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Many studies have provided strong evidence of a fundamental and complex role for sleep disturbances in adult posttraumatic stress disorder (PTSD). Investigations of adult PTSD using subjective and objective measures document sleep architecture abnormalities and high prevalence of sleep disordered breathing, periodic limb movement disorder, nightmares, and insomnia. PTSD treatment methods do appear to significantly improve sleep disturbance, and also studies suggest that treatments for sleep disorders often result in improvements in PTSD symptoms. Further, the most recent evidence suggests sleep abnormalities may precede the development of PTSD. Given the importance of sleep disorders to the onset, course, and treatment of adult PTSD, examination of sleep disturbances far earlier in the life course is imperative. Here we review the literature on what we know about sleep disturbances and disorders in pediatric PTSD. Our review indicates that the extant, empirical data examining sleep disturbance and disorders in pediatric PTSD is limited. Yet, this literature suggests there are significantly higher reports of sleep disturbances and nightmares in children and adolescents exposed to trauma and/or diagnosed with PTSD than in non-trauma-exposed samples. Sleep questionnaires are predominantly employed to assess sleep disorders in pediatric PTSD, with few studies utilizing objective measures. Given the important, complex relationship being uncovered between adult PTSD and sleep, this review calls for further research of sleep in children with PTSD using more specific subjective measures and also objective measures, such as polysomnography and eventually treatment trial studies.
Kovachy B; O'Hara R; Hawkins N; Gershon A; Primeau MM; Madej J; Carrion V. Sleep disturbance in pediatric PTSD: current findings and future directions. J Clin Sleep Med 2013;9(5):501-510.
Traditionally, sleep disorders have been understood as a secondary symptom of posttraumatic stress disorder (PTSD). Further, it was presumed that treatment of the overarching PTSD disorder would eliminate these sleep disturbances.1 Studies now suggest that sleep disturbances, including insomnia, nightmares, sleep disordered breathing (SDB), and periodic limb movement (PLM), play a central, complex role in PTSD with accompanying diagnostic, treatment, and neurobiological implications. However, far more empirical data exist on the prevalence and nature of sleep disturbances in adults diagnosed with PTSD than in youth diagnosed with PTSD.
Sleep disturbances are a frequent occurrence in adults with PTSD, with one study finding 70% to 91% of PTSD patients have sleep disturbances.2 In a comparison to healthy controls, patients with PTSD report much higher initial, middle, and terminal insomnia.3,4 Ohayon and Shapiro found that 18.8% of patients with PTSD reported nightmares, as opposed to their non-patient comparison group, in which only 4.2% reported nightmares.4 SDB and PLM are sleep disorders that have also been frequently observed among PSTD patients. Sleep architecture profiles also appear different in patients with PTSD (for review see Kobayashi5).
Further, after a trauma, individuals who would develop PTSD experienced shorter, more frequent REM sleep periods, which were associated with both insomnia and PTSD severity.6,7 Similarly, a prospective investigation of car accident victims revealed that severity of sleep complaints 1 month after the accident was significantly associated with the subsequent development of PTSD a year after the accident.8 The culminating evidence from investigations of adults with PTSD suggests that not only are specific sleep disorders and specific sleep architecture profiles more prevalent in PTSD, they may also precede and/or predict the development and severity of PTSD.6–12
Further evidence of the important yet complex relationship between sleep disturbances and adult PTSD stems from treatment results for both disorders.13 Evidence suggests that although PTSD-focused treatment may lead to some improvement in co-occurring sleep disorders, it does not lead to complete remission of the sleep disorder and may also leave patients vulnerable to recurrence of PTSD symptoms.14,15 These findings highlight the intrinsic severity of sleep problems, or alternatively, our gap in knowledge in identifying targets for sleep treatments. They also challenge the notion that sleep disorders in PTSD are merely secondary symptoms best treated by treatment of the overarching disorder.
The utilization of specific treatments for sleep disturbances that accompany PTSD appears to lead to significant improvements in both sleep disturbances and global PTSD symptoms.13,16–19 For example, the use of the drug prazosin to treat sleep disturbances significantly improved nightmare severity, insomnia, and also other PTSD symptom clusters such as re-experiencing and hyperarousal (measured by the Clinician-Administered PTSD Scale) in comparison to controls.20 In a placebo-controlled trial, Germain et al. found that treatment of sleep disturbances with prazosin or cognitive behavioral therapy (CBT) improved sleep disturbances and daytime PTSD symptoms in a sample of veterans (n = 50).21 Ulmer et al. found that the use of CBT for insomnia and imagery rehearsal therapy for nightmares significantly reduced insomnia and global PTSD symptoms.22 Similarly, treatment of SDB with continuous positive airway pressure has been found to reduce nightmares and improve overall PTSD symptoms.17,23 Given that poor sleep quality is associated with increased stress and anxiety, perhaps sleep treatments are successful in reducing global symptoms of PTSD because improvements in sleep quality result in improved resilience to new stressors and, in turn, reduced stress and anxiety. Taken together, these studies indicate the importance of targeting sleep disturbances to successfully treat PTSD and further suggest a fundamental role of sleep dysregulation in the maintenance of PTSD.16–24
In sum, the literature from adult studies of PTSD suggest that (a) sleep disturbances, particularly nightmares, are frequent symptoms of PTSD; (b) sleep disturbances often occur following a trauma prior to PTSD onset and may confer increased vulnerability for development of PTSD; (c) sleep disturbances predict global PTSD symptom severity; (d) sleep disturbances are often a residual symptom following treatment of PTSD; and (e) treatment of sleep disorders yields strong improvement in PTSD symptoms. Given the importance of sleep disorders to the onset, course, and treatment of adult PTSD, examination of sleep disturbances far earlier in the life course is imperative. Sleep disturbances may serve as a critical bio-marker for the development of pediatric PTSD. Indeed, sleep disturbances in childhood may increase the vulnerability for developing PTSD at any stage of the lifespan. At least, identification of the types of sleep disturbances and/or sleep disorders that occur in pediatric PTSD can provide key therapeutic targets, as most sleep disorders have available treatments. By normalizing sleep patterns, such treatments may in turn alleviate the symptoms of PTSD. Here we summarize the main findings on sleep in pediatric PTSD.
Currently, our knowledge about the fundamental sleep disorders, sleep dysregulation, and sleep architecture abnormalities that occur in children with PTSD is limited. Few studies have investigated the prevalence of pediatric PTSD. One investigation by Kilpatrick et al. found that 3.7% of males and 6.3% of females in a nationally representative sample of 4,023 children aged 12 to 17 years met DSM-IV diagnostic criteria for PTSD.25,26 However, studies specifically examining children exposed to trauma reveal much higher rates of PTSD. For example, in a Pynoos et al. study of 159 child witnesses of a sniper attack, 60.4% were diagnosed with PTSD.27 In children exposed to trauma, PTSD may be very prevalent and underestimated.
To date, the most extensively used methods for measuring sleep disturbances in children with PTSD are self-report questionnaires, parent-report questionnaires, and clinical interviews. Many studies use the Child Post-Traumatic Stress Reaction Index (CPTSD-RI), a self-report questionnaire that assesses for nightmares and sleep disturbances, along with other PTSD symptoms.
