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Common symptoms for patients with narcolepsy can have a significant impact on social health. As one peak for symptom onset is adolescence, these symptoms impact social relationships during a critical developmental period. Much of the existing literature in this domain has relied on broad questionnaires, with less insight into the nuances of their potential social struggles.Adolescents (12-17 years old) with narcolepsy and their parents individually completed a semi-structured interview (N=14 dyads). Interview transcripts were analyzed using a multi-stage thematic analysis.An overarching theme was the difficulty adolescent's experienced trying to balance narcolepsy symptom management with trying to engage in social activities in a meaningful way. Narcolepsy affected social relationships in three primary domains: mood, physical activities, and driving. Adolescents reported that they were frustrated with feeling as though narcolepsy sometimes defined their social lives. Adolescents and parents expressed a desire for medical providers to better understand their evolving priorities, to validate their social limitations, and to provide more information around the social implications of narcolepsy and its treatment.Narcolepsy has a significant impact on social relationships in adolescents, one which is not adequately managed in current clinical care models. A routine, structured assessment of social health is a vital first step for providers treating adolescents with narcolepsy. Medical centers and patient organizations can play an important role in facilitating social opportunities for this underserved population.

In fall 2019, California passed and signed into law SB328, the first US statewide legislation explicitly designed to protect adolescent sleep health by requiring most California public school districts to start no earlier than 8:00 AM for middle schools and 8:30 AM for high schools. Recognizing the unique opportunity presented by the bill's 3-year implementation period, a group of experts in adolescent sleep and school start times held a virtual summit on January 22-23, 2021 to (1) summarize the research on adolescent sleep and school start time change; (2) develop recommendations for relevant, refined, and innovative research areas and research questions; (3) provide input regarding research design, methodology, and implementation; and (4) offer a forum for networking, exchanging ideas, and establishing interdisciplinary research collaborations. Participants represented a multidisciplinary range of academic backgrounds including sleep and circadian biology, neuroscience, education, medicine, public health, mental health, safety, public policy, economics, implementation science, criminology, diversity studies, and science communication. This paper summarizes summit presentations regarding current knowledge on adolescent sleep health and school start times and key research recommendations from small group workshops on topics including research design and tools, methodological issues, sleep health disparities, logistical challenges in conducting school-based research, public-health impact, and novel and expanded approaches to research.

Objectives: We analyzed patient-reported sleep parameters for an extended-release methylphenidate formulation (PRC-063) in adolescents with attention-deficit/hyperactivity disorder. Methods: Clinic...

Introduction We demonstrated that a brief behavioral intervention enhanced children’s sleep; those with clinically meaningful improvements in sleep (> 30 m/night), had improvements in body mass index (BMI) and BMI z-scores (BMIz). Given emerging evidence regarding the potential importance of not only sleep duration but sleep timing (i.e., bedtimes) for obesity risk reduction, we explored whether sleep duration and/or sleep timing mediated effects of intervention on BMI and BMIz. We hypothesized that the effect of the intervention on 8-week BMI/BMIz would be mediated by earlier bedtimes and longer sleep duration at 2 weeks post-randomization. Methods Participants were 71 children 8-11 years old (mean (SD) age = 9.72 (1.00); 69% female; mean (SD) BMIz = 0.91 (0.935)) who slept < 9.5 h/night and were randomized to a 4-session behavioral intervention to increase nocturnal sleep duration (primarily via advancing bedtimes) or to a control (4 sessions; continue with sleep as usual). Sleep was assessed via 7-day actigraphy; height and weight were measured to calculate BMI/BMIz at baseline, 2- and 8-weeks post randomization. We assessed mediation using the medflex R package. Models predicting 8-week BMIz and BMI controlled for baseline BMIz and BMI, respectively. Duration (mean actigraph sleep period) and bedtime (mean actigraph sleep onset) were entered as continuous variables in models. Results Relative to control, the behavioral intervention decreased children’s 8-week BMIz by -0.027 (SE = 0.013) via its effect on week 2 bedtimes (z = -2.066, p = 0.039). There was no direct effect of intervention on 8-week BMIz (z = 1.584, p = 0.113), and although of marginal significance, week 2 sleep duration did not mediate effects of intervention on 8-week BMIz (z = -1.937, p = 0.053). Findings focused on BMI, although consistent, did not reach statistical significance. Conclusion A behavioral intervention designed to enhance school-aged children’s nocturnal sleep had a positive impact on children’s weight status via its effect on bedtimes, and to a lesser degree, sleep duration. Findings add to emerging work supporting the potential importance of sleep timing in weight regulation. Support (if any) R01HL092910; P20GM139743

Pediatric insomnia can affect physical and mental health and cause cognitive deficits, social deficits and decrease quality of life. There are no Food and Drug Administration approved medications approved for pediatric insomnia. Pharmacologic interventions derive mostly from adult data or pediatric case reports. This review focuses on Food and Drug Administration approved prescription drugs (in adults), over-the-counter drugs, and off-label pediatric insomnia drugs. This review helps the clinician learn general principles, practice guidelines, and pharmacologic considerations for medication selection in the pediatric population. Pharmacologic management should be considered in combination with behavior therapy, which is proven to have long-lasting outcomes.

Commonly held beliefs about sleep unsupported by scientific evidence (ie, myths) among adolescents and their parents/caregivers may adversely influence sleep-related attitudes and behaviors among adolescents. Thus, identifying such myths with the goal of developing effective evidence-based counter-messages has the potential to improve sleep health in adolescents.We identified myths with a panel of adolescent sleep health experts (n = 12) using the Delphi method in three sequential steps: (1) focus groups; (2) online discussion; and (3) closed-ended questionnaires with which the experts rated myths on: (1) falseness and (2) public health significance using 5-point Likert scales ranging from 1 (not at all false/important for public health) to 5 (extremely false/important for public health). Next, we explored the prevalence of the myths among a demographically diverse sample of parents/caregivers of adolescents in the United States. Finally, we report the counterevidence to refute each myth.Ten myths about adolescent sleep were identified by the experts using the Delphi method. The most prevalent myths were the beliefs that (1) "Going to bed and waking up late on the weekends is no big deal for adolescents, as long as they get enough sleep during that time," reported by 74% of parents/caregivers; (2) "If school starts later, adolescents will stay up that much later," reported by 69% of parents/caregivers; and (3) "Melatonin supplements are safe for adolescents because they are natural," reported by 66% of parents/caregivers.Parents/caregivers have the potential to serve as sleep health advocates for their adolescent and support their adolescent's sleep health behaviors. Our study found that many parents/caregivers endorse myths about adolescent sleep that may hinder their ability to support their adolescent's sleep health. Future research may explore methods for promoting evidence-based beliefs about adolescent sleep among parents/caregivers.

