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1.
JCPP Adv ; 3(2): e12157, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37753159

RESUMO

Background: Children with attention-deficit/hyperactivity disorder (ADHD) have more sleep problems than their peers which contribute to behavioral and functional impairments. This study examines the bidirectional relationship between nightly sleep (i.e., total sleep time and sleep efficiency) and daily behavior of children with ADHD. Method: Forty-three children (ages 6-13 [mean = 9.05, 54% male, 77% medicated]) participated in a 2-week study during an ADHD Summer Treatment Program (STP). Sleep was measured with actigraphy. Behavior was assessed using STP clinical data and daily parent and counselor ratings of ADHD symptoms, oppositional defiant disorder behaviors, and emotion regulation (e.g., difficulty regulating emotional disposition and controlling emotions). We hypothesized that healthier night's sleep measured by actigraphy (i.e., sleep efficiency and total sleep time [TST]) would relate to less ADHD symptoms, less emotional dysregulation, and better academic performance the next day. Additionally, we hypothesized that less ADHD symptoms, less emotional dysregulation, and greater academic performance would relate to healthier sleep that night. Results: Higher nightly sleep efficiency was related to improved parent-ratings of ADHD the next day (R 2 = 0.04, p = 0.04) and improved parent-ratings of ADHD during the day lead to higher sleep efficiency that night (R 2 = 0.002, p = 0.02). Higher rates of daily assignment completion were related to higher sleep efficiency at night (R 2 = 0.035, p = 0.03). TST was not related to any behavioral outcomes. Conclusion: Sleep efficiency may be more relevant than TST to behavioral performance the next day. Additionally, a bidirectional relationship exists between sleep efficiency and parent ratings of ADHD. Findings highlight the importance of assessing for manifestations of poor sleep efficiency, waking minutes, and wakings after sleep onset when diagnosing and treating ADHD.

2.
J Pediatr Psychol ; 48(8): 676-687, 2023 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-37290433

RESUMO

OBJECTIVE: To systematically review and summarize the outcomes of parenting interventions designed to improve child and/or parenting behavior for children born preterm and/or low birth weight (LBW). METHODS: We conducted systematic searches of Embase, Scopus, PubMed, PsycInfo, and CINAHL in September 2021. We identified articles published at any time that describe the outcomes of parenting interventions targeting the child and/or parenting behavior of children born preterm/LBW and their caregivers. Two independent raters assessed the risk of bias using the Revised Cochrane Risk-of-Bias Tool. RESULTS: Eight hundred sixteen titles and abstracts were screened, followed by 71 full-text articles, resulting in 24 eligible articles reporting on nine interventions with 1,676 participants. Eligible articles had an adequate risk of bias ratings. Sample characteristics, intervention components, and intervention effects were tabulated and described narratively by the intervention type. Preventative and treatment programs demonstrated positive intervention effects on externalizing behavior, parenting stress, and parenting behaviors, with mixed effects on internalizing behavior and emotion regulation. The few studies with longitudinal follow-up found little evidence of effects beyond 6 months postintervention. CONCLUSION: Behavior problems in children born preterm/LBW may be modifiable, and interventions targeting parenting behavior are promising. However, existing interventions may not produce long-lasting changes and are not designed for children older than four. Existing treatment programs may require adaptation for the neurocognitive, medical, and family needs of children born preterm/LBW (e.g., processing speed deficits, post-traumatic stress). Interventions that account for theories of sustained change may promote long-term effectiveness and the developmental tailoring of parenting skills.


