ABSTRACT
BACKGROUND: Sleep problems are common in children and can have an effect on behavioral and emotional functioning. Despite the importance of sleep for children's health, there is a lack of studies on this topic in Brazil. The aim of this study was to evaluate the efficacy of behavioral intervention for sleep problems in young children and to investigate the effects on their daytime behavior. METHODS: Sixty-two children (ages 1-5; M = 2.3, SD = 1.3) with bedtime problems and night waking were randomized to a parent-based intervention or a wait list control group. After the waiting period, the wait list participants were offered treatment. The intervention was composed of five sessions over 2 months, during which the parents were educated on their child's sleep and received guidance on the establishment of sleeping schedules and routines and on the use of extinction and positive reinforcement techniques. Sleep patterns and behavior problems were assessed with parent-report measures. Sleep patterns were also assessed with actigraphy. Assessments were completed at pre-intervention, post-intervention, 1-month follow-up, and 6-month follow-up. RESULTS: Children who received intervention showed greater baseline to post-treatment improvements in sleep latency, night waking, behavior such as resisting going to bed, the desire to sleep with their parents, and daytime behavior than the control group. These improvements were maintained at follow-up. CONCLUSIONS: We concluded that behavioral parent-based intervention is effective in improving the quality of sleep and the diurnal behavior of children. This study provides initial support for use of this protocol in psychology clinics/schools. Brazilian clinical trials registration, RBR-4kxxd5. Retrospectively registered on December 13, 2016.
ABSTRACT
OBJECTIVE: To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. METHOD: Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. RESULTS: CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms. CONCLUSIONS: Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children.
