Effekten av terapeutkompetanse i administrering av hjemmearbeid på utfallet av kognitiv terapi ved cluster C personlighetsforstyrrelse

Kognitiv terapi er en effektiv behandling for cluster C personlighetsforstyrrelse, men det vites lite om virkningsmekanismene bak behandlingen. I denne artikkelen blir datamateriale fra en tidligere randomisert kontrollert studie analysert for å undersøke hvorvidt terapeutkompetanse i administrering av hjemmearbeid har en unik effekt på behandlingsutfallet utover allianse og agendasetting. 24 pasienter med cluster C personlighetsforstyrrelse fikk 40 ukentlige timer hver med kognitiv atferdsterapi. Pasientenes symptomtrykk, interpersonlige problem og personlighetspatologi ble målt og samlet i en global residualisert komposittskåre. Terapeutkompetanse i administrering av hjemmearbeid og agendasetting ble målt med Cognitive Therapy Scale (CTS), og allianse ble mål med Helping Alliance Questionnaire (HAQ). Deretter ble trinnvis regresjonsanalyse brukt for å teste hypotesene. Resultatene viser at terapeutkompetanse har en unik, sterk positiv effekt på utfallet, også når det kontrolleres for initiell symptomlette

Prevalence and stability of insufficient sleep measured by actigraphy: a prospective community study

acceptedVersio

Prevalence and course of anxiety disorders and symptoms from preschool to adolescence: a 6-wave community study

Background: The rate of various anxiety disorders in early childhood and whether they continue into middle childhood or adolescence is not known. We therefore report on the prevalence and stability of DSM-5-defined anxiety disorders and their symptoms, capturing the period from preschool to adolescence. Methods: By means of interviewer-based clinical interviews, anxiety was measured in a sample of Norwegian children at six measurement points from age 4 to 14 (n = 1,041). To adjust for time-invariant factors, we applied random intercept cross-lagged panel models (RI-CLPMs) capturing within-person changes. Results: Nearly 10% (95% CI = 7.29, 12.63) had an anxiety disorder at some timepoint. Specific phobia was the most prevalent disorder in early and middle childhood, whereas generalized anxiety disorder (GAD) increased in prevalence and became the most common anxiety disorder at age 14 (4.51%, 95% CI = 2.78, 6.23). When time-invariant confounding was adjusted for, homotypic continuity in anxiety symptoms typically first emerged in late middle childhood or adolescence. Even so, such within-person analyses revealed a heterotypic path from increased number of early childhood symptoms of specific phobia to increased number of GAD symptoms in middle childhood (B = .41, 95% CI = .06, .75). Increased separation anxiety in middle childhood predicted increased symptoms of GAD in adolescence (B = .38, 95% CI = .14, .62), and vice versa(B = .05, 95% CI = .00, .09). Only minor gender differences were revealed. Conclusions: Anxiety disorders are prevalent in childhood. In early childhood, anxiety symptoms generally do not predict later anxiety symptoms. In middle childhood, however, such symptoms are less likely to vanish, indicating this developmental period to be particularly important for preventive and treatment efforts

Persistent Short Sleep from Childhood to Adolescence: Child, Parent and Peer Predictors

Purpose: Many children have periods when they sleep too little, with widely recognized detrimental effects. Less is known about persistent short sleep during childhood. Therefore, the present study aimed to investigate the prevalence of persistent short sleep in school-aged children and identify a set of child, parent, and peer predictors thereof. Participants and Methods: Objectively measured sleep duration (hip-held accelerometer) was biennially assessed in a community sample followed from 6 to 14 years (n=801). A latent profile analysis was applied to assess whether a subgroup of children slept consistently short across time and predictors of persistent short sleep were determined through regression analysis. Results: A subgroup of children (n=160; 20.2%) was identified as having persistent short sleep across time. Temperamental negative affectivity (β=0.08; 95% CI=0.01, 0.15; p=0.03) and low observer-assessed parental emotional availability (β=− .09; 95% CI=− .18, − .01; p=0.04) predicted membership to that group. Teacher ratings of victimization from bullying were not associated with persistent short sleep (β=0.01; 95% CI: − .10, 11; p=0.88). Conclusion: High child temperamental negative affectivity and low parental emotional availability may be involved in the development of persistent short sleep through childhood.publishedVersio

Prevalence and stability of insufficient sleep measured by actigraphy: a prospective community study

Background It is well established that reduced sleep has detrimental effects on school-aged children’s functioning, but the prevalence and stability of objectively measured insufficient sleep throughout childhood is unknown. Methods A sample of 799 children was followed biennially with 24-h 7-day accelerometer (hip-placed) measurements from ages 6 to 12 years. Insufficient sleep was conceptualized as sleeping <7 h on average (AIS) and as the number of nights with <7 h of sleep (NNIS). Results The prevalence of AIS ranged from 1.1% to 13.6%. Of those without AIS, 15.1–64.5% had >1 NNIS. At ages 6–10 years, NNIS was higher on weekend nights, but at age 12 years NNIS was lower on weekends (18.1%) compared to weekdays (23.4%). The stability of AIS was low from ages 6 to 8 years and from 8 to 10 years, but increased from age 10 to 12 years, whereas NNIS evidenced higher stability, increasing sharply through late middle childhood. Conclusions The prevalence of AIS was low during the preschool and early school years but increased toward preadolescence. The 2-year stability of insufficient sleep was very low when conceptualized as AIS and moderate when defined as NNIS, hence NNIS might be more sensitive than AIS. Insufficient sleep appears transient in middle childhood and thus might not warrant intervention unless it fosters impairment and endures

