Can Video Games Make Kids Violent? Answers to Parents’ Top Gaming Questions

Dave Anderson PhD
By: Dave Anderson, PhD

Vice President, Public Engagement and Education; Senior Psychologist, ADHD and Behavior Disorders Center Read More

A child psychologist on Grand Theft Auto VI, aggression, meltdowns, and how to keep gaming in balance

A new installment of the mega-popular Grand Theft Auto video game will be released soon, and in a lot of homes the request has already landed: Can I play it? It’s one of the most anticipated game releases in years, and it has prompted a wave of questions from parents who listen to Thriving Kids, a podcast from the Child Mind Institute.

Parents are also wondering when gaming becomes a problem, what to do about meltdowns when it’s time to stop, and how to handle games that eat into sleep and schoolwork. Here are my answers to nine of the questions we received, starting with Grand Theft Auto VI.

My 13-year-old wants GTA 6. Should I let them play it?

Like earlier games in the series, GTA 6 involves committing acts of violence and robbery, a lot of swearing, and characters who draw players into all kinds of actions that would be crimes in real life. But it’s also a world that can be genuinely fascinating to explore and figure out.

There are a few ways to approach your child’s request. First, check the rating. GTA 6 is rated M for Mature (17+), and in some other countries it’s rated even higher. This is highly adult content.

Second, consider your child’s maturity level. Some 13-year-olds have already been exposed to this kind of content and handle it well, meaning it doesn’t seem to affect their behavior, their language, how they treat their peers, or basic habits like sleep and homework.

Other 13-year-olds may be more vulnerable. A child with ADHD, for example, may already struggle with executive functioning, time management, or stopping something they enjoy to do homework or go to sleep — playing video games may make those challenges worse. But these are concerns with any game a child engages with, whatever its content.

A child who already struggles with impulsiveness, verbal or physical aggression toward peers, or foul language may also be more vulnerable. We probably don’t want that child repeatedly practicing similar behavior through the game.

If you look at this content and decide it isn’t right for your 13-year-old, that’s a sound decision. And if you know your child well and feel they can handle it, you don’t need to feel guilty about that either.

Can playing Grand Theft Auto make kids more violent?

Parents have worried about violent video games encouraging kids to commit violence since the 1990s. Such a link is not supported by research.

But aggression is different from violence. A more developed body of research suggests that violent games may make kids who are already prone to impulsivity or aggression — such as verbal aggression, bullying, or physical aggression — more aggressive. Playing violent video games can also allow people to “rehearse” aggressive thoughts and acts, and some experimental research suggests this can translate to more aggressive thinking or behavior, especially when kids play a lot or play with friends.

But keep in mind: There are more powerful factors that can influence a child’s behavior. The effect of violent video games is small in relation to the quality of the parent-child relationship, whether a child has been exposed to violence or trauma at home, and how closely parents keep track of where their teens are and who they spend time with.

So, here’s the short answer: When it comes to violent acts, the research doesn’t support a link. When it comes to aggressive thoughts and a slightly higher chance of aggressive behavior, there is some evidence. And there are many real-world factors in a child’s life that matter more than the games they play.

My child says everyone else is playing GTA. How should I respond?

As a psychologist, I generally advise parents not to be the most permissive parent in their child’s friend group, but not to be the strictest, either. It’s best to aim for somewhere in the middle. The research on parenting points the same way. The goal is to lead with support and add structure when kids need it.

You may not think your child is ready for this content. You may worry it could make a mental health challenge worse, or your child may already be prone to aggressive speech or teasing that borders on bullying. Those are all good reasons not to let them practice those things in their free time, and you can feel confident holding that boundary. You might say: “Sometimes I’ll be in line with your friends’ parents, and sometimes I won’t. I love you, and I want to help you experience lots of other things in life.”

You can also try a middle path with conditions attached: Your child can only play the game in a shared space where you can see and hear what’s going on. They can explain the game to you, and you can keep an eye on their behavior outside the game, putting more limits if you see any concerning changes. But be clear with your child about what you’re worried about and what would lead you to step in. Gaming that starts cutting into sleep or schoolwork, for example, is a clear signal to set a limit.

My child watches Grand Theft Auto content on YouTube but doesn’t play the game. Is that different?

Lots of kids watch streamers play the games they like on YouTube or Discord or watch short-form clips on social media. For a child who isn’t allowed to play a popular game, watching can be a way to understand it and stay in the conversation with friends.

Still, it’s reasonable to be cautious. Research is still emerging on how short-form video affects kids’ attention — and an algorithm may keep feeding them more violent content. So, you might nudge your child away from short clips and toward longer videos that follow a story.

It can help to know what they’re watching. Is the channel about the graphics and gameplay? Is it about glorifying violent acts? Or is it about how a team works together to complete a quest? You might start by watching together and let your child watch on their own once you’ve approved the content, or only when you’re around to keep an eye on it.

