Background The relationship between inadequate sleep and mood has been well-established in adults and is supported primarily by correlational data in younger populations. Given that adolescents often experience shortened sleep on school nights, we sought to better understand the effect of experimentally-induced chronic sleep restriction on adolescents’ mood and mood regulation. Methods Fifty healthy adolescents, ages 14 to 17, completed a three-week sleep manipulation protocol involving a baseline week, followed by a sleep restriction (SR) condition (6.5 hours in bed per night for five nights) and healthy sleep duration (HS) condition (10 hours in bed per night for five nights). The study used a randomized, counterbalanced, cross-over experimental design. Participants’ sleep was monitored at home via self-report and actigraphy. At the end of each condition, participants and their parents completed questionnaires of mood and mood regulation. To assess for expectancy effects, we also analyzed parent and teen ratings of hyperactivity/impulsivity, which prior research suggests is not sensitive to SR in adolescents. Wilcoxon Signed Rank tests compared questionnaire outcomes across the two conditions. Results Participants averaged 2.5 more hours of sleep per night during HS relative to SR. Compared to HS, adolescents rated themselves as significantly more tense/anxious, angry/hostile, confused, and fatigued, and as less vigorous (p = .001–.01) during SR. Parents and adolescents also reported greater oppositionality/irritability and poorer emotional regulation during SR compared to HS (p < .05). There were no cross condition differences in depression or hyperactivity/impulsivity (p > .05). Conclusions Findings complement prior correlational study results to show that after only a few days of shortened sleep, at a level of severity that is experienced regularly by millions of adolescents on school nights, adolescents have worsened mood and decreased ability to regulate negative emotions.

This review examines recent advances in sample size planning, not only from the perspective of an individual researcher, but also with regard to the goal of developing cumulative knowledge. Psychologists have traditionally thought of sample size planning in terms of power analysis. Although we review recent advances in power analysis, our main focus is the desirability of achieving accurate parameter estimates, either instead of or in addition to obtaining sufficient power. Accuracy in parameter estimation (AIPE) has taken on increasing importance in light of recent emphasis on effect size estimation and formation of confidence intervals. The review provides an overview of the logic behind sample size planning for AIPE and summarizes recent advances in implementing this approach in designs commonly used in psychological research.

IMPORTANCE Early, safe, effective, and durable evidence-based interventions for children and adolescents with chronic migraine do not exist.OBJECTIVE To determine the benefits of cognitive behavioral therapy (CBT) when combined with amitriptyline vs headache education plus amitriptyline. DESIGN, SETTING, AND PARTICIPANTSA randomized clinical trial of 135 youth (79% female) aged 10 to 17 years diagnosed with chronic migraine (Ն15 days with headache/month) and a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points were assigned to the CBT plus amitriptyline group (n = 64) or the headache education plus amitriptyline group (n = 71). The study was conducted in the Headache Center at Cincinnati Children's Hospital between October 2006 and September 2012; 129 completed 20-week follow-up and 124 completed 12-month follow-up.INTERVENTIONS Ten CBT vs 10 headache education sessions involving equivalent time and therapist attention. Each group received 1 mg/kg/d of amitriptyline and a 20-week end point visit. In addition, follow-up visits were conducted at 3, 6, 9, and 12 months. MAIN OUTCOMES AND MEASURESThe primary end point was days with headache and the secondary end point was PedMIDAS (disability score range: 0-240 points; 0-10 for little to none, 11-30 for mild, 31-50 for moderate, >50 for severe); both end points were determined at 20 weeks. Durability was examined over the 12-month follow-up period. Clinical significance was measured by a 50% or greater reduction in days with headache and a disability score in the mild to none range (<20 points).RESULTS At baseline, there were a mean (SD) of 21 (5) days with headache per 28 days and the mean (SD) PedMIDAS was 68 (32) points. At the 20-week end point, days with headache were reduced by 11.5 for the CBT plus amitriptyline group vs 6.8 for the headache education plus amitriptyline group (difference, 4.7 [95% CI, 1.7-7.7] days; P = .002). The PedMIDAS decreased by 52.7 points for the CBT group vs 38.6 points for the headache education group (difference, 14.1 [95% CI, 3.3-24.9] points; P = .01). In the CBT group, 66% had a 50% or greater reduction in headache days vs 36% in the headache education group (odds ratio, 3.5 [95% CI, 1.7-7.2]; P < .001). At 12-month follow-up, 86% of the CBT group had a 50% or greater reduction in headache days vs 69% of the headache education group; 88% of the CBT group had a PedMIDAS of less than 20 points vs 76% of the headache education group. Measured treatment credibility and integrity was high for both groups.CONCLUSIONS AND RELEVANCE Among young persons with chronic migraine, the use of CBT plus amitriptyline resulted in greater reductions in days with headache and migraine-related disability compared with use of headache education plus amitriptyline. These findings support the efficacy of CBT in the treatment of chronic migraine in children and adolescents.

