Tori R. Van Dyk

Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis.

CONTEXT: Mixed findings exist on whether stimulant medications alter youth sleep. OBJECTIVE: To determine the effect of stimulant medications on sleep. DATA STUDIES: Studies published through March 2015 were collected via CINAHL, PsycINFO, and PubMed. References of retrieved articles were reviewed. STUDY SELECTION: Eligibility criteria included studies with children/adolescents who had attention-deficit/hyperactivity disorder (ADHD), random assignment to stimulants, and objective sleep measurement. Studies that did not include information about key variables were excluded. DATA EXTRACTION: Study-level, child-level, and sleep data were extracted by 2 independent coders. Effect sizes were calculated by using random effects models. Potential moderators were examined by using mixed effect models. RESULTS: A total of 9 articles (N = 246) were included. For sleep latency, the adjusted effect size (0.54) was significant, indicating that stimulants produce longer sleep latencies. Frequency of dose per day was a significant moderator. For sleep efficiency, the adjusted effect size (−0.32) was significant. Significant moderators included length of time on medication, number of nights of sleep assessed, polysomnography/actigraphy, and gender. Specifically, the effect of medication was less evident when youth were taking medication longer. For total sleep time, the effect size (−0.59) was significant, such that stimulants led to shorter sleep duration. LIMITATIONS: Limitations include few studies, limited methodologic variability, and lack of unpublished studies. CONCLUSIONS: Stimulant medication led to longer sleep latency, worse sleep efficiency, and shorter sleep duration. Overall, youth had worse sleep on stimulant medications. It is recommended that pediatricians carefully monitor sleep problems and adjust treatment to promote optimal sleep.

Psychosocial Stressors and Health Behaviors Examining Sleep, Sedentary Behaviors, and Physical Activity in a Low-Income Pediatric Sample

Objective. To better understand the relationship between psychosocial stressors and health behaviors in a low-income pediatric sample. Method. Participants were 122 children (8-11 years old, 53.3% female) and their parents recruited from a low-income primary care clinic. Measures assessed child stressors and parental financial strain, and child sleep problems, sedentary behaviors, and physical activity. Results. Parental financial strain and child stressors were independently associated with sleep problems and sedentary behaviors, controlling for age and gender. Though stressors in general accounted for significant variance in physical activity, results indicate a complex relationship as parental financial strain predicted more physical activity and child stressors predicted less physical activity. Conclusion. Stressors are associated with adverse pediatric health behaviors. Consequently, chronic stressors could negatively affect long-term health, and interventions targeting stressors and health behaviors are indicated. Pediatric health care providers play a key role in promoting health behaviors among youth experiencing significant psychosocial stressors.

Physical Health Status as a Predictor of Treatment Outcomes Among Youth in Residential Care

In addition to complex behavioral and emotional issues, youth presenting to residential care tend to have higher rates of physical health conditions than those in the general population. Although a strong body of research has found a relationship between physical and mental health, the influence of health status on youth residential care outcomes has not been explored. This study examined the impact of poor physical health on mental health treatment outcomes in a sample of 1,735 youth entering residential care from 2000 to 2010. At intake, youth received medical evaluations identifying physical health conditions, medication prescriptions, and anthropometric measurements. Residential care outcomes were measured by changes in 1-year National Institute of Mental Health (NIMH) Diagnostic Interview Schedule for Children–IV mental health diagnoses and discharge setting. Rates of school dropout and placement stability were also examined 6 months after discharge. Results suggest that factors related to poor physical health, specifically nonpsychotropic medication prescriptions, are associated with suboptimal mental health outcomes at 1 year, discharge, and follow-up from residential care. These findings indicate that physical health issues adversely impact residential care outcomes, suggesting these youth may require specialized services, such as integrated treatment planning, to achieve optimal treatment outcomes.

Daily Bidirectional Relationships Between Sleep and Mental Health Symptoms in Youth With Emotional and Behavioral Problems

OBJECTIVE The present study examined the daily, bidirectional relationships between sleep and mental health symptoms in youth presenting to mental health treatment. METHODS Youth aged 6 to 11 (36% female, 44% European American) presenting to outpatient behavioral health treatment (N = 25) were recruited to participate in the study. Children and parents completed daily questionnaires regarding the childs sleep, mood, and behavior for a 14-day period, while youth wore an actigraph watch to objectively measure sleep. RESULTS Examining between- and within-person variance using multilevel models, results indicate that youth had poor sleep duration and quality and that sleep and mental health symptoms were highly related at the daily level. Between-person effects were found to be most important and significant bidirectional relationships exist. CONCLUSIONS Identifying and addressing sleep problems in the context of mental health treatment is important, as poor sleep is associated with increased symptomology and may contribute to worsened mental health.

A Meta-Analysis of the Effect of Experimental Sleep Restriction on Youth's Attention and Hyperactivity.

