Children's sleep and adjustment: a residualized change analysis

Gender Inequality in Managing Childhood Sleep: Which Parent Gets up at Night?

OBJECTIVE

Parental responsibilities for childcare remain unequally distributed between mothers and fathers. This study investigates whether such gender disparity also applies to night-time care, particularly when children experience sleep disorders.

METHODS

We conducted a cross-sectional survey study including 882 clinical files from sleep consultations for children aged 0 to 5 years, completed by one parent (98% mothers). To assess inter-rater reliability, 112 father-mother dyads outside the clinical setting were also surveyed. Additionally, 1409 mothers from the general population formed a control group.

RESULTS

In the clinical group, 60% of children were cared for exclusively by their mother at night, versus 9% by the father. In the control group, the figures were 64% and 6%, respectively. Gender disparities persisted even when both parents worked full-time or when the child was no longer breastfed. Inter-rater reliability was strong (r > 0.70). Factors such as number of night awakenings, child's age, and maternal education influenced caregiving distribution. Greater maternal involvement was associated with increased psychological distress and lower relationship satisfaction.

CONCLUSIONS

Mothers remain the primary caregivers at night, even in dual-earner families. This unequal distribution can affect maternal well-being and couple dynamics. Promoting paternal involvement may reduce maternal overload and improve child sleep outcomes.

Trajectories of actigraphy-derived sleep duration, quality, and variability from childhood to adolescence: downstream effects on mental health

STUDY OBJECTIVES

We examined growth trajectories of four actigraphy-derived sleep parameters (sleep minutes, sleep efficiency, and variability in sleep minutes and efficiency across a week of assessments) across childhood and adolescence and examined individual differences in trajectories according to participants' race/ethnicity and sex. We also assessed the predictive effect of growth trajectories of sleep parameters on growth trajectories of mental health outcomes and moderation by race and sex.

METHOD

Youth (N = 199, 49% female, 65% white, 32% black, 3% biracial) and their parents participated in five waves of data (M ages were 9, 10, 11, 17, and 18 across waves). Participants were from a diverse range of socioeconomic backgrounds.

RESULTS

Across participants, sleep minutes, sleep efficiency, and variability in sleep minutes and efficiency demonstrated significant linear change across childhood and adolescence. Whereas sleep duration shortened over time, sleep efficiency improved. Youth exhibited increases in night-to-night variability in sleep minutes and reductions in night-to-night variability in sleep efficiency. Highlighting the importance of individual differences, some race- and sex-related effects emerged. Black youth and male youth experienced steeper declines in their sleep duration across development relative to their respective counterparts. Black youth also demonstrated smaller improvements in sleep efficiency and greater variability in sleep efficiency compared to white youth. Finally, trajectories of sleep efficiency and variability in sleep minutes predicted trajectories of internalizing symptoms and externalizing behaviors.

CONCLUSIONS

Findings showed significant changes in developmental trajectories of four sleep parameters across childhood and adolescence. We discuss the empirical and translational implications of the findings.

Neighborhood determinants of sleep and the moderating role of cultural factors among native adolescents

OBJECTIVE

This study examined the association between neighborhood social environment and sleep among urban American Indian and Alaska Native (AI/AN) adolescents as well as the moderating role of cultural factors in this association.

METHOD

The analytic sample included 133 urban AI/AN adolescents (age 12-16, 57.1% female, Mage = 14.03, SDage = 1.35). Perceived neighborhood social environment included safety and cohesion. Cultural factors included AI/AN cultural identification and historical loss. Sleep duration, efficiency, and wake after sleep onset (WASO) were measured via actigraphy. Sleep disturbance was measured via a questionnaire.

RESULTS

Greater neighborhood safety was significantly associated with lower sleep disturbance (b = -2.17, SE = 0.8, p = .008), higher sleep efficiency (b = 1.75, SE = 0.64, p = .006), and lower WASO (b = -8.60, SE = 3.34, p = .01). Neighborhood cohesion was not associated with any sleep outcomes. Cultural factors moderated the association between neighborhood social environment and sleep outcomes (p < .05). Specifically, both neighborhood safety and cohesion were associated with lower sleep disturbance, only among individuals reporting higher levels of AI/AN cultural identification. Further, neighborhood safety was associated with greater sleep efficiency and lower WASO (i.e., better sleep) only among adolescents with higher contemplation of historical loss.

