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Nighttime fears in children are common, interfere with daily functioning, and result in considerable disruption in the family. The aim of the present review was to examine empirical literature from the past 25 years that investigated the assessment of nighttime fears in young children and the efficacy and effectiveness of psychosocial treatments for children's nighttime fears. The last review of this literature was in 1997 and examined studies conducted in and prior to 1995 (King et al. in Clin Psychol Rev 17:431–443, 1997). Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic review of the literature aimed at providing a synthesis of the Randomized Control Trials (RCTs) and controlled single-case multiple baseline design studies (MBLs) on the treatment of nighttime fears in children. A search of the literature identified 12 articles, with nine studies utilizing a between-group randomized controlled trial design and three studies utilizing a multiple baseline design. Results demonstrated significant improvements in children’s nighttime fears and reductions in disruptive nighttime behaviors using behavioral interventions and cognitive-behavioral strategies. This review provides a commentary on the effectiveness and limitations of the assessment and treatment approaches for nighttime fears in children and suggests directions for future research.
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Clinical Child and Family Psychology Review (2021) 24:391–413
https://doi.org/10.1007/s10567-021-00354-4
A 25‑Year Review ofNighttime Fears inChildren: Past, Present,
andFuture
KrystalM.Lewis1 · RenathaElRahi‑Ferreira2· GabrielleF.Freitag3· MaryComan4· ThomasH.Ollendick5
Accepted: 25 May 2021 / Published online: 14 June 2021
© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2021
Abstract
Nighttime fears in children are common, interfere with daily functioning, and result in considerable disruption in the family.
The aim of the present review was to examine empirical literature from the past 25years that investigated the assessment of
nighttime fears in young children and the efficacy and effectiveness of psychosocial treatments for children’s nighttime fears.
The last review of this literature was in 1997 and examined studies conducted in and prior to 1995 (King etal. in Clin Psychol
Rev 17:431–443, 1997). Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide-
lines, we conducted a systematic review of the literature aimed at providing a synthesis of the Randomized Control Trials
(RCTs) and controlled single-case multiple baseline design studies (MBLs) on the treatment of nighttime fears in children. A
search of the literature identified 12 articles, with nine studies utilizing a between-group randomized controlled trial design
and three studies utilizing a multiple baseline design. Results demonstrated significant improvements in children’s nighttime
fears and reductions in disruptive nighttime behaviors using behavioral interventions and cognitive-behavioral strategies.
This review provides a commentary on the effectiveness and limitations of the assessment and treatment approaches for
nighttime fears in children and suggests directions for future research.
Keywords Nighttime fears· Children· Dark phobia· Treatment· Assessment
Introduction
Nighttime fears in young children are common, as many
researchers have documented a developmental progression
of normal fears from early childhood into adolescence (Fer-
arri, 1986; Gullone, 2000; Muris etal., 2001). These fears
generally dissolve across development; however, for a signif-
icant number of children, nighttime fears persist and become
pathological (Bauer, 1976; Warren & Sroufe, 2004). Not
only may these fears persist into adolescence, but they can
also have adverse effects on child development, leading to
later anxiety and other diverse forms of child psychopathol-
ogy (Bittner etal., 2007). Indeed, fear of the dark or sleeping
alone constitutes one of the 10 most common fears in chil-
dren between seven and 10years of age (Canals etal., 2019;
Muris etal., 2001). Common fears can extend beyond fear
of being in the dark alone to fear of scary creatures or to bad
things happening at night, and such core fears can change
across development (Muris etal., 2001). Research with non-
clinical samples suggests that 73.3% of children and adoles-
cents report nighttime fears with rates varying depending on
developmental period (Muris etal., 2001). Within clinical
populations, up to 20–30% of children have severe, debili-
tating nighttime fears and sleep difficulties (Bauer, 1976;
Gordon, 2004; Gordon etal., 2007a; Ollendick & Muris,
2015; Sadeh, 2005). Furthermore, up to 15% of referrals for
the treatment of childhood phobias are related to the dark
* Krystal M. Lewis
krystal.lewis@nih.gov
1 National Institute ofMental Health, 9000 Rockville Pike, 10
Center Drive, Bldg.10 RM B1D43S, Bethesda, MD20814,
USA
2 Institute ofPsychiatry, Hospital da Clinicas - Faculty
ofMedicine, University ofSao Paulo, 785 Ovídio Pires de
Campos, SãoPaulo, SP05403903, Brazil
3 Department ofPsychology, Center forChildren andFamilies,
Florida International University, 11200 SW 8th Street,
Miami, FL33199, USA
4 Rochester, MN, USA
5 Department ofPsychology, Child Study Center, Virginia
Polytechnic Institute andState University, Blacksburg,
VA24060, USA
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... The total number of participants was 6,120. Four studies included a variety of anxiety diagnoses (i.e., OAD, SAD, SOP, AG, GAD, AD, SP, school phobia, OCD and PTSD) and only one focused exclusively on nighttime fears (Lewis et al., 2021). The ages of the participants ranged from 3 to 17 years. ...
... All five studies aimed to examine the effectiveness of psychological interventions for the treatment of anxiety disorders. Four reviews included CBT interventions (Gibby et al., 2017;Oldham-Cooper & Loades, 2017;Santacruz et al., 2002) or CBT-based techniques (Lewis et al., 2021), and one included brief, intensive, or concentrated (BIC) treatments (Öst & Ollendick, 2017). The study of Oldham-Cooper & Loades (2017) included CBT along with other therapeutic approaches (e.g., acceptance and commitment therapy, family-based interventions, or educational support). ...
