Sleep is a vital physiological behavior in children’s development, and as such it is important to be able to efficiently and accurately assess whether children display difficulties with sleep quality and quantity. The Children’s Sleep Habits Questionnaire [CSHQ; (1)] is one of the most commonly used assessment tools for pediatric sleep. However, this instrument has never been validated against the gold standard of sleep measurement [i.e., polysomnography (PSG)], and studies comparing it to actigraphy are limited. Therefore, the current study assessed the validity of four subscales of the CSHQ via direct comparison with PSG and actigraphy for 30 typically developing school-aged children (ages 6–12). No significant correlations between relevant CSHQ subscales and PSG variables were found. In terms of the actigraphy variables, only the CSHQ Night Wakings subscale achieved significance. In addition, sensitivity and specificity analyses revealed consistently low sensitivity and high specificity. Overall, the CSHQ Sleep Onset Delay, Sleep Duration, Night Wakings, and Sleep Disordered Breathing subscales showed low construct validity and diagnostic validity. These results underscore that caution should be taken when using the CSHQ as the sole screening tool for sleep problems in children.

The current study examined: (1) whether long-acting stimulant medication is effective in improving performance on measures of memory, attention, and academic productivity; and (2) whether sleep impacts the relationship between medication and performance. Participants were 21 newly diagnosed, medication-naïve children (mean age = 9.1 years) with ADHD, who participated in a 4-week blinded placebo-controlled randomized trial of long-acting MPH. Participants underwent assessments of sleep (i.e., polysomnography) and of cognitive performance. Long-acting stimulant medication was found to be an effective treatment for enhancing alerting attention, executive attention, working memory, and academic productivity, but resulted in poorer sleep. Moreover, sleep duration was found to impact the treatment response to medication, in that longer sleep duration at baseline was related to improved executive attention. These results underscore the importance of evaluating and monitoring sleep when prescribing stimulant medication as a treatment for ADHD in children.

The current study investigated the link between poor sleep and ADHD symptomatology. The effects of extending versus restricting sleep on subjective (questionnaires) and objective (actigraphy) measures of daytime movement were examined in 25 typically developing children aged 8-12 years. Subjective measures demonstrated an increase in ADHD symptomology following sleep restriction, with follow-up analyses indicating that findings were due to poorer attention, not changes in hyperactivity. The results of actigraphy data indicated that there were no differences found for mean or median daytime activity, but the standard deviation of activity was found to be significantly higher following sleep restriction. Contrary to the popular belief that sleep restriction results in increased overall activity, this study instead found an increase in variability of activity. This suggests that a sleep-restricted child's activity level may appear as alternating periods of high and low activity levels throughout the day.

This study sought to: (1) compare actigraphy-derived estimated sleep variables to the same variables based on the gold-standard of sleep assessment, polysomnography; (2) examine whether the correlations between the measures differ between children with attention-deficit/ hyperactivity disorder and typically developing children; and (3) determine whether these correlations are altered when children with attention-deficit/hyperactivity disorder are treated with medication. Participants (24 attention-deficit/hyperactivity disorder; 24 typically developing), aged 6-12 years, completed a 1-week baseline assessment of typical sleep and daytime functioning. Following the baseline week, participants in the attention-deficit/hyperactivity disorder group completed a 4-week blinded randomized control trial of methylphenidate hydrochloride, including a 2-week placebo and 2-week methylphenidate hydrochloride treatment period. At the end of each observation (typically developing: baseline; attention-deficit/hyperactivity disorder: baseline, placebo and methylphe-nidate hydrochloride treatment), all participants were invited to a sleep research laboratory, where overnight polysomnography and actigraphy were recorded concurrently. Findings from intra-class correlations and Bland-Altman plots were consistent. Actigraphy was found to provide good estimates (e.g. intra-class correlations >0.61) of polysomnography results for sleep duration for all groups and conditions, as well as for sleep-onset latency and sleep efficiency for the typically developing group and attention-deficit/hyperactivity disorder group while on medication , but not for the attention-deficit/hyperactivity disorder group during baseline or placebo. Based on the Bland-Altman plots, actigraphy tended to underestimate for sleep duration (8.6-18.5 min), sleep efficiency (5.6-9.3%) and sleep-onset latency, except for attention-deficit/hyperactivity disorder during placebo in which actigraphy overestimated (À2.1 to 6.3 min). The results of the current study highlight the importance of utilizing a multimodal approach to sleep assessment in children with attention-deficit/hyperactivity disorder.

e13557 Background: Clinical decision support (CDS) tools may support the delivery of guideline concordant cancer care yet must be integrated into EHR platforms and optimized for clinical workflow. Implementation outcomes are not well-documented in the literature for deployment of CDS tools in community oncology practices. Here we provide best practices for teams looking to implement CDS tools in diverse cancer care settings. Methods: The Automated Heart-Health Assessment (AH-HA-WF-1804CD) study is a clinic-randomized trial coordinated by the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base to support cardiovascular health assessment among cancer survivors. The AH-HA team developed and guided the implementation of the AH-HA tool, an EHR-based CDS visualization of the American Heart Association's Life's Simple 7 modifiable risk factors supplemented with cancer treatment information. Four NCORP clinics were randomized to the intervention arm and implemented the tool within their EHR leveraging Fast Healthcare Interoperable Resources (FHIR) standards and best practice advisories (BPAs). Information technology (IT) team authorization was required prior to randomization. We provided an implementation checklist to each clinic alongside virtual support from experts in implementing CDS for research and operational purposes. We describe our successful CDS tool implementation strategy and report the timeline for implementation at each clinic. Results: Although all clinics utilized the same EHR platform (Epic), clinics differed in terms of their time to approval, implementation, and tool activation, ranging in a total from 4 to 15 months. Although we provided step-by-step guidance for CDS deployment, each site required at least one technical assistance consultation. The estimated cost at each implementation site to deploy the tool, given a range of 40 to 80 hours at $150/hour, was $6,000 to $12,000 US dollars. Conclusions: Strengths of the implementation process included extensive documentation and clear communication of the steps for implementation. Clinics desired flexibility to adapt BPAs to their workflows. Site-level differences may pose challenges for interpretation of study implementation outcomes, including patient-level reach measures. Studies testing the impact of similar CDS tools should plan for clinic-level adaption and consider variability in timelines and assistance needed within the overall study timeline and budget. Clinical trial information: NCT03935282 .