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Although polysomnography is the gold standard for recording sleep, the use of actigraphy in conjunction with a sleep diary is now common in the study of sleep/wake patterns in infants, children, and adolescents. Actigraphy has the advantage of being able to record data over long periods of time while the subject carries out his or her normal routine. The devices are small, lightweight, and can be worn on the wrist in a similar manner to a wristwatch, or on the ankle as is often used in infant studies. A number of studies have validated actigraphy against polysomnography for determining sleep and found good agreements; however, the specificity for determining wake is low across all ages of children. In conjunction with a sleep diary, the accuracy of actigraphy is significantly improved. Conversely, accuracy of parental reporting of sleep and wake using a sleep diary can be significantly improved when used in conjunction with actigraphy. The use of actigraphy in clinical medicine is expanding as it provides important supplementary information to clinicians regarding a variety of sleep disorders.

Understanding that antisocial personality disorder and psychopathy are distinct but related constructs is crucial to clinical and forensic assessment of these patients. This article describes the use of the Hare Psychopathy Checklist-Revised, Rorschach, and Minnesota Multiphasic Personality Inventory (MMPI) for a comprehensive evaluation of these patients. These measures lend incremental validity to understanding these difficult patients, especially when combined with testing of intelligence and cognitive functioning. Integrating data from multiple domains is essential to answering the psycholegal and forensic treatment questions surrounding the antisocial and psychopathic patient. The forensically trained clinical psychologist is best suited to assess psychopathy, a task that historically has been overlooked or avoided in traditional mental health settings.

This chapter will focus on methods used to measure the endogenous circadian timing system in a pediatric population. To provide a basic understanding of the system that is being measured, the chapter begins by reviewing basic circadian terms and physiology. Then, behavioral measures, which are often associated with daily rhythms and can be used as global estimates of the circadian system, are reviewed. The focus will subsequently shift to physiological measures of the circadian system, with a specific focus on the endogenous rhythm of melatonin because currently it is the most commonly used physiological measure in human circadian research. The chapter will conclude with a brief description of how these physiological measures are used to make inferences about the central circadian clock. These circadian measures may complement and inform research studies relevant to health and behavior during development.

Behavioral sleep medicine (BSM) is defined by the Society of Behavioral Sleep Medicine (SBSM) as “the field of clinical practice and scientific inquiry that encompasses the study of behavioral, psychological, and physiological factors underlying normal and disordered sleep across the lifespan; and, the development and application of evidence-based behavioral and psychological approaches to the prevention and treatment of sleep disorders and co-existing conditions.” BSM plays an integral role in the assessment and treatment of a variety of sleep disorders and patient populations. Thus, training of BSM practitioners has become an increasingly important focus for the field of BSM. Formal training is best accomplished through accredited BSM training programs. In lieu of participating in an accredited BSM training program, two tracks have been established to allow qualified individuals to take the BSM credentialing examination. BSM practitioners have an important role in comprehensive sleep disorders centers, particularly in pediatric populations, and play a critical role in the diagnosis and treatment of sleep disorders. This chapter will provide an overview of BSM, information on BSM training and credentialing, and the role of BSM in sleep laboratories.

Behavior analysis is the scientific study of those interactions between individuals and their environment responsible for behavior change. Behavioral assessment and functional analysis are procedures that identify and quantify the causal and outcome variables in the behavior change process. This chapter summarizes a behavior analysis model of sleep in infants and children and discusses behavioral assessment and functional analysis as applied in family contexts to understanding and treating children’s sleep problems. It explains some key attributes of behavior analysis as a domain within psychology, shows how behavior analysis provides insight into the moment-by-moment interactional processes that contribute to the origin and maintenance of children’s sleep problems, and supplies a rationale for intervention guided by functional behavioral assessment and analysis.

With the increasing recognition of pediatric sleep disorders, there is a growing demand for pediatric sleep medicine services, including polysomnography (PSG). Treating a child’s and parent’s emotional, developmental, and psychosocial needs simultaneously with their medical needs has a significant positive and lasting impact on them, improving their future health care experiences and overall family satisfaction. This chapter will present the Rainbow Comfort Measures© (RCM©) model of care and how the model’s guiding principles can be effectively integrated in a pediatric sleep center’s operations and clinical practices. Practical interventions and coping strategies, integral to RCM©, will also be discussed. By incorporating these foundational principles into a pediatric sleep center’s standard of care, a parent and child’s anxiety will decrease and their understanding, cooperation, achievement, self-control, and self-esteem will be enhanced. Additionally, the sleep center staff’s knowledge base and confidence will be strengthened, the ability to gather high quality PSG data will improve, and overall patient satisfaction scores will increase.

Researchers have increasingly identified the ages of 17–23 as a separate developmental stage, referred to as “emerging adulthood,” distinct from our understanding of what it is to be in adolescence or to have reached adulthood. This chapter extends and deepens what is known about treating adults and middle adolescent patient populations to clarify the practice parameters in treating the late adolescent/emerging adult (LA/EA). With a focus on sleep disorders that will appear in this population, the chapter also highlights important developmental elements such as the LA/EA’s consideration of risk and reward, approaches to decision making, and goal-directed behaviors. Both practical and contextual aspects of clinical practice are outlined for the clinician with respect to the unique demands of this clientele.