Behavioral Sleep Problems and their Potential Impact on Developing Executive Function in Children

Association between maternal stress and child sleep quality: a nationwide ECHO prospective cohort study

BACKGROUND

Childhood sleep quality is associated with physical, cognitive, and behavioral health and predicts later sleep quality; it has many determinants, including developmental exposures.

OBJECTIVES

To examine associations between maternal stress during pregnancy and childhood sleep quality and determine whether postnatal stress mediates the association.

METHOD

Data from the Environmental Influences on Child Health Outcomes cohort were used. Perceived Stress Scale (PSS) T-scores were the exposure measure. Outcome measures were preschool Child Behavior Checklist (CBCL) sleep syndrome scale and Patient-Reported Outcomes Measurement Information System Sleep Disturbance Parent Proxy short form 4a (PSD4a) T-scores at ages 4-8 years. Linear mixed-effects regression modeling was performed for each sleep outcome, adjusting for maternal age at delivery and education and child sex, gestational age at birth, and age at outcome ascertainment, with random intercepts for cohorts.

RESULTS

Prenatal PSS score was associated with both CBCL (B = 0.09, 95% confidence interval [CI]: 0.06, 0.11; p < 0.01) and PSD4a (B = 0.07, 95% CI: 0.03, 0.12; p < 0.01) scores. Postnatal perceived stress mediated a proportion of the total effect of prenatal stress in both CBCL (66.3%) and PSD4a (95.9%) samples.

CONCLUSIONS

Both pre- and postnatal maternal perceived stress appear to influence sleep quality during early life.

IMPACT

Prenatal stress significantly associates with child sleep problems and disturbances at ages 4-8 years; postnatal maternal stress is a significant mediator of these associations. Research suggests a range of prenatal affective/distress exposures associated with child sleep problems, but the conclusions remain in doubt due to the mixture of exposures and outcomes employed. Ours is the first US-based effort to explore associations between perceived maternal stress during pregnancy and child sleep problems and disturbance in early and middle childhood. Even a small effect of a prevalent issue like psychosocial stress may have important public health implications at the population level.

Sleep problems and executive dysfunctions in pre-school children

AIM

The aim of the study was to examine the relationship between sleep problems and executive functions in pre-school children as reported by parents/caregivers.

METHODS

This cross-sectional study of caregiver-child dyads was conducted in a public kindergarten school in Northern Thailand. Sleep problems were evaluated using the Children's Sleep Habits Questionnaire (CSHQ), whereas executive functions were assessed using the Behavioural Rating Inventory of Executive Function - pre-school version (BRIEF-P). T-scores greater than 65 of the BRIEF-P were defined as deficits in executive functions. Multiple linear regressions were performed to assess the association between the executive function components and the total CSHQ scores.

RESULTS

Participants included 356 children, with a mean age of 5.04 (0.54) years. The total CSHQ scores of the executive dysfunction group were significantly higher than those of the group with executive functions below the cutoff (P < 0.001), which indicated more of sleep problems, including sleep-onset delay, night waking and daytime sleepiness. However, the duration of night sleep, night awake, afternoon nap and total sleep time reported by parents did not differ between the two groups. Weak positive correlations between the total CSHQ and subscale scores and the Global Executive Composite score of the BRIEF-P were noted. After adjusting for confounding variables, including child's age, gender, prematurity, maternal age and education, family income and media viewing time from the multiple linear regression analysis, the total CSHQ scores were significantly correlated with worse Global Executive Composite scores, which is the summary of five domains of executive functions (P < 0.001).

CONCLUSIONS

This study highlights the association between sleep problems and deficits in executive functions in healthy pre-school children. Health-care providers are encouraged to consistently advocate for proper sleep hygiene and practices to enhance executive functions in pre-schoolers.

Actigraphy-assessed sleep duration and quality and executive function in a sample of typically developing preschoolers

Sleep is essential for cognitive development and brain maturation during early childhood. Studies focused on preschool populations using objective measures of sleep are still scarce. The objective of this study was to examine the associations between objective measures of sleep duration and quality with executive functioning in a 133 non-clinical sample of Spanish participants (Mage = 60.33 months, SD = 9.04; ages 41-77 months; 51.1% girls). Sleep was assessed for five weeknights using actigraphy; Shape School task was applied to assess inhibition and cognitive flexibility; and Word Span task was used to assess working memory. The results revealed that relation between sleep and executive functioning was significant for inhibition and working memory. Preschoolers with higher sleep efficiency showed better results in executive functioning tasks after controlling for the effect of age. Additionally, age and sleep duration and quality variables were predictive of inhibition, working memory, and cognitive flexibility. These results suggest that the different dimensions of sleep could play an important role in the development of executive functions during preschool age. Therefore, improving sleep could lead to an improvement in children's executive functioning in both clinical and educational contexts.

Changes in Restless Sleep, Self-Control, and Alcohol-Related Problems with Police from Late Adolescence to Adulthood

Sleep quality is crucial for healthy adolescent brain development, which has downstream effects on self-control and involvement in risky behaviors, such as alcohol use. While previous studies have found that sleep and facets of self-control are associated with patterns of alcohol use, few have assessed whether these constructs are tied to alcohol-related problems with law enforcement during the transitional period from adolescence to adulthood. The current study uses self-report panel data from ages 16 to 27 from a population-based sample of U.S. youth (N = 956; 36.86% female). The goal of the current study is to assess the association between changes in restless sleep, impulsivity, sensation seeking, and problems with police during or shortly after consuming alcohol from adolescence to adulthood to begin to address this gap in the existing literature. Results from a multivariate latent growth curve model reveal that faster increases in restless sleep and slower declines in impulsivity are associated with slower declines in police contact. Correlated changes between restless sleep, impulsivity, and police contact are slightly greater from ages 16-21 than for ages 22-27, with males showing stronger associations. The reported results suggest that identifying developmental mechanisms between changes in poor sleep, impulsivity, and alcohol use behaviors during this life-course phase will be crucial moving forward to help divert youth away from alcohol-related contact with the police.

Recreational gymnastics exercise of moderate intensity enhances executive function in Chinese preschoolers: A randomized controlled trial

The current study aimed to investigate the impact of recreational gymnastics on executive function in Chinese preschoolers, with a focus on gymnastics potential to enhance core components of executive function. A total of 63 preschool children who received full-time education were randomly assigned to either an intervention group (N = 31, mean age = 66.27 months, SD = 3.12 months) or a control group (N = 32, mean age = 66.79 months, SD = 3.34 months). The intervention group engaged in recreational gymnastics for 60 min, three times a week for 12 weeks. Meanwhile, the control group continued with their typical outdoor activities at kindergarten and did not participate in any organized sports. The intervention program was primarily conducted through group play and was facilitated by teachers who underwent standardized training. Various simple and complex tasks were utilized to evaluate delay gratification (Snack delay and Wrapped gift), inhibitory control (Stop signal task and Circle drawing task), working memory (Letter memory task and Keep track task), and cognitive flexibility (Go/No-Go task and Dots task). The analysis of covariance revealed that the children who participated in the intervention outperformed the control group on most simple and complex executive function tasks. Specifically, these children demonstrated an enhanced ability to regulate persistent responses, process and update information, and manage high cognitive conflict. The findings of this investigation lend support to the hypothesis that moderate-intensity recreational gymnastics is an efficacious means of enhancing executive function in early childhood. Future research should employ a larger sample size, incorporate a long-term follow-up design, and utilize a multi-method approach to further substantiate the impact of moderate-intensity gymnastics on the executive function of young children, as well as to investigate its underlying mechanism and generalizability.

