Understanding the unique and common perspectives of partners engaged in knowledge mobilization activities within pediatric pain management: a mixed methods study.

BACKGROUND: Knowledge mobilization (KM) is essential to close the longstanding evidence to practice gap in pediatric pain management. Engaging various partners (i.e., those with expertise in a given topic area) in KM is best practice; however, little is known about how different partners engage and collaborate on KM activities. This mixed-methods study aimed to understand what different KM partner groups (i.e., health professionals, researchers, and patient/caregiver partners) perceive as supporting KM activities within pediatric pain management. METHODS: This study used a convergent mixed-methods design. Ten partners from each of the three groups participated in interviews informed by the Consolidated Framework for Implementation Research, where they discussed what impacted KM activities within pediatric pain. Participants then rated and ranked select factors discussed in the interview. Transcripts were analyzed within each group using reflexive thematic analysis. Group-specific themes were then triangulated to identify convergence and divergence among groups. A matrix analysis was then conducted to generate meta-themes to describe overarching concepts. Quantitative data were analyzed using descriptive statistics. RESULTS: Unique themes were developed within each partner group and further analysis generated four meta-themes: (1) team dynamics; (2) role of leadership; (3) policy influence; (4) social influence. There was full agreement among groups on the meaning of team dynamics. While there was partial agreement on the role of leadership, groups differed on who they described as taking on leadership positions. There was also partial agreement on policy influence, where health professionals and researchers described different institutions as being responsible for providing funding support. Finally, there was partial agreement on social influence, where the role of networks was seen as serving distinct purposes to support KM. Quantitative analyses indicated that partner groups shared similar priorities (e.g., team relationships, communication quality) when it came to supporting KM in pediatric pain. CONCLUSIONS: While partners share many needs in common, there is also nuance in how they wish to be engaged in KM activities as well as the contexts in which they work. Strategies must be introduced to address these nuances to promote effective engagement in KM to increase the impact of evidence in pediatric pain.

Acceptability of an online intervention for insomnia in children with neurodevelopmental disorders.

BACKGROUND: Most children with neurodevelopmental disorders (NDDs) experience insomnia. Online interventions may provide a way to reduce barriers to treatment access. AIMS: We explored whether parents of children with NDDs and their health care professionals (HCPs) perceived an online insomnia intervention as acceptable and the perceived pros and cons of this intervention delivery method. METHODS AND PROCEDURES: Participants included 43 parents of children with NDDs and 44 HCPs who work with children with NDDs. During focus groups/interviews participants shared their perceptions of a hypothetical online insomnia intervention. Responses were analyzed using qualitative content analysis and codes were grouped into pros and cons. OUTCOMES AND RESULTS: Parents and HCPs reported similar pros and cons. Pros focused on the intervention's accessibility, credibility, usability, usefulness, and design, whereas cons focused on feasibility of implementation. Participants felt that external support (e.g., an online coach) would improve the intervention's acceptability. CONCLUSIONS AND IMPLICATIONS: Overall, the majority of parents and HCPs perceived an online intervention for insomnia as acceptable but concerns about implementation were noted and need to be taken into account when developing online interventions.

Influences on help-seeking decisions for behavioral child sleep problems: Why parents do and do not seek help.

OBJECTIVES: Behavioral sleep problems affect 25% of children and impact functioning, but little is known about help-seeking for these problems. We identified (1) predictors for sleep problem perception and help-seeking, using nested-logit regression and (2) reasons why parents did not seek professional help for sleep problems, using chi-square. METHODS: Parents (N = 407) of children (2-10-years-old) completed the study online. Parents indicated whether their child had no sleep problem, a mild problem, or a moderate-to-severe problem and completed additional questionnaires on parent/child functioning. RESULTS: Overall, 5.4% ± 2.2% of parents sought professional help for a child sleep problem. Greater child sleep problem severity and greater child socioemotional problems were significant predictors of parents perceiving a sleep problem. Among parents who perceived a sleep problem, greater parental socioemotional problems significantly predicted professional help-seeking. Parents who perceived no problem or a mild sleep problem reported not needing professional help as the main reason for not seeking help; parents who perceived a moderate-to-severe problem reported logistic barriers most often (e.g. treatment unavailability, cost). CONCLUSIONS: Problem perception and help-seeking predictors resemble the children's mental health literature. Differences in barriers, based on problem severity, suggest differential help-seeking interventions are needed (e.g. education vs access).

