Longitudinal Sleep Problems in Children Linked With Negative Well-Being

September 2, 2020

The findings support the integration of sleep assessments into routine developmental screenings in school and primary care settings.

Recently published data suggest that children with longitudinal sleep problems are linked with negative outcomes on a number of measures of child well-being experienced by age 10 or 11 years, highlighting the gap in the early identification and matching intervention for children.1

Led by Ariel A. Williamson, PhD, DBSM, psychologist, Sleep Center, and faculty member, PolicyLab and the Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia (CHOP), she and colleagues analyzed data from the first 6 waves of the Longitudinal Study of Australian Children–Birth Cohort, consisting of 5107 children. They observed that 5 distinct sleep problem trajectories developed over time, and that the children most affected by sleep problems persistently experienced the greatest deficiencies across each outcome, save for cognitive skills.

"Our study shows that although those with persistent sleep problems have the greatest impairments when it comes to broad child well-being, even those with mild sleep problems over time experience some psychosocial impairments," Williamson said in a statement.2 "The range of impairments across academic and psychosocial domains in middle childhood indicate that it is important to screen for sleep problems consistently over the course of a child's development, especially to target children who experience persistent sleep problems over time."

The 5 sleep problem trajectories noted were persistent sleep problems through middle childhood (accounting for 7.7% of the sample), limited infant/preschool sleep problems (accounting for 9.0%), increased middle childhood sleep problems (accounting for 17.0%), mild sleep problems over time (accounting for 14.4%), and no sleep problems (accounting for 51.9%).

All told, Williamson et al. utilized a combination of caregiver‐ and teacher‐reported tasks, as well as child‐completed tasks to index well‐being outcomes at ages 10 to 11 years. These outcomes included emotional/behavioral functioning—described as internalizing and externalizing symptoms, and self‐control—as well as health‐related quality of life, cognitive skills, and academic achievement.

"Although this study cannot answer whether minor, early or persistent sleep problems represent a marker for the onset of behavioral health or neurodevelopmental conditions, our findings support consistently integrating questions about sleep into routine developmental screenings in school and primary care contexts," Williamson stated.2

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Those who were on the “persistent sleep problems” trajectory were observed to have moderate teacher-reported internalizing (effect size [ES], –0.65; 95% CI, –0.87 to –0.43; P <.001) as well as externalizing concerns (ES, –0.40; 95% CI, –0.58 to –0.21; P <.001). They also reported large caregiver-reported internalizing (ES, –0.75; 95% CI, –0.92 to –0.57; P <.001) and externalizing concerns (ES, –0.70; 95% CI, –0.86 to –0.53; P <.001) relative to those with no sleep problems. Those children on the “increased middle childhood sleep problems” trajectory also showed greater caregiver- and teacher-rated internalizing and externalizing symptoms, with small to moderate effect sizes (caregiver ES for both, –0.61 [95% CI, –0.76 to –0.46; P <.001]; teacher ES range, –0.29 to –0.39 [95% CI, –0.53 to –0.15; P <.001]).

Those with “limited infant/preschool sleep problems” and “mild sleep problems over time” only showed small impairments in teacher-rated internalizing symptoms (ES, –0.12; P <.05) and caregiver-rated internalizing symptoms (ES, –0.19; P <.001), respectively.

For measures of self-control, those on the trajectories of “persistent sleep problems” and “increased middle childhood sleep problems” experienced moderate impairments in caregiver-reported outcome compared to those without sleep problems (ES for both, –0.37; 95% CI, –0.52 to –0.21; P <.001).

For cognitive skills, there was no evidence of significant impairments in nonverbal reasoning for any of the trajectories in comparison with the children without sleep problems.

As for academic skills, those with persistent sleep problems reported moderate teacher-rated language/literacy and mathematical thinking impairments (ES, –0.41 for both; 95% CI, –0.60 to –0.23; P <.001). The children on the “increased middle childhood sleep problems” and “limited infant/preschool sleep problems” trajectories showed no significant differences in academic competencies. The “mild sleep problems” trajectory group did, however, show small impairments in those outcomes (ES range, –0.14 to –0.17; 95% CI: –0.31 to –0.004; P <.05).

Williamson and colleagues noted that “for academic achievement on standardized national testing followed a similar pattern, with children who had ‘persistent sleep problems’ showing lower achievement scores, with a small effect size.”

The teacher-rated approach to learning varied by sleep trajectory. The ‘persistent sleep problems’ group showed moderate impairments in learning-related behaviors (ES = 0.42, 95% CI: 0.59 to 0.25, p < .001), while the ‘increased middle childhood sleep problems’ showed small impairments (ES = 0.26, 95% CI: 0.41 to 0.12 to, p < .001). No differences emerged for children with ‘limited infant/preschool sleep problems’ or for those with ‘mild sleep problems.’

Quality of life outcomes reported by caregivers were significantly worse for children on all trajectories compared to the “no sleep problems” trajectory. The ESs were largest for those in the “persistent sleep problems” group (ES range, –0.78 to –0.90; 95% CI, –1.06 to –0.56; P <.001), followed by those in the “increased middle childhood sleep problems” trajectory (ES range, –0.33 to –0.75; 95% CI, –0.88 to –0.19; P <.001).

Those on the “limited infant/preschool sleep problems” trajectory (ES range, –0.12 to –0.13; 95% CI: –0.23 to –0.02; P <.05) and the “mild sleep problems over time” trajectory (ES range, –0.17 to –0.20; 95% CI, –0.32 to –0.05; P <.01) showed small impairments on quality of life.

REFERENCES
1. Williamson AA, Mindell JA, Hiscock H, Quach J. Longitudinal sleep problem trajectories are associated with multiple impairments in child well‐being. J Child Psychol Psyc. Published July 26, 2020. doi: 10.1111/jcpp.13303
2. Child sleep problems associated with impaired academic and psychosocial functioning. News release. CHOP. August 3, 2020. Accessed September 2, 2020. https://www.eurekalert.org/pub_releases/2020-08/chop-csp080320.php