Faculty Bibliography

Objectives: CBT for insomnia (CBT-I) in adolescents and young adults is a brief intervention that includes both behavioral and psychological procedures. At the end of this presentation, participants will be able to 1) describe when and for whom CBT-I is an appropriate form of treatment intervention; 2) provide practical guidelines for conducting CBT-I, including stimulus control, sleep restriction, cognitive restructuring, and sleep hygiene; and 3) practice arousal reduction and biofeedback for the treatment of insomnia. Methods: This session will provide a comprehensive literature review, lecture, and discussion. Results: Medications for the treatment of insomnia are sometimes necessary but most often are insufficient to fully address the problem. CBT-I, by contrast, represents an easily taught series of skills that are portable and time and cost effective. The utility of CBT-I has been repeatedly demonstrated for adults and adolescents. The goal of CBT-I is to alter the factors that perpetuate insomnia and include the following: 1) behavioral factors, such as poor sleep habits, and irregular sleep schedules; 2) psychological factors, such as unrealistic expectations, and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. CBT-I is indicated for primary and secondary insomnia in adolescents and adults and can be delivered on a one on one basis; in groups; and via telephone, telemedicine, and video. This presentation will describe the use of CBT-I and necessary adjustments when applying these techniques with children. Participants will practice arousal reduction and biofeedback techniques. Conclusions: The use of cognitive-behavior therapy for insomnia will be described, and participants will engage in a series of applied exercises to enhance their therapeutic skills

OBJECTIVE: The Child and Adolescent Mental Health Studies (CAMS) program is housed in a Liberal Arts undergraduate college of a large research university. Psychiatrists, clinical psychologists, and social workers at the university's medical center teach the courses. The purpose of this study is to evaluate the extent to which CAMS encourages graduates of the program to pursue a career in child and adolescent mental health (CAMH). METHODS: In 2015-2016, graduates of the CAMS program were invited to participate in a mixed methods study. In addition to statistical analyses, qualitative thematic analyses were performed to interpret free-text responses. RESULTS: Forty-five percent (314/702) of invited graduates completed the online survey. Interviews were conducted with 11% (34/314) of participants by study staff over the phone. Quantitative results suggested that 81% (149/185) of participants enrolled in educational programs after graduation due to an interest in CAMH. A significantly higher proportion of the total sample (t = 3.661, p < .001) reported that they changed their career goals while undergraduate students compared to those who did so after graduation. Results of qualitative interviews with 34 participants uncovered five key themes unique to CAMS that may explain the program's influence on graduates' career choices and career development: practitioners-as-instructors, instructor mentorship, novel course content, experiential learning opportunities, and career training and skills. CONCLUSIONS: Quantitative and qualitative results indicated that teaching college undergraduate students about CAMH encourages them to set career goals within the field. These findings suggest the utility of implementing similar programs at other undergraduate colleges.

Objectives: This presentation will provide participants with an understanding of standard sleep hygiene recommendations and their utility, along with other less commonly addressed interventions, to promote a good night's sleep. At the end of this presentation, participants will be able to 1) describe the evidence base for typical sleep hygiene recommendations; 2) identify the effects of exercise, napping, caffeine, alcohol, tobacco, and marijuana on sleep; and 3) determine which sleep hygiene practices are likely to be most effective for children and adolescents. Methods: This presentation will draw upon a comprehensive literature review, the physiology of sleep, and case-based material. Results: Sleep hygiene is ubiquitously recommended by psychiatrists, psychologists, and healthcare providers for the treatment of insomnia. However, many commonly suggested techniques are not founded upon convincing research and have not been proven effective in trials. In addition, there are other methods based on findings from sleep physiology studies that may be effective and worth using with children and adolescents who struggle with sleep. This presentation will describe the current knowledge base and deficit in sleep hygiene and then make sensible, evidence-based recommendations for improving sleep in children and adolescents. Common behavioral and exogenous factors, such as exercise, napping, caffeine, alcohol, and tobacco, and their effects on sleep will also be addressed. Conclusions: Understanding the physiology and circadian rhythmicity of sleep is key to understanding and applying sleep hygiene effectively. This presentation will summarize the core components of sleep hygiene that are likely to be of use for children and adolescents

Objectives: The goal of this session is to provide practicing clinicians with valuable advanced knowledge on the epidemiology, pathophysiology, and pharmacological and behavioral treatment of insomnia as commonly seen among children, adolescents, and young adults with psychiatric conditions Methods: This session will include a comprehensive literature review and case-based presentations. Results: Dr. Lewin will present on epidemiology of insomnia and neurobehavioral consequences of insufficient sleep. Dr. Johnson will focus on sleep requirements throughout development and evaluation of insomnia. Physiology of sleep states and circadian rhythm will be covered by Dr. Baroni. In his two presentations, Dr. Shatkin will provide practical guidelines on the use of sleep education and hygiene, in addition to an overview of cognitive behavioral therapy for insomnia with children, adolescents, and young adults. Dr. Owens will review a systematic approach to using medications for the treatment of pediatric insomnia. Finally, Dr. Ivanenko will address common challenges in the treatment of sleep problems in mental health settings. Conclusions: Learning how to address sleep disorders using behavioral and pharmacological treatments will provide clinicians with essential tools for their psychiatric practice

