“…The OPI discussed most often was sleep disturbances and difficulties (see Alers, 2014; Davis, 1999;Dutra et al, 2016;Eakman et al, 2017;Gerardi, 2009;Hyter et al, 2002;Kjorstad et al, 2005;Pizur-Barnekow & Erickson, 2011;Plach & Sells, 2013;Precin, 2011a;Rivers & Saunders, 2016;Roberts, 1995;Rogers et al, 2014;Scaffa, Gerardi, Herzberg, & McColl, 2006;Smith-Forbes et al, 2014;Speicher et al, 2014). As well, preschool-age children who have been exposed to trauma may experience flashbacks and nightmares, which can cause a decrease in both the quality and quantity of their sleep that further affects concentration and disrupts productive occupations like educational performance (see Alers, 2014; Davis, 1999;Kjorstad et al, 2005), which can further affect productive occupations, such as educational performance, as a result of decreased concentration (Alers, 2014). For adults and children, sleep difficulties can also be caused by increased arousal, keeping the person from falling and staying asleep (Roberts, 1995).…”