In children exposed to trauma, the frequency of sleep disturbances as measured by self-report or parent-report is higher than in non-trauma exposed populations of children (see Tables 1 and 2; for additional review see Charuvastra and Cloitre28). Noll et al. examined sleep in 78 sexually abused children and 68 control comparison children using 6 self-report questions that asked about trouble falling asleep, staying asleep, middle of the night awakenings, nightmares, and feeling rested.29 The subjects were 6 to 16 years at the time of abuse, and the mean age for the participants at the time of the study was 20.41 (SD = 3.38). The results revealed significantly more sleep disturbances, including insomnia and nightmares, in the sexually abused group and more instances of PTSD in the sexually abused group.29
Nightmares and sleep disturbance in average populations of children
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Nightmares and sleep disturbances in children exposed to trauma
Children exposed to war trauma and/or violence often have sleep disturbances.27,30–37 Thabet et al. examined 403 children aged 9-15 years living in refugee camps and found that 20.3% reported sleep disturbances "sometimes" and 31.6% reported sleep trouble "mostly, most of the time." 31 Similar rates of sleep disturbance were found among 311 Middle East refugee children aged 3-15 years. Specifically, sleep symptoms, such as nightmares and difficulties falling and staying asleep, were reported as "frequent" by nearly 20% of the children's parents.32 Following a playground sniper attack in Los Angeles, Pynoos et al. found that 77.1% of children on the playground reported sleep disturbances one month following the trauma.27 Nineteen children who were on the playground were followed longitudinally. At 14-month follow-up, 57.9% of this sample still reported sleep disturbances.33 A sample of 120 preadolescent Kuwaiti boys and girls (9-12 years old) who were initially assessed for exposure to war-related trauma during the Iraqi occupation and Gulf war of 1990 were reassessed for general health and sleep, using the Pittsburgh Sleep Quality Index (PSQI), approximately 10 years later. Findings showed direct effects between exposure to war related trauma and sleep difficulties, even after controlling for stressful life events experienced in the interim.34
A national phone survey of adults (N = 560) administered within 5 days of the 9/11 terrorist attacks in New York City attacks found 10% reporting that their children were experiencing difficulty falling or staying sleeping.35 Approximately one-fifth of residents living close to the World Trade Center, including children and adolescents, suffered symptoms of PTSD.36 A longitudinal study of preschoolers (N = 116) who were exposed to the World Trade Center attacks found that three years following the exposure, children who were exposed to "high-intensity" events of the attacks (e.g., witnessing the towers collapse, injured people, dead bodies, or people jumping out of the building) were approximately 5 times more likely to have sleep problems (assessed using the Child Behavior Checklist or CBCL) than those who had not been exposed to high-intensity events.37 Furthermore, a dose-response relationship was found, such that the greater the number of high-intensity events a child was exposed to, the greater the risk for sleep problems.37
Studies with children who experienced natural disasters similarly reveal associated sleep disturbance.38–40 After a typhoon in South Korea, 13% of a local sample of elementary school children (N = 261) experienced sleep disturbances.38 Following a lightning strike during a children's soccer game, 17% of exposed children (N = 29) experienced difficulty falling asleep and 21% had restless sleep.39 In an important recent longitudinal investigation, Brown et al. assessed sleep disturbance and fear of sleeping using the Revised Child Anxiety and Depression Scales in a sample of 202 children (aged 8 to 15 years) 24 months after they experienced trauma from Hurricane Katrina.40 Severity of sleep disturbance was associated with severity of PTS (post traumatic stress) symptoms. In addition, the presence of sleep disturbances 24 months after the hurricane was positively associated with the severity of PTS symptoms 30 months after the hurricane. In their analysis the authors controlled for age, sex, and severity of PTS symptoms at 24 months.40 Severely traumatic events have been shown to have both an immediate and long-term adverse impact on sleep in exposed youth. Findings further suggest that sleep disturbance after a trauma may serve as biomarker for subsequent PTSD in children,40 consistent with findings from the adult investigations discussed earlier.6–12
In both adult and child PTSD samples, self-reported nightmares also appear to play a role and may contribute to sleep disturbance in this disorder. According to the DSM IV, three of the main symptomatic groups for PTSD after exposure to a trauma are re-experiencing trauma symptoms, avoidance symptoms, and hyperarousal symptoms. Many nightmares experienced by PTSD patients are re-enactments of the trauma and thus account for the first DSM-IV PTSD symptomatic group.26
Many studies find nightmares occur in about 10% to 20% of the general pediatric population (Table 1). In addition, younger children tend to have more nightmares than adolescents (Table 1). In pediatric PTSD and trauma-exposed populations, parent-report, self-report, and clinician-administered questionnaires reveal higher reports of nightmares than in average populations (Table 2). Carrion and colleagues utilized a structured interview, the Clinician Administered PTSD Scale for Children and Adolescents (CAPS-CA), to assess posttraumatic symptomatology in a group of youth exposed to interpersonal violence. Sixty-four percent of the sample experienced distressing nightmares that were not only frequent but also intense in nature.41 Chimienti et al. compared the sleep reports from parents of Lebanese children, ages 3 to 9 years, who had experienced a trauma (n = 312) to reports from parents of children who had not experienced a trauma (n = 727).42 Thirty-six percent of parents in the trauma-exposed group reported nightmares in their children, which was significantly different from the 23% of parents in the no-trauma group who reported nightmares in their children.42
Several studies have documented similar rates of nightmares in children after a trauma,30,31,32,38,39,43 with some studies reporting prevalence rates as high as 50% to 80%.27,41,44 Arnberg et al. found that 50% of a group of sixth-grade children (ages 11 to 12 years) who were involved in a serious bus accident reported nightmares 9 months after the accident, compared to only 8% of indirectly affected children (classmates of the children in the crash).45 Cumulatively, these data strongly indicate high prevalence of nightmares among children exposed to trauma (Table 2). However, it should be noted that use of control groups is rare in these studies.
Some investigators have published their experiences with use of prazosin, clonidine, and guanfacine in individual case studies of children with PTSD, demonstrating modest improvement in sleep assessed subjectively, mostly in reducing nightmares.46–50 Behavioral treatments form the cornerstone of treatment of pediatric PTSD, yet little work has been done evaluating the impact of such treatments on sleep symptoms specifically. One behavioral treatment, image rehearsal therapy (IRT), a treatment for nightmares with demonstrated effectiveness in adult patients with PTSD, has been modified for treatment in adolescent populations.51 Krakow et al. adapted IRT for adolescent girls (ages 13-18) sentenced to Wyoming Girls School. They were able to decrease nightmare frequency and subjective distress, though PTSD symptoms and overall sleep complaints did not improve.51
Together, self-report studies find significantly higher reports of sleep disturbances and nightmares in children and adolescents who were exposed to trauma and/or diagnosed with PTSD than in non-trauma-exposed samples. However, there is considerable variability among these studies in the amount of sleep disturbances reported, ranging from 3% to 77.1%, and in the amount of nightmares reported, ranging from 20.3% to 80.8% (Table 2). This variability may reflect the use of unspecific, brief sleep questionnaires and the different study methods used across studies, including different populations examined, differing levels of PTSD severity and diagnosis, nature and duration of trauma, sample size, age, and other cultural and demographic variables.
For example, most studies measure subjective sleep disturbances in children exposed to a trauma. Thus, not all subjects examined have developed or will develop PTSD even if they experience some PTSD symptoms after the trauma. In fact, in some of the studies, only a minority of the sample have diagnosable PTSD.38,41,43,44,52 Other studies do not distinguish between disturbance of individuals who have been exposed to a trauma and individuals who have developed PTSD.32,39,42,45 In addition, the nature, intensity, and duration of the trauma experienced by the populations vary greatly across studies. Some subjects directly experienced a traumatic event, while others were witnesses. Additionally, whether the trauma is an acute event (e.g., lightning strike) or a chronically ongoing trauma (e.g., sexual or physical abuse) could significantly influence the degree and type of sleep dysregulation reported. Studies also varied in the temporal duration between the trauma exposure and the time of the sleep assessment, which may also contribute to variable outcomes.
