Abstract
We examined the longitudinal relationship between sleep problems and behavioral problems at primary school in Italian children. We recruited a school-based sample of 227 children (age range 6–10 years) in schools located in Pisa (Italy). Parents completed the Sleep Disturbance Scale for Children (SDSC), and teachers completed the Strengths and Difficulties Questionnaire (SDQ) to evaluate children’s behavioral difficulties. We used a two-step robust regression approach to identify which aspects of sleep problems might affect children’s behavior at school. After removing socio-demographic effects, results indicated an association between an increase in sleep problems and the worsening of inattentive and hyperactive behavioral problems at school 1 year later. This association was particularly robust in children whose sleep problems had gotten worse over the year. We found no associations between child sleep problems and conduct problems in school settings. Schools may be a suitable arena in which to identify and prevent the development of severe externalizing behaviors through screening procedures and intervention for children’s sleep problems.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aronen, E. T., Paavonen, E. J., Fjällberg, M., Soininen, M., & Törrönen, J. (2000). Sleep and psychiatric symptoms in school-age children. Journal of the American Academy of Child and Adolescent Psychiatry, 39(4), 502–508. https://doi.org/10.1097/00004583-200004000-00020.
Barth, J. M., Dunlap, S. T., Dane, H., Lochman, J. E., & Wells, K. C. (2004). Classroom environment influences on aggression, peer relations, and academic focus. Journal of School Psychology, 42(2), 115–133. https://doi.org/10.1016/j.jsp.2003.11.004.
Bergwerff, C. E., Luman, M., & Oosterlaan, J. (2016). No objectively measured sleep disturbances in children with attention-deficit/hyperactivity disorder. Journal of Sleep Research, 25(5), 534–540. https://doi.org/10.1111/jsr.12399.
Blair, R. J. (2013). The neurobiology of psychopathic traits in youths. Nature Reviews Neuroscience, 14(11), 786–799. https://doi.org/10.1038/nrn3577.
Bos, S. C., Gomes, A., Clemente, V., Marques, M., Pereira, A. T., Maia, B., et al. (2009). Sleep and behavioral/emotional problems in children: A population-based study. Sleep Medicine, 10(1), 66–74. https://doi.org/10.1016/j.sleep.2007.10.020.
Botvin, G. J., Griffin, K. W., & Nichols, T. D. (2006). Preventing youth violence and delinquency through a universal school-based prevention approach. Prevention Science, 7(4), 403–408. https://doi.org/10.1007/s11121-006-0057-y.
Bruni, O., Ottaviano, S., Guidetti, V., Romoli, M., Innocenzi, M., Cortesi, F., et al. (1996). The Sleep Disturbance Scale for Children (SDSC) Construct ion and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. Journal of Sleep Research, 5(4), 251–261. https://doi.org/10.1111/j.1365-2869.1996.00251.x.
Buckhalt, J. A., El-Sheikh, M., Keller, P. S., & Kelly, R. J. (2009). Concurrent and longitudinal relations between children’s sleep and cognitive functioning: The moderating role of parent education. Child Development, 80(3), 875–892. https://doi.org/10.1111/j.1467-8624.2009.01303.x.
Chervin, R. D., Archbold, K. H., Dillon, J. E., Panahi, P., Pituch, K. J., Dahl, R. E., et al. (2002). Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics, 109(3), 449–456.
Chervin, R. D., Dillon, J. E., Archbold, K. H., & Ruzicka, D. L. (2003). Conduct problems and symptoms of sleep disorders in children. Journal of the American Academy of Child and Adolescent Psychiatry, 42(2), 201–208. https://doi.org/10.1542/peds.109.3.449.
Coulombe, J. A., Reid, G. J., Boyle, M. H., & Racine, Y. (2009). Concurrent associations among sleep problems, indicators of inadequate sleep, psychopathology, and shared risk factors in a population-based sample of healthy Ontario children. Journal of Pediatric Psychology, 35(7), 790–799. https://doi.org/10.1093/jpepsy/jsp097.
De Crescenzo, F., Licchelli, S., Ciabattini, M., Menghini, D., Armando, M., Alfieri, P., et al. (2016). The use of actigraphy in the monitoring of sleep and activity in ADHD: A meta-analysis. Sleep Medicine Reviews, 26, 9–20. https://doi.org/10.1016/j.smrv.2015.04.002.
