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.

This thesis uses the limited research on LGBTQ+ specific hypervigilance and queer battle fatigue to explore the prevalence of hypervigilance and fatigue in trans+ medical experiences, even when emotions aren't centered in their narratives, while also using participants' narratives and minority stress theory to suggest changes to the American medical system. Data was taken from a previous study of in-depth interviews on healthcare experiences of 60 trans+ young adults ages 18-24. Analysis of the data was done in NVivo using line-by-line coding for mentions of emotional responses linked to hypervigilance within interview transcripts. Results show that 67% of participants shared fears about their medical care. The main themes revolved around being outed by medical providers to unsupportive parents, along with avoiding medical help out of fear of being mistreated by the provider and/or staff. Participants also shared frustration with having to educate medical providers and others in positions of power about their care or even having to go so far as to "reenter the closet" to ease through interactions. 58% of participants reported feeling anxiety and fatigue around their healthcare visits. The implications of this thesis are that the scholarship on trans+ hypervigilance applies to experiences when not asked about hypervigilance but also suggests adding ‘frustration' to transgender hypervigilance categories. Secondly, queer battle fatigue applies to systems outside of education, in this case, healthcare. Finally, the findings from this study further corroborate that the current medical systems can negatively impact trans+ patients and propose ways to de-center cisnormativity from healthcare.

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