Age matters here, too. For kids in middle school or younger, I’d monitor more closely — any site where they watch gaming videos will probably serve up more content with similar themes. With an older teen watching on their own device, it’s reasonable to say, something like, “Help me understand why this is valuable to you. Let’s watch some together, and then I’ll trust you to watch on your own.”

My child can focus on something like Grand Theft Auto for hours but can’t focus on homework. Why?

Almost everyone focuses better on something they enjoy than on something they don’t. It’s why so many of us procrastinate, scrolling social media or knocking out small, easy tasks instead of the one big thing we need to do. Kids are no different.

We want to teach kids how to sequence and prioritize tasks, how to bring their focus to something even when it isn’t the most interesting option, and how to build persistence. (My recent Thriving Kids episode with Julia Leonard, PhD, goes deeper on persistence.)

A helpful first step is bundling. If you’re going to allow your child to play video games, make sure it comes after homework. Your child shows you evidence that their homework is finished, and then they get access to games, whether that’s up until dinner, bath time, or getting ready for bed. They can also earn more time by getting down to work sooner. If you aren’t home in the afternoon, gaming can start once you get home.

Are some kids more vulnerable to problematic gaming than others?

Problematic gaming — excessive gaming at the cost of one’s well-being — follows a recognizable pattern. A child plays for very long stretches, more and more over time, and becomes increasingly distressed when they have to stop. Gaming starts to crowd out the things that matter for their development: schoolwork, real-life friendships, sleep, even eating properly.

Problematic gaming rarely happens on its own. Often a child has a co-occurring mental health condition. A child who is depressed may withdraw from activities and friends and find comfort and distraction in gaming, which then reinforces their depression. A child who struggles to make friends may find it easier to connect with people online and retreat into the digital world, making it harder to make friends in real life. A child with attention challenges may find it harder to put the brakes on fun and novel activities to do something less rewarding.

So yes, some kids are more vulnerable. But there are effective treatments both for the underlying conditions and for setting boundaries around gaming. For some kids, that means enforcing a break from gaming — for a short time or a longer one — because they can’t yet put on the brakes on gaming themselves. For others, it may mean moderation, with conditions in place to make sure their other responsibilities get done.

My child melts down when it’s time to stop playing. What should I do?

A meltdown at the end of gaming time can be a sign of problematic gaming, but on its own it’s just one indicator among several. It’s actually very common, especially for younger kids, to have a meltdown when they’re asked to stop something they enjoy and to do something less fun, like come to dinner, start homework, take a bath, or go to bed.

So, think of this as a lesson in emotion regulation, a set of skills kids learn in stages.

The first step to helping kids self-regulate is modeling. How do you regulate your own emotions, and do you talk about it out loud? Do you take deep breaths, step away for a break, reach out to someone, or do something distracting for a moment to reset?

The second step is reinforcement. How do you respond when your child does calm down? Do you give them positive feedback? Can they earn an activity or a special privilege when they practice these skills?

The third step is teaching these skills directly. Does your child know what emotion regulation looks like? (You can learn more about how to teach emotion regulation skills to kids of any age through the free resources, including short videos, that we have here.)

Finally, when your child does melt down, can you sit with their big feelings? As long as they aren’t screaming at you, refusing to go to bed, or getting physically aggressive, you can calmly acknowledge it by saying something like, “I know it’s hard to stop playing, but it’s time to get ready for bed.”

When that isn’t enough, a consequence can help. Tell your child that their gaming time depends on their ability to stop calmly. For example, a child who gets 30 minutes of gaming at night and melts down when it ends might lose 10 of those minutes the next day. Just make sure consequences, when needed, are applied consistently.

Many parents’ first instinct is simply to take the game away. That is an option, and you may need to use it. But try this process first — it can build skills that help with almost anything you’re trying to teach your child.

Should gaming be earned through chores, homework, or good behavior?

Much of life runs on a kind of social contract. When you get your responsibilities done, finish your homework, treat your sister kindly, and speak respectfully to your parents, you have access to certain privileges. For younger kids, that might be a favorite activity or dessert. As kids get older, it might be an allowance. For teenagers, it might be their social life, their curfew, rides, or a little money for meals out with friends. And in the working world, meeting your responsibilities is how you earn your salary.

That doesn’t mean every privilege has to depend on chores, homework, and good behavior. Systems like this take energy to run, so save them for when your child really needs to build a skill and fade them back as that need lessens. A child who does the dishes now and then, picks up their room, does their homework, and keeps safe hands around their sister may not need their 30 minutes of gaming tied to any of it. You can simply give them a set amount of gaming time each day.

When you are seeing problems with contributions at home, effort at school, or behavior, video games can absolutely be made contingent on those things.

What should parents do if they think gaming is affecting sleep, school, or friendships?

