Sleep Problems In Preschoolers Research Articles

Translation and validation of the Thai Version of the Japanese Sleep Questionnaire for Preschoolers (JSQ-P)

PurposeThis study aimed to translate and validate the Japanese Sleep Questionnaire for Preschoolers (JSQ-P) into a Thai version and to evaluate factors associated with sleep problems in preschoolers. MethodsThe cross-cultural adaptation of JSQ-P into Thai version of JSQ-P (TH-JSQ-P) was performed including forward translation, reconciliation, backward translation, and final approval by the original creator. Children aged 2–6 years from community and clinical settings were enrolled. The TH-JSQ-P was completed by parents of preschool children twice within 10–14 days to assess its reliability and validity. Six validity tests including face validity, content validity, structural validity, construct validity, criterion validity and predictive validity were assessed. Demographic data, Epworth sleepiness scale (ESS), medical and behavior problems, and socioeconomic status were collected for analysis. ResultsA total of 2613 participants completed the TH-JSQ-P, with 1207 completing it twice to assess test-retest reliability. The TH-JSQ-P had good internal consistency reliability and test-retest ability with Cronbach's alpha value of 0.898 and intraclass correlation coefficient of 0.814. The content validity was acceptable. The ESS had correlation with sleep problems in almost all subscales except for sleep habit. ConclusionsThe TH-JSQ-P is a valid and reliable instrument for evaluating sleep problems in preschool children in Thailand. It has the potential to be extensively utilized to screen for sleep problems, thereby enabling healthcare professionals to identify them early and implement prompt management.

Relationship between bedtime, nighttime sleep duration, and anxiety symptoms in preschoolers in China.

Sleep problems in preschoolers are becoming increasingly prominent, and the association between sleep status and anxiety symptoms has attracted growing attention. However, studies investigating the relationship between bedtime and nighttime sleep duration in preschoolers and their anxiety symptoms remain scant. We used the large sample data from the Longhua Cohort Study of Children in Shenzhen, China (LCCS) to analyze the association between bedtime and sleep in preschoolers and their anxiety symptoms. A cross-sectional study of 69,138 preschoolers in Longhua District, Shenzhen, China was conducted in 2022. Data on sociodemographic characteristics of families, bedtime, nighttime sleep duration of preschoolers, and their anxiety symptoms (measured by the Spence Preschool Children Anxiety Scale) were collected through a structured questionnaire completed by the parents. Using binary logistic regression models, the relationship between bedtime, nighttime sleep duration, and childhood anxiety symptoms was examined. The bedtimes of preschoolers were concentrated between 21:01-22:00 (52.41%). Among the preschoolers, 38.70% had bedtimes later than 22:00, and 75.49% had insufficient nighttime sleep duration. The positive screening rate for anxiety symptoms among preschoolers was 3.50%. After adjusting for confounding factors using binary logistic regression models, compared with preschoolers with bedtime ≤21:00, The OR (95%CI) values of anxiety in preschoolers with bedtime ≥23:01, 22:01-23:00 and 21:01-22:00 were 2.86 (2.21-3.69), 1.51 (1.27-1.79) and 1.48 (1.26-1.76), respectively. Compared with those with sufficient nighttime sleep duration, the OR (95%CI) of children with nighttime sleep duration less than 9 h was 1.36 (1.23-1.51). An association exists between bedtime and nighttime sleep duration in preschoolers and their anxiety symptoms. Preschoolers with 21:00 for bedtime and a nighttime sleep duration of 10 h may have lower anxiety symptoms. These findings support the importance of adequate sleep for preventing anxiety symptoms in children.

