Sleep is the underground stream that replenishes our souls. Most adults understand how a night of insomnia can disturb their work and upset their routines and relationships. But does poor sleep also afflict children, and might it be linked to other issues in their lives? A new study, focused on children with behavioral issues, explores exactly these questions. Sleep difficulties, the researchers discovered, are not uncommon among toddlers receiving treatment for a range of psychiatric conditions, suggesting early sleep problems may be both a cause and consequence of psychiatric symptoms.

Early Troubles

A good half of all lifetime cases of mental illness begin by age 14, the National Institute of Mental Health tells us, with four million American children and teens suffering from a serious mental disorder causing significant functional impairments at home, at school, and with their peers. For the current study, researchers examined the nature and prevalence of sleep disorders in a sample of 183 young children admitted to an early childhood psychiatric day treatment program. The Bradley Hospital program is a family-centered plan for children under the age of 6 who have serious emotional, behavioral, or relationship disturbances.

To assess the study participants, the researchers conducted the Diagnostic Infant and Preschool Assessment, a type of semi-structured interview that confirms sleep and other psychiatric disorders in children. At the same time, the researchers also examined the participant’s daily sleep diaries and administered a questionnaire to parents who rated their children on behavioral and emotional problems.

What did they discover? "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," said Dr. John Boekamp, clinical director of the Pediatric Partial Hospital Program (PPHP) at Bradley Hospital.

Of the total children, more than a third (41 percent) fulfilled the criteria for a sleep disorder: 23 percent met the diagnostic benchmarks for Sleep Onset Insomnia, four percent for Night Waking Insomnia, and 14 percent for both of these forms of sleep disorders. The insomniac children also took longer to fall asleep, had longer and more frequent awakenings in the night, had less total sleep time, and a lower sleep efficiency rating than their peers. (Sleep efficiency is a calculation of the time slept divided by the total time spent in bed, with anything above 85 percent being a good sleep efficiency rating.) Boekamp believes it is crucial that mental health providers who work with children ask their patients about the quality and quantity of their sleep.

Source: Boekamp JR, Williamson LR, Martin SE, Hunter HL, Anders TF. Sleep Onset and Night Waking Insomnias in Preschoolers with Psychiatric Disorders. Child Psychiatry & Human Development. 2014.