Publications by authors named "Thomas F Anders"

45 Publications

Behavioral interventions for infant sleep problems: the role of parental cry tolerance and sleep-related cognitions.

J Clin Sleep Med 2020 08;16(8):1275-1283

School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel.

Study Objectives: This study tested whether parental cry tolerance (PCT) and distress-attribution cognitions predict outcomes of behavioral interventions for infant sleep problems. It additionally examined intervention effects on these parental factors.

Methods: Participants were 91 infants aged 9-18 months (61% boys) with sleep-related problems and their parents. Families were randomized to 1 of 2 behavioral interventions for infant sleep problems: Checking-in or Camping-out. Assessments were completed at baseline and 1-month post-treatment. Infant sleep was assessed using actigraphy and parent reports on the Brief Infant Sleep Questionnaire. PCT was measured using the Intervention Delay to Infant Crying Video laboratory paradigm, and parental distress-attribution cognitions were assessed via the Infant Sleep Vignettes Interpretation Scale.

Results: Higher PCT and lower parental distress-attribution cognitions at baseline predicted greater improvement in parent-reported sleep problems post-treatment, and higher PCT additionally predicted larger reductions in the number of reported nighttime awakenings. Moreover, PCT increased, and distress-attribution decreased, following the interventions.

Conclusions: Parent factors both predict and are predicted by behavioral interventions for infant sleep problems. This study's findings suggest that parents with low cry tolerance and high distress-attribution cognitions derive less benefit from these interventions and may thus require augmented care.

Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Interventions for sleep problems in early childhood; URL: https://clinicaltrials.gov/ct2/show/NCT01489215;Identifier: NCT01489215.
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http://dx.doi.org/10.5664/jcsm.8488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446080PMC
August 2020

Autism Heterogeneity in a Densely Sampled U.S. Population: Results From the First 1,000 Participants in the RI-CART Study.

Autism Res 2020 03 20;13(3):474-488. Epub 2020 Jan 20.

Emma Pendleton Bradley Hospital, East Providence, Rhode Island.

The objective of this study was to establish a large, densely sampled, U.S. population-based cohort of people with autism spectrum disorder (ASD). The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by ASD. Diagnosis was based on direct behavioral observation via the Autism Diagnostic Observation Schedule, Second Edition. For the first 1,000 participants, ages ranged from 21 months to 64 years. Using Geographic Information System and published prevalence rates, the overall cohort is estimated to represent between 20% and 49% of pediatric age persons in Rhode Island with ASD, with demographics representative of U.S. Census. We observed a high rate of co-occurring medical and psychiatric conditions in affected individuals. Among the most prominent findings of immediate clinical importance, we found that females received a first diagnosis of ASD at a later age than males, potentially due to more advanced language abilities in females with ASD. In summary, this is the first analysis of a large, population-based U.S. cohort with ASD. Given the depth of sampling, the RI-CART study reflects an important new resource for studying ASD in a representative U.S. population. Psychiatric and medical comorbidities in ASD constitute a substantial burden and warrant adequate attention as part of overall treatment. Our study also suggests that new strategies for earlier diagnosis of ASD in females may be warranted. Autism Res 2020, 13: 474-488. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by autism spectrum disorder (ASD). In this article, we provide results from the first 1,000 participants, estimated to represent >20% of affected families in the state. Importantly, we find a later age at first diagnosis of ASD in females, which potentially calls attention to the need for improved early diagnosis in girls. Also, we report a high rate of co-occurring medical and psychiatric conditions in affected individuals.
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http://dx.doi.org/10.1002/aur.2261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060113PMC
March 2020

Behavioral interventions for pediatric insomnia: one treatment may not fit all.

Sleep 2020 04;43(4)

School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.

Study Objectives: Behavioral interventions for pediatric insomnia are cost-effective and benefit most families, but there is no evidence indicating which treatments are most suitable for specific patient populations. This randomized controlled trial evaluated the moderating role of infant separation anxiety in two brief interventions for infant sleep problems.

Methods: Ninety-one infants aged 9-18 months (61% boys) with pediatric insomnia were randomized to either Checking-in, a Graduated extinction protocol which involves gradual separation from parents, or to the Camping-out intervention, in which parental presence is maintained. Sleep was measured using actigraphy and parent reports. Infant separation anxiety was observed in the laboratory. Assessments were completed at baseline, post-treatment and 6-month follow-up.

Results: Improvement in sleep was demonstrated following both interventions and maintained at follow-up. Separation anxiety did not change significantly following treatment. Infant separation anxiety moderated treatment efficacy, with greater benefit for infants with high separation anxiety in the Camping-out compared to the Checking-in intervention.

