ARTICLES
Sleep and Psychiatric Symptoms in School-Age Children

https://doi.org/10.1097/00004583-200004000-00020Get rights and content

ABSTRACT

Objective

To assess associations between the quantity and quality of children's sleep and parent- and teacher-reported psychiatric symptoms.

Method

Forty-nine physically healthy 7- to 12-year-old children from normal classes participated. They were monitored for 72 consecutive hours with belt-worn activity monitors (actigraphs) to obtain objective data on their daytime and nighttime activity and sleep. In addition, Child Behavior Checklists and Teacher's Report Forms were filled out by the parents and teachers, respectively.

Results

Quantity of sleep was significantly associated with total symptom score on the Teacher's Report Form. The highest associations were found between low true sleep time and teacher-reported externalizing symptoms such as aggressive and delinquent behavior and attention and social problems. Sleep parameters were not associated with parent-reported psychiatric symptoms, except for the association found between delayed sleep latency and aggressive, delinquent behavior.

Conclusions

The objectively measured amount of school-age children's sleep was associated with teacher-reported psychiatric symptoms. Parents may be unaware of their child's sleep deficiencies as the behavioral problems may be more evident at school than at home. Sensitive and objective measurements are needed to rule out the possibility of inadequate sleep underlying behavioral problems.

Section snippets

Subjects

Forty-nine medically healthy volunteers aged 7 to 12 years attending normal classes were recruited for the study by advertising in 2 schools in the Helsinki area and in the hospital newsletter. Written informed consent was obtained from the parents and a verbal assent from the child. In the recruitment process the study was described as a study investigating daytime and nighttime activity levels and how activity levels are related to children's behavior and emotions at school and at home in

Sleep and Symptom Parameters

The descriptive statistics for the sleep and symptom parameters are presented in Table 1. No significant differences between boys and girls were found for any of these parameters (t test, all t values < 1.2, p values > .2, df = 46). Correlations between the CBCL and the TRF total scores and broad-band symptom sum scores were low (Pearson correlation coefficients < 0.185). Age and symptom scores (total, broad-band, and narrow-band) of the parent/teacher reports were not significantly correlated

DISCUSSION

In a nonclinical sample of 7- to 12-year-old children, the objectively measured true sleep time was associated with teacher-reported psychiatric symptoms. The decreased amount of sleep was associated more with externalizing than internalizing types of symptoms. A significant difference in the number of teacher-reported symptoms was found between the 3 groups of children having different true sleep times. Children who slept on average 9.6 hours per night (group A) had fewer symptoms according to

REFERENCES (31)

  • C Caron et al.

    Comorbidity in child psychopathology: concepts, issues and research strategies

    J Child Psychol Psychiatry

    (1991)
  • RD Chervin et al.

    Symptoms of sleep disorders, inattention, and hyperactivity in children

    Sleep

    (1997)
  • RE Dahl et al.

    The role of sleep disturbances in attention deficit disorder symptoms: a case study

    J Pediatr Psychol

    (1991)
  • GJ Emslie et al.

    Children with major depression show reduced rapid eye movement latencies

    Arch Gen Psychiatry

    (1990)
  • RF Ferdinand et al.

    Psychopathology from adolescence into young adulthood: an 8-year follow-up study

    Am J Psychiatry

    (1995)
  • Cited by (233)

    • Examining the Use of a Rest-Activity Ratio in a Pediatric Rehabilitation Setting

      2022, Archives of Physical Medicine and Rehabilitation
    • Observational and experimental studies on sleep duration and aggression: A systematic review and meta-analysis

      2022, Sleep Medicine Reviews
      Citation Excerpt :

      From 16 studies providing externalizing behavior as outcome category, twelve correlations could be pooled [38,39,44,51,52,54,67,71,73,83,91] yielding an estimate of −0.13 (95% CI -0.16, −0.10; I2 = 31.7%) (Fig. 2). Four studies could not be included in the meta-analysis; qualitative analysis showed that three studies [27,28,80] observed statistically significant associations between shorter sleep duration and higher levels of externalizing behavior, whereas one study did not show any association [55]. The pooled estimate from 5 studies [26,31,43,74,87] reporting correlations between sleep duration and anger was −0.29 (95% CI -0.49,-0.08; I2 = 91.8%) (Fig. 2).

    View all citing articles on Scopus

    This study was supported by grants from the Finnish Cultural Foundation, Signe and Ane Gyllenberg Foundation, Yrjö Jahnsson Foundation, Ella and Georg Ehrnrooth Foundation, and Helsinki University Central Hospital.

    View full text