0637 Associations Between Sleep Quality and Child Behavioral Problems, a Longitudinal Analysis

Abstract Introduction Internalizing and externalizing behaviors are important mental health outcomes in children. Internalizing symptoms are characterized by a disturbance in mood or emotion. Symptoms include loneliness, sadness, anxiety, rumination, and depression. Externalizing symptoms are behaviors that are aversive to others and experienced by other people. Symptoms include aggression, hyperactivity, property destruction, and losing one’s temper. This longitudinal analysis examined how children’s sleep quality related to their internalizing and externalizing behaviors. Methods 246 Children (n = 246 at T1, n = 196 at T2, n = 151 at T3), with a mean age of 9.9 (SD = 1.4) at time one, participated in a longitudinal study on sleep and substance use. Sleep quality was measured with the Adolescent Sleep Wake Scale (range 1-6); higher scores represent better sleep quality. Child internalizing and externalizing behavior problems were measured using the Childhood Behavior Checklist; higher scores indicate higher levels of behavioral problems. The associations between sleep quality, and internalizing and externalizing behavior at T1, T2, and T3 were examined. One year separated each time-point. Data were analyzed by structural equation modeling. Latent variables of sleep quality, internalizing, and externalizing were created from the observed measurements at the three time-points. Latent variables of internalizing and externalizing were regressed on sleep quality. Results The model indicated an excellent fit with the data (χ2 = 21.94, p = 0.46; CFI = 1.00; TLI = 1.00; RMSEA = 0.00). All observed variables loaded significantly onto their respective latent variables, internalizing, externalizing, and sleep quality (p < 0.001). Results indicated that the latent variable of sleep quality predicted both the latent variables of internalizing (b = -0.34, se = 0.09, p < 0.001) and latent externalizing behaviors (b = -0.31, se = 0.08, p < 0.001). Conclusion These results indicate children with better sleep quality have fewer internalizing and externalizing behavioral problems. This suggests that improving sleep quality could improve behavioral problems in children. Alternatively, improving behavioral problems may improve sleep quality. Future research should examine the directionality of this relationship. Future research should also test if sleep or behavioral interventions improve sleep quality and child behavioral problems. Support (if any) NIH Grant R01 AA020364