A new study has found that sleep difficulties, especially problems with falling asleep, are very common among toddlers and preschoolers treated for psychiatric disorders.
These sleep difficulties are often underdiagnosed in children with behavioral and emotional issues, yet can greatly affect well-being, according to John Boekamp, Ph.D., clinical director of the Pediatric Partial Hospital Program (PPHP) at Bradley Hospital in Providence, R.I.
“It is important for families to be aware of how important sleep is to the behavioral adjustment and well-being of young children,” said Boekamp.
“Sleep disorders may be unrecognized and under-diagnosed in young children, particularly when other behavioral or emotional problems are present.”
The most common sleep difficulties reported nationally for toddlers and preschoolers are problems going to bed, falling asleep, and frequent night awakenings, he reported, noting that collectively, these problems are referred to as behavioral insomnias of childhood.
“Sleep problems in young children frequently co-occur with other behavioral problems, with evidence that inadequate sleep is associated with daytime sleepiness, less optimal preschool adjustment, and problems of irritability, hyperactivity, and attention,” he said.
Boekamp explained that his research team was interested in learning more about sleep and sleep problems in young children with behavior problems, as early sleep problems may be both a cause and consequence of children’s difficulties with behavioral and emotional self-regulation.
“Essentially, these young children might be caught in a cycle, with sleep disruption affecting their psychiatric symptoms and psychiatric symptoms affecting their sleep-wake organization,” he said.
The program that Boekamp leads at Bradley Hospital is a family-centered, intensive day treatment program for very young children from newborn to six years old who have serious emotional, behavioral, or relationship disturbances.
The new study examined the nature and prevalence of diagnostically defined sleep disorders, including Sleep Onset Insomnia (SOI) and Night Waking Insomnia (NWI), in a group of 183 young children admitted to the program.
Diagnosable sleep disorders, particularly SOI, were quite common in the group, exceeding previous estimates obtained in community settings, the researchers noted.
Overall, 41 percent of the children in the study also met diagnostic criteria for a sleep disorder. Sleep problems were especially common in children with disruptive behavior, attention, anxiety, and mood problems, according to the study’s findings.
“Difficulties with sleep may be particularly important to address when children are also struggling with challenging daytime behaviors, such as problems with compliance, aggression, attention, and mood,” he said.
Sleepiness and fatigue may exacerbate these problem behaviors, he noted.
“This study is a great reminder that it’s critical for mental health providers working with young children and their families to ask about children’s sleep,” said Boekamp.
“Simple questions about children’s sleep patterns, including how long it takes a child to fall asleep at night and how frequently a child awakens after falling asleep, may yield important information that is relevant to clinical care, even when sleep problems are not the primary focus of treatment.”
The study was published in the journal Child Psychiatry & Human Development.