Who sleeps well in Canada? The social determinants of sleep health among middle-aged and older adults in the Canadian Longitudinal Study on Aging.

OBJECTIVES: Sleep health inequities likely contribute to disparities in health outcomes. Our objective was to identify social determinants of sleep health among middle-aged/older adults in Canada, where prior evidence is limited. METHODS: We analyzed cross-sectional data from the Canadian Longitudinal Study on Aging, a survey of over 30,000 community-dwelling adults aged 45-85years. Self-reported measures included sleep duration, sleep satisfaction, and sleep efficiency. We explored associations between sleep measures and social determinants of health. We used modified Poisson regression to estimate prevalence ratios for sleep satisfaction and sleep efficiency, and linear regression for sleep duration. Estimates were adjusted for all social, lifestyle, and clinical covariates. We explored effect modification by sex. RESULTS: Of the 11 social determinants explored, all were significantly associated with at least one domain of sleep health. These associations were reduced to 9 variables with adjustment for all social variables, and 7 with further adjustment for lifestyle and clinical covariates, including differences by sex, age, education, marital status, employment, race/ethnicity, and sexual orientation. Better sleep health in >1 domain was observed among males, older age groups (65 and older), higher income groups, the retired group, and homeowners with adjustment for social variables, and only in males and older age groups with additional adjustment for lifestyle and clinical variables. Only sleep duration associations were modified by sex. CONCLUSIONS: Sleep health disparities among Canadian adults exist across socioeconomic gradients and racial/ethnic minority groups. Poor sleep health among disadvantaged groups warrants increased attention as a public health problem in Canada.

Early nap cessation in young children as a correlate of language and psychosocial outcomes: Evidence from a large Canadian sample.

OBJECTIVES: Most children stop napping between 2 and 5years old. We tested the association of early nap cessation (ie, children who stopped before their third birthday) and language, cognition functioning and psychosocial outcomes. METHODS: Data were from a national, longitudinal sample of Canadian children, with three timepoints. Children were 0-to-1 year old at T1, 2-to-3 years old at T2, and 4-to-5 years old at T3. Early nap cessation was tested as a correlate of children's psychosocial functioning (cross-sectionally and longitudinally), cognitive function (longitudinally), and language skills (longitudinally). There were 4923 children (50.9% male; 90.0% White) and their parents in this study who were included in the main analyses. Parents reported on demographics, perinatal and developmental variables, child functioning, and child sleep. Children completed direct assessments of receptive language and cognitive ability. Nap cessation, demographic, and developmental-control variables were tested as correlates of cross-sectional and longitudinal outcomes using linear regression (with a model-building approach). RESULTS: Early nap cessation correlated with higher receptive language ability (ß = 0.059 ± 0.028) and lower anxiety (ß = -0.039 ± 0.028) at T3, after controlling for known correlates of nap cessation, nighttime sleep, and other sociodemographic correlates of the outcomes. Cognitive ability, hyperactivity-inattention, and aggression were not correlated with nap cessation. CONCLUSIONS: Early nap cessation is related to specific benefits (ie, better receptive language and lower anxiety symptoms). These findings align with previous research. Future research should investigate differences associated with late nap cessation and in nap-encouraging cultures, and by ethnicity.

Accessing and re-accessing mental health walk-in clinics for children and families.

Background: Many child and youth mental health (CYMH) agencies across Canada and in Ontario are using mental health walk-in clinics (MHWCs). Objectives: (1) Explore how MHWCs are used by families (e.g. mean, mode, and median number of visits), and (2) document how often and how soon families returned for a second MHWC visit and identify correlates of time to a second MHWC visit. Design: Administrative data from two CYMH agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. Methods: In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared to MHWC use exclusively. Results: About a third of children and families using MHWCs had two or more visits. Child age, guardianship, and disposition at discharge emerged as correlates of time to a second MHWC visit. Conclusion: MHWCs can save families' time, and both agencies' time and money by eliminating the need to complete a detailed assessment prior to treatment for cases that would go on to have a single visit within this service.

Accessing mental health walk-in clinics and other services for children and families.

