Understanding the unique and common perspectives of partners engaged in knowledge mobilization activities within pediatric pain management: a mixed methods study.

BACKGROUND: Knowledge mobilization (KM) is essential to close the longstanding evidence to practice gap in pediatric pain management. Engaging various partners (i.e., those with expertise in a given topic area) in KM is best practice; however, little is known about how different partners engage and collaborate on KM activities. This mixed-methods study aimed to understand what different KM partner groups (i.e., health professionals, researchers, and patient/caregiver partners) perceive as supporting KM activities within pediatric pain management. METHODS: This study used a convergent mixed-methods design. Ten partners from each of the three groups participated in interviews informed by the Consolidated Framework for Implementation Research, where they discussed what impacted KM activities within pediatric pain. Participants then rated and ranked select factors discussed in the interview. Transcripts were analyzed within each group using reflexive thematic analysis. Group-specific themes were then triangulated to identify convergence and divergence among groups. A matrix analysis was then conducted to generate meta-themes to describe overarching concepts. Quantitative data were analyzed using descriptive statistics. RESULTS: Unique themes were developed within each partner group and further analysis generated four meta-themes: (1) team dynamics; (2) role of leadership; (3) policy influence; (4) social influence. There was full agreement among groups on the meaning of team dynamics. While there was partial agreement on the role of leadership, groups differed on who they described as taking on leadership positions. There was also partial agreement on policy influence, where health professionals and researchers described different institutions as being responsible for providing funding support. Finally, there was partial agreement on social influence, where the role of networks was seen as serving distinct purposes to support KM. Quantitative analyses indicated that partner groups shared similar priorities (e.g., team relationships, communication quality) when it came to supporting KM in pediatric pain. CONCLUSIONS: While partners share many needs in common, there is also nuance in how they wish to be engaged in KM activities as well as the contexts in which they work. Strategies must be introduced to address these nuances to promote effective engagement in KM to increase the impact of evidence in pediatric pain.

The Association Between the Impact of COVID-19 and Internalizing Problems Among Children and Adolescents with ADHD: The Moderating Role of Parental Anxiety.

Previous research has identified an increase in internalizing problems during the COVID-19 pandemic in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Additionally, it has been observed that parents of children with ADHD had elevated levels of anxiety during the pandemic. The current study aimed to longitudinally assess whether the impact of COVID-19 was associated with internalizing problems in children and adolescents with ADHD during the middle (Time 1-Spring 2021 [T1]) and end (Time 2-Fall/Winter 2022 [T2]) of the pandemic, and whether parental anxiety moderated this relationship over time. Canadian parents of youth with ADHD (aged 3-18 years old) completed online questionnaires assessing their child's depression and anxiety symptoms, their own anxiety symptoms, and the pandemic's impact on their child, both at T1 (N = 278) and T2 (N = 89). The results indicated that the impact of COVID-19 on children at T1 was a unique predictor of child internalizing problems at T1 but not at T2. While parental anxiety did not moderate this association cross-sectionally, it was a significant moderator longitudinally. More specifically, low parental anxiety at T1 positively moderated the association between the COVID-19 impact on children at T1 and child internalizing problems at T2. The results highlight the importance of providing on-going psychological support for children and adolescents with ADHD and emphasize the need to aid parents in effectively supporting their children during the process of pandemic recovery.

Even a Mild Sleep Restriction Can Impact Daytime Functioning in Children with ADHD and Their Typically Developing Peers.

OBJECTIVES/BACKGROUND: Correlational studies show that short sleep is associated with negative daytime outcomes in school-aged children, but there are few experimental sleep manipulation studies to assess whether this is a causal relation. The aim of this study was to determine the impact of mild, cumulative sleep restriction on daytime functioning of typically developing (TD) children and children with attention-deficit/hyperactivity disorder (ADHD). PARTICIPANTS: A total of 36 school-aged children (n = 18 TD; n = 18 ADHD), aged 6-11 years participated. METHODS: Children participated in two sleep conditions (order counter-balanced). The Restricted condition required a 1 h reduction of time in bed for one week, and the Controlled Typical condition was based on participant's average baseline sleep. At the end of each condition, participants attended the sleep lab for overnight polysomnography and daytime functioning assessments. RESULTS: Children successfully reduced time in bed by ~1 h. Due to compensatory changes, total sleep time (TST) was reduced by only ~20 min, as children fell asleep faster and spent less time awake after sleep onset during the Restricted compared to Controlled Typical condition. Many daytime functions were not affected by this very mild sleep restriction, however, both groups showed significant changes in performance on an objective attention task and on a parent-rated emotional lability measure after six nights of minimal reductions in TST. There were no significant differences between groups. CONCLUSIONS: Results suggest that a very mild sleep restriction can affect children's attention and emotional regulation, even with evidence of compensatory sleep mechanisms.

