Adequate sleep is a crucial component of child health and development. Unfortunately, sleep problems are alarmingly common among children and adolescents [14, 20]. Approximately 25% of all children experience some type of sleep problem at some point during childhood [1, 14]. Suffering from sleep problems can have far-reaching consequences, impacting, e.g., cognitive function, behavior, academic performance, and even mental and physical health [1, 21]. The prevalence of sleep problems is even higher among children and adolescents with chronic medical, neurodevelopmental, and psychiatric conditions [14, 25]. Disrupted sleep in these populations can diminish health-related quality of life and exacerbate the severity of existing conditions [11, 25]. Consequently, healthcare professionals must be mindful of the impact of sleep on overall health and consider interventions to optimize sleep continuity [11].

In summary, the incidence of childhood sleep problems is alarmingly high, with important daytime consequences. Recognizing the importance of sleep and addressing sleep-related problems is therefore crucial for promoting the overall wellbeing of children and adolescents. Parents seek help in various ways, e.g., in the literature or the internet or from other parents, before consulting their pediatrician [30]. Therefore, low-threshold help strategies might be very important.

Psychotherapeutic pediatric stories

Psychotherapeutic stories, also known as therapeutic stories, are a powerful tool in psychotherapy and child psychotherapy [9]. These stories are specifically crafted to address emotional and psychological issues, helping children to understand and cope with their feelings and experiences.

Key elements of a psychotherapeutic story include the following [9, 22]:

a)

Assignable characters and situations: Characters should be relatable to the child’s age and experiences. Situations depicted should resonate with the child’s own life challenges and circumstances. Characters in animal form (anthropomorphism) are often presented and well accepted [3, 5, 27]. Bad or unfavorable children’s books are characterized by a subject that does not matter and presentation is more or less adult-oriented (adultism) [22, 26].

b)

Clear and correct information and message: The story should convey a clear therapeutic symptom-based message or moral, providing guidance and insight relevant to the child’s issues or problems. This information should be taught in an age-appropriate manner and the strategies should also be selected according to age [17, 18, 22]. In a previous study we assessed whether sleep-related picture book literature meets the abovementioned professional criteria: 608 children’s books focusing on sleep were found; of the books reviewed in detail, 40% recommend unhelpful or even harmful or sleep-impairing behavior (adventure in the night or evening, romping, turning on the light, eating biscuits, etc.) [22].

c)

Emotional engagement: The story should be engaging and emotionally compelling, capturing the child’s interest and imagination.

d)

Resolution and hope: It is crucial that the story has a resolution that offers hope and a sense of closure, reinforcing the idea that challenges can be overcome. One might differentiate between self-focused (the protagonist/child) solutions and external help (like parents). Further, the figure of the protagonist should not be a master version, but rather represent a coping model [18].

e)

Interactive elements: Incorporating interactive elements, such as asking the child to predict what happens next or explain how a character might feel, can enhance engagement and the therapeutic impact.

Effectiveness of psychotherapeutic stories for children

Various studies have shown that psychotherapeutic stories for children have a significant effect, for example regarding emotional regulation, for expression and describing their emotions, or for problem-solving, as therapeutic stories often involve characters facing and overcoming challenges, which can help children to develop problem-solving skills. Further, they allow perspective-taking and behavioral change by modeling positive behaviors. Describing characters that successfully manage their problems in such psychotherapeutic stories can reinforce positive behaviors and coping mechanisms in children. In addition, these stories can serve as a rehearsal space for children to visualize and practice new behavior and integrate cognitive behavioral techniques, such as recognizing and changing negative thought patterns, in a relatable and understandable way. Beyond this, metaphors and symbolic language in stories can help children gain insights into their own experiences and behaviors, thus fostering self-awareness.

Finally, by illustrating effective coping strategies, therapeutic stories can bolster a child’s resilience for future problems. In sum, many child psychotherapists and counselors use therapeutic stories as a regular part of their clinical practice [19].

Various studies have shown that therapeutic storytelling can reduce anxiety, improve emotional regulation, and enhance social skills in children [4, 6, 8, 23, 28] and can also be implemented in different settings, e.g., in schools [13].

However, concerning coping with sleep problems and sleep disturbances, the literature is quite sparse. In a recently published study, we examined the effectiveness of a low-threshold, preventive, guided, and supervised bibliotherapeutic intervention addressing sleep-related anxiety. Sleep-related anxieties and various problematic bedtime behaviors changed significantly after treatment [12].

AI in pediatric health systems

The use of artificial intelligence (AI) allows for automated tools, for example helping to detect disorders at an earlier stage to prevent long-term consequences. Current studies concentrate on detecting information in typical patient groups (most often adults), screening tools, machine learning algorithms, and data types, and various variables, such as socioeconomic status or insurance or other factors [7].

Similar to the case in adult sleep medicine, most studies concerning AI and sleep in children are focused on diagnostic procedures, e.g., detecting obstructive sleep apnea (OSA) [29]. However, to date, no study has proven the usefulness of AI in the context of cognitive behavioral therapy for insomnia (CBT-I)-oriented pediatric sleep medicine. Therefore, the goal of this study was to a) develop 10 psychotherapeutic stories constructed by a specialized psychotherapist (CBT therapist), b) to compare these studies with 10 AI-constructed psychotherapeutic studies, and c) to present these stories in a randomized way to four reviewers (CBT therapists) and investigate whether they recognize differences between them according to the abovementioned criteria.