Background: Mental health walk-in clinics (MHWCs) are a model of service delivery that has gained increasing interest and traction. The aim of the study was to better understand how MHWC use is related to use of other services provided by agencies. Objectives: (1) Explore if and how MHWCs are used alongside other services, including the different time points (e.g. MHWCs used exclusively, MHWCs used before other agency services); (2) identify correlates of MHWC use alongside other agency services. Design: Administrative data from two child and youth mental health agencies in Ontario were extracted, including demographics, visit data, and presenting concerns. Methods: In this exploratory, descriptive study, analyses of administrative data were conducted to identify patterns and correlates of MHWC use before other agency services, compared with MHWC use exclusively. Results: More than half of families used MHWCs and other agency services before or concurrently with other agency services. Child age, guardianship, and disposition at discharge emerged as correlates of MHWC use before other agency services. Conclusions: MHWCs are sufficient for some families, easing the pressure on other agency services. For the remaining families, MHWCs can help support them at the beginning of their service use journey.

Regular, intermittent, and spontaneous: Patterns of preschool Children's nap behavior and their correlates.

BACKGROUND: Daytime sleep during the preschool years (i.e., 1-5-years-old) is characterized by high inter-child variability in several components of nap behavior, including nap duration, nap timing, and the proportion of sleep during daytime. We used an empirical approach to examine variations amongst children in these aspects of napping and investigated correlates of these components of nap behavior. METHODS: A large, nationally representative sample (N = 702) of Canadian parents completed an online survey, including a one-month retrospective report of their 1.5-5 year old's daytime and nighttime sleep behavior and other questionnaires. To understand patterns of children's nap behaviors we applied Latent Profile Analysis (LPA) to typical nap duration, typical timing of naps, frequency of naps, proportion of sleep during the daytime, and the proportion of naps which were spontaneous (i.e., child just fell asleep). Then, multinominal logistic regression was used to examine correlates of profile membership. RESULTS: Four profiles of children emerged: (1) regular nappers; (2) intermittent nappers; (3) spontaneous nappers; and (4) non-nappers. After controlling for demographic variables (e.g., child age, sex, ethnicity) and known correlates of napping behaviors (e.g., birthweight, nighttime sleep duration), profile membership was related to parents' beliefs about napping, parents' own nap behaviors, family functioning, and child nighttime sleep problems in a multinominal logistic regression. CONCLUSIONS: An empirical approach aided in understanding the inter-child variability in napping amongst preschool-age children. Parental beliefs about napping and the home environment were shown to be critical factors influencing this variability.

Trends in population characteristics associated with mental health service use among youth and emerging adults in Canada from 2011 to 2016.

OBJECTIVES: Despite the high prevalence of mental disorders among youth (age 12 to 17) and emerging adults (age 18 to 24), few receive mental health (MH) services. Using a cross-sectional study design, we examined population characteristics associated with MH service use in this age group from 2011 to 2016. METHODS: Data were from six cycles of the Canadian Community Health Survey (2011-2016). Population characteristics associated with service use were analyzed using logistic regression models for each year. Changes in odds ratios over time were used to examine trends. RESULTS: Presence of a mood or anxiety disorder had the largest magnitude of association on MH service use in every year. Trends suggested an increased association size between self-rated MH status and service use; lower self-rated MH was associated with a 62% increase in odds of service use in 2011 and an 83% increase in 2016. Being female was associated with increased odds of MH service use (range: 59-107%). Compared with white respondents, individuals who were East and Southeast Asian or South Asian had decreased odds of MH service use. While the association size varied for South Asians, there was a trend toward decreasing likelihood of accessing care (55% decreased odds in 2011, 74% in 2016) for East and Southeast Asians. CONCLUSION: Trends suggest changes in population characteristics associated with access to MH care (e.g., self-rated MH status) as well as persistent inequity in MH service use in Canada for males and individuals from Asian ethnic groups.