Later ("evening") circadian preference is associated with poorer executive, academic, and attentional functioning in adolescents with and without ADHD

BACKGROUND

Adolescents vary considerably in their circadian phase preference; those with greater "eveningness" (also known as "night owls") have later bedtimes, wake times, and peak arousal compared to those with greater "morningness." Prior research suggests that (a) greater eveningness is associated with worse academic, executive, and attentional functioning; and (b) adolescents with attention-deficit/hyperactivity disorder (ADHD) tend to be high in eveningness and to have deficits in these school-related constructs. However, few studies have examined circadian preference alongside two potential confounds-sleep duration and sleep quality-as predictors of daytime functioning, or whether the strength of associations differs across adolescents with and without ADHD.

METHODS

Participants were 302 adolescents (Mage = 13.17 years; 44.7% female; 81.8% White); approximately half (52%) had ADHD. A multi-method, multi-informant design was used. Specifically, adolescents reported on their circadian preference, school night sleep duration, and sleep quality. Adolescents provided ratings of their academic motivation (intrinsic, extrinsic, and amotivation) and were administered standardized achievement tests in reading and math. Adolescents and parents completed ratings of daily life executive functioning (behavioral, emotion, and cognitive regulation), and they and teachers also provided ratings of ADHD inattentive symptoms.

RESULTS

Above and beyond sleep duration, sleep quality, and covariates (sex, family income, pubertal development, medication use), greater eveningness was uniquely associated with poorer academic, executive, and attentional functioning across most measures. Sleep quality was uniquely associated with a handful of outcomes, and sleep duration was not significantly uniquely associated with any outcome in the regression analyses. ADHD status did not moderate effects.

CONCLUSIONS

This study provides compelling evidence that poorer academic, executive, and attentional functioning are more closely associated with greater eveningness than with sleep duration or quality in adolescents. Findings suggest that targeting circadian preference may be important to reduce these problems in adolescents, especially in clinical samples such as ADHD for whom academic, executive, and attentional difficulties are exceptionally common.

The Association Between Sleep Problems and Attentional Network Functions in Patients with Self-Limited Epilepsy with Centrotemporal Spikes

Purpose

To investigate sleep problems in children with self-limited epilepsy with central temporal spiking (SeLECTS) and to assess the relationship between sleep problems and attention network dysfunction.

Patients and methods

107 children 6-14 years of age with SeLECTS and 90 age- and sex-matched healthy controls were recruited for this study. The sleep status of these participants was evaluated using the Children's Sleep Habits Questionnaire (CSHQ), while attentional network function was assessed with the attention network function test (ANT).

Results

Together, these analyses revealed that children with SeLECTS exhibited higher total CSHQ scores and sleep disorder incidence relative to healthy controls (P< 0.001). Children with SeLECTS had higher scores in delayed sleep onset, sleep duration, night awakenings, parasomnias, daytime sleepiness and sleep anxiety (P<0.01). Total CSHQ scores were negatively correlated with average ANT correct rates (ρ= -0.253, P<0.01), while they were positively correlated with total reaction time (ρ=0.367, P<0.01) and negatively correlated with the efficiency of the alerting and executive control networks (ρ=-0.344 P<0.01; ρ=-0.418 P<0.01).

Conclusion

Children with SeLECTS face a higher risk of experiencing sleep disorders relative to age-matched healthy children, while also demonstrating that the magnitude of the impairment of attentional network function in these children is positively correlated with sleep disorder severity. Thus, the prognosis and quality of life of children with SeLECTS can be improved by interventions addressing sleep disorders.

Early childhood sleep quantity, but not caregiver-reported sleep problems, predicts impulse control in children at age 8 years

Short duration of sleep and poor sleep quality have been linked to poor attention and impulse control in children. We aimed to determine the longitudinal predictive value of sleep quantity and quality during early childhood on objective and caregiver-report measures of attention, impulse control, and executive function in children at age 8 years. We used data from the Health Outcomes and Measures of the Environment (HOME) Study, a pregnancy and birth cohort. Caregivers reported on their child's sleep at ages 2, 2.5, 3, 4, and 5 years. Analysis included 410 participants. We used longitudinal growth curve models of early childhood sleep patterns to predict neurobehavioral functioning at age 8 years. Sleep problems did not predict any of our outcome measures at age 8 years. Sleep duration trended shorter as children matured, so predictive models examined both intercept and slope. Children with the least decline in sleep duration across early childhood had fewer impulsive errors at age 8 years on a continuous performance test (unadjusted p = .013; adjusted p = .013). Children with shorter duration of sleep across early childhood had worse caregiver-reported behavioral regulation at age 8 years (unadjusted p = .002; adjusted p = .043). Neither sleep duration slope nor intercept predicted inattention or metacognitive skills at age 8 years (p > .05). Total sleep time across early childhood predicts behavior regulation difficulties in school-aged children. Inadequate sleep during early childhood may be a marker for, or contribute to, poor development of a child's self-regulatory skills.

Carer-reported sleep disturbance and carer- and teacher-rated executive functioning in children with prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder

Children with prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD) have high rates of sleep disturbance and marked difficulties with executive functioning (EF). Sleep disturbance has been associated with poorer EF across development in typically developing children. The contribution of insomnia symptoms and nightmares to EF difficulties in children with PAE and FASD is unclear. The current study examined whether caregiver-reported insomnia symptoms and nightmares predicted difficulties with EF in children with PAE who were assessed at FASD diagnostic clinics. Archival data on 116 children with PAE assessed at FASD diagnostic clinics were extracted from databases. Children were assigned to a preschool-age group (3.1 to 5.9 years, n = 40) and a school-age group (5.9 to 10.9 years, n = 76). Insomnia symptoms and nightmares were measured using items extracted from the Child Behavior Checklist (CBCL) while EF was measured using the caregiver and teacher Behavior Rating Inventory of Executive Function (BRIEF) rating forms. Bootstrapped regression models were used examine the effects of insomnia symptoms and nightmares on domains of EF in each group while adjusting for potential confounds. For preschool children, insomnia symptoms were associated with greater daytime tiredness while nightmares were associated with greater difficulties with Emergent Metacognition according to their teachers. For school-age children, insomnia symptoms predicted greater EF difficulties across most domains according to their caregivers but not teachers. Sleep disturbance may compound EF impairments in children with PAE and should be screened for as part of FASD diagnostic assessment.

The efficacy of weighted blankets for sleep in children with attention-deficit/hyperactivity disorder-A randomized controlled crossover trial

Weighted blankets are a non-pharmacological intervention for treating sleep and anxiety problems in children with attention-deficit/hyperactivity disorder. However, research on the efficacy of weighted blankets is sparse. The aim of this randomized controlled trial with a crossover design (4 + 4 weeks) was to evaluate the efficacy of weighted blankets on sleep among children with attention-deficit/hyperactivity disorder and sleeping problems. Children diagnosed with uncomplicated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attention-deficit/hyperactivity disorder with verified sleep problems were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed at weeks 0, 4 and 8 using actigraphy, questionnaires and a daily sleep diary. T-tests were used to evaluate efficacy. The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years; 54 [57.4%] boys). Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen's d = 0.24), sleep efficiency (mean diff. 0.82%, p = 0.038, Cohen's d = 0.23) and wake after sleep onset (mean diff. -2.79 min, p = 0.015, Cohen's d = -0.27), but not on sleep-onset latency (p = 0.432). According to our exploratory subgroup analyses, weighted blankets may be especially beneficial for improving total sleep time in children aged 11-14 years (Cohen's d = 0.53, p = 0.009) and in children with the inattentive attention-deficit/hyperactivity disorder subtype (Cohen's d = 0.58, p = 0.016). Our results suggest that weighted blankets may improve children's sleep and could be used as an alternative to pharmacological sleep interventions.

