Sleep disturbances and childhood sexual abuse

Child maltreatment and insomnia symptoms among Chinese university students: the buffering role of self-efficacy

Insomnia symptoms represent a significant public health concern, as it engenders substantial long-term health consequences. Considerable research has established the detrimental impacts of child maltreatment on sleep problems among university students. However, the role of self-efficacy in the association between childhood maltreatment and insomnia remains unclear. This study aimed to examine the associations between child maltreatment and insomnia symptoms among university students, and to investigate whether self-efficacy moderated the effects of child maltreatment on insomnia symptoms. A total of 2014 participants with random cluster sampling method were recruited from Jinan University in Guangzhou, China, from October 2022 to November 2022. Adjusting for covariates, the results of multiple logistic regression indicated that the participants with the experience of any type of child maltreatment (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.63-3.07), childhood emotional abuse (OR 2.58, 95% CI 1.95-3.41), childhood emotional neglect (OR 1.16, 95% CI 0.87-1.54), childhood physical abuse (OR 2.15, 95% CI 1.60-2.8), childhood physical neglect (OR 2.19, 95% CI 1.64-2.92), childhood sexual abuse (OR 1.98, 95% CI 1.46-2.68) were more likely to report insomnia symptoms than those without. Individuals reporting one-two types and three-five types of child maltreatment were 1.81 times (95% CI 1.30-2.52) and 3.77 times (95% CI 2.58-5.50) more likely to report insomnia symptoms than those reporting zero types of child maltreatment, respectively. Furthermore, robust linear regression analysis revealed that self-efficacy moderated the associations between child maltreatment and insomnia symptoms (β = 0.007, 95% CI 0.004-0.010). These findings underscore the need for integrated mental health education, support services, and faculty training to address the impact of child maltreatment on insomnia symptoms among university students. Policy recommendations include advocating for comprehensive mental health services, incorporating self-efficacy initiatives, and fostering community engagement for a holistic approach to student well-being.

Characterization of sleep difficulties in maltreated children and adolescents

Numerous studies have identified connections between child maltreatment and sleep-related issues. However, poor is known on potential links between sleep patterns and day-to-day functioning, along with psychopathology in maltreated youths. Additionally, existing research on the relationship between sleep difficulties and maltreatment often lacks investigation into specific sleep difficulty profiles across different age ranges. The current study aimed to determine the prevalence of diverse sleep disturbance profiles in a sample of maltreated children and adolescents, exploring distinct sleep disorder profiles based on sex, age, and the type of maltreatment experienced. Potential variations in adaptive and psychopathological profiles between maltreated children with and without sleep disturbances were also explored. This retrospective study included 91 children and adolescents (56% males, 44% females), aged 6 to 17, with a history of maltreatment (physical maltreatment, sexual abuse, psychological abuse, or neglect), referring for a neuropsychiatric and psychological evaluation at a pediatric hospital. Data were obtained through a retrospective file review. Sleep difficulties were measured through the Sleep Disturbance Scale for Children; cognitive abilities, adaptive skills, and emotional and behavioral features were also investigated. Among maltreated youth, difficulties in initiating and maintaining sleep were the most frequently observed by caregivers. Poor sex differences emerged, whereas adolescents exhibited more daytime somnolence than school-age children. Children with sleep difficulties exhibited more anxiety symptoms and worse global functioning in comparison with children without sleep difficulties.Conclusion: Considering the vital impact of sleep quality on healthy development, practitioners should offer tailored services to child maltreatment victims. Enhancing the sleep quality of these children could help foster their resilience.

Considering the associations of adverse and positive childhood experiences with health behaviors and outcomes among emerging adults

Childhood is a sensitive period of development during which early life experiences can facilitate either positive or negative health trajectories across subsequent developmental periods. Previous research has established strong links between adverse childhood experiences (ACEs) and adverse health outcomes (e.g., sleep-related problems, pain, substance use). Despite this, less is known about positive childhood experiences (PCEs) and how they may buffer the effects of ACEs on health outcomes. The current study investigated whether PCEs moderate the associations between ACEs and health behavior and health-related outcomes (i.e., cannabis use, alcohol use, sleep disturbance, sleep-related impairment, pain intensity, and pain interference) in a sample of at-risk emerging adults. Participants (N = 165) were undergraduate college students (18-25 years of age) who reported frequent alcohol and/or cannabis use (≥3 times in the past week). A significant positive association was found between ACEs and cannabis use. There were also significant negative associations found between PCEs and pain interference and intensity. PCEs did not moderate any of the associations between ACEs and health behavior and health-related outcomes (i.e., cannabis use, alcohol use, sleep disturbance, sleep-related impairment, pain intensity, and pain interference). Findings suggest that PCEs may be unlikely to serve as a strong enough protective factor during early life to decrease risk for suboptimal health and health behaviors during emerging adulthood among individuals who report a greater accumulation of ACEs. Longitudinal research is needed to identify additional related risk and protective factors during early life to further support health and health behavior during this transitional period of development and beyond.

Sleep Health among Children Adopted from Foster Care: The Moderating Effect of Parent-Child Sleep Interactions

OBJECTIVES

Sleep disruption is prevalent among children placed in foster care, elevating risk for a range of deleterious outcomes. Theoretically, achieving permanency via adoption may have a positive influence on children's sleep via the presence of various factors, but little is known about the sleep health of children adopted from foster care, including predictors and moderators of sleep health.

METHOD

The current study included 226 parents who adopted a child from foster care in the U.S. (aged 4-11 years) within the past two years and a propensity score matched sample of 379 caregivers of children currently in foster care. Both samples completed online questionnaires about their child's sleep, physical, and mental health.

RESULTS

Comparatively, children in foster care experienced more nightmares, night terrors, moving to someone else's' bed during the night, and worse overall sleep quality, whereas adopted children were reported to experience significantly more nighttime awakenings. In the adopted sample, a greater number of prior foster placements unexpectedly predicted lower total sleep disturbance scores, but this relationship was moderated by parent-child interactions around sleep. In general, greater parental involvement in children's sleep was associated with lower levels of child sleep disturbance.

CONCLUSIONS

Findings suggest that while specific sleep problems might remit after children in foster care achieve permanence, nighttime sleep fragmentation often persists. Parent-child interactions surrounding sleep may be pivotal in improving sleep health in this population.