A significant limitation to these approaches is that the measures used to assess sleep are often designed for clinical assessment of PTSD symptoms and as such, contain only a minimal subset of questions addressing the child's sleep. Many studies examined in this review assess sleep in pediatric PTSD using the CPTSDRI,27,30,31,38,52 which is the pediatric version of the PTSD-RI intended to diagnose PTSD in pediatric populations. The CPTSD-RI asks the subject to rate degree of sleep disturbance and nightmares but does not ask more targeted questions about the nature and frequency of these sleep disturbances. Some ask nonspecifically about any sleep disturbance covering the general sleep patterns of the child, while others may be more specifically oriented to circadian tendency, SDB, or insomnia. Even when subjective assessments focus on a specific sleep disorder, they can vary with respect to the type and quality of sleep disturbance they assess. However, subjective sleep measures can be extremely valuable for indicating that the child's sleep is indeed disturbed.
While some pediatric studies will simply employ subjective measures of sleep that are validated for adults,34 e.g., the PSQI, several subjective assessments of pediatric sleep exist. In a recent review, Spruyt and Gozal identified 183 available measures, of which 57 had been psychometrically evaluated to some degree.53 These questionnaires are self-report or parent-report. As pointed out by Spruyt and Gozal, there is little consensus as to which questionnaire is most appropriate to evaluate sleep in pediatric populations. As these measures often focus on a specific sleep disturbance or disorder, it makes comparisons among studies difficult. However, each of these scales can provide information that is useful depending upon the clinical or research setting.53
Potential subjective specific sleep measures which can enhance the understanding of sleep disorders in pediatric PTSD include the Child Behavior Checklist (CBCL),54,55 the Pediatric Sleep Questionnaire (PSQ),56 the Sleep Disturbance Scale for Children (SDSC),57 Sleep Disorders Inventory for Students-Child and Adolescent form (SDIS),58 Childhood Sleep Habit Questionnaire (CSHQ),59 the Nightmare Frequency Questionnaire (NFQ),60 the Nightmare Distress Questionnaire (NDQ),61 and sleep diaries.
The CBCL is a parent-report subjective questionnaire that assesses child behavior difficulties and includes certain items on sleep including: "sleeps less than most kids," "sleeps more than most kids during day and/or night," "trouble sleeping," "nightmares," and "talks or walks in sleep."54,55 In a sample of 122 youth, ages 7-17 years, with anxiety disorders (19%), major depressive disorder (MDD) (9%), both anxiety and depression (26%), or no history of any psychiatric disorder (46%), Gregory et al. examined how sleep items in the CBCL corresponded to sleep measured via sleep diaries (4-6 days), actigraphy (1 week), and polysomnography (2 consecutive nights).62 After controlling for age, gender, and diagnostic status, specific items (e.g. being overtired, sleeps less, sleeps more, and trouble sleeping items) correlated well with objective sleep measures of sleep latency and number of arousals. However, some items did not correlate with objective measures; for example, "sleeps more" was not associated with total sleep time (TST) as assessed by objective polysomnography.62 Overall, the CBCL can be a valuable tool in assessing broad sleep disturbance subjectively. However, similar to the PTSD scales mentioned above, the CBCL ultimately is not designed to thoroughly evaluate sleep, and thus cannot always provide important information on the source of sleep disturbances such as breathing related sleep disorders.
As Spruyt and Gozal53 point out, 3 well-validated subjective assessments of pediatric sleep include the PSQ, the SDSC, and the SDIS. The PSQ is a 22-item questionnaire, well documented to be a reliable and valid measure for assessing snoring, insomnia, sleepiness, and associated daytime behaviors. It is considered to be a valuable alternative when polysomnography is not realistically available to measure specific sleep disorders in pediatric populations.56 Similarly, the SDSC is a 27-item parent questionnaire designed to assess disorders of initiating and maintaining sleep, insomnia, SRBDs, arousal disorders, sleep-wake transition disorders, sleepiness, and sleep hyperhidrosis in children.57,63 The SDIS evaluates SDB, excessive sleepiness, PLM, delayed sleep phase syndrome, and narcolepsy. It was designed for children aged 2-18 years, it is a parent-report questionnaire, and it includes computer scoring.53,58 However, it was developed to be used as a screening tool to determine which children should be referred to a sleep physician and not for the assessment of sleep disorders per se (although the scale is moderately accurate at determining the specific sleep disorder a subject has).64
The CSHQ is 45-item parent-report subjective questionnaire with 7 components assessing bedtime behavior, sleep onset, sleep duration, anxiety related to sleep, sleep and night waking behavior, SDB, parasomnias, and morning waking and daytime sleepiness.59 In a community sample of 469 children and 154 children with diagnosed sleep disorders, aged 4-10 years, sensitivity and specificity were 0.80 and 0.72, respectively.59 The CSHQ has also been employed to examine sleep in children aged 2 to 5.5 years old with autism diagnoses (n = 68), developmental delay (n = 57), and normal development (n = 69).65 This indicates that the CSHQ can be clinically utilized in even younger populations than children aged 4 to 10 years and in populations with developmental disorders. However, as yet, the CSHQ has not been utilized in pediatric populations of PTSD.
To assess frequency of nightmares and the level of associated daytime distress these nightmares cause, several questionnaires are employed. The Nightmare Frequency Questionnaire (NFQ) consists of 2 brief sections, and was validated in a sample of adults with PTSD who experienced sexual assault.60 Further, correlations between frequency of nightmares as determined by the NFQ and by prospective nightmare dream logs were highly significant.60 However, the NFQ has not yet been validated for pediatric populations. While the NFQ measures nightmare frequency, the Nightmare Distress Questionnaire (NDQ) is a 13-item questionnaire that measures the distress individuals experience during the day about their nightmares. It has been employed in pediatric as well as adult samples.61,66 One investigation in children aged 5 to 11 years used 3 simple, child-appropriate questions as follows: (1) Have you ever had a nightmare?; (2) How frequently do you experience nightmares?; (3) How scary would you rate the nightmare to be?67 While these methods have not been psychometrically evaluated in children, they may provide a useful, brief assessment regarding the frequency of nightmares and the subsequent distress associated with the nightmares in pediatric PTSD populations.
Sleep diaries are well documented to be an important means to assess sleep-wake and circadian rhythm patterns, and have been effectively used in pediatric populations, including children with autism spectrum disorders.68 Yet, in pediatric populations, discrepancies between sleep time scored by actigraphy and sleep time reported in sleep diaries have been identified.69 The authors suggest that this may occur because actigraphy measurement can overestimate wake after sleep onset time and underestimate total sleep time in pediatric populations. The authors also found that sleep characterization by sleep diary was well correlated with sleepiness and fatigue, but actigraphy recordings were not.69 Sleep diaries are considered important for the fuller characterization of sleep-wake patterns when employed in conjunction with actigraphy.
Subjective assessments of healthy and traumatized children do not always specify the frequency of sleep disturbances, which can be important for differentiating normal sleep from a clinically significant condition. Also, subjectively assessed sleep disturbances can reflect a broad range of sleep disorders, such as PLM, insomnia, restless leg syndrome, circadian rhythm disturbance, and SDB.70 Sleep questionnaires do not always provide sufficient information to identify which sleep disorders the subjects may suffer from, although more specific, targeted sleep questionnaires are evolving, such as the Pediatric Restless Legs Syndrome Severity Scale,71 to better characterize specific sleep disorders in youth. Even the most comprehensive subjective sleep measures cannot fully characterize sleep architecture, or capture the full spectrum of sleep disorders potentially underlying any identified sleep disturbance. However, when objective studies of sleep are not a realistic option—because of funding issues, population dynamics, or large samples in epidemiological studies—specific subjective sleep measures can provide a valuable, valid, and reliable assessment of sleep. As such, subjective measures of pediatric sleep could be used to significantly increase our understanding of sleep in psychiatric disorders in children who are already undergoing clinical assessment. Further, a comprehensive clinical interview in combination with pediatric sleep questionnaires and diaries represents a particularly reliable and valid approach for identifying specific sleep disorders, such as circadian rhythm disorders and insomnia.