Exploration of Sex and Age as Moderators Between Social Cumulative Risk and Sleep in a Representative Sample of Children and Adolescents Living in the United States

BACKGROUND

Youth who face adversity are at a disproportionate risk for poor sleep health across the life course. Identifying whether the association between adversity and poor sleep varies based upon age and sex is needed. This study aims to explore sex and age as moderators between social risk and sleep in a sample of U.S. youth.

METHODS

This study analyzed data of 32,212 U.S. youth (6-17 years) whose primary caregiver participated in the 2017-2018 National Survey of Children's Health. A social cumulative risk index (SCRI) score was calculated from 10 parental, family, and community risk indicators. Nighttime sleep duration was the number of hours the child slept during the past week. Weeknight sleep irregularity was operationalized as whether the child sometimes/rarely/never went to bed at the same time. Generalized logistic regression models estimated associations between SCRI and sleep duration/irregularity, with age and sex as moderators.

RESULTS

Age moderated the association between SCRI and short sleep (OR = 1.12, p < 0.001), such that the magnitude of the SCRI-sleep relationship was 12% greater in school-age children. Sex was not a significant moderator. In stratified models by age group, age was positively associated with short sleep in both groups, with a greater magnitude in school-age children. Female school-age children were less likely to have short sleep than males.

CONCLUSIONS

Younger children with greater social cumulative risk factors may be more vulnerable to short sleep duration. Further research into the mechanisms underlying the relationships between social risk and sleep health in school-age children is needed.

Distinct Constellations of Common Risk Factors Differentially Relate to Executive-Function Ability in Children

Executive functioning (EF) has been shown to relate to academic achievement and well-being. Independent bodies of work have aimed to understand what environmental or personal attributes influence EF ability. However, most research has not considered how constellations of risk factors create distinct patterns of influence on EF ability. The current study tested a sample of children aged 9 to 10 years from the United States (N = 10,323, 48.06% female, Mage = 9.9 years, age range = 8.9-11.08 years) using a latent profile analysis (LPA) to detect subgroups that varied in their combinations of various risk factors. Six distinct groups of risk factors for children emerged, which in turn related to different average EF abilities. We found that family socioeconomic measures related to a subgroup having above- or below-average EF ability, but we also found an effect on EF across different risk factors. These results inform our understanding of individual variations in EF ability and highlight the idea that EF interventions should consider risk holistically.

The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions

Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.

Sleep patterns among preschool offspring of parents with and without psychopathology: Association with the development of psychopathology in childhood

BACKGROUND

Disturbed sleep during early childhood predicts social-emotional problems. However, it is not known how various early childhood sleep phenotypes are associated with the development of childhood psychopathology, nor whether these relationships vary as a function of parental psychopathology. We identified sleep phenotypes among preschool youth; examined whether these phenotypes were associated with child and parent factors; and determined if early sleep phenotypes predicted later childhood psychopathology.

METHODS

Using data from the Pittsburgh Bipolar Offspring study, parents with bipolar disorder (BD), non-BD psychopathology, and healthy controls reported about themselves and their offspring (n = 218) when their children were ages 2-5. Offspring and parents were interviewed directly approximately every 2 years from ages 6-18. Latent class analysis (LCA) identified latent sleep classes; we compared these classes on offspring demographics, parental sleep variables, and parental diagnoses. Kaplan-Meier survival models estimated hazard of developing any new-onset Axis-I disorders, as well as BD specifically, for each class.

RESULTS

The optimal LCA solution featured four sleep classes, which we characterized as (1) good sleep, (2) wake after sleep onset problems, (3) bedtime problems (e.g., trouble falling asleep, resists going to bed), and (4) poor sleep generally. Good sleepers tended to have significantly less parental psychopathology than the other three classes. Risk of developing new-onset Axis-I disorders was highest among the poor sleep class and lowest among the good sleep class.

CONCLUSIONS

Preschool sleep phenotypes are an important predictor of the development of psychopathology. Future work is needed to understand the biopsychosocial processes underlying these trajectories.

Correlation Between Maternal Anxiety During Mid-Pregnancy and Subsequent Infant Sleep Issues: A Cross-Sectional Study from 2015 to 2016

Purpose

To explore the correlation between maternal anxiety during mid-pregnancy and infant sleep issues based on the anxiety status of mothers in mid-pregnancy.

Patients and Methods

A cohort of 2122 primigravida women from Ma'anshan City, Anhui Province, was followed from pregnancy until 6 months postpartum. The study analyzed the impact of maternal anxiety on infant sleep patterns, including primary caregivers, encompassing insufficient sleep duration, frequent nocturnal awakenings, prolonged nocturnal awakening durations, and elongated sleep latency.

Results

A total of 1891 mother-infant pairs were included in this analysis. After adjusting for confounding factors, a positive correlation was found between maternal anxiety during mid-pregnancy and insufficient sleep duration (OR=1.69, 95% CI:1.13-2.52), and elongated sleep latency (OR=2.26, 95% CI:1.61-3.18).

Conclusion

Maternal anxiety during mid-pregnancy is associated with sleep issues in infants. Addressing maternal mental health during pregnancy may enhance sleep quality for mothers and infants, promoting overall maternal-infant health.

Sleep disturbances and behavioral symptoms in pediatric Sotos syndrome

Background

Sotos syndrome (SoS) is a rare overgrowth genetic disease caused by intragenic mutations or microdeletions of the NSD1 gene located on chromosome 5q35. SoS population might present cognitive impairment and a spectrum of behavioral characteristics, with a worse profile in patients with microdeletion. Although patients with SoS are known to have impaired sleep habits, very little data are available. The present study aimed to assess the prevalence of sleep disorders (SDs) in a pediatric cohort of patients with SoS and their correlation with neuropsychiatric profiles.

Methods

We included patients with a SoS diagnosis and age < 18 years; all patients underwent a comprehensive neuropsychological assessment, including evaluation of cognition, adaptive functions through the Adaptive Behavior Assessment System-Second Edition (ABAS-II), and behavioral problems using the Achenbach Child Behavior Checklist (CBCL) and Conners' Parent Rating Scale-Revised (CPRS-R:L) questionnaire. To investigate the presence of SD parents, the Sleep Disturbance Scale for Children (SDSC) was completed.

Results

Thirty-eight patients (M 61%, F 39%, mean age 11.1 ± 4.65 years) were included in the study. Although only two had a prior SD diagnosis, 71.1% (N = 27) exhibited pathological scores on SDSC. No statistically significant associations were found between positive SDSC results and genetic microdeletion, intellectual disability (ID), or other medical conditions/treatments. However, a positive correlation emerged between SDSC scores and Conners' Global Index (p = 0.048) and Restless/Impulsive (p = 0.01) scores, CBCL externalizing (p = 0.02), internalizing (p = 0.01), and total scores (p = 0.05). Conversely, a negative linear relationship was observed between the SDSC score and the ABAS GAC and ABAS CAD scores (p = 0.025).

Conclusion

We detected an SD in 71.1% of our sample, with a positive relation between SD and internalizing and externalizing symptom levels, especially hyperactivity and impulsivity. Our study demonstrated a high prevalence of SD in pediatric patients with SoS, highlighting that all patients should be screened for this problem, which has a great impact on the quality of life of patients and their families.

Accelerometer-based sleep metrics and gut microbiota during adolescence: Association findings from a Brazilian population-based birth cohort

BACKGROUND

Sleep and gut microbiota are emerging putative risk factors for several physical, mental, and cognitive conditions. Sleep deprivation has been shown to be linked with unhealthy microbiome environments in animal studies. However, in humans, the results are mixed. Epidemiological studies evaluating the effect of accelerometer-based sleep measures on gut microbiome are scarce. This study aims to explore the relationship between sleep duration and efficiency with the gut microbiota in adolescence.