Assuntos
Poder Familiar , Comportamento Problema , Recém-Nascido , Criança , Humanos , Poder Familiar/psicologia , Recém-Nascido de Baixo Peso
3.
J Pediatr Psychol ; 48(3): 241-253, 2023 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-36565462

RESUMO

OBJECTIVE: The aim of this study was to examine the efficacy of the SMART (Self-Management After Recent Traumatic brain injury) program and potential moderators. METHODS: Parallel randomized controlled trial (ClinicalTrials.gov Identifier: NCT03498495) was conducted. Eligibility criteria included treatment for mild traumatic brain injury in the emergency department and age 11-18 years. Participants were assigned equally to SMART (n = 35) or usual care (UC; n = 36). SMART included symptom monitoring and online modules supporting the return to activities and symptom management. Coping and quality of life (QoL) (primary outcomes) and post-concussive symptoms (secondary outcome) were assessed at baseline and weekly for 4 weeks. RESULTS: Groups did not differ in coping, QoL, or return to pre-injury symptom levels at any time point. Problem-focused engagement (PFE) moderated group differences over time (p = .02). At high PFE, UC participants reported lower QoL at time 1 (effect size [ES] = 0.60); SMART participants did not report a decline at any point. At low PFE, SMART participants reported declining QoL from pre-injury to time 1 (ES = 0.68), whereas UC participants reported an increase from time 1 to 3 (ES = 0.56). PFE also moderated group differences on the Health and Behavior Inventory (HBI) cognitive (p = .02) and somatic symptom scales (p = .05). At high PFE, SMART participants reported a more rapid return to pre-injury levels than UC participants (p = .05). Resilience also moderated group differences in QoL and HBI cognitive recovery. CONCLUSION: Effectiveness of the SMART app varied based on preinjury coping styles and resilience, underscoring the potential need to tailor treatments to individual characteristics.


Assuntos
Concussão Encefálica , Lesões Encefálicas Traumáticas , Autogestão , Humanos , Criança , Adolescente , Concussão Encefálica/terapia , Qualidade de Vida , Lesões Encefálicas Traumáticas/psicologia
4.
J Pediatr Psychol ; 48(3): 205-215, 2023 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-36240452

RESUMO

OBJECTIVE: To assess the feasibility and acceptability of an online parenting-skills program for caregivers of young children with traumatic brain injury (TBI). Positive parenting contributes to recovery following early TBI and social and emotional development in typically developing children. Yet, few interventions have been designed to support psychosocial recovery and subsequent development after early TBI. METHODS: This study protocol was registered with clinicaltrials.gov (NCT05160194). We utilized an academic hospital's Trauma Registry to recruit caregivers of children, ages 0-4 years, previously hospitalized for TBI. The GROW intervention integrated six online learning modules with videoconference meetings with a coach to review and practice skills while receiving in vivo coaching and feedback. Interactive modules addressed strategies for responsive parenting, stimulating cognition, and managing parenting stress. Enrollment and retention rates served as feasibility metrics and satisfaction surveys assessed acceptability. RESULTS: 18 of 72 families contacted (25%) consented, and 11 of 18 (61%) completed the intervention and follow-up assessments. All participants rated the intervention as helpful and indicated that they would recommend the intervention to others. All endorsed a better understanding of brain injury and how to optimize their child's recovery and development. Both coaches rated intervention delivery as comparable to traditional face-to-face treatment. CONCLUSIONS: Low levels of uptake and initial engagement underscore the challenges of intervening with caregivers following early TBI, which likely were exacerbated due to the COVID-19 pandemic. High levels of acceptability and perceived benefit support the potential utility of GROW while highlighting the need to improve accessibility and early engagement.


Assuntos
Lesões Encefálicas Traumáticas , COVID-19 , Intervenção Baseada em Internet , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Lesões Encefálicas Traumáticas/terapia , Cuidadores/psicologia , Pandemias , Poder Familiar/psicologia , Projetos Piloto
5.
J Head Trauma Rehabil ; 37(3): 134-143, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35125434