OBJECTIVE: The purpose of this study was to examine the associations of sleep duration and socioecological protective factors with patterns of adolescent risk behaviors in Fairfax County, VA - one of the largest public-school districts in the United States. METHODS: A total of 21,360 and 20,330 students in 10(th) and 12(th) grades who completed the youth risk behavior survey were included in this cross-sectional analysis. Sleep duration was measured by self-report of the average number of hours of sleep on a school night. Ten socioecological protective factors included individual-peer, family, school, and community domains. Latent class analysis was used to classify 7 risk behaviors (alcohol use, cigarette use, illicit drug use, inappropriate prescription drug use, risky sexual behavior, deviant behavior, and academic failure) into 4 class-memberships (Low, Some, Moderate, and High). Multinomial regression models were adjusted for age, gender, and race. RESULTS: Adolescents who reported sleeping the recommended 8–9 hours were significantly less likely to belong to the class-memberships of greater risk behaviors compared to those who reported short and longer sleep duration after controlling for age, gender, race, and survey year. There was a significant inverse relationship between the number of socioecological protective factors and risk behaviors for both 10th and 12th graders. Potential risks of age, sex, and race on risky behaviors were observed. No significant interaction between sleep duration and protective factors was found in both grades. CONCLUSIONS: This study highlights the significant associations between sleep duration and risk behaviors in adolescents with diverse socioecological protective factors. Prioritization of prevention-focused resources should consider sleep duration in addition to the socioecological protective factors commonly cited in the literature when addressing adolescent risk behaviors.

This study evaluated psychometric properties of the Pediatric Narcolepsy Screening Questionnaire (PNSQ), developed in response to the difficulty of identifying pediatric narcolepsy.The initial PNSQ was updated following debriefing interviews with parents of children with suspected/diagnosed narcolepsy. Subsequently, newly recruited caregivers were categorized into groups: clinician-confirmed narcolepsy, other sleep problems (OSP), and no sleep problems (controls). Caregivers completed the 11-item PNSQ assessing narcolepsy symptomatology. PNSQ psychometric properties were evaluated; mean PNSQ Total Score (TS) was compared inter-group using analysis of variance.The analysis population (N = 158) included patients with narcolepsy (n = 49), OSP (n = 55), and controls (n = 54); mean ± SD age was 13.8 ± 2.8, 10.2 ± 4.3, and 10.0 ± 3.8 years, respectively. Inter-item Pearson correlations (range, 0.22-0.75) indicated good construct validity. Principal component analysis confirmed unidimensionality. Item discriminative power was high for narcolepsy vs control (range, 0.693-0.936) and lower for narcolepsy vs OSP (range, 0.584-0.729). The latent trait was well covered (separation index = 0.868). Item 7 (vivid dreams/nightmares), having low discriminative power and specificity, was removed. Cronbach's alpha (final PNSQ) indicated high internal consistency reliability (raw alpha = 0.88). Mean ± SD PNSQ TS (range, 0-50) in the narcolepsy, OSP, and control groups were 34.98 ± 7.98, 25.20 ± 9.43, and 9.54 ± 9.38, respectively (nominal P lt; 0.0001). Classification by PNSQ TS was defined: PNSQ+ (likely narcolepsy, TS ≥ 29), PNSQ 0 (likely OSP, TS 19-28), and PNSQ- (narcolepsy unlikely, TS ≤ 18); patients with narcolepsy were classified as PNSQ+ (79.6%), PNSQ 0 (18.4%), and PNSQ- (2.0%).The PNSQ demonstrated good psychometric properties and excellent performance discriminating narcolepsy, OSP, and control groups.

To determine whether self-reported drowsy driving was associated with an evening chronotype, a biologically-based difference in circadian sleep-wake timing, and shorter school-night sleep duration in a sample of high school drivers.Cross-sectional observational data were obtained from an online survey in spring 2015 of 431 drivers, age 15.5-18.7 years, attending Fairfax County (Virginia) Public schools. Drowsy driving was defined as having ever "driven a car or motor vehicle while feeling drowsy" in the last year. School-night sleep duration was calculated from school-night bedtime and wake time. Those with scores in the lower and upper tertiles of the Morningness-Eveningness Scale for Children were designated as having an evening or morning chronotype, respectively.Among survey respondents, 63.1% drove at least several times a week and 47.6% reported drowsy driving. The covariate-adjusted prevalence of drowsy driving was 13.9% (95% CI 3.0%-24.9%) higher in students who slept7 hours on school-nights than in those who slept 8 or more hours. Compared with those with a morning chronotype, the adjusted prevalence of drowsy driving was 15.2% (95% CI 4.5%-25.9%) higher among those with an evening chronotype.Among adolescent drivers, both an evening chronotype and shorter school-night sleep duration were associated with more frequent reports of drowsy driving. Interventions to improve the timing and duration of nighttime sleep in adolescents may reduce the occurrence of drowsy driving.

Study Objectives To examine associations among instructional approaches, school start times, and sleep during the COVID-19 pandemic in a large, nationwide sample of U.S. adolescents. Methods Cross-sectional, anonymous self-report survey study of a community-dwelling sample of adolescents (grades 6–12), recruited through social media outlets in October/November 2020. Participants reported on instructional approach (in-person, online/synchronous, online/asynchronous) for each weekday (past week), school start times (in-person or online/synchronous days), and bedtimes (BT) and wake times (WT) for each identified school type and weekends/no school days. Sleep opportunity was calculated as BT-to-WT interval. Night-to-night sleep variability was calculated with mean square successive differences. Results Respondents included 5,245 racially and geographically diverse students (~50% female). BT and WT were earliest for in-person instruction; followed by online/synchronous days. Sleep opportunity was longer on individual nights students did not have scheduled instruction (>1.5 h longer for online/asynchronous than in-person). More students obtained sufficient sleep with later school start times. However, even with the same start times, more students with online/synchronous instruction obtained sufficient sleep than in-person instruction. Significantly greater night-to-night variability in sleep-wake patterns was observed for students with in-person hybrid schedules versus students with online/synchronous + asynchronous schedules. Conclusions These findings provide important insights regarding the association between instructional approach and school start times on the timing, amount, and variability of sleep in U.S. adolescents. Given the public health consequences of short and variable sleep in adolescents, results may be useful for education and health policy decision-making for post-pandemic secondary schools.