Barriers and facilitators to treating insomnia in children with autism spectrum disorder and other neurodevelopmental disorders: Parent and health care professional perspectives.

BACKGROUND/AIMS: Insomnia is highly prevalent in children with neurodevelopmental disorders (NDDs), yet little research exists on sleep treatment access, utilization, and provision in this population. This study explores barriers and facilitators to access, use, and provision of treatment for sleep problems as experienced by parents of children with NDDs, including Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder (ADHD), Cerebral Palsy (CP) and Fetal Alcohol Spectrum Disorder (FASD), and health care professionals who work with children with these conditions. METHOD: Transcripts from online focus groups and interviews, conducted separately with parents of children with NDDs (n = 43) and health care professionals (n = 44), were qualitatively analyzed using content analysis for key themes. RESULTS: Barriers included limited access to/availability of treatment, lack of knowledge/training, NDD-specific factors (e.g., symptoms, medications, and comorbidities), parent factors (e.g., capacity to implement treatment, exhaustion), and the challenging, intensive nature of sleep treatment. Facilitators included positive beliefs and attitudes, education, support, and ability to modify treatments for NDD symptoms. Barriers and facilitators were similar across all four NDDs. CONCLUSIONS: Results highlight a need for more education about sleep in NDDs and to develop accessible interventions, as well as the potential of a transdiagnostic approach to sleep treatment in this population.

An eHealth insomnia intervention for children with neurodevelopmental disorders: Results of a usability study.

BACKGROUND: Sleep problems, particularly insomnia, are highly prevalent in children with neurodevelopmental disorders (NDD) and can negatively affect health and development. eHealth interventions may increase access to evidence-based care for insomnia for children with NDD, as programs are rare in most communities. Better Nights, Better Days (BNBD) is an online, parent-implemented intervention for pediatric insomnia in typically developing 1- to 10-year-olds. AIMS: The present study examined whether parents of children with NDD perceived the original BNBD to be usable, acceptable, and feasible, and what modifications might be necessary to adapt it for children with NDD. METHODS AND PROCEDURES: Twenty Canadian parents/caregivers of children aged 4-10 years with NDD and insomnia implemented the BNBD intervention with their children, and completed usability questionnaires. Questionnaire data were analyzed quantitatively (descriptive statistics) and qualitatively (thematic analysis). OUTCOMES AND RESULTS: Participants reported the intervention to be usable, useful, acceptable, and feasible. Several modifications were suggested to make the intervention more appropriate and acceptable for use with children with NDD. CONCLUSIONS AND IMPLICATIONS: Results support a largely transdiagnostic approach to treating sleep in children with NDD, and will inform the development of BNBD for Children with Neurodevelopmental Disorders (BNBD-NDD).

A systematic review to explore the feasibility of a behavioural sleep intervention for insomnia in children with neurodevelopmental disorders: A transdiagnostic approach.

Children with neurodevelopmental disorders (NDD) are at high risk for sleep problems, especially insomnia. It is currently not known whether behavioural sleep interventions developed for typically developing (TD) children are effective for children with NDD, and if interventions need to be modified for each diagnostic group. The aim of this systematic review was to identify and evaluate commonalities, trends in outcomes, and the methodological quality of parent-delivered behavioural sleep interventions for children with NDD, specifically Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Cerebral Palsy, and Fetal Alcohol Spectrum Disorder. Nine databases were searched. A total of 40 studies met eligibility criteria. The majority of studies were conducted with ASD and ADHD populations. Common sleep problems were evident across the NDD populations. The most frequently reported included bedtime resistance, night-waking, early morning awakening, and co-sleeping. The most common interventions used were implementation of healthy sleep practices, reinforcement, graduated extinction, and faded bedtime. All studies reported at least one behavioural treatment component as effective. Commonalities across NDD populations, as well as the TD population, for both sleep problems reported and behavioural interventions implemented, suggest the feasibility of developing a transdiagnostic behavioural sleep intervention suitable for children with a range of NDD.

Optimizing an eHealth insomnia intervention for children with neurodevelopmental disorders: a Delphi study.