Sleep, Emotional, and Behavioral Problems Among Youth Presenting to Treatment Following Sexual Abuse

Research indicates that sleep problems are fairly common in childhood. However, the relationship between child sexual abuse (CSA) and sleep problems and how sleep issues influence psychological symptoms in children presenting for treatment remain unclear. The purpose of this study was to examine the presence of sleep problems and the association between sleep problems and psychological symptoms in youth presenting to treatment following CSA. Participants included 276 non-offending caregiver-child dyads at pre-treatment and 106 dyads at post-treatment. Youth were 6 to 19 years old and predominately female (82.9%). Caregivers were 23 to 72 years old and predominately female (87.4%). Youth and caregivers identified as predominately European American (76.6% and 86.0%, respectively). Results indicated that caregiver endorsement of a particular youth sleep problem (as measured by the Child Behavior Checklist sleep items) at pre-treatment ranged between 17.9 and 51.4%. Sleep problems were positively associated with psychological symptoms per caregiver- and youth self-report. Interestingly, a substantial proportion of youth reported decreased sleep problems at the end of treatment even though the treatment did not target sleep issues. This study highlights the commonality of sleep problems in children who experienced sexual abuse. Findings suggest that CSA interventions that do not directly address sleep may be missing a component that can contribute to successful recovery. The results provide preliminary evidence that sleep problems and mental health concerns among youth who experienced CSA are associated, indicating a need for further investigation into the association and potential implications for treatment. Other implications for future research and treatment following CSA are discussed.

Child sexual abuse versus adult sexual assault: A review of psychological and neurobiological sequelae

Sexual trauma (ST) occurs with alarming frequency in the United States (U.S.) in the form of both childhood sexual abuse (CSA) and adulthood sexual assault (ASA). It is well-established that the effects of ST are pervasive, and that ST can be a risk factor for the development of several psychiatric disorders. However, the potential for distinct psychological consequences or neural correlates between CSA and ASA has received little attention. Furthermore, despite the high prevalence of sexual revictimization, the combinatorial effects of CSA and ASA are understudied in comparison to each form of ST on its own. In the current review, we present results from both clinical psychology and neuroscience research on the impacts of CSA and ASA, describing major psychological, biopsychosocial, and neuroimaging findings for each form of ST. We further highlight limitations in the current state of the research and needed areas of future research to better understand the distinct, overlapping, and cumulative effects of ST in both childhood and adulthood. The present study summarizes the state of the literature on this critical form of trauma and provides recommendations for future clinical research practices to mitigate the deleterious outcomes of ST.

Disengagement coping and sleep problems among trauma-exposed adolescents

BACKGROUND

The formation of healthy sleep patterns is a critical component of positive adolescent development. Dysregulated sleep habits can put youth at risk for the development of a multitude of inimical outcomes, particularly among those who are exposed to a traumatic event.

DESIGN AND METHODS

The present study investigated the links between voluntary disengagement coping (e.g., avoidance, denial, wishful thinking) and sleep outcomes among 86 trauma-exposed and non-exposed adolescents between the ages of 12-17 (Mage = 15.44, SD = 1.51; 41.9% female).

RESULTS

The relationship between voluntary disengagement coping and sleep outcomes was significant only among trauma-exposed adolescents, such that greater use of voluntary disengagement strategies was associated with greater sleep disturbances and greater daytime dysfunction.

CONCLUSIONS

Targeting disengagement coping may be an important strategy to improve sleep health among trauma-exposed adolescents. Continued efforts in improving the efficacy of trauma-exposed adolescent intervention strategies are needed.

Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents

Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.

Childhood sleep: assessments, risk factors, and potential mechanisms

BACKGROUND

Sleep problem is a highly prevalent health issue among pediatric populations across the world. In this review, we aimed to identify risk factors contributing to sleep deficiency and poor sleep hygiene in children. Potential biological, psychosocial, and environmental mechanisms as well as research gaps in the literature are also discussed.

DATA SOURCES

A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info. Both relevant data based and systematic reviews are included.

RESULTS

This paper summarizes many risk factors for childhood sleep problems, including biological (e.g., genetics, gender, age and puberty, prenatal factors, postnatal factors); nutritional (e.g., macronutrients, micronutrients, omega-3 fatty acids, obesity); environmental (e.g., heavy metals, noise, light, air pollution); interpersonal (e.g., family, exposure to violence, screen media use, physical injury); and community/socioeconomic variables (e.g., racial/ethnicity and cultural factors, neighborhood conditions and socioeconomic status, school factors, public health disasters/emergencies), to better understand the development of sleep problems in children.

CONCLUSIONS

Poor childhood sleep is a multifactorial issue affected by a wide range of prenatal and early-life biological, environmental, and psychosocial risk factors and contributors. A better understanding of these risk factors and their mechanisms is an important first step to develop future research and prevention programs focusing on pediatric sleep problems.

Sleep Disturbances and Hygiene of Adolescent Female Survivors of Domestic Minor Sex Trafficking

INTRODUCTION

This cross-sectional quantitative study investigated the sleep hygiene and disturbances of adolescent female survivors of domestic minor sex trafficking (DMST) compared to an online sample of community-dwelling adolescent females.

METHOD

Community-dwelling adolescent females (aged 13-17 years, n = 61) and survivors of DMST housed in residental care (aged 12-17 years, n = 19) completed the Children's Report of Sleep Patterns (adolescent version). Descriptive statistics on sleep health in both samples were computed and compared using chi-square and t-tests.

RESULTS

Among the survivors of DMST, the majority reported insufficient sleep duration, okay-to-poor sleep quality, waking thirsty, and frequent nightmares. Compared with community-dwelling adolescents, survivors of DMST had more symptoms of insomnia, sleepiness, nightmares, and waking thirsty (p < .05).

DISCUSSION

Sleep disturbances among adolescent female survivors of DMST may be more prevalent than in community-dwelling adolescent females. Further empirical research on appropriate assessment and trauma-informed treatment of sleep in this population is needed.

The association between child sexual abuse and self-reported sleep in adolescent girls

STUDY OBJECTIVES

Child sexual abuse is associated with negative consequences on both physical and mental health. It has been found to influence child and adolescent sleep, which is an important developmental factor, which also influences mental and physical health. However, the literature examining this topic is plagued by methodological limitations, such as small sample sizes and unvalidated measures.

METHODS

Using the Pittsburgh Sleep Quality Index (PSQI), the present study examined 7 self-reported sleep dimensions, including sleep latency, efficiency, duration, disturbances, subjective sleep quality, daytime dysfunction, and use of sleep medication, in a sample of 707 adolescent girls aged 14-18 years old.

RESULTS

Statistical analyses revealed that child sexual abuse had a significant moderate association with the total PSQI score. Sexually abused adolescent girls, compared with their nonabused counterparts, reported more sleep difficulties. Significant differences also emerged on all sleep dimensions, with abused girls reporting increased difficulties. However, the magnitude of these associations differed from one dimension to another.

CONCLUSIONS

Our findings support the continued study of sleep in adolescent girls who experienced sexual abuse. They also support the use of a fine-grained perspective when assessing various dimensions of sleep health in girls with a history of child sexual abuse for improved tertiary prevention and intervention.

CITATION

Langevin R, Pennestri M-H, Hershon M, Pirro T, Hébert M. The association between child sexual abuse and self-reported sleep in adolescent girls. J Clin Sleep Med. 2023;19(11):1933-1939.

Nightmares and Sleep Disturbances in Children with PTSD: A Polysomnographic and Actigraphy Approach Evaluation

RATIONALE

Sleep disturbances (insomnia and nightmare symptoms) are the most sensitive and persistent symptoms of pediatric post-traumatic stress disorder (PTSD). Untreated, these sleep disturbances (SD) associated with PTSD are predictive of PTSD persistence and increased psychiatric complications. The aim of this study was to evaluate sleep and circadian rhythms in children with PTSD under both laboratory and ecological conditions in comparison with a control population and to test for the first time the hypothesis that SD and circadian rhythms are positively correlated with PTSD severity and its comorbidities.

METHOD

This prospective pilot study evaluated PTSD, SD (insomnia, nightmares), and sleep-wake rhythms in 11 children with PTSD (aged 3-18), compared with the age and sex-matched control groups. Assessment of PTSD and subjective and objective measures of sleep and sleep-wake rhythms (questionnaires, 24-h in-laboratory video-polysomnography, 15-day at-home actigraphy recording) were performed between 1 and 6 months after the traumatic event.

RESULTS

Children with PTSD had higher sleep fragmentation (increased wake-after-sleep onset, increased number of sleep stage changes) compared to controls, with a change in sleep microarchitecture (micro-arousal index at 14.8 versus 8.2, p = 0.039). Sleep fragmentation parameters correlated with PTSD symptomatology, insomnia, and post-traumatic nightmare severity. The within-group comparison revealed a better sleep architecture in the controlled (sleep laboratory) than in the ecological condition (at home) (total sleep time 586 versus 464 min, p = 0.018).

CONCLUSIONS

Sleep and rhythm disturbances are strongly associated with PTSD in children. The assessment of SD in children with PTSD should be carried out systematically and preferentially under ecological conditions, and management of SD should integrate the environment (environmental design, psycho-education for the children and their parents) more fully into therapy focused on sleep and trauma.

Adverse Childhood Experiences and Poor Sleep Quality in Older Adults: The Influence of Emotion Regulation

BACKGROUND

Adverse childhood experiences (ACEs) are associated with sleep impairment across the life span, but little is known about modifiable factors that may ameliorate this relationship, such as adaptive emotion regulation (ER) skills.

METHODS

Data were obtained from an online questionnaire completed by a community sample of older adults (N = 278). The questionnaire included the Pittsburgh Sleep Quality Index, an Adverse Childhood Experiences questionnaire, the Cognitive Emotion Regulation Questionnaire (CERQ), and measures of health conditions, and other sample demographics. Moderation analyses were used to examine the interaction between ACEs and 5 adaptive ER skills of CERQ on sleep quality in older adults, while accounting for the effects of age, sex, income, body mass index, and health.

RESULTS

ACEs were significantly associated with worse sleep quality in older adults, and this effect was moderated by positive reappraisal and refocusing on planning (all ps < .05). For individuals reporting greater use of these ER skills, ACEs had no effect on sleep quality, whereas for individuals reporting less frequent use of these ER skills, ACEs were associated with substantially worse sleep quality. This relationship remained significant after accounting for age, sex, income, body mass index, and health conditions in the model.

CONCLUSIONS

The effects of ACEs on sleep quality persist into older age; however, greater use of ER skills that focus on positively reframing negative events and identifying strategies for coping protect against sleep impairment in individuals with higher ACEs.

The impact of adverse childhood experiences (ACEs) on sleep adequacy for children with special health care needs (CSHCN) in the United States

BACKGROUND

Adverse childhood experiences (ACEs), are associated with poor mental and physical health, risky behaviors, chronic diseases in adulthood, and premature death. ACEs are also associated with poor sleep among children and adults. It is not clear if this association is true for children with special health care needs (CSHCN).

OBJECTIVE

To explore the impact of ACEs on sleep duration among CSHCN, adjusting for demographic, family, and health characteristics.

METHODS

This study used a subsample of 17,049 CSHCN from the 2019-2020 National Survey of Children's Health between 4 months and 17 years. Multivariable logistic regression was used to examine if the number of ACEs experienced by a child is associated with a child sleeping the recommended number of hours for their age while controlling for demographic, family, and health characteristics. There was no sign of multicollinearity among the variables of interest.

RESULTS

CSHCN without adequate sleep had a higher prevalence of ACEs. When adjusting for demographic characteristics, children with 1 ACE (aOR: 0.81, 95% CI: 0.69-0.96) or at least 2 ACEs (aOR: 0.60, 95% CI: 0.51-0.71) were less likely to sleep the adequate number of hours. That association was no longer significant when adjusting for family characteristics or BMI. Other significant predictors in the adjusted models include race, poverty level, the highest level of education in households, and caregiver mental health.

CONCLUSION

Results demonstrate an inverse relationship between the number of ACEs and the odds of sleep adequacy for CSHCN and highlight racial and economic disparities in sleep adequacy.

Adverse childhood experiences, sleep problems, low self-control, and adolescent delinquency: A longitudinal serial mediation analysis

Several studies link adverse childhood experiences (ACEs) to delinquency. Yet, developmental sequalae accounting for this association remain unclear, with previous research limited by cross-sectional research designs and investigations of singular mediating processes. To redress these shortcomings, this study examines the longitudinal association between ACEs and delinquency as mediated by both sleep problems and low self-control, two factors which past research implicates as potentially important for understanding how ACEs contribute to antisocial behavior. Data collected from 480 adolescents (71.3% boys; 86.3% White) and their parents participating in the Michigan Longitudinal Study was used to conduct a serial mediation analysis. The association between ACEs (prior to age 11) and delinquency in late adolescence was found to operate indirectly via sleep problems in early adolescence and low self-control in middle adolescence. Nonetheless, a direct association between ACEs and later delinquency remained. Pathways through which ACEs contribute to later delinquency are complex and multiply determined. Findings indicate that early behavioral interventions, including improving sleep and self-control, could reduce later delinquency. Still, more research is needed to identify additional avenues through which the ACEs-delinquency association unfolds across development.