Conclusions: This study provides support for considering infant separation anxiety in the effort to personalize treatment for pediatric insomnia. Pediatricians should incorporate evaluation of infant separation anxiety to assessment processes, and favor more gentle treatment approaches, such as Camping-out, over Graduated extinction for highly anxious infants.

Clinical Trial Registration: NCT01489215.
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http://dx.doi.org/10.1093/sleep/zsz268DOI Listing
April 2020

Household chaos and family sleep during infants' first year.

J Fam Psychol 2018 08 21;32(5):622-631. Epub 2018 May 21.

Department of Human Development & Family Studies, The Pennsylvania State University.

Household chaos has been linked with dysregulated family and individual processes. The present study investigated linkages between household chaos and infant and parent sleep, a self-regulated process impacted by individual, social, and environmental factors. Studies of relations between household chaos and child sleep have focused on older children and teenagers, with little attention given to infants or parent sleep. This study examines these relationships using objective measures of household chaos and sleep while controlling for, respectively, maternal emotional availability at bedtime and martial adjustment, in infant and parent sleep. Multilevel modeling examined mean and variability of sleep duration and fragmentation for infants, mothers, and fathers when infants were 1, 3, 6, 9, and 12 months (N = 167). Results indicated infants in higher chaos homes experienced delays in sleep consolidation patterns, with longer and more variable sleep duration, and greater fragmentation. Parent sleep was also associated with household chaos such that in higher chaos homes, mothers and fathers experienced greater variability in sleep duration, which paralleled infant findings. In lower chaos homes, parents' sleep fragmentation mirrored infants' decreasingly fragmented sleep across the first year and remained lower at all timepoints compared to parents and infants in high chaos homes. Collectively, these findings indicate that after controlling for maternal emotional availability and marital adjustment (respectively) household chaos has a dysregulatory impact on infant and parent sleep. Results are discussed in terms of the potential for chaos-induced poor sleep to dysregulate daytime functioning and, in turn, place parent-infant relationships at risk. (PsycINFO Database Record
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http://dx.doi.org/10.1037/fam0000422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6072580PMC
August 2018

Brief Report: Factors Influencing Healthcare Satisfaction in Adults with Autism Spectrum Disorder.

J Autism Dev Disord 2017 06;47(6):1896-1903

Rhode Island Consortium for Autism Research and Treatment (RI-CART), E. P. Bradley Hospital, East Providence, RI, USA.

The current study investigated healthcare satisfaction and factors related to satisfaction in 92 adults with Autism Spectrum Disorder (ASD). Participants or their caregiver completed a survey about their experiences with primary care and specialty physicians. Respondents reported a high level of satisfaction with their healthcare. The only factor significantly associated with satisfaction was age, with participants under age 26 reporting significantly higher levels of satisfaction than participants above age 26. Participants under age 26 also were significantly more likely to live at home, have private health insurance, and have others making their healthcare decisions than participants above age 26. Results indicate that healthcare satisfaction can be high for adults with ASD that have good family and community support.
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http://dx.doi.org/10.1007/s10803-017-3087-3DOI Listing
June 2017

Low parental tolerance for infant crying: an underlying factor in infant sleep problems?

J Sleep Res 2016 10 16;25(5):501-507. Epub 2016 Mar 16.

Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.

Parenting behaviours play a major role in the evolution of infant sleep. Sleep problems in infancy have been associated with excessive parental involvement at night-time, and with shorter delays in response to infant night wakings and signalling. Infant crying and sleep problems are linked, yet little is known about the impact of parental responses to crying on infant sleep patterns. This study examined the hypothesis that lower parental tolerance for crying is associated with infant sleep problems. We studied 144 married couples divided into three groups: parents of infants suffering from night-waking problems (i.e. the clinical group), parents of infants without sleep problems and childless couples. Crying tolerance was assessed using questionnaires, audio recordings of crying infants and using a novel paradigm, in which participants were shown a video of a crying infant and asked when they would intervene. Parents in the clinical group demonstrated shorter intervention delays in the crying infant clip (group effect: P < 0.0001), and tended to attribute more distress to the crying infants compared to parents in both control groups (P < 0.05). Additionally, women demonstrated lower tolerance for infant crying on most measures compared to men. Our results suggest that parents of sleep-disturbed infants appear to have lower tolerance for infant crying, which may be a predisposition underlying their excessive involvement in soothing their infants to sleep which may lead to the development of sleep problems. These preliminary findings should be explored further to assess their clinical validity and utility.
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http://dx.doi.org/10.1111/jsr.12401DOI Listing
October 2016

Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders.