RESUMO

OBJECTIVE: To understand usage patterns of SMART (Self-Monitoring Activity Regulation and Relaxation Treatment) mHealth app among adolescents with acute mild traumatic brain injuries (mTBIs) and to identify individual characteristics that influenced app usage. SETTING: Emergency departments of tertiary care children's medical center. PARTICIPANTS: Children aged 11 to 18 years with mTBI in the past 2 weeks, English-speaking, no evidence of severe TBI, and no preexisting neurological impairment. DESIGN: Nested cohort of the intervention arm of a randomized clinical trial (n = 34). MHEALTH APP INTERVENTION: SMART was a month-long educational program on mTBI designed to promote self-monitoring and management of recovery. SMART included digital symptom and activity self-monitoring surveys, feedback on symptom changes, and 8 modules providing psychoeducation, strategies for symptom management, and training in active problem solving. MAIN MEASURES: App usage time, navigation, and interaction data were automatically collected. Usage involved inputting symptom ratings/activities and reviewing modules. Patterns of symptom/activity reporting and completion of learning modules data were analyzed. Predictors of app utilization, including individual characteristics, resilience (Connor-Davidson Resilience Scale), and coping (Coping Strategies Inventory-Short Form), were analyzed using Spearman correlations. RESULTS: Participants completed symptom monitoring an average of 9 days over the month. Participants completed an average of 1.87 learning modules out of 7. Parent income and education, comorbid attention-deficit/hyperactivity disorder (ADHD), and emotional engagement coping style predicted symptom monitoring. Parental income, comorbid ADHD, and greater reliance on emotional engagement coping predicted module completion. SIGNIFICANT ADVERSE EVENTS: None. CONCLUSION: Adolescents of higher socioeconomic status and those who manage their emotions using active engagement spent more time on both components of the SMART program.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Concussão Encefálica , Telemedicina , Adolescente , Criança , Humanos , Pais , Inquéritos e Questionários
6.
J Atten Disord ; 26(7): 1051-1066, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34738484

RESUMO

OBJECTIVE: An open trial tested the feasibility, acceptability, and preliminary effectiveness of a behavioral sleep intervention in adolescents with ADHD. METHOD: Fourteen adolescents (ages 13-17 years; 50% male) with ADHD and co-occurring sleep problems received the cognitive-behavioral-based Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C). Adolescent, parent, and teacher ratings, actigraphy, and daily sleep diaries were collected at pre-intervention, post-intervention, and 3-month follow-up. RESULTS: Adolescents experienced moderate to large improvements in sleep, mental health symptoms, and daily life executive functioning from pre-treatment to post-treatment, and improvements were generally maintained at 3 months. Pre-intervention, 71.4% of adolescents were classified as poor sleepers and this was reduced to 21.4% and 28.6% at post-treatment and follow-up, respectively. CONCLUSION: This study provides strong preliminary evidence that TranS-C improves sleep and associated outcomes in adolescents with ADHD and co-occurring sleep problems. A randomized controlled trial is needed to rigorously test the efficacy of TranS-C in this population.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtornos do Sono-Vigília , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Terapia Comportamental , Estudos de Viabilidade , Feminino , Humanos , Masculino , Projetos Piloto , Sono , Transtornos do Sono-Vigília/complicações , Transtornos do Sono-Vigília/terapia
7.
Clin J Sport Med ; 31(6): e298-e305, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32058452

RESUMO

OBJECTIVE: To investigate the impact of pediatric mild traumatic brain injury (mTBI), using a broad parent-reported measure, and to determine whether parent-ratings of mTBI symptoms are higher among those with premorbid attention-deficit/hyperactivity disorder (ADHD) and females. DESIGN: Retrospective case-control. SETTING: Hospital-based sports medicine clinic. PARTICIPANTS: The retrospective chart review included 1346 (age: M = 13.11 years, SD = 2.6; 61.7% male) pediatric patients with (n = 209) and without (n = 1137) ADHD. INDEPENDENT VARIABLES: Group membership (ADHD vs non-ADHD) and sex (male vs female). MAIN OUTCOME MEASURES: Baseline and current Post-Concussion Symptom Inventory-Parent Report Form (PCSI-P) Physical, Emotional, Cognitive, and Fatigue subscale scores. This study used a retrospective chart review; therefore, the hypotheses reported for the current study were formed after data were collected. RESULTS: Controlling for patient age and days from mTBI, patients with ADHD had significantly higher retrospective parent-reported pre-mTBI ratings of physical, emotional, and cognitive symptoms (ds = 0.17-0.62) and higher post-mTBI ratings across all 4 symptom domains (ds = 0.18-0.57) than those without ADHD. There was no group × time interaction for any of the PCSI-P subscales. Females overall had higher retrospective parent-reported pre-injury Fatigue and Emotional symptoms (ds = 0.13-0.19) and higher post-mTBI symptoms in all 4 PCSI-P symptom domains (ds = 0.23-0.35), relative to males. CONCLUSIONS: Attention-deficit/hyperactivity disorder-related postinjury exacerbations in parent-reported symptoms can be explained, in part, by elevated retrospective parent-reported ADHD-related pre-mTBI ratings. These results highlight the importance of assessing a patient's baseline symptoms post-mTBI. These data also indicate that ADHD status and sex should be considered when interpreting mTBI symptom severity during clinical evaluation of concussion.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Concussão Encefálica , Síndrome Pós-Concussão , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Criança , Fadiga , Feminino , Humanos , Masculino , Síndrome Pós-Concussão/diagnóstico , Estudos Retrospectivos
8.
J Child Adolesc Psychopharmacol ; 28(10): 727-738, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30148660

