Variation in common preschool sleep problems as an early predictor for depression and anxiety symptom severity across time

Abstract

Background Child and adolescent psychopathology has been linked to increased sleep problems, but there has been less investigation of this relationship in younger samples with early-onset psychopathology. This study examined three specific but commonly observed aspects of sleep behaviors in young children-- 1. Sleep onset latency, 2. Refusal to sleep alone, and 3. Nighttime awakenings -- measured during preschool, and investigated whether these sleep problems predicted anxiety and/or depression across the next six years until school age (ages 9–13). Methods Data were analyzed from N = 292 participants from a prospective longitudinal study of preschool-age children (ages 3–6). At baseline, parent-reported clinical interviews of psychiatric symptoms, as well as sleep problems were conducted using the Preschool-Age Psychiatric Assessment (PAPA). Follow-up clinical interviews were also conducted annually through school-age using the Childhood and Adolescent Psychiatric Assessment (CAPA). Results Parent reported sleep onset latency and refusal to sleep alone were significant independent predictors of MDD and anxiety severity, but not ADHD severity across time, even after controlling for family income-to-needs ratio and maternal internalizing psychopathology. In exploratory analyses using only healthy preschoolers, parent reported sleep onset latency and refusal to sleep alone also predicted anxiety severity. Conclusions We demonstrate that specific, yet relatively common sleep problems predict diagnostic severity of depression and anxiety across time, but not ADHD. Increased clinical attention to and screening for sleep onset latency and refusal to sleep alone during preschool may be warranted.

Depression and Anxiety in Preschoolers

“…Changes in sleep and increased fatigue are also commonly reported symptoms of preschool depression 47,51 However, sleep patterns have also been shown to be a risk-factor for preschool depression and anxiety. Specifically, parent-reported sleep onset latency and the child’s refusal to sleep alone independently predicted both preschool-onset depression and anxiety severity across time 53 . This work suggests that two, relatively common sleep problems may be important to target in early interventions for preschool depression.…”

Preschoolers' self‐regulation and developmental trajectories of sleep problems in early childhood

“…Indeed, the high prevalence of sleep problems and their potential adverse effects on the psychosocial development of the child continue to remain major research and clinical issues in early childhood development (Sadeh, ; Sadeh & El‐Sheikh, ). Poor quality and insufficient amount of sleep have been repeatedly found to serve as risk factors for cognitive, behavioural, and emotional problems during preschool age and beyond (Bernier, Beauchamp, Bouvette‐Turcot, Carlson, & Carrier, ; Gregory & Sadeh, ; Reid, Hong, & Wade, ; Simola et al, ; Troxel et al, ; Wang et al, ; Whalen, Gilbert, Barch, Luby, & Belden, ); they are also related to internalizing pathology in adulthood (Gregory et al, ). As noted in the review of Gregory and Sadeh (), the last two decades have seen a substantial number of studies, both cross‐sectional and longitudinal, with clinical and non‐clinical samples, mostly address one side of possible effects, i.e., they explore the role of sleep on emotional and behavioural problems in later years.…”

“…As noted in the review of Gregory and Sadeh (), the last two decades have seen a substantial number of studies, both cross‐sectional and longitudinal, with clinical and non‐clinical samples, mostly address one side of possible effects, i.e., they explore the role of sleep on emotional and behavioural problems in later years. Meanwhile, only some recent findings point to the bidirectional effects of behavioural, emotional, and sleep problems (Wang et al, ; Whalen et al, ). The findings of a longitudinal study by Wang et al () tracking the developmental trajectories of sleep problems from ages 5 to 14 years also show that behavioural problems share a close link with the initial level rather than the change of sleep problems over time and further suggest that studies of the relationships between these emotional and behavioural problems and sleep should focus on the earlier years of life, prior to age 5.…”

“…And finally, it also could be that better sleep in infancy and toddlerhood could add to better self‐regulation or, more specifically, to better executive functions, which is also documented in the study by Bernier et al (). Sleep duration and sleep onset latency in toddlerhood are claimed to be significant for the cognitive and behavioural functioning outcomes in early childhood and later on (Lukowski & Bell, ; Touchette et al, ; Whalen et al, ), probably also showing their effect on better self‐regulation.…”

Agreement Between Actigraphy and Diary‐Recorded Measures of Sleep in Children With Epilepsy

“…Large‐scale cross‐cultural studies have documented both high global and regional prevalence rates estimating that 10.10% to 75.93% of children experience sleep problems during the first 6 years of life (Mindell, Sadeh, Kwon, & Goh, ; Mindell, Sadeh, Wiegand, How, & Goh, ), with Asian countries having higher recorded prevalence rates than Western countries. Problematic sleep in early childhood can persist into school age and has been associated with lower nonverbal intelligence and depression as well as anxiety symptom severity (Kocevska et al., ; Whalen, Gilbert, Barch, Luby, & Belden, ). Sleep problems, including difficulty falling asleep, night awakenings, reduced sleep duration, and daytime sleepiness, are even more serious in children with epilepsy, whose sleep can be disrupted by seizures occurring during the night or during the day (Chan et al., ; Larson et al., ; Stores, ).…”