Child Psychiatry Hum Dev 2015 Aug;46(4):622-31

Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA,

This study examined the nature and prevalence of diagnostically defined sleep disorders, including Sleep Onset Insomnia (SOI) and Night Waking Insomnia (NWI), in a sample of 183 young children admitted to an early childhood psychiatric day treatment program. A semi-structured diagnostic interview, the Diagnostic Infant and Preschool Assessment, was used to assess for sleep and other psychiatric disorders. Daily sleep diaries and the Child Behavior Checklist were also examined. 41 % of children met criteria for a sleep disorder; 23 % met diagnostic criteria for SOI and 4 % met criteria for NWI, with an additional 14 % meeting criteria for both (SOI + NWI). Sleep-disordered children demonstrated longer latency to sleep onset, longer and more frequent night awakenings, less total sleep, and lower sleep efficiency than non-sleep disordered participants. Diagnosable sleep disorders, particularly SOI, were quite common in this acute clinical sample, exceeding previous estimates obtained in community and pediatric practice samples.
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http://dx.doi.org/10.1007/s10578-014-0505-zDOI Listing
August 2015

Clinical neurosciences training for psychiatrists: one proposed model.

Acad Psychiatry 2014 Apr 5;38(2):151-3. Epub 2014 Feb 5.

, South Dartmouth, MA, USA,

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http://dx.doi.org/10.1007/s40596-014-0053-7DOI Listing
April 2014

How are our children? A dialogue.

J Am Acad Child Adolesc Psychiatry 2013 Jul;52(7):674-6

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http://dx.doi.org/10.1016/j.jaac.2013.04.017DOI Listing
July 2013

Daytime secretion of salivary cortisol and alpha-amylase in preschool-aged children with autism and typically developing children.

J Autism Dev Disord 2012 Dec;42(12):2648-58

School of Public Health, University of California, 101 Haviland Hall, Berkeley, CA 94720, USA.

We examined daytime salivary cortisol and salivary alpha-amylase (sAA) secretion levels and variability in preschool-aged children with autism (AUT) and typically developing children (TYP). Fifty-two subjects (26 AUT and 26 TYP) were enrolled. Salivary samples were obtained at waking, midday, and bedtime on two consecutive days at three phases (baseline, 3 months later, 6 months later). There were modest increases in waking cortisol and sAA levels in AUT relative to TYP, but the increases were not statistically significant. Important differences were observed in cortisol and sAA variability between AUT and TYP. There was also a graded response among AUT by functional status--cortisol and sAA secretion levels were higher when IQ was lower.
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http://dx.doi.org/10.1007/s10803-012-1522-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3602445PMC
December 2012

Six-month sleep-wake organization and stability in preschool-age children with autism, developmental delay, and typical development.

Behav Sleep Med 2011 ;9(2):92-106

Department of Psychiatry and Behavioral Sciences, UC Davis M.I.N.D. Institute, Sacramento, CA 95817, USA.

This study examined sleep-wake patterns in 3 matched comparison groups of preschool-aged children: children with autism (AUT), children with developmental delay (DD) without AUT, and children who are developing typically (TYP). Sleep was assessed via actigraphy and parent-report diaries for 7 consecutive 24-hr periods across 3 time points: at enrollment (n = 194), 3 months later (n = 179), and 6 months after enrollment (n = 173). At each recording period, children in the AUT group slept less per 24-hr period, on average, and were less likely to awaken at night than children in the other two groups. In contrast, children in the DD group had more frequent and longer duration nighttime awakenings than children in the AUT group. Overall, children in the 2 neurodevelopmentally disordered groups demonstrated more night-to-night variability in their sleep-wake measures than children in the TYP group.
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http://dx.doi.org/10.1080/15402002.2011.557991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498819PMC
August 2011

Daytime sleep and parenting interactions in infants born preterm.

J Dev Behav Pediatr 2011 Jan;32(1):8-17

Department of Psychiatry and Behavioral Sciences, MIND Institute, University of California, Davis, CA 95817, USA.

Objective: After a transactional perspective, this longitudinal study assessed concurrent and time-lagged associations between infant daytime sleep behaviors and maternal play interactions within a sample of infants born preterm.

Method: Data were collected from 134 families recruited from 3 Wisconsin neonatal intensive care units. Multiple methods were used to collect data at infant neonatal intensive care unit discharge and when infants were 4, 9, and 24 months postterm, including parent report infant sleep logs, family sociodemographic assets, and a 15-minute video-taped play session.

Results: Within time points, infants who napped more had mothers who were rated as more positive and communicative or less negative during play interactions at 4, 9, and 24 months compared with infants who napped less. Time-lagged findings indicated that infants who took more naps experienced more optimal maternal interactive behaviors later in development than infants who took fewer naps. In addition, mothers who expressed more negative affect at 4 or 9 months predicted more infant daytime sleep later in development.

