Bidirectional Associations Between Child Sleep Problems and Internalizing and Externalizing Difficulties From Preschool to Early Adolescence

Jon L. Quach; Cattram D. Nguyen; Kate E. Williams; Emma Sciberras

doi:10.1001/jamapediatrics.2017.4363

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Bidirectional Associations Between Child Sleep Problems and Internalizing and Externalizing Difficulties From Preschool to Early Adolescence

Journal article

Peer reviewed

Bidirectional Associations Between Child Sleep Problems and Internalizing and Externalizing Difficulties From Preschool to Early Adolescence

Jon L. Quach, Cattram D. Nguyen, Kate E. Williams and Emma Sciberras

JAMA Pediatrics, Vol.172(2), 174363

2018

DOI: https://doi.org/10.1001/jamapediatrics.2017.4363

PMCID: PMC5839274

PMID: 29204659

Abstract

Importance: Although multiple cross-sectional and longitudinal studies have established that sleep problems and behavioral difficulties are associated in children, the directionality of this association and whether sleep problems are differentially associated with different types of childhood behavioral difficulties are unclear. Understanding these associations will inform the focus and timing of interventions. Objective: To determine whether longitudinal and reciprocal associations exist between child sleep problems and externalizing, internalizing, or both behavioral difficulties. Design, Setting, and Participants: Prospective cohort study using nationally representative data from the first 5 waves (2004, 2006, 2008, 2010, and 2012) of the kindergarten cohort (4983 children aged 4-5 years in 2004) collected for the Longitudinal Study of Australian Children. Associations were evaluated using cross-lagged structural equation model analyses performed from May 25, 2016, to September 20, 2017. Main Outcomes and Measures: Child sleep problems and internalizing and externalizing behavioral difficulties. Sleep problems were defined using parent-reported child sleep problem severity and specific difficulties (ie, difficulty getting to sleep at night, not happy sleeping alone, waking during the night, and restless sleep) on 4 or more nights of the week. Child behavioral difficulties were defined using the parent-reported Strengths and Difficulties Questionnaire for externalizing difficulties (conduct problems and hyperactivity/inattention subscales) and internalizing difficulties (emotional problems subscale). Results: The 4983 children enrolled in 2004 had a mean (SD) age of 4.7 (0.2) years and comprised a similar percentage of boys (2536 [50.9%]) and girls. In 2012, 3956 children (79.4%) aged 12 to 13 years were retained. Significant bidirectional associations were detected between sleep problems and externalizing difficulties during the elementary school transition period, with greater sleep problems associated with later externalizing behavior and vice versa (cross-lagged path coefficient, 0.04 [95% CI, 0.01-0.08] to 0.09 [95% CI, 0.06-0.13]). Although sleep was a significant driver of later internalizing difficulties (coefficient, 0.10 [95% CI, 0.07-0.14] to 0.16 [95% CI, 0.12-0.19]), the reverse association was not significant. In the final model that included all 3 constructs, the associations were attenuated but remained significant over time. Conclusions and Relevance: These results suggest that future studies should investigate whether implementing sleep problem intervention decreases the occurrence of both externalizing and internalizing difficulties. Interventions targeting externalizing, but not internalizing, difficulties may benefit childhood sleep.

Details

Title: Bidirectional Associations Between Child Sleep Problems and Internalizing and Externalizing Difficulties From Preschool to Early Adolescence
Authors: Jon L. Quach (Author) - University of Melbourne
Cattram D. Nguyen (Author) - Royal Children's Hospital
Kate E. Williams (Author) - Queensland University of Technology
Emma Sciberras (Author) - University of Melbourne
Publication details: JAMA Pediatrics, Vol.172(2), 174363
Publisher: American Medical Association
DOI: 10.1001/jamapediatrics.2017.4363
ISSN: 2168-6211
PMID: 29204659; PMC5839274
Grants: How health shapes young children’s academic outcomes, and opportunities to intervene, DE140100751, Australian Research Council (Australia, Canberra) - ARC
Improving outcomes for children with ADHD: mapping developmental trajectories and developing targeted interventions, 1110688, National Health and Medical Research Council (Australia, Canberra) - NHMRC
Organisation Unit: School of Education and Tertiary Access
Language: English
Record Identifier: 99990897802621
Output Type: Journal article