Sleep Problems In Adolescents Research Articles

Exposure to peer aggression and adolescent sleep problems: Moderation by parental acceptance.

Many adolescents experience or witness aggression by peers at school. The purpose of the current study was to examine associations between exposure to peer aggression (i.e., peer victimization and witnessing school violence) and sleep problems and whether these associations are moderated by parental acceptance. Participants included 272 adolescents attending high school (M age = 17.27 years; 49% female; 59% White/European American, 41% Black/African American). Adolescents reported on exposure to peer aggression, parental acceptance, and two key sleep domains: sleep quality problems and daytime sleepiness. Results indicated that exposure to peer aggression was directly associated with poor sleep quality and sleepiness. Furthermore, peer victimization and witnessing school violence interacted with parental acceptance to predict sleep quality. Specifically, exposure to peer aggression was associated with sleep quality problems at higher (but not lower) levels of parental acceptance. The lowest levels of sleep quality problems were apparent at low levels of peer aggression and high levels of parental acceptance, but parental acceptance did not protect adolescents with high exposure to peer aggression against sleep problems. Findings illustrate the importance of considering moderators of effects and the conjoint roles of family and peer processes when considering individual differences in adolescents' sleep. Future research should examine whether parental strategies targeted to address peer victimization are protective against the detrimental effects of exposure to peer aggression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Associations between sleep, daytime sleepiness and functional outcomes in adolescents with ADHD

Objective/backgroundAdolescents with attention-deficit/hyperactivity disorder (ADHD) experience greater difficulties in the domains of sleep, daytime sleepiness, and functioning compared to their peers. However, the relationship between these domains has not been fully elucidated. This study aimed to examine the relationship between sleep problems (including daytime sleepiness), ADHD severity, and functional outcomes (irritability, sluggish cognitive tempo, homework difficulties, and substance use) in a sample of adolescents with ADHD. Patients/methodsEighty-two adolescents (13–17 years) and their families participated in the study. Sleep was measured by both adolescent and parent-report. Adolescent irritability and sluggish cognitive tempo were reported by both adolescents and parents, while other variables were reported by a single reporter (homework difficulties – parent; ADHD severity – parent; substance use – adolescent). Analyses controlled for demographic factors and internalising and externalising comorbidities. ResultsA weak relationship was found between adolescent-reported sleep problems and daytime sleepiness, which became non-significant in adjusted analyses (β = −0.19, p = 0.115). In adjusted analyses, there was an association between adolescent-reported sleep problems and adolescent-reported irritability (β = −0.27, p = 0.023) as well as between adolescent-reported daytime sleepiness and parent-reported sluggish cognitive tempo (β = 0.28, p = 0.033). In adjusted analyses, parent-reported adolescent sleep problems were associated with ADHD severity (β = 0.54, p = <0.001), parent-reported sluggish cognitive tempo (β = 0.64, p = <0.001), both reporters of irritability (parent-report: β = 0.32, p = 0.004; adolescent-report: β = 0.29, p = 0.022), and homework problems (β = 0.37, p = 0.003). Parent-reported daytime sleepiness was associated with parent-reported sluggish cognitive tempo (β = 0.34, p = 0.024). ConclusionsThis study demonstrates the importance of a holistic assessment of adolescents with ADHD, not only focusing on symptomatology but also on sleep problems and functional outcomes. The importance of multi-informant assessment of sleep problems is also reinforced.

Reciprocal Relationships between Sleep Problems and Problematic Smartphone Use in Taiwan: Cross-Lagged Panel Study.

Prior studies have suggested a link between sleep problems and problematic smartphone use. However, the causal relationships between these two variables have not been identified, particularly in adolescence. Utilizing longitudinal panel data from Taiwan, this report examined the temporal relationships between sleep problems and problematic smartphone use among adolescents. One thousand and thirty-nine students (Grades 7–12) were surveyed at two-time points with a 6-month interval. The results of cross-lagged panel analysis showed that sleep problems at Time 1 significantly predicted problematic smartphone use at Time 2. Problematic smartphone use at Time 1 also significantly predicted sleep problems at Time 2. These findings applied to boys and girls and suggested that temporal relationships between sleep problems and problematic smartphone use among teenagers are reciprocal. Accordingly, increasing sleep quality may prevent future problematic smartphone use, while reducing problematic smartphone use may prevent sleep problems in adolescents.

