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Assessment of brief interventions for nighttime fears in preschool children

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Abstract

Nighttime fears (NF) and sleep problems continue to be major problems in clinical services. The aim was to assess the effects of two brief interventions on NF, and related sleep problems and parental fear-reducing behaviors in children. One hundred and four children aged 4–6 years with significant NF were randomly assigned into two intervention groups: the Huggy-Puppy intervention (HPI), which is based on providing children a puppy doll with a request to take care of the doll, and a revised version (HPI-r) which is based on providing the same doll with a cover story that the doll will serve as a protector. At baseline, the domains of NF, behavior problems, and sleep disruptions were assessed. Data were collected from parents and children using objective and subjective measures. The effects of the interventions were assessed by comparing four time points: baseline, first week of intervention, 1 month, and 6 months after initial intervention time. A waiting list comparison group (WL) was used as spontaneous recovery comparison group. Both interventions significantly reduced NF with similar impact. The improvement after 1 month was significantly higher than in the WL group. Furthermore, both interventions significantly reduced parental fear management behaviors and children’s sleep problems. Finally, the reduction in NF and parental fear management strategies were maintained 6 months post-treatment. Conclusions: Relatively simple and cost-effective doll interventions can reduce NF and their associated sleep problems. Further research is needed to implement these interventions for other anxiety disorders in childhood.

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References

  1. Acebo C, Sadeh A, Seifer R, Tzischinsky O, Wolfson AR, Hafer A, Carskadon MA (1999) Estimating sleep patterns with activity monitoring in children and adolescents: how many nights are necessary for reliable measures? Sleep 22:95–103

    PubMed  CAS  Google Scholar 

  2. Achenbach TM, Edelbrock CS (1983) Manual for the child behavior checklist and revised child behavior profile. University of Vermont, Department of Psychiatry, Burlington

    Google Scholar 

  3. Adair R, Bauchner H, Philipp B, Levenson S, Zuckerman B (1991) Night waking during infancy—role of parental presence at bedtime. Pediatrics 87:500–504

    PubMed  CAS  Google Scholar 

  4. Baloyi L (2006) Teddy bear therapy. Child Abuse Research in South Africa 7:17–25

    Google Scholar 

  5. Blader JC, Koplewicz HS, Abikoff H, Foley C (1997) Sleep problems of elementary school children—a community survey. Arch Pediatr Adolesc Med 151:473–480

    Article  PubMed  CAS  Google Scholar 

  6. Bloch YH, Toker A (2008) Doctor, is my teddy bear okay? The “Teddy Bear Hospital” as a method to reduce children’s fear of hospitalization. Isr Med Assoc J 10:597–599

    PubMed  Google Scholar 

  7. Chambless DL, Hollon SD (1998) Defining empirically supported therapies. J Consult Clin Psychol 66:7–18

    Article  PubMed  CAS  Google Scholar 

  8. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, Hillsdale

    Google Scholar 

  9. Cohen J (1992) A power primer. Psychol Bull 112:155–159

    Article  PubMed  CAS  Google Scholar 

  10. Compton SN, Burns BJ, Egger HL, Robertson E (2002) Review of the evidence base for treatment of childhood psychopathology: internalizing disorders. J Consult Clin Psychol 70:1240–1266

    Article  PubMed  Google Scholar 

  11. Dahl RE, Pelham WE, Wierson M (1991) The role of sleep disturbances in attention-deficit disorder symptoms—a case-study. J Pediatr Psychol 16:229–239

    Article  PubMed  CAS  Google Scholar 

  12. Gordon J, King N (2002) Children’s night-time fears: an overview. Couns Psychol Q 15:121–132

    Article  Google Scholar 

  13. Gordon J, King NJ, Gullone E, Muris P, Ollendick TH (2007) Treatment of children’s nighttime fears: the need for a modern randomised controlled trial. Clin Psychol Rev 27:98–113

    Article  PubMed  Google Scholar 

  14. Graziano AM, Mooney KC (1980) Family self-control instruction for children’s nighttime fear reduction. J Consult Clin Psychol 48:206–213

    Article  PubMed  CAS  Google Scholar 

  15. Graziano AM, Mooney KC (1982) Behavioral treatment of nightfears in children—maintenance of improvement at 2 1/2-year to 3-year follow-up. J Consult Clin Psychol 50:598–599

    Article  PubMed  CAS  Google Scholar 

  16. Gregory AM, O’Connor TG (2002) Sleep problems in childhood: a longitudinal study of developmental change and association with behavioral problems. J Am Acad Child Adolesc Psychiatry 41:964–971