Conclusion: Previous studies document that nighttime parent-child interactions influence nighttime sleep. This study presents the natural extension that daytime sleep influences daytime interactions. This study draws attention to the understudied area of daytime naps in young children and provides support for the longitudinal bidirectional processes between sleep and parenting interactions.
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http://dx.doi.org/10.1097/DBP.0b013e3181fa57e4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072039PMC
January 2011

The efficacy of melatonin for sleep problems in children with autism, fragile X syndrome, or autism and fragile X syndrome.

J Clin Sleep Med 2009 Apr;5(2):145-50

Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, University of California Davis Health System, Sacramento, CA 95817, USA.

Study Objective: To determine the efficacy of melatonin on sleep problems in children with autistic spectrum disorder (ASD) and fragile X syndrome (FXS).

Methods: A 4-week, randomized, double blind, placebo-controlled, crossover design was conducted following a 1-week baseline period. Either melatonin, 3 mg, or placebo was given to participants for 2 weeks and then alternated for another 2 weeks. Sleep variables, including sleep duration, sleep-onset time, sleep-onset latency time, and the number of night awakenings, were recorded using an Actiwatch and from sleep diaries completed by parents. All participants had been thoroughly assessed for ASD and also had DNA testing for the diagnosis of FXS.

Results: Data were successfully obtained from the 12 of 18 subjects who completed the study (11 males, age range 2 to 15.25 years, mean 5.47, SD 3.6). Five participants met diagnostic criteria for ASD, 3 for FXS alone, 3 for FXS and ASD, and 1 for fragile X premutation. Eight out of 12 had melatonin first. The conclusions from a nonparametric repeated-measures technique indicate that mean night sleep duration was longer on melatonin than placebo by 21 minutes (p = .02), mean sleep-onset latency was shorter by 28 minutes (p = .0001), and mean sleep-onset time was earlier by 42 minutes (p = .02).

Conclusion: The results of this study support the efficacy and tolerability of melatonin treatment for sleep problems in children with ASD and FXS.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670334PMC
April 2009

Sleep problems, sleepiness and daytime behavior in preschool-age children.

J Child Psychol Psychiatry 2009 Dec 1;50(12):1532-40. Epub 2009 Jul 1.

Department of Psychiatry and Behavioral Sciences, UC Davis M.I.N.D. Institute, Sacramento, CA 95817, USA.

Background: Sleep problems are a common complaint of parents of preschool children. Children with neurodevelopmental disorders have even more disrupted sleep than typically developing children. Although disrupted nighttime sleep has been reported to affect daytime behavior, the pathway from sleep disruption to sleep problems, to impairments in daytime performance or behavior is not clear. This multi-method, preliminary study assessed this path in 68 children with autism, matched to 57 children with developmental delay without autism and 69 children developing typically.

Methods: Actigraphy, structured questionnaires, laboratory assessments, and parent reports were obtained in 194 children.

Results: Controlling for diagnosis and developmental age of the child, nighttime sleep problems determined by parent reports were significantly associated with decrements in daytime behavior, also measured by parent report instruments. However, actigraph-defined sleep problems and objective measures of daytime sleepiness were not associated with decrements in daytime performance.

Conclusions: Parent report measures substantiate relationships between disrupted sleep patterns and waking behavior. Further understanding of the pathway from sleep disorders to daytime sleepiness and decrements in waking performance, however, may require more rigorous methods of assessment such as polysomnography and the multiple sleep latency test.
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http://dx.doi.org/10.1111/j.1469-7610.2009.02110.xDOI Listing
December 2009

Six-month persistence of sleep problems in young children with autism, developmental delay, and typical development.

J Am Acad Child Adolesc Psychiatry 2009 Aug;48(8):847-854

All of the authors are with the University of California, Davis. Electronic address:

Objective: This study examined the persistence of sleep problems in preschool children with autism and two matched comparison groups: children with developmental delay without autism and typically developing children. Sleep problems were defined subjectively by parent report, by the Children's Sleep Habits Questionnaire (CSHQ), and objectively by quantitative Research Diagnostic Criteria (RDC) derived from actigraphic recordings.

Method: Children were studied on three occasions, each separated by a 3-month interval. At each assessment, the children were recorded actigraphically for 1 week, and parents completed sleep-wake diaries and the CSHQ. Descriptive statistics and odds ratios were used to assess the occurrence and stability of sleep problems within children and across groups and to explore how actigraph- and CSHQ-defined sleep problems affect parental sleep problem reports.