Sleep behavior and problems in children and adolescents of a psychiatric day clinic sample: results and requirements for systematic diagnostic

Sleep behavior and problems in children and adolescents of a psychiatric day clinic sample: results and requirements for systematic diagnostic Abstract. Sleep disorders are common in adults as well as children and adolescents. Children and adolescents in psychiatric treatment (CAP) are especially affected by sleep problems. Cognitive behavioral therapy represents the first-line treatment, preceded by a standardized procedure for sleep diagnostics. To date, no study has investigated sleep behavior in CAP day clinics in Germany. In this study, N = 46 children/adolescents receiving CAP treatment in a day clinic completed a sleep diary (7 days) and a sleep anamnesis scheme with the help of their parents, and their sleep behavior was assessed by a clinician. Furthermore, a parent- and a self-report questionnaire plus a clinical assessment of the mental disorders in the children/adolescents were collected. 52 % of the children/ adolescents exhibited sleep disorders or sleep abnormalities (= sleep disorder symptoms in the context of comorbid disorders), in particular problems falling asleep or to falling asleep and sleeping through the night (26 %). In addition, 33 % reported having nightmares. Their sleep behavior correlated significantly with their external behavior problems (r = .38 .61, p = .02-.04); their sex (female: p = .01-≤ .001, |d| = 1.57-2.50) and their age (older: p = .05, |d| = .78) also significantly influenced sleep behavior. Particularly external behavior problems were associated with sleep problems in this day-care population. In summary, a multi-method-multi-informant procedure should be established for the systematic diagnostics of sleep abnormalities, together with individualized cognitive-behavioral therapy of sleep problems, especially in patients with external behavior problems.

Collateral Child and Parent Effects of Function‑Based Behavioral Interventions for Sleep Problems in Children and Adolescents with Autism.

This study follows McLay et al., Journal of Autism and Developmental Disorders, (2020) to investigate whether the function-based behavioral sleep interventions received by 41 children and adolescents with autism spectrum disorder (ASD) produced collateral improvements in ASD severity, internalizing and externalizing symptoms and parent relationship quality, ratings of depression, anxiety and stress, and personal sleep quality. Concomitant with reduced sleep problem severity, improvements were found in children's internalizing and externalizing behavior and ASD symptom severity. Small improvements were also found in maternal sleep quality and parental stress. There was little change in parental relationship quality post-treatment, possibly reflecting high baseline scores. Overall, collateral benefits were generally small but positive, consistent with the limited extant research, and underscore the importance of investigating collateral effects across a range of variables.

Daytime sleepiness underlies the link between adverse parenting and youth psychopathology among adolescent girls

IntroductionAdverse parenting is associated with sleep problems in adolescence, including sleep quality, inadequate sleep, and daytime sleepiness. Adolescents who experience sleep problems are at greater risk for developing internalizing and externalizing problems. However, research on the intervening role of sleep in the link between adverse parenting and youth psychopathology remains limited. The present study aimed to examine the indirect effects of adverse parenting on youth internalizing and externalizing psychopathology via sleep problems, and to examine the moderating role of gender in associations between parenting and sleep. MethodsParticipants were 101 low-income youth aged 9–12 (52.5% female; 75.2% African-American) and their primary caregivers. Families were from a non-metropolitan region in the Southeastern United States. Data were collected at two time points (T1; Mage = 10.28, SD = 1.2; T2; Mage = 12.08, SD = 1.2). Adverse parenting was measured at T1, youth-reported sleep problems (inadequacy, disturbance) and daytime sleepiness were assessed at T2, and parent-reported internalizing and externalizing symptoms were measured at T2. ResultsDaytime sleepiness served as an intervening variable in associations between adverse parenting and internalizing and externalizing problems, but sleep problems did not. This indirect association was moderated by gender, such that the association between adverse parenting and daytime sleepiness only emerged as significant for girls. ConclusionsThese findings suggest that daytime-related sleep behaviors may serve as a mechanism through which harsh or neglectful parenting is related to internalizing and externalizing psychopathology in adolescence, particularly for adolescent girls.

