Treatment for Sleep Problems in Children with Autism and Caregiver Spillover Effects

Tilford, John M.; Payakachat, Nalin; Kuhlthau, Karen; Pyne, Jeffrey M.; Kovacs, Erica; Bellando, Jayne; Williams, David; Brouwer, Werner; Frye, Richard E.

doi:10.1007/s10803-015-2507-5

Cited by 60 publications

(55 citation statements)

References 53 publications

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“…Notably, the probability of the CCBT+MCI arm being cost-effective lessened when a more restricted NHS perspective was adopted and the gains from reduced school absenteeism and mothers' productivity/employment excluded. This indicates that costs associated with childhood anxiety disorders are likely to be underestimated if a purely healthcare provider perspective is adopted, and it affirms the importance of including wider family/ society born costs and outcomes in mental health economic evaluations (Creswell et al, 2017;Tilford et al, 2015;Tubeuf & Guthmuller, 2017). Despite these potential broader economic benefits, it is important to consider the lack of significant clinical effects of the two active adjunct interventions (MCI/MCBT).…”

Section: Discussionmentioning

confidence: 93%

A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost‐effectiveness outcomes

Creswell

Violato

Cruddace

et al. 2019

Child Psychology Psychiatry

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BackgroundThis study evaluated whether clinical and economic outcomes from CBT for child anxiety disorders in the context of maternal anxiety disorders are improved by adding treatment focused on (a) maternal anxiety disorders or (b) mother–child interactions.MethodsTwo hundred and eleven children (7–12 years, 85% White British, 52% female) with a primary anxiety disorder, whose mothers also had a current anxiety disorder, were randomised to receive (a) child‐focused CBT with nonspecific control interventions (CCBT+Con), (b) CCBT with CBT for the maternal anxiety disorder (CCBT+MCBT), or (c) CCBT with an intervention targeting the mother–child interaction (CCBT+MCI). A cost‐utility analysis from a societal perspective was conducted using mother/child combined quality‐adjusted life years (QALYs). [Trial registration: https://doi.org/10.1186/isrctn19762288].Results MCBT was associated with immediate reductions in maternal anxiety compared to the nonspecific control; however, after children had also received CCBT, maternal outcomes in the CCBT+MCI and CCBT+Con arms improved and CCBT+MCBT was no longer superior. Neither CCBT+MCBT nor CCBT+MCI conferred a benefit over CCBT+Con in terms of child anxiety disorder diagnoses post‐treatment [primary outcome] (adj RR: 1.22 (95% CI: 0.88, 1.67), p = .23; adj RR: 1.21 (95% CI: 0.88, 1.65), p = .24, respectively) or global improvement ratings (adj RR: 1.25 (95% CI: 0.99, 1.57), p = .06; adj RR: 1.18 (95% CI: 0.93, 1.50), p = .17) or six and 12 months later. No significant differences between the groups were found on the main economic outcome measures (child/mother combined QALY mean difference: CCBT+MCBT vs. CCBT+Con: −0.04 (95% CI: −0.12, 0.04), p = .29; CCBT+MCI vs. CCBT+Con: 0.02 (95% CI: −0.05, −0.09), p = .54). CCBT+MCI was associated with nonsignificantly higher costs than CCBT (mean difference: £154 (95% CI: −£1,239, £1,547), p = .83) but, when taking into account sampling uncertainty, it may be cost‐effective compared with CCBT alone.ConclusionsGood outcomes were achieved for children and their mothers across treatment arms. There was no evidence of significant clinical benefit from supplementing CCBT with either CBT for the maternal anxiety disorder or treatment focussed on mother–child interactions, but the addition of MCI (and not MCBT) may be cost‐effective.

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Section: Discussionmentioning

confidence: 93%

A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost‐effectiveness outcomes

Creswell

Violato

Cruddace

et al. 2019

Child Psychology Psychiatry

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“…Addressing COCs can be just as important as the underlying diagnosis of ASD. For example, sleep disruption can decrease the quality of life for both the child and the parent [Tilford et al, ]. Most importantly, early morbidity and mortality in individuals with ASD may be related to COCs [Hirvikoski et al, ], particularly epilepsy [Pickett, Xiu, Tuchman, Dawson, & Lajonchere, ] and psychiatric conditions [Hirvikoski et al, ].…”