From childhood adversity to latent stress vulnerability in adulthood: the mediating roles of sleep disturbances and HPA axis dysfunction

Childhood adversity is a prominent predisposing risk factor for latent stress vulnerability, expressed as an elevated likelihood of developing stress-related psychopathology upon subsequent exposure to trauma in adulthood. Sleep disturbances have emerged as one of the most pronounced maladaptive behavioral outcomes of childhood adversity and are also a highly prevalent core feature of stress-related psychopathology, including post-traumatic stress disorder (PTSD). After reviewing the extensive literature supporting these claims, the current review addresses the notion that childhood adversity-induced sleep disturbances may play a causal role in elevating individuals' stress vulnerability in adulthood. Corroborating this, sleep disturbances that predate adult trauma exposure have been associated with an increased likelihood of developing stress-related psychopathology post-exposure. Furthermore, novel empirical evidence suggests that sleep disturbances, including irregularity of the sleep-wake cycle, mediate the link between childhood adversity and stress vulnerability in adulthood. We also discuss cognitive and behavioral mechanisms through which such a cascade may evolve, highlighting the putative role of impaired memory consolidation and fear extinction. Next, we present evidence to support the contribution of the hypothalamic-pituitary-adrenal (HPA) axis to these associations, stemming from its critical role in stress and sleep regulatory pathways. Childhood adversity may yield bi-directional effects within the HPA stress and sleep axes in which sleep disturbances and HPA axis dysfunction reinforce each other, leading to elevated stress vulnerability. To conclude, we postulate a conceptual path model from childhood adversity to latent stress vulnerability in adulthood and discuss the potential clinical implications of these notions, while highlighting directions for future research.

Effects of Adverse Events and 12-Week Group Step Aerobics on Sleep Quality in Chinese Adolescents

BACKGROUND

In China, sleep disorders have become a public health concern. This study aimed to model the relationship between adverse events and sleep quality, as well as the effect of group step aerobics on sleep quality.

METHODS

The modeling was built on surveying 2760 16-19-year-old adolescents. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality, and the Adolescent Self-rating Life Events Checklist (ASLEC) was used to evaluate adverse events. Adolescents with sleep disorders (PSQI ≥ 8) were randomized into the control (n = 26) and exercise (n = 26) groups. The exercise group participated in 12-week step aerobics, and the 300 min weekly volume is compliant with the WHO physical activity guidelines.

RESULTS

The double Poisson distribution was chosen to fit the data. ASLEC had a nonlinear relationship with the PSQI. Participants in the exercise group slept better (p < 0.05) from the eighth week until the end of the study. A random adolescent, therefore, has a 92.5% probability of experiencing improved sleep quality after 12 weeks of step aerobics.

CONCLUSIONS

Intervention should be implemented before adverse events accumulate. An active lifestyle should be a preparedness strategy for increasing the resilience of adolescent mental health in the face of adversity.

A network approach to the symptom-level associations between smoking and posttraumatic stress disorder (PTSD) among young adults exposed to childhood sexual abuse

Background

Previous empirical literature has examined the associations between childhood sexual abuse (CSA) exposure, posttraumatic stress disorder (PTSD), and smoking. However, few studies examined symptom-level associations between smoking and PTSD among CSA victims. Thus, the aims of this study were 1) to explore symptom-level associations between smoking and PTSD among combustible cigarette (CC) and electronic cigarette (EC) users exposed to CSA and 2) to compare the differences manifested in two network structures between EC and CC users with CSA experiences.

Methods

This cross-sectional study covers all 63 universities and colleges in Jilin province, China, from October 26 to November 18, 2021. A total of 117 769 students participated in this study, while 3479 young adults were exposed to CSA (3.62%, 95% CI = 3.50%-3.73%). Childhood sexual abuse, PTSD, and smoking symptoms were measured using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), 10-item Trauma Screening Questionnaire (TSQ-10), and the 6-item Fagerstrom Test for Nicotine Dependence (FTND-6), respectively. In addition, network analysis was applied to analyse psychopathological symptoms between EC and CC users with CSA experiences. Both the edges and centralities were computed, and the network properties were compared among the two groups.

Results

Four symptoms of PTSD (i.e. emotional cue reactivity, hypervigilance, nightmares, and difficulty concentrating) were both central and bridge symptoms between PTSD and smoking among EC and CC users with CSA experiences. Moreover, compared with CC users with CSA, there were significantly stronger associations between "nightmares" - "difficulty with restrictions" and "irritability / anger" - "more during wake up" among young EC users with CSA.

Conclusions

The four symptoms (i.e. emotional cue reactivity, hypervigilance, nightmares, and difficulty concentrating) were keystones for treatments or interventions targeting these CSA victims with PTSD and smoking symptoms. Increasing efforts should be taken to restrict morning smoking among EC users with CSA. In addition, target interventions and strategies founded on these core symptoms and associations should be implemented to relieve the comorbid PTSD and smoking in EC and CC users with CSA experiences.

Adverse childhood experiences and sleep duration among U.S. 65 years and older: results from the 2020 BRFSS

BACKGROUND

Adverse childhood experiences (ACEs) are a risk factor for many chronic diseases and health behaviors. This study explores the relationship between ACEs and sleep duration in elderly populations in 22 U.S. states in 2020.

METHODS

This study is a cross-sectional analysis of aged 65 years or older in the 2020 Behavioral Risk Factor Database (BRFSS). The weighted multivariate logistic regression was used to assess the association of ACEs status, ACEs type, and ACE scores with sleep duration. Subgroup analysis was used to estimate differences based on covariates.

RESULTS

Among the 42,786 participants (55.8 % female) included in this analysis, 50.5 % reported at least one ACE, and 7.3 % reported 4 or more ACEs. Adjusting for confounding factors, experiencing ACEs was associated with short and long sleep duration (Odds Ratio (OR): 2.03, 95 % Confidence Interval (CI): 1.51,2.73; OR:1.78, 95%CI:1.34,2.36). Older adults who experienced sexual abuse in children were 146 % more likely to short sleep (OR:2.46,95%CI:1.84,3.31) and 99 % more likely to long sleep (OR:1.99, 95%CI:1.35,2.92). There was a dose-response gradient between ACEs scores and sleep duration, reporting ≥ 4 ACEs had 3.10 (OR:3.10,95%CI:2.12,4.53) and 2.13 (OR:2.13, 95%CI:1.33,3.40) times the risk for short-sleep and long-sleep duration compared to respondents reporting no ACEs.

CONCLUSIONS

This study showed the association between ACEs and a high risk of sleep duration, which increased with increasing ACEs scores.