Resilience buffers the effects of sleep problems on the trajectory of suicidal ideation from adolescence through young adulthood

ObjectivesTo examine both the between-person and within-person effects of sleep problems on the trajectory of suicidal ideation from ages 14 to 22 and investigate whether resilience moderates the effects. Age and sex differences were explored in the main and interaction effects of sleep problems and resilience on suicidal ideation. MethodsThe study sample included 2491 adolescents (1260 males and 1231 females) who participated in a prospective study spanning 2009 through 2016 in northern Taiwan. Sex-stratified multilevel models were used to examine the between-person and within-person effects of sleep problems and the moderating effects of resilience on the trajectory of suicidal ideation in males and females. ResultsAcross adolescents, higher levels of sleep problems contributed to an elevated risk of suicidal ideation for both sexes. Within individuals, a higher risk of suicidal ideation was observed when an adolescent's sleep problems exceeded their typical levels. The within-person effects of sleep problems were further determined to vary by age in males, with the effects gradually decreasing throughout late adolescence but increasing again in young adulthood. The buffering effects of resilience were only observed in females. The relationships between the within-person effects of sleep problems and suicidal ideation were only significant in female adolescents with low levels of resilience. ConclusionsOur findings extend the research by demonstrating both the between-person and within-person association between sleep problems and suicidal ideation. We further revealed age and sex differences in the within-person effects of sleep problems and the buffering effects of resilience. Prevention and intervention programs that target sleep problems could be tailored based on individuals’ age, sex, and levels of resilience to prevent suicidal ideation.

Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial

The potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p < 0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251, Date: 11.31. 2014

767 Sleep architecture and sleep problems in adolescents and young adults with and without ADHD: A systematic review and meta-analysis

Abstract Introduction During the past years, an increasing number of articles has focused on comparing sleep in youths with and without ADHD. However, so far no meta-analysis has been conducted summarizing the findings. Therefore, the current study assesses sleep architecture (i.e. the basic sleep structure), sleep problems, and sleep hygiene. Sleep was assessed both subjectively and objectively and the two groups were compared on multiple variables. Methods Two researchers independently performed a literature search (1980–2020). Studies using a case-control design comparing sleep in youths (12–25 years) with and without ADHD were included. Study quality was evaluated using the Newcastle-Ottawa Scale. Standardized mean differences were calculated for each outcome domain being reported by at least two studies. Results 10379 publications were screened, resulting in 11 studies and 52 effect sizes (nADHD=2377, ncontrol=21687). These effect sizes were summarized into 7 objective and 11 subjective variables measuring sleep. Two objective sleep variables were significantly worse in the ADHD group; total sleep time (z=2.16, p=.03) and sleep onset latency (z=2.39, p=.02). The two groups did not differ on sleep efficiency, sleep onset/offset time, and time in bed. Comparing the groups on subjective variables resulted in the same pattern, with total sleep time (z=21.27, p&amp;lt;.001) being significantly shorter in the ADHD group, and sleep onset latency (z=15.39, p&amp;lt;.001) and wake after sleep onset (z=13.50, p&amp;lt;.001) being significantly longer. Additionally, the ADHD group reported a significantly lower sleep efficiency (z=20.15, p&amp;lt;.001) and subjective sleep satisfaction (z=3.50, p&amp;lt;.001). Wake time and number of awakenings during the night were not significant. Youths with ADHD also reported significantly more sleep problems, including insomnia (z=6.38, p&amp;lt;.001), daytime sleepiness (z=26.68, p&amp;lt;.001) and sleep disturbances (z=8.00, p&amp;lt;.001). Due to only two studies measuring it, with a focus on different variables, sleep hygiene could not be included. Conclusion In general, youths with ADHD have a disrupted sleep architecture and experience more sleep problems compared to their typically developing peers. Consequently, sleep assessment should become a routine part during the diagnostic process of ADHD. Additionally, more research is needed focusing on sleep architecture and sleep hygiene, and on the development of a sleep intervention for youths with ADHD. Support (if any):