Persistent Short Sleep from Childhood to Adolescence: Child, Parent and Peer Predictors

Purpose: Many children have periods when they sleep too little, with widely recognized detrimental effects. Less is known about persistent short sleep during childhood. Therefore, the present study aimed to investigate the prevalence of persistent short sleep in school-aged children and identify a set of child, parent, and peer predictors thereof. Participants and Methods: Objectively measured sleep duration (hip-held accelerometer) was biennially assessed in a community sample followed from 6 to 14 years (n=801). A latent profile analysis was applied to assess whether a subgroup of children slept consistently short across time and predictors of persistent short sleep were determined through regression analysis. Results: A subgroup of children (n=160; 20.2%) was identified as having persistent short sleep across time. Temperamental negative affectivity (β=0.08; 95% CI=0.01, 0.15; p=0.03) and low observer-assessed parental emotional availability (β=− .09; 95% CI=− .18, − .01; p=0.04) predicted membership to that group. Teacher ratings of victimization from bullying were not associated with persistent short sleep (β=0.01; 95% CI: − .10, 11; p=0.88). Conclusion: High child temperamental negative affectivity and low parental emotional availability may be involved in the development of persistent short sleep through childhood

Persistent Short Sleep from Childhood to Adolescence: Child, Parent and Peer Predictors

Purpose: Many children have periods when they sleep too little, with widely recognized detrimental effects. Less is known about persistent short sleep during childhood. Therefore, the present study aimed to investigate the prevalence of persistent short sleep in school-aged children and identify a set of child, parent, and peer predictors thereof. Participants and Methods: Objectively measured sleep duration (hip-held accelerometer) was biennially assessed in a community sample followed from 6 to 14 years (n=801). A latent profile analysis was applied to assess whether a subgroup of children slept consistently short across time and predictors of persistent short sleep were determined through regression analysis. Results: A subgroup of children (n=160; 20.2%) was identified as having persistent short sleep across time. Temperamental negative affectivity (β=0.08; 95% CI=0.01, 0.15; p=0.03) and low observer-assessed parental emotional availability (β=− .09; 95% CI=− .18, − .01; p=0.04) predicted membership to that group. Teacher ratings of victimization from bullying were not associated with persistent short sleep (β=0.01; 95% CI: − .10, 11; p=0.88). Conclusion: High child temperamental negative affectivity and low parental emotional availability may be involved in the development of persistent short sleep through childhood

Association Between Objectively Measured Sleep Duration and Symptoms of Psychiatric Disorders in Middle Childhood

Importance The long-term association between sleep duration and mental health in children is currently unknown. Objective To investigate the prospective associations between sleep duration and symptoms of emotional and behavioral disorders at ages 6, 8, 10, and 12 years. Design, Setting, and Participants This population-based cohort study obtained data from the Trondheim Early Secure Study in Trondheim, Norway. A representative, stratified random sample of children born between January 1, 2003, and December 31, 2004, were invited to participate. Participants were followed up biennially from age 4 years (2007-2008) to 12 years (2013-2014). Data analysis was conducted from January 2, 2019, to May 28, 2019. Main Outcomes and Measures Sleep duration was assessed with 1 week of continuous use of a triaxial accelerometer. Symptoms of emotional (anxiety and depression) and behavioral (oppositional defiant, conduct, and attention-deficit/hyperactivity) disorders were measured by semistructured clinical interviews (using the Preschool Age Psychiatric Assessment and the Child and Adolescent Psychiatric Assessment) with parents (at all ages) and children (from age 8 years). Results The analytical sample comprised 799 children (mean [SD] age at time point 2, 6.0 [0.2] years; 405 [50.7%] boys; and 771 [96.5%] Norwegian). Shorter sleep duration at age 6 years (β [unstandardized regression coefficient] = −0.44; 95% CI, −0.80 to −0.08; P = .02) and 8 years (β = −0.47; 95% CI, −0.83 to −0.11; P = .01) forecasted symptoms of emotional disorders 2 years later. Comparatively short sleep duration at age 8 years (β = −0.65; 95% CI, −1.22 to −0.08; P = .03) and 10 years (β = −0.58; 95% CI, −1.07 to −0.08; P = .02) was associated with symptoms of behavioral disorders 2 years later among boys but not among girls at age 8 years (β = −0.14; 95% CI,− 0.52 to 0.24; P = .48) or 10 years (β = −0.05; 95% CI, = −0.49 to 0.40; P = .84). These associations were statistically significant among boys compared with girls at age 8 years (Δχ21 = 13.26; P < .001) and 10 years (Δχ21 = 10.25; P = .001). Symptoms of psychiatric disorders did not forecast sleep duration at any age. Conclusions and Relevance This study found an association between short sleep duration and increased risk of future occurrence of emotional disorder symptoms in both boys and girls and between reduced sleep and behavioral disorder symptoms in boys. These results suggest that improving sleep in children may help protect against the development of symptoms of common psychiatric disorders and may be advantageous in the treatment of such disorders