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Shen C, Luo Q, Chamberlain SR, Morgan S, Romero-Garcia R, Du J, Zhao X, Touchette É, Montplaisir J, Vitaro F, Boivin M, Tremblay RE, Zhao XM, Robaey P, Feng J, Sahakian BJ. What Is the Link Between Attention-Deficit/Hyperactivity Disorder and Sleep Disturbance? A Multimodal Examination of Longitudinal Relationships and Brain Structure Using Large-Scale Population-Based Cohorts. Biol Psychiatry 2020; 88:459-469. [PMID: 32414481 PMCID: PMC7445427 DOI: 10.1016/j.biopsych.2020.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) comorbid with sleep disturbances can produce profound disruption in daily life and negatively impact quality of life of both the child and the family. However, the temporal relationship between ADHD and sleep impairment is unclear, as are underlying common brain mechanisms. METHODS This study used data from the Quebec Longitudinal Study of Child Development (n = 1601, 52% female) and the Adolescent Brain Cognitive Development Study (n = 3515, 48% female). Longitudinal relationships between symptoms were examined using cross-lagged panel models. Gray matter volume neural correlates were identified using linear regression. The transcriptomic signature of the identified brain-ADHD-sleep relationship was characterized by gene enrichment analysis. Confounding factors, such as stimulant drugs for ADHD and socioeconomic status, were controlled for. RESULTS ADHD symptoms contributed to sleep disturbances at one or more subsequent time points in both cohorts. Lower gray matter volumes in the middle frontal gyrus and inferior frontal gyrus, amygdala, striatum, and insula were associated with both ADHD symptoms and sleep disturbances. ADHD symptoms significantly mediated the link between these structural brain abnormalities and sleep dysregulation, and genes were differentially expressed in the implicated brain regions, including those involved in neurotransmission and circadian entrainment. CONCLUSIONS This study indicates that ADHD symptoms and sleep disturbances have common neural correlates, including structural changes of the ventral attention system and frontostriatal circuitry. Leveraging data from large datasets, these results offer new mechanistic insights into this clinically important relationship between ADHD and sleep impairment, with potential implications for neurobiological models and future therapeutic directions.
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Affiliation(s)
- Chun Shen
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China
| | - Qiang Luo
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and Human Phenome Institute, Fudan University, Shanghai, China; Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China.
| | | | - Sarah Morgan
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom; Alan Turing Institute, London, United Kingdom
| | | | - Jingnan Du
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Xingzhong Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Évelyne Touchette
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Jacques Montplaisir
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada; Center for Advanced Research in Sleep Medicine, CIUSSS-NIM, Montréal, Québec, Canada
| | - Frank Vitaro
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
| | - Michel Boivin
- School of Psychology, Université Laval, Québec City, Québec, Canada
| | - Richard E Tremblay
- Department of Pediatrics and Psychology, Université de Montréal, Montréal, Québec, Canada; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Xing-Ming Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Philippe Robaey
- Department of Psychiatry, Université de Montréal, Montréal, Québec, Canada; Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China; School of Mathematical Sciences, Fudan University, Shanghai, China; Department of Computer Science, University of Warwick, Coventry, United Kingdom; Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Institute of Brain-Intelligence Technology, Zhangjiang Laboratory, Shanghai, China.
| | - Barbara J Sahakian
- Institute of Science and Technology for Brain-Inspired Intelligence, MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Shanghai, China; Behavioural and Clinical Neuroscience Institute, Department of Psychology, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
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Garmroudinezhad Rostami E, Touchette É, Huynh N, Montplaisir J, Tremblay RE, Battaglia M, Boivin M. High separation anxiety trajectory in early childhood is a risk factor for sleep bruxism at age 7. Sleep 2020; 43:zsz317. [PMID: 31894243 PMCID: PMC7355392 DOI: 10.1093/sleep/zsz317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 11/18/2019] [Indexed: 12/25/2022] Open
Abstract
STUDY OBJECTIVES The evolution of sleep bruxism manifestations and their co-occurrence with separation anxiety in early childhood remain unclear. Our threefold aim was to: (1) describe developmental sleep bruxism trajectories in early childhood, (2) investigate co-occurrences between trajectories of sleep bruxism and separation anxiety, and (3) determine whether distinct trajectories of separation anxiety increase the risk of presenting sleep bruxism during the first year of elementary school. METHODS This study is part of the Québec Longitudinal Study of Child Development. Sleep bruxism scores were assessed from age 1.5 to 7 years with the Self-Administered Questionnaire for Mother (n = 1946). Separation anxiety scores were measured from age 1.5 to 6 years with the Interviewer-Completed Computerized Questionnaire (n = 2045). RESULTS We identified four sleep bruxism trajectories from age 1.5 to 6 years: High-Increasing sleep bruxism at age 1.5 (14.1%), High-Increasing sleep bruxism at age 4 (18.3%), Low-Persistent sleep bruxism (12.1%), and Never-Persistent sleep bruxism (55.5%); and four separation anxiety trajectories from age 1.5 to 6 years: Low-Persistent separation anxiety (60.2%), High-Increasing separation anxiety (6.9%), High-Decreasing separation anxiety (10.8%), and Low-Increasing separation anxiety (22.1%). Sleep bruxism and separation anxiety trajectories were weakly associated (X2 = 37.84, p < 0.001). Compared with preschoolers belonging to the Low-Persistent separation anxiety trajectory, preschoolers in the High-Increasing separation anxiety trajectory had almost double the risk of presenting sleep bruxism at age 7 (95% CI = 1.25-3.22, p = 0.04). CONCLUSION When separation anxiety issues are detected in early childhood, it would be useful to target sleep bruxism during the first year of elementary school.