Objective To determine whether prenatal and childhood tobacco smoke exposure (TSE) are each independently associated with mild sleep-disordered breathing (SDB) symptoms throughout early childhood, and whether the association between childhood TSE and SDB differs according to the level of prenatal exposure. Methods Longitudinal cohort study, using data from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort from the United Kingdom. Primary exposures were repeated measures of mother-reported prenatal and childhood TSE through age 7 years. Outcomes were mother-reported measures of mild SDB symptoms, including snoring, mouth breathing, and witnessed apnea, repeated annually through age 7 years. Results A total of 12,030 children were followed for a median duration of 7 years. About 24.2% were exposed to prenatal tobacco smoke, 46.2% were exposed at least once in childhood, and 20.6% were exposed during both periods. Both prenatal and childhood TSE were associated with SDB symptoms throughout early childhood (adjusted OR [aOR] for any prenatal TSE 1.23; 95% confidence interval [CI] 1.08, 1.40; aOR for any childhood TSE 1.17; 95% CI 1.06, 1.29). We observed a dose-response effect between TSE and SBD symptoms, and found evidence of effect modification for those exposed during both time periods (combined high level exposure both prenatally and during childhood: aOR snoring 2.43 [95% CI 1.50, 3.93], aOR apnea 2.65 [95% CI 1.46, 4.82]). Conclusions Prenatal and childhood TSE were both independently associated with mild SDB symptoms throughout early childhood in a dose-dependent manner, further supporting the critical importance of maintaining a tobacco-free environment throughout gestation and childhood.

Coronavirus disease 2019 (COVID-19) has resulted in a significantly large number of psychological consequences, including sleep health. The present study evaluated sleep patterns, sleep disturbances, and associated factors in Chinese preschoolers confined at home during the COVID-19 outbreak. Caregivers of 1619 preschoolers (aged 4-6 years) recruited from 11 preschools in Zunyi, Guizhou province completed the Children's Sleep Habit Questionnaire (CSHQ) between 17th and 19th February 2020. Data were compared to a sociodemographically similar sample of preschoolers (included in the 11 preschools) in 2018. Compared to the 2018 sample, the confined preschoolers demonstrated changes in sleep patterns characterized by later bedtimes and wake times, longer nocturnal and shorter nap sleep durations, comparable 24-hr sleep duration, and fewer caregiver-reported sleep disturbances. Moreover, behavioural practices (sleeping arrangement, reduced electronic device use, regular diet) and parenting practices (harmonious family atmosphere and increased parent-child communication) were associated with less sleep disturbances in the confined sample. The present study provides the first description of the impact of prolonged home confinement during the COVID-19 outbreak on sleep patterns and sleep disturbances in preschoolers, as well as highlighting the importance of the link between sleep health and family factors. Given that disrupted and insufficient sleep has been linked to immune system dysfunction, our findings also have potential implications for resilience to infection in young children during the COVID-19 pandemic. Future studies should further explore deficient sleep as a risk factor for coronavirus infection.

ObjectiveTo review pharmacologic and nonpharmacologic strategies for treating sleep disturbances in children and adolescents with autism spectrum disorder (ASD) and to develop recommendations for addressing sleep disturbance in this population.MethodsThe guideline panel followed the American Academy of Neurology 2011 guideline development process, as amended. The systematic review included studies through December 2017. Recommendations were based on evidence, related evidence, principles of care, and inferences.Major recommendations (Level B)For children and adolescents with ASD and sleep disturbance, clinicians should assess for medications and coexisting conditions that could contribute to the sleep disturbance and should address identified issues. Clinicians should counsel parents regarding strategies for improved sleep habits with behavioral strategies as a first-line treatment approach for sleep disturbance either alone or in combination with pharmacologic or nutraceutical approaches. Clinicians should offer melatonin if behavioral strategies have not been helpful and contributing coexisting conditions and use of concomitant medications have been addressed, starting with a low dose. Clinicians should recommend using pharmaceutical-grade melatonin if available. Clinicians should counsel children, adolescents, and parents regarding potential adverse effects of melatonin use and the lack of long-term safety data. Clinicians should counsel that there is currently no evidence to support the routine use of weighted blankets or specialized mattress technology for improving disrupted sleep. If asked about weighted blankets, clinicians should counsel that the trial reported no serious adverse events with blanket use and that blankets could be a reasonable nonpharmacologic approach for some individuals.

The aim of this study was to examine the association between a 50-minute delay (7:20 am to 8:10 am) in high school start times in Fairfax County (FC) Virginia and changes in rates of adolescent motor vehicle crashes. Crash rates in FC were also compared to those in the rest of the state during the same time period.Virginia Department of Motor Vehicles crash data in drivers age 16 to 18 years old between September and June of each year in FC versus the rest of the state were compared in the combined 2-year periods preceding (2013-2014 and 2014-2015; T1) and following (2015-2016 and 2016-2017; T2) school start time change in the fall of 2015.The crash rate per 1000 in 16- to 18-year-old licensed drivers in FC during T1 was significantly higher compared to T2, 31.63 versus 29.59 accidents per 1,000 (95% confidence interval, 1.0-1.14, odds ratio 1.07, P = .03). In contrast, adolescent crash rates in the rest of Virginia were not statistically significantly different at T1 versus T2. With regard to subtypes of crashes, there was a trend toward significance in distraction-related crashes per 1,000 in FC at T1 compared to T2 at 7.01 versus 6.13 (95% confidence interval, 0.99-1.31, odds ratio 1.14, P = .05), but were not significantly different in the remainder of the state.The results of this study suggest that school start time delay is associated with decreased adolescent motor vehicle crash risk, with significant implications for public health and safety.

BACKGROUND: Daily behaviors such as sleep can be targeted by smartphone app-based interventions, with potential utility amongst young people of minority ethnic backgrounds who commonly access smartphone devices and are short sleepers. There is a need to understand the acceptability and youth’s readiness to use apps to improve sleep, and to identify desired app components that would motivate engagement. PARTICIPANTS AND METHODS: We conducted three focus group discussions (N=27 total, age 14 to 18 years) within low- and middle-income ethnically diverse Boston neighborhoods. We also interviewed 10 participants who provided specific feedback on two commercially available sleep promoting apps, one of which they had used on their smartphone preceding the interviews. All focus group discussions and interviews were audio-recorded, transcribed and thematically analyzed. RESULTS: We identified several barriers to adoption of sleep hygiene interventions, namely reluctance to follow scheduled sleep routines on weekends and concern about “parting” with electronics at bedtime. Participants were intrigued by the idea of adopting an app-based sleep intervention, but were skeptical that they could successfully adopt sleep hygiene practices, and were more interested in making changes on school days than on weekends. Nonetheless, the overall feedback on two commercial sleep apps, both not targeted at youth, was positive, with a good adherence and engagement rate, and perceived health benefits. CONCLUSIONS: Our findings highlight the need to adapt sleep hygiene recommendations to targeted populations, considering preferences and social and cultural contextual factors. Our research also underscores the importance of the platform, setting and messenger when delivering health information to adolescents.

Introduction Using data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N=6,578), we investigated if race/ethnicity (64.6% were White and 35.4% identified as a racial/ethnic minority, mixed, or “other”) and community social vulnerability affected the association between COVID stress and sleep disturbance. Methods Data on sociodemographic factors (age, race, sex, grade, zip code [for neighborhood social vulnerability index, SVI]), COVID-related stress, depression, anxiety, instructional format (online, in-person, or hybrid), and sleep disturbance (PROMIS Pediatric Sleep Disturbance) were captured through an online survey. Descriptive and inferential analyses (Hierarchical Binary Logistic Regression (HBLR), SPSS v. 25) in 4171 adolescents examined associations between sleep disturbance and COVID-related stress, adjusting for race, sex, SVI, grade level, learning format, household density, and mental health factors. Results Sleep disturbance was prevalent among adolescents (89% above average, T-score >50); about two-thirds (64.4%) reported greater stress due to the pandemic. Compared to White (88.5%) adolescents, sleep disturbance was more common in Black (91.2%), Hispanic (90.5%), American Indian/Alaska native (95.1%), and Mixed (92.3%) and less common in Asian (83.9%) adolescents. Chi-square analysis indicated that both race/ethnicity (□2 = 14.96, p Conclusion COVID-related stress and symptoms of depression and anxiety are associated with sleep disturbance. We observed differences in sleep disturbance across racial/ethnic groups and neighborhood social vulnerability strata, for specific racial/ethnic groups. Support (if any) AS was supported by funding from the NIH (K01HL135452, R01HL152453)

Introduction COVID-19 fundamentally altered education in the United States. A variety of in-person, hybrid, and online instruction formats took hold in Fall 2020 as schools reopened. The Nationwide Education and School in TEens During COVID (NESTED) study assessed how these changes impacted sleep. Here we examined how instruction format was associated with sleep disruption and learning outcomes. Methods Data from 4148 grade 6-12 students were included in the current analyses (61% non-male; 34% non-white; 13% middle-school). Each student’s instructional format was categorized as: (i) in-person; (ii) hybrid [≥1 day/week in-person]; (iii) online/synchronous (scheduled classes); (iv) online/asynchronous (unscheduled classes); (v) online-mixed; or (vi) no-school. Sleep disturbances (i.e., difficulty falling/staying asleep) were measured with validated PROMIS t-scores. A bootstrapped structural equation model examined how instructional format and sleep disturbances predict school/learning success (SLS), a latent variable loading onto 3 outcomes: (i) school engagement (ii) likert-rated school stress; and (iii) cognitive function (PROMIS t-scores). The model covaried for gender, race-ethnicity, and school-level Results Our model fit well (RMSEA=.041). Examining total effects (direct + indirect), online and hybrid instruction were associated with lower SLS (b’s:-.06 to -.26; p’s Conclusion These analyses from the NESTED study indicate that sleep disruption may be one mechanism through which online instruction impacted learning during the pandemic. Sleep disturbances were unexpectedly influential for unscheduled instruction (i.e., asynchronous). Future analyses will examine specific sleep parameters (e.g., timing) and whether sleep’s influence differs in teens who self-report learning/behavior problems (e.g., ADHD). These nationwide data further underscore the importance of considering sleep as educators and policy makers determine school schedules. Support (if any)

Objective To determine whether simultaneous school start time changes (delay for some schools; advance for others) impact adolescents' sleep. Design Quasi-experimental study using cross-sectional surveys before and after changes to school start times in September 2015. Setting Eight middle (grades 7-8), 3 secondary (grades 7-12), and 8 high (grades 9-12) schools in Fairfax County (Virginia) public schools. Participants A total of 2017 (6% of ~34,900) students were surveyed before start time changes, and 1180 (3% of ~35,300) were surveyed after. Intervention A 50-minute delay (7:20 to 8:10 am ) in start time for high schools and secondary schools and a 30-minute advance (8:00 to 7:30 am ) for middle schools. Measurements Differences before and after start time changes in self-reported sleep duration and daytime sleepiness. Results Among respondents, 57.5% were non-Hispanic white, and 10.3% received free or reduced-priced school meals. Before start time changes, high/secondary and middle school students slept a mean (SD) of 7.4 (1.2) and 8.4 (1.0) hours on school nights, respectively, and had a prevalence of daytime sleepiness of 78.4% and 57.2%, respectively. Adjusted for potential confounders, students with a 50-minute delay slept 30.1 minutes longer (95% confidence interval [CI], 24.3-36.0) on school nights and had less daytime sleepiness (−4.8%; 95% CI, −8.5% to −1.1%), whereas students with a 30-minute advance slept 14.8 minutes less (95% CI, −21.6 to −8.0) and had more daytime sleepiness (8.0%; 95% CI, 2.5%-13.5%). Conclusions Both advances and delays in school start times are associated with changes in adolescents' school-night sleep duration and daytime sleepiness. Larger changes might occur with later start times.

Objective To determine whether school start time changes impact adolescents’ mood, self-regulation, safety, and health. Methods In September 2015, two school start time changes were implemented in Fairfax County (VA) Public Schools: a 50-minute delay (to 8:10 am ) for high schools and secondary schools and a 30-minute advance (to 7:30 am ) for middle schools. We conducted cross-sectional surveys of students’ sleep, mood, self-regulation, health, and safety before (2017 students) and after (1180 students) these changes. Results Adjusted for confounders, a 50-minute delay was associated with a decreased prevalence of low mood (−4.7%; 95% confidence interval [CI]: −8.2%, −1.2%), drowsy driving, (−8.4%; 95% CI: −15.9%, −0.9%), and skipping breakfast (−4.2%; 95% CI: −8.1%, −0.2%) but no other significant changes. There were no significant changes associated with a 30-minute advance. Conclusions A 50-minute delay in school start time in high schools and secondary schools was associated with a decreased prevalence of low mood, drowsy driving, and skipping breakfast. A 30-minute advance in start time in middle schools was not associated with any appreciable changes.