CONCLUSIONS

Findings highlight the importance of considering cultural factors in addressing sleep and health disparities. AI/AN cultural identification and a sense of historical loss may be important targets for identifying adolescents who might benefit the most from policies and interventions focused on improving the social environment in order to improve sleep and other health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Associations of Changes in Sleep and Emotional and Behavioral Problems From Late Childhood to Early Adolescence

Importance

Sleep problems and psychopathology symptoms are highly comorbid and bidirectionally correlated across childhood and adolescence. Whether these associations are specific to discrete profiles of sleep problems and specific internalizing and externalizing phenomena is currently unclear.

Objective

To characterize individual changes in profiles of sleep problems and their prospective associations with psychopathology symptoms across the transition from childhood to adolescence.

Design, Setting, and Participants

This observational cohort study used baseline data (participant age of 9 to 11 years) and 2-year follow-up data (participant age of 11 to 13 years) from the community-setting, multicenter Adolescent Brain Cognitive Development (ABCD) study. Individuals were assessed for a range of sleep problems at both waves and categorized into profiles via latent profile analysis. The stability and change in these profiles over time was assessed via latent transition analysis. Logistic regression models examined whether psychopathology symptoms were cross-sectionally associated with profile membership and whether transitions between profiles were associated with changes psychopathology symptoms over time. Data were collected from September 2016 to January 2020, and data were analyzed from August 2021 to July 2022.

Exposures

Sleep problems were assessed at both baseline and follow-up via the parent-reported Sleep Disturbance Scale for Children (SDSC).

Main Outcomes and Measures

Psychopathology symptoms at both baseline and follow-up were assessed using the internalizing and externalizing dimension scores derived from the parent-reported Child Behavior Checklist.

Results

A total of 10 313 individuals (4913 [47.6%] were female) were categorized into 4 latent profiles of sleep problems at both baseline and follow-up: a low disturbance profile, a sleep onset/maintenance problems profile, a moderate and nonspecific disturbance profile (termed mixed disturbance), and a high disturbance profile. Individuals in the 3 more severe problem profiles displayed greater risk of concurrent internalizing symptoms (sleep onset/maintenance problems: odds ratio [OR], 1.30; 95% CI, 1.25-1.35; P < .001; mixed disturbance: OR, 1.29; 95% CI, 1.25-1.33; P < .001; high disturbance: OR, 1.44; 95% CI, 1.40-1.49; P < .001) and externalizing symptoms (sleep onset/maintenance problems: OR, 1.20; 95% CI, 1.16-1.23; P < .001; mixed disturbance: OR, 1.17; 95% CI, 1.14-1.20; P < .001; high disturbance: OR, 1.24; 95% CI, 1.21-1.28; P < .001). Transitions between sleep profiles over time were associated with prospective internalizing and externalizing symptoms, but not vice versa.

Conclusions and Relevance

There are substantial changes in sleep problems across the transition to adolescence that are associated with later internalizing and externalizing symptoms. Sleep profiles could be targeted in future intervention and treatment programs to improve sleep-related and mental health-related outcomes across development.

Sleep and behavioral problems in preschool-age children with Down syndrome

Sleep is a major concern, especially in people with Down Syndrome (DS). Beyond Obstructive Sleep Apnea, a number of other sleep difficulties have been reported in children with DS, such as delayed sleep onset, night-time awakenings, and early morning awakenings. The detrimental effect of sleep difficulties seems to contribute to and exacerbate the cognitive and behavioral outcomes of DS. Although the screening for sleep disorders is recommended early in age in DS, only a few studies have evaluated the sleep profile in preschool-age children with DS. The aim of the current study was to assess the association between sleep disturbances and behavioral problems in a group of preschool-age children with DS, by means of a feasible and easy-to-administer parent-report questionnaires. Seventy-one preschool-age children with DS, ranging in age from 3 to 5.11 years, were included in this retrospective study. Sleep disturbances were evaluated by means of the Sleep Disturbance Scale for Children, while emotional and behavioral problems by means of the Child Behavior Checklist. Sleep breathing disorders were the most frequent sleep difficulties reported by parents. Moreover, children with clinical scores in total sleep problems exhibited elevation of psychopathological symptoms, namely Total problems, Affective problems, Anxiety problems, Pervasive Developmental Problems, and Attention Deficit/Hyperactivity Problems. The identification of the broader connection between sleep difficulties and emotional and behavioral problems in preschool-age children with DS leads to important considerations for intervention.