    Article  PubMed  Google Scholar 

  17. Gregory AM, Rijsdijk FV, Dahl RE, McGuffin P, Eley TC (2006) Associations between sleep problems, anxiety, and depression in twins at 8 years of age. Pediatrics 118:1124–1132

    Article  PubMed  Google Scholar 

  18. Johnson CM (1991) Infant and toddler sleep—a telephone survey of parents in one community. J Dev Behav Pediatr 12:108–114

    PubMed  CAS  Google Scholar 

  19. Kazdin AE, Weisz JR (1998) Identifying and developing empirically supported child and adolescent treatments. J Consult Clin Psychol 66:19–36

    Article  PubMed  CAS  Google Scholar 

  20. King N, Ollendick TH, Tonge BJ (1997) Children’s nighttime fears. Clin Psychol Rev 17:431–443

    Article  PubMed  CAS  Google Scholar 

  21. Li HCW, Lopez V, Lee TLI (2007) Effects of preoperative therapeutic play on outcomes of school-age children undergoing day surgery. Res Nurs Health 30:320–332

    Article  Google Scholar 

  22. Luborsky L, Barber JP, Beutler L (1993) Introduction to special section: a briefing on curative factors in dynamic psychotherapy. J Consult Clin Psychol 61:539–541

    Article  PubMed  CAS  Google Scholar 

  23. McMenamy C, Katz RC (1989) Brief parent-assisted treatment for childrens nighttime fears. J Dev Behav Pediatr 10:145–148

    Article  PubMed  CAS  Google Scholar 

  24. Medoff D, Schaefer CE (1993) Children sharing the parental bed: a review of the advantages and disadvantages of cosleeping. Psychol J Hum Behav 30:1–9

    Google Scholar 

  25. Milos M, Reiss S (1982) Effects of three play conditions on separation anxiety in young children. J Consult Clin Psychol 50:389–395

    Article  PubMed  CAS  Google Scholar 

  26. Minde K, Faucon A, Falkner S (1994) Sleep problems in toddlers—effects of treatment on their daytime behavior. J Am Acad Child Adolesc Psychiatr 33:1114–1121

    Article  CAS  Google Scholar 

  27. Mindell J, Sadeh A, Kohyama J, Howd TW (2010) Parental behaviors and sleep outcomes in infants and toddlers: a cross-cultural comparison. Sleep Med 11:393–399

    Article  PubMed  Google Scholar 

  28. Muris P, Merckelbach H, Ollendick TH, King NJ, Bogie N (2001) Children’s nighttime fears: parent–child ratings of frequency, content, origins, coping behaviors and severity. Behav Res Ther 39:13–28

    Article  PubMed  CAS  Google Scholar 

  29. Muris P, Verweij C, Meesters C (2003) The “anti-monster letter” as a simple therapeutic tool for reducing nighttime fears in young children. Behav Change 20:200–207

    Article  Google Scholar 

  30. O’Brien LM (2009) The neurocognitive effects of sleep disruption in children and adolescents. Child Adolesc Psychiatr Clin N Am 18:813–823

    Article  PubMed  Google Scholar 

  31. Ollendick TH, Hagopian LP, Huntzinger RM (1991) Cognitive-behavior therapy with nighttime fearful children. J Behav Ther Exp Psychiatry 22:113–121

    Article  PubMed  CAS  Google Scholar 

  32. Passman RH, Weisberg P (1975) Mothers and blankets as agents for promoting play and exploration by young children in a novel environment: the effects of social and nonsocial attachment objects. Dev Psychol Schools 11:170–177

    Google Scholar 

  33. Prins PJM, Ollendick TH (2003) Cognitive change and enhanced coping: missing mediational links in cognitive behavior therapy with anxiety-disordered children. Clin Child Fam Psychol Rev 6:87–105

    Article  PubMed  Google Scholar 

  34. Rath FH, Okum ME (1995) Parents and children sleeping together—cosleeping prevalence and concerns. Am J Orthopsychiatry 65:411–418

    Article  PubMed  Google Scholar 

  35. Reisner AD (2005) The common factors, empirically validated treatments, and recovery models of therapeutic change. Psychol Record 55:377–399

    Google Scholar 

  36. Rutter M (1985) Resilience in the face of adversity—protective factors and resistance to psychiatric-disorder. Br J Psychiatry 147:598–611