Sleep, school, and friendships are core areas of a child’s wellness and development.

Whenever parents ask about screens, video games, or phones, I go through a checklist. Think about your child’s diet and hydration, physical activity, sleep, mood, friendships online and off, investment in school and homework, and whether they take part in at least one extracurricular activity or hobby. We also want to think about their relationships with parents and friends, and whether they have a supportive adult in their life.

These are the building blocks of a child’s wellness. When a child’s screen time is in balance with them there is less cause for concern.

When gaming cuts into sleep, set a time when screens end, and keep all devices out of your child’s room at bedtime.

When schoolwork is slipping, structure the afternoon so homework comes before gaming.

When you’re worried about extracurriculars or time with friends in real life, look for ways to restore that balance. You can remove games for a short or long period if you need to. Kids don’t need games to live.

At the same time, we don’t want to dismiss kids’ interests or tell them gaming is terrible. You can say: “This is your interest, and I want to support you in it. I also want to support your wellness as a whole.”

Sometimes restoring that balance is still really hard. It may lead to a lot of conflict, big fights, or your child becoming more aggressive or disrespectful. That’s the time to reach out for help, perhaps with a school counselor or therapist.

This blog post is adapted from the Thriving Kids episode “Can Video Games Influence Children and Teen Behavior?” Listen on Apple Podcasts, watch on YouTube, or subscribe wherever you get your podcasts. Have a question for a future episode? Email podcast@childmind.org.

The post Can Video Games Make Kids Violent? Answers to Parents’ Top Gaming Questions appeared first on Child Mind Institute.

Examining the Feasibility, Acceptability, and Preliminary Efficacy of a Health App for Postacute Pandemic Years in Managing Physical and Psychological Distress Symptoms: Pilot Quasi-Experimental Study

<strong>Background:</strong> Physical and psychological distress symptoms can adversely affect daily functioning and quality of life, highlighting the need for accessible self-management support. Although mobile health (mHealth) interventions show promise in supporting physical symptom management, evidence regarding their feasibility and potential effects on psychological distress remains limited. <strong>Objective:</strong> This pilot study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of the health app for postacute pandemic years (HAPPY) for managing physical and psychological distress symptoms. <strong>Methods:</strong> A 2-arm, single-blind, quasi-experimental trial was conducted from July 2023 to January 2024. Thirty-eight participants experiencing distress symptoms related to COVID-19 were assigned to the experimental group or a waitlist control group. The experimental group received a 24-week mHealth intervention through the HAPPY app, which included an 8-week supervised phase with weekly face-to-face sessions and a 16-week self-management phase. The control group received no active treatment. Feasibility was assessed through recruitment, adherence, and adverse event monitoring, whereas preliminary efficacy was evaluated at 8 weeks (T1) and 24 weeks (T2) and compared with baseline (T0) using quantitative measures of distress, fatigue, sleep quality, pain, emotional regulation, and posttraumatic stress disorder (PTSD). <strong>Results:</strong> The study demonstrated the feasibility of the HAPPY app, with a recruitment rate of 88.37% (38/43), a dropout rate of 10.5% (4/38), and an adherence rate of 93.33% (14/15) for the supervised sessions. No adverse events were reported. Significant within-group improvements were observed for distress (Kessler Psychological Distress Scale [K10]; <i>P</i>&lt;.001), fatigue (Brief Fatigue Inventory–Chinese [BFI-C]; <i>P</i>&lt;.001), sleep quality (Chinese Pittsburgh Sleep Quality Index [CPSQI]; <i>P</i>=.009), and PTSD symptoms (Chinese Impact of Event Scale–Revised [CIES-R]; <i>P</i>=.02). However, between-group differences were limited. <strong>Conclusions:</strong> The study demonstrated the HAPPY app’s feasibility, acceptability, and potential efficacy for managing physical and psychological distress symptoms. High recruitment, retention, and adherence rates, along with measurable improvements in distress, fatigue, sleep quality, and pain, suggest the app’s promise as a scalable intervention. <strong>Trial Registration:</strong> ClinicalTrials.gov NCT05459896; https://clinicaltrials.gov/study/NCT05459896

Maladaptive state allocation: an orexin-based framework linking sleep disturbance, chronic pain, and substance use disorder