METHODS

A subsample of 352 participants from the 2004 Pelotas (Brazil) Birth Cohort Study with sleep and fecal microbiota data available were included in the study. Sleep duration and sleep efficiency were obtained from actigraphy information at 11 years old whereas microbiota information from fecal samples was collected at 12 years. The fecal microbiota was analyzed via Illumina MiSeq (16S rRNA V3-V4 region) and the UNOISE pipeline. Alpha was assessed in QIIME2. Association measures for sleep variables and microbial α-diversity, and bacterial relative abundance were assessed through generalized models (linear and logistic regression), adjusting for maternal and child variables confounders.

RESULTS

Adjusted models showed that sleep duration was positively associated with Simpson index of α-diversity (β = 0.003; CI95 %: 0.00004; 0.01). Both sleep duration (OR = 0.43; CI95 % 0.25; 0.74) and efficiency (OR = 0.55; CI95 % 0.38; 0.78) were associated with lower Bacteroidetes abundance.

CONCLUSION

Our results suggest that sleep duration and efficiency are linked to gut microbiota diversity and composition even with 1-2 years gap from exposure to outcome. The findings support the role of sleep in the gut-brain axis as well as provide insights on how to improve microbiota health.

The Feasibility of Screening for Sleep Problems in Early Childhood Education Programs

OBJECTIVES

Assess the feasibility and staff experience of screening for behavioral sleep problems (BSP) and sleep disordered breathing (SDB) in early childhood education (ECE) settings; examine BSP/SDB prevalence and caregivers' knowledge/attitudes, perception of child sleep problems, and sleep health engagement in this sample.

METHOD

Eight staff representatives from four ECE sites involved with sleep problem screening procedures within a larger RCT on ECE sleep health, discussed their experiences in a focus group; transcript content reviewed. A random subset of caregiver-child dyads (n = 59) from the four ECE sites completed sleep problem measures (BSP: Children's Sleep Habits Questionnaire, Short form [SF-CSHQ], Tayside Children's Sleep Questionnaire [TCSQ-sleep disturbance and difficulty] and SDB: Pediatric Sleep Questionnaire [PSQ], in addition to RCT measures (Parent Knowledge/Attitude/Self-efficacy/Beliefs survey and sleep health goals). Caregiver sleep health engagement was measured by the sleep health goals set.

RESULTS

ECE staff reported sleep problem screening as self-explanatory and doable but sometimes administratively burdensome. BSPs were identified in 44% (SF-CSHQ) to 63% (TCSQ-sleep disturbance) of children; SDBs in 13%. Only 11% of caregivers endorsed their child having a sleep "difficulty" (TCSQ). Sleep health goals were set by 85% of caregivers; 63% employed educational materials' language.

CONCLUSION

Sleep problem screening in ECE is feasible, and problems are elicited. While caregivers readily engage in setting healthy sleep goals, few endorse sleep as difficult. ECE education could improve caregiver understanding/recognition of sleep problems.

Association between meeting the 24-h movement guidelines and psychosocial health in children: A cross-sectional study

OBJECTIVE

Emerging evidence suggests that meeting the 24-h movement guidelines is associated with optimal mental health. However, there remains some uncertainty regarding this association in children. Therefore, this study aimed to examine the association between meeting the 24-h movement guidelines and psychosocial health in children.

METHODS

A cross-sectional study design was employed to investigate 2005 children aged 9-12 years from four districts of Shanghai, China. The 24-h movement behaviours were assessed using selected items from the Health Behaviour in School-aged Children (HBSC) survey questionnaire. Children's self-rated psychosocial health was evaluated using the Strengths or Difficulties Questionnaire (SDQ). Generalised Linear Models with the ordinal logistic module were employed to analyse the association between meeting the 24-h movement guidelines and psychosocial health.

RESULTS

The overall prevalence of meeting all three 24-h movement recommendations was 10.2%. Among children, 7.9% of them exhibited abnormal total difficulties, with a notable difference between sex (boys: 11.2%, girls: 7.0%, p = 0.001). Meeting all three 24-h movement behaviour recommendations was associated with reduced total difficulties, emotional symptoms, conduct problems, hyperactivity and peer problems. Furthermore, a dose-response association was observed, indicating that meeting a greater number of 24-h movement behaviour recommendations was associated with enhanced psychosocial health, particularly in boys.

CONCLUSION

The findings of this study highlight the positive association between meeting the 24-h movement guidelines and psychosocial health in children. Notably, meeting more of these recommendations was associated with a lower likelihood of experiencing psychosocial problems, with greater benefits observed in boys compared with girls.

The trajectory of maternal perinatal depressive symptoms predicts executive function in early childhood

BACKGROUND

Perinatal maternal depression may affect fetal neurodevelopment directly or indirectly via exposures such as smoking, alcohol, or antidepressant use. The relative contribution of these risk factors on child executive function (EF) has not been explored systematically.

METHODS

A prospective pregnancy cohort of 197 women and their children was studied to determine whether maternal depression diagnosis and the trajectory of maternal depressive symptoms (MDSs) from early pregnancy to 12 months postpartum predicts child EF at age 4 (measured using the preschool age psychiatric assessment, NEPSY-II, and Shape School task) using latent growth curve modeling. Indirect effects of smoking, alcohol, and antidepressant use were also formally tested.

RESULTS

Increasing maternal perinatal depressive symptoms over time predicted more inattentive symptoms, poorer switching, and motor inhibition, but not cognitive inhibition. When adjusted for multiple comparison, and after accounting for maternal cognition and education, the association with child inattentive symptoms remained significant. However, diagnosed depression did not predict child EF outcomes. Prenatal exposure to smoking, alcohol, and antidepressants also did not mediate pathways from depressive symptoms to EF outcomes. Our findings were limited by sample size and statistical power to detect outcome effects of smaller effect size.

CONCLUSIONS

This study suggests that increasing MDSs over the perinatal period is associated with poorer EF outcomes in children at age 4 - independent of prenatal smoking, drinking, or antidepressant use. Depressive chronicity, severity, and postpartum influences may play crucial roles in determining childhood outcomes of EF.

Is the association between sleep and socio-emotional development mediated by weight in toddlers aged 12 to 36 months?

Introduction

Childhood is an important stage for socio-emotional development. Understanding the associations of lifestyle habits with the healthy development of social and emotional skills is crucial for better interventions early in life. This study aims to analyze the association between sleep and socio-emotional development in toddlers aged 12 to 36 months and examine whether weight mediated these associations.

Methods

This study is part of a cluster randomized controlled trial developed in Portuguese childcare centers. A sample of 344 children (176 females) enrolled in the study. Participants' anthropometrics were measured while at childcare centers using standardized procedures. Body mass index (BMI) was computed as the body weight/height2 (kg/m2) ratio. Sleep quality was collected with the Tayside Children's Sleep Questionnaire, a 10-item scale that evaluates the child's ability to initiate and maintain sleep. Two additional questions regarding sleep duration were added. Parental questionnaires assessed the child's sex and date of birth, socioeconomic status, and total energy intake (TEI). Motor (fine and gross) was assessed using Bayley-III scales and socio-emotional (SE) by the Greenspan Social-Emotional Growth Chart questionnaire. Linear regression models were used to examine the associations between sleep (duration and quality) and SE with adjustments for sex, age, BMI, mothers' education, motor development, and TEI. Mediation analysis was conducted using path analysis.

Results

SE development was significantly associated with nighttime sleep duration even when adjusted for confounders (β = 0.223; 95% CI: 0.001, 0.004 and β = 0.168; 0.0003, 0.003; respectively). Sleep quality was not significantly associated with SE development, and the weight did not explain the associations between sleep and SE development.

Conclusion

This study supports that sleep duration is directly associated with SE development in toddlers. From a public health perspective, sleep duration should be prioritized in intervention programs to improve socio-emotional development early in life.