Linking ethnic/racial discrimination to adolescent mental health: Sleep disturbances as an explanatory pathway

Ethnic/racial discrimination is associated with negative psychosocial outcomes, and this study considered sleep disturbance as a mediating pathway. Employing a combination of daily diary and biannual surveys, multilevel structural equation models estimated the indirect effects of sleep/wake concerns on negative, anxious, and positive mood, rumination, and somatic symptoms. In a sample of 350 urban Asian (74% Chinese, 8% Korean, 4% Indian, 1% Filipinx, 1% Vietnamese, and 12% other), Black, and Latinx (25% Dominican, 24% South American, 22% Mexican, 15% Puerto Rican, 5% Central American, and 9% other) youth (M = 14.27 years, 69% female, 77% U.S. born, 76% monoethnic/racial, data collected from 2015 to 2018), there was evidence for sleep disturbances mediating the impact of ethnic/racial discrimination on adjustment. Nighttime disturbance, daytime dysfunction, and daytime sleepiness evidenced partial or full mediation for daily- and person-level outcomes (υ = 0.1%-17.9%). Reciprocal associations between sleep disturbances and negative mood and rumination were also observed.

Parenting and maternal reported child sleep problems in infancy predict school-age aggression and inattention

OBJECTIVE

To examine caregiving predictors of maternal reported sleep problems and child behavioral and cognitive outcomes in early childhood.

DESIGN

A prospective longitudinal study from 6 to 84 months of age.

SETTING

Lab visits, assessments, and questionnaires conducted with a community-based sample.

PARTICIPANTS

One hundred sixty-four African American and White children, their mothers, and teachers.

MEASUREMENT

Parenting behavior was measured during a free-play task at 6 months of age, maternal-report of child sleep problems was completed at 6 timepoints, and teacher report of child aggression and attention was collected in kindergarten and second grade.

RESULTS

Latent growth curve modeling revealed that maternal reported sleep problems decreased in children from 18 to 84 months and harsh-intrusive parenting at 6 months predicted sleep problems at 18 months. Maternal reported sleep problems at 18 months predicted aggressive behaviors in kindergarten and second grade.

CONCLUSION

Parenting at 6 months of age exerts an influence on sleep quality at 18 months which is associated with aggressive behavior in early childhood.

Longitudinal bidirectional association between sleep and behavior problems at age 6 and 11 years

BACKGROUND

Although a growing number of longitudinal studies have found that sleep problems precede behavior problems, few have examined potential bidirectional relationships longitudinally. The present study examined prospective associations between sleep problems and internalizing, externalizing, and attention problems over the course of childhood.

METHODS

Participants included 775 children from the China Jintan Cohort Study. Sleep problems were rated by mothers at ages six and 11.5, as well as self-reported by children at age 11.5. Behavior problems were rated by mothers and teachers at ages six and 11.5, and self-reported by children at age 11.5.

RESULTS

At age six, 15.0% of children were reported to have sleep problems as rated by mothers. At age 11, this prevalence was 12% as rated by mothers and 20% as rated by youth. Bidirectional relationships between sleep problems and behavior problems were observed. Mother-reported sleep problems at age six were predictive of self-reported internalizing and attention problems at age 11.5, even after controlling for baseline behavioral problems. At age six, teacher-reported externalizing, internalizing, and attention problems, and mother-rated internalizing and externalizing problems were all related to sleep problems at age 11.5, even after controlling for baseline sleep problems. Other sociodemographic covariates including child sex, age, and parental education were controlled for.

CONCLUSIONS

Findings provide further support for the reciprocal relationship between sleep problems and behavior problems. Early interventions that target both types of problems may be especially effective in preventing this aggravating health-behavior cycle.

The association of sleep quality and aggression: A systematic review and meta-analysis of observational studies

Poor sleep quality is closely related to aggression, but despite the promise of new therapeutic possibilities, a systematic synthesis of observational research on the association between sleep quality and aggression is lacking. This systematic review and meta-analysis examined the association between sleep quality and aggression, using the academic databases PubMed and PsycINFO. Subjective and objective measures of sleep quality were included, as well as multiple measures of aggression, assessing aggressive and externalizing behavior, anger, hostility and irritability. Ninety-two observational articles, containing 96 studies, encompassing a total of 58.154 children, adolescents and adults were sourced out of 7161 references identified. Methodological quality was moderate or strong in 76% of studies. Data for meta-analysis was available from 74 studies. Poorer sleep quality was associated with higher aggression in 80.8% of studies. Pooled results showed a correlation of 0.28 (95%CI 0.25-0.31; I² = 90.1%) and odds ratio of 3.61 (95%CI 1.13-11.51; I² = 88.3%). Effect estimates and heterogeneity varied according to population type and measurement instruments, but not according to article quality or age group. Our findings confirm that poor sleep quality is consistently associated with higher aggression. As most evidence is cross-sectional, more prospective and high-quality experimental evidence is required to elucidate cause-effect and optimize prevention and treatment of aggression.