Associations between gestational age and childhood sleep: a national retrospective cohort study

BackgroundBoth sleep quality and quantity are essential for normal brain development throughout childhood; however, the association between preterm birth and sleep problems in preschoolers is not yet clear, and the effects of gestational age across the full range from preterm to post-term have not been examined. Our study investigated the sleep outcomes of children born at very-preterm (<31 weeks), moderate-preterm (32–33 weeks), late-preterm (34–36 weeks), early-term (37–38 weeks), full-term (39–40 weeks), late-term (41 weeks) and post-term (>41 weeks).MethodsA national retrospective cohort study was conducted with 114,311 children aged 3–5 years old in China. Children’s daily sleep hours and pediatric sleep disorders defined by the Children’s Sleep Habits Questionnaire (CSHQ) were reported by parents. Linear regressions and logistic regression models were applied to examine gestational age at birth with the sleep outcomes of children.ResultsCompared with full-term children, a significantly higher CSHQ score, and hence worse sleep, was observed in very-preterm (β = 1.827), moderate-preterm (β = 1.409), late-preterm (β = 0.832), early-term (β = 0.233) and post-term (β = 0.831) children, all p<0.001. The association of pediatric sleep disorder (i.e. CSHQ scores>41) was also seen in very-preterm (adjusted odds ratio [AOR] = 1.287 95% confidence interval [CI] (1.157, 1.433)), moderate-preterm (AOR = 1.249 95% CI (1.110, 1.405)), late-preterm (AOR = 1.111 95% CI (1.052, 1.174)) and post-term (AOR = 1.139 95% CI (1.061, 1.222)), all p<0.001. Shorter sleep duration was also found in very-preterm (β = −0.303), moderate-preterm (β = −0.282), late-preterm (β = −0.201), early-term (β = −0.068) and post-term (β = −0.110) compared with full-term children, all p<0.01. Preterm and post-term-born children had different sleep profiles as suggested by subscales of the CSHQ.ConclusionsEvery degree of premature, early-term and post-term birth, compared to full-term, has an association with sleep disorders and shortened daily sleep duration. Preterm, early-term, and post-term should therefore all be monitored with an increased threat of sleep disorder that requires long-term monitoring for adverse sleep outcomes in preschoolers.

Sleep Problems in Preschoolers With Autism Spectrum Disorder Are Associated With Sensory Sensitivities and Thalamocortical Overconnectivity

BackgroundProjections between the thalamus and sensory cortices are established early in development and play an important role in regulating sleep as well as in relaying sensory information to the cortex. Atypical thalamocortical functional connectivity frequently observed in children with autism spectrum disorder (ASD) might therefore be linked to sensory and sleep problems common in ASD. MethodsHere, we investigated the relationship between auditory-thalamic functional connectivity measured during natural sleep functional magnetic resonance imaging, sleep problems, and sound sensitivities in 70 toddlers and preschoolers (1.5–5 years old) with ASD compared with a matched group of 46 typically developing children. ResultsIn children with ASD, sleep problems and sensory sensitivities were positively correlated, and increased sleep latency was associated with overconnectivity between the thalamus and auditory cortex in a subsample with high-quality magnetic resonance imaging data (n = 29). In addition, auditory cortex blood oxygen level–dependent signal amplitude was elevated in children with ASD, potentially reflecting reduced sensory gating or a lack of auditory habituation during natural sleep. ConclusionsThese findings indicate that atypical thalamocortical functional connectivity can be detected early in development and may play a crucial role in sleep problems and sensory sensitivities in ASD.

Associations between preschool sleep problems and observed dimensions of elementary classroom engagement

Sleep has clear importance for academic success. However, most research in this area has focused on older children and adolescents and has used narrow measures of academic achievement, overlooking the importance of early sleep problems in shaping children's classroom behaviors that support academic success. Using a community sample (N = 276, 50% female), the current study examined associations between parent-reported preschool sleep problems (Mage = 3.84, SD = 0.83) and three dimensions of classroom engagement coded during live classroom observations in the first grade (Mage = 6.72, SD = 0.34). The moderating role of family socioeconomic status (SES) was also considered. A multivariate multilevel model found that more preschool sleep problems were associated with less focused engagement (defined as involvement in academic tasks, such as writing or asking questions), but more competing responses (defined as inappropriate or distracting behaviors). Preschool sleep problems were not associated with task management (defined as preparation for academic tasks, such as locating classroom materials). Although family SES did not moderate any of these associations, higher income-to-needs ratios in preschool were associated with more focused engagement and fewer competing responses. Findings highlight the role of early sleep problems in classroom behaviors that facilitate academic success. Targeting sleep problems prior to the school transition may serve as a useful approach to optimizing learning conditions during this key developmental period.

