Sleep Health among Children Adopted from Foster Care: The Moderating Effect of Parent-Child Sleep Interactions.

OBJECTIVES: Sleep disruption is prevalent among children placed in foster care, elevating risk for a range of deleterious outcomes. Theoretically, achieving permanency via adoption may have a positive influence on children's sleep via the presence of various factors, but little is known about the sleep health of children adopted from foster care, including predictors and moderators of sleep health. METHOD: The current study included 226 parents who adopted a child from foster care in the U.S. (aged 4-11 years) within the past two years and a propensity score matched sample of 379 caregivers of children currently in foster care. Both samples completed online questionnaires about their child's sleep, physical, and mental health. RESULTS: Comparatively, children in foster care experienced more nightmares, night terrors, moving to someone else's' bed during the night, and worse overall sleep quality, whereas adopted children were reported to experience significantly more nighttime awakenings. In the adopted sample, a greater number of prior foster placements unexpectedly predicted lower total sleep disturbance scores, but this relationship was moderated by parent-child interactions around sleep. In general, greater parental involvement in children's sleep was associated with lower levels of child sleep disturbance. CONCLUSIONS: Findings suggest that while specific sleep problems might remit after children in foster care achieve permanence, nighttime sleep fragmentation often persists. Parent-child interactions surrounding sleep may be pivotal in improving sleep health in this population.

Foster Caregivers' Perceptions of Children's Sleep Patterns, Problems, and Environments.

OBJECTIVE: The disparity of problems, impairments, and disorders among children in foster care is well-documented and spans virtually every domain of functioning. Sleep, however, has received minimal attention among this vulnerable group, which is concerning given the multitude of ways sleep affects children's development, health, and behavior. METHODS: A total of 485 foster caregivers from across the United States completed a survey including quantitative items and qualitative, open-ended questions about sleep and related health and behavior for one child (M = 6.4 years, SD = 2.2; range 4-11 years) currently in their care. RESULTS: Overall, caregivers reported developmentally appropriate child sleep and wake times; however, difficulty falling asleep (avg. 46 min per night) and staying asleep (avg. 34 min awake overnight) were common. Additionally, a high prevalence of sleep-related problems was reported including moving to someone else's bed during the night (85.8%), nightmares (51.2%), sleep terrors (26.4%), snoring (32.8%), bedwetting (31.6%), and teeth grinding (21.8%). Qualitative responses indicated emotional and behavioral challenges at bedtime, particularly elevated fear, and anxiety. CONCLUSIONS: Findings are consistent with previous work finding significant health disparities among children placed in foster care. Results highlight a need for trauma-informed, behavioral sleep interventions for this pediatric population which might serve to reduce other health disparities.

The Role of Anxiety Sensitivity in the Association Between Childhood Maltreatment and Sleep Disturbance Among Adults in Psychiatric Inpatient Treatment.

ABSTRACT: The present investigation examined associations of childhood maltreatment, anxiety sensitivity (AS), and sleep disturbance among a diverse sample of adults in psychiatric inpatient treatment. We hypothesized that childhood maltreatment would be indirectly associated with greater sleep disturbance through elevated AS. Exploratory analyses examined the indirect effect models with three AS subscales ( i.e. , physical, cognitive, and social concerns) as parallel mediators. A sample of adults in acute-care psychiatric inpatient treatment ( N = 88; 62.5% male; Mage = 33.32 years, SD = 11.07; 45.5% White) completed a series of self-report measures. After accounting for theoretically relevant covariates, childhood maltreatment was indirectly associated with sleep disturbance through AS. Parallel mediation analyses revealed that no individual subscale of AS significantly accounted for this association. These findings suggest that heightened levels of AS may explain the association between childhood maltreatment and sleep disturbance among adults in psychiatric inpatient treatment. Interventions targeting AS can be brief and efficacious and have the potential to improve clinical outcomes among psychiatric populations.

Sleep Disturbances and Delayed Sleep Timing are Associated with Greater Post-Traumatic Stress Symptoms in Youth Following Hurricane Harvey.

