1 Submitted: 1 August, 2019; Revised: 1 October, 2019 © Sleep Research Society 2019. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com. Original Article Behavioral interventions for pediatric insomnia: one treatment may not ft all Michal Kahn 1, *, Michal Juda-Hanael 1 , Efrat Livne-Karp 1 , Liat Tikotzky 2 , Thomas F. Anders 3 and Avi Sadeh 1 1 School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel, 2 Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel and 3 Department of Psychiatry at Brown University, Providence, RI *Corresponding author. Michal Kahn, School of Psychological Sciences, Tel Aviv University, Ramat Aviv 69978, Israel. Email: michalkahn10@gmail.com. Abstract Study Objectives: Behavioral interventions for pediatric insomnia are cost-effective and beneft most families, but there is no evidence indicating which treatments are most suitable for specifc patient populations. This randomized controlled trial evaluated the moderating role of infant separation anxiety in two brief interventions for infant sleep problems. Methods: Ninety-one infants aged 9–18 months (61% boys) with pediatric insomnia were randomized to either Checking-in, a Graduated extinction protocol which involves gradual separation from parents, or to the Camping-out intervention, in which parental presence is maintained. Sleep was measured using actigraphy and parent reports. Infant separation anxiety was observed in the laboratory. Assessments were completed at baseline, post-treatment and 6-month follow-up. Results: Improvement in sleep was demonstrated following both interventions and maintained at follow-up. Separation anxiety did not change signifcantly following treatment. Infant separation anxiety moderated treatment effcacy, with greater beneft for infants with high separation anxiety in the Camping-out compared to the Checking-in intervention. Conclusions: This study provides support for considering infant separation anxiety in the effort to personalize treatment for pediatric insomnia. Pediatricians should incorporate evaluation of infant separation anxiety to assessment processes, and favor more gentle treatment approaches, such as Camping-out, over Graduated extinction for highly anxious infants. Clinical Trial Registration: NCT01489215. Key words: infant sleep; pediatric insomnia; randomized controlled trial; actigraphy; separation anxiety Statement of Signifcance Behavioral interventions for pediatric insomnia, such as Graduated extinction and Camping-out, have a solid base of evidence for improving infant sleep. However, while not all families beneft from treatment, factors that may moderate effcacy have yet to be examined. In this randomized controlled trial infant separation anxiety moderated treatment outcomes, with greater improvement in actigraphic and parent reported wake after sleep onset for infants with high separation anxiety in the Camping-out compared to the Graduated extinction inter- vention. These fndings inform clinicians about the importance of tailoring treatment to specifc patient characteristics, as opposed to the one-treatment-fts-all approach. Future research should test whether infant separation anxiety moderates effcacy of other intervention protocols, and identify additional infant and parent moderators of outcome. SLEEPJ, 2020, 1–9 doi: 10.1093/sleep/zsz268 Advance Access Publication Date: 2 November 2019 Original Article Downloaded from https://academic.oup.com/sleep/article/43/4/zsz268/5611128 by guest on 06 November 2022