Results: Parent reports of a generic sleep problem were more prevalent than RDC- and CSHQ-defined sleep problems, especially for children with neurodevelopmental disorders. For all groups, objectively measured sleep problems were rarely persistent during the 6-month period. The children in both neurodevelopmental groups, however, had more sleep problems on one or two occasions, using actigraph and the CSHQ, than typically developing children.

Conclusions: Objective and subjective measures of sleep problems in preschool-aged children produce different results. In a community sample, the rate of actigraph- and CSHQ-defined sleep problems in children with autism did not differ from rates for typically developing children, although the parent report of a generic sleep problem was significantly greater.
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http://dx.doi.org/10.1097/CHI.0b013e3181a8135aDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770939PMC
August 2009

Child and adolescent psychiatry for the future: challenges and opportunities.

Psychiatr Clin North Am 2009 Mar;32(1):213-26

Department of Psychiatry and Behavioral Sciences, University of California, Davis, School of Medicine, Medical Investigation of Neurodevelopmental Disorders Institute, Sacramento, CA 95817, USA.

In this article, the authors focus on three particularly salient sets of issues that face the field of child and adolescent psychiatry as a sub-specialty of general psychiatry today-those related to workforce, public perception, and professional identity. In an article directed at the general psychiatrist, the authors present possibilities for refocusing the activities of the child and adolescent psychiatrist to emphasize consultative and collaborative roles. The authors embrace working in systems of care with communities and families as partners. Finally, they discuss the training implications of such shifts in professional identity, and the need to maintain the centrality of a scientifically-based developmental biopsychosocial formulation.
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http://dx.doi.org/10.1016/j.psc.2008.11.008DOI Listing
March 2009

Objective sleep measurement in typically and atypically developing preschool children with ADHD-like profiles.

Child Psychiatry Hum Dev 2009 Jun 14;40(2):257-68. Epub 2009 Jan 14.

Department of Psychiatry, MIND Institute, Sacramento, CA, USA.

Objective: This study investigated the association between preschool children's sleep patterns measured by actigraphy and parent-reported hyperactivity symptoms. Many previous studies have reported sleep problems in children with attention deficit hyperactivity disorder (ADHD)-like symptoms.

Methods: This study examined a cross-sectional sample of 186 preschoolers age 2-5 years in three groups: children with autism, children with developmental delay without autism, and typically developing children recruited from the general population. One week of actigraphic sleep data plus a parent report of the presence or absence of a current sleep problem were collected. Parents completed the child behavior checklist; a subset of children in preschool had teachers who completed the caregiver-teacher report form. Sleep behavior was compared for those children with and without clinical levels of attention-deficit/hyperactivity symptoms (T scores > or = 65).

Results: The prevalence of a parent-defined sleep problem across the entire sample was 36.1%. Thirty-four percent of the sample had a parent-reported ADHD composite in the clinical range. Those children with a clinical ADHD profile were more likely to be described by parents as having a sleep problem. However, no significant differences in actigraphic sleep patterns or night-to-night sleep-wake variability were found for children with an ADHD profile in the clinical range.

Conclusions: In this non-clinical sample of preschool age children, parental reports of clinical ADHD profiles were significantly associated with parental reports of sleep problems but not with actigraphically recorded sleep-wake data.
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http://dx.doi.org/10.1007/s10578-009-0124-2DOI Listing
June 2009

A 2-year progress report of the AACAP-Harvard Macy Teaching Scholars Program.

Acad Psychiatry 2008 Sep-Oct;32(5):414-9

Division of Child and Adolescent Psychiatry, Brown Medical School, Bradley Hospital, East Providence, RI 02864, USA.

Objective: The American Academy of Child and Adolescent Psychiatry (AACAP) has partnered with the Harvard Macy Program for Healthcare Educators so that selected child and adolescent psychiatry academic faculty might enhance their teaching expertise in order to possibly enhance recruitment of medical students into child and adolescent psychiatry.

Methods: Thirteen child psychiatry faculty have graduated from the AACAP-Harvard Macy Teaching Scholars Program (HMTSP). There are 10 additional child and adolescent psychiatry faculty members in the process of completing the program. A survey was created to broadly assess the effect of the AACAP-HMTSP training on the first 13 graduates of the program as a pilot to guide future study of the program. Three teaching scholars who are the first authors of this article (JH, DS, MH) conducted this survey and the data interpretation for this study.

Results: Thirteen of the scholars submitted responses to the survey. All participants indicated a high degree of satisfaction with the HMTSP and with the overall usefulness of the concepts learned. All but one of the scholars reported that the program enhanced their teaching effectiveness. The scholars reported increased teaching of medical students (9 of 13) and psychiatry residents (6 of 13) after the HMTSP.