The Role of Anxiety Sensitivity in the Association Between Childhood Maltreatment and Sleep Disturbance Among Adults in Psychiatric Inpatient Treatment

The present investigation examined associations of childhood maltreatment, anxiety sensitivity (AS), and sleep disturbance among a diverse sample of adults in psychiatric inpatient treatment. We hypothesized that childhood maltreatment would be indirectly associated with greater sleep disturbance through elevated AS. Exploratory analyses examined the indirect effect models with three AS subscales (i.e., physical, cognitive, and social concerns) as parallel mediators. A sample of adults in acute-care psychiatric inpatient treatment (N = 88; 62.5% male; Mage = 33.32 years, SD = 11.07; 45.5% White) completed a series of self-report measures. After accounting for theoretically relevant covariates, childhood maltreatment was indirectly associated with sleep disturbance through AS. Parallel mediation analyses revealed that no individual subscale of AS significantly accounted for this association. These findings suggest that heightened levels of AS may explain the association between childhood maltreatment and sleep disturbance among adults in psychiatric inpatient treatment. Interventions targeting AS can be brief and efficacious and have the potential to improve clinical outcomes among psychiatric populations.

Early Life Stress, Neuroinflammation, and Psychiatric Illness of Adulthood

Stress exposure during early stages of life elevates the risk of developing psychopathologies and psychiatric illness in later life. The brain and immune system are not completely developed by birth and therefore continue develop after birth; this post birth development is influenced by several psychosocial factors; hence, early life stress (ELS) exposure can alter brain structural development and function. A growing number of experimental animal and observational human studies have investigated the link between ELS exposure and increased risk of psychopathology through alternations in the immune system, by evaluating inflammation biomarkers. Recent studies, including brain imaging, have also shed light on the mechanisms by which both the innate and adaptive immune systems interact with neural circuits and neurotransmitters, which affect psychopathology. Herein, we discuss the link between the experience of stress in early life and lifelong alterations in the immune system, which subsequently lead to the development of various psychiatric illnesses.

Adverse Childhood Experiences and Insufficient Sleep Among U.S. Children and Adolescents

OBJECTIVE

To examine associations between adverse childhood experiences (ACEs) and age-specific insufficient sleep duration (ISD) in American youth.

METHODS

Data from the 2016-2017 National Survey of Children's Health, a sample of 46,209 youth ages 6 to 17 were analyzed. The main outcome was sleep duration that did not meet the recent recommendations of the American Academy of Sleep Medicine. Nine types of ACEs, as well as a cumulative count of ACEs, were examined as independent variables in unadjusted and adjusted logistic regression models.

RESULTS

Approximately half of U.S. children and adolescents (ages 6-17) experienced at least one ACE and a third did not get sufficient sleep. Among those exposed to any ACE, 40.3% had ISD. Seven of the 9 ACEs examined were significantly associated with a 20% to 60% increase in odds of not getting sufficient sleep (adjusted ORs between 1.2 and 1.6). Children exposed to 2 or more ACEs were nearly twice as likely as those exposed to no ACE to have ISD (adjusted OR = 1.7, 95% CI: 1.5-1.9). Moreover, each individual ACE, except parental death was significantly associated with more than 1 hour less sleep than recommended.

CONCLUSIONS

This study reports the association of specific and cumulative ACEs with ISD in a nationally representative sample of American youth. The study findings underscore the importance of screening for both ACEs and insufficient sleep during primary care encounters and addressing potential sleep problems in those exposed to ACEs.

Associations between childhood maltreatment, poor sleep, and prenatal distress in pregnant adolescents

Childhood maltreatment (CM) is a known risk factor for adolescent pregnancy. Sleep disturbances and psychological distress, both common negative sequelae of CM, often co-occur during pregnancy, although directionality remains unclear. Furthermore, little is known about how CM affects sleep-distress associations during pregnancy. In pregnant adolescents, we examined: (a) whether there are significant predictive associations from CM to sleep quality and distress and (b) bidirectional influences of distress and sleep quality. Healthy pregnant adolescents (n = 204) were recruited before or during the 2nd trimester. CM was assessed at enrollment; sleep quality and distress were assessed in the 2nd and 3rd trimesters. Hypotheses were tested using path analysis. Findings revealed that CM was associated with worse 2nd trimester sleep quality and distress (β = .19, p < .05 for sleep; β = .30, p < .001 for distress). Higher levels of 2nd trimester distress were associated with lower 3rd trimester sleep quality (β = .19, p < .05). Findings provide novel information about (a) associations from CM to prenatal mood and sleep in pregnant adolescents, and (b) sleep-distress directionality over the course of pregnancy. These results have implications for better understanding the ways in which CM potentially exerts influences later in life, and for targeting interventions to address physical and mental health during pregnancy.

Adverse Childhood Experiences and Their Impact on Sleep in Adults: A Systematic Review

Adverse childhood experiences (ACEs) before the age of 18 years are pervasive and noteworthy public health concerns. The ACEs are associated with sleep disorders in later life. In this study, we conduct a systematic review to explore the effects of ACEs on sleep in adulthood. Using Medical Subject Headings keywords, we searched Medline, PubMed, PubMed Central, the American Psychological Association PsycArticles, and PsychInfo databases to evaluate the association between ACEs and sleep disturbances. ACEs increase the odds of developing chronic short sleep duration, that is, <6 hours of sleep per night compared with optimal sleep duration of 7-9 hours per night during adulthood. The ACEs are positively associated with poor sleep characteristics such as short sleep duration and long-term sleep problems. Clinicians should pay close attention to developmental trauma care, access community health programs, and help develop better coping skills, resiliency, and good sleep habits in their patients.

Associations between Childhood Maltreatment and Behavioral Sleep Disturbances Across the Lifespan: A Systematic Review

Childhood maltreatment has a range of long-term developmental and health consequences. Emerging research suggests that sleep disturbances may be a key behavioral health risk factor implicated in the relationship between maltreatment and poor health across the lifespan. This systematic review examined the association between maltreatment and behavioral sleep disturbances in childhood and adulthood. Studies were identified through PsycINFO, PubMed, and alternative search strategies such as Google Scholar and reference list checks, with an end date of July 2021. Quantitative, peer-reviewed articles examining behavioral sleep outcomes and/or characteristics among maltreatment-exposed samples were included. We assessed the potential risk of bias by examining study design and sleep and maltreatment assessment methods. Across 73 studies included in this review, there was a robust association between childhood maltreatment and behavioral sleep disturbances. Findings suggest that linkages between maltreatment and sleep outcomes diverge with respect to maltreatment characteristics, type of behavioral sleep disturbance assessed, use of subjective versus objective measures, and study design. Given that behavioral sleep disturbances are modifiable, more research is needed that incorporates objective measures of sleep and longitudinal designs to identify specific points of intervention to mitigate the potential long-term impacts of childhood maltreatment on health across socio-demographically diverse populations.

