Insomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia may improve sleep and functioning in children with autism and their parents, but delivery involving multiple office visits limits accessibility. This single-arm pilot study tested telehealth delivery of eight-session cognitive behavioral treatment for childhood insomnia in 17 children (6–12 years) with autism spectrum disorder and insomnia and their parent(s). Treatment integrity was assessed each session ( delivery, by therapist; receipt, participant understanding; and enactment, home practice). Treatment satisfaction was assessed after treatment. Children and parents wore actigraphs and completed electronic diaries for 2 weeks, children completed 5-min Holter Monitoring (assessed heart rate variability, physiological arousal indicator), and parents completed Aberrant Behavior Checklist before and after 1 month. Average integrity scores were high (98%, delivery; 93%, receipt; and 82%, enactment). Parents found cognitive behavioral treatment for childhood insomnia helpful, age-appropriate, and autism-friendly. Paired-samples t-tests (family-wise error controlled) indicated telehealth cognitive behavioral treatment for childhood insomnia improved child and parent sleep ( objective and subjective) and functioning (child—decreased irritability, lethargy, stereotypy, hyperactivity; parent—decreased fatigue). At 1 month, inappropriate speech also decreased, but hyperactivity was no longer decreased. Other gains were maintained. Most children demonstrated reduced arousal following treatment. This pilot shows telehealth cognitive behavioral treatment for childhood insomnia is feasible and may improve child and parent sleep, child behavior and arousal, and parent fatigue. A randomized controlled trial of telehealth cognitive behavioral treatment for childhood insomnia for children with autism is needed. Lay abstract Insomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia (CBT-CI) may improve sleep and functioning in children with autism and their parents, but typical delivery involving multiple office visits can make it difficult for some children to get this treatment. This pilot study tested telehealth delivery of CBT-CI using computers, which allowed children and their parents to get the treatment at home. This pilot shows therapists that parents and children were able to use telehealth CBT-CI to improve child and parent sleep, child behavior and arousal, and parent fatigue. Parents found telehealth CBT-CI helpful, age-appropriate, and autism-friendly. Telehealth CBT-CI holds promise for treating insomnia in school-aged children with autism and deserves further testing.

As one out of five children in the United States demonstrate some type of mental or behavioral health concern warranting additional intervention, federal policies have emphasized the need for school‐based mental health (SBMH) services and an expansion of Medicaid reimbursement for eligible children and families. Most youth access mental health services at school; therefore, it is important to evaluate how staffing ratios, credentialing, and state Medicaid policies may influence school psychologists’ involvement in the delivery of SBMH services. A survey of 192 school psychologists found that as practitioner to student ratios increased, the availability and provision of SBMH services decreased. As state Medicaid policies have been found to influence the provision of mental health services at school, current study results demonstrate an association between state level Medicaid policies and the number of school psychologists qualified to bill for Medicaid‐reimbursable services. Implications for service delivery and policy development are discussed.

Universal screening is useful in the early identification of behavioral and emotional concerns, but teacher-related variance can potentially influence screening scores and resulting decisions. The current study examined the extent to which burnout and self-efficacy as teacher-level variables accounted for variance in universal screening scores. The study participants included 1,314 K-6 students and 56 elementary school teachers. Teachers completed the Social, Academic, and Emotional Behavior Risk Screener (SAEBRS) for each student in their classroom, while also completing rating scales regarding their personal self-efficacy and levels of burnout. Hierarchical linear modeling was employed to estimate the extent of teacher-related variance and whether burnout and self-efficacy accounted for this variance. Unconditional models indicated 12–30% of variance in screening scores was between teachers. Conditional models indicated teacher self-efficacy and the depersonalization component of teacher burnout were statistically significant predictors of Emotional Behavior and Total Behavior scores on the SAEBRS. Results further suggested that when combined, burnout and self-efficacy variables accounted for 7–30% of between-teacher variance in screening scores. Implications for practice and future research are discussed.

No abstract

No abstract