Sleep disturbance, chronic pain, and substance use disorders are highly prevalent conditions that frequently co-occur and exacerbate one another. Although traditionally studied as distinct clinical entities, growing evidence suggests they share common neurobiological mechanisms. Among these, the orexin (OX; also known as hypocretin) system has emerged as a critical regulator of arousal, motivation, stress responsiveness, and nociception, positioning it as a potential contributor to interactions among sleep, pain, and addiction. In this review, we propose that OX may function as a state-integration network that coordinates behavioral responses to competing physiological and environmental demands. Through widespread projections to brainstem, thalamic, limbic, and mesolimbic circuits, OX transmission dynamically regulates vigilance, salience attribution, pain modulation, and reward-seeking behavior. Under physiological conditions, these actions promote adaptive behavioral prioritization. However, chronic dysregulation of OX transmission may result in maladaptive state allocation characterized by persistent hyperarousal, amplified pain-related salience, and excessive motivational value assigned to drug-associated cues. We synthesize experimental evidence implicating OX-dependent circuits in the pathophysiology of sleep disturbance, chronic pain, and substance use disorder and introduce a conceptual triad model linking these conditions. Within this framework, we propose that sleep loss may increase pain sensitivity and craving, chronic pain may disrupt sleep and promote substance use, and repeated drug exposure may further destabilize sleep and pain regulation, creating a self-reinforcing cycle. Finally, we discuss individual factors that may influence vulnerability to triadic comorbidity and highlight emerging therapeutic approaches targeting the OX system.

Associations between insomnia and suicidal ideation in depressed adolescents: the mediating effect of cognitive symptoms and sex differences

BackgroundAmong adolescents diagnosed with major depressive disorder (MDD), suicidal ideation (SI) may be closely linked to cognitive symptoms and insomnia. However, the potential pathways connecting these three factors remain unclear. This study aimed to systematically investigate the mediating role of cognitive symptoms between insomnia and SI, and to further examine whether this mediating pathway differs by sex.MethodsThis cross-sectional study was conducted from January 2021 to September 2023, recruiting 332 adolescents diagnosed with MDD and 123 healthy controls (HCs). To assess depression severity, cognitive symptoms, insomnia, and suicidal ideation (SI), we administered the Clinical Global Impression – Severity Scale (CGI-S), Hamilton Depression Rating Scale-24 (HAMD-24), Insomnia Severity Index (ISI), and Positive and Negative Suicide Ideation inventory (PANSI), respectively. The PROCESS macro (Model 4) for SPSS was employed to perform mediation analysis, examining whether cognitive symptoms mediated the relationship between insomnia and SI.ResultsSI was significantly more prevalent among adolescents with MDD than among their healthy counterparts. Within the MDD group, PANSI scores were negatively correlated with sex, age, and age of onset, but positively correlated with CGI-S, ISI, and HAMD-Cog scores (all p < 0.001). These correlations were more pronounced among female patients. Mediation analysis demonstrated that cognitive symptoms, significantly mediated the relationship between insomnia severity (ISI) and suicidal ideation (PANSI). In the overall sample, the total effect, direct effect, and indirect effect values were 0.657 (95% CI: 0.452 – 0.863), 0.463 (95% CI: 0.279 – 0.647), and 0.195 (95% CI: 0.096 – 0.303), respectively. A sex-stratified analysis revealed a significant mediation effect among female patients, with total, direct, and indirect effect values of 0.734 (95% CI: 0.502 – 0.966), 0.539 (95% CI: 0.326 – 0.752), and 0.195 (95% CI: 0.088 – 0.315), respectively. Conversely, in male patients, neither the total nor the direct effects were statistically significant (confidence intervals included zero), and the indirect effect also lacked statistical significance (effect size: 0.132, 95% CI: -0.064 – 0.345), indicating that the mediating role of cognitive symptoms was not supported in this subgroup.ConclusionAdolescents with MDD exhibit elevated levels of SI, which is significantly associated with both cognitive symptoms and insomnia, particularly among females. Furthermore, cognitive symptoms could serve as a mediating factor in the link between insomnia and SI. This indirect effect was statistically significant in female patients, while results for male patients were inconclusive due to limited sample size. Consequently, in clinical practice, it is essential to understand the interconnected pathways linking insomnia, cognitive symptoms, and SI, with close attention to sex differences in the underlying mechanisms. This approach is crucial for enabling more precise risk assessment and targeted intervention.

Orexin receptor antagonists for sleep disturbance in attention-deficit/hyperactivity disorder and autism spectrum disorder: a systematic review