Sleep problems mediate the influence of childhood emotional maltreatment on adolescent non-suicidal self-injury: The moderating effect of rumination

BACKGROUND

Non-suicidal self-injury (NSSI) is a highly serious public health problem among adolescents in China, and childhood emotional maltreatment has been found to be a risk factor for NSSI.

OBJECTIVE

Little is known about the longitudinal association between childhood emotional maltreatment and NSSI as well as its underlying mediating and moderating mechanisms. Thus, we hypothesized whether sleep problems mediated the association between childhood emotional maltreatment and NSSI, and whether this indirect effect was moderated by rumination.

PARTICIPANTS AND SETTING

A total of 1987 Chinese adolescents (56.1 % males; ages 10 to 14, M = 12.32, SD = 0.53) completed self-report questionnaires regarding childhood emotional maltreatment, sleep problems, rumination non-suicidal self-injury (NSSI) in three waves.

METHODS

Structural equation model was used to test a moderated mediation model, with gender, age and socioeconomic status and baseline measures as covariates.

RESULTS

Childhood emotional maltreatment was significantly associated with NSSI, and this association was mediated by sleep problems. Moderated mediation analyses revealed that rumination intensified the relation between childhood emotional maltreatment and sleep problems as well as the relation between sleep problems and NSSI.

CONCLUSIONS

Findings of this study demonstrate a relationship among childhood emotional maltreatment, sleep problems, rumination and NSSI. Interventions that target sleep problems and rumination may be beneficial for reducing NSSI for at-risk adolescents.

Sleep disturbances in individuals with down syndrome: An overview

Down Syndrome, or Trisomy 21, is one of the most common birth defects, with 6,000 babies born annually with Down Syndrome in the U.S. One of many health risk factors individuals with Down Syndrome experience is sleep issues, ranging from poor sleep quality to high prevalence of obstructive sleep apnea. This literature review aims to review these sleep challenges in this population and explore consequences and treatment options.

Associations Between Dimensional Persistence of ADHD and Adult Sleep Quality in a Prospective Study of Girls

OBJECTIVES

We investigated the prospective association between (a) ADHD symptom dimensions, including their persistence and (b) adult sleep quality in a female sample, covarying adult depressive symptoms.

METHODS

Participants comprised four persistence groups (persisters, partials, desisters, and comparison) based on overall ADHD diagnosis and separate dimensions of inattention and hyperactivity/impulsivity (HI) in childhood, late adolescence, and early adulthood, featuring girls with (n = 140) and without (n = 88) carefully diagnosed ADHD.

RESULTS

Only persistence of inattention predicted lower adult sleep quality when covarying young-adult depression, which was also a significant predictor. When additionally covarying stimulant medication use in adulthood, inattention persistence lost significance, although depression maintained significance, with medication use predicting worse sleep quality.

CONCLUSIONS

Persistence of inattentive (but not HI) symptoms was significantly related to adult sleep quality in the context of concurrent depression. Sleep quality is an important outcome for research on and treatment for ADHD.

Experiences of Using Weighted Blankets among Children with ADHD and Sleeping Difficulties

Introduction

Sleeping difficulties are common in children with attention deficit hyperactivity disorder (ADHD). A sleep intervention with weighted blankets was designed to increase current understanding of using weighted blankets to target children's individual needs in connection with sleep and daytime functioning.

Aim

To explore how children with ADHD and sleeping difficulties experience the use of weighted blankets.

Methods

An explorative qualitative design in which 26 children with ADHD and sleeping difficulties, 6-15 years old, were interviewed about a sleep intervention with weighted blankets. Four categories emerged from qualitative content analysis.

Results

Children's experiences revealed that the use of weighted blankets 1) requires a commitment, by adjusting according to needs and preferences and adapting to the environment; 2) improves emotional regulation by feeling calm and feeling safe; 3) changes sleeping patterns by creating new routines for sleep and improving sleep quality; and 4) promotes everyday participation by promoting daily function and balancing activity and sleep.

Conclusions

Using weighted blankets promoted children's management of daily life with ADHD and sleeping difficulties. Occupational therapists can improve the assessment and delivery of weighted blankets tailored to individual needs based on increased knowledge from the children themselves.

Effect of sleep on development of early childhood caries: a systematic review

PURPOSE

To investigate the impact of sleep on the development of early childhood caries (ECC).

METHODS

Seven electronic databases and grey literature were searched with various keyword combinations. Two reviewers independently selected studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale. The studies were included if they evaluated the impact of sleep parameters on the caries experience or severity of ECC in children under 6 years of age.

RESULTS

Four cross-sectional studies and two longitudinal studies were included. Children who had irregular bedtimes had a 66-71% higher chance of developing ECC. Children who slept after 11 pm might have a 74-85% higher chance of developing ECC. Children who slept less than 8 h during the night had a 30% increased risk of caries than children who slept more than 11 h.

CONCLUSION

Irregular or late bedtime and fewer sleeping hours could be an independent risk factor for ECC. The risk of ECC might be related inversely in a dose-response manner to the number of sleep hours.

Behavioural sleep problems in children

Behavioural sleep problems are very common in children and are concerns for many parents. This review discusses normal sleep physiology and sleep development and focuses on common behavioural sleep problems in childhood, including behavioural insomnia of childhood, parasomnias and sleep-related movement disorders, highlighting their clinical features and management. Behavioural insomnia of childhood is characterised by learned difficulties in falling asleep and/or staying asleep. Management includes establishing bedtime routines and behavioural techniques. Parasomnias include confusional arousals, sleepwalking, sleep terrors and nightmares, and these usually resolve with time. Management includes parental reassurance and behavioural interventions such as scheduled awakening. With regards to sleep enuresis, management includes behavioural modifications, enuresis alarm and desmopressin. Sleep-related movement disorders include sleep-related bruxism and sleep-related rhythmic movements, of which body rocking is the most common. Early identification and management of behavioural sleep problems may prevent their negative impact on children as well as their families.

Sleep Patterns in Young Children with Congenital Heart Disease

Sleep patterns of 419 toddlers with congenital heart disease were comparable with the normative population except for increased likelihood across the cohort of sleeping in parents' room and increased disrupted sleep in children aged 18-23 months. Disrupted sleep patterns were associated with lower maternal education and increased medical complexity.

Early childhood sleep problems predict increased risk for the later development of suicidal thoughts

Suicidal thoughts and behaviors in youth are an escalating and immediate public health concern. To better understand youth suicidal thoughts and behaviors, it is important to identify risk factors in early childhood that predict the later emergence of youth suicidal thoughts and behaviors. Research with adults and adolescents has identified sleep disturbances as a risk factor for suicidal thoughts and behaviors, but this has yet to be examined in early childhood. Using a prospective, 17-year longitudinal design, the current study explored the association between early childhood sleep disturbances and concurrent and later suicidal thoughts and behaviors (in separate models) across childhood and adolescence. Results indicate that sleep problems in early childhood are associated with increased probability for suicidal thoughts after age 8, even when controlling for prior and concurrent depression severity. Our findings suggest that early childhood sleep difficulties warrant increased clinical attention and management, as they may contribute to the maintenance and exacerbation of suicidal thoughts over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Factors that influence morningness-eveningness and daytime sleepiness: A cross-cultural comparison of Iranian and Brazilian adolescents

As adolescents get older, they become more evening oriented and, because they are usually expected to wake early to attend school, they often present daytime sleepiness, which is associated with negative outcomes. It is still unclear if this is similar cross-culturally. Here, we studied morningness-eveningness and daytime sleepiness in early adolescence from two different developing nations (Brazil and Iran). A total sample of 697 Iranian and Brazilian early adolescents (9- to 15-year-old; 358 boys) from Tehran, Iran, and São Paulo, Brazil, varying in age and parental schooling (a proxy of socioeconomic status: SES) completed the Morningness-Eveningness Scale for Children (MESC) and the Pediatric Daytime Sleepiness Scale (PDSS) and reported their total sleep time on school nights. They also filled in the Pubertal Developmental Scale to determine their pubertal status. A negligible cross-cultural difference in morningness-eveningness was found, indicating that Brazilians showed a slight circadian-phase delay compared with Iranians throughout all tested ages. There was also seen a very slight increase in phase delay as early adolescents aged, indicative of more eveningness. However, there were no country differences in daytime sleepiness once total sleep time during school nights was controlled for, which was the only factor that affects PDSS scores.

