Difficulties initiating and maintaining sleep may be transient or persistent. In practice, children and adolescents should be included in the diagnostic and therapeutic process.

Nightmares are defined as dreams with strong negative emotions which awaken the dreamer and are common during childhood: cross-sectional data shows the highest prevalence rates between the ages of five and ten. The present longitudinal study was designed to study the stability of nightmares over the course of 2 years. Sleep questionnaires and Strengths and Difficulties Questionnaires were completed by 851 10-years-old children and their parents, separately. In the total sample, nightmares occurred often in 2.5% (parental estimates) to 3.5% (self estimates of the children). The findings indicate that nightmare stability is considerably high, i.e., nightmare occurrence was predicted by the prevalence the year before (in addition to the concurrent amount of emotional symptoms). Children with 'chronic' nightmares showed more psychopathological symptoms. It would be interesting to follow-up these children in order to investigate whether childhood nightmares are also predictive for adult psychopathology.

Objective: This cross-section study investigated the prevalence of sleep disorders and the relationship between sleep problems (insomnias, parasomnias, and daytime sleepiness) and school refusal behavior in school-age children (fourth grade elementary school in Cologne, Germany). Method: A sample of 1,490 children (age range: 8-11 years) and their parents each completed a sleep questionnaire and the School Refusal Assessment Scale. Results: The results indicate that sleep problems in childhood are frequent. Furthermore, the results of the study clearly indicate that there is a relationship between sleep problems and school refusal behavior. Children suffering from insomnias (sleep onset problems, difficulties maintaining sleep), parasomnias (nightmares, night terrors), and daytime sleepiness showed without exception significantly higher scores in 3 out of 4 school refusal behavior maintaining conditions compared to children without sleep problems. These three conditions are all associated with anxiety disorders (anxiety or depressive disorder, as well as separation anxiety disorder). Only in the fourth condition, which is associated with oppositional defiant or conduct disorders, truancy, or no disorder at all, were there no significant differences between children with and children without sleep problems. Conclusions: For research and clinical practice, it is important to view sleep problems and school refusal behavior in relation to each other rather than as isolated phenomena.

Sleep disorders increase the risk of daytime fatigue and of psychological problems in general, including both hyperactivity and excessive emotional stress. These results imply that sleep problems and emotional disturbances are intimately connected and underscore the importance of diagnosing sleep problems in young children.

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