Conclusion: The AACAP-Harvard Macy Teaching Scholars reported high levels of satisfaction with the overall program. Whether the reported increase in medical student and psychiatry resident mentoring and teaching will eventually lead to increased medical student recruitment into child and adolescent psychiatry remains to be determined.
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http://dx.doi.org/10.1176/appi.ap.32.5.414DOI Listing
February 2009

Sleep patterns in preschool-age children with autism, developmental delay, and typical development.

J Am Acad Child Adolesc Psychiatry 2008 Aug;47(8):930-8

Department of Psychiatry and Behavioral Sciences, University of California, Davis MIND Institute, USA.

Objective: A prominent noncore symptom of autistic disorder is disturbed sleep, but relatively few studies have investigated this symptom.

Method: A multimethod approach assessed the quantity and quality of sleep in 194 children (68 with autism [AUT], 57 with developmental delay without autism [DD], 69 with typical development) recorded over 1 week. Parent perceptions, structured questionnaires, and actigraphy were compared. In addition, problem sleep as defined by parents was compared with research diagnostic criteria for behavioral insomnia obtained from actigraph recordings.

Results: On actigraphy, children in the DD group, after sleep onset, exhibited more and longer awakenings than the other two groups. In contrast, children in the AUT group exhibited less total sleep time in 24 hours than the other two groups. Parent reports of sleep problems were higher in the AUT and DD groups than the typical development group, but parent reports did not concur with more objective RDC for behavioral insomnia. Parent reports of sleep problems in all of the groups were significantly associated with increased self-reports of stress. Total 24-hour sleep durations for all of the groups were shorter than recommended for preschool-age children.

Conclusions: Our study provides objective evidence that sleep patterns are different in preschool children across the categories of AUT, DD, or typical development.
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http://dx.doi.org/10.1097/CHI.ObO13e3181799f7cDOI Listing
August 2008

The Children's Sleep Habits Questionnaire in toddlers and preschool children.

J Dev Behav Pediatr 2008 Apr;29(2):82-88

M.I.N.D. Institute and Department of Psychiatry and Behavioral Sciences, U.C. Davis, Sacramento, CA 95817, USA.

Objective: Twenty to 40% of young children are reported to have behavioral insomnias of childhood. Concerns about sleep at these ages are the most common problem expressed to pediatricians at the time of well child visits. A screening questionnaire, the Children's Sleep Habits Questionnaire (CSHQ), has been used in clinical settings and in research studies to assess children ages 4 to 10 for the presence of sleep problems. A CSHQ total score has distinguished clinical populations from community samples.

Methods: The current study assesses the CSHQ in a younger age group than previously reported and in a diverse population. A total of 194 children, ages 2 to 51/2 years, were recruited into 3 diagnostic groups: 68 children with autism, 57 children with developmental delay without autism, and 69 typically developing children. All children's parents completed the CSHQ and a sleep log, and all children were studied for 7 days and nights with actigraphy. The children were divided into problem sleep and non-problem sleep groups on the basis of a parent report of a generic sleep problem at the time of entry into the study. The CSHQ responses for the problem and non-problem sleep groups were then compared.

Results: The results suggest that the CSHQ is clinically useful for screening of sleep problems in typically developing children at these young ages as well as in children with diverse neurodevelopmental diagnoses.

Conclusions: The somewhat higher subscale scores than previously reported for older children appear to be consistent with more sleep problems in younger children.
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http://dx.doi.org/10.1097/dbp.0b013e318163c39aDOI Listing
April 2008

The use of actigraphy to study sleep disorders in preschoolers: some concerns about detection of nighttime awakenings.

Sleep 2008 Mar;31(3):395-401

Department of Human and Community Development, UC Davis School of Medicine, University of California, Davis, Sacramento, USA.

Study Objectives: This study compared actigraphy with videosomnography in preschool-aged children, with special emphasis on the accuracy of detection of nighttime awakenings.

Design: Fifty-eight participants wore an actigraph for 1 week and were videotaped for 2 nights while wearing the actigraph.

Setting: Participants were solitary sleepers, studied in their homes.

Participants: One group (n = 22) was diagnosed with autism, another group (n = 11) had developmental delays without autism, and a third group (n = 25) were typically developing children; age ranged from 28 to 73 months (mean age 47 months); 29 boys and 29 girls.

Interventions: N/A.

Measurements And Results: Nocturnal sleep and wakefulness were scored from simultaneously recorded videosomnography and actigraphy. The accuracy of actigraphy was examined in an epoch-by-epoch comparison with videosomnography. Findings were 94% overall agreement, 97% sensitivity, and 24% specificity. Statistical corrections for overall agreement and specificity resulted in an 89% weighted-agreement and 27% adjusted specificity.