Healthy sleep for healthy schools: A pilot study of a sleep education resource to improve adolescent sleep.

ISSUE ADDRESSED: Insufficient sleep and unhealthy sleep practices in adolescents are associated with significant health risks. Sleep education programs in schools aim to improve sleep behaviour. A new eLearning sleep education program, Healthy Sleep for Healthy Schools (HS4HS), was developed focused on these goals and is distinguishable from other sleep education programs because it is delivered by teachers, making it more sustainable and adaptable for schools. We aimed to evaluate if HS4HS would improve student sleep knowledge, healthy sleep practices, sleep duration and reduce sleepiness. We also aimed to understand if this intervention could be successfully implemented by trained teachers. METHODS: Teachers trained in sleep delivered HS4HS to 64 South Australian students in year 9 (aged 13-14 years) over 6 weeks during regular school curriculum. A sleep education survey assessing sleep patterns (such as healthy sleep practices, time in bed and sleepiness), and a sleep knowledge questionnaire was completed pre- and post-HS4HS delivery. Evaluations were also completed by teachers. RESULTS: Sleep knowledge and healthy sleep practices significantly improved post intervention. Time in bed on both school days and weekends increased slightly and sleepiness decreased slightly, but these changes were not statistically significant. Teachers found the program useful, comprehensive and easy to incorporate into their curricula. CONCLUSIONS: After short training, teachers can deliver sleep education during class and improve sleep practices in their students. This suggests that this program may offer potential as an effective and useful resource for teachers wanting to include sleep health in their curriculum. SO WHAT?: Sleep is the foundation of good health and teachers can promote and integrate sleep education into their curricula for the first time with this online teacher focussed program, which has the potential to be a sustainable sleep health promotion resource.

Children's Sleep During COVID-19: How Sleep Influences Surviving and Thriving in Families.

OBJECTIVE: The COVID-19 pandemic has the potential to disrupt the lives of families and may have implications for children with existing sleep problems. As such, we aimed to: (1) characterize sleep changes during the COVID-19 pandemic in children who had previously been identified as having sleep problems, (2) identify factors contributing to sleep changes due to COVID-19 safety measures, and (3) understand parents' and children's needs to support sleep during the pandemic. METHODS: Eighty-five Canadian parents with children aged 4-14 years participated in this explanatory sequential, mixed-methods study using an online survey of children's and parents' sleep, with a subset of 16 parents, selected based on changes in their children's sleep, participating in semi-structured interviews. Families had previously participated in the Better Nights, Better Days (BNBD) randomized controlled trial. RESULTS: While some parents perceived their child's sleep quality improved during the COVID-19 pandemic (14.1%, n = 12), many parents perceived their child's sleep had worsened (40.0%, n = 34). Parents attributed children's worsened sleep to increased screen time, anxiety, and decreased exercise. Findings from semi-structured interviews highlighted the effect of disrupted routines on sleep and stress, and that stress reciprocally influenced children's and parents' sleep. CONCLUSIONS: The sleep of many Canadian children was affected by the first wave of the COVID-19 pandemic, with the disruption of routines influencing children's sleep. eHealth interventions, such as BNBD with modifications that address the COVID-19 context, could help families address these challenges.

Concordance of actigraphy with polysomnography in children with and without attention-deficit/hyperactivity disorder.