BackgroundSleep disturbance is among the commonest and most impairing comorbidities of attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Melatonin has the strongest evidence base, but its action is chronobiotic, its maintenance effect inconsistent, and adult evidence sparse. Orexin receptor antagonists reduce wake drive rather than induce sedation, a mechanistically distinct alternative.MethodsReported in accordance with PRISMA 2020. PubMed, Europe PMC, OpenAlex and ClinicalTrials.gov were searched on 23 September 2026 using three complementary concept searches with backward citation tracking; Embase and PsycINFO were not searched. Screening applied a mechanical rule, and every candidate was assessed at full text by two independent reviewers. Eligible reports described a person with diagnosed ADHD or ASD given an orexin receptor antagonist, with a sleep, behavioural, cognitive or safety outcome. Risk of bias was appraised at domain level and certainty against the GRADE domains without categorical ratings. Pooling was precluded by heterogeneity and by the absence of comparable controlled effect estimates.ResultsEight reports representing seven patient groups described 41 exposed participants, 25 with ADHD and 16 with ASD. No completed trial provides peer-reviewed or registry-posted diagnosis-specific outcomes. The strongest signal is a one-month open-label study of daridorexant 50 mg in 24 adults with ADHD and insomnia, where median insomnia severity fell from 16 to 8 and actigraphic total sleep time rose by about 24 minutes, both surviving correction, and 62.5% responded; no cognitive outcome survived correction, one worsened, and the favourable attention results required excluding sleep non-responders. In ASD the evidence is case reports and small series confounded by co-medication, the only comparison-group report being null. No report provides ADHD-stratified paediatric outcomes. Of two registered trials one is recruiting and one completed, the latter’s sponsor releasing top-line data without diagnosis-stratified outcomes.ConclusionOrexin receptor antagonism is a mechanistically coherent approach to sleep disturbance in ADHD and ASD, but no appraisable, diagnosis-specific controlled evidence supports its use, and the evidence is too sparse and biased for causal inference. The signal that sleep gains may accompany attention gains requires a randomised test. Routine use cannot be recommended, and off-label prescribing requires individualised specialist assessment.

Latent profile analysis of sleep quality and associated factors in Chinese adolescents with major depressive disorder

BackgroundSleep disturbances are pervasive among adolescent patients with major depressive disorder (MDD), yet the heterogeneity of sleep phenotypes within this population remains underexplored. This study aimed to identify latent profiles of sleep quality in Chinese adolescent patients with MDD and to examine their associations with sociodemographic, clinical, and psychosocial factors.MethodsA total of 1,467 adolescent patients with MDD were assessed using the Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), the Borderline Personality Features Scale for Children (BPFS-C), and a self-designed sociodemographic and clinical inventory. Latent profile analysis (LPA) was conducted using the seven PSQI component scores as profile indicators. Multinomial logistic regression was subsequently performed to determine factors associated with profile membership.ResultsA five-profile solution was identified: Normal Sleep Group (13%), Mild Disturbance-Low Hypnotic Use (36%), Mild Disturbance-High Hypnotic Use (22%), Severe Disturbance-Low Hypnotic Use (16%), and Severe Disturbance-High Hypnotic Use (13%). Logistic regression revealed that the presence of non-suicidal self-injury (NSSI) and exposure to negative life events significantly increased the odds of belonging to more severe sleep disturbance profiles (OR = 2.92-8.37 and 2.33-2.60, respectively; all p < 0.05). Notably, patients without left-behind experiences exhibited higher odds of being classified into the Severe Disturbance-High Hypnotic Use profile compared to those with such histories (OR = 0.46, p < 0.001). Furthermore, profiles characterized by poorer sleep quality and profiles characterized by more frequent self-reported sleep medication use were cross-sectionally associated with greater anxiety and borderline features in this study.ConclusionSleep quality among adolescent patients with MDD exhibits distinct typological heterogeneity, characterized primarily by severity and hypnotic use patterns. These findings provide preliminary exploratory evidence for the development of personalized, profile-informed clinical interventions for this vulnerable population.

Compassion-Focused Implementation of Smartwatches in Acute Mental Health Care: Mixed Method Replicated Single-Case Study

Background: Smartwatches can support mental health care by providing insights into activity and sleep, which are closely linked to mental health and daily functioning. However, their implementation in mental health care practice remains limited. Professionals can feel resistance toward digital mental health interventions if they feel their use is not aligned with therapeutic values, and report a need for guidance on how to use technologies in ways that do align with such values. Compassion, a core value in mental health care, may offer a meaningful frame for implementation. Therefore, we previously co-designed compassion-focused implementation materials: a card set offering practical suggestions of how smartwatch data can support group treatments in ways that counter the self-optimization logic of commercial devices and instead align with compassion. Objective: The current study evaluated the compassion-focused card set in practice, to explore whether the introduction of the card set influenced the use of smartwatches in treatment sessions, and mental health professionals’ experienced compassion when working with smartwatches, the therapeutic alliance, and acceptance of smartwatches. Methods: The card set was evaluated in a mixed methods replicated single-case design with 5 social psychiatric nurses from an acute mental health care team. Data collection included pre- and post-questionnaires, repeated measures, a focus group, and interviews. Results: For smartwatch use, no significant intervention effects were found, though several participants did report the start or increase of use of the smartwatch in sessions during the intervention phase. For compassion, only P2 showed a significant effect of the intervention on experienced compassion when using smartwatches (Tau-U=0.53, 95% CI −0.11 to 0.86=.02). This participant reported that the card set helped to make the use of smartwatches more concrete and insightful. For therapeutic alliance and acceptance of the smartwatches, no intervention effects were found. These scores were rather stable over time for most participants. The card set was experienced as flexible and easy to use, supporting session structure and enabling more in-depth, compassionate conversations. At the same time, barriers to sustained smartwatch integration included low patient uptake, challenges in mixed groups in which only some patients wore the smartwatch, and varying digital affinity among professionals. Conclusions: These findings suggest that compassion-focused materials may trigger initial adoption and help reframe smartwatch use in line with therapeutic values. Broader implementation strategies, including further training and tailoring to patient readiness, are required for sustainable integration.
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The Effect of Bipolar Disorder Illness Course on Physiological Digital Signals: Observational Study