RESUMO

Objective: We aimed to (1) examine differences in observed visual attention and motor activity, as well as comprehension of a science video between children with and without attention-deficit/hyperactivity disorder (ADHD) and (2) explore if psychostimulant medication improves ADHD behaviors and comprehension of a science video in children with ADHD. Method: Children aged 7-11 with (n = 91) and without (n = 45) ADHD watched a science video and then completed a comprehension test. Then, children with ADHD began a 4-week within-subject, randomized, double-blind crossover trial of methylphenidate (MPH). At post-testing, children were randomized to receive placebo or their optimal dosage, watched another science film, and completed a comprehension test. Results: Children with ADHD exhibited higher rates of motor activity during, and worse comprehension of material discussed within, the science video. Mediation models revealed that increased motor activity suppressed between-group differences in comprehension. MPH improved comprehension and visual attention, but not motor activity during the science video. Conclusion: Children with ADHD may benefit from MPH to improve comprehension of and sustained attention during audiovisually presented learning material.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Atenção/efeitos dos fármacos , Compreensão/efeitos dos fármacos , Atividade Motora/efeitos dos fármacos , Materiais de Ensino , Gravação em Vídeo , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Estimulantes do Sistema Nervoso Central/administração & dosagem , Estimulantes do Sistema Nervoso Central/efeitos adversos , Criança , Feminino , Humanos , Masculino , Técnicas Psicológicas , Resultado do Tratamento
9.
Eur Child Adolesc Psychiatry ; 27(3): 353-365, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28983772

RESUMO

Children with attention-deficit/hyperactivity disorder (ADHD) display more sleep problems than their peers, but it remains unclear whether comorbid mental health symptoms [i.e., anxiety, depression, oppositional-defiant disorder (ODD)] are uniquely related to sleep functioning. It is also largely unknown whether boys and girls with ADHD differ in their sleep functioning. This study (1) examined whether boys or girls with ADHD differ in their sleep functioning, (2) evaluated comorbid symptoms as uniquely related to sleep functioning domains, and (3) explored whether sex moderated associations between comorbid symptoms and sleep. Participants were 181 children (ages 7-13; 69% male; 82% White) diagnosed with ADHD. Parents completed measures assessing their child's ADHD symptoms, comorbid symptoms, and sleep functioning. Girls had poorer sleep functioning than boys across most sleep functioning domains. Sixty percent of children met cutoff criteria for having sleep problems, though rates differed significantly between girls (75%) and boys (53%). No differences in rates of sleep problems were found between ADHD subtypes/presentations or between younger and older children. In path models including ADHD and comorbid symptom dimensions, anxiety symptoms were uniquely associated with increased bedtime resistance and sleep anxiety, ADHD hyperactive-impulsive symptoms were associated with more night wakings and more parasomnia behaviors, and ODD and depressive symptoms were associated with shorter sleep duration. Depression was also uniquely associated with increased daytime sleepiness and overall sleep problems. Sex did not moderate associations between comorbid symptoms and sleep problems. This study provides important preliminary evidence that girls with ADHD experience more sleep problems than boys with ADHD. Findings also demonstrate that the associations between comorbid symptoms and sleep functioning in children with ADHD vary based on both the specific symptoms and sleep domains examined.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Saúde Mental/tendências , Adolescente , Criança , Comorbidade , Feminino , Humanos , Masculino , Fatores Sexuais , Transtornos do Sono-Vigília/epidemiologia , Fatores de Tempo
10.
Sleep Med ; 30: 93-96, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28215271