Subjective measures and questionnaires also identify a significant problem in pediatric PTSD that needs further examination: namely, children with PTSD report having more sleep disturbances and nightmares than do normal populations of children. Given the methodological limitations of the subjective understanding of pediatric PTSD and sleep, studies employing more specific sleep questionnaires and interviews to assess nightmares and objective measures to assess sleep disturbance would provide a more complete understanding of the sleep dysregulation in pediatric PTSD. To date, however, very few studies have utilized objective measures to record sleep in children with PTSD.
Actigraphy and polysomnography are the most common methods of objectively measuring sleep. Actigraphic methods measure sleep-wake activity, which during the night includes TST, sleep onset latency, sleep efficiency, and number of awakenings. Studies using actigraphy in children with psychiatric disorders tend to support the findings of subjective sleep questionnaires. In a sample of 122 children aged 7 to 17 years diagnosed with MDD, an anxiety disorder, or both, those who reported "trouble sleeping" were also more likely to have longer sleep onset latency as recorded by actigraphy.62 Sadeh et al. performed actigraphic measurements on 39 children (7 to 14 years old) in a psychiatric inpatient unit. The children were divided into 3 groups, those who had experienced physical abuse, sexual abuse, or no abuse. Children who experienced physical abuse had significantly more fragmented sleep than the children who had experienced no abuse or sexual abuse. The physical abuse group had a quiet sleep percentage (the percent of sleep without movement) of 58.3%, which was significantly lower than the 67.8% of quiet sleep of the group with no abuse and 67.3% of the sexual abuse group. These results suggest physical abuse may lead to greater fragmentation of sleep and poorer overall sleep quality. Although the authors used actigraphy on 8 children with PTSD, they did not differentiate between those with and without PTSD in their analysis, so no direct relationship between disturbed sleep and childhood PTSD can be inferred.72
Using actigraphy, Glod et al. measured sleep over 3 consecutive nights in a sample of 19 abused children (13 were diagnosed with PTSD), 10 depressed children, and 15 non-abused controls.73 The children were aged 6 to 12 years. The abused children with PTSD had significantly higher sleep onset latencies compared to both the depressed and the control groups. Further, the nocturnal activity in the group with PTSD and abuse was almost twice that of controls. Although abused children with and without PTSD had significantly more sleep impairments than controls, when the authors compared the abused PTSD and non-PTSD groups, they found more sleep impairments in the non-PTSD group.73 This suggests that the sleep disturbances observed may be more related to abuse than to the presence of PTSD per se. Still, the sample sizes were quite small in both these studies,72,73 and more in-depth, larger studies are required to further address this important issue.
Overall, the extant data from actigraphic investigations of pediatric PTSD suggest that this population experiences increased sleep onset latency, nocturnal activity, and fragmentation of sleep. That said, it remains to be determined which specific aspects of sleep-wake activity, specifically nocturnal activity, are disturbed in children with PTSD, given the limited amount of research using actigraphy to investigate sleep in children with PTSD.
Polysomnography is considered the gold standard for characterizing sleep architecture. It provides measurements of sleep architecture including REM sleep, stages 1 and 2 sleep, slow wave sleep (SWS), REM latency, sleep latency, and sleep efficiency. To date, there are no studies that have specifically employed polysomnography to measure sleep disturbances, disorders, and architecture in children with PTSD. However, several polysomnography studies have been conducted on adults with PTSD. These studies reveal high rates of SDB and PLM in adult PTSD patients—disorders that could help explain the sleep disturbances frequently reported by adults with PTSD.9,74,75 Further, among this population, abnormalities in REM and SWS are frequently observed. Yet, the results of the studies are sometimes inconsistent. A recent meta-analytic review of twenty polysomnographic studies5 found overall modest differences in sleep in adult patients with PTSD. Adult PTSD patients typically exhibit less SWS, higher REM density, and more stage 1 sleep than do controls.5,28 The authors suggest that their findings support previous findings of centrally measured hyperarousal in PTSD patients.5 The authors also found a significant moderating effect of age, with reduced TST in the younger patients and decreased SWS and REM density in older adults, suggesting different sleep architecture profiles at different stages of the lifespan. These age effects suggest the modest differences observed in the sleep of adults with PTSD cannot be taken as evidence that substantial differences may not exist in the sleep of children with PTSD. Further, the authors were not able to fully disentangle the effects of age and time since the index trauma.5 Since children likely are closer to the index trauma temporally, by virtue of their age, the effects on sleep and sleep architecture may be more profound.
The meta-analysis also identified comorbid depression as an important moderating factor of the relationship between PTSD and sleep disturbances. Specifically, studies in which adult PTSD patients had lower rates of comorbid depression tended to show greater sleep abnormalities.5 As such, comorbid psychiatric symptoms may contribute to differences in sleep in patients with PTSD.
Better characterization of sleep in children exposed to trauma may provide further insights into the development of PTSD in adults as well as guidance for areas of potential intervention or prevention. To date, we are aware of no polysomnographic study of pediatric PTSD. Polysomnography studies of healthy populations of children provide a base for comparison.76–78 One study by Ohayon et al. examined many studies of control populations of all ages. They found that TST, SWS, and REM latency decreased as age increased for the entire lifespan as well as for childhood through adolescence. Additionally, their meta-analysis revealed that stage 2 sleep percentage slightly increased with age. Across the life span, sleep latency and stage 1 sleep percentage increased with age and sleep efficiency decreased with age, although no significant changes with age were found within childhood and adolescence. Lastly, they found that REM sleep time increased until adolescence and then decreased throughout adult life.78
While there are no polysomnography studies on children with PTSD, Forbes et al. utilized polysomnography to investigate groups of children from 7 to 17 years old: 24 with anxiety disorders, 128 with major depressive disorder, and 101 with no psychiatric disorder.79 The authors found that the children with anxiety disorders had less SWS, greater sleep onset latency, and more awakenings than the control or major depressive disorder group. While this study examined children with any anxiety disorders and not specifically PTSD, the general trends are consistent with those found in adults with PTSD.79
Longitudinal studies have implicated a connection between childhood sleep problems and future neuropsychological functioning and psychiatric symptomatology, including depression and anxiety.81–84 For example, one study found in a sample of 6,000 twins pairs followed at ages 3, 4, and then again at age 7, that sleep disturbance reported at ages 3 and 4 predicted anxiety at age 7.82 In yet another investigation, the sleep and behavioral/ emotional problems of 499 children were measured by the CBCL. Reported sleep problems at age 4 were predictive of behavioral/ emotional problems in mid adolescence.83 A bidirectional and interactive relationship between sleep and stress-related psychiatric symptoms and disorders has been proposed.85,86 The authors suggest that patterns of sleep disturbance early in life may actually increase vulnerability to the subsequent development of stress-related behavioral and psychiatric disorders, while stressful events and associated symptoms may increase the risk for the development of sleep disturbance and sleep disorders later in life. Indeed, recent empirical evidence suggests that nightmares increase the risk for the development of PTSD.86 Specific aspects of sleep wake patterns, sleep macroarchitecture, and microarchitecture including sleep spindles may serve as important biomarkers of developmental and psychiatric disorders.87–90 For example, Buckley et al. found that children with autism spectrum disorder had reduced REM sleep and increased REM latency relative to typically developing children and those with developmental delay, and have begun to consider pharmacological approaches for augmentation of REM in autism spectrum disorder.91,92 Similar approaches may be valuable for increasing our understanding and treatment of pediatric PTSD.
