Construction and Initial Examination of Inter-Rater Reliability of a Structured Clinical Interview for DSM-5-TR Sleep Disorders (SCISD) - Kid.

STUDY OBJECTIVES: To construct and evaluate the inter-rater reliability of the Structured Clinical Interview for DSM-5-TR Sleep Disorders - Kid (SCISD-Kid). METHOD: The SCISD-Kid was modeled on the adult SCISD-R and accounted for pediatric developmental and sociocultural factors. Fifty sleep-disturbed children (Mage = 11.9, SD = 2.9) and 50 caregivers responded to the final SCISD-Kid. Video recordings were double-scored to evaluate inter-rater reliability. RESULTS: The final SCISD-Kid contained approximately 90 questions. Eight of the nine covered disorders had prevalence rates sufficient for analyses for both samples (i.e., k > 2). Inter-rater reliability was examined using Cohen kappa coefficients (κ); reliability estimates ranged from excellent to good. For youth, restless legs syndrome yielded the lowest reliability (.48), while nightmare disorder, narcolepsy, and NREM sleep arousal disorder - sleepwalking type showed the highest reliability (1.00). Across caregivers, NREM sleep arousal disorder - sleep terror type (.49) and hypersomnolence (.54) had the lowest reliability. In contrast, circadian rhythm - delayed sleep phase type, nightmare disorder, and NREM sleep arousal disorder - sleepwalking type showed the highest reliability (1.00). CONCLUSIONS: The SCISD-Kid is a promising tool for screening sleep disorders. It showed good to excellent reliability across both samples. Next steps for validation will be discussed.

Methodological changes to improve retention: Results from two pediatric cognitive behavioral therapy studies.

OBJECTIVE: Retention is challenging in clinical research with pediatric populations. The retention obstacles that are experienced in adult samples are compounded because child samples depend on caregiver support and engagement. The present paper describes retention improvements following protocol adaptations across a pair of cognitive behavioral pilot studies for nightmare sufferers aged 6-17. METHODS: Study 1 (N = 20) focused retention efforts on rapport and engagement, flexible scheduling, treatment location choice, and incentives. Study 2 (N = 31) sought to increase retention by improving continuity of care, increasing scheduling flexibility, reducing participant time and effort, and increasing choice and attractiveness of incentives. RESULTS: Only 13 participants (65%) were retained in Study 1; n = 6 (54.5%) treatment and n = 7 (77.78%) waitlist. In contrast, 29 participants (93.5%) were retained in Study 2; n = 15 (93.8%) treatment and n = 14 (93.3%) waitlist. CONCLUSION: We conclude that asking for and responding to patient feedback to assess all perceived barriers and burdens for participants is essential to ensure that benefits exceed effort. Allowing choices in size and frequency of incentives, as well as improving continuity of care, and reducing session length even while increasing number of sessions, were noted improvements in Study 2.

The Role of Executive Function in Predicting Children's Outcomes in a Cognitive Behavioral Treatment for Trauma-Related Nightmares and Secondary Sleep Disturbances.

Predictors of children's outcomes in trauma-focused interventions are well documented. However, little is known about the role of higher-order cognitive processes, specifically executive function (EF) abilities, in determining children's responses to treatments specifically for trauma-related sleep disturbances. EF is independently related to PTSD reactions, sleep deficits, and nightmares. Furthermore, well-developed EF can be protective; thus, we sought to examine whether higher EF predicted better treatment outcomes for trauma-related sleep disturbances. Twenty-three children aged 5 to 17 presenting with post-traumatic nightmares (PTNs) participated in a cognitive behavioral therapy to address their trauma-related nightmares (CBT-NC). Pre- and post-treatment data were used in analyses. Findings from discriminant function analyses revealed that EF was not a statistically significant predictor of treatment outcomes across indices of nightmare frequency and distress, sleep quality, and PTSD symptomology. However, effect sizes suggested that EF was a moderate predictor of sleep quality outcomes, which has clinical implications. Treatment duration for sleep problems could be related to EF with briefer interventions being more suitable for children with high EF, whereas children with low EF may benefit from longer treatment protocols.