title: Sleep problems and cognitive behavior therapy in pediatric obsessive-compulsive disorder have bidirectional effects.
abstract: OBJECTIVE
  To investigate the presence of sleep problems and their reaction to CBT in pediatric obsessive compulsive disorder (OCD). Moreover, we investigated whether sleep problems predict the outcome of CBT on OCD-symptoms.
  
  
  METHODS
  269 children and adolescents, age 7-17 years, with DSM-IV primary OCD that took part in the first step of a stepwise treatment trial, were assessed with regard to both individual sleep problems and a sleep composite score (SCS) using the Child Behavior Checklist (CBCL). Their OCD symptoms were rated using the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS).
  
  
  RESULTS
  We found elevated symptoms of sleep deprivation and nightmares before treatment. However most sleep problems (e.g. nightmares (p=.03), too little sleep (p<.001), trouble sleeping (p<.001) and parasomnias p=.03)) as well as being over-tired (p<.001) reduced during CBT treatment. Co-morbidities had no effect on the reduction of SCS. Moreover, elevated levels of sleep problems using the SCS (p<.001), as well as any sleep problem at baseline (p<.001) predicted less effect of CBT on the OCD symptoms.
  
  
  CONCLUSIONS
  Sleep problems in paediatric OCD are frequent and interfere with treatment outcome. They need to be assessed using better methods in future trials. Moreover, lack of resolution of sleep problems need to be recognized and treated as it seems probable that continued sleep problems may have a negative impact on CBT efficacy.
authors.affiliation: The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Norway. Electronic address: tord.ivarsson@r-bup.no.
authors.forename: Tord
authors.initials: T
authors.lastname: Ivarsson
authors.affiliation: The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Norway.
authors.forename: Gudmundur
authors.initials: G
authors.lastname: Skarphedinsson
mesh_terms: D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D012893:Sleep Wake Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Cognitive behavior therapy; Insomnia; Obsessive-compulsive disorder; Outcome; Parasomnia; Sleep