    Article  PubMed  CAS  Google Scholar 

  37. Sadeh A (2004) A brief screening questionnaire for infant sleep problems: validation and findings for an Internet sample. Pediatrics 113:E570–E577

    Article  PubMed  Google Scholar 

  38. Sadeh A (2005) Cognitive–behavioral treatment for childhood sleep disorders. Clin Psychol Rev 25:612–628

    Article  PubMed  Google Scholar 

  39. Sadeh A (2007) Consequences of sleep loss or sleep disruption in children. Sleep Med Clin 2:513–520

    Article  Google Scholar 

  40. Sadeh A, Acebo C (2002) The role of actigraphy in sleep medicine. Sleep Med Rev 6:113–124

    Article  PubMed  Google Scholar 

  41. Sadeh A, Gruber R, Raviv A (2002) Sleep, neurobehavioral functioning and behavior problems in school-age children. Child Dev 73:405–417

    Article  PubMed  Google Scholar 

  42. Sadeh A, Hauri PJ, Kripke DF, Lavie P (1995) The role of actigraphy in the evaluation of sleep disorders. Sleep 18:288–302

    PubMed  CAS  Google Scholar 

  43. Sadeh A, Hen-Gal S, Tikotzky L (2008) Young children’s reactions to war-related stress: a survey and assessment of an innovative intervention. Pediatrics 121:46–53

    Article  PubMed  Google Scholar 

  44. Sadeh A, Lavie P, Scher A, Tirosh E, Epstein R (1991) Actigraphic home-monitoring sleep-disturbed and control infants and young children: a new method for pediatric assessment of sleep–wake patterns. Pediatrics 87:494–499

    PubMed  CAS  Google Scholar 

  45. Sadeh A, Raviv A, Gruber R (2000) Sleep patterns and sleep disruptions in school-age children. Dev Psychol 36:291–301

    Article  PubMed  CAS  Google Scholar 

  46. Sadeh A, Sharkey KM, Carskadon MA (1994) Activity-based sleep–wake identification: an empirical test of methodological issues. Sleep 17:201–207

    PubMed  CAS  Google Scholar 

  47. Sadeh A, Tikotzky L, Scher A (2010) Parenting and infant sleep. Sleep Med Rev 19:103–110

    Google Scholar 

  48. Tikotzky L, Sadeh A (2001) Sleep patterns and sleep disruptions in kindergarten children. J Clin Child Psychol 30:579–589

    Google Scholar 

  49. Tikotzky L, Sadeh A (2010) The role of cognitive–behavioral therapy in behavioral childhood insomnia. Sleep Med 11:686–691

    Article  PubMed  Google Scholar 

  50. Triebenbacher SL (1997) Children’s use of transitional objects: parental attitudes and perceptions. Child Psychiatry Hum Dev 27:221–230

    Article  PubMed  CAS  Google Scholar 

  51. Westen D, Novotny CA, Thompson-Brenner H (2004) The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychol Bull 130:631–663

    Article  PubMed  Google Scholar 

  52. Winnicott DW (1953) Transitional objects and transitional phenomena: a study of the first not-me possession. Int J Psychoanal 34:89–97

    PubMed  CAS  Google Scholar 

  53. Wolf AW, Lozoff B (1989) Object attachment, thumb sucking, and the passage to sleep. J Am Acad Child Adolesc Psychiatry 28:287–292

    Article  PubMed  CAS  Google Scholar 

  54. Wolfson A, Lacks P, Futterman A (1992) Effects of parent training on infant sleeping patterns, parents stress, and perceived parental competence. J Consult Clin Psychol 60:41–48

    Article  PubMed  CAS  Google Scholar 

  55. Zilber N, Auerbach J, Lerner Y (1994) Israeli norms for the Achenbach Child-behavior Checklist—comparison of clinically-referred and non-referred children. Isr J Psychiatry Relat Sci 31:5–12

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The study was supported by the Israel Science Foundation (grant no. 1047/08 to Avi Sadeh) which is a national institute that supports academic research. The authors are thankful to Ornit Arbel for coordinating and managing the study and to the participating families.

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The authors have no conflict of interest to report.

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Correspondence to Avi Sadeh.

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Kushnir, J., Sadeh, A. Assessment of brief interventions for nighttime fears in preschool children. Eur J Pediatr 171, 67–75 (2012). https://doi.org/10.1007/s00431-011-1488-4

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  • DOI: https://doi.org/10.1007/s00431-011-1488-4

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