Family stress during the pandemic worsens the effect of adverse parenting on adolescent sleep quality

BACKGROUND

Adverse parenting is consistently associated with increased sleep problems among adolescents. Shelter-in-Place restrictions and the uncertainty linked to the Covid-19 pandemic have introduced new stressors on parents and families, adding to the risk for youth's sleep problems.

OBJECTIVE

Using multidimensional assessments of child maltreatment (CM; threat vs. deprivation), the present study examined whether parent-report and child-report of Covid-19 related stress potentiated the effect of CM on sleep problems among boys and girls.

PARTICIPANTS AND SETTING

The study focused on a sample of 124 dyads of adolescents (Mage = 12.89, SD = 0.79; 52% female) and their primary caregivers (93% mothers) assessed before and during the pandemic (May to October 2020).

METHOD

Data were obtained from both youth and their parents. Structural equation modeling (SEM) was used to test all study hypotheses. Simple slopes and Johnson-Neyman plots were generated to probe significant interaction effects.

RESULTS

Deprivation, but not threat, directly predicted increased sleep problems among boys during the pandemic. Additionally, elevation in Covid-19 stress (both parent and child report) intensified the link between CM (threat and deprivation) and sleep problems among boys.

CONCLUSION

Our findings inform prevention and intervention efforts that aim to reduce sleep problems among boys during stressful contexts, such as the Covid-19 pandemic.

Can You Sleep? - Effect of Retrospective Recall of Child Maltreatment on Sleep Parameters and the Mediating Role of Psychological Distress Among Students of Two German Universities

PURPOSE

Child maltreatment may be linked with long-term sleeping disorders and limited coping with stress. Yet, the potential relationships are only marginally studied.

PATIENTS AND METHODS

Based on a sample of young adults (n = 312) this study aims at exploring the effects of child maltreatment and the experience of threat to personal safety and life in childhood on sleep disturbances in early adulthood. Data were collected at the two study sites, Ulm University and Bielefeld University, by an online survey. For both risk factors, child maltreatment and the experience of threat to personal safety and life in childhood, a direct impact on sleep disturbances and an indirect path via psychological distress were tested using Structural Equation Modelling (SEM).

RESULTS

In these models, the direct path to sleep disturbances turned out to be significant for the experience of threat to personal safety and life (Path C: b = 0.18, p = 0.013), but not for child maltreatment (Path C: b = 0.05, p = 0.491). However, the current level of psychological distress was found to have a mediating effect on sleep disturbances for both risk factors, thereby confirming indirect significant effects.

CONCLUSION

Considering that the etiological pathway of child maltreatment on sleeping disturbances is mediated via psychological distress, this provides a venue to test in future research whether stress reduction interventions can reduce the negative consequences of child maltreatment on sleep disorders.

Women with abuse-related PTSD sleep more fitfully but just as long as healthy controls: an actigraphic study

STUDY OBJECTIVES

Subjective reports of sleep impairments are common in individuals with posttraumatic stress disorder (PTSD), but objective assessments of sleep have yielded mixed results.

METHODS

We investigated sleep via actigraphy and e-diary on 6 consecutive nights in a group of 117 women with PTSD after childhood abuse (CA; PTSD group), a group of 31 mentally healthy women with a history of CA (healthy trauma controls, HTC group) and a group of 36 non-traumatized mentally healthy women (healthy controls, HC group).

RESULTS

The PTSD group reported lower sleep quality, more nights with nightmares, and shorter sleep duration than both HTC and HC. Actigraphic measures showed more and longer sleep interruptions in the PTSD group compared to HTC and HC, but no difference in sleep duration. While the PTSD group underestimated their sleep duration, both HTC and HC overestimated their sleep duration. HTC did not differ from HC regarding sleep impairments.

CONCLUSIONS

Sleep in women with PTSD after CA seems to be more fragmented but not shorter compared to sleep patterns of mentally healthy control subjects. The results suggest a stronger effect of PTSD psychopathology on sleep compared to the effect of trauma per se.

Dysregulated arousal as a pathway linking childhood neglect and clinical sleep disturbances in adulthood

BACKGROUND

A history of childhood maltreatment has a well-established association with clinical sleep disturbances in adulthood, which is a transdiagnostic contributor to many chronic diseases.

OBJECTIVE

Determine whether actigraphy-measured indices of dysregulated arousal during sleep explain associations between abuse or neglect in childhood and clinical sleep disturbances in adulthood.

PARTICIPANTS AND SETTING

Participants were 646 individuals, ages 25-83 (59.3% female) from the MIDUS II Biomarker, Refresher studies.

METHODS

Participants completed the Childhood Trauma Questionnaire, wore an actigraph for seven days, and rated sleep quality using the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Both neglect (b = 0.66, SE = 0.33, p = .04) and abuse (b = 1.09, SE = 0.32, p < .001) were associated with clinical sleep disturbance. Actigraphy-measured sleep efficiency mediated the link between neglect and clinical sleep disturbances (ab = 0.33, SE = 0.12, 95%CI [0.12, 0.57]). However, no such link between abuse and clinical sleep disturbances was mediated by actigraphy-measured indices. Sleep onset latency did not mediate the link between neglect or abuse and sleep disturbance. Models covaried for other maltreatment, gender, and age.

CONCLUSIONS

While the unique associations between abuse or neglect and clinical sleep disturbances were robust in this sample, only sleep efficiency emerged as a mediator linking maltreatment and clinical sleep disturbances. Critically, this mediation was specific to neglect. Abuse and neglect may lead to disease through distinct pathways. Moreover, potential dysregulation in arousal that leads to sleep inefficiency may be a specific pathway through which experiences of neglect in childhood contribute to chronic disease.

Childhood Maltreatment, Sleep Disturbances, and Anxiety and Depression: A Prospective Longitudinal Investigation

This research sought to determine whether inadequate sleep conditions in childhood and sleep problems in young adulthood in part explain the relationship between childhood abuse and neglect and anxiety and depression later in life. Children with documented histories of abuse and neglect and matched controls were followed up and assessed in young and middle adulthood. Abused and neglected children were more likely to report experiencing inadequate sleep conditions in childhood, sleep problems in young adulthood, and higher levels of depression and anxiety later in middle adulthood. Results revealed significant indirect paths from childhood maltreatment to anxiety and depression in middle adulthood through inadequate sleep conditions in childhood and sleep problems in young adulthood. This longitudinal follow-up of children with documented cases of maltreatment reveals the important role of sleep disturbances in the lives of maltreated children and adults and sleep disturbances in the development of subsequent anxiety and depression.