RéSUMé: OBJECTIFS: Les jeunes (12 à 17 ans) et les adultes émergents (18 à 24 ans) sont peu nombreux à recevoir des services de santé mentale (SSM) malgré la prévalence élevée des troubles mentaux dans ces deux groupes d'âge. À l'aide d'une étude transversale, nous avons examiné les caractéristiques démographiques associées à l'utilisation des SSM dans ces groupes d'âge entre 2011 et 2016. MéTHODE: Les données provenaient des six cycles de l'Enquête sur la santé dans les collectivités canadiennes (2011­2016). Les caractéristiques démographiques associées à l'utilisation des services ont été analysées à l'aide de modèles de régression logistique pour chaque année étudiée. Les changements dans les rapports de cotes au fil du temps ont servi à analyser les tendances. RéSULTATS: Pour chaque année, c'était la présence d'un trouble de l'humeur ou d'un trouble anxieux qui était la plus largement associée à l'utilisation des SSM. Les tendances ont indiqué une association accrue entre l'état de santé mentale autoévalué et l'utilisation des services; une moins bonne santé mentale autoévaluée était associée à une hausse de 62 % de la probabilité d'utilisation des services en 2011 et à une hausse de 83 % en 2016. Le sexe féminin était associé à une probabilité accrue d'utilisation des SSM (intervalle : 59­107 %). Comparativement aux répondants blancs, les personnes originaires de l'Asie de l'Est, du Sud-Est ou du Sud présentaient une probabilité réduite d'utilisation des SSM. Malgré la variabilité de l'ampleur de l'association chez les Asiatiques du Sud, nous avons observé une tendance à la baisse dans la probabilité d'avoir accédé aux soins (probabilité réduite de 55 % en 2011 et de 74 % en 2016) chez les Asiatiques de l'Est et du Sud-Est. CONCLUSION: Ces tendances indiquent des changements dans les caractéristiques démographiques associées à l'accès aux SSM (p. ex. l'état de santé mentale autoévalué), ainsi qu'une iniquité persistante dans l'utilisation des SSM au Canada chez les hommes et les personnes appartenant aux groupes ethniques asiatiques.

Examining the interactive association of family- and neighborhood-level socio-economic characteristics on children's sleep beyond the associations of residency and neighborhood violence.

OBJECTIVE: To examine the interactive association of neighborhood and family socio-economic characteristics (SEC) on children's sleep. DESIGN: Secondary data analyses were completed on the 2014 Ontario Child Health Study, a cross-sectional sample of 10,802 children aged 4-17. PARTICIPANTS: Children (aged 4-11, 50% male; N = 6264) with available sleep outcome data. METHODS: Multilevel modeling was used to assess the interactive relationship between family- and neighborhood-level poverty in relation to child sleep outcomes (problems falling asleep, problems staying asleep, weekday and weekend time in bed), above the associations of variables known to be related to sleep at the child (ie, child age, sex, internalizing problems, externalizing problems, chronic illness), family (ie, negative parenting behaviors, family structure, parent mental health, years lived in neighborhood, parent education level), and neighborhood levels (ie, neighborhood size, antisocial behavior). RESULTS: Neighborhood poverty (p < .01, ß = -0.001, 95% confidence interval [-0.007, -0.002]) was significantly related to shorter weekday time in bed and the interactive association of family and neighborhood poverty was significantly related to weekend time in bed (p < .05, ß = 0.012, 95% confidence interval [0.004, 0.021]). Children living in low poverty neighborhoods with families of higher SEC backgrounds, and children living in high poverty neighborhoods with families of lower SEC backgrounds had the shortest weekend time in bed (9.7 hours). CONCLUSIONS: There is a compound relationship of family and neighborhood poverty on children's sleep above and beyond family- and child-level risk factors.

Complex skills are required for new primary health care researchers: a training program responds.

BACKGROUND: Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders - require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research. MAIN BODY: In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program's goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context - a context that requires researchers who are able to respond to multiple challenges. CONCLUSION: We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.

The Pain Coping Questionnaire short-form: preliminary reliability and validity.