Quality of father-child relationships as a predictor of sleep developments during preschool years

Substantial developmental changes in sleep occur during the preschool period, but few studies have investigated the factors that forecast these developments. The aim of this study was to examine whether three aspects of father-child relationships in toddlerhood predicted individual differences in developmental patterns of change in five actigraphy-derived sleep variables during the preschool period (N = 67; sleep assessed yearly between 2 and 4 years). In a predominantly White and middle-to-higher income sample, paternal mind-mindedness and quality of father-child interactions were assessed during father-child free play at 18 months and fathers self-reported on their involvement in childrearing at age 2. Multilevel growth modeling revealed that children whose father made more mind-related comments during father-child interactions had a higher proportion of sleep taking place during nighttime as well as shorter daytime and total sleep duration at 2 years. This was, however, followed by a relative leveling off (i.e., less rapid change) of these sleep features between 2 and 4 years. Given previous studies documenting that nighttime sleep proportion increases while daytime and total sleep duration decrease during preschool years, the findings suggest that children who are exposed to more paternal mind-mindedness may reach more mature sleep patterns earlier in development.

Pediatric sleep health: It matters, and so does how we define it

In 2014, Buysse published a novel definition of sleep health, raising awareness for the importance of this construct for individuals, populations, clinical care, and research. However, the original definition focused on adults, with the recommendation that it should be adapted for children and adolescents. As children live within a complex and dynamic system, and may not always have control over their own sleep, this theoretical review will examine and apply Buysse's five dimensions of sleep health within the context of pediatrics. In addition, using examples from the pediatric sleep literature we introduce a modified definition that takes into consideration the influence of the socio-ecological system within which children live, and the sleep-related behaviors that are critical in supporting or hindering sleep health. Finally, we discuss how the proposed theoretical framework, Peds B-SATED, can be applied to clinical practice, research, and training in the field of pediatric sleep.

Sleep development in preschool predicts executive functioning in early elementary school

This report investigates the role of normative developments in sleep during preschool years in the prediction of child EF performance at early school age. Sleep was assessed by actigraphy at ages 2, 3, and 4, and EF with behavioral tasks when children were in Grade 2. The results revealed that children whose sleep followed expected developmental trends more rapidly showed better EF performance: a more pronounced decrease in sleep duration between ages 2 and 4 predicted better subsequent working memory, whereas a more pronounced increase in sleep efficiency was predictive of better inhibitory control performance. These findings suggest that age-related development may be a key characteristic of sleep as it relates to children's executive skills.

Sleep and Coping in Early Childhood During the COVID-19 Pandemic

Sleep disturbances in early childhood are associated with mood and anxiety disorders. Children also exhibit sleep disruptions, such as nighttime awakenings, nightmares, and difficulties falling asleep, in conjunction with adverse events and stress. Prior studies have examined independently the role of sleep on adaptive processing, as well as the effects of stress on sleep. However, how childhood sleep and children's adaptive behavior (i.e., coping strategies) bidirectionally interact is currently less known. Using a within-subjects design and actigraphy-measured sleep from 16 preschool-aged children (M_age = 56.4 months, SD = 10.8, range: 36-70 months), this study investigated how prior sleep patterns relate to children's coping during a potentially stressful event, the COVID-19 pandemic, and how prior coping skills may influence children's sleep during the pandemic. Children who woke earlier had greater negative expression both before and during the pandemic. During the pandemic, children slept longer and woke later on average compared to before the pandemic. Additionally, for children engaged in at-home learning, sleeping longer was associated with less negative expression. These findings highlight how sleep behaviors and coping strategies are related, and the stability of this relationship under stress.

Pediatric obstructive sleep apnea revisited: Perioperative considerations for the pediatric Anesthesiologist

Pediatric obstructive sleep apnea presents in up to 7% of children and represents a constellation from nasal turbulence to cessation in gas exchange. There are numerous end organ sequelae including neurocognitive morbidity associated with persistent OSA. Adenotonsillectomy (AT), the first line therapy for pediatric OSA, has not been demonstrated to reduce all end organ morbidity, specifically neurological and behavioral morbidity. Furthermore, certain at-risk populations are at higher risk from neurocognitive morbidity. Precise knowledge and perioperative planning is required to ensure optimal evidence-based practices in children with OSA. This comprehensive review covers the seminal perioperative implications of OSA, including preoperative polysomnography, pharmacotherapeutics, and postoperative risk stratification.