Factors Affecting Sleep Problems in Preschoolers

Background: Sleep problems are self-care deficits of sleep experienced by more than 44% of preschoolers. Some studies have showed that physical, psychological, family, environmental, and temperamental factors could cause sleep problems among children. However, other research showed that there is no correlation between sleep problems and environmental factors. There are pro-cons regarding the causes of sleep problems. Purpose: The purpose of this study was to analyze factors affecting sleep problems among preschoolers.Methods: A cross-sectional study was conducted among 297 preschoolers selected by systematic random sampling. Data were collected using the Children’s Sleep Habits Questionnaires (CSHQ) and analyzed using bivariate (Chi-Square and Fisher tests) and multivariate (logistic regression) analyses. Results: Results of the bivariate analysis showed that some variables were related to sleep problems among preschoolers, including family income (p=0.027), the education level of the mother (p&lt;0.001), and bed-sharing (p=0.003). Multivariate analysis found that factors related to sleep problems were bed-sharing (p=0.031; OR=2.377), gadget use in two hours before sleep (p=0.039; OR= 2.703), and the education level of the mother (p=0.007; OR=2.244).Conclusion: Factors related to sleep problems in preschoolers were bed-sharing, gadget use in two hours before sleep, the education level of the mother, and family income. This study recommends that environmental and family factors should be modified by limiting bed-sharing and reducing the use of gadgets before bedtime.

Sleep Difficulties in Preschoolers with Psychiatric Diagnoses.

Background: Sleep problems among preschoolers are highly prevalent. Given the impact of poor sleep quality on development, this relationship is particularly relevant in vulnerable populations but is less documented. This study aims to document parental perception of sleep problems in preschoolers assessed in a psychiatric clinic, as a function of diagnosis type. Methods: Children (14–71 months, n = 228) were evaluated by a psychiatrist, and diagnoses were pooled into four categories: behavioral disorders, relational disorders/psychosocial problems, developmental coordination disorder (DCD), and communication disorders. Sleep problems were measured using the Child Behavior Checklist (CBCL). Results: In this clinical sample of preschoolers, 21.6% of children were identified as having a sleep problem by their parents. Behavioral disorders and communication disorders were associated with increased parental report of sleep problems (respectively, trouble falling asleep and nighttime awakenings), while DCD was associated with lower parental report of sleep problems (fewer nighttime awakenings and less difficulty falling asleep) (p < 0.05). Relational disorders were not associated with parental reports of sleep difficulties (p > 0.05). Moreover, some psychiatric categories were associated with specific sleep symptoms (such as difficulty falling asleep and night awakenings). Conclusion: Parents of preschoolers with behavioral disorders and communication disorders are more likely to report sleep problems in their children than parents of preschoolers with DCD and relational disorders. Since different categories of psychiatric disorders are associated with specific types of sleep complaints, screening, and treatment should be adapted accordingly.

Young Children’s Sleep Problems: The Impact of Parental Distress and Parenting Style

Research examining factors contributing to preschool sleep problems is limited. This study investigated the mediating role of parenting styles (authoritarian, authoritative, and permissive parenting) in the relationship between parental psychological distress and sleep problems in young children. Participants were parents of 232 young children aged three to five years. Parents completed the Children's Sleep Habits Questionnaire, the Parenting Style and Dimensions Questionnaire—Short Version, and the Depression Anxiety and Stress Scale. Only permissive parenting was found to significantly mediate the relationship between parental distress and preschool sleep problems (indirect effect = 0.16, p < 0.01), with a significant direct effect of parental psychological distress on child sleep problems (0.16, p < 0.01) also being present. Authoritarian and authoritative parenting were found to be unrelated to child sleep problems. These findings suggest that augmenting treatment programs for preschool sleep problems with strategies targeting parental distress and permissive parenting where required, may be beneficial in improving preschool sleep problems.