Polysomnography is required to measure sleep macro and microarchitecture, and as a result, we know little about these features in pediatric PTSD. Further, while a comprehensive clinical interview, combined with sleep questionnaires and sleep diaries, can help diagnose circadian rhythm disorders and insomnia, subsets of the bioparameters measured by polysomnography, such as electroencephalogram (EEG), electrooculogram (EOG), submental electromyogram (EMG), expiratory/inspiratory nasal airway pressure, nasal/oral airflow, finger pulse oximetry, electrocardiogram (ECG), movements of the rib cage and abdomen, snoring, and body position, are integral to the diagnosis of many sleep disorders, including sleep apnea, REM disturbance, and PLMs. Sleep disturbance can reflect very different sleep disorders. Highly effective treatment approaches are available for many of these sleep disorders, not only ameliorating and alleviating the sleep disturbance itself, but also improving daytime functioning. Treatment of sleep complaints in adult PTSD patients has been shown to be effective at reducing symptoms of insomnia and nightmares as well as improving daytime PTSD symptoms.93 However, most of the current research discussing treatment of pediatric PTSD does not address sleep disturbances, and we are aware of no sleep treatment studies in pediatric PTSD.94,95 Indeed, due to a lack of objective sleep measures, we often lack knowledge as to which specific sleep disorders underlie the sleep disturbance observed in youth with PTSD, and as a consequence, appropriate targeted treatments are not always provided.
However, conducting full objective, overnight measures of sleep, such as polysomnography in children with PTSD, has significant challenges. These pediatric patients often have extreme difficulty with novel procedures and strange environments that are typically involved when conducting polysomnography. Techniques, such as systematic desensitization, in which individuals learn to cope and overcome their anxiety regarding a process in a sequence of steps in a hierarchy of increased exposure to the source of the anxiety, eventually leading to overcoming anxiety regarding the procedure or process, may represent a valuable approach to enhancing the ability of children with PTSD to overcome their fear regarding polysomnography assessment.
To date, studies have predominately used subjective questionnaires and interviews to measure sleep disturbance in children with PTSD. These investigations strongly suggest that there are higher rates of sleep disturbance and nightmares in pediatric PTSD populations than in normal pediatric populations. Consistent with subjective reports of sleep disturbance, studies using actigraphy document increased sleep onset latency, nocturnal activity, and sleep fragmentation in pediatric PTSD populations.
The current understanding of sleep disturbances in pediatric PTSD and their connection to development of PTSD over the lifespan is limited and warrants further investigation. Although studies to date have demonstrated sleep disturbance as a fundamental issue in trauma-exposed pediatric populations, the current research into pediatric PTSD and sleep disorders is limited in that (a) almost all measures of sleep in this population are from subjective questionnaires or interviews; (b) these subjective measures often do not provide specific information about the nature, duration, and frequency of sleep disturbances; (c) thus, these measures do not provide sufficient enough information to assess which sleep disturbances trauma-exposed populations are experiencing and if there are abnormal sleep architecture patterns as well; (d) in pediatric PTSD the effect of comorbidity with other psychiatric disorders that are associated with sleep disturbance, such as depression, needs exploration; (e) no studies with large sample sizes have examined the sleep of this population using actigraphy, and none have employed polysomnography, a method that can identify the specific sleep mechanisms disrupted and provide a better understanding of the associated sleep disorders; and (f) the longitudinal implications of sleep disturbance in childhood for PTSD onset across the lifespan have not been investigated.
Future investigations employing full polysomnography are critical for diagnosing the underlying sleep disorders in pediatric PTSD. Actigraphy does provide an objective assessment of activity during the night, providing reasonable estimates of total time in bed and sleep efficiency. However, it does not provide qualitative information on the type of activity nor does it provide many of the bioparameters that are routinely derived from polysomnography and are required for the diagnosis of many sleep disorders. Only full polysomnography provides measures of sleep stage and architecture, using recordings of EEG, EOG, submental EMG, and typically includes expiratory/inspiratory nasal airway pressure, nasal/oral airflow, finger pulse oximetry, ECG, movements of the rib cage and abdomen, snoring, and body position. These measures are integral to the diagnosis of most sleep disorders, including sleep apnea, REM disturbance, and PLMs. Further, as identified by polysomnography, abnormal sleep architecture patterns in pediatric PTSD populations may serve as a critical biomarker for onset of PTSD and other sleep disorders after a trauma.
As a result, a multi-method, longitudinal study examining phenomenology and utilizing polysomnography on children with PTSD would greatly contribute to our current understanding of sleep disorders in pediatric PTSD. Once the specific sleep disorders in pediatric PTSD have been objectively determined, treatment development and outcome studies would be crucial for not only reducing negative symptoms in patients but also for identifying sleep disturbance as a biomarker for development of PTSD. In adults, studies have already demonstrated that sleep disruption does predict severity and onset of PTSD.6–8,11,12 Treating sleep dysregulation early in life, as well as after a trauma at any age, could have significant implications for reducing risk of PTSD onset both in childhood and across the lifespan.
This was not an industry supported study. The authors have indicated no finanical conflicts of interest.
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text:
By Ed Harris
The Southington Democrats have announced their slate for November, a mixture of old and new faces.
"I'm excited with the candidates we're presenting," said Robert Berkmoes, a member of the nominating committee.
For Town Council the Democrats are running incumbents John Barry, Dawn Miceli and Christopher Palmieri. They are joined by Dennis Conroy, who served on the Council for a term in the late 1970s, Chris Kelley and David Rinaldi.
Palmieri, who has served as minority leader for the last two years, said it is important for the Democrats to win back the Town Council, adding that the majority party has control over appointments to the non-elected boards in town.
"It's time to get good Democrats back in office," he said.
Rinaldi may be a somewhat new name to Southington politics, but the Council candidate has a long family history of public service. His father, the late Donald M. Rinaldi, served as a state senator in the 16th district for two years and David has previously served ten years as an alderman in Waterbury. He moved to Southington ten years ago.
"It's time to get back in," he said. "Make myself part of the community."
Rinaldi said the education system in town is what drew him to Southington. He said he would like to keep the schools running at a high level, grow the town's manufacturing base and to make the town more affordable for people, especially young adults returning from college.
For the Board of Finance, the Democrats are running incumbent Sandra Feld with Kevin Beaudoin, John Moise and Edward Rosenblatt. Both Moise and Beaudoin served previously on the Board of Finance and lost bids to the Town Council two years ago.
"I've been sitting there for two years," said Moise, who served on the tax board previously for six years, with two as chairman. "What I've seen over the last couple of years is continued bonding. Putting off what we could pay for today [until] tomorrow."
Moise also said that the Board of Finance had lost its teeth, allowing the Town Council to bypassed the board several times.
For the Board of Education, the Democrats are running incumbents David Derynoski, Patricia Johnson and Zaya Oshana. They are joined by Jerry Belanger, Gail Doerfler and William Lutz.
For the Planning and Zoning Commission, incumbent James Sinclair is running with alternates Susan Locks and Ryan Rogers. They are joined by Anthony Cervoni Jr.
For the Board of Water Commissioners, incumbents Thomas Murphy and Angelina Santa Maria are running with Rudolph Cabata.