Conclusions: Actigraphy has poor agreement for detecting nocturnal awakenings, compared with video observations, in preschool-aged children.
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http://dx.doi.org/10.1093/sleep/31.3.395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276752PMC
March 2008

Nocturnal sleep and daytime nap behaviors in relation to salivary cortisol levels and temperament in preschool-age children attending child care.

Biol Res Nurs 2008 Jan;9(3):244-53

Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA 98195-7266, USA.

The purpose of this study was to describe nocturnal sleep and daytime nap duration in relation to salivary cortisol levels and child temperament in nonproblem nappers and problem nappers. Nighttime sleep and nap durations were obtained with continuous actigraph recordings for 3 days and nights (Tuesday, Wednesday, and Thursday) on 38 children aged 3 to 5 years who attended full-day child care centers. Nap times and disruptive behaviors were also observed and coded on each of the 3 days. Parents completed a temperament scale, sleep diaries, and the Children's Sleep Habits Questionnaire. Salivary cortisol samples were collected midmorning and in the afternoon after a nap on 2 consecutive days (Wednesday and Thursday). Problem napping and disruptive behaviors were associated with more negative affect, higher afternoon cortisol levels, and a smaller decrement in cortisol from morning to afternoon. Problem napping and disruptive behaviors were also associated with longer nighttime sleep, shorter nap durations, and later rise times. These data provide some insight into the associations among nighttime sleep, napping behavior, and salivary cortisol.
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http://dx.doi.org/10.1177/1099800407310158DOI Listing
January 2008

The pharmaceutical industry, academic medicine, and the FDA.

Authors:
Thomas F Anders

J Child Adolesc Psychopharmacol 2007 Oct;17(5):727-30; discussion, 731-2

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http://dx.doi.org/10.1089/cap.2007.0093DOI Listing
October 2007

Sleep and napping patterns in 3-to-5-year old children attending full-day childcare centers.

J Pediatr Psychol 2008 Jul 23;33(6):666-72. Epub 2007 Oct 23.

Biobehavioral Nursing & Health Systems, University of Washington, Seattle, WA 98195-7266, USA.

Objective: To describe daytime naps and nighttime sleep-wake patterns in children attending full-day childcare centers.

Methods: A descriptive cross-sectional study of sleep and daytime nap patterns in 52 healthy children 3-5 years of age. Sleep and nap data were obtained over 3 days and nights (Tuesday, Wednesday, and Thursday) with continuous ankle actigraphy recording on children attending two university-affiliated childcare centers.

Results: Children averaged about 10 hr (610 min +/- 38 SD) of total sleep in 24 hr, as estimated by actigraphy. For the 41 children who napped, average nap duration was 75.8 min (+/-20 SD). Nocturnal sleep was less for children who napped (9.0 hr +/- 0.71 SD) compared to those who did not nap (9.8 hr +/- 0.53 SD).

Conclusions: Findings indicate that the majority of 3-to-5-year-old children nap when given an opportunity. Preschool children's sleep and napping patterns on weekends and in other types of childcare environments warrant further research to assess health effects and impact on growth and development.
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http://dx.doi.org/10.1093/jpepsy/jsm102DOI Listing
July 2008

A web-based data repository and review system for faculty evaluation and promotion.

Acad Med 2007 Jul;82(7):704-12

University of California-Davis School of Medicine, Sacramento, California, USA.

The authors describe the development of MyInfoVault (MIV), a Web-based central data repository with a variety of integrated applications that generate a series of professional documents. These documents can be circulated and archived. MIV was developed and piloted over several years (2002-2006) at the University of California-Davis in response to a perceived need to improve management of faculty merit and promotion dossiers. This article focuses on the faculty advancement module (PacketOnline) of MIV. Additional applications for generating a personal curriculum vitae and NIH Biosketch are also briefly described. The authors report their experience with a two-year pilot program for PacketOnline, including an evaluation of its functionality derived from a user survey. Tasks for dossier preparation were rated fairly equivalently to the conventional method. Initial data entry was reported to be tedious, and there were frustrations with unanticipated glitches, typical of new systems. The largest improvements and benefits were seen in electronic review of dossiers, which was considered to be more efficient and effective than the conventional paper method. The authors found all users to be generally supportive of the new electronic system. The authors conclude that an electronic database with applications for faculty merit and promotion review is a worthwhile tool, and they suggest using a multidisciplinary team of users to achieve buy-in. Additional enhancements and monitors of performance of the MIV system are ongoing.
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http://dx.doi.org/10.1097/ACM.0b013e318067489eDOI Listing
July 2007

Triple board training and new "portals" into child psychiatry training.