222 COVID-19 Related Stress Intensify the Impact of Child Maltreatment on Sleep Quality

IntroductionChild maltreatment (CM) is a significant stressor that is associated with sleep problems in children and adolescents. The COVID-19 pandemic introduces new psychosocial stressors, which may be particularly harmful to youth already experiencing stress in the home environment. Using multi-dimensional (threat vs deprivation) assessments of CM, the present study aimed to test whether COVID-19 related stress intensified the association between maltreatment (abuse vs neglect) and sleep problems among youth.MethodsThis study utilized data from a longitudinal sample of youth (N=126; Mage at T1=12.9) assessed between January 2019 and March 2020 (T1) and after the beginning of the COVID-19 pandemic (May 2020; T2). Latent factors for COVID-19 related stress included three questions asking about negative changes, uncertainty about the future, and stress-induced by disruptions. CM at T1 was measured with the Childhood Trauma Questionnaire (CTQ). Multidimensional aspects of CM included a threat factor (sum of Emotional, Physical, and Sexual Abuse) and a deprivation factor (sum of Emotional and Physical Neglect). Sleep-related problems at both T1 and T2 were assessed using the Pittsburgh Sleep Quality Index (PSQI) global score. Structural equation modeling was conducted in Mplus 8.1 to test direct and interaction effects of CM and COVID-19 related stress on sleep problems at T2 while controlling for sleep problems at T1 and demographic covariates.ResultsThreat-related abuse was significantly associated with increased sleep problems at T2 (β =.43, p < .01) but neglect was not (β =.03, p = .85). Additionally, COVID-19 related stress significantly intensified the link between abuse and sleep problems (β =.14, p < .05) as well as between neglect and sleep problems (β =.43, p < .01) at T2. Among youth who experienced higher levels of CM, increased COVID-19 related stress exacerbated sleep problems.ConclusionThese results bolster extant research on the negative impact CM bears on youth sleep health and indicates that COVID-19 stress may exacerbate sleep problems. Our findings inform future prevention and intervention efforts that aim to reduce sleep problems among youth who experience CM during the COVID-19 pandemic.Support (if any)NIH/NIDA K Grant 1K01DA045219-01

The experience of sleep problems for adolescents with depression in short-term psychological therapy.

A growing body of literature demonstrates a strong relationship between sleep disturbances and depression in adolescence. In spite of this, few studies have explored how adolescents with depression experience sleep problems. The present study aimed to qualitatively explore the experience of sleep problems in adolescents with depression, including their understanding of how a psychological therapy impacted on these sleep difficulties. The sample included 12 adolescents with sleep disturbances who had been offered treatment for depression through a large, multi-centre, randomised controlled trial. Semi-structured interviews conducted after treatment and 1-year post treatment were analysed using thematic analysis. Two main themes were identified. Both themes demonstrated how an overarching desire to escape impacted the adolescents' sleep in distinct ways; 'thinking about the 'bad stuff'' was characterised by ruminative thinking, which prevented sleep, whereas 'sleep as an escape' indicated a desire to sleep excessively due to feelings of helplessness. Overall, the findings demonstrate a nuanced relationship between sleep and depression in adolescence, and imply that the underlying meaning of the sleep difficulties for each young person should be considered in the delivery of therapy for adolescent depression.

Sleep problems in children and adolescents following traumatic life events.

Rates of childhood trauma exposure are extremely high, with approximately 70% of children and adolescents experiencing at least one traumatic event. Among the most common non-specific consequences of stress and trauma are disruptions of sleep. Sleep problems, such as shorter sleep duration, difficulty falling asleep, frequent awakenings, nightmares, sleepless nights, and early-morning wakefulness appear to have a higher prevalence among children and adolescents following traumatic events. This review will illustrate the role of sleep problems in traumatized children and adolescents, and emphasize the need to consider a wide range of etiological mechanisms for these symptoms. However, the relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research. Moreover, in view of the adverse consequences of long-term disrupted sleep on mental health outcomes following trauma, the need to effectively address sleep disturbances in traumatized children and adolescents is crucial.

Sleep problems in children and adolescents following traumatic life events

Sleep problems in children and adolescents following traumatic life events

Sleep Problems in Children and Adolescents with Autism: Type, Severity and Impact

Sleep problems of varying kind and severity, including both insomnias and parasomnias, are a commonly reported clinical problem among children and adolescents with autism spectrum disorder (ASD) and, it is estimated that approximately 50–80% of children with ASD and their families are affected by such problems. Without effective treatment, these sleep problems are likely to persist and can result in adverse long-term effects for the child and other family members. Despite the higher prevalence of sleep problems in individuals with ASD, little is known about the interaction between the type of sleep problems and the impact they have on the individual and their families. The purpose of this study was to examine the types of sleep problems reported by parents of children with ASD and their secondary impact. Specifically, using data from a survey of families with a child with ASD we classified the types of sleep problems reported and examined correlations between these sleep problems and reported effects on the individual and their family. Data from 244 children with ASD were reported to experience various types of sleep problems, particularly insomnia and bedtime resistance. Further, the findings confirm the far reaching adverse effects of sleep problems on child and family wellbeing. The implications of these findings and future research directions are discussed.

