Evaluation of a treatment of sleep-related problems in children with anxiety using a multiple baseline design
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Abstract
Children with anxiety frequently experience sleep-related problems (SRPs) such as longer sleep onset latency, sleep dependence, and sleep anxiety. Despite the significant mental and physical health consequences of SRPs and the high prevalence of SRPs in school-aged children with anxiety, little research has examined sleep treatments for this population. This project utilized a single case multiple baseline design to evaluate the feasibility, acceptability, and preliminary efficacy of a four-session parent training intervention for reducing SRPs in youth with anxiety. Participants were ten children (M=9.6 years, range 8-12 years, 8 female) who met criteria for an anxiety disorder as well as a diagnosis of chronic insomnia. Throughout the study, parents tracked subjective child sleep onset latency (subjective SOL) using a daily sleep diary, children wore actigraphy monitors to capture daily objective sleep onset latency (objective SOL), parents completed a daily parent-child sleep interaction questionnaire, and parents and children completed qualitative interviews at post-treatment. Additional assessment of SRPs occurred at baseline, post-treatment, and one-month follow up. Results of the study showed that it was feasible to design and implement a four-session parent training intervention designed to treat SRPs in school-aged children with anxiety, and that this intervention was acceptable to participants. Consistent with hypotheses, the majority of participants (n=9) no longer met criteria for chronic insomnia at post-treatment or follow-up (n=6), the frequency of SRPs was significantly lower at these time points, and the majority of participants (n=7) reported significant reductions in subjective SOL. However, only three participants showed significant reductions in objective SOL. Qualitative results helped to further clarify this discrepancy by demonstrating that participants experienced a shift in sleep perception across treatment (e.g., before treatment, normal objective SOL lengths were experienced as subjectively longer due to anxiety). Both quantitative and qualitative results demonstrated that parent behaviors (e.g., parental accommodation) and parent-child interactions (e.g., sleep dependence) both improved during the study. Future research should investigate changes in parent behaviors and parent-child interactions as potential mechanisms of treatment.