We evaluated the efficacy of a 6-month clinic and home-based behavioral intervention (Learning about Activity and Understanding Nutrition for Child Health; LAUNCH) to reduce obesity in preschool children ≥95th BMI percentile compared to enhanced standard of care (Pediatrician Counseling; PC). LAUNCH was a family-based behavioral intervention that taught parents to use child behavior management strategies to increase healthy eating and activity for their children and themselves. PC presented the same diet and activity recommendations, but was delivered in a one-time PC session. Eighteen children aged 2–5 years (mean 4.71 ± 1.01) with an average BMI percentile of 98 (±1.60) and an overweight parent were randomized to LAUNCH or PC. Assessments were conducted at baseline, 6 months (end of LAUNCH treatment) and 12 months (6 months following LAUNCH treatment). LAUNCH showed a significantly greater decrease on the primary outcomes of child at month 6 (post-treatment) BMI z (−0.59 ± 0.17), BMI percentile (−2.4 ± 1.0), and weight gain (−2.7 kg ± 1.2) than PC and this difference was maintained at follow-up (month 12). LAUNCH parents also had a significantly greater weight loss (−5.5 kg ± 0.9) at month 6 and 12 (−8.0 kg ± 3.5) than PC parents. Based on the data from this small sample, an intensive intervention that includes child behavior management strategies to improve healthy eating and activity appears more promising in reducing preschool obesity than a low intensity intervention that is typical of treatment that could be delivered in primary care.

Introduction Deteriorating type 1 diabetes management and control are common among adolescents, yet clinical evidence suggests that individual trajectories can vary. The aim of this study was to examine patterns and predictors of blood glucose monitoring (BGM) frequency and glycemic control (A1c). Methods Prospective data analysis spanning 18–24 months with 150 adolescent-parent pairs. Latent group-based trajectory modeling identified subgroups and determined medical, demographic, psychological, and family predictors of subgroup membership. Results Three subgroups emerged, representing diabetes management and control that is “meeting treatment targets” (40%; A1c at baseline= 7.4%, blood glucose monitoring (BGM) frequency at baseline = 4.8 checks/day) and two levels “not meeting targets”: “normatively similar” youth (40%; A1c = 9.2%, BGM frequency = 2.8 checks/day), and “high risk” youth (20%; A1c = 11.2%, BGM frequency = 2.9 checks/day). Subgroup membership was maintained over 18–24 months. There was minimal change across time, although only one-third met treatment targets. Older age, longer diabetes duration, ethnic minority status, unmarried caregiver status, insulin delivery via injections vs. CSII, greater depressive symptoms, negative affect about BGM, and diabetes-specific family conflict each predicted membership in a subgroup with poorer diabetes management and control. Conclusions Among the nearly two-thirds of adolescents with management and control that do not meet treatment targets, modifiable and non-modifiable factors may signal the need for prevention or intervention. Demographic and medical factors may call for proactive efforts to prevent deterioration, while psychological symptoms and family conflict signal opportunities for clinical intervention to promote improved diabetes management and control in adolescence.