INTRODUCTION: The Pain Coping Questionnaire (PCQ) has support for its validity and reliability as a tool to understand how a child copes with pain of an extended duration. However, measure length may limit feasibility in clinical settings. OBJECTIVES: The primary goal of this study was to develop a short-form (PCQ-SF) that could be used for screening how children cope with chronic or recurrent pain and examine its reliability and validity. METHODS: The PCQ-SF was developed in a stepwise manner. First, a confirmatory factor analysis was computed using an amalgamated data set from the validation studies of the PCQ (N = 1225). Next, ratings from researchers and clinicians were obtained on PCQ item content and clarity (n = 12). Finally, the resulting 16-item short-form was tested in a pediatric sample living with chronic and recurrent pain (65 parent-child dyads; n = 128). RESULTS: The PCQ-SF has acceptable preliminary reliability and validity. Both statistical and expert analyses support the collective use of the 16 items as an alternative to the full measure. CONCLUSIONS: The compact format of the PCQ-SF will allow practitioners in high-volume clinical environments to quickly determine a child's areas of strengths and weaknesses when coping with pain. Future research using larger more diverse samples to confirm clinical validity is warranted.

Thoughts and affect experienced by parents of preschool- and school-aged children during night-waking interactions.

Measures of parents' cognitions have advanced our understanding of infants' sleep. But, few comparable measures exist for use with parents of preschool- or school-age children. The Parents' night-waking thoughts and affect questionnaire (PNTQ), a self-report measure of parents' thoughts and feelings when their children wake during the night, addresses this need. This scale was evaluated in two community samples of parents (N = 473). Sample 1 included preschool-age children (2-5-years-old), and Sample 2 included preschool- and school-age children (2-10-years-old). A subsample completed 1-month test-retest reliability for the PNTQ (n = 201). Parents completed the PNTQ and measures of agreement with night-waking strategies, parenting stress, mental health, and night-waking. The psychometric properties of the PNTQ (i.e., internal consistency, test-retest reliability; content, construct, and convergent validity) were evaluated. A four-factor solution (positive thoughts about limit-setting, positive thoughts about active comforting, concerns about limit-setting, and distress about night-waking) demonstrated adequate fit in Sample 1 (robust CFI = .900; robust RMSEA = .060), which was replicated in Sample 2 (robust CFI = .870; robust RMSEA = .080). Internal consistency (αc = .68-.88) and test-retest reliability (r = .46-.80) were acceptable across subscales and samples. There was good evidence for convergent validity in both samples-including correlating with parent-reported night-waking behaviour. The PNTQ is a promising measure of thoughts and affect related to night-waking experienced by parents whose children wake during the night. The PNTQ may increase understanding of parents' use of specific night-waking strategies and may account for resistance to employing alternate techniques. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Parenting Practices, Bedtime Routines, and Consistency: Associations with Pediatric Sleep Problems.

OBJECTIVES: Investigate the direct and moderating effects of daytime parenting practices on the relationship between bedtime routines and pediatric sleep problems. METHODS: A community sample of 407 parents with children 2-10 years old completed measures of parenting practices (i.e., laxness and over-reactivity) and bedtime routines (i.e., consistency and reactivity to changes in routines). Sleep problems (i.e., severity and signaled night waking) were assessed by a parent-report questionnaire and sleep diaries. RESULTS: Higher parenting laxness (ß = .13) and less bedtime routine consistency (ß = -.34) significantly predicted sleep problem severity. Laxness moderated the relationship between bedtime reactivity and sleep problem severity: when bedtime reactivity was high, higher parental laxness was associated with more severe sleep problems. CONCLUSIONS: Daytime parenting practices are important to consider when children are reactive to changes in bedtime routines, as permissive or inconsistent daytime parenting practices were found to be associated with more severe sleep problems. Future research should examine the effects of parenting practices and bedtime routines on problematic signaled night waking in a clinical sample of children.

Children's Sleep During COVID-19: How Sleep Influences Surviving and Thriving in Families.

OBJECTIVE: The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic. METHODS: Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. RESULTS: While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep. CONCLUSIONS: The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.

Re-Accessing Mental Health Care After Age 18: A Longitudinal Cohort Study of Youth Involved with Community-based Child and Youth Mental Health Agencies in Ontario.

