A 25-Year Review of Nighttime Fears in Children: Past, Present, and Future

Measures of Sleep-Related Fears in Children: A Systematic Review of Psychometric Properties Using COSMIN

Sleep-related fears (i.e. fears related to sleep, nighttime and/or occurring before sleep) are linked to the development of anxiety and sleep problems in children. Parent- and child-report measurement tools are key to increasing understanding and facilitating better identification for treatment to prevent disorder development. We conducted a systematic review with the aim of identifying the breadth of parent- and child-report measures that include an assessment of sleep-related fears in children from 7 to 12 years old (stage 1) and reviewing the psychometric properties of measures that more comprehensively assess sleep-related fears (i.e. 3 or more items) using the COSMIN checklist (stage 2) to provide recommendations for measures (stage 3). A systematic search was performed using MEDLINE, EMBASE, ERIC and PsycINFO in accordance with PRISMA guidelines. At stage 1, we retrieved 14,495 records. Of these, 66 papers met eligibility and included 43 distinct measures. At stage 2, 11 out of the 43 measures met criteria for more comprehensive measurement of sleep-related fears. Findings demonstrated mixed and incomplete data and very little high-quality evidence. No measures met criteria for recommendation and the majority of measures require further validation studies.

Individualized approaches to pediatric chronic insomnia: Advancing precision medicine in sleep disorders

The manifestations of chronic insomnia undergo age-related changes. In younger infants and children, behavioral insomnia emerges as the most prevalent form and typically responds to behavioral interventions. However, distinct clusters of clinical presentations suggest the presence of various phenotypes, potentially implicating the primary involvement of specific neurotransmitters. These conceptualizations, coupled with genetic studies on pleiotropy and polygenicity, may aid in identifying individuals at risk of persistent insomnia into adulthood and shed light on novel treatment options. In school-age children, the predominant presentation is sleep-onset insomnia, often linked with nighttime fears, anxiety symptoms, poor sleep hygiene, limit-setting issues, and inadequate sleep duration. The manifestations of insomnia in adolescence correlate with the profound changes occurring in sleep architecture, circadian rhythms, and homeostatic processes. The primary symptoms during adolescence include delayed sleep onset, sleep misperception, persistent negative thoughts about sleep, and physiological hyperarousal-paralleling features observed in adult insomnia. An approach centered on distinct presentations may provide a framework for precision-based treatment options. Enhanced comprehension of insomnia's manifestations across diverse developmental stages can facilitate accurate assessment. Efforts to subtype insomnia in childhood align with this objective, potentially guiding the selection of appropriate treatments tailored to individual neurobiological, clinical, and familial features.

How Are the Sleep Problems of Children in the US Foster Care System Addressed?

OBJECTIVE

Evidence of poor sleep health among children in foster care continues to mount, but information about whether and how sleep problems are addressed is unavailable. The goal of this study was to begin to fill these significant knowledge gaps.

METHODS

Four hundred eighty-five foster caregivers from across the United States completed a survey focused on the sleep health of one child, 4 to 11 years ( M = 6.4; SD = 2.2) currently in their care. Caregivers provided quantitative and qualitative responses to questions regarding training, information, and services received in relation to their child's sleep. Caregivers also reported on the factors and strategies they perceived as most important for helping children in their care sleep well.

RESULTS

Only 13% of caregivers reported receiving any information/education about sleep from agencies or case workers, whereas 55% had sought help from a health provider related to their child's sleep. Nearly half of all caregivers (46%) reported giving their child melatonin. Caregivers reported that a bedtime routine/consistency, reassurance of safety/love, and a calming environment were most important for helping their child sleep well. A recurrent theme in qualitative responses was a need to mitigate child fear/anxiety at night.

CONCLUSION

Children in foster care face a range of risk factors that increase the likelihood of poor/insufficient sleep, but these findings suggest this critical aspect of health requires greater clinical and research attention. As these data were collected during the initial months of the COVID-19 pandemic, replication studies are necessary.

Nighttime coping response in children: Development and validation of a new scale

Coping strategies can play an important role in dealing with nighttime fears and related anxiety problems in school-aged children, but well-established self-reporting tools are lacking, and research in this area is limited. The aim of this study was to develop a new self-report instrument assessing coping strategies in school-aged children when facing nighttime fears, the Nighttime Coping Response Scale (NCRS), and to examine its psychometric properties. Participants were 786 children (48.7% boys) aged 8-12 years, who completed the NCRS and other measures related to anxiety and behavioral problems. The construction of the NCRS was based on relevant prior literature and experts' criteria. Exploratory and confirmatory analyses supported a three-factor structure, comprising 15 items measuring coping strategies related to self-control, social support seeking, and avoidance. The NCRS was shown to have good internal consistency, test-retest reliability, and convergent and divergent validity. This research found preliminary support for the use of the NCRS, suggesting the potential suitability of this brief tool to be used by clinicians and researchers to identify and address the use of children's maladaptive coping strategies when dealing with nighttime fears. The NCRS could also be important to enable the development of further research in this field.