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Affiliation(s)
- Elham Garmroudinezhad Rostami
- Research Unit on Children’s Psychosocial Maladjustment, Québec, Québec, Canada
- School of Psychology, Laval University, Québec, Québec, Canada
| | - Évelyne Touchette
- Research Unit on Children’s Psychosocial Maladjustment, Québec, Québec, Canada
- Department of Psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Nelly Huynh
- Faculty of Dental Medicine, University of Montréal, Montréal, Québec, Canada
- Research Centre, CHU Ste-Justine, Montreal, Québec, Canada
| | - Jacques Montplaisir
- Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Departments of Pediatrics and Psychology, University of Montréal, Montréal, Québec, Canada
| | - Richard E Tremblay
- Research Unit on Children’s Psychosocial Maladjustment, Québec, Québec, Canada
- Research Centre, CHU Ste-Justine, Montreal, Québec, Canada
- Departments of Pediatrics and Psychology, University of Montréal, Montréal, Québec, Canada
- Geary Institute for Public Policy, UCD School of Economics and School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Division of Child, Youth, & Emerging Adulthood Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michel Boivin
- Research Unit on Children’s Psychosocial Maladjustment, Québec, Québec, Canada
- School of Psychology, Laval University, Québec, Québec, Canada
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Battaglia M, Touchette É, Garon-Carrier G, Dionne G, Côté SM, Vitaro F, Tremblay RE, Boivin M. Distinct trajectories of separation anxiety in the preschool years: persistence at school entry and early-life associated factors. J Child Psychol Psychiatry 2016; 57:39-46. [PMID: 25912177 DOI: 10.1111/jcpp.12424] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about how children differ in the onset and evolution of separation anxiety (SA) symptoms during the preschool years, and how SA develops into separation anxiety disorder. In a large, representative population-based sample, we investigated the developmental trajectories of SA symptoms from infancy to school entry, their early associated risk factors, and their associations with teachers' ratings of SA in kindergarten. METHODS Longitudinal assessment of SA trajectories and risk factors in a cohort of 1,933 families between the ages of 1.5 and 6 years. RESULTS Analyses revealed a best-fitting, 4-trajectory solution, including a prevailing, unaffected Low-Persistent group (60.2%), and three smaller groups of distinct developmental course: a High-Increasing (6.9%), a High-Decreasing (10.8%), and a Low-Increasing group (22.1%). The High-Increasing group remained high throughout the preschool years and was the only trajectory to predict teacher-assessed SA at age 6 years. Except for the High-Increasing, all trajectories showed substantial reduction in symptoms by age 6 years. The High-Increasing and High-Decreasing groups shared several early risk factors, but the former was uniquely associated with higher maternal depression, maternal smoking during pregnancy, and parental unemployment. CONCLUSIONS Most children with high SA profile at age 1.5 years are expected to progressively recover by age 4-5. High SA at age 1.5 that persists over time deserves special attention, and may predict separation anxiety disorder. A host of child perinatal, parental and family-contextual risk factors were associated with the onset and developmental course of SA across the preschool years.