Introduction The COVID-19 pandemic significantly disrupted how and when adolescents attended school. This analysis used data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study to examine the association of instructional format (in-person, virtual, hybrid), school start times, and sleep in a large diverse sample of adolescents from across the U.S. Methods In October/November 2020, 5346 nationally representative students (grades 6–12, 49.8% female, 30.6% non-White) completed online surveys. For each weekday, participants identified if they attended school in person (IP), online-scheduled synchronous classes (O/S), online-no scheduled classes (asynchronous, O/A), or no school. Students reported school start times for IP or O/S days, and bedtimes (BT) and wake times (WT) for each applicable school type and weekends/no school days (WE). Sleep opportunity (SlpOpp, total sleep time proxy) was calculated from BT and WT. Night-to-night sleep variability was calculated with mean square successive differences. Results Significant differences for teens’ sleep across instructional formats were found for all three sleep variables. With scheduled instructional formats (IP and O/S), students reported earlier BT (IP=10:54pm, O/S=11:24pm, O/A=11:36pm, WE=12:30am), earlier WT (IP=6:18am, O/S=7:36am, O/A=8:48am, WE=9:36am), and shorter SlpOpp (IP=7.4h, O/S=8.2h, O/A=9.2h, WE=9.2h). Small differences in BT, but large differences in WT were found, based on school start times, with significantly later wake times associated with later start times. Students also reported later WT on O/S days vs. IP days, even with the same start times. Overall, more students reported obtaining sufficient SlpOpp (>8h) for O/S vs. IP format (IP=40.0%, O/S=58.8%); when school started at/after 8:30am, sufficient SlpOpp was even more common (IP=52.7%, O/S=72.7%). Greater night-to-night variability was found for WT and SlpOpp for students with hybrid schedules with >1 day IP and >1 day online vs virtual schedules (O/S and O/A only), with no differences in BT variability reported between groups. Conclusion This large study of diverse adolescents from across the U.S. found scheduled school start times were associated with early wake times and shorter sleep opportunity, with greatest variability for hybrid instruction. Study results may be useful for educators and policy makers who are considering what education will look like post-pandemic. Support (if any)

Introduction Adolescents are vulnerable to short, insufficient sleep stemming from a combined preference for late bedtimes and early school start times, and also circadian disruptions from frequent shifts in sleep schedules (i.e., social jetlag). These sleep disruptions are associated with poor mental health. The COVID-19 pandemic has impacted education nationwide, including changes in instructional formats and school schedules. With data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study, we examined whether sleep variability and social jetlag (SJL) during the pandemic associate with mental health. Methods Analyses included online survey data from 4767 students (grades 6-12, 46% female, 36% non-White, 87% high school). For each weekday, participants identified if they attended school in person (IP), online-scheduled synchronous classes (O/S), online-no scheduled classes (asynchronous, O/A), or no school. Students reported bedtimes (BT) and wake times (WT) for each instructional format and for weekends/no school days. Sleep opportunity (SlpOpp) was calculated from BT and WT. Weekday night-to-night SlpOpp variability was calculated with mean square successive differences. SJL was calculated as the difference between the average sleep midpoint on free days (O/A, no school, weekends) versus scheduled days (IP, O/S). Participants also completed the PROMIS Pediatric Anxiety and Depressive Symptoms Short Form. Data were analyzed with hierarchical linear regressions controlling for average SlpOpp, gender, and school-level (middle vs high school). Results Mean reported symptoms of anxiety (60.0 ±9.1; 14%≧70) and depression (63.4 ±10.2; 22%≧70) fell in the at-risk range. Shorter average SlpOpp (mean=8.3±1.2hrs) was correlated with higher anxiety (r=-.10) and depression (r=-.11; p’s Conclusion In the context of system-wide education changes during COVID-19, students on average reported at-risk levels of anxiety and depression symptoms which were associated with greater variability in sleep opportunity across school days and greater social jetlag. Our findings suggest educators and policymakers should consider these sleep-mental health associations when developing instructional formats and school schedules during and post-pandemic. Support (if any) T32MH019927(P.W.)

Summary This systematic review assessed the prevalence of restless sleep in children, documented the association of restless sleep with other conditions, and summarized the existing evidence regarding whether restless sleep should be considered a distinct sleep disorder. A comprehensive search of electronic databases was performed using the broad search term “restless sleep” in all fields. Of the 266 articles retrieved, 107 were retained for inclusion in this review. The majority (n = 93) were observational studies. The studies were grouped under several pathologic/condition categories: sleep-disordered breathing (n = 19); adenotonsillectomy (n = 7); respiratory disorders, otitis media, and smoke exposure (n = 12); sleep-related movement disorders and restless sleep disorder (n = 11); neurologic or psychiatric disorders (n = 7); Down syndrome/other neurodevelopmental disorders (n = 10); sleep-related bruxism and other sleep disorders (n = 7); and restless sleep in the general population/mixed clinical samples (n = 18). A high prevalence of restless sleep was found in children with many of these underlying conditions, likely related to associated inherent sleep disruption and frequent awakenings (e.g., apnea and periodic limb movements), pain, sleep instability, and caregiver perception. The majority of studies identified restless sleep as reported by the caregiver, only 34 studies attempted to define restless sleep further. Four studies provided supportive evidence for designating restless sleep as an independent sleep disorder, restless sleep disorder (RSD). This review highlights the fact that the prevalence, etiology and sequelae (including daytime impairments) of restless sleep in children are important topics deserving of further research and that clinical definitions based on empirical evidence need to be developed. The designation of “primary” versus “secondary” restless sleep may be a useful construct, especially with regard to developing clinical trials and treatment algorithms.

Objective: To evaluate measures of sleep (exploratory endpoints) in two pivotal studies of a multilayer bead extended-release methylphenidate (MPH-MLR) treatment of attention-deficit/hyperactivity disorder in children. Methods: Study 1 evaluated the time course of response to MPH-MLR (n = 26) patients in an analog classroom setting through four phases: screening (≤28 days), open label (OL) dose optimization (4 weeks), double-blind (DB) crossover (2 weeks; placebo vs. optimized dose), and follow-up call. Study 2 was a forced-dose parallel evaluation of MPH-MLR (n = 230) in four phases: screening (≤28 days), DB (1 week; placebo or MPH-MLR 10, 15, 20, or 40 mg/day), OL dose optimization (11 weeks), and follow-up call. Sleep was evaluated by parents using the Children's or Adolescent Sleep Habits Questionnaire (CSHQ or ASHQ) during the DB and OL phases. DB analysis: Study 1 (crossover), analysis of variance; Study 2, analysis of covariance. OL analysis: paired t-test. Results: DB: treatments were significantly different in Study 1 only for CSHQ Sleep Onset Delay (MPH-MLR, 1.90 vs. placebo, 1.34; p = 0.0046, placebo was better), and Study 2 for CSHQ Parasomnias (treatment, p = 0.0295), but no MPH-MLR treatment was different from placebo (pairwise MPH-MLR treatment to placebo, all p ≥ 0.170). OL: CSHQ total and Bedtime Resistance, Sleep Duration, Sleep Anxiety, Night Wakings, Parasomnias, and Sleep-disordered Breathing subscales decreased (improved, Study 1) significant only for CSHQ Night Wakings (p