Insomnia, which is related to daytime deficits and is a common problem for children with neurodevelopmental disorders (NDDs), is often successfully treated with behavioral strategies. However, there are barriers to accessing these treatments, and there has been little research examining what these interventions need to be usable and effective. The goal of this study was to gain consensus from experts in the field on the key components of an eHealth, parent-implemented, intervention program aimed at improving sleep in children with attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, and fetal alcohol spectrum disorder. This was achieved using the Delphi method, which involves asking participants to respond to open-ended questions about a topic of interest and then, in iterative rounds, to rate the recommendations that were made by the group. In the current study, participants (27 responders in the first round, 21 in the second, and 18 in the third) rated a total of 131 recommendations. Of those 131 recommendations, 52 items had high importance and high consensus and were deemed to be priority items to consider for creating an eHealth, parent-delivered, behaviorally-based intervention for insomnia in children with NDD. Furthermore, 75% (n = 84) of the 112 recommendations from the first round were believed to be applicable across all 4 NDD groups, thus providing evidence of the potential for a transdiagnostic intervention.

Evaluation of an Internet-Based Behavioral Intervention to Improve Psychosocial Health Outcomes in Children With Insomnia (Better Nights, Better Days): Protocol for a Randomized Controlled Trial.

BACKGROUND: Up to 25% of 1- to 10-year-old children experience insomnia (ie, resisting bedtime, trouble falling asleep, night awakenings, and waking too early in the morning). Insomnia can be associated with excessive daytime sleepiness and negative effects on daytime functioning across multiple domains (eg, behavior, mood, attention, and learning). Despite robust evidence supporting the effectiveness of behavioral treatments for insomnia in children, very few children with insomnia receive these treatments, primarily due to a shortage of available treatment resources. OBJECTIVE: The Better Nights, Better Days (BNBD) internet-based program provides a readily accessible electronic health (eHealth) intervention to support parents in providing evidence-based care for insomnia in typically developing children. The purpose of the randomized controlled trial (RCT) is to evaluate the effectiveness of BNBD in treating insomnia in children aged between 1 and 10 years. METHODS: BNBD is a fully automated program, developed based on evidence-based interventions previously tested by the investigators, as well as on the extant literature on this topic. We describe the 2-arm RCT in which participants (500 primary caregivers of children with insomnia residing in Canada) are assigned to intervention or usual care. RESULTS: The effects of this behavioral sleep eHealth intervention will be assessed at 4 and 8 months postrandomization. Assessment includes both sleep (actigraphy, sleep diary) and daytime functioning of the children and daytime functioning of their parents. Results will be reported using the standards set out in the Consolidated Standards of Reporting Trials statement. CONCLUSIONS: If the intervention is supported by the results of the RCT, we plan to commercialize this program so that it is sustainable and available at a low cost to all families with internet access. TRIAL REGISTRATION: ClinicalTrials.gov NCT02243501; https://clinicaltrials.gov/show/NCT02243501 (Archived by WebCite at http://www.webcitation.org/6x8Z5pBui).

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 children's sleep problems.

The development of and interaction among alerting, orienting, and executive attention in children.

A sex-balanced sample (N = 96) of children from age 6.5 to age 12.5 completed a modified Attention Network Test. Across these ages, we found evidence for developmental changes to alerting and executive control but stable orienting. Additionally, we found that the youngest members of our sample manifested an interaction between alerting and executive control that is opposite to that typically found in adults; a reversal that diminishes with age to achieve the adult pattern by the older end of the age range of our sample.

Manipulating sleep duration alters emotional functioning and cognitive performance in children.

OBJECTIVE: To examine the impact of sleep duration on emotional functioning and cognitive performance in children. METHODS: 32 children (8-12 years) wore actigraphs for 3 weeks. Following a week of typical sleep, each child was randomly assigned to go to bed 1 hr earlier for 4 nights (Long Sleep) or 1 hr later for 4 nights (Short Sleep) relative to their typical bedtime. Each child then completed the opposite condition. After each week, emotional and cognitive functioning were assessed using objective and subjective measures. RESULTS: Results revealed impaired functioning in the Short- relative to the Long-Sleep condition on measures of positive affective response, emotion regulation, short-term memory, working memory, and aspects of attention. CONCLUSIONS: Results suggest that even modest differences in sleep duration over just a few nights can have significant consequences for children's daytime functioning. These findings demonstrate the important impact of sleep duration on children's daytime functioning.