Sandra L. Brunoli is the candidate for town clerk. Current town clerk Leslie Cotton will retire in January, after serving for 20 years.
"I know [this] will be a winning slate this fall," said Southington Democratic Town Committee Chairman Elaine Bedard.
Democrats announce slate for
By Ed Harris

subset: commoncrawl


text:
50 Cent Talks VitaminWater Deal, Music and His Upbringing on 'Larry King Now'
50 Cent is not just a rapper, he is a shrewd businessman. On the latest episode of 'Larry King Now,' the New York rapper talked about his business acumen, rap music and growing up in Queens.
During the interview, Fiddy revealed how he discovered VitaminWater and how it made him a rich man. "I wanted to sell water," 50 recalls, telling his late friend and manager Chris Lighty of the idea.
After spotting people drinking the beverage at a Los Angeles gym, he wanted to invest in the flavored drink. 50 ended up financing 10 percent into the company. A few years later, Coca-Cola buys the company for $4.1 billion and 50 walks away with a windfall rumored to be around $100 million. (Side note: A more detailed story about the VitaminWater deal can be found in Dan Charnas' book, 'The Big Payback: The History of the Business of Hip-Hop.')
"I had to sign a non-disclosure agreement so I can't tell you how much I made, but I can show you all of my teeth," 50 says with a huge smile from ear to ear.
Elsewhere in the interview, 50 discloses that he has no interest in seeing his biological father who he hasn't known since he was a kid. He also talks about growing up in Queens and being shot nine times. The 'Get Rich or Die Trying' rapper even discusses the music industry and how he ran his successful G-Unit label.
When asked if he believes in life after death, 50 Cent replied, "No."
"Life after death? That sounds like a Biggie Smalls album," he adds.
Watch 50 Cent's Interview on 'Larry King Now'


text:
What makes a trained Scouts BSA Leader? Four training modules (five for Scoutmasters and Assistants), available online through My.Scouting.org and through group training in the districts and council.
A direct-contact Scout leader is considered fully trained and entitled to wear the trained leader emblem when he or she has completed the above-mentioned training courses.


text:
Monday, December 25, 2006
Merry Christmas!
It's been nice having a quiet couple of days at home, but I'm ready to go hit the after Christmas sales tomorrow! I've already hit a few digi-scrapping sales today!
Saturday, December 23, 2006
We had a nice quiet evening last night after all the events earlier in the week. Camden did not deal well with his cousins, but he's settled down some now. We've had a fun day of just hanging out at home, finishing up wrapping gifts. I made a dessert, and we're headed to my in-laws tonight to celebrate Christmas with them. Camden is getting quite excited about opening gifts, and I'm excited to celebrate Christmas morning.
Here are the two layouts I've managed this week. I love using Christmas kits, and there are just so many out there! I'm trying to resist the Scrapartist sale on their Christmas kits tomorrow, but not sure I'll be able to!
Thursday, December 21, 2006
I'm off!
My sister, brother, and twin nephews came into town and stayed with us last night. They're running around today, but will be back tonight. Should be fun! Camden seems to be having issues with letting them touch his toys! I guess this will be a good lesson in sharing for him!
I just have one layout to share, but it's one of my favorites! The template is mine and available here.
Tuesday, December 19, 2006
Hustle and Bustle
Just a couple of scrapping pieces of news I want to share. First, just wanted to direct everyone's attention to Jennilyn's My Kinda Christmas available at The DigiShoppe. This preview doesn't do it justice - there's a ton of fun stuff in here and I will have a layout soon! I especially love the little train details, and I have the perfect pictures to go with this kit!
Next, if I can toot my own horn, check out this thread. I'm the featured scrapper at DST. How fun is that!
We got lots of laundry (I'm embarrassed to announce how much here) done last night and some cleaning. It's so great to have Brian home at night! Tonight it's more cleaning because my sister, brother-in-law and twin nephews are coming to stay with us tomorrow. Camden is so excited to see them. He has always been so sweet with them, but I'm interested to see how he does now that they're 11 months old and crawling everywhere. I'm wondering if he'll still be sweet or if he'll think they're invading his territory! I also can't wait to take cute pictures of the three of them! I know that I take a ton when we're together, but they'll be moving back to France next summer and then it will be 2-3 years before we're all together again so I want to take as many pictures as I can while we have the opportunity. I'm especially excited about the Christmas pictures because I bought them matching Gymboree p.j.'s.
Okay, enough rambling and I think my lunch hour is over anyway!
Sunday, December 17, 2006
Busy Weekend
Insomnia has struck again! I probably slept all of 2 hours last night. Combine that with Camden getting up 4 times in the night, and I've got huge bags under my eyes! My Starbucks peppermint mocha should be pulling me out of my sleepiness soon.
I scrapped one page over the weekend - and it took me all weekend to finish for some reason! It's a picture of Kim's little girl Izzy (who I think is the cutest baby girl ever!).
Friday, December 15, 2006
I've scrapped so much for Christmas gifts the last couple of weeks that I'm just feeling really burnt out. Not sure I can crank out a layout for another couple of days!
I've been tagged by Nikki (I think this is a first for me so here goes.)
1. Egg Nog or Hot Chocolate? Most definitely hot chocolate.
2. Does Santa wrap presents or just sit them under the tree? Santa who?
3. Colored lights on tree/house or white? white
4. Do you hang mistletoe? No
5. When do you put up your decorations? The day after Thanksgiving.
6. What is your favorite holiday dish? There is no way to narrow it down to one, but a couple of favorites are Neiman Marcus dip, Russian teacakes, and party mix.
7. Favorite Holiday memory as a child? Well, I have my mother's memory so I can't really remember!
8. When and how did you learn that Santa isn't real? I don't think we ever really believed in Santa
9. Do you open a gift on Christmas Eve? Depends on where we are and with whose family.
10. How do you decorate your Christmas Tree? I have lots and lots of cute snowman ornaments with gold, burgandy, and green ornaments and plenty of white lights.
11. Snow! Love it or Dread it? I only love it if there's alot and there's no chance I have to drive in it first thing in the morning to head to work.
12. Can you ice skate? yes, but it kills my ankles!
13. Do you remember your favorite gift? Once again, I've inherited my mother's memory and have no idea!
14. What's the most important thing about the Holidays for you? The fact that it's Jesus' birthday and that it usually means a trip home!
15. What is your favorite Holiday Dessert? Chocolate, chocolate, chocolate!
16. Favorite holiday tradition? Reading the Christmas story from Luke before opening gifts.
Tuesday, December 12, 2006
Super Heroes
I am having serious issues sleeping, which makes me grumpy! The last 3 or 4 nights I go to bed at normal time and then lay there for hours! I wake up again about 3:00 and am awake for another hour or so before finally falling asleep again. This morning seems worse because I'm catching a cold, which only adds to my grumpiness! Don't I sound fun today?
No layouts to share - I just had no motivation last night! Maybe tonight!
Monday, December 11, 2006
I have got several cute things to share about Camden today. First up - he's got a little cold and has been coughing up junk from his throat. Brian thought it would be a great idea to tell him he could spit it out in the trashcan (and even gave a demonstration!). So, now Camden's new past time is spitting in the trash. Fun. Second - lately, he has been so sweet in telling me at every meal, "thank you for fixing me supper and putting it in my bowl." Third, he tells me he missed me every time we're apart. I love it!
I was a scrapping fool over the weekend! I worked on several calendars for a friend, as well as scrapping some of my own pictures and also completing a CT assignment (used pics of Kim's sweet girl Izzy). All of these layouts were created with Dani Mogstad and Shawna Clingermans A Year of Memories 2007 collection.