Background: Although bipolar disorder (BD) lacks objective biomarkers of illness progression, wearable devices enable continuous, real-world collection of physiological digital biosignals, offering a promising approach to address this gap. Measures such as electrodermal activity (EDA) and heart rate variability (HRV) fluctuate with mood state and symptom severity. Previous studies have reported reduced EDA during depressive episodes and increased HRV following symptom resolution after acute mood episodes. Furthermore, greater illness burden in BD has been associated with lower HRV, suggesting that digital biosignals may capture not only state-related changes but also aspects of illness course. Objective: This study investigated whether naturalistic EDA and heart rate (HR) profiles differ according to illness course variables in BD—including diagnosis, predominant polarity, years since onset, and lifetime number of episodes—in euthymic patients, to evaluate their potential as illness course biomarkers. Methods: This cross-sectional post hoc analysis used data from 80 euthymic patients on the BD spectrum from the INTREPIBD-TIMEBASE cohort. Participants were recruited at Hospital Clínic de Barcelona (Spain) between 2021 and 2024 and wore an Empatica E4 wristband for 48 hours in naturalistic settings. Inclusion criteria comprised a current or past (, Fifth Edition) diagnosis of BD confirmed by structured interview and sustained euthymia. We examined the effects of 4 illness course variables (diagnosis, predominant polarity, years since onset, and number of lifetime episodes) on 3 biosignals (mean EDA, EDA peaks per minute, and HR) using generalized additive models. Interactions between illness course variables and circadian patterns were also assessed. All models were adjusted for age, sex, and current antipsychotic use and included a participant-specific random effect. Results: Of the 80 participants, 49 (61.3%) were female; participants’ mean age was 46.9 (SD 14.1) years. After adjustment for covariates and multiple comparisons, no significant associations were observed between illness course variables and EDA or HR. In sensitivity analyses excluding patients with schizoaffective disorder (n=75), years since illness onset and predominant polarity were associated with EDA peaks per minute after multiple comparison correction. Specifically, patients with more than 22 years since illness onset had fewer EDA peaks compared with other groups (β=−1.06, 95% CI −1.71 to −0.41; =.001). No significant interactions were found between illness course variables and circadian patterns of EDA or HR. Conclusions: To our knowledge, this is the first study to examine the association between illness course variables and EDA and HR recorded in naturalistic settings in BD. In contrast to prior findings linking illness burden with HRV, our results suggest that years since illness onset may show modest associations with phasic EDA activity. These findings indicate that digital biosignals may be more sensitive to state-related changes than to illness course characteristics, limiting their use as longitudinal biomarkers of disease progression.
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Symptom interactions of insomnia, anxiety, and depression in early pregnancy: a network analysis perspective

BackgroundPregnancy is a unique phase involving significant physical, social, and psychological changes, increasing vulnerability to anxiety, depression, and insomnia. These conditions are interrelated and often overlap, yet their symptom-symptom relationships during early pregnancy remain underexplored.MethodsA total of 1,830 women in early pregnancy (≤12 weeks) who attended the Children’s Hospital of Shanxi Province /Shanxi Maternal and Child Health Hospital, China, between 2021 and 2024 were included. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale (HADS), and insomnia with the Athens Insomnia Scale (AIS). Regularized partial correlation networks (EBICglasso applied to polychoric correlations) were estimated to examine the connections among symptoms of anxiety, depression, and insomnia; node centrality and bridge symptoms connecting the three symptom clusters were examined, and the accuracy and stability of the estimates were assessed with bootstrapping.ResultsIn total, 148 women (8.09%) screened positive for depression, 115 (6.28%) for anxiety, and 316 (17.27%) for insomnia. In the symptom network, the symptoms with the highest point estimates of strength centrality were ‘I feel as if I am slowed down’ (depression), a reduced sense of well-being during the day (insomnia), and ‘I feel cheerful’ (depression, reverse-scored); these symptoms did not differ reliably from one another or from several other symptoms in bootstrapped difference tests. The same symptoms, together with ‘worrying thoughts go through my mind’ (anxiety) and ‘I can sit at ease and feel relaxed’ (anxiety, reverse-scored), showed the highest bridge strength, and this set of five bridge symptoms was identical across all four correlation and estimation methods examined. Bridge expected influence, which retains the direction of the associations, identified the slowed-down item and the worry item as the strongest bridge symptoms.ConclusionAnxiety, depression, and insomnia are common, interconnected concerns in early pregnancy. Targeting the core and bridge symptoms identified here may enhance intervention effectiveness; however, causal inferences require longitudinal or experimental validation.