Behavioral interventions for sleep problems in children with autism spectrum disorders: current findings and future directions.

OBJECTIVE: To examine behavioral interventions for sleep problems in children with autism spectrum disorders (ASD). METHODS: A systematic review evaluating all published studies examining the effectiveness of behavioral treatment of sleep problems in children with ASD is presented. RESULTS: Based on the Chambless criteria for treatment efficacy, both standard extinction and scheduled awakenings met criteria for possibly efficacious interventions for sleep problems in children with ASD. Some positive outcomes have been reported, but there has not been enough research examining graduated extinction, faded bedtime, stimulus fading and chronotherapy to make any firm conclusions regarding treatment efficacy for children with ASD. CONCLUSIONS: Although more rigorous research is required in order for any sleep interventions for children with ASD to be considered probably efficacious or well-established, the current literature should be used to guide clinical decisions and direct research questions.

Alerting, orienting, and executive attention in children with ADHD.

OBJECTIVE: This study evaluated the alerting, orienting, and executive attention abilities of children with ADHD and their typically developing (TD) peers using a modified version of the adult attention network test (ANT-I). METHOD: A total of 25 children with ADHD, Combined Type (ADHD-C, mean age = 9.20 years), 20 children with ADHD, Predominantly Inattentive Type (ADHD-I, mean age = 9.58 years), and 45 TD children (mean age = 9.41 years) matched on age and intelligence to the ADHD group completed the ANT-I. RESULTS: As hypothesized, children with ADHD (n = 45) displayed significantly weaker alerting and executive attention than TD children (n = 45) but did not differ from TD children in orienting ability. Children with ADHD-C (n = 25) did not differ from children with ADHD-I (n = 20) on any of the three networks. CONCLUSIONS: Results supported the growing body of evidence that has found alerting and executive attention deficits in children with ADHD.

Social information processing in elementary-school aged children with ADHD: medication effects and comparisons with typical children.

Examined social information processing (SIP) in medicated and unmedicated children with ADHD and in controls. Participants were 75 children (56 boys, 19 girls) aged 6-12 years, including 41 children with ADHD and 34 controls. Children were randomized into medication conditions such that 20 children with ADHD participated after receiving placebo and 21 participated after receiving methylphenidate (MPH). Children were shown scenarios depicting peer interactions and asked to interpret each scenario and to generate possible responses to the scenario. Results showed that children with ADHD who received MPH generated more hostile responses to provocation than controls, but children with ADHD on placebo did not. Results also showed that children with ADHD regardless of medication generated more hostile responses to provocation than to peer entry, whereas controls did not. Findings suggest that children with ADHD generate more aggressive responses to provocation than controls and that this may be exacerbated by administration of MPH. Limitations and future directions are discussed.

Interference control in children with and without ADHD: a systematic review of Flanker and Simon task performance.

The present review systematically summarizes the existing research that has examined two reaction-time-based interference control paradigms, known as the Eriksen Flanker task and the Simon task, in children with and without ADHD. Twelve studies are included, yielding a combined sample size of 272 children with ADHD (M age 9.28 yrs) and 280 typically developing children (M age 9.38 yrs). As predicted, specific disadvantages were found in the ADHD group in terms of reaction time, percentage of errors, and efficiency of performance on incongruent relative to congruent trials, providing evidence for weaker interference control in this group.

Subtypes of aggression in children with attention deficit hyperactivity disorder: medication effects and comparison with typical children.

We examined aggressive behavior in 6- to 12-year-old children, including 20 children with attention deficit hyperactivity disorder (ADHD) on stimulant medication, 19 children with ADHD on placebo (n = 19), and 32 controls. Children completed a laboratory provocation task designed to measure hostile, instrumental, reactive, and proactive aggression. Children in the ADHD-placebo group exhibited increased proactive and reactive aggression following high levels of provocation compared to controls. On the last trials, instrumental aggression dissipated for controls and hostile aggression dissipated for children in the ADHD-placebo group. Both instrumental and hostile aggression dissipated for children in the ADHD-medication group.