New research
Modifying the Impact of Eveningness Chronotype (“Night-Owls”) in Youth: A Randomized Controlled Trial

https://doi.org/10.1016/j.jaac.2018.04.020Get rights and content

Objective

To determine whether an intervention to reduce eveningness chronotype improves sleep, circadian, and health (emotional, cognitive, behavioral, social, physical) outcomes.

Method

Youth aged 10 to 18 years with an evening chronotype and who were “at risk” in 1 of 5 health domains were randomized to: (a) Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C; n = 89) or (b) Psychoeducation (PE; n = 87) at a university-based clinic. Treatments were 6 individual, weekly 50-minute sessions during the school year. TranS-C addresses sleep and circadian problems experienced by youth by integrating evidence-based treatments derived from basic research. PE provides education on the interrelationship between sleep, stress, diet, and health.

Results

Relative to PE, TranS-C was not associated with greater pre−post change for total sleep time (TST) or bed time (BT) on weeknights but was associated with greater reduction in evening circadian preference (pre−post increase of 3.89 points, 95% CI = 2.94−4.85, for TranS-C, and 2.01 points, 95% CI = 1.05−2.97 for PE, p = 0.006), earlier endogenous circadian phase, less weeknight−weekend discrepancy in TST and wakeup time, less daytime sleepiness, and better self-reported sleep via youth and parent report. In terms of functioning in the five health domains, relative to PE, TranS-C was not associated with greater pre−post change on the primary outcome. However, there were significant interactions favoring TranS-C on the Parent-Reported Composite Risk Scores for cognitive health.

Conclusion

For at-risk youth, the evidence supports the use of TranS-C over PE for improving sleep and circadian functioning, and improving health on selected outcomes.

Clinical trial registration information: Triple Vulnerability? Circadian Tendency, Sleep Deprivation and Adolescence. https://clinicaltrials.gov; NCT01828320.

Section snippets

Study Design

Based in a university clinic, from March 2013 to March 2016, youth were randomly assigned, stratified by sex and age (10−14 years, 15−18 years), in a 1:1 parallel group design, to receive either TranS-C or PE. Sibling pairs (n = 3) were randomized to the same condition.

Assessors were blinded to treatment allocation. Sequentially numbered, opaque, sealed envelopes were generated using a computer-generated random number list. A project coordinator conducted randomization after all eligibility

Participant Characteristics

There were no differences in demographic or clinical characteristics between treatment groups at pretreatment (Table 2). There were no significant differences between participants randomized versus excluded for age (p = 0.27) or sex (p = 0.19). There was no group difference in the rate of dropouts during treatment (TranS-C =7.9%, PE = 2.3%; p = 0.09) or follow-up (TranS-C = 1.1%, PE = 3.4%; p = 0.30). The two treatment groups also did not differ with respect to time between treatment sessions (p

Discussion

Relative to PE, TranS-C was associated with a greater decrease in evening circadian preference, an earlier endogenous circadian phase, greater decrease in daytime sleepiness, and greater increase in sleep via the PSQI. This pattern of findings was also observed on the parent-reported CBCL Sleep Composite and on two sleep diary outcomes: weeknight−weekend discrepancy for TST and WUP. In addition, youth who received TranS-C demonstrated significantly longer TST on weeknights (23 minutes) from

References (66)

  • A.G. Harvey et al.

    Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms

    Clin Psychol Rev

    (2011)
  • J. Maslowsky et al.

    Developmental trends in sleep duration in adolescence and young adulthood: evidence from a national United States sample

    J Adolesc Health

    (2014)
  • S.P. Becker et al.

    Convergent validity of the Child Behavior Checklist sleep items with validated sleep measures and sleep disorder diagnoses in children and adolescents referred to a sleep disorders center

    Sleep Med

    (2015)
  • E.O. Poznanski et al.

    Preliminary studies of the reliability and validity of the Children's Depression Rating Scale

    J Am Acad Child Psychiatry

    (1984)
  • J. Kaufman et al.

    Schedule for Affective Disorders and Schizophrenia for School-Age Children−Present and Lifetime Version (K-SADS-PL): initial reliability and validity data

    J Am Acad Child Adolesc Psychiatry

    (1997)
  • J.S. March et al.

    Test-retest reliability of the Multidimensional Anxiety Scale for Children

    J Anxiety Disord

    (1999)
  • M.T. Stephenson et al.

    Brief measures of sensation seeking for screening and large-scale surveys

    Drug Alcohol Depend

    (2003)
  • D.J. Buysse et al.

