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Childhood Sleep Problems Linked to Later Behavioral, Emotional Impairments

Published on August 24, 2020 in Cornerstone Blog · Last updated 9 months ago


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CHOP researchers studied the effect of childhood sleep problems on behavior later in childhood.

shafere1 [at] (By Emily Shafer)

Children who don’t catch enough Z’s may not just be tired and grumpy the next day. Researchers at Children’s Hospital of Philadelphia found those with persistent sleep problems through early and middle childhood, from birth to age 10-11 years, and those whose sleep problems started in middle childhood, are at increased risk for emotional and behavioral impairments, and some academic concerns, later in childhood. The findings highlight the importance of screening for sleep problems at every age.

“For both teacher-rated and parent-rated mental health concerns, such as internalizing and externalizing problems, children with persistent sleep problems had the greatest impairments,” said Ariel A. Williamson, PhD, DBSM, psychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at CHOP and assistant professor of Psychiatry and Pediatrics at the University of Pennsylvania Perelman School of Medicine. “But we also found that even kids with sleep problems limited to early childhood or mild sleep problems over time had more emotional and behavioral concerns compared to the children with no sleep problems.”


Ariel Williamson, PhD, DBSM

Dr. Williamson and co-researchers analyzed data children from the Longitudinal Study of Australian Children – Birth Cohort, which included more than 5,000 infants who were followed biennially. Caregivers rated their children’s sleep from birth to age 10-11 years. At ages 10-11 years, caregivers and teachers completed information about child well-being and children in the study completed academic measures. Outcomes included child mental health concerns (internalizing and externalizing symptoms), self-control, quality of life, and cognitive and academic skills.

The researchers found five distinct groups of children with sleep problems: Those with persistent sleep problems from infancy through middle childhood (7.7% of the sample); children with sleep problems only during the infancy/preschool years (9%); children with increasing sleep problems in middle childhood (17%); children with mild sleep problems over time (14.4%); and children with no sleep problems (51.9%).

Children with persistent sleep problems experienced the greatest impairments across all outcomes, except for cognitive skills, when compared to children with no sleep problems. In addition, children who experienced increased middle childhood sleep problems showed greater mental health concerns, worse quality of life, and poorer teacher-rated academic skills. Children who had sleep problems only in early childhood and those with mild sleep problems over time also showed increased internalizing problems and worse quality of life, but the effect sizes were smaller. The study appeared in The Journal of Child Psychology and Psychiatry.

“It’s also important to reassure parents that just because their child has a sleep problem, it doesn’t mean they are destined for mental health concerns later in life,” Dr. Williamson said. “Parents who are concerned about their children’s sleep should consult their pediatrician and consider seeking sleep treatment.”

She noted that screening for child sleep problems at every well child visit is important for preventing and addressing sleep concerns, but that this can be challenging due to limited time in primary care visits. Dr. Williamson is working with Alexander Fiks, MD, MSCE, director of the Clinical Futures, a CHOP Research Institute Center of Emphasis, and The Possibilities Project at CHOP, to systematically integrate evidenced-based pediatric sleep problem screening into well child visits in the CHOP Care Network.

Future studies are in the works to identify if there are risk factors associated with following one sleep trajectory vs. another. In addition, Dr. Williamson is currently piloting a behavioral sleep intervention for young children in primary care, and hopes to expand this work to increase the rate of screening for, identifying, and treating sleep problems in children.