The Role of Sleep in Childhood Psychiatric Disorders

Abstract

Although sleep problems often comprise core features of psychiatric disorders, inadequate attention has been paid to the complex, reciprocal relationships involved in the early regulation of sleep, emotion, and behavior. In this paper, we review the pediatric literature examining sleep in children with primary psychiatric disorders as well as evidence for the role of early sleep problems as a risk factor for the development of psychopathology. Based on these cumulative data, possible mechanisms and implications of early sleep disruption are considered. Finally, assessment recommendations for mental health clinicians working with children and adolescents are provided toward reducing the risk of and improving treatments for sleep disorders and psychopathology in children and adolescents.

Sleep, emotional and behavioral difficulties in children and adolescents

“…Overall, discrepancies between studies may be partly explained by Sleep, emotional and behavioural problems in youth 11 differences in the age of participants and severity of depression symptoms (for a review, see elsewhere). 32 Studies using other objective sleep assessment methods shed additional light on this topic. For example, an actigraphic study of rest-activity cycles in children with MDD found that in comparison to controls these children present damped circadian amplitude and lower light exposure and daytime activity levels.…”

Sleep-Related Problems and the Effects of Anxiety Treatment in Children and Adolescents

“…At the same time, sleep disruption results in decreased emotion regulation (e.g., Sagaspe et al, 2006) and increased pain sensitivity (Roehrs, Hyde, Blaisdell, Greenwald, & Roth, 2006). Thus, sleep disruption may exacerbate emotional, behavioral, attentional, and somatic symptoms, further interfering with sleep quality (Alfano & Gamble, 2009). Given that sleep behaviors in young children reflect early attempts to self-regulate (Alfano & Gamble, 2009), persistent sleep disruption may represent a prodromal form of emotion dysregulation, sharing neurological and hormonal circuitry (Leahy & Gradisar, 2012).…”

Anxiety Symptoms Account for the Link between Reactive Aggression and Sleep Problems Among Latino Adolescents

“…Reactive aggression has been repeatedly found to be associated with symptoms of anxiety (e.g., Card and Little 2006;Fite et al 2010;Seah and Ang 2008;Xu and Zhang 2008), and anxiety symptoms are associated with sleep difficulties (Becker 2014;Manni et al 1997;Sarchiapone et al 2014). These sleep difficulties are likely the result of the physiological and psychological arousal experienced as a result of these symptoms (Alfano and Gamble 2009;Dahl 2006;El-Sheikh and Buckhalt 2005;Gregory and Sadeh 2012). In contrast, proactive aggression was not associated with anxiety and was unrelated to sleep problems once also considering the variance associated with reactive aggression.…”

“…In addition, there is strong evidence to suggest that anxiety is associated with sleep difficulties (Alfano and Gamble 2009;Becker 2014;Manni et al 1997;Sarchiapone et al 2014). For example, among anxious youth, clinically-significant sleep problems were reported by 85 % of parents (Alfano et al 2010).…”

“…It may be that anxiety mediates the association between reactive aggression and sleep problems. That is, high levels of reactive aggression may elicit negative emotions and physiological arousal, specifically anxiety, which results in sleep difficulties (Alfano and Gamble 2009). Accordingly, reactive aggression was expected to be more strongly associated with sleep problems than proactive aggression, and anxiety symptoms were expected to account for this association.…”