Mental Health Diagnoses and Symptoms in Preschool and School Age Youth Presenting to Insomnia Evaluation: Prevalence and Associations with Sleep Disruption

ABSTRACTObjective/Background: Sleep problems and emotional and behavioral difficulties are highly correlated in community samples of youth and in youth presenting to mental health treatment. However, fewer studies have characterized the associations between sleep and psychopathology symptoms in youth presenting to pediatric sleep clinics. This retrospective, cross-sectional study examined the prevalence of psychopathology symptoms and their associations with sleep disruption in youth presenting to a behavioral sleep medicine clinic. Participants: Participants were 373 preschoolers (1.5 to 5 years old) and 300 school age youth (6 to 10 years old) presenting to a pediatric behavioral sleep medicine clinic with a primary insomnia diagnosis. Methods: As a part of routine clinical care, parents completed a battery of pre-evaluation measures assessing insomnia severity, sleep disturbance, history of mental health diagnosis, and psychopathology symptoms. Results: Both preschool and school age youth had high rates of parent-reported mental health diagnoses (35% and 74%, respectively) and clinically elevated psychopathology symptoms (69% of preschoolers and 77% of school age youth) at initial insomnia evaluation. These symptoms were significantly associated with sleep disruption, with ADHD and affective problems most consistently associated with sleep problems in preschoolers and symptoms of anxiety, affective, and behavioral problems most consistently associated with sleep problems in school age youth. Conclusions: Psychopathology symptoms should be regularly assessed in youth presenting to behavioral sleep medicine clinics. Further, the role of psychopathology should be considered in insomnia conceptualization and treatment and, when appropriate, psychopathology symptoms should be targeted in treatment or appropriate referrals should be made.

Longitudinal Association Between Peer Victimization and Sleep Problems in Preschoolers: The Moderating Role of Parenting

This study examined the moderating role of parental behaviors in the longitudinal link between peer victimization and sleep problems during preschool. The sample consisted of 1,181 children (594 girls) attending day care between the ages of 3 and 6 years. Participants were part of the Quebec Longitudinal Study of Child Development, a longitudinal study of child development led by the Institut de la Statistique du Quebec. Controlling for potential confounders, latent growth curve analyses revealed that the association between peer victimization and sleep problems varied depending on parents’ behaviors. Coercive parenting exacerbated the link between peer victimization and parasomnias. In contrast, positive parenting mitigated the link between peer victimization and insomnia. The findings suggest that persistent sleep problems at a young age may be an indicator of chronic peer victimization but that parents’ behaviors can play a key role in victimized children’s sleep problems.

EFFECT OF HEALTH EDUCATION OF SLEEP HYGIENE ON SLEEP PROBLEMS IN PRESCHOOLERS

Background: Children need adequate sleep for good health status. Without a balanced sleep, it will encourage the emergence of serious health or developmental problems. Previous studies showed more than 40% of preschoolers experienced sleep problems.&#x0D; Objective: To examine the effect of HESH (Health Education of Sleep Hygiene) on sleep problems in preschoolers.&#x0D; Methods: Pretest posttest design non-equivalent control group was used in this study. Sixty participants recruited by consecutive sampling. Parents in the experimental group received health education using power point and booklet HESH for 100 minutes, parents in the control group received health education using power point for 100 minutes without booklet HESH. Telephone follow up was done for evaluation program. Sleep problem was measured with Children’s Sleep Habits Questionnaire (CSHQ) completed by children’s parents. Data analysis used unpaired t-test with 95% confidence interval.&#x0D; Results: The result showed that there was effect of HESH toward sleep problems in preschooler (experimental group: -3.367±5.269; control group: 0.033±5.061, p= 0.015).&#x0D; Conclusion: HESH in parents could decrease sleep problems in preschoolers in Indonesia. It is expected that HESH can be used as an alternative nursing intervention involved parents to decreases sleep problem in preschooler.