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Affiliation(s)
- Marco Battaglia
- Department of Psychiatry and Neurosciences, Université Laval, Québec city, QC, Canada.,Centre de Recherche Institut Universitaire en Santé Mentale de Québec, Québec city, QC, Canada
| | - Évelyne Touchette
- Département de psychoéducation, Université du Québec à Trois-Rivières, Québec city, QC, Canada.,GRIP, École de psychologie, Université Laval, Québec city, QC, Canada
| | | | - Ginette Dionne
- GRIP, École de psychologie, Université Laval, Québec city, QC, Canada
| | - Sylvana M Côté
- Department of Pediatrics and Psychology, Université de Montréal, Montreal, QC, Canada
| | - Frank Vitaro
- Département de Psychoéducation, Université de Montréal, Montreal, QC, Canada
| | - Richard E Tremblay
- Department of Pediatrics and Psychology, Université de Montréal, Montreal, QC, Canada.,Institute of Genetic, Neurobiological and Social Foundations of Child Development, Tomsk State University, Tomsk, Russia.,School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
| | - Michel Boivin
- GRIP, École de psychologie, Université Laval, Québec city, QC, Canada.,Institute of Genetic, Neurobiological and Social Foundations of Child Development, Tomsk State University, Tomsk, Russia
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Dion J, Blackburn ME, Auclair J, Laberge L, Veillette S, Gaudreault M, Vachon P, Perron M, Touchette É. Development and aetiology of body dissatisfaction in adolescent boys and girls. Int J Adolesc Youth 2015; 20:151-166. [PMID: 25931646 PMCID: PMC4391290 DOI: 10.1080/02673843.2014.985320] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/04/2014] [Indexed: 11/12/2022] Open
Abstract
This longitudinal study aims to describe the development of body dissatisfaction (BD), measured with the Contour Drawing Rating Scale, between the ages of 14 and 18, and to identify factors associated with BD at age 18, among 413 adolescents. Between the ages of 14 and 18, the proportion of girls wanting to be thinner increased, although it remained unchanged among boys. A ratio of 1:2 girls and 1:5 boys reported having seriously tried to lose weight. Factors associated with BD in girls at age 18 were (1) wanting to be thinner, (2) body mass index (BMI), (3) weight control behaviours and (4) negative comments about weight. Factors associated with BD in boys at age 18 were (1) wanting to be thinner or bigger, (2) BMI, (3) having experienced sexual intercourse and (4) negative comments about weight. The high prevalence of BD and weight-related concerns suggest a need for early interventions.
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Affiliation(s)
- Jacinthe Dion
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Marie-Eve Blackburn
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
- ÉCOBES Recherche et Transfert, Cégep de Jonquière, Saguenay, Québec, Canada
| | - Julie Auclair
- ÉCOBES Recherche et Transfert, Cégep de Jonquière, Saguenay, Québec, Canada
| | - Luc Laberge
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
- ÉCOBES Recherche et Transfert, Cégep de Jonquière, Saguenay, Québec, Canada
| | - Suzanne Veillette
- ÉCOBES Recherche et Transfert, Cégep de Jonquière, Saguenay, Québec, Canada
| | - Marco Gaudreault
- ÉCOBES Recherche et Transfert, Cégep de Jonquière, Saguenay, Québec, Canada
| | - Patrick Vachon
- Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Michel Perron
- ÉCOBES Recherche et Transfert, Cégep de Jonquière, Saguenay, Québec, Canada
- Département des Sciences Humaines, Université du Québec à Chicoutimi, Saguenay, Québec, Canada
| | - Évelyne Touchette
- Département de psychoéducation, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
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Melchior M, Touchette É, Prokofyeva E, Chollet A, Fombonne E, Elidemir G, Galéra C. Negative events in childhood predict trajectories of internalizing symptoms up to young adulthood: an 18-year longitudinal study. PLoS One 2014; 9:e114526. [PMID: 25485875 PMCID: PMC4259330 DOI: 10.1371/journal.pone.0114526] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 11/12/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Common negative events can precipitate the onset of internalizing symptoms. We studied whether their occurrence in childhood is associated with mental health trajectories over the course of development. METHODS Using data from the TEMPO study, a French community-based cohort study of youths, we studied the association between negative events in 1991 (when participants were aged 4-16 years) and internalizing symptoms, assessed by the ASEBA family of instruments in 1991, 1999, and 2009 (n = 1503). Participants' trajectories of internalizing symptoms were estimated with semi-parametric regression methods (PROC TRAJ). Data were analyzed using multinomial regression models controlled for participants' sex, age, parental family status, socio-economic position, and parental history of depression. RESULTS Negative childhood events were associated with an increased likelihood of concurrent internalizing symptoms which sometimes persisted into adulthood (multivariate ORs associated with > = 3 negative events respectively: high and decreasing internalizing symptoms: 5.54, 95% CI: 3.20-9.58; persistently high internalizing symptoms: 8.94, 95% CI: 2.82-28.31). Specific negative events most strongly associated with youths' persistent internalizing symptoms included: school difficulties (multivariate OR: 5.31, 95% CI: 2.24-12.59), parental stress (multivariate OR: 4.69, 95% CI: 2.02-10.87), serious illness/health problems (multivariate OR: 4.13, 95% CI: 1.76-9.70), and social isolation (multivariate OR: 2.24, 95% CI: 1.00-5.08). CONCLUSIONS Common negative events can contribute to the onset of children's lasting psychological difficulties.
