Addressing sleep in children with anxiety disorders

Childhood anxiety disorders are highly prevalent and are often associated with significant sleep disturbance. Although data are still somewhat limited and results may vary across different diagnoses, methods, and informants, empirical evidence has begun to emerge to corroborate high rates of subjective sleep complaints in anxious youth, primarily those with GAD. The sleep problems, patterns, and practices of clinically anxious youth represent an important window onto the relationship between sleep and emotional regulation, and may assist in answering questions regarding the relative contributions of sleep-wake schedules versus disruptions to daytime emotional impairments. Research focused on further specifying the types of sleep disturbances experienced by youth with various forms of anxiety is also needed to inform theoretical models and the development of effective interventions. Multiple mechanisms may well influence acute and long-term relationships between sleep and anxiety, and several factors in particular represent viable targets for clinical research. Overlapping deficits in the processing of emotional information, parenting behaviors that hinder the development of self-regulatory skills, catastrophizing about sleep, and other cognitive biases are common to both sleep-deprived and anxious youth, all or any of which may serve as a functional pathway for the development of these problems. Investigation of such factors may not only inform the content of effective intervention approaches, but may help to instruct the ideal timing and sequencing of such methods, especially as co-occurring sleep disturbance may reduce the effectiveness of anxiety-based treatment modalities. TBT is an example of a novel prescriptive intervention targeting both sleep and anxiety in children with GAD that has demonstrated initial efficacy in both domains, thereby setting the stage for the development of further research.