Sleep as a mediator in the context of emotional problems in adolescents with IBD: A pilot study

Background: Sleep has an impact on daily life. Particularly among adolescents with IBD, adequate sleep seems to be important, as the disease itself and the associated symptoms can cause distress and impair daytime functioning. However, often parental and youth reports differ regarding perceived sleep problems of adolescents. Besides sleep problems, depression and anxiety are often prominent in young IBD patients. To date, the interplay between sleep, anxiety/depression symptoms and IBD is not fully understood. Therefore, the aim of this study was to (1) evaluate sleep problems in adolescents suffering from IBD, (2) compare adolescents’ sleep quality and impairments according to self- and parental reports, and (3) investigate the interaction between IBD symptomatology, emotional problems and sleep disturbances. Methods: 29 adolescents (age 10 - 22; M = 14.44 , SD = 1.78 ) with IBD and their parents took part in the study. Adolescents and parents completed questionnaires concerning sleep, emotional problems, and IBD symptomatology. Results: Especially overtiredness, insomnia symptoms, and nightmares play a prominent role regarding sleep problems in youths. Self-rated sleep problems and parental ratings were inconsistent, particularly for nightmares (Z = -2.12; p = .034). However, other ratings concerning emotional problems and sleep, especially anxiety and nightmares, were significantly related(r = .426, p = .034), even though we found no mediation effect for the association between IBD, nightmares and anxiety. Discussion: The present study revealed the importance of sleep and emotional well-being for adolescents suffering from IBD. Moreover, it became clear that the role of anxiety in youths suffering from IBD and sleep problems is not sufficiently answered yet. Not only emotional behavior but also sleep should be addressed when diagnosing IBD or during treatment of IBD. In addition, these results show the need for further investigation regarding the differences between parental and self-reports concerning sleep problems in young IBD patients.

Supplemental Material for Exposure to Peer Aggression and Adolescent Sleep Problems: Moderation by Parental Acceptance

Supplemental Material for Exposure to Peer Aggression and Adolescent Sleep Problems: Moderation by Parental Acceptance

Parent ethnic-racial socialization during childhood protects against increases in bedtime sleep problems in Black adolescents.

Racial disparities in sleep have been reported with Black adolescents showing the least amount of sleep relative to other youth. Yet, few within-group studies have examined factors that protect Black adolescents from sleep problems. To address this gap, we tested whether parent ethnic-racial socialization (i.e., instilling a sense of cultural and racial pride) at fourth grade moderated the associations between bedtime sleep problems at third and sixth grade. Using data from a sample of Black parents and children who participated in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (n = 173), we found that for children with low, but not high, parent ethnic-racial socialization at fourth grade bedtime problems increased from third and sixth grade. We discuss these findings within the existing parent ethnic-racial socialization and sleep literatures and how they further our understanding of the protective effects of parent ethnic-racial socialization. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Relationship between Adverse Childhood Experiences and Sleep Problems among Adolescent Students: Mediation by Depression or Anxiety.

Adverse childhood experiences (ACEs) are known to be closely related to depression, anxiety and sleep problems. However, it remains unclear whether adolescents with ACEs have sleep problems regardless of depression or anxiety or under a mediating effect from depression or anxiety. Therefore, our aim was to examine whether depression or anxiety mediates the relationship between ACEs and sleep problems in adolescents by using a community sample. The Early Trauma Inventory Self Report–Short Form (ETISR-SF) and List of Threatening Experiences Questionnaire (LTE-Q) were used to assess traumatic ACEs. Ultimately, data from 737 students (M = 448, F = 289, 15.1 ± 1.4 years old) were included in the statistical analysis. A total of 576 (78.1%) participants reported that they had experienced one or more ACEs. Adolescents with ACEs had higher levels of depression, anxiety and sleep problems than did adolescents without ACEs, and boys tended to experience more trauma than girls. Depression and anxiety partially mediated the relationship between ACEs and sleep problems. The results of this study suggest the need for depression and anxiety interventions for adolescents with ACEs to reduce the long-term consequences, including sleep problems and physical health problems.