This study sought to: (1) compare actigraphy-derived estimated sleep variables to the same variables based on the gold-standard of sleep assessment, polysomnography; (2) examine whether the correlations between the measures differ between children with attention-deficit/hyperactivity disorder and typically developing children; and (3) determine whether these correlations are altered when children with attention-deficit/hyperactivity disorder are treated with medication. Participants (24 attention-deficit/hyperactivity disorder; 24 typically developing), aged 6-12 years, completed a 1-week baseline assessment of typical sleep and daytime functioning. Following the baseline week, participants in the attention-deficit/hyperactivity disorder group completed a 4-week blinded randomized control trial of methylphenidate hydrochloride, including a 2-week placebo and 2-week methylphenidate hydrochloride treatment period. At the end of each observation (typically developing: baseline; attention-deficit/hyperactivity disorder: baseline, placebo and methylphenidate hydrochloride treatment), all participants were invited to a sleep research laboratory, where overnight polysomnography and actigraphy were recorded concurrently. Findings from intra-class correlations and Bland-Altman plots were consistent. Actigraphy was found to provide good estimates (e.g. intra-class correlations >0.61) of polysomnography results for sleep duration for all groups and conditions, as well as for sleep-onset latency and sleep efficiency for the typically developing group and attention-deficit/hyperactivity disorder group while on medication, but not for the attention-deficit/hyperactivity disorder group during baseline or placebo. Based on the Bland-Altman plots, actigraphy tended to underestimate for sleep duration (8.6-18.5 min), sleep efficiency (5.6-9.3%) and sleep-onset latency, except for attention-deficit/hyperactivity disorder during placebo in which actigraphy overestimated (-2.1 to 6.3 min). The results of the current study highlight the importance of utilizing a multimodal approach to sleep assessment in children with attention-deficit/hyperactivity disorder.

Better Nights/Better Days-Distance Intervention for Insomnia in School-Aged Children With/Without ADHD: A Randomized Controlled Trial.

OBJECTIVE: Better Nights/Better Days, a distance intervention for insomnia in school-aged children (with and without attention-deficit/hyperactivity disorder [ADHD]), was evaluated to determine its effectiveness on children's sleep and psychosocial functioning. METHODS: A single center, parallel group design randomized controlled trial (stratified on ADHD diagnosis) was conducted. Parents were randomized to intervention (n = 31) or waitlist control (n = 30), and completed questionnaires administered over the phone at baseline, postintervention (2 months), and follow-up (6 months). Actigraphy was also collected. The intervention consisted of a five-session manual and weekly telephone coach support. RESULTS: The intervention group demonstrated a significant reduction in sleep problems and improved psychosocial functioning at postintervention and follow-up. Actigraphy results indicated improved sleep onset, but not sleep duration. Children with and without ADHD responded in a similar manner to this intervention. Parents provided high satisfaction ratings. CONCLUSIONS: This intervention holds promise as an accessible, sustainable, and effective program to address insomnia in school-aged children.

Core competencies for health professionals' training in pediatric behavioral sleep care: a Delphi study.

The need to train non-sleep-specialist health professionals in evidence-based pediatric behavioral sleep care is well established. The objective of the present study was to develop a list of core competencies for training health professionals in assisting families of 1- to 10-year old children with behavioral insomnia of childhood. A modified Delphi methodology was employed, involving iterative rounds of surveys that were administered to 46 experts to obtain consensus on a core competency list. The final list captured areas relevant to the identification and treatment of pediatric behavioral sleep problems. This work has the potential to contribute to the development of training materials to prepare non-sleep-specialist health professionals to identify and treat pediatric behavioral sleep problems, ideally within stepped-care frameworks.

Barriers and facilitators of evidence-based practice in pediatric behavioral sleep care: qualitative analysis of the perspectives of health professionals.

Behavioral sleep problems are highly prevalent among young and school-aged children. Despite strong evidence for effective interventions, few children receive evidence-based care. In this study, 124 Canadian health professionals answered open-ended questions regarding barriers and facilitators of their provision of evidence-based behavioral sleep-related care, and responses were analyzed for content. Responses represented issues at an individual practice level, as well as broader systemic issues. The most frequently reported barrier and facilitator related to knowledge, training, and education. Other barriers included lack of time and institutional support, and facilitators included supportive sleep attitudes and beliefs. This study may inform the design of education programs for health professionals, and provides support for broader systems-level initiatives targeted at increasing evidence-based practice.