Sleep patterns following a natural disaster are associated with mental health difficulties, but research in youth samples has been limited to subjective reports of sleep. Participants (N = 68, 8-17 years old) completed an assessment 6-9 months after Hurricane Harvey, which included subjective measures of sleep, chronotype, hurricane-related post-traumatic stress symptoms, and one week of actigraphy. Prior to the hurricane, parents provided reports on emotional symptoms. Controlling for age, sex, socioeconomic status, participation time, and pre-hurricane emotional symptoms, subjective sleep disturbances and an eveningness chronotype were associated with greater post-traumatic stress, with the strongest effects observed for re-experiencing, negative cognitions/mood, and arousal/reactivity symptoms. Later sleep timing as measured by actigraphy was associated with greater arousal/reactivity symptoms and shorter sleep duration was associated with greater avoidance symptoms. As extreme weather-related events are expected to become more frequent and severe, these findings contribute to models of youth risk and resilience.

Adolescent Sleep Disturbance, Emotion Regulation and Borderline Features in an Inpatient Setting.

Objective: The current study aimed to examine the relation between sleep disturbance, emotion dysregulation and borderline personality features in adolescent inpatients.Method: N = 217 adolescents (67.1% female; ages 12-17) with the following racial/ethnic breakdown: 67.4% White, 3.7% Hispanic, 2.8% Asian, 1.8% African American, and 6.4% multiracial) completed self-report measures of sleep disturbance, emotion dysregulation and borderline personality symptoms at admission to, discharge from, and at 6-months-post discharge from an inpatient psychiatric hospital. Group comparison and path analyses were conducted to examine differences in sleep disturbance between those with and without borderline personality disorder and the mediating role of emotion dysregulation in the relation between sleep disturbance and borderline personality features.Results: Borderline personality features and emotion dysregulation were significantly related to indices of sleep disturbance. Path models revealed that some sleep disturbance indices at admission directly predicted levels of borderline features at discharge and at 6-months-post-discharge. However, none of the indirect pathways between sleep disturbance at admission, emotion dysregulation at discharge, and borderline features at discharge or 6-months post-discharge were significant.Conclusions: Findings are consistent with prior literature which suggest that a unique relation exists between sleep disturbance and BPD, beyond comorbid depression symptoms. However, contrary to our hypotheses, the current study did not provide empirical support for the mediating role of emotion regulation in this relation. These findings have implications for existing personality disorder and sleep interventions and suggest further research into the mechanisms underlying the relation between sleep disturbance and borderline personality pathology is necessary.

Validation of the Mental Health Checklist (MHCL) during COVID-19 lockdown.

The COVID-19 pandemic resulted in unprecedented disruption to everyday life, including widespread social distancing and self-quarantining aimed at reducing the virus spread. The Mental Health Checklist (MHCL) is a measure developed to assess psychological health during extended periods of isolation and confinement, and has shown strong psychometric properties in community samples and during Antarctic missions. This study validated the MHCL in a sample of 359 U.S. and U.K adults during the peak of the COVID-19 lockdown. Confirmatory factor analysis (CFA) tested model fit, and convergent validity analyses were conducted to compare the MHCL with validated measures of depression, anxiety and stress, as well as insomnia. The MHCL exhibited good model fit for most CFA indices, and showed strong convergent validity with other measures of psychological well-being. Findings suggest that the MHCL is useful for assessing mental health in a variety of environments and conditions.

Later sleep timing predicts accelerated summer weight gain among elementary school children: a prospective observational study.

OBJECTIVES AND BACKGROUND: Social demands of the school-year and summer environment may affect children's sleep patterns and circadian rhythms during these periods. The current study examined differences in children's sleep and circadian-related behaviors during the school-year and summer and explored the association between sleep and circadian parameters and change in body mass index (BMI) during these time periods. METHODS: This was a prospective observational study with 119 children ages 5 to 8 years with three sequential BMI assessments: early school-year (fall), late school-year (spring), and beginning of the following school-year in Houston, Texas, USA. Sleep midpoint, sleep duration, variability of sleep midpoint, physical activity, and light exposure were estimated using wrist-worn accelerometry during the school-year (fall) and summer. To examine the effect of sleep parameters, physical activity level, and light exposure on change in BMI, growth curve modeling was conducted controlling for age, race, sex, and chronotype. RESULTS: Children's sleep midpoint shifted later by an average of 1.5 h during summer compared to the school-year. After controlling for covariates, later sleep midpoints predicted larger increases in BMI during summer, (γ = .0004, p = .03), but not during the school-year. Sleep duration, sleep midpoint variability, physical activity levels, and sedentary behavior were not associated with change in BMI during the school-year or summer. Females tended to increase their BMI at a faster rate during summer compared to males, γ = .06, p = .049. Greater amounts of outdoor light exposure (γ = -.01, p = .02) predicted smaller increases in school-year BMI. CONCLUSIONS: Obesity prevention interventions may need to target different behaviors depending on whether children are in or out of school. Promotion of outdoor time during the school-year and earlier sleep times during the summer may be effective obesity prevention strategies during these respective times.