What Are Night Terrors?

Growing up, my little brother experienced a phenomenon known as night terrors, though my parents, at first, weren’t sure what to call them. Extreme nightmares? Sleeping meltdowns? A born ’fraidy-cat, I would have guessed he had been possessed by a demon.

He would go to bed and fall asleep. But not long after, he would sit bolt upright, eyes wide open, and let out a blood-curdling scream. Sometimes it lasted only a minute before he closed his eyes and lay back down again. Other times, he would scream and cry for 10 or 15 minutes. For my parents and me, it felt like an eternity.

“Looking at his eyes and his face, you knew he wasn’t awake,” my mom told me recently. But it was disturbing because it also felt hard to believe that he was asleep.

In the morning, my brother would have no memory of what had happened — of sitting up, of screaming or being soothed, or even of being afraid. We remembered, though. So, when my mom discovered the term for these episodes, she felt it was a more fitting description for the parent’s experience than that of the child. “It throws you into a night terror,” she said.

What are night terrors?

Night terrors are technically called “sleep terrors” because they can happen anytime a child is sleeping, not just at night. They’re a kind of sleep-wake disorder, specifically a parasomnia, or abnormal sleep behavior. Like another common parasomnia, sleepwalking, they typically happen within the first three hours of falling asleep.

Night terrors are characterized by behavior that suggests extreme terror and panic. This is because the child’s brain engages a fear response, even as the child remains mostly, if not completely, unaware of it.

Night terrors are not indicators of a psychological condition — a question parents often ask, says Shelby Harris, PsyD, a clinical psychologist and sleep expert. Along the same lines, night terrors are not traumatic for children, nor should they be interpreted as a sign of trauma.

Night terrors come on suddenly, most often out of nowhere — as in, without a trigger like a sudden noise or flipping on a light. In a typical attack, a child will open their eyes and scream or cry. Other behaviors may include:

  • Sitting upright in bed or jumping out of bed
  • Kicking or moving around the room
  • Extreme agitation
  • Rapid breathing and heart rate
  • Sweating
  • Flushed face or dilated pupils
  • Confused or incoherent speech

Episodes usually last for one to five minutes, though they can extend for 20 minutes or more. In the vast majority of cases, children do not remember having had a night terror when they wake up.

How common are night terrors?

Night terrors typically occur in childhood, though some adults experience them. Children usually grow out of them as they age, and they become less common after puberty.

Estimates of prevalence vary widely, though, ranging from 1 percent to about 6.5 percent of children between the ages of 1 and 12. Some kids experience them only once or a few times; for others, night terrors happen frequently.

Why do night terrors happen?

Night terrors are a disorder of arousal: They happen when a child gets “stuck” between the deepest stage of sleep and waking.

When we sleep, we cycle through three stages of deep non-rapid eye movement (NREM) sleep and lighter rapid-eye movement (REM) sleep. Night terrors typically occur during the deepest NREM stage, 3NREM. A child partially wakes up, then gets stuck in transition, unable to wake up completely.

“I once had a mentor many years ago describe it as if you’re driving a manual, a stick-shift car, and you’re shifting between gears,” says Dr. Harris. “That’s what’s happening when you’re going between sleep stages.”

When a child is having a night terror, they’re “grinding the gears” between the deepest stage of NREM sleep and awakening, she explains. The grinding gears explanation also applies to sleepwalking, another disorder of arousal, says Dr. Harris. It’s just a different presentation of the same glitch.

Night terror or nightmare?

It’s 3 o’clock in the morning, and your child wakes up, upset. They run into your bedroom and tell you they had a bad dream about a monster that crawled in through the window and hid under their bed, demanding pizza. The timing, the story-like quality of the dream, and your child’s fear are good signs that this is a nightmare.

Night terrors happen during the deepest stage of sleep earlier in the night, while nightmares typically occur during lighter REM sleep at the end of the night.

Dr. Harris offers a good rule of thumb: “Who remembers it? And who is more freaked out by it? If you, the parent, were more freaked out and remember it, it was probably a sleep terror. If the kid remembers it more, then it was probably a nightmare.”

Risk factors for night terrors

Common risk factors include:

  • Fever or illness
  • Stress or anxiety
  • Medical issues, like sleep apnea

Children with autism spectrum disorder tend to experience more sleep problems, including night terrors, than kids who don’t have autism.

Disorders of arousal can be hereditary, so if you have ever experienced them, your child is more likely to. Dr. Harris was a sleepwalker as a child, and her children experienced both sleepwalking and night terror episodes.