Modeling Parenting Programs as an Interim Service for Families Waiting for Children's Mental Health Treatment.

Using a discrete choice conjoint experiment, we explored the design of parenting programs as an interim strategy for families waiting for children's mental health treatment. Latent class analysis yielded 4 segments with different design preferences. Simulations predicted the Fast-Paced Personal Contact segment, 22.1% of the sample, would prefer weekly therapist-led parenting groups. The Moderate-Paced Personal Contact segment (24.7%) preferred twice-monthly therapist-led parenting groups with twice-monthly lessons. The Moderate-Paced E-Contact segment (36.3%), preferred weekly to twice-monthly contacts, e-mail networking, and a program combining therapist-led sessions with the support of a computerized telephone e-coach. The Slow-Paced E-Contact segment (16.9%) preferred an approach combining monthly therapist-led sessions, e-coaching, and e-mail networking with other parents. Simulations predicted 45.3% of parents would utilize an option combining 5 therapist coaching calls with 5 e-coaching calls, a model that could reduce costs and extend the availability of interim services. Although 41.0% preferred weekly pacing, 58% were predicted to choose an interim parenting service conducted at a twice-monthly to monthly pace. The results of this study suggest that developing interim services reflecting parental preferences requires a choice of formats that includes parenting groups, telephone-coached distance programs, and e-coaching options conducted at a flexible pace.

Usability of an eHealth sleep education intervention for university students.

Background: It has been estimated that more than one-third of university students suffer from insomnia. Few accessible eHealth sleep education programmes exist for university students and of the ones that do exist, fewer were developed using a user-centred approach, which allows for student input to be systematically collected and utilized to provide students with a programme that they consider to be easy to use and implement and to be effective. Better Nights, Better Days-Youth (BNBD-Youth) is a four-session eHealth sleep education programme designed for youth but previously only evaluated in younger adolescents (ages 14-18 years). Aims: The purpose of this study is to evaluate the usability of the BNBD-Youth programme with university students using Morville's User Experience Honeycomb framework to determine if this programme would meet the needs of university students and if so what modifications would be needed. Methods: Canadian undergraduate students (n = 46) completed the BNBD-Youth programme. Students completed online usability questionnaires based on the seven dimensions of Morville's User Experience Honeycomb (i.e. useful, usable, valuable, credible, desirable, accessible and findable) after each session and after completion of the programme. Open- and closed-ended questions were used to obtain both quantitative and qualitative responses. Results: Average quantitative ratings were positive across user experience dimensions, ranging from 3.43 to 4.46 (out of 5). Qualitative responses indicated overall positive experiences with the programme. The only constructive feedback that met the criteria for revising the programme was to include more interactive features in Session 4. Conclusions: This study demonstrates that university students found BNBD-Youth to be a usable programme for older youth. Demonstrating usability is an essential step in developing a programme with a user-centred design that university students will want to use in the future. Once the BNBD-Youth programme is revised to create the BNBD-University (BNBD-Uni) programme, additional usability and effectiveness testing will be conducted.

Examining the role of the visuospatial sketchpad in children's math calculation skills using Baddeley and Hitch's model of working memory.

Math difficulties (MDs) occur in about 3-7 % of children and have been associated with academic, health, and occupational challenges. To date, findings about the role of working memory in MDs have been conflicting. The Automated Working Memory Assessment Battery (AWMA), which assesses all components of Baddeley and Hitch's model of working memory, was used to investigate which component of the model was most related to math calculation skills in elementary-school children. Participants were 94 (52 male) children (M age = 9 years 1 month; Range = 6 years 0 months to 11 years 8 months). As hypothesized, math calculation scores were correlated with all four working memory components (phonological loop, visuospatial sketchpad, verbal and visuospatial central executive). After accounting for age, phonological processing, and attention, the visuospatial sketchpad was the only memory component that contributed to the prediction of math calculation scores, explaining an additional 10.2 % of unique variance. Short-term visuospatial memory should be assessed in children having difficulty with math and children could benefit from interventions that include attention to the development of both visuospatial memory and math calculation skills. This study did not use a longitudinal design and so we cannot conclude that weak visuospatial memory impedes the development of math calculation skills. Future research should use longitudinal designs and investigate other types of math skills.