Main and Interactive Effects of Nicotine Product Type on Sleep Health Among Dual Combustible and E-Cigarette Users.

BACKGROUND AND OBJECTIVES: E-cigarette use is associated with concurrent use of combustible cigarettes among adults and may increase the risk of future combustible cigarette use in adolescents and young adults. Detrimental effects of combustible cigarette use on sleep health are well documented, but little is known about the additive effects of concurrent e-cigarette use. The current study examined the main and interactive effects of daily nicotine product frequency on various components of sleep health. METHODS: Two hundred and twenty-seven dual-product users (54.2% female, Mage = 36.89, SD = 10.17) completed questionnaires regarding demographic information, average number of cigarettes smoked per day, average number of times e-cigarettes used per day, and sleep health. RESULTS: Combustible cigarette frequency uniquely predicted shorter sleep duration, whereas e-cigarette frequency uniquely predicted increased daytime dysfunction due to sleepiness. Further, there was an interactive effect of combustible and electronic cigarettes on the use of sleeping medications. DISCUSSION AND CONCLUSIONS: Findings may suggest differential adverse effects on sleep, depending on the type of nicotine product used, and highlight potential intervention targets for users. Future work should examine these associations prospectively and/or use objective measurements of sleep and nicotine use to further elucidate the nature of these relationships. SCIENTIFIC SIGNIFICANCE: This is the first study to explore the main and interactive effects of dual-product use on various dimensions of subjective sleep quality. This is important to investigate, given that dual nicotine users are at greater risk for physical health problems as well as the adverse effects of nicotine on sleep health. (Am J Addict 2020;00:00-00).

Emotion dysregulation, fatigue, and electronic cigarette expectancies.

Emotion dysregulation and the experience of fatigue have both been linked to the maintenance of substance use. However, limited empirical data has evaluated individual differences in these constructs in terms of e-cigarette use expectancies. The present study examined a theoretically relevant model focused on whether the experience of more severe fatigue explains, in part, the relation between individual differences in emotion dysregulation and positive and negative e-cigarette expectancies among 525 adult e-cigarette users (50.9% female, Mage = 35.25 years, SD = 10.10). It was hypothesized that emotion dysregulation, via fatigue severity, would significantly predict greater positive and negative e-cigarette expectancies, which was examined in two separate mediation models. Fatigue severity significantly explained, in part, the relation between emotion dysregulation and positive (b = 0.02, CI [0.01, 0.02]) and negative expectancies of e-cigarette use (b = 0.02, 95% CI [0.02, 0.03]). The current findings suggest that the experience of fatigue helps explain the relation between emotion dysregulation and positive and negative e-cigarette expectancies among adult e-cigarette users. Future work is needed to explicate how reducing fatigue severity in the context of emotion dysregulation may change expectancies about e-cigarette expectancies.

Sleep restriction alters children's positive emotional responses, but effects are moderated by anxiety.

BACKGROUND: An abundance of cross-sectional research links inadequate sleep with poor emotional health, but experimental studies in children are rare. Further, the impact of sleep loss is not uniform across individuals and pre-existing anxiety might potentiate the effects of poor sleep on children's emotional functioning. METHODS: A sample of 53 children (7-11 years, M = 9.0; 56% female) completed multimodal, assessments in the laboratory when rested and after two nights of sleep restriction (7 and 6 hr in bed, respectively). Sleep was monitored with polysomnography and actigraphy. Subjective reports of affect and arousal, psychophysiological reactivity and regulation, and objective emotional expression were examined during two emotional processing tasks, including one where children were asked to suppress their emotional responses. RESULTS: After sleep restriction, deleterious alterations were observed in children's affect, emotional arousal, facial expressions, and emotion regulation. These effects were primarily detected in response to positive emotional stimuli. The presence of anxiety symptoms moderated most alterations in emotional processing observed after sleep restriction. CONCLUSIONS: Results suggest inadequate sleep preferentially impacts positive compared to negative emotion in prepubertal children and that pre-existing anxiety symptoms amplify these effects. Implications for children's everyday socioemotional lives and long-term affective risk are highlighted.