RESUMO

OBJECTIVE/BACKGROUND: Few adolescents report obtaining adequate amounts of sleep. Correlational studies have linked adolescent short sleep with driving crashes and sluggish cognitive tempo (SCT), a cluster of symptoms that include sluggishness and low persistence that are related to but distinct from inattention and sleepiness. The relationship between SCT and driving is understudied, and no study has experimentally examined the relationship between SCT and sleep. We examined the relationship between SCT and driving problems in a sample of chronically short-sleeping adolescents. We also examined whether experimentally extending sleep improved SCT and driving behaviors. PARTICIPANTS/METHODS: Licensed 16- to 18-year-old adolescents who regularly obtained five to seven hours of sleep completed a five-week at-home experimental protocol: a baseline week to determine typical sleep (TYP), followed in a counterbalanced order by two-week spans in which school-night bedtimes and rise times were (a) matched to TYP or (b) modified to extend (EXT) time in bed by 1.5 h/night. Sleep was monitored by actigraphy. Self- and parent-reported SCT and inattention and self-reported driving problems were recorded at baseline and following each condition. Of the 38 eligible participants who completed the baseline session, 24 completed all five weeks of the protocol. RESULTS: After controlling for inattention, only parent-reported SCT was significantly positively associated with self-reported purposeful driving violations at baseline. Adolescents reported lesser SCT during EXT than during TYP. Further, after controlling for inattention, participants who reported improvement in SCT demonstrated fewer driving problems during EXT than during TYP. CONCLUSIONS: Preliminary findings suggest that extending sleep in short-sleeping adolescents may help alleviate SCT symptoms and improve driving.


Assuntos
Atenção , Condução de Veículo , Cognição , Privação do Sono/complicações , Sono , Adolescente , Feminino , Humanos , Masculino
11.
Sleep Med Rev ; 34: 94-121, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-27818086

RESUMO

Substantial research attention has been devoted to understanding the importance and impact of sleep in children and adolescents. Traditionally, this has focused on mean sleep variables (e.g., a child's "typical" or average sleep duration), yet research increasingly suggests that intraindividual variability (IIV) of sleep/wake patterns (sometimes referred to as sleep variability or night-to-night variability) regularly occurs and may have implications for adjustment. A systematic search of five electronic databases identified 52 empirical studies published between 2000 and 2015 that examined correlates of sleep IIV in children and adolescents, with a recent increase in the publication rate of such studies. Identified studies were often atheoretical and included post hoc analyses, though IIV in select aspects of sleep does appear to be associated with increasing age/pubertal status, non-White race, physical and neurodevelopmental conditions (e.g., attention-deficit/hyperactivity disorder; autism), psychopathology symptoms (e.g., anxiety, depression, inattention), body weight, stress, aspects of cognitive functioning, and poorer sleep functioning/habits. The limited intervention work examining sleep IIV in adolescents is promising, though studies are needed using more rigorous intervention designs. Clinical sleep recommendations may not only need to address overall sleep duration and sleep habits but also the stability of sleep duration and timing. It will be important for future research examining sleep IIV in children and adolescents to use a developmental framework in advancing theory pertaining to the causes, mechanisms, moderators, and outcomes of sleep IIV in youth, and a conceptual model is proposed to help guide such efforts.


Assuntos
Variação Biológica Individual , Distúrbios do Início e da Manutenção do Sono/fisiopatologia , Sono/fisiologia , Atenção , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Cognição , Humanos
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