    The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research

    Psychiatry Res

    (1989)
  • J.S. Silk et al.

    Daily emotional dynamics in depressed youth: a cell phone ecological momentary assessment study

    J Exp Child Psychology

    (2011)
  • G.J. Devilly et al.

    Psychometric properties of the credibility/expectancy questionnaire

    J Behav Ther Exp Psychiatry

    (2000)
  • J.A. Horne et al.

    A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms

    Int J Chronobiol

    (1976)
  • M.A. Carskadon et al.

    Contemporary sleep patterns of adolescents in the USA: results of the 2006 National Sleep Foundation Sleep in America poll

    J Sleep Res

    (2006)
  • T.T. Dang-Vu et al.

    A role for sleep in brain plasticity

    Pediatr Rehabil

    (2006)
  • H. Caci et al.

    Inattentive symptoms of ADHD are related to evening orientation

    J Atten Disord

    (2009)
  • S.S. Gau et al.

    Association between morningness-eveningness and behavioral/emotional problems among adolescents

    J Biol Rhythms

    (2007)
  • R. Clarisse et al.

    Daily rhythmicity of attention in morning- vs. evening-type adolescents at boarding school under different psychosociological testing conditions

    Chronobiol Int

    (2010)
  • A. Adan

    Chronotype and personality factors in the daily consumptions of alcohol and psychostimulants

    Addiction

    (1994)
  • C. Randler

    Differences between smokers and non-smokers in morning-eveningness

    Social Behav Personal

    (2008)
  • A. Adan et al.

    Relationship between circadian typology and functional and dysfunctional impulsivity

    Chronobiol Int

    (2010)
  • N.L. Digdon et al.

    College students who have an eveningness preference report lower self-control and greater procrastination

    Chronobiol Int

    (2008)
  • E.J. Susman et al.

    Morningness/eveningness, morning-to-afternoon cortisol ratio, and antisocial behavior problems during puberty

    Dev Psychol

    (2007)
  • F. Campos-Hirata et al.

    Depression in medical school: the influence of morning-eveningness

    Chronobiol Int

    (2007)
  • S.J. Motivala

    Sleep and inflammation: psychoneuroimmunology in the context of cardiovascular disease

    Ann Behav Med

    (2011)
  • Cited by (83)

    • Sleep and Mood Disorders Among Youth

      2024, Psychiatric Clinics of North America
    View all citing articles on Scopus

    This research was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD071065).

    This study was presented in a keynote at the 47th Annual Congress of the European Association for Behavioural and Cognitive Therapies in Ljubljana, Slovenia, September 13−16, 2017 and World Sleep in Prague, Czech Republic, October 7−11, 2017.

    Drs. Dong and Rabe-Hesketh served as the statistical experts for this research.

    The authors are grateful to the team for their assistance, particularly Emily M. Clark, BA, Brenden Mei, BA, Xin Zhao, BA, Leah M. Miller, BA, O’Min Kwon, BA, Aaron T. Daley, BA, Armando Martinez, BA, Emily Pfannenstiel, BA, Shay O’Brien, MSW, and Jie Jane Chen, BA, of the University of California, Berkeley, for assistance with project co-ordination; Eve Fine, MSW, Davin Duval, MSW, Annie Liang, MSW, Caitlin Eggleston, BA, Deidre Abrons, MFT, and Ania Foster, MFT, of the University of California, Berkeley, for assistance with conducting treatment; Elizabeth Mason, PhD, of the University of New South Wales, Lauren Asarnow, PhD, of Stanford University, and Adriane Soehner, PhD, of the University of Pittsburgh, for assistance with project set-up.

    Disclosure: Dr. Harvey has received research support from the National Institutes of Health and book royalties from American Psychological Association, Guilford Press, and Oxford University Press. Dr. Rabe-Hesketh has received book royalties from Stata Press and Springer. Dr. Wyatt has served as a consultant to Philips-Respironics and has received royalties from UpToDate. Dr. Hinshaw has received book royalties from Cambridge University Press, St. Martin’s Press, Ballantine Books, and Oxford University Press. Dr. Silk has received research support from the National Institutes of Health. Dr. Blum has received research support from Pau Innovation Gift Fund Seed Grant; has served as a consultant to Circadia Technologies; and has received book royalties from Parallax Press. Ms. Dolsen has received research support from the National Institutes of Health. Ms. Gumport has received research support from the National Institutes of Health. Drs. Dong, Kanady, Smith, Thompson and Mss. Hein and Zannone report no biomedical financial interests or potential conflicts of interest.

    View full text