Feldman, M. A., Ojanen, T., Gesten, E. L., Smith-Schrandt, H., Brannick, M., Totura, C. M. W., et al. (2014). The effects of middle school bullying and victimization on adjustment through high school: Growth modeling of achievement, school attendance, and disciplinary trajectories. Psychology in the Schools, 51(10), 1046–1062. https://doi.org/10.1002/pits.21799.
Ferreira, V. R., Carvalho, L. B., Ruotolo, F., de Morais, J. F., Prado, L. B., & Prado, G. F. (2009). Sleep disturbance scale for children: Translation, cultural adaptation, and validation. Sleep Medicine, 10(4), 457–463. https://doi.org/10.1016/j.sleep.2008.03.018.
Gau, S. S. (2006). Prevalence of sleep problems and their association with inattention/hyperactivity among children aged 6–15 in Taiwan. Journal of Sleep Research, 15(4), 403–414. https://doi.org/10.1111/j.1365-2869.2006.00552.x.
Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38(5), 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x.
Gregory, A. M., & O’Connor, T. G. (2002). Sleep problems in childhood: A longitudinal study of developmental change and association with behavioral problems. Journal of the American Academy of Child and Adolescent Psychiatry, 41(8), 964–971. https://doi.org/10.1097/00004583-200208000-00015.
Gregory, A. M., & Sadeh, A. (2012). Sleep, emotional and behavioral difficulties in children and adolescents. Sleep Medicine Reviews, 16(2), 129–136. https://doi.org/10.1016/j.smrv.2011.03.007.
Gruber, R., Cassoff, J., Frenette, S., Wiebe, S., & Carrier, J. (2012). Impact of sleep extension and restriction on children’s emotional lability and impulsivity. Pediatrics, 130(5), 1155–1161. https://doi.org/10.1542/peds.2012-0564.
Gruber, R., Somerville, G., Bergmame, L., Fontil, L., & Paquin, S. (2016). School-based sleep education program improves sleep and academic performance of school-age children. Sleep Medicine, 21, 93–100. https://doi.org/10.1016/j.sleep.2016.01.012.
Hochadel, J., Frölich, J., Wiater, A., Lehmkuhl, G., & Fricke-Oerkermann, L. (2014). Prevalence of sleep problems and relationship between sleep problems and school refusal behavior in school-aged children in children’s and parents’ ratings. Psychopathology, 47(2), 119–126. https://doi.org/10.1159/000345403.
Holland, P. W., & Welsch, R. E. (1977). Robust regression using iteratively reweighted least-squares. Communications in Statistics-Theory and Methods, 6(9), 813–827. https://doi.org/10.1080/03610927708827533.
Lam, P., Hiscock, H., & Wake, M. (2003). Outcomes of infant sleep problems: A longitudinal study of sleep, behavior, and maternal well-being. Pediatrics, 111(3), e203–e207. https://doi.org/10.1542/peds.111.3.e203.
Lucas, I., Mulraney, M., & Sciberras, E. (2017). Sleep problems and daytime sleepiness in children with ADHD: Associations with social, emotional, and behavioral functioning at school, a cross-sectional study. Behavioral Sleep Medicine. https://doi.org/10.1080/15402002.2017.1376207.
Masi, G., Pisano, S., Milone, A., & Muratori, P. (2015). Child behavior checklist dysregulation profile in disruptive behavior disorder: A Longitudinal Study. Journal of Affective Disorder, 186, 249–253. https://doi.org/10.1016/j.jad.2015.05.069.
Masten, A. S., Desjardins, C. D., McCormick, C. M., Sally, I., Kuo, C., & Long, J. D. (2010). The significance of childhood competence and problems for adult success in work: A developmental cascade analysis. Development and Psychopathology, 22(3), 679–694. https://doi.org/10.1017/S0954579410000362.
Moffitt, T. E. (2006). Life-course-persistent versus adolescence-limited antisocial behavior. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology: Risk, disorder, and adaptation (pp. 570–598). Hoboken, NJ: Wiley. https://doi.org/10.1002/9780470939406.ch15.
