Sleep disorders are highly prevalent in children and adolescents, affecting approximately 25-40% of this population. Questions about sleep are among the most frequent concerns that parents raise to their child’s pediatric medical provider. Behavioral treatments are the empirically supported treatments for addressing behavioral disordered sleep, and pediatric medical providers often endorse using such strategies. However, given the time constraints of primary care visits, such strategies are delivered in a very brief format. Whether or not these recommendations result in a change in the child’s disordered sleep symptoms has not been explored. Further, it is likely that this brief recommendation format is effective for some patients but not others. For example, children with comorbid neurodevelopmental conditions, severe sleep problems, and anxiety are less likely to respond to brief sleep interventions, and, therefore, may require a more comprehensive, time-intensive behavioral intervention. The current study aimed to explore factors related to the efficacy of a brief behavioral intervention provided via telehealth. Thirteen parents completed all portions of the study. Three were parents of children between the ages of 8 to 15 years and 10 were parents of children between the ages of 4 to 7 years (M = 6.8; SD = 2.7). All parents identified as White mothers. All children were also identified as White with 38.5% being female. Due to small sample size, quantitative analyses were not appropriate, so a qualitative examination of the data was conducted to explore relationships among participant demographics, sleep hygiene behaviors, sleep knowledge, sleep symptom severity, anxiety symptoms, and effects of the intervention. Results indicated that 37.50% of parents accurately assessed whether their child had problematic sleep. Minor variations in sleep knowledge were observed between parents who accurately identified their child’s sleep problems and those who did not (7.67 and 6.40 out of 10, respectively). Overall, participants had an average initial sleep knowledge score of 6.68, an average follow up sleep knowledge score of 7.31, and an average change in knowledge score of 0.62. Regarding effects of the intervention on sleep symptom severity, the average initial sleep symptom severity score was 50.25, the average follow up sleep severity score was 48.77, and the average change in sleep severity score was -2.00. An examination of sleep hygiene characteristics highlighted that while 81.25% of participants endorsed having a bedtime routine, almost 70% reported that the routine included an electronic device. Differences in initial sleep symptom severity and sleep knowledge scores were noted between participants who did and did not include electronic devices in their bedtime routines. The clinical implications of these findings are discussed further. Differences in intervention efficacy between participants with and without ADHD was also examined, but differences were not apparent. Intervention acceptability and feasibility were also examined. The current study demonstrated that the intervention was feasible to deliver for most participants within 10 minutes and, therefore, would be conducive to a primary care setting. Additionally, parents reported high levels of satisfaction with the content, understandability, and comprehensiveness of the treatment, which is encouraging for parents’ willingness to utilize the intervention if it was available to them. This study acted as an important initial step to determining the feasibility and acceptability of a brief behavioral sleep intervention. Clinical implications and future directions are discussed.

Disordered sleep affects 20-40% of children and adolescents. Such disorders can result in academic difficulties, emotional regulation difficulties, and decreased immune system functioning. Behavioral treatments are the empirically supported treatment for pediatric sleep problems. With most children getting yearly well-child visits, pediatric medical professionals are in an optimal position to identify sleep difficulties and refer children for treatment. However, research suggests that medical professionals receive limited formal education in disordered sleep, and they more frequently recommend medication over behavioral interventions. Therefore, referrals to psychologists for behavioral treatments may often be warranted. The factors that influence medical professionals’ referral decisions have not been investigated. The current study investigated factors implicated in referral behaviors including pediatric medical professionals’ knowledge, screening patterns, treatment preferences, and referral patterns in the area of pediatric behavioral disordered sleep. A total of 65 medical professionals were recruited to complete an online survey to investigate these factors. Results indicated that participants in the current study demonstrated significantly higher sleep knowledge and rates of screening than what was found in a previous study. Regarding predictors of sleep knowledge, taken together, specialty, years in practice, and screening behaviors significantly predicted sleep knowledge scores. Additionally, sleep knowledge of participants who indicated that a referral was necessary when presented with a hypothetical case example of a child presenting with disordered sleep was significantly lower than the sleep knowledge of those who did not refer. Further, rates of referral were significantly lower than reported in previous research. Confidence in managing sleep problems and rates of providing behavioral recommendations were also explored. Overall, results of the current study indicate that pediatric medical professionals may benefit from additional training in the area of pediatric behavioral sleep and increased awareness of appropriate referral sources. Further exploration into the influence of screening behaviors and treatment preferences on referral behavior is necessary.

Sleep is an essential part of life, and obtaining quality sleep is important for various areas of functioning. Behaviors to promote sleep include physical activity, managing stress, reducing anxiety symptoms, maintaining a consistent sleep schedule, and obtaining bright light exposure. Many of these behaviors overlap with benefits observed from pet ownership (PO). The present study aimed to examine the relation between PO and sleep as well as moderators and mediators of this relation. Four research questions were examined: 1) Is PO significantly related to sleep? 2) Does gender moderate the relation between PO and sleep? 3) Do sleep-promoting behaviors (i.e., physical activity, perceived stress, anxiety symptoms, bright light exposure, sleep-wake variability) mediate the relation between PO and sleep? 4) Do the mediating effects of the sleep-promoting behaviors on the relation between PO and sleep depend on the regularity of walking? Participants (N = 1,250; 80.8% White; 50.5% men) residing in the United States reported on their sleep, physical activity, perceived stress, anxiety symptoms, and light exposure. Participants were 25.5% non-pet owners (NPO), 24.1% cat-only owners (CO), 25.7% dog-only owners (DO), and 24.7% owned dogs and cats (DCO). Data analyses included ANCOVA, Moderation, Parallel Mediation, and Conditional Process Modeling. Key findings included that PO was significantly related to sleep, with NPO sleeping worse than PO (CO/DO/DCO combined) and DCO reporting the best sleep of all four PO groups. The relation between PO and sleep did not significantly differ for men and women. The relation was significantly mediated by anxiety symptoms, perceived stress, light exposure, and sleep-wake variability depending on the groups compared and scoring methods used. Anxiety symptoms and perceived stress were the most robust mediators of the relation between PO and sleep. Walking regularity did not change the mediating effects between PO and sleep. This study is one of the first to examine daytime mechanisms of the relation between PO and sleep. The findings provide a foundation for future research examining how the integration of PO and sleep-promoting behaviors can improve adherence to sleep health recommendations, thus improving owners’ sleep.