In response to the scientific evidence documenting both profound developmental changes in sleep and circadian biology during adolescence and the myriad of negative health, performance, and safety outcomes risks associated with chronic sleep loss, at least 70 public school districts in the United States, representing approximately 1,000 schools, have successfully implemented a delay in high school start times. However, despite the compelling evidence supporting school start time change as a key strategy in addressing the epidemic of adolescent sleep loss, many school districts across the country with early high school start times have not considered the option to implement later bell schedules for adolescents. Moreover, while the current scientific literature has clearly documented the positive outcomes associated with delayed high school start times, these studies contain limited information regarding the process by which school districts consider, approve and implement bell schedule changes. Thus, this in-depth examination of those school districts that have been successful in changing their bell schedules is intended to support the efforts of other districts in various stages of contemplating this measure. We utilized a multi-pronged approach (literature review, case studies, telephone interviews, online survey) to summarize the experiences of school districts across the United States in regard to challenges faced, strategies employed, and lessons learned in the hope that this

The increasing availability of highly caffeinated beverages, including energy drinks, in the United States has resulted in a rise in consumption by children and adolescents. In addition, there is mounting evidence that these products are often consumed by youth for their perceived fatigue-mitigating and mood- or performance-enhancing effects. Although such perceptions by children and adolescents about the potential consequences of caffeine consumption are highly likely to influence decision making regarding the use of such products, there is still a relative paucity of studies that focus on the effect of caffeinated beverages on sleep, mood, and performance in the pediatric population. This review summarizes the following aspects of this topic, as derived from the information currently available: 1) the perception, among youth, of caffeine's risks and benefits and the sources of information about caffeine, particularly with regard to sleep, mood, and performance; 2) the bidirectional effect of caffeine on sleep in children and adolescents and the association of caffeine with other sleep-related practices, and 3) the evidence that supports caffeine as a performance and mood enhancer as well as a countermeasure to sleepiness in the pediatric population. Finally, gaps in knowledge are identified, and a direction for future research is outlined.

Sleep disturbances in children with autism spectrum disorder (ASD) exist worldwide, but little is known about this issue in non-Western cultures. This study aimed to characterize sleep disturbances in Chinese children with ASD and to examine associated sociodemographic factors and emotional/behavioral problems. Parents of 60 Chinese children with ASD (aged 6-17 years) from Shenzhen, China completed the Children's Sleep Habits Questionnaire (CSHQ), and the Strengths and Difficulties Questionnaire (SDQ). Sleep disturbances were severe and common, with rates of 70.0% for overall disturbances and 15.0% (daytime sleepiness) to 40.0% (sleep duration) for specific domains. The severity and rate of sleep disturbances were higher compared to previous studies in typically developing children from the same region of China and American children with ASD, respectively. Further, there were significant correlations between most CSHQ and SDQ domains. Female gender, older parental age, higher hyperactivity, and poorer prosocial behavior were associated with increased overall sleep disturbances.

Massage for hospitalized adolescents with cancer is feasible, well received, and can potentially improve patients' sleep. A randomized multicenter efficacy study is warranted.

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