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Affiliation(s)
- Maria Melchior
- Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France
| | - Évelyne Touchette
- Groupe de Recherche en Inadaptation Psychosociale (GRIP), Laval University, School of Psychology, Québec City, Québec, Canada
| | - Elena Prokofyeva
- Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France
| | - Aude Chollet
- Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France
| | - Eric Fombonne
- Brain Institute, Oregon Health & Science University, Portland, OR, United States of America
| | - Gulizar Elidemir
- Inserm, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France
| | - Cédric Galéra
- Université de Bordeaux, Pôle Pédopsychiatrie Universitaire, Hôpital Charles-Perrens, INSERM U897, Bordeaux, France
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Touchette É, Petit D, Séguin JR, Boivin M, Tremblay RE, Montplaisir JY. Associations between sleep duration patterns and behavioral/cognitive functioning at school entry. Sleep 2008; 30:1213-9. [PMID: 17910393 PMCID: PMC1978413 DOI: 10.1093/sleep/30.9.1213] [Citation(s) in RCA: 329] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of the study was to investigate the associations between longitudinal sleep duration patterns and behavioral/cognitive functioning at school entry. DESIGN, SETTING, AND PARTICIPANTS Hyperactivity-impulsivity (HI), inattention, and daytime sleepiness scores were measured by questionnaire at 6 years of age in a sample of births from 1997 to 1998 in a Canadian province (N=1492). The Peabody Picture Vocabulary Test--Revised (PPVT-R) was administered at 5 years of age and the Block Design subtest (WISC-III) was administered at 6 years of age. Sleep duration was reported yearly by the children's mothers from age 2.5 to 6 years. A group-based semi-parametric mixture model was used to estimate developmental patterns of sleep duration. The relationships between sleep duration patterns and both behavioral items and neurodevelopmental tasks were tested using weighted multivariate logistic regression models to control for potentially confounding psychosocial factors. RESULTS Four sleep duration patterns were identified: short persistent (6.0%), short increasing (4.8%),10-hour persistent (50.3%), and 11-hour persistent (38.9%). The association of short sleep duration patterns with high HI scores (P=0.001), low PPVT-R performance (P=0.002), and low Block Design subtest performance (P=0.004) remained significant after adjusting for potentially confounding variables. CONCLUSIONS Shortened sleep duration, especially before the age of 41 months, is associated with externalizing problems such as HI and lower cognitive performance on neurodevelopmental tests. Results highlight the importance of giving a child the opportunity to sleep at least 10 hours per night throughout early childhood.
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Affiliation(s)
- Évelyne Touchette
- Sleep Disorders Center, Sacre-Coeur Hospital, Montreal, Canada
- Department of Psychology, University of Montreal, Canada
| | - Dominique Petit
- Sleep Disorders Center, Sacre-Coeur Hospital, Montreal, Canada
| | - Jean R. Séguin
- Research Center, Ste-Justine Hospital, Montreal, Canada
- Research Unit on Children's Psychosocial Maladjustment, University of Montreal, Montreal, Canada
- Department of Psychiatry, University of Montreal, Montreal, Canada
| | - Michel Boivin
- Research Unit on Children's Psychosocial Maladjustment, Laval University, Quebec, Canada
- Department of Psychology, Laval University, Quebec, Canada
| | - Richard E. Tremblay
- Department of Psychology, University of Montreal, Canada
- Research Center, Ste-Justine Hospital, Montreal, Canada
- Research Unit on Children's Psychosocial Maladjustment, University of Montreal, Montreal, Canada
- Department of Psychiatry, University of Montreal, Montreal, Canada
- Department of Pediatrics, University of Montreal, Montreal, Canada
| | - Jacques Y. Montplaisir
- Sleep Disorders Center, Sacre-Coeur Hospital, Montreal, Canada
- Department of Psychiatry, University of Montreal, Montreal, Canada
- Address correspondence to: Jacques Montplaisir, MD, CRCP(c), PhD,
Sleep Disorders Center, Sacre-Coeur Hospital, Montreal 5400 Gouin Blvd. West, Montreal, Quebec, Canada, H4J 1C5(514) 338-2693(514) 338-2531
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