... The psychological interventions reported ranged from 1 (one-session interventions) to 29 sessions, and the duration could last between 1 day and 20 weeks. Three reviews did not report the mean number of sessions and the duration of the treatments (Gibby et al., 2017;Lewis et al., 2021;Oldham-Cooper & Loades, 2017). Three studies reported the professionals providing the interventions: clinical psychologists with high level of expertise (Santacruz et al., 2002); clinical psychologists, counselors, and students (Öst & Ollendick, 2017); and all the aforementioned along with social workers and family therapists (Oldham-Cooper & Loades, 2017). ...
Article
Anxiety disorders are highly prevalent in children and adolescents. The associated functional limitations and the negative psychological consequences have led to increased research into effective psychological interventions. What is missing, however, is a comprehensive review of the literature addressing the effectiveness of these treatments for specific disorders. A systematic review of systematic reviews and meta-analyses evaluating the effectiveness of psychological treatments for specific anxiety disorders in children and adolescents was performed. The study followed PRISMA guidelines. Four bibliographic databases were searched: MEDLINE (PubMed), PsycINFO, Web of Science (Core Collection), and The Cochrane Library. Two authors independently screened the articles by title, abstract, and full-text, according to established inclusion and exclusion criteria. Two independent authors evaluated the methodological quality of the included reviews using AMSTAR-2. Five records were included in this systematic review. Four studies included children and adolescents with specific phobias, generalized anxiety disorder, and separation anxiety disorder and one focused solely on nocturnal fears. Cognitive behavioral therapy-based interventions have been shown to be effective for the treatment of these diagnoses in both short and long term. The methodological quality of the included studies was classified as critically low. Cognitive behavioral interventions are effective in treating specific phobias, generalized anxiety disorder, and separation anxiety disorder and nighttime fears in children and adolescents. The improvement of the methodological quality and the need for further studies focusing on the effectiveness of treatments for specific disorders are discussed.
... In their recent 25-year review of studies into the treatment of children's nighttime fears, Lewis and colleagues [35] conclude that "A goal of clinical scientists should be to expand the accessibility of evidence-based treatment in order to reach as many children and families as possible" (p. 409). ...
Article
Study Objectives Recurrent nightmares in childhood may have a range of detrimental effects for both the child and parents. This randomized controlled trial evaluated the efficacy of a novel parent-based intervention for childhood nightmares, using a new device called the “Dream Changer.” Methods A total of 56 children aged 3–10 years (M = 7.1 ± 2.1 years; 51.8% boys), and one of their parents were randomized to either the intervention or waitlist control group. The intervention group received a “Dream Changer”—a light-emitting remote-control-like device that the child was encouraged to take to bed and use upon experiencing a nightmare. Parents completed online surveys at baseline, 1-week, and 2-weeks following the intervention. Parents in the intervention group additionally completed a 3-month follow-up survey. Outcome variables included children’s nightmare frequency, sleep-wake patterns, and sleep anxiety, as well as parents’ daytime sleepiness. Results Significant group-by-time interaction effects were found for nightmare frequency (p = 0.001) and sleep anxiety (p = 0.006). Parents of children who received the “Dream Changer” reported fewer nightmares (Mdifference = 1.7, p < 0.001, d = 1.06) and decreased anxiety (Mdifference = 0.9, p = 0.001, d =0.41) at post-intervention, whereas such benefits were not found in the waitlist control group. Three-month follow-up assessments demonstrated that gains were maintained over-time. Interaction effects were not significant for children’s sleep metrics or for parents’ daytime sleepiness. Conclusions The present study provides preliminary evidence for the efficacy of a brief, highly accessible intervention for reducing children’s nightmares and nighttime anxiety. Future research may wish to test these effects using larger samples and longer follow-up assessments. Clinical Trial Registration The trial has been registered at the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/; Identifier:ACTRN12620000633987).
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Full-text available
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Background The Online Assessment of Preschool Anxiety (OAPA) is a newly developed measure that assesses anxiety disorders in preschool children aged 3–6 years. This study aimed to explore the OAPA's initial psychometric properties with a particular focus on examining its construct validity, both convergent and discriminant. Method The OAPA was completed online by a community sample of 319 Australian parents of temperamentally inhibited preschool children (M: 5.3 years). Preliminary diagnoses were automatically generated before assessment reports were reviewed by a psychologist. Construct validity was examined by assessing the degree of agreement between the OAPA and existing valid questionnaire measures that were simultaneously administered online. Results Nearly half of participants met criteria for a child anxiety disorder according to the OAPA, most commonly social phobia. Findings supported convergent validity with the Revised Preschool Anxiety Scale (an anxiety symptom measure), the Children's Anxiety Life Interference Scale – Preschool Version (a measure of life interference from anxiety), the Emotional Symptoms scale of the Strengths and Difficulties Questionnaire‐Parent Version (a measure of broader internalizing symptoms), as well as an over‐involved/protective parenting scale. Findings also supported initial discriminant validity with the Conduct Problems scale of the Strengths and Difficulties Questionnaire‐Parent Version. Conclusions Results of this study provide evidence for the OAPA's preliminary construct validity. With further research into the OAPA's reliability (test–retest and interrater) and confirming construct validity, the OAPA may be a useful instrument for use in research settings and clinical practice.