This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Generalized Anxiety Disorder (GAD) is among the most common anxiety disorders in children and is associated with impairments in multiple areas of functioning including academic, occupational, social, familial, and psychological domains. In addition to chronic worry and somatic complaints, patients with GAD frequently experience insomnia (defined as difficulty initiating and/or maintaining sleep). Although well-recognized in up to 70% of adults with the disorder, only recently has research begun to examine the extent of sleep disturbance in children. Preliminary research conducted by the PI and consultants based on both subjective and objective assessment indicates that 90% children with GAD experience sleep problems (Alfano, Ginsburg &Kingery, 2007;Forbes et al., 2008). However, in the absence of controlled, prospective studies, the persistence and severity of these problems are unknown. In otherwise healthy children, persistent sleep disturbance is associated with functional impairment including academic failure (Kahn et al., 1989), deficits in working memory and attention (Bruni et al., 2005;Steenari et al., 2003), decreased emotion regulation (Leotta et al.,1997;Wolfson &Carskadon, 1998), and injury risk (Owens et al., 2005). The presence of persistent sleep disturbance among children with GAD may therefore compound existing impairments in daytime functioning, exacerbate anxiety symptoms, and result in lower recovery rates. The current study will use both naturalistic and laboratory-based methods of assessment to evaluate the persistence, severity and features of sleep disturbance in children with GAD, including relationships with anxiety symptoms and impairments in functioning. Shared and unique factors associated with sleep disturbance also will be investigated including neurophysiological and cognitive dimensions of pre-sleep arousal, and parenting and environmental factors. Findings from this study may serve to identify children at risk for the later development of insomnia and GAD, as well as specific targets for clinical research and practice.
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