Category: Child / Adolescent - Anxiety

PS12- #B35 - Examining the Associations Between Sleep Problems and Treatment Outcome in a Pediatric Anxiety Specialty Clinic

Saturday, Nov 18
1:30 PM – 2:30 PM
Location: Indigo Ballroom CDGH, Level 2, Indigo Level

Keywords: Child Anxiety | Sleep | Treatment-CBT

Cognitive behavioral therapy (CBT) is an effective treatment for pediatric anxiety (Bennett et al., 2016). Research on the active components of CBT implicates learning as a key mechanism of treatment (Craske et al., 2014). As not all anxious children respond to CBT, understanding factors that impact learning may improve treatment response.


Sleep quality has been found to be related to learning (Dieklemann & Born, 2010). It stands to reason that sleep-related problems (SRPs) could impact the effectiveness of CBT. This is important as SRPs are reported in up to 90% of anxious youth (Cowie et al., 2014). Previous research has found that improvements in sleep promote reductions in anxiety (Kleim et al., 2014) and facilitate generalization of extinction following exposure (Pace-Schott et al., 2009). Poorer sleep quality has been shown to predict slower improvement and worse post-treatment anxiety in adults with social anxiety disorder (Zalta et al., 2013). No research to date has examined the relation between SRPs and response to anxiety treatment in children. The purpose of this study was to examine whether parent- or self-reported sleep difficulties at intake are related to early treatment outcomes in a specialty pediatric anxiety clinic.


Participants were 71 youth (meanage = 12.1; SD = 3.01; 57.7% female) who received CBT for anxiety disorders. The Child Behavior Checklist for Children (CBCL) and Youth Self Report (YSR) (Achenbach & Rescorla, 2001), and the Screen for Child Anxiety and Related Disorders, Parent and Child versions (SCARED; Birmaher et al., 2006) were administered at intake and 3 months. Consistent with prior research (Becker, Ramsey, and Byars, 2015), six items from the CBCL were used to assess SRPs, including a Total Sleep Problems (TSP) composite (sum of those items). Five corresponding items from the YSR were also examined.


Child anxiety significantly decreased from intake to 3 months based on the SCARED-C (t(31) = 2.78; p .01, d = 0.49), but not the SCARED-P (t(36) = 1.45; p = 0.16). YSR child reports of nightmares (r(34) = .51, p < .01) and being overtired (r(34) = .50, p < .01) were related to SCARED-C Total scores at intake, and CBCL parent reports of nightmares were significantly related to SCARED-P Total scores at intake (r(54) = .30, p < .05). All other relations between self- and parent-reported sleep problems and anxiety at intake failed to reach statistical significance, including the relation between CBCL TSP and anxiety (r(50) = .23, p = .09). Regarding early treatment response, only parent reports of children being overtired at intake predicted SCARED-P Total scores at 3 months, after controlling for intake anxiety (β = 0.22, t(32) = 2.01, p < .05).


Results will be discussed within the context of prior research, including the potential limitations of using the CBCL and YSR sleep items to assess SRPs.

Elizabeth Lagbas

Clinic Coordinator
Evidence Based Treatment Centers of Seattle
Seattle, Washington

Ariel Ravid

Clincial Psychologist
Evidence Based Treatment Centers of Seattle
Seattle, Washington

Kenya Makhiawala

Postdoctoral Fellow
Evidence Based Treatment Centers of Seattle
Seattle, Washington

Susanna Coco

Postdoctoral Fellow
Evidence Based Treatment Centers of Seattle
Seattle, Washington

Madeline Johnson

Client Services Coordinator
Evidence Based Treatment Centers of Seattle
Seattle, Washington

Travis L. Osborne

Co-Director, Anxiety Center & Director of Training & Director of Outcomes Monitoring
Evidence Based Treatment Centers of Seattle; University of Washington, Department of Psychology; University of Washington, Department of Psychiatry and Behavioral Sciences
Seattle, Washington

Stacy Shaw Welch

Executive Clinical Director, EBTCS & Co-Director, Anxiety Center & Co-Director, Child Anxiety Center
Evidence Based Treatment Centers of Seattle; University of Washington, Department of Psychology; University of Washington, Department of Psychiatry and Behavioral Sciences
Seattle, Washington

Jennifer Tininenko

Co-Director, Child Anxiety Center & Clinical Psychologist, Anxiety Center
Evidence Based Treatment Centers of Seattle; University of Washington, Department of Psychology
Seattle, Washington