This meta-analysis examined the effect experimental sleep restriction has on youth’s attention and hyperactivity outcomes. Thirteen published studies containing 17 independent samples were included (N = 496). Random- and fixed-effects models were used to estimate pooled effect sizes and moderator effects, respectively. Results indicate that sleep-restricted youth had significantly worse attention outcomes than youth with extended sleep, but no differences were evident regarding hyperactivity. Significant moderators of this effect included age and sex. These results have important implications for both the prevention and treatment of attention problems, highlighting the need for health professionals to screen for and treat underlying sleep issues.

Anger and children’s health: Differentiating role of inward versus outward expressed anger on sleep, medical service utilization, and mental health

ABSTRACT Objective: To examine the differential associations between children’s anger expression styles and selected health constructs. Method: Measures assessed sleep problems, medical service utilization, and mental health in 125 children (M = 9.48 years). Results: Anger expression styles predicted health outcomes in a multivariate model. As hypothesized, anger-out significantly predicted sleep problems, number of medical visits, externalizing problems, and internalizing problems. Anger-in was not significantly related to any health outcome measure. Conclusion: This study demonstrates the importance of anger expression styles for health, as they are differentially related to impairments. Clinicians are urged to recognize anger problems to broadly impact children’s health.

Parenting stress and child physical health among a low-income sample: The moderating role of child anxiety.

This study examined child anxiety as a potential moderator of the relationship between parenting stress and child physical health. Low-income youth (N = 109, M = 9.51 years old) and their parents completed measures of anxiety, health-related quality of life, and parenting stress in an outpatient clinic. As an objective measure of physical health, medical service utilization was extracted from medical records. Parenting stress was associated significantly with worse health-related quality of life and higher service utilization. Child anxiety moderated the relationship between stress and health. Health psychologists should target both family stress and child anxiety in promoting better health outcomes among low-income families.

Peer Victimization and Child Physical Health: The Moderating Role of Pessimism

OBJECTIVE Involvement in peer victimization has been associated with numerous negative consequences, including poor physical health. The purpose of this study is to improve on previous research evaluating the victimization-health relationship by examining the health (i.e., health-related quality of life [HRQoL], medical service utilization) of both victims and aggressors and examining individual variation in this relationship through the moderating effect of pessimism. METHOD The sample included 125 ethnically diverse youth aged 8-11 years recruited from a low-income medical practice. Child-report of involvement in peer victimization and pessimism was assessed along with parent-report of HRQoL. 2-year medical service utilization was extracted from medical records. RESULTS Although not all hypotheses were supported, victims and aggressors were found to be at increased risk for certain poor health outcomes, which were exacerbated by high levels of pessimism. CONCLUSION Findings expand on research into peer victimization and health and provide important implications for identification, prevention, and intervention strategies with at-risk youth.

Mental Health Diagnoses and Symptoms in Preschool and School Age Youth Presenting to Insomnia Evaluation: Prevalence and Associations with Sleep Disruption

ABSTRACT Objective/Background: Sleep problems and emotional and behavioral difficulties are highly correlated in community samples of youth and in youth presenting to mental health treatment. However, fewer studies have characterized the associations between sleep and psychopathology symptoms in youth presenting to pediatric sleep clinics. This retrospective, cross-sectional study examined the prevalence of psychopathology symptoms and their associations with sleep disruption in youth presenting to a behavioral sleep medicine clinic. Participants: Participants were 373 preschoolers (1.5 to 5 years old) and 300 school age youth (6 to 10 years old) presenting to a pediatric behavioral sleep medicine clinic with a primary insomnia diagnosis. Methods: As a part of routine clinical care, parents completed a battery of pre-evaluation measures assessing insomnia severity, sleep disturbance, history of mental health diagnosis, and psychopathology symptoms. Results: Both preschool and school age youth had high rates of parent-reported mental health diagnoses (35% and 74%, respectively) and clinically elevated psychopathology symptoms (69% of preschoolers and 77% of school age youth) at initial insomnia evaluation. These symptoms were significantly associated with sleep disruption, with ADHD and affective problems most consistently associated with sleep problems in preschoolers and symptoms of anxiety, affective, and behavioral problems most consistently associated with sleep problems in school age youth. Conclusions: Psychopathology symptoms should be regularly assessed in youth presenting to behavioral sleep medicine clinics. Further, the role of psychopathology should be considered in insomnia conceptualization and treatment and, when appropriate, psychopathology symptoms should be targeted in treatment or appropriate referrals should be made.

Effectiveness of a Parent Health Report Intervention to Increase Physical Activity among Preschoolers and Kindergarteners

This study was designed to assess the efficacy of a brief parent report intervention for increasing preschoolers’ physical activity participation. Children wore accelerometers for three days and parents subsequently received a report of their child’s average daily physical activity in comparison to national recommendations. Post-intervention physical activity was assessed using accelerometers. Following the intervention, participation in moderate physical activity increased by 5.12 minutes per day on average. Vigorous physical activity did not increase significantly following the intervention. A brief parent report of physical activity may provide an effective intervention to increase preschooler’s’ physical activity participation as part of larger physical activity promotion efforts.