# Nighttime fears in children: clinical characterisation and the user needs and preferences for a digital parent-led intervention

## TL;DR

This study explores the clinical profile of children with nighttime fears and identifies parent needs for a digital intervention to address these issues.

## Contribution

The study introduces a co-designed, parent-led digital intervention for children with nighttime fears, informed by clinical and parental insights.

## Key findings

- Separation Anxiety Disorder and Specific Phobia were the most common diagnoses among children with nighttime fears.
- 70% of children experienced pathological sleep disturbances related to initiating and maintaining sleep.
- Parents and psychologists emphasized the need for accessible, structured support and clear guidance for managing nighttime fears.

## Abstract

Nighttime fears are highly prevalent and are associated with sleep disturbances and later anxiety disorders. Despite their impact, research and treatment options remain limited. Few studies have examined the clinical profile of this population. Families have few intervention options, especially those that are accessible and evidence-based. This mixed-methods study aimed to [1] assess the clinical profile of children experiencing nighttime fears, and [2] explore parents’ needs and preferences to inform the co-design of a digital, parent-led exposure-based intervention.

A co-design approach (N = 44) was used involving an online assessment battery with parents of children aged 7–12 years experiencing nighttime fears (n = 34; M child age = 9.6 years; 56% female), two phases of semi-structured interviews with a separate group of parents (n = 5; median child age = 10.7 years; 60% female), and a focus group with psychologists (n = 5; median age: 31.0; 60% female). The assessment battery included a diagnostic instrument assessing DSM-5 psychiatric disorders, and a measure of sleep disturbances. Interviews explored both parents’ experiences and their feedback on a prototype intervention. Psychologists discussed clinical insights and treatment approaches. Quantitative data were analysed descriptively; qualitative data were analysed using framework analysis.

Separation Anxiety Disorder (24%) and Specific Phobia – Natural/Environment type (23%) were the most common primary diagnoses. Sleep disturbances were prevalent, with 70% scoring in the pathological range for initiating and maintaining sleep. Qualitative findings revealed significant emotional distress for both children and parents, limited access to care and the need for clear guidance. Psychologists emphasised the central role of parents and the need for structured support.

Children with nighttime fears often meet criteria for psychiatric disorders and experience significant sleep issues. A co-designed and parent-led digital intervention may address a critical gap for families.

The online version contains supplementary material available at 10.1186/s13034-025-01011-2.