Associations of adverse childhood experiences with adolescent total sleep time, social jetlag, and insomnia symptoms

STUDY OBJECTIVE

Adverse childhood experiences (ACEs) are associated with sleep problems in adulthood, but less research has focused on ACEs and sleep during adolescence. The goal of the present study was to explore associations between ACEs reported at ages 5 and 9 years, and sleep (ie, total sleep time (TST), social jetlag, and insomnia symptoms) at age 15.

METHODS

Participants comprised 817 families from the Fragile Families and Child Wellbeing Study, a nationally representative sample of children born to unwed parents. Number of ACEs was constructed from primary-caregiver reports at ages 5 and 9, and sleep measures (ie, TST, social jetlag, and insomnia symptoms) were derived from adolescent-reported sleep behaviors at age 15.

RESULTS

Adjusting for sex and race/ethnicity, ACEs at age 9 were associated with longer weekend TST (B = 0.16, 95% CI = 0.04, 0.28), more social jetlag (B = 0.17, 95% CI = 0.07, 0.27), and higher odds of trouble falling asleep ≥3 times per week (Odds Ratio = 1.24, 95% CI = 1.01, 1.53). In females only, ACEs were associated with greater school night TST (B = 0.12, 95% CI = 0.01, 0.23). Results were similar after further adjustment for symptoms of anxiety and depression. Associations among ACEs, social jetlag, and insomnia symptoms appeared strongest among Non-Hispanic Black adolescents.

CONCLUSION

ACEs appear to be related to multiple aspects of sleep in adolescence. Additional research is needed to confirm these associations and examine the extent to which sleep disturbances associated with ACEs account for later health outcomes.

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

INTRODUCTION

Adverse 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.

METHODS

Participants 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.

RESULTS

Daytime 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.

CONCLUSIONS

These 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.

Sleep problems and complexity of mental health needs in adolescent psychiatric inpatients

Sleep problems are highly co-morbid with psychiatric disorders and are part of the complex and multiple factors contributing to symptoms and functional disability. The current study aimed to determine how sleep problems in the period preceding psychiatric admission relate to profiles of mental health needs in adolescent inpatients. This retrospective study included 424 adolescents (13-17 years) admitted over a five-year period to an acute crisis stabilization unit in a tertiary care pediatric hospital. Adolescents were divided into two age- and sex-matched groups based on the presence of moderate to severe sleep problems. Profiles of mental health needs were assessed at admission using the Child and Adolescent Needs and Strengths - Mental Health Acute (CANS-MH) and a complexity score was calculated as the total number of actionable CANS-MH items. Results showed a positive association between sleep problems and needs pertaining to eating disturbances, adjustment to trauma, and school attendance. Odds ratios for sleep problems increased progressively as the complexity scores increased, reaching a plateau at six needs beyond which odds ratios remained at their highest level. Adolescents with sleep problems were more likely to undergo medication changes during psychiatric hospitalization and were more likely to be discharged with antipsychotic medication. These findings suggest that sleep difficulties in adolescent inpatients may be associated with distinct and more complex profiles of mental health needs. The evaluation of sleep problems early in the course of psychiatric hospitalization may be an important part of the psychiatric assessment process to inform the global treatment plan.

Changes in child abuse experience associated to sleep quality: results of the Korean Children & Youth Panel Survey

Background

A victim of child abuse can often develop mental illness. The early detection of mental illness of children could be supported by observing sleep quality. Therefore, we examined the relationship between sleep quality and the changes in child abuse by the child’s own parents over the study period.

Methods

Data from the 2011–2013 Korean Children and Youth Panel Survey was used, and 2012 was set as the baseline. Adolescents who had poor sleep quality in 2011 were excluded from the analysis to obtain the final study population of 1276 adolescents aged 14 and 15 years. The generalized estimating equation model (GEE) was used for statistical analysis.

Results

Children who had experienced and/or were currently experiencing child abuse showed significantly poorer sleep quality (current year abuse only: odds ratio [OR] = 0.57, 95% confidence interval [CI] = 0.41, 0.79; prior year abuse only: OR = 0.72, 95% CI = 0.52, 0.99; continuous abuse: OR = 0.56, 95% CI = 0.39, 0.80) compared to children who had no experience of child abuse.

Conclusion

Child abuse remains a traumatic experience that influences the quality of sleep and hinders the child’s proper psychological development. We suggest approaching this issue at both the community and national levels to protect the victims.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11309-3.

Childhood maltreatment reports in adult seasonal affective disorder: Associations with sleep disturbances, maladaptive cognitions, and brooding

BACKGROUND

Although childhood maltreatment has been studied in multiple psychopathologies, its role in Seasonal Affective Disorder (SAD) is unknown. The current study examined possible mediators of the relationship between retrospectively-reported childhood maltreatment and adult SAD symptom severity during a major depressive episode in winter.

METHODS

Participants (N = 113), ages 18 to 65, completed measures of childhood maltreatment, SAD severity, sleep disturbances, ruminative brooding, and maladaptive cognitions. Mediation analyses testing the relationship between childhood maltreatment and SAD symptom severity via sleep and cognitive factors were conducted using PROCESS (Hayes, 2012).

RESULTS

Mediation analyses suggested that insomnia, hypersomnia, brooding, and seasonal maladaptive beliefs may account for the association between childhood maltreatment and SAD symptom severity.

LIMITATIONS

Analyses were cross-sectional and should be interpreted with caution. Participants completed self-report childhood trauma measure retrospectively as adults.

CONCLUSION

The present study is the first to examine childhood maltreatment in SAD, a disorder commonly viewed with circadian etiology. Covariance between childhood maltreatment and SAD symptom severity is indirectly explained by sleep difficulties, cognitive factors, and brooding, which may suggest therapeutic targets if replicated in longitudinal or experimental manipulations of sleep and cognition.

Sleep disturbance and the long-term impact of early adversity

Sleep disturbance may be a central, yet underappreciated mechanism by which early adversity has a long-term impact upon mental and physical health. The fundamental regulatory processes shaped by early adversity - neural, neuroendocrine, and immune - are also central to sleep. Sleep problems, in turn, lead to a similar constellation of chronic health problems that have been linked to early adversity. We bring together work from the fields of early adversity and sleep in order to suggest a model by which sleep disturbance plays a critical role in the far-reaching impacts of early adversity on health. Future research should employ more longitudinal designs and pay particular attention to the impact of developmental periods such as adolescence and midlife when maturational and environmental factors conspire to create a unique time of sleep disturbance. We also suggesting that intervening to minimize sleep disturbance may be a promising means by which to test the model, as well as potentially blunt the long-term impact of early adversity on health.

Abuse in Childhood and Risk for Sleep Disruption in Adulthood in the Black Women's Health Study

OBJECTIVE

To investigate the association of early life abuse with sleep disruption risk in adulthood among U.S. Black women.