WHAT'S KNOWN ON THIS SUBJECT: Sleep problems are common during childhood, but screening for sleep problems in the clinic setting is often cursory. Moreover, there are few longitudinal studies examining the prevalence and persistence of sleep problems in young children. WHAT THIS STUDY ADDS:Patterns of sleep problems vary across early development, but sleep problems arising in infancy persist in 21% of children through 36 months of age. Parent response to a nonspecific query about sleep problems may overlook relevant sleep symptoms and behaviors. abstract OBJECTIVE: Examine the prevalence, patterns, and persistence of parent-reported sleep problems during the first 3 years of life. METHODS:Three hundred fifty-nine mother/child pairs participated in a prospective birth cohort study. Sleep questionnaires were administered to mothers when children were 6, 12, 24, and 36 months old. Sleep variables included parent response to a nonspecific query about the presence/absence of a sleep problem and 8 specific sleep outcome domains: sleep onset latency, sleep maintenance, 24-hour sleep duration, daytime sleep/naps, sleep location, restlessness/vocalization, nightmares/night terrors, and snoring. RESULTS:Prevalence of a parent-reported sleep problem was 10% at all assessment intervals. Night wakings and shorter sleep duration were associated with a parent-reported sleep problem during infancy and early toddlerhood (6-24 months), whereas nightmares and restless sleep emerged as associations with report of a sleep problem in later developmental periods (24-36 months). Prolonged sleep latency was associated with parent report of a sleep problem throughout the study period. In contrast, napping, sleep location, and snoring were not associated with parent-reported sleep problems. Twenty-one percent of children with sleep problems in infancy (compared with 6% of those without) had sleep problems in the third year of life.CONCLUSIONS: Ten percent of children are reported to have a sleep problem at any given point during early childhood, and these problems persist in a significant minority of children throughout early development. Parent response to a single-item nonspecific sleep query may overlook relevant sleep behaviors and symptoms associated with clinical morbidity. Pediatrics 2012;129:e276-e284 AUTHORS:

Key Points Question Does the disproportionate increase in suicide rates among female youth indicate a narrowing of the historically large gap between male and female youth in suicide? Findings This cross-sectional study of 85 051 youth suicide deaths found a significant reduction in the gap between male and female rates of suicide among youth aged 10 to 19 in the United States, with the most pronounced narrowing in younger individuals. Female suicide rates by hanging or suffocation are approaching those of male youth, and significant differences by race/ethnicity also exist. Meaning A narrowing gap between male and female youth suicide rates underscores the importance of early suicide prevention efforts that take both sex and developmental level into consideration.

Methods for planning sample size (SS) for the standardized mean difference so that a narrow confidence interval (CI) can be obtained via the accuracy in parameter estimation (AIPE) approach are developed. One method plans SS so that the expected width of the CI is sufficiently narrow. A modification adjusts the SS so that the obtained CI is no wider than desired with some specified degree of certainty (e.g., 99% certain the 95% CI will be no wider than ). The rationale of the AIPE approach to SS planning is given, as is a discussion of the analytic approach to CI formation for the population standardized mean difference. Tables with values of Keywords: sample size planning, standardized mean difference, accuracy in parameter estimation, power analysis, precision analysis One of the simplest measures of effect is the difference between two independent group means. It is this difference that is evaluated with the two-group t test to infer whether the population difference between two group means differs from some specified null value, which is generally set to zero. However, in the behavioral, educational, and social sciences, units of measurement are often arbitrary, different researchers might measure the same phenomenon with different scalings of the same instrument, or different instruments altogether might be used. Because of the lack of standard measurement scales and procedures for most behavioral, educational, and social phenomena, the ability to compare measures of effect across different situations has led many researchers to use standardized measures of effect. Measures of effect, or effect sizes, that are standardized yield scale-free numbers that are not wedded to a specific instrument or scaling metric. Given the measurement issues in behavioral, educational, and social research, such standardized effect sizes provide what is arguably the optimal way to estimate the size of an effect, along with its corresponding confidence interval, for a more communal knowledge base to be developed and so that the results from different studies can be compared more readily.A commonly used and many times intuitively appealing effect size is the standardized mean difference.