Manipulating sleep duration alters emotional functioning and cognitive performance in children.

OBJECTIVE: To examine the impact of sleep duration on emotional functioning and cognitive performance in children. METHODS: 32 children (8-12 years) wore actigraphs for 3 weeks. Following a week of typical sleep, each child was randomly assigned to go to bed 1 hr earlier for 4 nights (Long Sleep) or 1 hr later for 4 nights (Short Sleep) relative to their typical bedtime. Each child then completed the opposite condition. After each week, emotional and cognitive functioning were assessed using objective and subjective measures. RESULTS: Results revealed impaired functioning in the Short- relative to the Long-Sleep condition on measures of positive affective response, emotion regulation, short-term memory, working memory, and aspects of attention. CONCLUSIONS: Results suggest that even modest differences in sleep duration over just a few nights can have significant consequences for children's daytime functioning. These findings demonstrate the important impact of sleep duration on children's daytime functioning.

Remote population-based intervention for disruptive behavior at age four: study protocol for a randomized trial of Internet-assisted parent training (Strongest Families Finland-Canada).

BACKGROUND: Oppositional Defiant Disorder (ODD) is characterized by angry and noncompliant behaviour. It is the most common disruptive behaviour disorder (DBD), with prevalence estimates of 6-9% for preschoolers and is closely linked to several long-term difficulties, including disorders of conduct, mood, anxiety, impulse-control, and substance abuse. ODD in children is related to parental depression, family dysfunction, and impairments in parental work performance. Children displaying early DBDs exhibit more symptoms of greater severity, more frequent offences, and commit more serious crimes later in life. The goal of the Strongest Families Finland Canada (SFFC) Smart Website intervention research program is to develop and evaluate an affordable, accessible, effective secondary prevention parent training program for disruptive behaviour in preschoolers to prevent the negative sequelae of ODD. Strongest Families is an 11-session program with two booster sessions that focuses on teaching skills to: strengthen parent-child relationships; reinforce positive behaviour; reduce conflict; manage daily transitions; plan for potentially problematic situations; promote emotional regulation and pro-social behaviour and decrease antisocial behaviour. METHODS/DESIGN: This protocol paper describes an ongoing population-based randomized controlled trial (RCT) of high-risk 4 year-olds attending well-child clinics in Turku, Finland and environs to examine the effectiveness of the Strongest Families Smart Website intervention compared to an Education Control condition. Randomization consists of a 1:1 ratio for intervention versus the education group, stratified by the child's sex. The participants randomized to the intervention group receive access to the Strongest Families Smart Website and weekly telephone coaching sessions. The participants randomized to the Education Control condition receive access to a static website with parenting tips. Children are followed using parental and daycare teacher measures at 6 and 12 months after randomization. DISCUSSION: The Strongest Families Smart Website intervention is hypothesized to improve parenting skills, reduce child disruptive behaviour, reduce parental distress and improve family functioning. These results will likely inform subsequent investigations, public policy, and early treatment of childhood disruptive behaviour problems. TRIAL REGISTRATION: ClinicalTrials.gov # NCT01750996.

Parental Perceptions of the Impact of the COVID-19 Pandemic on the Sleep of Children With Neurodevelopmental Disorders.

INTRODUCTION: Little is known about the impact of the COVID-19 pandemic on sleep in schoolaged children with neurodevelopmental disorders. This study aimed to (1) determine and describe the impact of the COVID-19 pandemic, and (2) identify and describe contributing factors. METHOD: Parents of children with neurodevelopmental disorders and insomnia symptoms (n = 100) were surveyed to determine if their child's sleep had changed because of the COVID-19 pandemic. Parents who reported changes were asked to describe how the pandemic influenced their child's sleep. RESULTS: Most parents (66%) reported the pandemic did not worsen their child's sleep, 30% stated their child's sleep had worsened, and 4% reported an improvement. Stress and anxiety about the pandemic, disrupted routines, and increased screen time were common parent-identified contributing factors. DISCUSSION: Health care providers should explore strategies to mitigate contributing factors, such as anxiety about the pandemic, disrupted routines, and increased screen time.