Sleep disturbances, depressive symptoms, and cognitive efficiency as determinants of mistakes at work in shift and non-shift workers

Introduction

Shift work is known to reduce productivity and safety at work. Previous studies have suggested that a variety of interrelated factors, such as mood, cognition, and sleep, can affect the performance of shift workers. This study aimed to identify potential pathways from depression, sleep, and cognition to work performance in shift and non-shift workers.

Material and methods

Online survey including the Center for Epidemiologic Studies Depression Scale (CES-D), Cognitive Failure Questionnaire (CFQ), and Pittsburgh Sleep Quality Index (PSQI), as well as two items representing work mistakes were administered to 4,561 shift workers and 2,093 non-shift workers. A multi-group structural equation model (SEM) was used to explore differences in the paths to work mistakes between shift and non-shift workers.

Results

Shift workers had higher PSQI, CES-D, and CFQ scores, and made more mistakes at work than non-shift workers. The SEM revealed that PSQI, CES-D, and CFQ scores were significantly related to mistakes at work, with the CFQ being a mediating variable. There were significant differences in the path coefficients of the PSQI and CES-D between shift and non-shift workers. The direct effects of sleep disturbances on mistakes at work were greater in shift workers, while direct effects of depressive symptoms were found only in non-shift workers.

Discussion

The present study found that shift workers made more mistakes at work than non-shift workers, probably because of depressed mood, poor sleep quality, and cognitive inefficiency. Sleep influences work performance in shift workers more directly compared to non-shift workers.

Comparison of polysomnographic characteristics between low birthweight and normal birthweight children in the Northern Territory of Australia: A case-control study

OBJECTIVES

To describe the sleep architecture of pediatric patients according to whether they were born low birthweight (birthweight <2500 g, LBW) or normal birthweight (birthweight >2500 g).

DESIGN

Case control study.

SETTING

Pediatric sleep laboratory in the Northern Territory of Australia during a 5-year study period (2015- 2020).

PARTICIPANTS

Pediatric patients (aged <18 years) referred to the specialist sleep service for assessment of clinically suspected sleep disorders.

MEASUREMENTS

Sleep onset latency, rapid eye movement (REM) sleep latency, wake time after sleep onset, total sleep time, sleep efficiency, non-rapid eye movement stages N1/N2/N3, and REM sleep duration, total/spontaneous/respiratory/limb related arousal indexes, total/non-rapid eye movement/REM obstructive apnea-hypopnea index and oxygen saturation.

RESULTS

One hundred and seventy-two pediatric patients had birthweight data available of whom 19 were LBW. LBW patients showed significantly greater sleep disruption and higher prevalence of poor sleepers (<80% efficiency). In multivariate regression models, increasing birthweight was associated with significantly greater sleep efficiency and total sleep time. After accounting for gestational age LBW was associated with increased odds of obstructive sleep apnea.

CONCLUSIONS

Among pediatric patients LBW is associated with increased sleep disruption and reduced sleep efficiency. This is attenuated by gestational age, though both gestational age and LBW significantly influence odds of obstructive sleep apnea. This sleep health deficit may contribute to development of chronic disease in this vulnerable population, and should be monitored to provide avenues for early intervention.

Understanding Problematic Social Media Use in Adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): A Narrative Review and Clinical Recommendations

Attention-Deficit/Hyperactivity Disorder (ADHD) is consistently associated with a host of social problems, such as victimization and difficulties in maintaining close friendships. These problems are not limited to offline relations but also manifest in the online social world, as previous research shows that ADHD is associated with problematic use of social media. Given the ubiquitous nature of social media, the goal of the current review is to understand why adolescents with ADHD demonstrate more problematic social media use than their typically developing peers. To this end, we provide a narrative review on the evidence for the link between ADHD and social media use, and consequently present an integrative framework, which encompasses neurobiological mechanisms (i.e., imbalance theory of brain development and dual pathway model of ADHD) and social mechanisms, including influences from peers and parents. We conclude that empirical work shows most consistent evidence for the link between problematic social media use and ADHD (symptoms), while intensity of social media use is also associated with several other behaviors and outcomes. Finally, we hypothesize how existing interventions for ADHD may work on the identified mechanisms and provide at-hand clinical recommendations for therapists working with adolescents with ADHD who exhibit problematic social media use.

The Effect of Napping on the Function of Problem Behavior for One Child With an Acquired Brain Injury

Many children experience sleep disruption in the form of difficulties falling asleep, staying asleep, or getting back to sleep. Children with acquired brain injuries (ABI) sometimes experience an exacerbation of these symptoms. Thus, researchers and practitioners alike need to identify creative assessment and treatment approaches to meet this population’s needs. The purpose of the current case study was to highlight one method for (a) determining a nap schedule and (b) evaluating the effect of fatigue on behavioral function for one child diagnosed with an ABI. We conducted a scatterplot analysis to identify periods in which problem behaviors occurred more or less often. These data informed when the child took naps. Afterward, the child participated in a functional analysis of problem behavior before a nap and again after a nap. Results showed both negative and positive reinforcement maintained problem behaviors before naps, while only positive reinforcement maintained problem behaviors after naps. Functional communication training (FCT) programs implemented to address escape, tangible, and attention functions before naps reduced problem behavior and increased communication. These data suggested that (a) motivating operations for problem behavior can differ depending on fatigue and (b) FCT is an effective intervention for problem behavior affected by fatigue. The current study provides an example of an assessment and treatment approach when biologic factors, like sleep, may influence problem behavior.

Motor skills and cognitive benefits in children and adolescents: Relationship, mechanism and perspectives

OBJECTIVE

There is a strong interaction between motor skills and cognitive benefits for children and young people. The aim of this paper is to explore the relationship between motor skill types and their development and the cognitive benefits of children and adolescents. In turn, on this basis, it proposes pathways and mechanisms by which motor skills improve cognition, and provide a basis for subsequent teaching of skills that follow the laws of brain cognitive development.

METHODS

This paper summarizes the research on the relationship between different types of motor skills and their development and cognitive benefits of children and adolescents. Based on these relationships, pathways, and mechanisms for motor skills to improve cognition are tentatively proposed.

RESULTS

There is an overall pattern of "open > closed, strategy > interception, sequence > continuous" between motor skill types and the cognitive benefits of children and adolescents. Long-term motor skill learning practice is accompanied by increased cognitive benefits as skill proficiency increases. The dynamic interaction between motor skills and physical activity exposes children and adolescents to environmental stimuli and interpersonal interactions of varying complexity, promoting the development of agility, coordination and cardiorespiratory fitness, enhancing their motor experience, which in turn improves brain structure and functional activity.

CONCLUSION

Motor skills training promote cognitive efficiency in children and adolescents. Motor skill interventions that are open-ended, strategic and sequential in nature are more effective. Environmental stimuli, interpersonal interaction, agility, coordination, and cardiorespiratory fitness can be considered as skill attribute moderators of motor skills to improve cognition.

