Association between childhood sleep problems and perinatal factors, parental mental distress and behavioral problems

Abstract

SUMMAR Y The aim of this study was to examine the effect of age, gender and perinatal risk factors on the risks for sleep problems, and investigate the relation between childhood sleep problems and children's behavioral syndromes and parental mental distress in early and middle childhood. We recruited a representative sample of 1391 children, ages 4-9, from nine kindergartens and three elementary schools by using a multistage sampling method. Parents of child participants completed a questionnaire including perinatal risk factors, sleep habits and problems, the Child Behavior Checklist (CBCL) and the Chinese Health Questionnaire (CHQ). A mixed model was used for data analysis to address cluster effect from the same classes and schools. Results showed that boys suffered from more sleep problems than girls. Early insomnia, sleep terrors and enuresis decreased with ages, but sleepwalking increased with ages. Perinatal exposure to alcohol, coffee and non-prescribed medication, vaginal bleeding, artificial delivery, firstborn order and higher parental CHQ score ( ‡4) were significantly associated with several childhood sleep problems. In addition, children with sleep problems had higher T-scores of the eight behavioral syndromes derived from the CBCL. Our findings indicated that the childhood sleep problems were associated with perinatal risk factors, parental psychopathology and children's behavioral problems.k e y w o r d s child behavior checklist, childhood sleep problems, parental mental distress, perinatal risk factors

Demographic and perinatal factors for behavioral problems among children aged 4–9 in Taiwan

“…13 Prenatal factors included maternal exposure to regular use of alcohol (at least once per week), regular use of tobacco (at least once per week), coffee (at least one cup every week) and non-prescribed medication, and pregnancy complications (i.e. vaginal bleeding, hypertension, diabetes, viral infection, thyroid disease, and pre-eclampsia).…”

“…[10][11][12] For example, the most powerful predictor of high scores on the Child Behavioral Checklist (CBCL) among premature preschoolers is maternal self-reported depressive symptoms. 11,12 Although previous work has shown that maternal psychological distress is associated with several types of sleep problems in children, 13 no study has been done to examine its relationship with children's emotional/behavioral problems.…”

“…16 These findings highlight the importance of identifying comorbid behavioral patterns in childhood to offset future development of psychopathology and adverse social outcome. 16 Despite several epidemiological studies on Taiwanese child and adolescent populations, 13,[17][18][19] there has been no specific study to investigate the age and gender difference in the comorbid behavioral problems patterns, or to examine the effect of prenatal/ perinatal factors on behavioral problems in young children of an ethnic Chinese population. Hence, we conducted an epidemiological survey of childhood behavioral problems in Taiwan to investigate the effects of age, gender, prenatal/perinatal factors, and maternal psychological distress on childhood emotional/behavioral problems, and the gender difference in the patterns of comorbid emotional/ behavioral problems.…”

Dyssomnias and Parasomnias in Early Childhood

“…32 Although many studies found no gender difference for somnambulism in older children and adolescents, 9,32 it was recently reported to be more common in boys than in girls, a finding that is consistent with our results, in a large cohort of children who were aged 4 to 9 years. 33 An explanation for the relationship between somnambulism and high hyperactivity-inattention scores is unclear. However, it has been reported that hyperactivity is increased in children with sleep problems 14,34 or daytime sleepiness 35 and that hyperactivity-inattention disorder often disappears when sleep disorders are treated.…”

Intervenção comportamental para problemas de sono na infância

“…O choro da criança funciona como um estímulo discriminativo aversivo, na presença do qual os comportamentos de embalar e dar atenção são reforçados negativamente (fuga) pela retirada do estímulo aversivo (choro) (Ferreira et al, 2012). Skinner (1953Skinner ( /1998 Vários estudos já apontaram associação entre problemas de sono e problemas no perfil internalizante e/ou externalizante (Blunden & Chervin, 2008;Gregory et al, 2008;Hall et al, 2007;Scher et al, 2005;Sourander, 2001;Shang, Gau & Soong, 2006;Stein et al, 2001;Storch, Murphy, Lack, Geffken, Jacob & Goodman, 2008 De acordo com Sadeh et al (2010), os problemas de comportamento dos pais, bem como problemas cognitivos e emocionais destes, podem contribuir para comportamentos parentais dependentes, isto é, contato físico excessivo e pouco incentivo da autonomia infantil na hora do sono, influenciando a qualidade do sono da criança. Os autores sugerem que comportamentos parentais que incentivam a independência da criança, com assistência mínima no momento de dormir, estão associados com maior consolidação do sono infantil, em contraste com a excessiva assistência e o envolvimento parental na hora do sono, que estão associados ao aumento de despertares à noite.…”