Objectives: Risk-taking and reckless behavior among adolescents and young adults all too often result in severe emotional distress and dysfunction, serious injury, and death. Rates of motor vehicle accidents, drug and alcohol use, violence, and sexual activity skyrocket during adolescence, often heralding depression, anxiety, and other psychiatric conditions. Of course, the real tragedy is that these risks are by and large self-inflicted and preventable. Methods: New and emerging research in neuroscience, evolutionary biology, decision-making, and peer effects will be reviewed. The problems with popular universal risk-prevention programs, such as D.A.R.E. (Drug Abuse Resistance Education), Scared Straight, and Zero Tolerance Policies, will be discussed, along with typical clinical approaches to teaching adolescents about managing risk such as pro/con analysis. Results: Many adolescent risk-prevention programs and clinical efforts are designed to convince our youth that they are in great danger. These interventions encourage logical, adult-like thinking. Implicit within these approaches is the belief that if adolescents could only think analytically like adults and gain insight into their behavior, they would cast aside their delusions of invincibility, realize the dangers looming, and change their behavior. Most often, however, adolescents already believe themselves to be much more vulnerable to bad outcomes than they actually are, and entirely different mechanisms are at work for adults and adolescents when it comes to assessing risk. Counterintuitively, mature adults make decisions involving risk, with the least amount of information possible, by using intuition and experience, not large amounts of objective data, and by viewing risk in absolute but not relative terms. Fuzzy trace theory, the benefits of gist thinking, quantitative versus qualitative risk assessment, optimistic bias, and framing effects, among other factors, will be called upon to explain which approaches to risk prevention are likely to be or not to be successful with adolescents and young adults. Conclusions: This presentation will use neuroscience and decision-making research to inform both a clinical and population level of understanding risk, thereby providing direction for the efforts that are likely to be successful in enhancing resilience

Objectives: It is estimated that 25 percent of children and adolescents suffer from a sleep problem at some point before entering adulthood. Research shows that over 95 percent of CAPs prescribe at least one sleep medication monthly, yet numerous studies show that CBT-I works just as well as medication, is extremely cost effective, and has longer-lasting benefits. However, unfortunately, most CAPs are not trained in CBT-I. This workshop will teach participants when and for whom CBT-I is an appropriate treatment intervention; the six primary components of CBT-I; and how to design CBT-I treatment plans for a variety of adolescent and young adult patients diagnosed with insomnia. Methods: This workshop will be based upon a comprehensive literature review and the clinical expertise of the instructors. In advance of the workshop, registered participants will be sent a variety of standardized rating scales so that they may begin to assess their own sleep in preparation for learning how to improve the sleep of their patients. Results: CBT-I consists of an easily taught series of evidence-based skills that are portable and time and cost effective. The goals of CBT-I are to alter the factors that perpetuate insomnia and include the following: 1) behavioral training in stimulus control, sleep restriction, and sleep hygiene; 2) cognitive training in managing dysfunctional thoughts and maladaptive behaviors related to sleep, such as unrealistic expectations and rumination over the consequences of insomnia; and 3) physiological factors, such as hyperarousal and somatic and mental tension. Conclusions: This workshop will provide instruction on the use of CBT-I for adolescents and adults, and practitioners will be guided through a series of applied exercises to enhance their therapeutic skills

Objectives: This course provides an overview of the most common pediatric sleep problems in the context of psychiatric disorders. The most advanced and relevant pharmacological and behavioral treatment options will be presented. Methods: This session will consist of comprehensive literature review and case-based presentations. Results: Dr. Reut Gruber will examine the associations between insomnia and the affective and cognitive mechanisms implicated in internalizing problems in adolescents and discuss the implications of these associations to treatment. Dr. Judith Owens will review a systematic approach to the evaluation of adolescents presented to a child psychiatry practice, with a chief complaint of daytime sleepiness, including differential diagnosis, diagnostic tools, and reasons to refer to a sleep clinic. Dr. Argelinda Baroni will describe common parasomnias in children and adolescents, with an emphasis on psychological and behavioral comorbidities. Dr. Kyle Johnson will review the prevalence and characteristics of sleep disorders in children with ASD and discuss their impact on the functioning of the child and family, along with currently available treatments. Finally, Dr. Anna Ivanenko will define clinical characteristics of sleep disorders and their potential underlying neurobiological mechanisms in children with ADHD. She will review current knowledge of the treatment options for sleep disorders in children with ADHD. Conclusions: Learning how to address sleep disorders using behavioral and pharmacological treatments will provide clinicians with essential tools for their psychiatric practice

Insomnia among children and adolescents is ubiquitous and takes a great toll on youth and their families, impacting academic achievement, mood, social functioning, and a variety of developmental outcomes. Unfortunately, however, pediatric insomnia most often remains unidentified and untreated. When treatment is provided, it is most often in the form of medications, which are not FDA approved for that indication in children and adolescents. A comprehensive literature review was employed to establish the recommendations in this report. This article provides a review of sleep physiology and both current and recommended approaches to assessing and treating pediatric insomnia. Comprehensive assessment, accurate diagnosis, and evidence-based treatment of insomnia is imperative to the healthy development of children and adolescents. While clinicians often prescribe a variety of medications to treat pediatric insomnia, there is insufficient data to demonstrate efficacy and endorse their routine use. At this time, behavioral techniques, such as cognitive behavior therapy for insomnia and sleep hygiene education, should remain the first line of treatment. As a second-line consideration, melatonin, a dietary supplement, may be effective. Pediatric insomnia has an enormous impact on children, adolescents, and their families that requires adequate attention from clinicians and parents alike.