OBJECTIVE: About 20-26% of children and youth with a mental health disorder (depending on age and respondent) report receiving services from a community-based Child and Youth Mental Health (CYMH) agency. However, because agencies have an upper age limit of 18-years old, youth requiring ongoing mental health services must "transition" to adult-oriented care. General healthcare providers (e.g., family physicians) likely provide this care. The objective of this study was to compare the likelihood of receiving physician-based mental health services after age 18 between youth who had received community-based mental health services and a matched population sample. METHOD: A longitudinal matched cohort study was conducted in Ontario, Canada. A CYMH cohort that received mental health care at one of five CYMH agencies, aged 7-14 years at their first visit (N=2,822), was compared to age, sex, region-matched controls (N=8,466). RESULTS: CYMH youth were twice as likely as the comparison sample to have a physician-based mental health visit (i.e., by a family physician, pediatrician, psychiatrists) after age 18; median time to first visit was 3.3 years. Having a physician mental health visit before age 18 was associated with a greater likelihood of experiencing the outcome than community-based CYMH services alone. CONCLUSION: Most youth involved in community-based CYMH agencies will re-access services from physicians as adults. Youth receiving mental health services only within community agencies, and not from physicians, may be less likely to receive physician-based mental health services as adults. Collaboration between CYMH agencies and family physicians may be important for youth who require ongoing care into adulthood.

OBJECTIF: Environ 20 à 26 % des enfants et des adolescents souffrant d'un trouble de santé mentale (dépendant de l'âge et du répondant) déclarent recevoir des services d'un organisme communautaire de santé mentale pour enfants et adolescents (SMEA) Toutefois, puisque les organismes ont une limite d'âge supérieur de 18 ans, les jeunes nécessitant des services de santé mentale doivent faire la « transition ¼ aux soins pour adultes. Les prestataires de soins de santé généraux (p. ex., les médecins de famille) dispensent probablement ces services. La présente étude visait à comparer la probabilité de recevoir des services de santé mentale par un médecin après l'âge de 18 ans entre un jeune qui avait reçu des services de santé mentale et un échantillon apparié dans la population. MÉTHODE: Une étude de cohorte longitudinale appariée a été menée en Ontario, Canada. Une cohorte SMEA qui recevait des soins de santé mentale à l'un des cinq organismes SMEA, âgés entre 7 et 14 ans à leur première visite (N = 2,822), a été comparée pour l'âge, le sexe, les contrôles appariés par région (N = 8,466). RÉSULTATS: Les jeunes des SMEA étaient deux fois plus susceptibles que l'échantillon de comparaison d'avoir une visite de santé mentale par un médecin (c.-à-d. par un pédiatre médecin de famille, des psychiatres) après l'âge de 18 ans le temps moyen avant une première visite était 3,3 ans. Avoir une visite de santé mentale avec un médecin avant l'âge de 18 ans était associé à une plus grande probabilité de connaître le résultat que par les services SMEA communautaires à eux seuls. CONCLUSION: La plupart des jeunes impliqués dans les organismes communautaires SMEA accéderont de nouveau aux services de médecins en tant qu'adulte. Les jeunes recevant des services de santé mentale uniquement d'organismes communautaires et non de médecins peuvent être moins susceptibles de recevoir des services de santé mentale par un médecin en tant qu'adultes. La collaboration entre les organismes SMEA et les médecins de famille peut être importante pour les jeunes qui nécessitent des soins constants à l'âge adulte.

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).

A protocol for a scoping review of equity measurement in mental health care for children and youth.

BACKGROUND: Mental health (MH) problems are among the most important causes of morbidity and mortality for children and youth. Problems of lack of equity in child and youth MH services (CYMHS)-including, but not limited to, problems in inaccessibility and quality of services-are widespread. Characterizing the nature of equity in CYMHS is an ongoing challenge because the field lacks a consistent approach to conceptualizing equity. We will conduct a scoping review of how equity in MH services for children and youth has been defined, operationalized, and measured. Our objectives are to discover: (1) What conceptual definitions of equity are used by observational studies of CYMHS?; (2) What service characteristics of CYMHS care do indices of equity cover?; (3) What population dimensions have been used to operationalize equity?; (4) What statistical constructs have been used in indices that measure CYMHS equity?; and (5) What were the numerical values of those indices? METHODS: The following databases will be searched: Medline, Embase, PsycINFO, Cochrane Controlled Register of Trials, CINAHL, EconLit, and Sociological Abstracts. Searches will be conducted from the date of inception to the end of the last full calendar year (December 2019). Studies will be included if they include an evaluation of a mental health service for children or youth (defined as those under 19 years of age) and which quantify variation in some aspect of child or youth mental health services (e.g., accessibility, volume, duration, or quality) as a function of socio-demographic and/or geographic variables. Study selection will occur over two stages. Stage one will select articles based on title and abstract using the liberal-accelerated method. Stage two will review the full texts of selected titles. Two reviewers will work independently on full-text reviewing, with each study screened twice using pre-specified eligibility criteria. One reviewer will chart study characteristics and indices to be verified by a second reviewer. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the types and characteristics of the indices used to evaluate MH services equity. DISCUSSION: The planned, systematic scoping review will survey the literature regarding how equity in MH services for children and youth has been operationalized and help inform future studies of equity in CYMHS. SYSTEMATIC REVIEW REGISTRATION: Open Science Foundation ID SYSR-D-19-00371, https://osf.io/58srv/ .