Relationships between sleep and internalizing problems in early adolescence: Results from Canadian National Longitudinal Survey of Children and Youth

BACKGROUND

Both inadequate sleep and internalizing problems, such as symptoms of anxiety and depression, are prevalent among adolescents with sparse epidemiological literature outlining sex-specific relationships at this critical age.

OBJECTIVE

To examine cross-sectional and prospective relationships between self-reported sleep problems, indicated by sleep duration, difficulties getting to sleep and changes in difficulties getting to sleep with internalizing problems in early adolescence.

METHODS

This study was a secondary analysis of data from the Canadian National Longitudinal Survey of Children and Youth. Multivariable linear regression was used to estimate cross-sectional and longitudinal associations. Relevant family and social context variables were controlled for in multivariable analyses. Family functioning was assessed as a potential effect modifier.

RESULTS

There were 993 and 736 participants [longitudinal cohort entry age of 10 or 11 years; 49% male] in longitudinal and cross-sectional analyses, respectively. Most cross-sectional multivariable analyses of sleep duration and internalizing problems revealed no statistical associations. Difficulties sleeping and concurrent internalizing problems were positively associated in 12/13 year old females (β = 1.77 [0.94, 2.61], R² = 17%) and males (β = 1.18 [0.36, 2.01], R² = 16%). High persistent difficulties sleeping in females aged 12/13 to 14/15 years also positively predicted internalizing problems in females age 14/15 years (β = 1.90 [0.52, 3.29], R² = 21%) while controlling for initial internalizing symptoms. Family functioning was not found to be an effect modifier.

CONCLUSION

Findings highlight the potential role of difficulties sleeping for adolescents' mental health. Public health initiatives to promote sleep hygiene in this population subgroup are critical to prevent the potential long-term health impact of sleep problems.

Sociodemographic and environmental factors associated with childhood sleep duration

OBJECTIVES

This study investigates sociodemographic and environmental correlates of sleep duration among school-aged children.

DESIGN & SETTING

The New York City 2009 Child Community Health Survey was analyzed using weighted regression analyses.

PARTICIPANTS

1293 Asian, Black, Latino and White children ages 6-12 years, 999 children in Pre-K - 5th grade and 294 children in the 6th-8th grades.

MEASUREMENTS

Parents/guardians completed a survey about the target child's sleep duration on a typical school night/day, and sociodemographic and household characteristics.

RESULTS

Most children (89.3%) met the National Sleep Foundation's (NSF) recommendation of 9-11 h of sleep per night. Pre-K-5th grade children who were born in the United States were less likely than children born outside of the United States to sleep 9-11 h. When sleep duration was examined continuously, children slept an average of 9 h 44 min. On average, with each additional year of age, children slept 7.2 min less than children who were one year younger. Although there were no differences among ethnic/racial groups in sleeping the recommended 9-11 h/night, when sleep duration was measured as a continuous variable, Asian, Latino, and Black children slept an average of 23, 14, and 17 min fewer, respectively, than White children, adjusting for sociodemographic and environmental factors.

CONCLUSIONS

Sleep duration varied across sociodemographic groups of children in New York City in 2009. Future studies should determine causal influences and whether these differences persist.

Longitudinal sleep problem trajectories are associated with multiple impairments in child well-being

BACKGROUND

This study examined whether distinct sleep problem trajectories from infancy through middle childhood were associated with multiple aspects of child well-being at ages 10-11 years.

METHODS

Data were from the first six waves of the Longitudinal Study of Australian Children - Birth Cohort (5,107 children recruited at birth). Caregivers reported on child sleep problems at each time point. A combination of caregiver-reported, teacher-reported and child-completed tasks were used to index child well-being outcomes at ages 10-11 years including emotional/behavioural functioning (internalizing and externalizing symptoms; self-control), health-related quality of life, cognitive skills and academic achievement.

RESULTS

Latent class analysis identified five distinct sleep problem trajectories over time: persistent sleep problems through middle childhood (7.7% of the sample), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%) and no sleep problems (51.9%). Compared to those with no sleep problems, children with persistent sleep problems had the greatest impairments across all outcomes except cognitive skills (perceptual reasoning), with moderate to large effect sizes. Children with increased middle childhood sleep problems similarly experienced greater internalizing and externalizing symptoms and worse quality of life, but few academic impairments. Both the limited infant/preschool sleep problems and mild increases over time trajectories also showed internalizing concerns and worse caregiver-reported quality of life, although effects were smaller than the other sleep trajectories.