Adolescent sleep patterns are associated with the selection of positive and negative emotional situations.

Poor sleep in youth is a risk factor for experiencing increased negative emotions and decreased positive emotions, which can contribute to the development of later emotional disorders. Understanding of specific processes that produce sleep-related alterations in emotion is limited, although preliminary studies suggest changes in the ability to appropriately regulate or control emotions as one mechanism. The current study builds on this research by examining the relationship between adolescent sleep patterns and a previously unexplored emotion regulation strategy: situation selection. Situation selection strategies are implemented prior to the onset of an emotional experience via decisions to approach rewarding/positive situations or avoid unwanted/negative situations. Fifty-four healthy adolescents (ages 13-17 years) completed 1 week of actigraphy and assessments of situation selection using: (a) trait-based questionnaires; (b) daily reports; and (c) an experimental lab task where participants were given the option to watch various emotional video clips of their choice. Greater variability in sleep timing was associated with less avoidance of negative emotional situations, and a longer sleep-onset latency was associated with more avoidance of negative emotional situations. Greater variability in nightly sleep patterns was also associated with decreased tendencies to select positive emotional situations as assessed by trait questionnaires, daily reports, and the lab-based task, but only for boys. These findings add to a growing body of research on sleep and emotional experience, and provide further support for the importance of intra-individual variability of sleep patterns in youth.

Poor sleep and emotion dysregulation mediate the association between depressive and premenstrual symptoms in young adult women.

A large portion of reproductive-aged women report experiencing distressing premenstrual symptoms. These symptoms can be exacerbated by concurrent mood problems and contribute to long-term depressive risk. However, difficulty sleeping and regulating emotional responses are also associated with the premenstrual phase and represent additional, well-established risk factors for depression. The aim of this study was to investigate whether habitual sleep problems and emotion regulation strategies serve to mediate the relationship between mood and premenstrual symptoms in non-treatment-seeking young women. Participants included 265 adult women between the ages of 18 and 25 who provided retrospective self-reports of depressive symptoms, habitual sleep quality, and premenstrual symptoms for the past month. Trait-based difficulties in regulating emotions were also assessed. Greater depressive symptoms significantly predicted greater premenstrual symptoms and both poor sleep and ineffective emotion regulation were shown to mediate this relationship. Poor sleep may enhance experience of premenstrual symptoms via its well-established impact on physical, cognitive, and/or affective functioning. Similarly, an inability to effectively regulate emotional responses in general may exacerbate experience or perception of somatic and mood symptoms during the premenstrual period, contributing to mood disturbances and risk. Findings require replication in future studies using prospective designs and more diverse samples of women.

Potential circadian and circannual rhythm contributions to the obesity epidemic in elementary school age children.

Children gain weight at an accelerated rate during summer, contributing to increases in the prevalence of overweight and obesity in elementary-school children (i.e., approximately 5 to 11 years old in the US). Int J Behav Nutr Phys Act 14:100, 2017 explained these changes with the "Structured Days Hypothesis" suggesting that environmental changes in structure between the school year and the summer months result in behavioral changes that ultimately lead to accelerated weight gain. The present article explores an alternative explanation, the circadian clock, including the effects of circannual changes and social demands (i.e., social timing resulting from societal demands such as school or work schedules), and implications for seasonal patterns of weight gain. We provide a model for understanding the role circadian and circannual rhythms may play in the development of child obesity, a framework for examining the intersection of behavioral and biological causes of obesity, and encouragement for future research into bio-behavioral causes of obesity in children.

Heart rate variability and anxious arousal: Unique relations with sleep-related problems in stress-exposed adolescents.

