Sleep-based outcomes from an intervention program for anxious youth
Clementi, Michelle A.
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Background: Extensive research has shown that anxious children report high rates of sleep problems. Longitudinal and experimental studies demonstrate a bidirectional relationship between sleep and anxiety in which problems in one domain are robust predictors of problems in the other. However, it remains relatively unknown whether anxiety-focused interventions for children produce improvements in sleep or, alternatively, whether sleep problems might require direct intervention. The current study examined whether a 12-week early intervention program for children with anxiety disorders resulted in improvements in broad and/or specific types of sleep problems. Potential predictors of sleep improvement at post-treatment also were explored. Methods: A total of 88 children (ages 7-16) participated in an early intervention program for anxiety as part of the Arizona Anxiety Resilience Building Project. The current study includes a subset of 25 children (13 female; Mage = 9.9 years, SDage = 2.6) for whom sleep-based outcomes were collected. Children and parents completed a diagnostic interview in addition to measures of sleep problems, anxiety symptoms, and depressive symptoms at pre- and post-intervention. Results: One-way repeated measure ANOVAs revealed significant decreases in total sleep problems, bedtime resistance, and sleep anxiety from pre- to post-intervention. However, evidence of clinically significant improvement based on the reliable change index (RCI) was apparent in only a small portion of the sample. Hierarchical linear regression revealed that hypothesized predictors (i.e., age, anxiety severity, and depressive symptoms) did not predict sleep-related treatment outcomes. Discussion: Results suggest that purely anxiety-focused interventions may be useful for reducing sleep problems in a portion of anxious children. However, the extent to which reduction in certain types of parent-reported sleep problems (e.g., bedtime resistance, sleep anxiety) reflect improvements in actual sleep duration or quality is unknown. Further, the clinical meaningfulness of these changes is unclear as few youth had sleep problem scores in the normative range at post intervention. This suggests that the sleep problems of anxious youth may require direct attention as part of treatment. Limitations and implications for future research are discussed.