CONCLUSIONS

The linkages between sleep problems and negative child outcomes across domains underscore the importance of early identification and targeted intervention to address sleep problems and promote child well-being.

The Relative Importance of Sleep Duration and Bedtime Routines for the Social-Emotional Functioning of Chinese Children

OBJECTIVE

Although the importance of sleep has been widely supported by empirical research, researchers have only recently linked sleep to children's social-emotional development. This study aimed to investigate 2 aspects of sleep-namely, sleep duration and bedtime routines-in relation to the social skills and problem behavior in a group of Chinese school-aged children.

METHOD

This study involved 228 Chinese children (mean age = 8.32 years). Parents reported their child's sleep duration, the consistency of bedtime routines, and social-emotional functioning.

RESULTS

Both sleep duration and the consistency of bedtime routines had unique contributions to children's social-emotional functioning. Sex differences were found regarding the sleep-child adjustment link. Sleep duration was negatively associated with child problem behavior for both boys and girls. However, the relationship between bedtime routines and social skills was more pronounced for boys, while the relation between sleep duration and social skills was more evident for girls.

CONCLUSION

Our findings highlight the importance of consistent bedtime routines and adequate sleep for the social-emotional development of Chinese school-aged children.

Sleep, psychopathology and cultural diversity

Research on ethnic/racial disparities in sleep in the United States finds minorities to have shorter self-reported and actigraphy-recorded sleep duration and poorer sleep quality. Disparities in mental health mirror disparities in sleep with ethnic/racial minorities reporting higher prevalence and more severe struggles. This review focuses on recent research in sleep and mental health disparities and considers ethnic/racial discrimination as an important third variable that may link these two domains of disparities research. For example, research has found discrimination to mediate ethnic/racial disparities in sleep; at the same time, sleep has been observed to mediate the link between discrimination and mental health. The review concludes with the importance of considering ethnicity/race and accompanying sociodemographic, environmental, and behavioral influences on sleep and mental health research.

Pediatric obstructive sleep apnea: Preoperative and neurocognitive considerations for perioperative management

Obstructive sleep apnea (OSA) affects up to 7.5% of the pediatric population and is associated with a variety of behavioral and neurocognitive sequelae. Prompt diagnosis and treatment is critical to halting and potentially reversing these changes. Depending on the severity of the OSA and comorbid conditions, different treatment paradigms can be pursued, each of which has its own unique risk:benefit ratio. Adenotonsillectomy is first-line recommended surgical treatment for pediatric OSA. However, it carries its own perioperative risks and the decision regarding surgical timing is therefore made in the context of procedural risk versus patient benefit. This article presents the seminal perioperative and neurocognitive risks from pediatric OSA to aid with perioperative management.

Anxiety Treatment and Targeted Sleep Enhancement to Address Sleep Disturbance in Pre/Early Adolescents with Anxiety

Sleep disturbance is prevalent in anxious youth and prospectively predicts poor emotional adjustment in adolescence. Study 1 examined whether anxiety treatment improves subjective and objective sleep disturbance in anxious youth. Study 2 examined whether a sleep intervention called Sleeping TIGERS can further improve sleep following anxiety treatment. Study 1 examined 133 youth (ages 9-14; 56% female; 11% ethnic/racial minority) with generalized, social, or separation anxiety over the course of anxiety treatment (cognitive behavioral treatment or client-centered treatment). Sleep-related problems (parent-, child-report) and subjective (diary) and objective (actigraphy) sleep patterns were assessed across treatment in an open trial design. Study 2 included 50 youth (ages 9-14; 68% female; 10% ethnic/racial minority) who continued to report sleep-related problems after anxiety treatment and enrolled in an open trial of Sleeping TIGERS. Pre- and postassessments duplicated Study 1 and included the Focal Interview of Sleep to assess sleep disturbance. Study 1 demonstrated small reductions in sleep problems and improvements in subjective sleep patterns (diary) across anxiety treatment, but outcomes were not deemed clinically significant, and 75% of youth stayed above clinical cutoff. Study 2 showed clinically significant, large reductions in sleep problems and small changes in some subjective sleep patterns (diary). Anxiety treatment improves, but does not resolve, sleep disturbance in peri-pubertal youth, which may portend risk for poor emotional adjustment and mental health. The open trial provides preliminary support that Sleeping TIGERS can improve sleep in anxious youth to a clinically significant degree.