Sleep-related problems (SRPs) among adolescents are a growing concern. Theory and research suggest that emotional arousal may have cyclical relation with SRPs, but whether emotional dysregulation plays a role is not clear. We investigated associations between two physiological indices of emotion regulation (video baseline heart rate variability and change in heart rate variability to a stressor) and SRPs in a sample of 80 adolescents (ages 11-17 years; 51% female; 37.5% African American). The findings showed a negative relation between video baseline heart rate variability and SRPs, controlling for non-sleep-related anxiety disorder symptoms (ß = -0.29) and general manifest anxiety (ß = -0.25). We found no relation between change in heart rate variability to a stressor and SRPs when non-sleep-related anxious arousal was controlled. If replicated, findings illustrate the importance of physiological regulation of emotion influencing (or influenced by) SRPs during adolescence.

Examination of the Intolerance of Uncertainty Construct in Youth With Generalized Anxiety Disorder.

Intolerance of uncertainty (IU) is a dispositional characteristic reflecting negative cognitive, behavioral, and emotional reactivity in response to events or situations that are uncertain. Although closely associated with a generalized anxiety disorder (GAD) diagnosis in adulthood, IU has received little attention in youth. The goal of this study was to examine the construct in children with GAD and nonanxious children, including its incremental validity in predicting GAD severity and worry beyond anxiety. Ninety-eight children 6 to 11 years of age (51% male; 57% Caucasian) were assessed. The sample included 24 with a GAD diagnosis only (i.e., pure GAD), 36 with GAD plus at least one other disorder (i.e., comorbid GAD), and 38 healthy control children. Clinician, parent, and child reports of IU, anxiety, worry, and GAD severity were collected. Significant differences in levels of IU were found across all three groups; the highest levels in children with comorbid GAD, followed by children with pure GAD, and healthy controls. IU significantly contributed to worry but not GAD severity beyond the effects of anxiety. A significantly larger proportion of self-reported IU data were missing for younger (e.g., 6-8 years) as compared to older children, raising question about the validity of the construct in younger children. Overall findings suggest that IU is not specific to a GAD diagnosis in childhood. IU may instead serve as a broad cognitive risk factor for more severe (e.g., comorbid) forms of affective psychopathology. Future directions for research, including developmental considerations, are discussed.

Stability and Predictive Validity of the Parent-Child Sleep Interactions Scale: A Longitudinal Study Among Preschoolers.

Little research has examined the processes underlying children's persistent sleep problems and links with later psychopathology. The current study examined the stability of parent-child sleep interactions as assessed with the parent-reported Parent-Child Sleep Interactions Scale (PSIS) and examined whether sleep interactions in preschool-age children predict sleep problems and psychiatric symptoms later in childhood. Participants included 108 preschool-age children (50% female) and their parents. Parents completed the PSIS when children were 3-5 years (T1) and again when they were 6-9 years (T2). The PSIS includes three subscales-Sleep Reinforcement (reassurance of child sleep behaviors), Sleep Conflict (parent-child conflict at bedtime), Sleep Dependence (difficulty going to sleep without parent)-and a total score. Higher scores indicate more problematic bedtime interactions. Children's sleep problems and psychiatric symptoms at T1 and T2 were assessed with a clinical interview. PSIS scores were moderately stable from T1 to T2, and the factor structure of the PSIS remained relatively consistent over time. Higher total PSIS scores at T1 predicted increases in children's sleep problems at T2. Higher PSIS Sleep Conflict scores at T1 predicted increases in oppositional defiant disorder symptoms at T2. Children with more sleep problems and higher PSIS Sleep Reinforcement scores at T1 showed increases in attention deficit/hyperactivity disorder, depressive, and anxiety symptoms at T2. These findings provide evidence for the predictive validity of the PSIS and highlight the importance of early parent-child sleep interactions in the development of sleep and psychiatric symptoms in childhood. Parent-child sleep interactions may serve as a useful target for interventions.

The role of sleep in adolescents' daily stress recovery: Negative affect spillover and positive affect bounce-back effects.

The present study examined the role of sleep in daily affective stress recovery processes in adolescents. Eighty-nine American adolescents recorded their emotions and stress through daily surveys and sleep with Fitbit devices for two weeks. Results show that objectively measured sleep (sleep onset latency and sleep debt) moderated negative affective responses to previous-day stress, such that stress-related negative affect spillover effects became more pronounced as amount of sleep decreased. Total sleep time and sleep debt moderated cross-day positive affect "bounce-back" effects. With more sleep, morning positive affect on days following high stress tended to bounce back to the levels that were common following low stress days. Conversely, if sleep was short following high stress days, positive affect remained low the next morning. No evidence for subjective sleep quality as a moderator of spillover/bounce-back effects was found. This research suggests that sleep quantity could relate to overnight affective stress recovery.