Association between leisure activities and sleep disturbances among children with and without cerebral palsy

Background/Aims

Sleep disturbances are common among children with cerebral palsy, resulting in adverse consequences. Investigating the association between leisure activities and sleep disturbances could help to develop ways to promote their sleep quality. This study primarily aimed to investigate the association between leisure activities and sleep disturbances among children with and without cerebral palsy. The secondary aim was to study the prevalence of sleep disturbances and some of its associated factors.

Methods

A total of 75 children with cerebral palsy (study group) (mean age 10.0 ± 2.5 years) and 75 typically developing children (control group) (mean age 10.5 ± 2.9 years) were randomly selected to completed the Children's Assessment of Participation and Enjoyment. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children. Factors associated with sleep disturbances (age, gender, school attendance, bedroom sharing, type of cerebral palsy, motor functions, eating and drinking ability and communication functions) were statistically analysed and the prevalence of sleep disturbances was calculated.

Results

Overall frequency of leisure participation was strongly correlated with overall sleep disturbances (P<0.001) among both groups. The prevalence of overall sleep disturbances was 17.1% and 10.6% among the study and the control groups respectively. Eating and drinking ability and spastic quadriplegia emerged as the strongest predictors of overall negative scores on the Sleep Disturbance Scale for Children.

Conclusions

Greater participation in leisure activities is associated with better sleep. Occupational therapists are encouraged to consider this association when planning for occupation-based interventions aimed at enhancing occupational performance.

Neurobehavioral Associations with NREM and REM Sleep Architecture in Children with Autism Spectrum Disorder

Objective: Insomnia and daytime behavioral problems are common issues in pediatric autism spectrum disorder (ASD), yet specific underlying relationships with NonRapid Eye Movement sleep (NREM) and Rapid Eye Movement (REM) sleep architecture are understudied. We hypothesize that REM sleep alterations (REM%, REM EEG power) are associated with more internalizing behaviors and NREM sleep deficits (N3%; slow wave activity (SWA) 0.5–3 Hz EEG power) are associated with increased externalizing behaviors in children with ASD vs. typical developing controls (TD). Methods: In an age- and gender-matched pediatric cohort of n = 23 ASD and n = 20 TD participants, we collected macro/micro sleep architecture with overnight home polysomnogram and daytime behavior scores with Child Behavior Checklist (CBCL) scores. Results: Controlling for non-verbal IQ and medication use, ASD and TD children have similar REM and NREM sleep architecture. Only ASD children show positive relationships between REM%, REM theta power and REM beta power with internalizing scores. Only TD participants showed an inverse relationship between NREM SWA and externalizing scores. Conclusion: REM sleep measures reflect concerning internalizing behaviours in ASD and could serve as a biomarker for mood disorders in this population. While improving deep sleep may help externalizing behaviours in TD, we do not find evidence of this relationship in ASD.

The associations of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder

STUDY OBJECTIVES

The current study aimed to examine the association of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder (ADHD).

METHODS

Thirty-six children with ADHD and insomnia symptoms, 27 children with ADHD without insomnia symptoms, and 21 age-matched healthy controls were recruited in this study (age range: 6-12 years, 70% male). They were assessed by parent-report questionnaires on insomnia symptoms (Children's Sleep Habits Questionnaire) and ADHD symptoms (Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale [SWAN]), and completed a battery of cognitive tests including the Continuous Performance Test (CPT) for sustained attention, Letter-digit test for processing speed, Digit Span forward test and N-back task for working memory, Tower of London (TOL) test for planning skills and Bergs Card Sorting Test (BCST) for set-shifting ability.

RESULTS

Children with ADHD and insomnia symptoms had the highest scores on SWAN total and inattention and hyperactivity subscales, followed by children with ADHD without insomnia and healthy controls (all P < .05). After controlling for potential confounders, children with ADHD and insomnia symptoms showed poorer performance on the CPT and Letter-digit test as compared with children with ADHD without insomnia and healthy controls (all P < .05).

CONCLUSIONS

Insomnia symptoms are associated with more severe ADHD symptoms and cognitive impairments in children with ADHD, especially deficits in sustained attention and processing speed. Future longitudinal studies are needed to explore the long-term impacts of insomnia symptoms and the effects of sleep-focused intervention on cognitive functioning in children with ADHD.

CITATION

Li X, Shea KSC, Chiu WV, et al. The associations of insomnia symptoms with daytime behavior and cognitive functioning in children with attention-deficit/hyperactivity disorder. J Clin Sleep Med. 2022;18(8):2029-2039.

Chronic insomnia of early childhood: Phenotypes and pathophysiology

This paper aims to review the limitations of the current classification of insomnia of early childhood and propose a new conceptual model allowing a better understanding of its pathophysiology. Our hypothesis is that chronic insomnia of childhood has different phenotypical expressions, associated to different pathophysiological mechanisms. Based on a long-lasting experience in evaluating a very large number of children with specific insomnia symptoms (nocturnal awakenings, difficulty in falling asleep, nocturnal restlessness, early morning awakenings) and on published data, we hypothesize that different phenotypes of insomnia might exist with different therapeutic implications. We describe three phenotypes of insomnia in early childhood: a) insomnia with motor restlessness; b) insomnia characterized without difficulties in falling asleep but with long-lasting early morning awakenings; c) insomnia with multiple night awakenings and falling asleep difficulty. This type of categorization might have important implications for treatment, based on the different hypothetical neurotransmitter dysfunctions. The early identification of a phenotype of insomnia might guide to specific behavioral and/or pharmacological interventions with the aim to prevent chronic insomnia.

The impacts of a combined exercise on executive function in children with ADHD: A randomized controlled trial

PURPOSE

The purpose of this study was to examine the effects of aerobic and neurocognitive exercise with moderate-to-vigorous physical activity levels on executive functions (EFs) and sleep quality in children with attention-deficit/hyperactivity disorder (ADHD).

METHODS

In a parallel two-group randomized controlled trial (RCT) design, 80 children with ADHD aged 6-12 years (Mage = 8.46 ± 1.50) were assigned to either a 12-week combined aerobic-and neurocognitive-exercise experimental group (EG; three sessions per week for 60-min) or a wait-list control group (CG). Forty children with typical development aged 6-12 years (Mage = 8.49 ± 1.51) were recruited as healthy controls (HC). A Polar heart rate (HR) monitor was used to track the exercise intensity (60%-80% predicted HRmax) throughout the intervention. Three core EFs (inhibitory control [IC], working memory [WM], and cognitive flexibility [CF]) were assessed by computer-based neurocognitive tasks, and sleep quality and physical activity (PA) levels were assessed by self-report questionnaires.

RESULTS

The results showed that the exercise intervention was beneficial for improving three core EFs, shortening sleep latency and decreasing sleep disturbances. The intervention effects on EFs and sleep quality appeared to be sustained for at least 12 weeks in EG. In addition, children with ADHD after intervention showed non-significant differences in IC, CF and multiple sleep quality outcomes compared with HC. Furthermore, a significant PA-EFs-sleep correlation was found in children with ADHD after the intervention.

CONCLUSION

The findings suggest that a 12-week combined aerobic and neurocognitive exercise intervention appears to be an effective treatment program for EFs and sleep quality in children with ADHD.

Early life circadian rhythm disruption in mice alters brain and behavior in adulthood

Healthy sleep supports robust development of the brain and behavior. Modern society presents a host of challenges that can impair and disrupt critical circadian rhythms that reinforce optimal physiological functioning, including the proper timing and consolidation of sleep. While the acute effects of inadequate sleep and disrupted circadian rhythms are being defined, the adverse developmental consequences of disrupted sleep and circadian rhythms are understudied. Here, we exposed mice to disrupting light–dark cycles from birth until weaning and demonstrate that such exposure has adverse impacts on brain and behavior as adults. Mice that experience early-life circadian disruption exhibit more anxiety-like behavior in the elevated plus maze, poorer spatial memory in the Morris Water Maze, and impaired working memory in a delayed match-to-sample task. Additionally, neuron morphology in the amygdala, hippocampus and prefrontal cortex is adversely impacted. Pyramidal cells in these areas had smaller dendritic fields, and pyramidal cells in the prefrontal cortex and hippocampus also exhibited diminished branching orders. Disrupted mice were also hyperactive as adults, but otherwise exhibited no alteration in adult circadian locomotor rhythms. These results highlight that circadian disruption early in life may have long lasting and far-reaching consequences for the development of behavior and the brain.