Acceptability of an online intervention for insomnia in children with neurodevelopmental disorders.

BACKGROUND: Most children with neurodevelopmental disorders (NDDs) experience insomnia. Online interventions may provide a way to reduce barriers to treatment access. AIMS: We explored whether parents of children with NDDs and their health care professionals (HCPs) perceived an online insomnia intervention as acceptable and the perceived pros and cons of this intervention delivery method. METHODS AND PROCEDURES: Participants included 43 parents of children with NDDs and 44 HCPs who work with children with NDDs. During focus groups/interviews participants shared their perceptions of a hypothetical online insomnia intervention. Responses were analyzed using qualitative content analysis and codes were grouped into pros and cons. OUTCOMES AND RESULTS: Parents and HCPs reported similar pros and cons. Pros focused on the intervention's accessibility, credibility, usability, usefulness, and design, whereas cons focused on feasibility of implementation. Participants felt that external support (e.g., an online coach) would improve the intervention's acceptability. CONCLUSIONS AND IMPLICATIONS: Overall, the majority of parents and HCPs perceived an online intervention for insomnia as acceptable but concerns about implementation were noted and need to be taken into account when developing online interventions.

Sleep Architecture and EEG Power Spectrum Following Cumulative Sleep Restriction: A Comparison between Typically Developing Children and Children with ADHD.

No studies have looked at the effects of cumulative sleep restriction (CSR) on sleep architecture or the power spectrum of sleep EEG (electroencephalogram) in school-age children, as recorded by PSG (polysomnography). This is true for both typically developing (TD) children and children with ADHD (attention deficit/hyperactivity disorder), who are known to have more sleep difficulties. Participants were children (ages 6-12 years), including 18 TD and 18 ADHD, who were age- and sex-matched. The CSR protocol included a two-week baseline and two randomized conditions: Typical (six nights of sleep based on baseline sleep schedules) and Restricted (one-hour reduction of baseline time in bed). This resulted in an average of 28 min per night difference in sleep. Based on ANOVAs (analysis of variance), children with ADHD took longer to reach N3 (non-rapid eye movement), had more WASO (wake after sleep onset) (within the first 5.1 h of the night), and had more REM (rapid eye movement) sleep than TD children regardless of condition. During CSR, ADHD participants had less REM and a trend toward longer durations of N1 and N2 compared to the TD group. No significant differences in the power spectrum were found between groups or conditions. In conclusion, this CSR protocol impacted some physiological aspects of sleep but may not be sufficient to cause changes in the power spectrum of sleep EEG. Although preliminary, group-by-condition interactions suggest that the homeostatic processes in children with ADHD may be impaired during CSR.

Focus Groups to Inform User-Centered Development of an eHealth Sleep Intervention for Adolescents: Perspectives of Youth with Insomnia Symptoms, with and without Pain.

INTRODUCTION: Adolescence is a developmental stage that often coincides with increasing sleep problems. Focus groups were conducted to inform development of an adolescent eHealth sleep intervention by exploring opinions about (1) healthy sleep practices, and (2) using an eHealth intervention. METHODS: Adolescents 14-18 years old experiencing symptoms of insomnia based on the Insomnia Sleep Index, with and without recurrent pain, and associated stakeholders (i.e., parents, school personnel, and health care providers) were recruited. Across six online focus groups, 24 adolescents with insomnia participated (14 pain-free, 10 with recurrent pain; 10 male, 14 female). Across seven online focus groups, 22 stakeholders participated, including 8 parents, 9 school professionals, and 5 health care providers (10 male, 8 female). Using a content analysis, subthemes were induced from transcripts. RESULTS: Most healthy sleep practices were perceived as reasonable for adolescents to implement, except avoiding technology before bed and using bedrooms only for sleep. Three primary barriers to sleep practices were identified, including a variable schedule due to lifestyle factors, technology at night, and academics interfering with sleep, and only in the pain group, the barrier related to pain was identified. Content addressing adolescent-specific barriers was considered important to include in a sleep intervention. Desirable eHealth components included interactive features, videos, audio, and pictures to present information. A common barrier to using an eHealth sleep intervention was the program feeling too academic, with accessibility of the sleep information and strategies as a common facilitator. CONCLUSIONS: This research represents the first step in a user-centered approach to developing an adolescent eHealth sleep intervention. These results provide insights from a range of perspectives on guiding adolescents to follow healthy sleep practices. Next, these findings will be integrated in the development of an eHealth intervention for adolescents with and without recurrent pain.