Child Adolesc Psychiatr Clin N Am 2007 Jan;16(1):55-66, viii

Department of Psychiatry, University of Utah School of Medicine, 650 South Komas Drive, Salt Lake City, UT 84108, USA.

Originally an experiment in medical training, the triple board program has established itself as a permanent and successful training program. It offers a viable 5-year alternative to the traditional 7 to 8 years of residency training required for board eligibility in pediatrics, general psychiatry, and child and adolescent psychiatry. One primary objective of this course was to address for workforce shortage of child psychiatrists by recruiting medical students who may otherwise have pursued general pediatrics. The second objective was to bridge the gap between child psychiatry and pediatrics by training physicians proficient in the culture, language, and content of both specialty fields. Although the shortage crisis continues, both objectives were met. The success of the triple board experiment has facilitated further consideration and support for the development of other novel training portals into child psychiatry.
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http://dx.doi.org/10.1016/j.chc.2006.09.001DOI Listing
January 2007

Sleep Architecture in Infants of Substance-Abusing Mothers.

Infant Ment Health J 2006 Mar;27(2):141-151

University of California.

This longitudinal, year-long study compared sleep-wake state organization in two groups of infants-infants whose mothers abused substances during their pregnancies and nonexposed, typically developing, age-matched comparison infants-to determine whether differences in sleep-wake state organization existed between the two groups. Seventeen infants of mothers who were participating in a parent-infant residential treatment program for substance abuse were enrolled. Their sleep-wake state organization over the first year of life was compared to that of 17 age-matched comparison infants. The intent was to follow each infant on five occasions over the first year of life using established methods of time-lapse videosomnography to record sleep-wake state organization; however, attrition in the substance-abusing group was problematic. Some sleep-wake variables (i.e., Active Sleep%, Quiet Sleep%, Awake%, number of nighttime awakenings) were similar for both groups of infants at comparable ages across the first year. Total sleep time and the longest sustained sleep period (sleep continuity variables) differed significantly at some of the ages measured. Although overall sleep architecture appears highly resilient and well organized, some indications of sleep fragmentation and shortened nighttime sleep periods were observed in the substance-exposed infants. More research is needed to explain why sleep-continuity variables and not sleep-state proportion variables differed between the two groups.
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http://dx.doi.org/10.1002/imhj.20085DOI Listing
March 2006

Children: our most valuable resource.

Authors:
Thomas F Anders

J Am Acad Child Adolesc Psychiatry 2006 Jan;45(1):1-5

Dr. Anders is President-Elect of the American Academy of Child and Adolescent Psychiatry and is with the University of California-Davis, M.I.N.D. Institute, Sacramento.. Electronic address:

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http://dx.doi.org/10.1097/01.chi.0000186399.59723.ddDOI Listing
January 2006

Multispecialty telephone and e-mail consultation for patients with developmental disabilities in rural California.

Telemed J E Health 2004 ;10(4):413-21

Department of Clinical Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA 95817, USA.

The University of California (UC), Davis Health System, and California Department of Developmental Services (CDDS) developed the Physician Assistance, Consultation and Training Network (PACT Net) to assist primary-care providers (PCPs) care for patients with developmental disabilities in rural California. This manuscript describes PACT Net, a warm line using phone and e-mail, and its multispecialty panel. A pilot study evaluated whether or not PCPs needed such a consultation service, whether or not it assisted them in providing care, and their overall satisfaction with the service. PCPs were informed on how to request a consultation. Data were collected from patients (demographics), PCPs (satisfaction with preexisting consultation availability and quality, PACT Net consultation reason, preferred mode of contact, duration, and, satisfaction), and specialists (ease, quality of request, and satisfaction). Satisfaction was measured prospectively using a 7-point Likert scale. Data were collected on 30 consultations, 28 by telephone and 2 by e-mail; other data were by combined methods. The average duration of consultation was 47 minutes, and 24 responses occurred within one business day. The top three services requested for consultation were psychiatry (e.g., management of behavioral disturbance), medical genetics (diagnosis), and gastroenterology (miscellaneous). PCPs rated baseline satisfaction with: (1) pre-existing local services at 3.37, (2) timeliness of the PACT Net consultation at 5.45, (3) quality of the communication at 6.3, and (4) overall quality and utility of the consultation at 6.2. Specialists rated the quality of the communication at 6.45, and the ease of the service at 6.46. Phone and e-mail consultation appears satisfactory to PCPs and specialty providers as a way to enhance specialty input to rural patients.
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http://dx.doi.org/10.1089/tmj.2004.10.413DOI Listing
March 2005
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