Sleep, Affect, and Social Competence from Preschool to Preadolescence: Distinct Pathways to Emotional and Social Adjustment for Boys and for Girls

Using a normative sample of 1,057 children studied across 4 waves over 6 years with multiple informants, we investigated transactional relations for sleep problems, anxious-depressed symptoms, and social functioning from preschool to preadolescence, assessing cumulative effects on children's emotional and social adjustment. To examine sex differences in the developmental processes, we conducted separate analyses for boys and girls. For both boys and girls, longitudinal cross-lagged panel analyses showed that preschool sleep problems directly predicted anxious-depressed symptoms 2 years later; indirect effects continued into preadolescence. For girls, early and later sleep problems directly or indirectly predicted a wide variety of preadolescent emotional and social adjustment domains (e.g., depressive symptoms, school competence, emotion regulation, risk-taking behaviors). For boys, social competence played a more important role than sleep problems in predicting preadolescent adjustment. Among the first set of findings that demonstrate longitudinal relations between sleep problems and social functioning in middle childhood and preadolescence, these results support Dahl's and Walker's neurological models of sleep and emotional functioning. We discuss these findings in light of relations between sleep and affect during pre-pubertal development and discuss differential findings for boys and girls.

A Developmental Cascade Model of Behavioral Sleep Problems and Emotional and Attentional Self-Regulation Across Early Childhood

This article documents the longitudinal and reciprocal relations among behavioral sleep problems and emotional and attentional self-regulation in a population sample of 4,109 children participating in Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC)-Infant Cohort. Maternal reports of children's sleep problems and self-regulation were collected at five time-points from infancy to 8-9 years of age. Longitudinal structural equation modeling supported a developmental cascade model in which sleep problems have a persistent negative effect on emotional regulation, which in turn contributes to ongoing sleep problems and poorer attentional regulation in children over time. Findings suggest that sleep behaviors are a key target for interventions that aim to improve children's self-regulatory capacities.

The Role of Sleep in the Relationship Between Victimization and Externalizing Problems in Adolescents

Victimization is linked to externalizing outcomes in adolescents and recent theorizing suggests that sleep plays a role in this relationship; however, there is little evidence examining sleep as a mediator. This study examines associations between victimization experiences and changes in aggression, delinquency, and drug use. Data were obtained from three waves of a school-based study with middle-school youth (n = 785; 55 % female; 20 % African American; M = 12.32, SD = .51 years at T1), and path analyses were used to test the key hypotheses. Analyses controlling for major life events, demographic factors, and school site revealed that victimization indirectly affected delinquency and drug use, but not aggression, through its relationship with sleep problems. Further, the effects of sleep problems on drug use were specific to females. These data suggest that intervening to address sleep problems resulting from victimization may serve to reduce some forms of externalizing behavior.

Longitudinal relations between parent-child conflict and children's adjustment: the role of children's sleep

Sleep was examined as a process variable in relations between verbal and physical parent-child conflict and change in children's internalizing and externalizing symptoms over time. Participants were 282 children at T1 (M age = 9.44 years; 48% girls), 280 children at T2 (M age = 10.41 years), and 275 children at T3 (M age = 11.35 years). Children reported on parent-child conflict, sleep was assessed with actigraphy, and parents reported on children's internalizing and externalizing symptoms. Autoregressive effects for sleep and internalizing and externalizing symptoms were controlled to examine change over time. Supportive of intervening processes, physical parent-child conflict at T1 and increased change in internalizing and externalizing symptoms at T3 were indirectly related through their shared association with reduced sleep continuity (efficiency, long wake episodes) at T2. Findings build on a small but growing literature and highlight the importance of considering the role of sleep in relations between family conflict and child development.

The effects of ethnic/racial discrimination and sleep quality on depressive symptoms and self-esteem trajectories among diverse adolescents

Ethnic/racial discrimination has persistent negative implications for both physical and mental health. The current study employs a risk and resilience framework to explore the joint effects of ethnic/racial discrimination and sleep disturbance on psychosocial outcomes among adolescents. In a sample of 146 minority and White adolescents (70% female), changes in depressive symptoms, anxiety, and self-esteem over 3 years are explored using growth curve models. Regardless of ethnic background, adolescents reporting high levels of ethnic/racial discrimination and poor sleep also reported a corresponding increase in depressive symptoms and lower levels of self-esteem over time. Adolescents reporting all other combinations of sleep quality and ethnic/racial discrimination reported more positive adjustment over time. The joint effects of sleep and ethnic/racial discrimination on adolescent psychosocial development are discussed.

