The role of psychiatric symptoms, sociodemographic factors, and baseline sleep variables on pediatric insomnia treatment outcomes in a clinically referred population

Abstract

Study Objectives: The current study aimed to examine clinically relevant psychiatric and sociodemographic predictors of insomnia treatment outcomes in pediatric patients clinically referred for insomnia. Methods: Pediatric patients (n = 1,428; ages 1.5–18 years) presenting for insomnia evaluation in a medical/sleep center–based behavioral sleep clinic were followed for treatment as clinically indicated. According to patient age, parents/patients completed validated measures of insomnia severity, psychiatric symptoms, and sociodemographic measures. Patients were also categorized by treatment outcome status (ie, not recommended to follow-up after initial evaluation and treatment session, successful treatment completion, lost to follow-up after initial evaluation and treatment session, and early termination) according to the clinically indicated treatment recommended and dose of treatment received. Results: Youth had elevated scores on psychiatric screening indexes and affective problems were highest for all age groups. Other comorbid sleep disorders were present in nearly 25% of patients with insomnia and use of sleep aids (melatonin or hypnotics) was commonplace. Baseline insomnia severity significantly predicted sleep treatment trajectories and posttreatment insomnia severity with large effects for all age groups. Other clinically relevant predictors of insomnia treatment outcomes included medication use and externalizing mental health concerns in younger patients and internalizing mental health concerns and chronological age in older patients. Lack of treatment follow-up and premature treatment termination was observed for patients with the worst insomnia symptoms at time of initial evaluation. Conclusions: Pediatric health providers delivering insomnia treatment should take a developmentally sensitive approach that is proactive with regards to managing treatment barriers that are likely influenced by severity of insomnia and comorbid mental health concerns.