Trends in Sleep Problems Among Japanese Adolescents: 2004 to 2017

Background: Adolescence is a period of physical, mental, and social development. Sleep problems in adolescence, such as insomnia and short sleep duration, have been associated with physical and mental health problems. Little is known about the recent trends in sleep problems among adolescents. This study aimed to examine trends in sleep problems among Japanese adolescents. Methods: Using data from the Lifestyle Survey of Adolescents collected in 2004, 2008, 2010, 2012, 2014, and 2017, we calculated the prevalence of insomnia, short sleep duration, late bedtime, long sleep duration, and poor sleep quality. Multivariable logistic regression analysis models were used to examine the association of each sleep problem and survey years. Sampling weights were constructed based on participation rates. Findings: We analyzed data from 545,285 Japanese adolescents. Results indicated that, since 2004, the odds of insomnia decreased (AOR 0·86, 95%CI 0·84-0 ·88), as did the odds of short sleep duration (AOR 0·89, 95%CI 0·90-0·94) and poor sleep quality (AOR 0·93, 95%CI 0·92-0·95). However, the odds of late bedtime tended to increase (AOR 1·07, 95%CI 1·05-1·10) during this period. Interpretation: The prevalence of insomnia symptoms, short sleep duration, and poor sleep quality among adolescents decreased from 2004 to 2017. However, the prevalence of late bedtime increased. These changes are both relieving and concerning. Teachers, parents, and health professionals should consider educating adolescents regarding sleep hygiene, adjusting schedules of extracurricular activities, and enhancing time management to improve their sleep quality. Funding Statement: This study was supported by a grant for Comprehensive Research on Lifestyle-Related Diseases including Cardiovascular Diseases and Diabetes Mellitus by the Ministry of Health and Welfare Health Science Research Fund in Japan (grant no. 29060801). Declaration of Interests: Adam P. Spira received an honorarium from Springer Nature Switzerland AG for Guest Editing a Special Issue of Current Sleep Medicine Reports. The other authors declare no conflicts of interest associated with this manuscript. Ethics Approval Statement: Informed written consent was obtained from all study participants. Due to the new epidemiological research guidelines, informed consent was obtained from each junior high school student’s parent or guardian in the 2017 survey. Parents’ and guardians’ informed consent was not required by the guidelines governing anonymous and non-invasive research entailing students who had finished junior high school in the earlier years. The teachers explained the nature of confidentiality and voluntary participation to all the students, and completed questionnaires were returned to the working group in sealed envelopes. This protocol is in accordance with the Japanese Ethical Guidelines for Epidemiological Research announced by the Ministry of Health, Labour and Welfare and the Ministry of Education, Culture, Sports, Science and Technology of Japan. The working group used anonymized questionnaires to prevent the identification of individual participants and to safeguard their privacy. This study was approved by the ethical review board of the Nihon University School of Medicine.

Trajectories of sleep problems in childhood: associations with mental health in adolescence

We examined initial levels (intercepts) of sleep-wake problems in childhood and changes in sleep-wake problems across late childhood (slopes) as predictors of externalizing behavior problems, depressive symptoms, and anxiety in adolescence. To ascertain the unique effects of childhood sleep problems on adolescent mental health, we controlled for both childhood mental health and adolescent sleep problems. Participants were 199 youth (52% boys; 65% White/European American, 35% Black/African American). Sleep-wake problems (e.g. difficulty sleeping and waking up in the morning) were assessed during three time points in late childhood (ages 9, 10, and 11) with self-reports on the well-established School Sleep Habits Survey. At age 18, multiple domains of mental health (externalizing behavior problems, depressive symptoms, and anxiety) and sleep-wake problems were assessed. Latent growth curve modeling revealed that children with higher levels of sleep-wake problems at age 9 had consistently higher levels of such problems between ages 9 and 11. The initial level of sleep-wake problems at age 9 predicted externalizing behaviors, depressive symptoms, and anxiety at age 18, controlling for mental health in childhood and concurrent sleep-wake problems in adolescence. The slope of sleep-wake problems from ages 9 to 11 did not predict age 18 mental health. Youth who had higher sleep-wake problems during late childhood had higher levels of mental health problems in adolescence even after controlling for childhood mental health and concurrent sleep-wake problems. Findings illustrate that childhood sleep problems may persist and predict adolescent mental health even when potentially confounding variables are rigorously controlled.