Thursday, December 07, 2006
Happy Birthday
We tried it was time to try giving up the night-time pull-ups again, but after 4 nights and about 8 bed changes, we decided to wait a while! I just don't think he's ready, and all those bed changes in the middle of the night are not fun!
Went grocery shopping after I picked Camden up from school today since I'm working tomorrow and part of Saturday. Camden was so funny. I let him walk beside the cart instead of riding in it. He's just too big for the cart these days, even though that's so much easier! Well, he pretended the cart was Lightning McQueen (from Cars) and talked and talked to that cart the entire time. It was hilarious!
Got our first call from our new social worker today. She seems really nice and helpful. Also had our first little snag. I'm trying to just let it go and not worry. No used getting worked up on what will only be the first of many hitches in this process!
We found out yesterday that Camden's class at school has a Christmas program tomorrow night. I'm so excited about seeing him in it - I bet they'll all be adorable!
Okay, I guess this is enough rambling about nothing! Here's a LO I did tonight using Dani Mogstad and Shawna Clingerman's A Year of Memories.
Wednesday, December 06, 2006
Not much to say
Monday, December 04, 2006
Happy Monday!
I have a very busy week ahead of me, but I'm not feeling like Scrooge yet, so that's good news! Maybe ask me at the end of the week. Sometimes the Christmas festivities (mostly involving work) just take over the season and make it hard to be excited about my own holiday events. I've got to get some Christmas shopping done soon! I have a total of 5 gifts under the tree, and 3 of them are gift cards.
I was able to do some scrapping this weekend. First, let me direct your attention to my cute new blog header. Is he cute in that Santa hat or what? Why did I not do this earlier (like when he was a baby??). I used a Kimberly Geswein blog banner template, and Tracy Ann's I Believe tag and ribbons. I really like the two layouts I did this weekend. The first is using a picture taken by my friend several weeks ago, and the second is an adorable picture of my friend's little girl! I loved scrapping in pink! Hopefully, I'll have more to share this week. I'm not expecting to get too much scrapping time in the next couple of weeks, though. How will I ever survive?
Friday, December 01, 2006
Think Pink
Tuesday, November 28, 2006
I'm really busy today and just posting during a quick work break, so I'll leave you with 3 layouts. The first two are using papers and elements by Stacie Prinzo and The DigiShoppe. The third layout uses papers and elements by Dani Mogstad available soon at The DigiShoppe. Happy Wednesday!
Perfectionist and Basketball
I have no layouts to share today because I spent 3 hours (yes, 3 HOURS) working on our Christmas card last night. I probably shouldn't mention this is my second version, and that I probably spent at least 3 hours on the first version. Being a perfectionist is not easy, I tell you. I think I'm close to being finished, though.
One more funny thing about Camden. He's developed a chuckle! It's this forced little laugh that is just so funny. It sounds totally fake, but he uses it in appropriate situations, so it must still be in development phase.
And one not-so-funny thing about Camden these days is that he's decided it's really fun to copy us, and he doesn't always choose the best times to do this. Usually, if we're slightly impatient or in a hurry or in a discussion, he decides it's great to just copy everything we say. He's even done it while he's in trouble. Sometimes it's hard not to laugh. Others, it's just not funny!
And, let's leave you with a positive story. He's slept straight through the night two nights in a row and has been dry both nights! Yesterday, he got a donut for breakfast; today, stickers. Hopefully, this will work.
Sunday, November 26, 2006
Well. . .
Camden had a blast putting up the Christmas tree Friday night. He was soooooooooooooo excited! It was hard for him to wait while we actually put it together and got lights on it before he could work with the ornaments. He called Gram and Gramps and Grandma and Grandpa in the meantime because he was so excited and couldn't wait to tell someone the tree was up. Of course, he put all the ornaments in one spot so I went and fixed them when he wasn't looking! He's loving the Christmas music and insists that our Christmas tree stay lit at all times (even when he gets up in the middle of the night to go potty he must check on it!).
Saturday was pretty laid back and relaxed. Brian took Camden to the park to play soccer, and we rented Over the Hedge and planned to have a little family fun night with pizza, ice cream, the works. Unfortunately, Camden's lack of sleep over the weekend caught up to him, and he threw several horrible temper tantrums! We tried to avoid taking away the fun night, but he pretty much made it impossible! He ended up asking to go to bed at 6:00, and we let him!
Yesterday, Brian had a funeral to attend and was gone all afternoon, but Camden and I enjoyed a nice quiet time. He took a 3 hour nap, and I did some scrapping, which is always nice!
I think that's our Thanksgiving holiday in a nutshell. I think this is only the second major holiday (of any kind) in our 9.5 years of marriage that we haven't traveled, and while I definitely missed being with my family, it made our 4 days together feel like an eternity (in a good way) and it was very relaxing.
One funny story before I go. Yesterday on the way home from church, Camden was falling asleep, and so I tried to urge him to not go to sleep since we were almost home. He said in his sleepy, little monotone voice, "I'm not going to sleep. I'm just watching the world go by."
Camden: Mommy, will you play with me?
Me: Hang on a second while I dry my hair.
Camden: But why?
Me: So it doesn't stick out everywhere and look ugly.
A few minutes later.
Camden: Mommy, will you play with me?
Me: Hang on a second while I finish my makeup.
Camden: Before your face gets ugly?
Friday, November 24, 2006
Black Friday
On a lighter note, I've enjoyed Black Friday so far! We got up and left about 7:00 a.m., which is much later than we normally go, but we had Camden with us. He did really well, just very hyper and required a lot of attention, but hey, he's only 3! Target was crazy! I stood in line for about 30 minutes for a $3.99 Candyland game, and a $5.98 Polar Bear Express DVD. Kinda silly, I know! At Bath and Body Works, I waited over 40 minutes, but got some really great deals there. Headed to Gymboree next where everything, including clearance, was an additional 30% off (plus I had a $25 gift card!). Picked up a couple of really fun items for Camden there. We had breakfast at Panera and hit a few more stores, but not too many. Camden's behavior was deteriorating rapidly at that point.
Camden is very excited to put up the Christmas tree this evening. He keeps insisting it's going to snow tomorrow and be Christmas. Sorry to say it's only November 24, and the temperature is 70 degrees!
I mentioned a few posts ago about the bad wreck Brian and Camden were in last November. I decided to do a layout of it, so here is just one picture of the car, as well as a picture of Camden waiting for the police in the car oblivious to what had just happened.
Enjoy the rest of your weekend!
Wednesday, November 22, 2006
Happy Thanksgiving!
I'm getting my hair chopped this afternoon. I grew it out for almost a year, and after that it's been the same length/style for about 8 months now, and I'm just ready for a change. Hopefully nothing too drastic, but definitely a change. Might even go for some long, side-swept bangs (which will probably drive me to distraction!).
Anyone else planning to shop on Friday? We almost always do. There's something really fun to get up at a ridiculous hour and rush to the stores and find all those great deals. We've always had family to watch Camden before, but this year I think he's going to have to come with us, so that might be tricky!
Cancelling cable and Netflix today; just another step along the way as we work on saving for our next adoption. I know neither of those are big ticket items, but every little bit helps, so we're just gonna do without. Totally worth it, of course!
All right, I guess that's all I have for today. Happy Thanksgiving!
Tuesday, November 21, 2006
A Little Motivation
Going to lunch with a group from work today. We always go out right after payday and take turns choosing places. Most choose crazy places like White Trash Cafe or Fat Mo's Burgers, but the guy choosing this time likes clean so he'll choose somewhere good.
Here are a couple of layouts from last night.