Relationships between sleep and internalizing problems in early adolescence: Results from Canadian National Longitudinal Survey of Children and Youth.

BACKGROUND: Both inadequate sleep and internalizing problems, such as symptoms of anxiety and depression, are prevalent among adolescents with sparse epidemiological literature outlining sex-specific relationships at this critical age. OBJECTIVE: To examine cross-sectional and prospective relationships between self-reported sleep problems, indicated by sleep duration, difficulties getting to sleep and changes in difficulties getting to sleep with internalizing problems in early adolescence. METHODS: This study was a secondary analysis of data from the Canadian National Longitudinal Survey of Children and Youth. Multivariable linear regression was used to estimate cross-sectional and longitudinal associations. Relevant family and social context variables were controlled for in multivariable analyses. Family functioning was assessed as a potential effect modifier. RESULTS: There were 993 and 736 participants [longitudinal cohort entry age of 10 or 11 years; 49% male] in longitudinal and cross-sectional analyses, respectively. Most cross-sectional multivariable analyses of sleep duration and internalizing problems revealed no statistical associations. Difficulties sleeping and concurrent internalizing problems were positively associated in 12/13 year old females (ß = 1.77 [0.94, 2.61], R2 = 17%) and males (ß = 1.18 [0.36, 2.01], R2 = 16%). High persistent difficulties sleeping in females aged 12/13 to 14/15 years also positively predicted internalizing problems in females age 14/15 years (ß = 1.90 [0.52, 3.29], R2 = 21%) while controlling for initial internalizing symptoms. Family functioning was not found to be an effect modifier. CONCLUSION: Findings highlight the potential role of difficulties sleeping for adolescents' mental health. Public health initiatives to promote sleep hygiene in this population subgroup are critical to prevent the potential long-term health impact of sleep problems.

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.

Correction to: Predicting Dropout from Children's Mental Health Services: Using a Need-Based Defnition of Dropout.

The original version of this article was unfortunately published with an error in Table 2. The confidence intervals listed in Table 2 were published incorrectly. The correct version of confidence intervals in Table 2 should read as below.

Risk and protective factors and processes for behavioral sleep problems among preschool and early school-aged children: A systematic review.

Behavioral sleep problems in early childhood are common, affecting about 25% of children, and include symptoms such as problems going to sleep and staying asleep. This review employed the developmental psychopathology framework and 4P model (Predisposing, Precipitating, Perpetuating, Protective) to organize the diverse risk/protective factors (distal variables experienced indirectly by the child) and processes (proximal variables experienced directly by the child) for child sleep problems among preschool (1-5 y) and school-age (6-10 y) children. Variables were categorized into biological, psychological, and environmental factors/processes at the individual, family/parent, and community levels. The quality of evidence was assessed using GRADE. A literature search identified 98 articles meeting inclusion criteria. Older child age, difficult temperament, previous sleep problems, externalizing psychopathology, internalizing psychopathology, and electronics use (e.g., bedtime TV viewing) were identified as child risk variables predicting sleep problems. Parental presence at bedtime (risk), negative parenting style (e.g., lax or permissive parenting; risk), consistent bedtime routines (protective), and lower composite socioeconomic status (risk) were identified as family/parent variables predicting child sleep problems. No well-established predictors were found at the community level. Future research should employ advanced research designs more frequently and investigate: 1) risk pathways across development; and 2) nightly fluctuations in sleep problems.