Section: Introductionmentioning

confidence: 99%

Clustering of co‐occurring conditions in autism spectrum disorder during early childhood: A retrospective analysis of medical claims data

et al. 2019

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Individuals with autism spectrum disorder (ASD) are frequently affected by co-occurring medical conditions (COCs), which vary in severity, age of onset, and pathophysiological characteristics. The presence of COCs contributes to significant heterogeneity in the clinical presentation of ASD between individuals and a better understanding of COCs may offer greater insight into the etiology of ASD in specific subgroups while also providing guidance for diagnostic and treatment protocols. This study retrospectively analyzed medical claims data from a private United States health plan between years 2000 and 2015 to investigate patterns of COC diagnoses in a cohort of 3,278 children with ASD throughout their first 5 years of enrollment compared to 279,693 children from the general population without ASD diagnoses (POP cohort). Three subgroups of children with ASD were identified by k-means clustering using these COC patterns. The first cluster was characterized by generally high rates of COC diagnosis and comprised 23.7% (n = 776) of the cohort. Diagnoses of developmental delays were dominant in the second cluster containing 26.5% (n = 870) of the cohort. Children in the third cluster, making up 49.8% (n = 1,632) of the cohort, had the lowest rates of COC diagnosis, which were slightly higher than rates observed in the POP cohort. A secondary analysis using these data found that gastrointestinal and immune disorders showed similar longitudinal patterns of prevalence, as did seizure and sleep disorders. These findings may help to better inform the development of diagnostic workup and treatment protocols for COCs in children with ASD.Lay Summary: Medical conditions that co-occur with autism spectrum disorder (ASD) vary significantly from person to person. This study analyzed patterns in diagnosis of co-occurring conditions from medical claims data and observed three subtypes of children with ASD. These results may aid with screening for co-occurring conditions in children with ASD and with understanding ASD subtypes.

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“…We see this as a relatively low-cost intervention, which is costeffective in terms of reducing child sleep problems. While there are no available benchmarks for the value of a percentage point change in child sleep problems, Tilford et al (2015) provide estimates of the association of child sleep problems measured by CSHQ with significant impacts on child and family wellbeing. Applying these estimates to the change in CSHQ seen here estimates the value of our intervention at AUD750 using the common Australian benchmark of AUD50000 per quality adjusted life year.…”

Section: Discussionmentioning

confidence: 99%

Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: a cluster‐randomized, translational trial

Hiscock

Mulraney

Heussler

et al. 2019

Child Psychology Psychiatry

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Background:We have demonstrated the efficacy of a brief behavioral intervention for sleep in children with ADHD in a previous randomized controlled trial and now aim to examine whether this intervention is effective and costeffective when delivered by pediatricians or psychologists in community settings. Methods: Translational, clusterrandomized trial of a behavioral intervention versus usual care from 19th January, 2015 to 30th June, 2017. Participants (n = 361) were children aged 5-13 years with ADHD and parent report of a moderate/severe sleep problem who met criteria for American Academy of Sleep Medicine criteria for chronic insomnia disorder, delayed sleep-wake phase disorder, or were experiencing sleep-related anxiety. Participants were randomized at the level of the pediatrician (n = 61) to intervention (n = 183) or usual care (n = 178). Families in the intervention group received two consultations with a pediatrician or a psychologist covering sleep hygiene and tailored behavioral strategies. Results: In an intention-to-treat analysis, at 3 and 6 months respectively, the proportion of children with moderate to severe sleep problems was lower in the intervention (28.0%, 35.8%) compared with usual care group (55.4%, 60.1%; 3 month: risk ratio (RR): 0.51, 95% CI 0.37, 0.70, p < .001; 6 month: RR: 0.58; 95% CI 0.45, 0.76, p < .001). Intervention children had improvements across multiple Children's Sleep Habits Questionnaire subscales at 3 and 6 months. No benefits of the intervention were observed in other domains. Cost-effectiveness of the intervention was AUD 13 per percentage point reduction in child sleep problem at 3 months. Conclusions: A low-cost brief behavioral sleep intervention is effective in improving sleep problems when delivered by community clinicians. Greater sample comorbidity, lower intervention dose or insufficient clinician supervisions may have contributed to the lack benefits seen in our previous trial.

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Treatment for Sleep Problems in Children with Autism and Caregiver Spillover Effects

Cited by 60 publications

References 53 publications

A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost‐effectiveness outcomes

A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost‐effectiveness outcomes

Clustering of co‐occurring conditions in autism spectrum disorder during early childhood: A retrospective analysis of medical claims data

Impact of a behavioral intervention, delivered by pediatricians or psychologists, on sleep problems in children with ADHD: a cluster‐randomized, translational trial

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