“When my kids would be with either set of grandparents when they were really little, they’d come home, and I always knew I was going to have a night of sleep terrors,” Dr. Harris says. “Because they had been staying up late, eating lots of sugar, and not getting enough sleep.”

Kids who are susceptible to night terrors may be more likely to have one if they’re overtired or thrown off their sleep schedule. Sleep deprivation is really the big thing, says Angela Breidenstine, PhD, a psychologist at the Child Mind Institute. “Anything that’s disrupting sleep that might be making a child overly tired can increase the likelihood of having a sleep terror.”

That’s why sleep hygiene — including a good, consistent bedtime routine — is the best defense against them.

Diagnosis and treatment

Night terrors don’t need to be officially diagnosed to be addressed or treated. But it never hurts to talk to your doctor about them, especially if your child is getting regular sleep or having them for the first time at an older age, says Dr. Harris.

Your child’s doctor may recommend tests for medical conditions, such as sleep apnea. In rare cases, they may recommend an overnight sleep study.

How to deal with night terrors

In general, experts stress the importance of trying not to intervene during an episode. To master the right hands-off approach for your child, consider a few dos and don’ts.

Do stay present and keep them safe

You don’t want them falling out of bed or running into things if they’re prone to moving around. As with sleepwalkers, it may behoove you to remove sharp objects from the room, close open windows, or move furniture they could trip over before they go to bed. But try not to hold or restrain them — it could be startling. Instead, says Dr. Harris, use a gentle touch to guide them back to the bed or to lie back down.

Don’t wake them up

“If you try to wake them up, that actually can prolong the event,” Dr. Harris explains. They are stuck between sleep and waking, so the goal is to help them back to sleep. It’s not dangerous to wake them, Dr. Breidenstine explains, “but it usually doesn’t work out well. It just makes it more confusing and agitating for them.”

Do help them ride it out

And if you talk to them, be quiet, soothing, and brief. “You can say something like, ‘It’s bedtime. It’s time for sleep,’” while gently guiding them back to bed, says Dr. Harris. Remember, they are asleep. “They’re out of it. They have no understanding of what’s going on.”

Don’t take it personally if they pull away or reject attempts to be soothed

While frustrating, this is completely normal. Not being able to soothe your child as you normally do can make you feel helpless — one scientific paper describes night terrors as a “parental nightmare” — but keep in mind, night terrors call for comfort of a different kind.

What is anticipatory waking?

If your child is having frequent night terrors, a doctor will likely recommend working on their sleep hygiene, including going to bed on time and keeping a consistent schedule. But if the night terrors continue, they may suggest a prevention tactic called anticipatory waking — but it requires a good amount of preparation. You can start by keeping a sleep journal. Consider:

  • What time did your child go to bed?
  • What time did they fall asleep?
  • What time did the night terror happen?
  • How long did it last?

After a few weeks, you might notice — for example — that your child consistently has a sleep terror about two-and-a-half hours after they fall asleep. “Then you have a pattern where you can intervene,” says Dr. Breidenstine.

Anticipatory waking, sometimes called scheduled awakening, means waking the child about 10 to 20 minutes before they would usually have a night terror.

“Basically, it interrupts the time where their brain is normally hitting this shift from deep sleep to the next stage, where it’s having this difficulty that results in the sleep terror,” Dr. Breidenstine explains. “You’re proactively preventing that by waking them up before it happens, and then it kind of resets the sleep cycle.”

It’s not necessary to wake the child completely — nudging them just enough to see them shift position or hear them make a noise is fine, says Dr. Harris. “Usually after about two weeks of doing that, it tends to fix it for some people,” she says.

But given the difficulty of implementing this approach, anticipatory waking isn’t typically a first-line recommendation.

Calming siblings — and yourself

While kids have no memory of having had a night terror when they wake up in the morning, other family members certainly do. Night terrors can disrupt sleep for parents and siblings, and their intensity can make it hard to fall back asleep. Dr. Harris recommends deep breathing exercises to calm yourself, or other children, down.

Siblings might also be confused about night terror episodes. Be reassuring and take care to explain the behavior, says Dr. Breidenstine. You can try saying something like: “Part of his body woke up, but he’s still sleeping — that’s why he screams like that. But he’s not hurting. He probably won’t remember it tomorrow. You don’t need to try to wake him up or help him. He’s okay. It will pass.”

By the same token, avoid talking about episodes in a dramatic or frightening way in front of the child.

“If parents are talking a lot about it the next day and then telling the child how scary the episode was, that might make the child feel anxious,” says Dr. Breidenstine. If they ask about them, she recommends offering them a similar script: “When you’re sleeping, sometimes part of your brain wakes up before the rest of it. You might sit up and yell or make a sound, but you’re mostly asleep. It’s not dangerous. We’re making sure you’re okay until you’re sleeping quietly again.”

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