An eHealth Program for Insomnia in Children With Neurodevelopmental Disorders (Better Nights, Better Days): Protocol for an Economic Evaluation of a Randomized Controlled Trial.

BACKGROUND: Children with neurodevelopmental disorders have a high risk of sleep disturbances, with insomnia being the most common sleep disorder (ie, chronic and frequent difficulties with going and staying asleep). Insomnia adversely affects the well-being of these children and their caregivers. Pediatric sleep experts recommend behavioral interventions as the first-line treatment option for children. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a 5-session eHealth behavioral intervention delivered to parents to improve outcomes (eg, Pediatric Quality of Life Inventory [PedsQL]) for their children (ages 4-12 years) with insomnia and who have a diagnosis of mild to moderate attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, or fetal alcohol spectrum disorder. If cost-effective, BNBD-NDD can be a scalable intervention that provides value to an underserved population. OBJECTIVE: This protocol outlines an economic evaluation conducted alongside the BNBD-NDD randomized controlled trial (RCT) that aims to assess its costs, efficacy, and cost-effectiveness compared to usual care. METHODS: The BNBD-NDD RCT evaluates the impacts of the intervention on children's sleep and quality of life, as well as parents' daytime functioning and psychosocial health. Parent participants were randomized to the BNBD-NDD treatment or to usual care. The economic evaluation assesses outcomes at baseline and 8 months later, which include the PedsQL as the primary measure. Quality of life outcomes facilitate the comparison of competing interventions across different populations and medical conditions. Cost items include the BNBD-NDD intervention and parent-reported usage of private and publicly funded resources for their children's insomnia. The economic evaluation involves a reference case cost-effectiveness analysis to examine the incremental cost of BNBD-NDD per units gained in the PedsQL from the family payer perspective and a cost-consequence analysis from a societal perspective. These analyses will be conducted over an 8-month time horizon. RESULTS: Research funding was obtained from the Kids Brain Health Network in 2015. Ethics were approved by the IWK Health Research Ethics Board and the University of Calgary Conjoint Health Research Ethics Board in January 2019 and June 2022, respectively. The BNBD-NDD RCT data collection commenced in June 2019 and ended in April 2022. The RCT data are currently being analyzed, and data relevant to the economic analysis will be analyzed concurrently. CONCLUSIONS: To our knowledge, this will be the first economic evaluation of an eHealth intervention for insomnia in children with neurodevelopmental disorders. This evaluation's findings can inform users and stakeholders regarding the costs and benefits of BNBD-NDD. TRIAL REGISTRATION: ClinicalTrial.gov NCT02694003; https://clinicaltrials.gov/study/NCT02694003. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46735.

Associations of active and passive smartphone use with measures of youth mental health during the COVID-19 pandemic.

Smartphone use provides a significant amount of screen-time for youth, and there have been growing concerns regarding its impact on their mental health. While time spent in a passive manner on the device is frequently considered deleterious, more active engagement with the phone might be protective for mental health. Recent developments in mobile sensing technology provide a unique opportunity to examine behaviour in a naturalistic manner. The present study sought to investigate, in a sample of 451 individuals (mean age 20.97 years old, 83% female), whether the amount of time spent on the device, an indicator of passive smartphone use, would be associated with worse mental health in youth and whether an active form of smartphone use, namely frequent checking of the device, would be associated with better outcomes. The findings highlight that overall time spent on the smartphone was associated with more pronounced internalizing and externalizing symptoms in youth, while the number of unlocks was associated with fewer internalizing symptoms. For externalizing symptoms, there was also a significant interaction between the two types of smartphone use observed. Using objective measures, our results suggest interventions targeting passive smartphone use may contribute to improving the mental health of youth.