Impact of sleep restriction versus idealized sleep on emotional experience, reactivity and regulation in healthy adolescents.

Sleep loss is associated with affective disturbances and disorders; however, there is limited understanding of specific mechanisms underlying these links, especially in adolescence. The current study tested the effects of sleep restriction versus idealized sleep on adolescents' emotional experience, reactivity and regulation (specifically cognitive reappraisal). Following 1 week of sleep monitoring, healthy adolescents (n = 42; ages 13-17 years) were randomized to 1 night of sleep restriction (4 h) or idealized sleep (9.5 h). The following day, adolescents provided self-reports of affect and anxiety and completed a laboratory-based task to assess: (1) emotional reactivity in response to positive, negative, and neutral images from the International Affective Picture System (IAPS); and (2) ability to use cognitive reappraisal to decrease negative emotional responses. Large effects were observed for the adverse impact of sleep restriction on positive affect and anxiety as well as a medium-sized effect for negative affect, compared to the idealized sleep condition. Subjective reactivity to positive and neutral images did not differ between the groups, but a moderate effect was detected for reactivity to negative images whereby sleep-restricted teens reported greater reactivity. Across both sleep conditions, use of cognitive reappraisal down-regulated negative emotion effectively; however, sleep restriction did not impact upon adolescents' ability to use this strategy. These findings add to a growing body of literature demonstrating the deleterious effects of sleep restriction on aspects of emotion and highlight directions for future research in adolescents.

Sleep Architecture Relates to Daytime Affect and Somatic Complaints in Clinically Anxious but Not Healthy Children.

It is increasingly clear that seminal sleep-affective relationships begin to take root in childhood, yet studies exploring how nighttime sleep characteristics relate to daytime affective symptoms, both in clinical and healthy populations of children, are lacking. The current study sought to explore these relationships by investigating whether trait-like and/or daily reports of affective and somatic symptoms of children with generalized anxiety disorder and matched controls relate to sleep architecture. Sixty-six children (ages 7-11; 54.4% female; 56.1% Caucasian; 18.2% biracial; 6.1% African American; 3% Asian; 16.7% Hispanic) participated including 29 with primary generalized anxiety disorder (without comorbid depression) and 37 healthy controls matched on age and race/ethnicity. Participants underwent structured diagnostic assessments including child-report measures and subsequently reported on their negative affect and somatic symptoms over the course of 1 week. Children also completed 1 night of polysomnography. Among children with generalized anxiety disorder only, greater amounts of slow wave sleep corresponded with less negative affect, and greater amounts of rapid eye movement sleep was related to more somatic complaints across the week. Similarly, for trait-like measures, more rapid eye movement sleep and shorter latency to rapid eye movement sleep were related to greater depressive symptoms in the anxious group only. The current findings suggest that physiologic sleep characteristics may contribute in direct ways to the symptom profiles of clinically anxious children. The functional relevance of such findings (e.g., how specific sleep characteristics serve to either increase or reduce long-term risk) is a vital direction for future research.

Childhood Bedtime Problems Predict Adolescent Internalizing Symptoms Through Emotional Reactivity.

OBJECTIVE: Sleep problems are frequent in children and robustly predict internalizing symptoms in adolescence and adulthood. Longitudinal investigations have nonetheless used broad measures of childhood sleep problems, precluding understanding of the specific sleep problems that presage affective disturbances. Similarly, prospective examinations of mechanistic variables linking early sleep with subsequent internalizing symptoms are lacking. METHOD: Childhood bedtime and nighttime waking problems were examined as independent predictors of adolescent internalizing symptoms within a community sample from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,089). The mediational role of emotional reactivity in late childhood also was examined. RESULTS: Bedtime but not nighttime waking problems significantly predicted adolescent internalizing problems. This relationship was partially explained by child emotional reactivity. CONCLUSIONS: Some childhood sleep problems may more reliably predict later internalizing symptoms than others. Temperamentally based emotional reactivity may potentiate affective risk associated with childhood sleep difficulties.