Effectiveness of behavioral sleep interventions on children's and mothers' sleep quality and maternal depression: a systematic review and meta-analysis

This systematic review and meta-analysis was conducted to investigate the effectiveness of behavioral sleep interventions (BSIs) on the number of child night awakenings, and maternal sleep quality and depression. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) using PubMed, CINAHL, Cochrane, and EMBASE databases and retrieved studies published until April 2021. We calculated the odds ratios (ORs) and 95% confidence intervals (CIs) for child sleep problems, and the mean differences (MD) and 95% CI for the number of child night awakenings, and maternal sleep quality and depression. Ten studies of 1628 initial searched were included in the final analysis. Two of the 10 studies were divided into two subgroups by participants and intervention type; thus, 12 subgroups were included in the meta-analysis. BSIs significantly reduced child sleep problems (OR 0.51; 95% CI 0.37-0.69) and improved maternal sleep quality (MD - 1.30; 95% CI - 1.82 to - 0.77) in the intervention group. There were no significant differences in the number of child night awakenings and maternal depression between the two groups. More RCTs to examine the effect of BSIs considering children's age, duration of intervention, and outcome measuring time points are needed.

The Role of Sleep-Disordered Breathing Symptoms in Neurocognitive Function Among Youth With Sickle Cell Disease1

OBJECTIVE

To examine associations between sleep-disordered breathing (SDB) and executive/attentional function in pediatric sickle cell disease (SCD).

METHODS

Sixty youth with SCD ages 8-18 years and caregivers completed the Pediatric Sleep Questionnaire (PSQ), Delis Kaplan Executive Function System Trail Making Test (DKEFS TMT), Psychomotor Vigilance Test (PVT), and the Behavior Rating Inventory Of Executive Function, Second Edition (BRIEF-2) Parent Report.

RESULTS

The PSQ significantly predicted the BRIEF-2 Parent Report, F(1, 58) = 44.64, p < .001, R² = 0.44, f² = 0.77.

CONCLUSIONS

Sleep-disordered breathing symptoms may predict informant-rated executive dysfunction in pediatric SCD, but not performance-based executive function.

Association of nighttime sleep with behaviors in Japanese early childhood

BACKGROUND

Preschool children in Asian countries, including Japan, sleep for a shorter duration at night than those in Europe and the USA. We examined the effects of the nighttime sleep duration on behavioral development in early childhood in Japan.

METHODS

We used data from a large Japanese nationwide, population-based, longitudinal survey that began in 2001. We restricted the study participants to children born after 37 gestational weeks, with a birth weight ≥ 2500 g and singleton births (n = 41 890). The nighttime sleep duration was examined at 2.5 years old. Responses to survey questions regarding age-appropriate behavior at 5.5 years old were used as indicators of behavioral development. We conducted logistic regression analyses with adjustment for confounding factors, with ≥11 h of nighttime sleep as the reference group.

RESULTS

The odds ratios for children who had ≤9 h of nighttime sleep, which was associated with being unable to listen with fidgeting and being unable to remain patient, were 1.26 (95% confidence interval, 1.14-1.39) and 1.27 (1.16-1.38), respectively. Children who had an irregular nighttime sleep duration were associated with age-appropriate behavioral inabilities. These results were similar in children who usually and sometimes took naps to those before stratification by the frequency of napping.

CONCLUSION

A short nighttime sleep duration especially affects hyperactivity and impulsivity. An irregular nighttime sleep duration increases the inability to perform overall age-appropriate behaviors more than a short sleep duration. Ensuring a regular and sufficient nighttime sleep duration in early childhood is important for healthy behavioral development.

Disruptive Behaviors and Intellectual Disability: Creating a New Script

BACKGROUND

Terms currently used to describe the so-called challenging and disruptive behaviors (CBDs) of children with intellectual disabilities (ID) have different connotations depending on guiding contextual frameworks, such as academic and cultural settings in which they are used. A non-judgmental approach, which does not attempt to establish existing categorical diagnoses, but which describes in a neutral way, is missing in the literature. Therefore, we tried to describe CDBs in youth with ID in an explorative study.

METHODS

Interviews with families investigated the CDBs of five youth with Down syndrome. At home, families tracked youth's sleep/wake behaviors and physical activity. Youth were observed in a summer school classroom. The collected information and suggested explanatory models for observed CDBs were reviewed with the families.

RESULTS

We grouped CDBs as challenging, if they were considered to be reactive or triggered, or unspecified, if no such explanatory model was available. A third category was created for light-hearted CDBs: goofy, acknowledging the right to laugh together with peers. We found some relationships between sleep, physical activity, and CDBs and developed an explorative approach, supporting a child-centered perspective on CDBs.

CONCLUSION

The controversial discussions on terminology and management of CDBs in the literature demonstrate the need for a non-judgmental approach. Such an explorative approach, allowing non-professionals to not label, has been missing. The fact that, up to now, the light-hearted behaviors of an individual with ID have not been integrated in commonly-used behavioral checklists as their natural right, proves our concept and indicates that a paradigm change from judgment-based to exploratory-driven approaches is needed.

Promoting physical activity and health in Hong Kong primary school children through a blended physical literacy intervention: protocol and baseline characteristics of the "Stand+Move" randomized controlled trial

BACKGROUND

Children predominantly remain sedentary in a traditional classroom. This study aimed to demonstrate the design and baseline characteristics of a three-armed intervention program that targeted enhancements in children's physical literacy (PL), physical activity (PA), sleep, and executive functions by constructing an active classroom environment in primary schools. The blended approach involved organized PA participation during recess combined with changes to the classroom environment in response to the emphasis on nurturing children's PL in Hong Kong.

METHODS

This blended "Stand + Move" intervention adopted a randomized controlled trial design to investigate its effectiveness in improving health-related aspects. Three groups were compared: (1) PA recess intervention, (2) blended (sit-stand desks and PA recess) experimental, and (3) control groups. In this 13-week intervention (from March to September 2019), 76 students (59.2% girls) were recruited and randomly assigned to the three groups. The primary outcomes were children's PL and PA. The secondary outcomes were children's sleep and executive functions.

RESULTS

Baseline data were evaluated. The mean age was 9.6 years [standard deviation = 0.61, range 9.0-12.0]. There were no significant differences between trial arms at baseline concerning any of the outcomes (all P = 0.06-0.89). Overall, 22.4% met the recommended PA guidelines, 36.8% met the sleep guidelines, and 10.5% met both guidelines. Three aspects of executive functions were evaluated: inhibition, executive control, and planning. Over half of the participants reported satisfaction with their perceived sleep quality.

CONCLUSIONS

The designed intervention is regarded as an innovative strategy that incorporates sit-stand desks and PA breaks to reconstruct children's traditional classroom environment. The baseline results suggest that intervention was satisfactory in reducing students' sitting time and increasing their PA engagement. We demonstrated the benefits of this intervention on children's PL, various sleep patterns, and executive functions. As expected, the designed intervention changes made to the classroom improved children's health behaviors, as well as the support from stakeholders at schools and the children's families. Our results also provided the desired evidence for policy reforms in teaching and learning strategies.

TRIAL REGISTRATION

ChiCTR ChiCTR2000035038 . Registered on July 29, 2020-retrospectively registered.