Differences in sleep problems between Japanese and Chinese preschoolers: a cross-cultural comparison within the Asian region

Study objectivesPrevious studies have performed cross-cultural comparisons of differences in childhood sleep problems between Asian and Western countries. However, whether such differences can be observed among Asian countries remains unclear. The present study aimed to investigate differences in the pattern of sleep problems between Japanese and Chinese preschoolers. MethodsData were collected from one city in Japan and 10 cities in China. The present study recruited 438 Japanese and 1020 Chinese preschoolers aged four and five years. Sleep problems and patterns were assessed on the basis of parental reports using the Children's Sleep Habits Questionnaire (CSHQ). ResultsAnalysis of covariance revealed no significant difference in total CSHQ scores between Japanese and Chinese preschoolers, thus indicating that the total severity of sleep problems did not differ between the groups. Japanese preschoolers exhibited higher scores on the bedtime resistance subscale of the CSHQ than Chinese preschoolers. Conversely, Chinese preschoolers exhibited higher subscale scores for night wakings and sleep-disordered breathing. In addition, Japanese preschoolers exhibited earlier bedtimes and wake times and shorter total sleep times than Chinese preschoolers. ConclusionsOur findings indicate that the patterns of sleep problems in preschoolers differ between Japan and China and that such differences may be due to differences in cosleeping practices, bedtime routines, and/or environmental conditions. Thus, investigators studying sleep in preschoolers should consider regional differences in the pattern of sleep problems, even among Asian countries.

Sleep problems in preschoolers and maternal depressive symptoms: An evaluation of mother- and child-driven effects.

Child sleep problems are associated with maternal depressive symptoms. It is unclear to what extent the association is due to direct effects or common risk factors for mother and child. Direct effects could represent child-driven processes, where child sleep problems influence maternal depressive symptoms, or mother-driven processes, where maternal depressive symptoms influence child sleep problems. Common factors could be shared genetic and familial environmental risk. Child- and mother-driven processes are direct in the sense that they are not due to common factors. However, such processes could be mediated by a range of unmeasured variables. By using an autoregressive fixed-effects model on a community-based longitudinal sample comprising 956 families assessed when children were 1.5, 2.5, and 4 years of age, we estimated the direction of effect between, and common causes of, child sleep problems and maternal depressive symptoms. We were able to explain the association between child sleep problems and maternal depressive symptoms by both child-driven and mother-driven processes. The effect of child-driven processes was significantly larger than the effect of mother-driven processes. The clinical implication of the study is that treatment of child sleep problems will have considerable effect on maternal depressive symptoms. Furthermore, our model supports that treatment of current child sleep problems will have a direct effect on future sleep problems and also an indirect effect on future maternal depressive symptoms. We recommend that health professionals assess child sleep problems in mothers at risk for depression. (PsycINFO Database Record

Sleep, Affect, and Social Competence from Preschool to Preadolescence: Distinct Pathways to Emotional and Social Adjustment for Boys and for Girls.

Using a normative sample of 1,057 children studied across 4 waves over 6 years with multiple informants, we investigated transactional relations for sleep problems, anxious-depressed symptoms, and social functioning from preschool to preadolescence, assessing cumulative effects on children's emotional and social adjustment. To examine sex differences in the developmental processes, we conducted separate analyses for boys and girls. For both boys and girls, longitudinal cross-lagged panel analyses showed that preschool sleep problems directly predicted anxious-depressed symptoms 2 years later; indirect effects continued into preadolescence. For girls, early and later sleep problems directly or indirectly predicted a wide variety of preadolescent emotional and social adjustment domains (e.g., depressive symptoms, school competence, emotion regulation, risk-taking behaviors). For boys, social competence played a more important role than sleep problems in predicting preadolescent adjustment. Among the first set of findings that demonstrate longitudinal relations between sleep problems and social functioning in middle childhood and preadolescence, these results support Dahl's and Walker's neurological models of sleep and emotional functioning. We discuss these findings in light of relations between sleep and affect during pre-pubertal development and discuss differential findings for boys and girls.