Sleep in infancy and childhood: implications for emotional and behavioral difficulties in adolescence and beyond

PURPOSE OF REVIEW

Extensive scientific efforts have been made in an attempt to identify early markers of behavioral and emotional problems. In this context, sleep has received considerable research attention, as it appears to be closely linked to developmental psychopathology. The present review synthesizes some of the most recent findings regarding the concurrent and longitudinal associations between psychopathology and behavioral manifestations of sleep in childhood and adolescence.

RECENT FINDINGS

Recent evidence suggests that compromised sleep is associated with both internalizing and externalizing problems in childhood and adolescence. Moreover, sleep problems have been shown to predict the development of various emotional and behavioral problems, including depression, anxiety, attention-deficit hyperactivity disorder, risk-taking and aggression. Yet, inconsistencies are apparent, particularly among findings that are based on objective sleep measurement.

SUMMARY

Taken together, most recent findings suggest that poor sleep in childhood and adolescence constitutes a risk factor for psychopathological symptoms. Accordingly, the importance of early detection and intervention should be a primary goal in clinical settings. In the research domain, the underlying mechanism of these associations should receive future research attention, in an attempt to broaden the understanding of the relationship between sleep and psychopathology.

Associations of child insomnia, sleep movement, and their persistence with mental health symptoms in childhood and adolescence

STUDY OBJECTIVES

To examine the patterns of insomnia and sleep-related movement from ages 4.5 to 9 years, their concurrent associations with mental health symptoms in childhood, and the longitudinal associations of sleep-problem persistence with mental health symptoms at ages 9 and 18 years.

DESIGN

A 14-year prospective follow-up study. Assessments included maternal report on the Children's Sleep Habits Questionnaire at ages 4.5 and 9, and child mental health symptoms via maternal report at age 4.5, multi-informant (child, teacher, mother) report at age 9, and adolescent report at age 18.

SETTING

Community.

PARTICIPANTS

A total of 396 children (51% female).

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Sleep problems were more common at age 4.5 than 9; symptoms of insomnia and abnormal sleep movement both had persistence rates of 9-10%. At age 4.5, insomnia was associated with hostile-aggressive and hyperactive-distractible behavior, but there were no significant associations for sleep movement. At age 9, both insomnia and sleep movement were associated with symptoms of depression, externalizing, and attention deficit hyperactivity disorder (ADHD). Insomnia persistence was associated with symptoms of depression, externalizing, and ADHD at age 9 and anxiety and externalizing at age 18; sleep- movement persistence was associated with externalizing and ADHD at age 9, and ADHD at age 18. The age 18 persistence effects for insomnia and anxiety and for sleep movement and ADHD were significant when controlling for earlier mental health.

CONCLUSIONS

Childhood insomnia and sleep movement are common and associated with mental health symptoms. Their persistence from middle to late childhood predicts associations with specific types of mental health symptoms at age 18.

Children's sleep and cognitive performance: a cross-domain analysis of change over time

Relations between changes in children's cognitive performance and changes in sleep problems were examined over a 3-year period, and family socioeconomic status, child race/ethnicity, and gender were assessed as moderators of these associations. Participants were 250 second- and third-grade (8-9 years old at Time 1) boys and girls. At each assessment, children's cognitive performance (Verbal Comprehension, Decision Speed) was measured using the Woodcock-Johnson III Tests of Cognitive Abilities, and sleep problems (Sleepiness, Sleep/Wake Problems) were collected via self-report. Individual growth models revealed that children who reported increases in Sleepiness exhibited little growth in Verbal Comprehension over time compared with their peers who reported decreases in Sleepiness, resulting in a nearly 11-point cognitive deficit by the end of the study. These associations were not found for Sleep/Wake Problems or Decision Speed. Child race/ethnicity and gender moderated these associations, with Sleepiness serving as a vulnerability factor for poor cognitive outcomes, especially among African American children and girls. Differences in cognitive performance for children with high and low Sleepiness trajectories ranged from 16 to 19 points for African American children and from 11 to 19 points for girls. Results build substantially on existing literature examining associations between sleep and cognitive functioning in children and are the first to demonstrate that children's sleep trajectories over 3 waves were associated with changes in their cognitive performance over time.