Mulraney, M., Giallo, R., Lycett, K., Mensah, F., & Sciberras, E. (2016). The bidirectional relationship between sleep problems and internalizing and externalizing problems in children with ADHD: A prospective cohort study. Sleep Medicine, 17, 45–51. https://doi.org/10.1016/j.sleep.2015.09.019.
Muratori, P., Bertacchi, I., Giuli, C., Nocentini, A., & Lochman, J. E. (2017). Implementing coping power adapted as a universal prevention program in italian primary schools: A randomized control trial. Prevention Science, 18(7), 754–761. https://doi.org/10.1007/s11121-016-0715-7.
Muratori, P., Bertacchi, I., Giuli, C., Nocentini, A., Ruglioni, L., & Lochman, J. E. (2016). Coping Power adapted as universal prevention program: Mid term effects on children’s behavioral difficulties and academic grades. The Journal of Primary Prevention, 37(4), 389–401. https://doi.org/10.1007/s10935-016-0435-6.
O’Brien, L. M., Holbrook, C. R., Mervis, C. B., Klaus, C. J., Bruner, J. L., Raffield, T. J., et al. (2003). Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics, 111(3), 554–563. https://doi.org/10.1542/peds.111.3.554.
O’Brien, L. M., Lucas, N. H., Felt, B. T., Hoban, T. F., Ruzicka, D. L., Jordan, R., et al. (2011). Aggressive behavior, bullying, snoring, and sleepiness in schoolchildren. Sleep Medicine, 12(7), 652–658. https://doi.org/10.1016/j.sleep.2010.11.012.
Pesonen, A. K., Räikkönen, K., Paavonen, E. J., Heinonen, K., Komsi, N., Lahti, J., et al. (2010). Sleep duration and regularity are associated with behavioral problems in 8-year-old children. International Journal of Behavioral Medicine, 17(4), 298–305. https://doi.org/10.1007/s12529-009-9065-1.
Shanahan, L., Copeland, W. E., Angold, A., Bondy, C. L., & Costello, E. J. (2014). Sleep problems predict and are predicted by generalized anxiety/depression and oppositional defiant disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 53(5), 550–558. https://doi.org/10.1016/j.jaac.2013.12.029.
Spruyt, K., Cluydts, R., & Verleye, G. B. (2004). Pediatric sleep disorders: Exploratory modulation of their relationships. Sleep, 27(3), 495–501. https://doi.org/10.1093/sleep/27.3.495.
Spruyt, K., & Gozal, D. (2011). Sleep disturbances in children with attention-deficit/hyperactivity disorder. Expert Review of Neurotherapeutics, 11(4), 565–577. https://doi.org/10.1586/ern.11.7.
Stein, M. A., Mendelsohn, J., Obermeyer, W. H., Amromin, J., & Benca, R. (2001). Sleep and behavior problems in school-aged children. Pediatrics, 107(4), e60–e60. https://doi.org/10.1542/peds.107.4.e60.
Swaim, R. C., Henry, K. L., & Kelly, K. (2006). Predictors of aggressive behaviors among rural middle school youth. Journal of Primary Prevention, 27(3), 229–243. https://doi.org/10.1007/s10935-006-0031-2.
Williams, K. E., Berthelsen, D., Walker, S., & Nicholson, J. M. (2017). A developmental cascade model of behavioral sleep problems and emotional and attentional self-regulation across early childhood. Behavioral Sleep Medicine, 15(1), 1–21. https://doi.org/10.1080/15402002.2015.1065410.
Acknowledgements
We are grateful for the close collaboration with the Tongiorgi Public Schools, Pisa, Italy. We greatly appreciate the hard work and dedication of the many staff members and students (Giulia Burgalassi, Giuditta Tinti, Elena Guarguagli, Giulia Borgiani, Sara Paoletti, and Francesca Vacca) who collected the evaluation data.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Danilo Menicucci was funded by the University of Pisa, the ECSPLAIN-FP7 IDEAS-ERC ref.338866. Other authors declare that they have no conflicts of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Muratori, P., Menicucci, D., Lai, E. et al. Linking Sleep to Externalizing Behavioral Difficulties: A Longitudinal Psychometric Survey in a Cohort of Italian School-Age Children. J Primary Prevent 40, 231–241 (2019). https://doi.org/10.1007/s10935-019-00547-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10935-019-00547-2