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

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 - (i) Sleep onset latency, (ii) Refusal to sleep alone, and (iii) Nighttime awakenings - measured during preschool, and investigated whether these sleep problems predicted anxiety and/or depression across the next 6years until school age (ages 9-13). 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). 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. 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.

Sleep problems are more frequent and associated with problematic behaviors in preschoolers with autism spectrum disorder

BackgroundChildren with autism spectrum disorder (ASD) often suffer from sleep problems that in turn correlate with behavioral problems. However, in Japan, there have been few studies of sleep problems in children with ASD. AimsThis study compared sleep problems in preschoolers from the community and preschoolers with ASD in Japan, and examined whether sleep problems were related to problematic behaviors in ASD preschoolers. Methods and proceduresSleep problems were assessed in 965 community and 193 ASD preschoolers using the Japanese Sleep Questionnaire for Preschoolers, which was developed to assess sleep problems in Japanese preschoolers. Behavioral problems were assessed in 107 ASD preschoolers using the Child Behavior Checklist. Outcomes and resultsCompared with community preschoolers, ASD preschoolers experienced significantly more sleep problems, including obstructive sleep apnea and parasomnias. ASD preschoolers with sleep problems exhibited more behavioral problems than those without sleep problems. The severity of sleep problems, especially insomnia, was significantly correlated with behavioral problems in ASD preschoolers. Conclusions and implicationsThe present study suggests that sleep problems, especially obstructive sleep apnea, are more common in ASD preschoolers than in community preschoolers. The study also shows that sleep problems, especially insomnia, are related to problematic behavior in ASD preschoolers.

Preschool Sleep Problems and Differential Associations With Specific Aspects of Executive Control in Early Elementary School

This study examined the differential associations between parent-reported child sleep problems in preschool and specific aspects of executive control in early elementary school in a large sample of typically developing children (N = 215). Consistent with expectations, sleep problems were negatively associated with performance on tasks assessing working memory and interference suppression inhibition, even after controlling for general cognitive abilities, but not with flexible shifting or response inhibition. The findings add to the literature on cognitive impairments associated with pediatric sleep loss and highlight the need for early intervention for children with sleep problems to promote healthy cognitive development.

Adverse Associations of Infant and Child Sleep Problems and Parent Health: An Australian Population Study

Infant sleep problems are strongly associated with poorer maternal mental health. It is not known whether they are also associated with poorer paternal mental health, nor whether sleep problems in older children are associated with maternal or paternal mental health. We aimed to examine relationships between child sleep problems and maternal and paternal mental health and general well-being in each of the infant and preschool-aged groups. Participants of this cross-sectional survey included families of infants (n = 5107) and preschool-aged children (n = 4983) participating in the first wave of the nationally representative Longitudinal Study of Australian Children, surveyed March through November 2004. The primary outcomes were mother and father serious psychological distress (measured by the Kessler-6) and general health (parent report of general health taken from the 12-item Short Form Health Survey and dichotomized into poor versus good health). A primary caregiver's report of the child's sleep problem was dichotomized into moderate/severe versus none/mild. The prevalence of severe psychological distress ranged from 3% to 5%, and prevalence of poor general health ranged from 8% to 11%. Moderate to severe sleep problems affected 17% of infants and 14% of preschool-aged children. Infant sleep problems were associated with poor general health in mothers and with poor general health in fathers. Preschool sleep problems were associated with poor maternal general health. In mothers with no past history of depression, infant sleep problems had a greater effect on severe psychological distress compared with mothers with a past history of depression. Sleep problems are common in infants and preschool-aged children. Infant sleep problems, in particular, are associated with poorer health in both parents, especially the mental health of mothers with no past history of depression.