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    Sleep problems in children are highly prevalent (range 15-30%) and even higher in children with special needs (50-80%). Sleep disturbances may persist for years. Moreover, age-appropriate quantity and quality of sleep is required for optimal development and functioning. The most common sleep problem in children is behavioural insomnia, including difficulty settling at night, frequent night wakings, and/or early morning awakenings.

    Given the high prevalence rates and the chronic nature of child sleep problems, as well as the significant impact sleep problems have on the child’s functioning, it is imperative to have empirically validated interventions. While pharmacological treatments can be effective in the short-term, these treatments are not effective in the long term and are poorly accepted by caregivers. Furthermore, there are no FDA-approved medications for the treatment of insomnia in children. Behavioural interventions are viewed more favourably by caregivers and there is growing evidence for the short- and long-term effectiveness of these interventions. However, there is limited research examining the effectiveness of these interventions for school-aged children.

    Our study, funded by Nova Scotia Health Research Foundation (NSHRF), evaluated the effectiveness of a five week behaviour intervention for treating behavioural insomnia in elementary school-aged children through the use of a randomized controlled trial (Principal Investigators: Penny Corkum & Patrick McGrath; Co-Investigators: Christine Chambers, Sheila Laredo, & Jennifer Mullane).

    Participants included 55 children, with 27 randomized to the sleep intervention and 28 randomized to the standard care and waitlist condition. The active treatment group received an intervention that consisted of five weekly sessions. The sessions included information on:

    1. basic sleep physiology and impact of sleep problems
    2. appropriate sleep hygiene, establishing a bedtime routine, and handling night awakenings and early arising
    3. the implementation of the specific sleep intervention. The specific sleep intervention, a faded bedtime with a response cost (FBRC), consists of systematically delaying bedtime in 20-minute time units through a fading procedure which gradually reduces the time needed to fall asleep and therefore increases total sleep time. An incentive program using a sticker chart was also incorporated into the procedure.

    The results of this study indicated that, based on parent-completed questionnaires, children in the intervention group had improved sleep onset, longer sleep duration and less daytime sleepiness compared to children in the control group. In addition to improved sleep, the children in the intervention group also were reported to have improved daytime functioning, such as less behavioural challenges. We also found that the intervention seemed to be similarly effective for typically developing children and children with ADHD. Caregivers were happy with this intervention and provided a mean satisfaction rating of 4.9/5.0.

    Given the findings of this study, along with similar findings from other research examining different age groups, we were successful in our application for a CIHR Team grant in Sleep and Circadian Rhythms. (Principal Investigator: Penny Corkum; Co-Investigators: Pan Andreou, Melanie Barwick, Christine Chambers, Roger Godbout, Reut Gruber, Wendy Hall, Patrick McGrath, Graham Reid, Ben Rusak, Robyn Stremler, Terrance Wade, Carolyn Watters, Shelly Weiss, & Manisha Witmans).

    We are currently taking our program described above, as well as three other programs developed by Canadian researchers, and using these as the foundation for a web-based intervention (Better Nights: Better Days). This program will be used by parents to provide intervention for children ages 1-10 years who have sleep problems. We plan to launch the RCT for this study in January 2013. It is our hope that this web-based intervention will address some of the access barriers and allow Canadian parents to have ready access to evidence-based interventions for the treatment of their children’s sleep problems. Ultimately, we hope that improved sleep will enhance the daytime functioning of children and their families.

    Topic:

    Dr. Penny Corkum

    dr-corkum

    Dr. Corkum is a Registered Psychologist with a background in School and Child Clinical Psychology. She is an Associate Professor in the Psychology Department at Dalhousie University, with cross-appointments in Psychiatry and Pediatrics. She is also on the scientific team at IWK Health Centre in the Department of Pediatrics. In addition to her academic appointments, she is the Co-director and Co-founder of the Colchester East Hants ADHD Clinic. She conducts clinical research in the areas of child psychopathology (particularly ADHD) and pediatric sleep.

     

    Her studies have been published in psychology, psychiatry and sleep journals. She is the recipient of the Roger Broughton Young Investigator Award, which is given each year to a scientist for important early career research contributions in the area of sleep. One of her research areas is aimed at intervention in pediatric sleep problems, with the primary goal being to reduce the negative impact of sleep problems on the development of the child (attention, learning, behaviour, social-emotional) and the functioning of the family.