Given the genuine gaps in the availability of clinical sleep services for children, sleep coaching as a field has emerged and appears to be significantly increasing. Sleep coaches are typically individuals who provide individualized services, often via the Internet or phone, to families of infants and young children (and increasingly to older children, adolescents, and adults as well) with sleep problems. At this time, there is no universally accepted definition of sleep coach, nor are there clear guidelines regarding educational background, training requirements, scope of practice, or credentialing. To start to address the needs of families seeking the services of a sleep coach, educational materials were developed for parents and health care providers regarding issues to consider. Furthermore, there is a need going forward that (1) the designation sleep coach or consultant be clear and well defined, with a clear standard of care and scope of practice; (2) there is a standard core body of knowledge included in all training programs; (3) a certification process is developed for sleep coaches that is reputable and has recognizable and clear standards; and (4) that care for sleep problems in infants and young children are available to diverse populations, irrespective of socioeconomic status.

Pediatric insomnia, defined as chronic and clinically significant difficulty with initiating and/or maintaining sleep in children and adolescents, can profoundly impact functioning and well-being on both the child and their family. Behavioral interventions for insomnia in pediatric populations have been shown to be highly effective. This review expands upon this growing literature by summarizing the studies that have examined behavioral treatments for insomnia in children and adolescents published since 2013. Three themes emerge: (1) how pediatric insomnia is being treated in health settings; (2) efforts to adapt treatment to unique patient populations; and (3) the development of novel delivery methods for effective dissemination of treatment. Recommendations for important future clinical research questions are discussed.

Due to an ongoing recent evolution in practice, sleep medicine as a discipline has been compelled to respond to the converging pressures to reduce costs, improve outcomes, and demonstrate value. Patient "researchers" are uniquely placed to participate in initiatives that address the specific needs and priorities of patients and facilitate the identification of interventions with high likelihood of acceptance by the "customer." To date, however, the "patient voice" largely has been lacking in processes affecting relevant policies and practice guidelines. In this Special Report, patient and research leaders of the Sleep Apnea Patient-Centered Outcomes Network (SAPCON), a national collaborative group of patients, researchers and clinicians working together to promote patient-centered comparative effectiveness research, discuss these interrelated challenges in the context of sleep apnea, and the role patients and patient-centered networks may play in informing evidence-based research designed to meet patient's needs. We first briefly discuss the challenges facing sleep medicine associated with costs, outcomes, and value. We then discuss the key role patients and patient-centered networks can play in efforts to design research to guide better sleep health care, and national support for such initiatives. Finally, we summarize some of the challenges in moving to a new paradigm of patient-researcher-clinician partnerships. By forging strong partnerships among patients, clinicians and researchers, networks such as SAPCON can serve as a living demonstration of how to achieve value in health care.

SummaryBackground Paediatric observational studies demonstrate associations between sleep, television viewing and potential changes in daytime activity levels. Objective(s) To determine whether experimental changes in sleep lead to changes in children's sedentary and physical activities. Methods Using a within-subject counterbalanced design, 37 children 8–11 years old completed a 3-week study. Children slept their typical amount during a baseline week and were then randomized to increase or decrease mean time in bed by 1.5 h/night for 1 week; the alternate schedule was completed the final week. Children wore actigraphs on their non-dominant wrist and completed 3-d physical activity recalls each week. Results Children reported watching more television (p

Parasomnias are phenomena which may arise from NREM sleep (confusional arousals, sleep terrors, and sleepwalking) or REM sleep (nightmares). All are more common in children. While generally benign and outgrown with age, they may come to clinical attention when sufficiently disruptive to the patient or the patient’s family and in some cases may pose significant safety concerns. In addition to proper preventative measures, behavioral techniques—such as alteration of sleep timings, implementation of scheduled awakenings, and psychotherapy—are important tools in the clinician’s armamentarium. Research into the effectiveness of these interventions primarily consists of case series. However, particularly in the treatment of nightmare disorder, several randomized controlled studies also support their use and in fact suggest they may equally if not more effective as pharmacotherapy for treatment of these common sleep disorders.

Citation:Zhou ES, Michaud AL, Owens J, Recklitis CJ. Sleep in young-adult cancer survivors during the COVID-19 pandemic. J Clin Sleep Med. 2020;16(11):1991.

Introduction Increasing attention to the importance of sleep among children raises questions about how to implement accessible, effective interventions. Part of answering those questions rests in determining interest in and demand for programming. Pajama Program (PJP), a 501(c)(3), works with nearly 4,000 community-based organizations (CBOs) nationally that work with children exposed to adversity, including: foster care/child welfare; shelters; low-income schools, after-school, and early care and education programs; and social-service providers. Anticipating its launch of sleep health education programs, PJP and its Good Night Advisory Council of sleep experts designed a CBO needs assessment. Methods The survey was distributed electronically to staff at 3,911 CBOs; 1,635 organizations responded (42%). Results Across respondents, 65% work with children birth to 18 in settings that were non-residential (39%), residential (18%), or both (43%); most (91%) worked with participants for over one month. CBOs included child welfare/foster care (20.6% of respondents); transitional housing/shelter (20.5%); social services (15.6%); and early care and education (12.7%). Interest in sleep health education was high across all program types: 80 to 89% of programs within each type wanted information for staff and/or caregivers, specifically handouts (among 93% of programs), articles (88%), videos (85%), and workshops (70%). At least 90% of respondents who provided early care and education, parenting, and crisis services were interested in sleep health education for program staff. These program types also had high interest in sleep health education for caregivers, as did child welfare/foster care, school/after school, and shelters (all at least 90% of respondents). Conclusion The CBOs in this sample recognize sleep is an issue among the children they serve, but most did not have access to information on sleep health. These results establish the need for sleep health education and suggest preferred modalities. The project is a model for partnerships involving researchers, nonprofits, and community-based organizations. Support Funding for this project was provided by Pajama Program, a national 501(c)(3) non-profit.

