title: Parental functioning and pediatric sleep disturbance: an examination of factors associated with parenting stress in children clinically referred for evaluation of insomnia.
abstract: BACKGROUND
  Parenting stress is an aspect of parent functioning relevant in clinical settings. Within the context of behavioral sleep medicine, the role of parenting stress is not well understood.
  
  
  METHODS
  Prospective evaluation of patients 1.5-10 years old with insomnia. Subjects were 156 primary caregiver-child pairs who completed the Parenting Stress Index-Short Form (PSI-SF), Child Sleep Habits Questionnaire (CSHQ) and Child Behavior Checklist (CBCL).
  
  
  OBJECTIVE
  (1) determine prevalence of clinically significant parenting stress in primary caregivers of children clinically referred for insomnia; (2) identify childhood sleep problems that play a role in parenting stress; (3) identify relevant correlates of parenting stress within the context of a behavioral sleep medicine clinic; and (4) identify the most salient child sleep and behavioral variables associated with parenting stress.
  
  
  RESULTS
  Forty-seven percent of primary caregivers had clinically significant parenting stress. When examining the relationship between child sleep problems and parenting stress, bedtime resistance (p=0.030) and daytime sleepiness (p=0.0003) stood alone as having the most salient associations with parenting stress. When considering a broader range of covariates (child age and child gender) and clinically relevant variables (parent history of sleep problems, parent history of psychiatric conditions, child behavior problems and child sleep problems) in a single regression equation, both child externalizing behavior problems (β=0.570, p<0.0001) and child daytime sleepiness (β=0.152, p=0.028) independently explained significant variability in parenting stress.
  
  
  CONCLUSIONS
  Many primary caregivers of children clinically-referred for insomnia evaluation and treatment have significant parenting stress. Parenting stress is associated with daytime behavioral problems and sleepiness in children with insomnia. Clinicians working with pediatric insomnia patients should carefully evaluate parenting stress and child daytime behavior as these aspects of functioning may have an impact on service delivery and treatment outcomes.
authors.affiliation: Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH 45229-3039, USA. Kelly.Byars@cchmc.org
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Byars
authors.forename: Gloria
authors.initials: G
authors.lastname: Yeomans-Maldonado
authors.forename: Jennie G
authors.initials: JG
authors.lastname: Noll
mesh_terms: D000328:Adult; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D015995:Prevalence; D011584:Psychology; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology* / Q000523:psychology*; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires