided demographic information and completed the NVS and measures of night-waking and general parenting behavior. RESULTS Few mothers endorsed strong agreement or disagreement with limit-setting, active comforting, or rewards; mothers generally disagreed with punishment. Significant associations between agreement with night-waking strategies, child sex, and maternal educational attainment were observed; only agreement with punishment was correlated with general parenting. Agreement with night-waking strategies differed across the night-waking behaviors depicted in the NVS vignettes. Agreement with limit-setting and agreement with active comforting were correlated with night-waking. CONCLUSIONS Mothers may be ambivalent about common night-waking strategies. Night-waking schemas appear to be complex.

Assessing Parental Sleep Attitudes and Beliefs in Typically Developing Children and Children With ADHD and ASD

Sleep problems are commonly reported in children, yet often go untreated. Parental beliefs about sleep may be a contributing factor. This study developed a measure to assess these beliefs. The Sleep Attitudes and Beliefs Scale (SABS) was administered to parents of typically developing (TD) children (n = 179) and children with attention deficit hyperactivity disorder (ADHD; n = 84) and autism spectrum disorder (ASD; n = 92). Results indicated that the psychometric properties (i.e., inter-item reliability and Cohens alpha) of the SABS are good and that, in comparison to the TD sample, parents of children with ADHD and ASD held beliefs that childrens sleep problems were more intrinsic, less modifiable, and less responsive to treatment. Further work is required, but it is hoped that the SABS can be used both clinically, to determine factors that may contribute to and maintain childrens sleep problems, and in research settings.