Introduction Sleep is vital for healthy development from infancy through adolescence. Despite its importance, false beliefs that conflict with scientific evidence (myths) may be common among caregivers and impair sleep health during these crucial stages. Methods Researchers compiled a list of potential myth statements using internet searches of popular press and scientific literature. We utilized a Delphi process with experts (n=12) from the fields of pediatric, sleep, and circadian research and clinical practice. Selection and refinement of myths by sleep experts proceeded in three phases, including: focus groups (Phase 1); email-based feedback to edit, add, or remove myths (Phase 2); and closed-ended questionnaires (Phase 3) where experts rated myths on two dimensions: (1) falseness and (2) public health significance using 5-point Likert scale: 1 (“not at all”) to 5 (“extremely false/important”). Results Thirty-two sleep myths were identified across three developmental categories: infant (14 myths), child (6 myths), and adolescent (12 myths). Mean expert ratings illuminated the most pressing myths in each developmental category: infant sleep (“Sleep training causes psychological harm, including reduced parent-child attachment:” falseness =4.7, s.d.=0.7; public health significance=4.0, s.d.=1.1); child sleep (“Heavy, loud snoring for my child means he’s sleeping deeply:” falseness=4.8, s.d.=0.6; public health significance=4.7, s.d.=0.7), and teenager sleep (“Falling asleep in class means your teenager is lazy and not motivated:” falseness=4.8, s.d.=0.5; public health significance=4.3, s.d.=0.8). Conclusion The current study identified commonly-held myths about infant, child, and adolescent sleep that are not supported by (or worse, counter to) scientific evidence. If unchecked, these myths may hinder sleep at a critical developmental stage. Future research may include public health education to correct myths and promote healthy sleep among infants, children, and teenagers. Support 5T32HL007901

Introduction Children exposed to adversity (e.g., homelessness, poverty) are at risk of poor sleep. Community settings that serve these children, both residential (e.g., foster care group homes, shelters) and non-residential (e.g., early care and education, schools), hold important understandings to the barriers to sleep they experience. We surveyed a heterogeneous national sample of community-based organizations (CBOs) in our Pajama Program sample to explore these barriers. Methods Pajama Program, a national 501(c)(3) nonprofit, administered an online needs assessment in May 2016 to staff at 3,911 CBOs. This poster reports on qualitative responses to the question, What are the primary barriers to sleep and bedtime among children your organization serves? Responses from residential and non-residential CBOs were analyzed separately. Two trained coders independently used the constant comparative method to analyze transcripts. Results Survey respondents (1,635) provided services in non-residential (42%), residential (18%) and combined (43%) settings. Organizations provided child welfare/foster care (20.6% of programs); transitional housing/shelter (20.5%); social services (15.6%); and early care and education (12.7%) services. Responses to the target open-ended item were from 127 non-residential and 55 residential programs. Sleep barriers common to both settings included: late/irregular bedtimes; no bedtime routine; lack of sleep education; housing/food insecurity; stress; disrupted/uncomfortable sleep; and adapting to new environments. Trauma was a barrier among residential (vs. non-residential) programs. Non-residential providers noted unstable family situations, bedding insecurity, and poor sleep hygiene. Conclusion Our research highlights barriers to sleep among children exposed to adversity, a largely understudied yet high risk group. Barriers reported by residential and non-residential CBOs were more similar than different. was Across program types and settings, CBOs expressed a need for sleep health education interventions for children and caregivers. Support Funding for this project was provided by Pajama Program, a national 501(c)(3) non-profit.

Sleep disturbances in children with neurodevelopmental disabilities are very common. While sleep problems in these children are usually not significantly different compared to those of typically developing children, they are often more chronic and severe, more challenging to treat, and more than one type of sleep disturbance is common. Due to the high prevalence of sleep disturbances in this population, it is important for clinicians to systematically screen for sleep problems and to perform a thorough sleep evaluation once problems are identified. This evaluation should be based on a very detailed sleep history, including a comprehensive description of the presenting complaint(s), sleep schedules and sleep habits, as well as daytime sleepiness and behavioral issues and/or mood changes related to sleep. The evaluation should include a medical history, developmental/school history, family history, psychosocial history, behavioral assessment, and physical examination. The clinician should be familiar with the appropriate indications for and interpretation of sleep diagnostic tools, such as sleep diaries, overnight polysomnogram, multiple sleep latency test, and actigraphy.

To determine associations among objectively-measured nocturnal sleep time, bedtime and obesogenic behaviors, including dietary intake, timing of intake, and physical activity, in a diverse sample of school-aged children who presented for behavioral treatment to enhance sleep duration.Eighty-seven children (8-11 y, 66.7% female, zBMI: 0.86 ± 1.0) who self-reported sleeping9.5 h/night were studied for one week using wrist actigraphy to estimate sleep; hip-worn accelerometers to measure physical activity; and 24 h dietary recalls to capture dietary intake and meal timing. Pearson and Spearman's rho correlations and linear regressions controlling for age, gender and race were used for statistical analyses.Mean bedtime was 10:31 PM (±58.2 min) and mean nocturnal sleep time was 7.7 h (±37.5 min). Although later bedtime was associated with shorter sleep time (r = -0.61, p 0.001), the two variables were differentially related to obesity risk factors. Later bedtime, but not sleep time, correlated with greater daily fat intake, later first meal of the day, and greater after-dinner intake (all p 0.05). Nocturnal sleep time, but not bedtime, correlated with zBMI (p = 0.04). Both sleep time and later bedtime were associated with a later last meal of the day (all p 0.05). Findings remained consistent after controlling for demographic factors. In short-sleeping school-aged children, bedtime may be more predictive of dietary obesity risk factors whereas sleep duration may be more predictive of zBMI. Results suggest that health providers should consider both bedtime and sleep duration for reducing obesity risk in children.Enhancing Sleep Duration: Effects on Children's Eating and Activity Behaviors, NCT03186508, https://clinicaltrials.gov/ct2/show/NCT03186508.

Objective Deficient sleep is highly prevalent in disadvantaged adolescents and contributes to a range of adverse health and behavioral outcomes. We examined mediating mechanisms and strategies that adolescents adopt to improve sleep, and possible levers for promoting sleep in this population. Methods We conducted three focus groups ( N = 27 total, age 14–18 years) in adolescents living in low- and middle-income racially/ethnically diverse neighborhoods of Boston, Massachusetts. Participants completed a survey on their sleep and health habits prior to the moderator-led discussions. Discussions were audio-recorded, transcribed, and thematically analyzed. Results The study population did not meet the minimum sleep recommendations, and we found a high prevalence of “social jet-lag.” We also identified a disconnect between the acknowledgment of the importance of sleep and actual behavior, especially for electronic use. Phone use and screen time were the most commonly cited barriers to a good night's sleep, along with caffeine consumption, which was also high in this sample. There was also a general lack of awareness of sleep hygiene practices and recommendations. Participants reported regulating food intake and physical activity, using allopathic sleep aids, creating a comfortable sleeping environment, and a routine as some strategies to improve sleep. Conclusion Results from this study suggest facilitating the linkage between participant-generated mediating factors and strategies for better-designed interventions. These include making the negative impact of sleep on health more explicit, improving youth awareness about sleep hygiene, targeting caffeine consumption and electronic use, and introducing sleep recommendations through appropriate and effective channels.

