I was just reading a study that examined the proposed pathways from sleep problems in preschool children to behavioral disruption during the day. Specifically, a team from the MINDS institute at UC Davis was interested in exploring some possible reasons that could explain why sleep problems often lead to behavioral dysregulation during the day. The most obvious candidate, and the target for their study, is daytime sleepiness. It is commonly reported by parents and educators, that children that experience sleep problems at night are usually sleepy during the day, and this sleepiness may be the trigger for behavioral problems.

The authors examined 194 preschool children, including 68 kids with Autism, 57 with non-autism developmental delays, and 69 typically developing. Sleep problems were measured via parents reports but also through the use of actigraphs. These are very sensitive motion sensors that are attached to the child’s leg and are able to reliably identify when the child falls asleep or wakes up during the night. This allows the researcher to determine a number of specific sleep indicators, such as total sleep hours during the day, sleep efficiency (total hours of actual sleep while in bed), sleep latency (how long does it take the child to fall asleep), and wake after sleep duration (total minutes awake after initially falling asleep).

In sum, the authors failed to find support the proposed hypothesis (that sleep problems lead to sleepiness and this is leads to behavioral disruptions) but there were a number very interesting findings regarding discrepancies between parental reports and the actigraphs.

Parental perception of whether his/her child had a sleep problem was not associated with total sleep hours throughout the day/night, efficiency of sleep, or latency of sleep onset as recorded by the motion sensors. Parental report was only associated with ‘wake after sleep’ duration. These findings suggest that parents perception of sleep problem may be reflecting only one aspect of sleep dysregulation, in that parents may be more sensitive (or reactive) to the kids’ waking throughout the night than to other potential problems like reduced total sleep or difficulties falling asleep.

The actigraphs did not fully support the common finding that children with special needs, and specifically kids with autism, have significantly more sleep problems than typically developing kids. That is, the 3 groups of kids (autism, non-autism developmental delays, and typical) did not differ in sleep efficiency, sleep latency, and wake after sleep. Instead, total sleep hours was the only significant difference between these kids.

These findings made me think about the reliability of methods that assess child sleep difficulties based solely on parental report, and the validity of long held beliefs regarding sleep problems when such beliefs respond mostly to parental perceptions of the kids sleep difficulties. The concern is not necessarily that parental reports may be unreliable, but that they may be limited in that they can reflect only one aspect of the potential problems with the sleep cycle. These findings also suggest that clinicians should take a comprehensive approach when interviewing parents about their kids sleep problems.

Goodlin-Jones, B., Tang, K., Liu, J., & Anders, T. (2009). Sleep problems, sleepiness and daytime behavior in preschool-age children Journal of Child Psychology and Psychiatry DOI: 10.1111/j.1469-7610.2009.02110.x

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