METHODS

We analyzed data from the Black Women's Health Study, a prospective cohort study. In 2005, 29,998 women completed a self-administered questionnaire on early-life experiences of abuse (child and teen) and exposure to danger at any life stage. Participants reported on their sleep quality (snoring and diagnosed sleep apnea) in 2001, whether their "sleep was restless" in 2005, and their average sleep duration in 2009. We used log-binomial regression models to derive risk ratios (RRs) and 95% confidence intervals (CIs) for the association of child/teen abuse and danger at any life stage with snoring, diagnosis of sleep apnea, restless sleep, and short sleep duration.

RESULTS

Nearly 50% of participants reported one or more measure of sleep disruption in adulthood. Higher severity of physical abuse was associated with increased risk of sleep disruption and higher severity of sexual abuse was associated with increased risk for most sleep disruptions. The RR comparing child/teen physical and sexual abuse relative to no abuse was highest for diagnosed sleep apnea (2.03, 95% CI: 1.70, 2.41). Feeling in danger at any life stage (child, teen, adult, past year) was generally associated with greater increases in risk of sleep disruption among women with a history of early life abuse than among women without such a history.

CONCLUSIONS

Our findings suggest that abuse as a child and/or teen is related to disrupted sleep in adulthood.

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.

The Young Adolescent Project: A longitudinal study of the effects of maltreatment on adolescent development

The Young Adolescent Project (YAP) is an ongoing longitudinal study investigating the effects of abuse and neglect on adolescent development. It is a multidisciplinary study guided by a developmental, ecological perspective, and designed to consider the physical, social, and psychological effects of childhood maltreatment through the transition from childhood to adolescence. Four waves of data collection have been completed, ranging from early (Mean age = 10.95) to late adolescence (Mean age = 18.24). Members of the maltreated group (n = 303) were selected from new cases that had been opened by the Department of Child and Family Services, whereas the comparison group (n = 151) were not involved with child welfare but lived in the same neighborhoods as the maltreated group. The study assessed a wide variety of domains including physical development (e.g., height, weight, body mass, pubertal development); physiological reactivity (e.g., cortisol); cognitive abilities; mental health (e.g., symptoms of depression, anxiety, trauma, and aggression); risk behavior (e.g., sexual activity, delinquency, or substance use); social development (e.g., self-esteem, competence, and social support); family environment; and exposure to community violence. Overall, our findings demonstrated the pervasive and persistent adverse effects of child maltreatment both within and across domains, but they also identified maltreated youth with positive functioning. Our hope is that this work will help move us toward identifying targets for intervention to cultivate resilience and positive adaptation after early maltreatment experiences.

Challenges in researching the immune pathways between early life adversity and psychopathology

Exposure to childhood adversity is a critical risk factor for the development of psychopathology. A growing field of research examines how exposure to childhood adversity is translated into biological risk for psychopathology through alterations in immune system functioning, most notably heightened levels of inflammation biomarkers. Though our knowledge about how childhood adversity can instantiate biological risk for psychopathology is growing, there remain many challenges and gaps in the field to understand how inflammation from childhood adversity contributes to psychopathology. This paper reviews research on the inflammatory outcomes arising from childhood adversity and presents four major challenges that future research must address: (a) the measurement of childhood adversity, (b) the measurement of inflammation, (c) the identification of mediators between childhood adversity and inflammation, and (d) the identification of moderators of inflammatory outcomes following childhood adversity. We discuss synergies and inconsistencies in the literature to summarize the current understanding of the association between childhood adversity, a proinflammatory phenotype, and the biological risk for psychopathology. We discuss the clinical implications of the inflammatory links between childhood adversity and psychopathology, including possibilities for intervention. Finally, this review conclude by delineates future directions for research, including issues of how best to detect, prevent, and understand these “hidden wounds” of childhood adversity.

Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents

Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.

Understanding the Relationship Between Sleep Problems in Early Childhood and Borderline Personality Disorder: A Narrative Review

OBJECTIVE

Recent research indicates that sleep problems in childhood precede the development of borderline personality disorder (BPD) symptoms, but the mechanisms by which sleep problems associate with BPD are still unknown. This narrative review aims to provide some potential explanations for how early sleep problems might associate with BPD.

METHODS

We used the biosocial developmental model of BPD as a framework to discuss how sleep problems may associate with BPD. Articles were identified via PubMed and Embase, and papers published between January 1991 and April 2021 were extracted. Authors made a series of literature searches using the following keywords: Sleep problems, Insomnia, Nightmares, Hypothalamic-Pituitary-Adrenal Axis (HPA), Prefrontal Cortex, Family Psychopathology, Disrupted Attachment, Child Maltreatment, Impulsivity, Emotion Regulation, Internalizing, Externalizing, Rumination, Childhood, Adolescence, Young people. The inclusion criteria were published in peer-reviewed journals; human studies or reviews; published in English. The exclusion criteria were commentaries; abstracts from conferences; studies with animal samples. A total of 96 articles were included for the purpose of this review.

RESULTS

The evidence from this review suggests that some biological factors and core features of BPD act as potential mechanisms mediating the associations between early sleep and subsequent BPD, while some family-related factors might constitute common risk factors for sleep problems and BPD.

CONCLUSION

The biosocial developmental model of BPD provides a plausible characterization of how sleep disruption might lead to subsequent BPD. Further research on new developmental and early intervention approaches to understand how sleep in early stages associates with BPD could have significant clinical impact on these patients and could inform targeted therapeutic interventions.

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.

Attention Problems and Comorbid Symptoms following Child Sexual Abuse

Treatment utilization following child sexual abuse (CSA) is essential in combatting the various negative consequences of CSA. Youth may present to treatment for CSA with symptoms that cut across multiple diagnostic presentations that impact their ability to successfully engage in treatment. In particular, children who have difficulties with attention may have unique treatment needs following CSA. The purpose of this study was to examine how attention problems interplay with comorbid symptoms and how these clinical presentations impact treatment outcomes for youth who have been sexually abused. Participants included 323 families presenting to treatment for CSA. Youth were 7 to 19 years old, 78.5% female, and 76.6% identified as Caucasian/White. Results indicated that 22.9% of the youth presented with clinically elevated attention problems as collected through parent-report of the Child Behavior Checklist (CBCL). Results demonstrated that child survivors of CSA who presented with attention problems self-reported more psychological concerns (e.g., symptoms of depression, anxiety, and post-traumatic stress). At post-treatment, attention problems, interpersonal problems, and thought problems were significantly reduced for youth initially presenting with attention problems. Further implications for treatment following CSA and unique needs for youth with attention problems are discussed.