Purpose of review This article provides an overview of the clinical features, diagnosis, and treatment of insomnia, restless legs syndrome, periodic limb movements of sleep, parasomnias, narcolepsy, and sleep-related breathing disorders among children and adolescents. Recent findings Pediatric presentations of sleep disorders differ from adult presentations, making diagnosis challenging. Specific clinical syndromes, such as cataplexy in children with narcolepsy type 1, can have an altogether different presentation compared to adult-onset symptoms, contributing to diagnostic delays and potential misdiagnoses. More broadly, research shows strong associations between sleep and daytime cognition, mood, and behavior among children with and without neurologic conditions and thus suggests a need to identify and treat sleep problems to optimize daytime functioning. Summary Addressing sleep problems in children with neurologic conditions and neurodevelopmental disorders improves quality of life for patients and their families and, in many cases, reduces neurologic disease burden.

Family stress was examined in the context of children's homework load and parents' perception of their capacity to assist their children with homework. Homework load was measured utilizing the 10 Minute Rule promulgated by the National Education Association. Family stress, measured by self-report, increased as homework load increased and as parent's perception of their capacity to assist decreased. Contrary to the 10 Minute Rule, primary school children received about three times the recommended load of homework. The amount of homework load reported also varied significantly between English and Spanish speakers, as it did between parents with limited education and those with advanced education.

Background: Narcolepsy is a chronic and lifelong neurologic disorder with onset commonly occurring in childhood or adolescence, and affecting approximately 0.025% to 0.05% of the general population. The primary symptom is excessive daytime sleepiness, which is accompanied by cataplexy in 70% of patients. Other common symptoms include sleep paralysis, hallucinations upon falling asleep or waking, and disrupted nocturnal sleep. Narcolepsy is associated with a considerable burden of illness (BOI), which has been well characterized in adults, and is exacerbated by delays in symptom recognition, diagnosis, and intervention. METHODS: This review describes the specific characteristics and BOI of pediatric narcolepsy, using a wide range of published research data. RESULTS: Pediatric narcolepsy presents distinct challenges in diagnosis and management. Narcolepsy symptoms often initially manifest differently in children and adolescents versus adults, which may pose diagnostic dilemmas. Children often respond to sleepiness with irritability, hyperactivity, and poor attention, which may be misinterpreted as misbehavior or neurocognitive sequelae of other conditions. Pediatric cataplexy symptoms may include subtle and unusual facial expressions or choreic-like movements, which are not observed in adults. Insufficient sleep and circadian rhythm disorders presenting with excessive daytime sleepiness are common in adolescents, potentially confounding narcolepsy diagnosis. Pediatric narcolepsy is also associated with comorbidities including rapid weight gain, precocious puberty, and attention deficit hyperactivity disorder, and increased risk for deficits in social functioning, depression, and anxiety. School performance is also typically impaired, requiring special education services. CONCLUSIONS: Thus, the discrete BOI of pediatric narcolepsy underscores the need for prompt and accurate diagnosis, and appropriate treatment of this disorder.

The investigation of the relationship between the time of day that school begins and the effects it could have on students began in the mid-1990s. Since that time, many articles have been written either for the medical literature or the educational literature. This review is intended to bridge that gap by examining together the findings for both academic and health outcomes, exploring what we know and what is needed in further investigation.Teens who are sleep deficient (defined as obtaining less than 8 h per night) because of early starting time for their school are much more likely to engage in risky behaviours, such as drug, cigarette and alcohol use, have significant feelings of depression, get lower grades and are at greater risk for car crashes. Many studies of academic performance and later school start time indicate benefits, although further research is needed to understand the related mechanisms that contribute to improvements in achievement. Recent research in adolescent sleep and outcomes is being shaped by not only measuring sleep duration, but also examining the timing in which sleep occurs.Early school starting time for middle and high students has a clear, deleterious effect on their health and well being. Most recently, sleep deficit in teens is being viewed as a public health issue that needs a wider discussion about its impact and it necessitates improved public education about the sleep phase shift that occurs during adolescence.

Sleep problems in infants and young children are common and often underdiagnosed. The potential negative outcomes that chronic disrupted sleep can have on a child's daytime functioning, as well as the adverse impact it can have on the family, are well known. There is considerable evidence to support the use of behavioral interventions to treat childhood insomnia. These strategies not only produce reliable and durable positive changes in sleep in most young children, but may also improve child and family well-being without negative effects on a child's social-emotional development. This article serves as a guide to help the pediatric provider identify, evaluate, and treat insomnia in infants and young children. [ Pediatr Ann . 2017;46(9):e321–e326.]

Objectives Behavioral sleep problems (BSPs) are prevalent and consequential in young children. There is a need for screening tools that identify BSPs—which are often rooted in the parent-young child relationship—and typically respond to behavior management. Such a tool would increase capacity to identify and treat BSPs. We sought to validate a short-form version of the widely used Children's Sleep Habits Questionnaire (SF-CSHQ) that omitted items that would not be responsive to behavioral strategies. Methods The original 33-item CSHQ elicits parent report of "behaviorally-based" and "medically-based" sleep items (eg, parasomnias and sleep disordered breathing). We conducted analyses to develop a SF-CSHQ that excludes its "medically-based" items, to determine (a) the SF-CSHQ threshold score corresponding to the full CSHQ clinical cut-off score (≥41), and (b) preliminary validity of this SF-CSHQ. Data were re-analyzed from the original data that established the CSHQ's psychometric properties in 4–10 year olds, and a second dataset that established its validity in 24–66 month olds. Results In both datasets, a threshold score of 30 had correlations of 0.90–0.94 with the original cut-off. This 23-item SF-CSHQ cut-off functioned as well as the full CSHQ cut-off in discriminating between children with vs without a parent-reported behavioral sleep problem, and with vs without prolonged sleep latency (per actigraphy). Conclusion We established preliminary validity of modified version of the widely-used CSHQ. This SF-CSHQ may be useful for widening screening and first-line guidance for behavioral sleep problems in young children, among professionals who are not sleep medicine specialists.