Monday, November 20, 2006
A Great Weekend
Saturday was pretty low-key as well. Just hung around the house doing a little cleaning and alot of relaxing. Sunday we had church in the morning, but no evening service, which was wonderful! What is it about cancelled church services that's so nice?
Work today has been hectic, but I'm happy there's only 1.5 more work days left this week!
I had plenty of time to scrap this weekend, but am having serious issues! I scrapped four pages and promptly trashed all of them - just not satisfied at all. I've got lots of really great photos to scrap so maybe my inspiration will return quickly. I did finally finish one up tonight that I'm happy with. The photo is slightly blurred, but I think it's cute enough that it's okay. I used Amanda Rockwell's fabulous Back in Black collection.
Much too cute
Friday, November 17, 2006
Date Night
It's 10:20, I'm still in p.j.'s, and Camden is calling me to help him put together his Thomas track that takes up the whole living room. Not my favorite thing, but I've been parked in front of the computer all morning finishing this calendar for my in-law's Christmas gift so he deserves some time from me! I used Kimberly Geswein's calendar templates (found here), and they fit perfectly in the Winkflash calendar, just upload the pictures, arrange on calendar and order. I can't wait to get them. I accidentally deleted August, and don't have time to put it back up, so you'll just have to miss seeing that one.
Have a great weekend!
Thursday, November 16, 2006
Wednesday, November 15, 2006
More Gifts
So my friend Kathy got me a cool gift set from L'Occitane en Provence. I've been wanting to try something from there, but haven't yet so now I can! The great thing is I've been to that area in France. I really want to try their lavender products.
I got a gift card for my birthday I'm dying to use, but can't decide what to get. I might try the lavender products from L'Occitane, or I really want this Vera Bradley purse.
Origins is another favorite of mine. I'm sure you've noticed these are all girly, not-very-practical items! But hey, it's my gift card, isn't it!
I managed to get a layout done last night. I love this picture and hope the layout does it justice! Camden is so full of personality, and I think this picture helps show it off. You can find the credits here. I'm quite busy at work today, so I better finish up my break and get back to it!
Tuesday, November 14, 2006
Let's talk Shoppe. . .
I came home to a fun surprise last night. Brian had fixed supper and (more importantly) had brought home ice cream from Cold Stone Creamery for a little belated birthday fun. It was great to have him home last night! Only a couple more weeks before this semester is over. Next semester won't be quite as bad, and then we're home free!
Monday, November 13, 2006
We had a good visit with my brother. Camden absolutely loved having his Uncle Matt around. Of course, it doesn't hurt that Uncle Matt brought him the movie, Cars, as then took him to the toystore and bought him a Cars racetrack with remote controlled cars, and then played with him almost every second! He had a blast. We were also able to meet up with my cousin, uncle, and respective girlfriends for dinner on Saturday night.
Yesterday was my 31st birthday (I am so old!!), and I can't say it was the best day I've ever had, but that's all right. I'm an adult, so my birthday doesn't have to be a big deal, right?
Exactly one year ago today, Brian and Camden were headed to West Virginia with my in-laws for a quick visit to family when they hit a spot on the road where a truck had been leaking diesel fuel. They were in a horrible wreck, and on two separate occasions during the wreck, tractor trailers were headed straight for the backend of their car where Camden was sitting in his carseat. I know God's hand kept them safe, because it's just not possible they escaped any other way. My father-in-law is our pastor, and he used this story as an illustration in his sermon yesterday and just talked about how quickly life can be taken away. It was very hard to sit and listen to because he was talking about my husband and baby!
I wish I had layouts to share, but there was just no time this weekend. I'm so happy Brian will be home tonight. He had class all yesterday instead. It's so rare he's home at night, that I know Camden and I will both enjoy it!
Friday, November 10, 2006
Here are two layouts from last night.


text:
At 11:55 a.m., the presidential motorcade leaves Love Field for it's 9.5 mile journey to the Dallas Trade Mart, where President Kennedy was scheduled to speak at about 1 p.m.
The motorcade was to carry the presidential party out of Love Field on Lemmon Avenue toward Cedar Springs Road. From there, it would follow Cedar Springs to Harwood Street into downtown. The motorcade would turn onto Main Street from Harwood before arriving in Dealey Plaza and taking a right on Houston Street and a left on Elm Street to reach the access road to Stemmons Freeway.
The motorcade, according to the Warren Report, consisted of the following:
- Motorcycles - Dallas police motorcycles lead the motorcade
- The Pilot Car - Manned by Dallas police officers, the Pilot Car preceded the main party by about a quarter of a mile and was to alert stationary officers along the route that the motorcade was coming.
- Motorcycles - The Pilot Car was followed by four to six Dallas police officers on motorcycles whose main function was crowd control.
- The Lead Car - A rolling, unmarked Dallas police car that was the command vehicle. In the JFK motorcade, it was driven by Dallas Chief of Police Curry and occupied by Dallas County Sheriff J.E. Decker and Secret Service Agents Sorrels and Lawson. Those in the lead car were scouting for trouble ahead of the presidential limousine.
- The Presidential Limousine - A specially-designed 1961 Lincoln convertible that carried the presidential party, including JFK, the first lady, Gov. John Connally, Mrs. Connally, the driver Secret Service Special Agent William R. Greer and Assistant Special Agent in Charge Roy Kellerman. It was outfitted with a clear bubble-top that was neither bulletproof or nor bullet resistant. Due to clear skies on Nov. 22 in Dallas, the top was removed. The car had running boards for Secret Service to ride on, when necessary.
- Motorcycles - Behind the Presidential Limousine were four motorcycles, two flanked on each side whose main purpose was crowd control.
- Presidential Follow-Up Car - A 1955 eight-passenger Cadillac convertible especially outfitted for the Secret Service. It carried eight agents, two in the front, two in the rear and two on each of the right and left running boards. Each agent was armed and the car also carried additional weaponry. The agents in the car watched for trouble along the route while those on the running boards moved into positions near the President and first lady when the President's car slowed or when he would stop to greet a crowd.
- Vice Presidential Car - A four-door Lincoln obtained locally that carried the Vice President, his wife, Sen. Yarborough and Rufus Youngblood, special agent in charge of the Vice President's detail. A Texas State Trooper was the driver.
- Vice Presidential Follow-Up Car - A Dallas police officer drove three additional Secret Service Agents as well as the Vice President's assistant, Clifton C. Garter.
- Remainder of the Motorcade - The rest of the motorcade consisted of five cars for other dignitaries including the Mayor of Dallas and Texas Congressmen, a White House communication car and press photographers. Following the cars were buses for White House staff and the press.
- Motorcycles and Police Cars - Dallas police rounded out the end of the motorcade to keep unauthorized vehicles from joining the procession.
The President's motorcade left Love Field and, at Kennedy's direction, stopped twice before arriving in downtown so that he could shake hands with people along the motorcade route.
JFK first stopped at 12:06 p.m. at the corner of Lemmon Avenue and Lomo Alto Drive after seeing children holding a sign asking him to stop and shake their hands.†
A few blocks down the road, Kennedy again orders the motorcade to stop when he spots a Catholic nun and a group of small children.
At about 12:23 p.m., just seven minutes from arriving in Dealey Plaza, the motorcade turns onto Main Street and slows to a crawl as the motorcade entered the heart of downtown.† The crowd quickly became very dense and, according to the Warren Report, "spectators gave the President a tremendous reception."
At 12:29 p.m., the lead motorcycles turn the corner from Main Street onto Houston Street and JFK's limousine soon followed.
†Bugliosi, Vincent. Reclaiming History, pg. 34-37.


text:
Equipment for Heat, Wear & Corrosive Applications
Product Grid subheader
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