1. DESCRIPTIVES AND CORRELATIONS
Sleep Problems and Problem Behavior in Adolescence: Complex Relationships Meredith A. Henry and Sylvie Mrug
INTRODUCTION
DATA ANALYSIS
MAIN MODELS
Sleep problems and insufficient sleep are rising health concerns, especially among adolescents (CDC, 2011).
29% of year olds and 56% of year olds report insufficient sleep, defined as 7 or fewer hours per night (National Sleep Foundation, 2014).
Low quantity and quality of sleep are associated with both behavioral problems (e.g., aggression; Coulombe et al., 2011) and emotional problems (e.g., depression; Roane & Taylor, 2008).
However, the directionality of these effects is not clear. Sleep problems may contribute to more behavior problems, e.g. through decreased self-regulation (Pieters et al., 2015), but problem behaviors might also increase the risk of sleep problems, e.g. through increased arousal (Ireland & Culpin, 2006; Reynolds & O’Hara, 2013).
In addition, most studies rely on only self-report or parent-report of adolescent sleep problems. Since sleep patterns experience a developmental shift during adolescence (Pieters et al., 2015), research may benefit from multiple informants.
The present study investigates bi-directional relationships between sleep problems and adolescent behavioral and emotional problems, using both parent and adolescent reports.
At Wave 1, both parent and adolescent reported sleep problems were associated with concurrent conduct problems (β = .28 to .29, p <.01), hyperactivity (β = .35 to .36, p <.001), emotional problems (both β = .39, p <.001), and less prosocial behavior (β = -.23 to -.24, p <.05).
At Wave 2, residuals of parent reported sleep problems were associated with residuals of concurrent conduct problems (β = .22, p <.05) and peer problems (β = .27, p <.05).
No residual correlations were significant at Wave 3.
Higher levels of parent reported sleep problems at Wave 1 predicted more hyperactivity (β = .36, p <.001) and peer problems (β = .26, p <.05) at Wave 2.
Higher levels of conduct problems at Wave 2 predicted more adolescent reported sleep problems at Wave 3 (β = .24, p <.05).
Descriptives and bivariate associations were examined.
Prospective, bi-directional relationships between adolescent sleep problems and behavioral and emotional problems were tested with autoregressive cross-lagged models conducted in Mplus version 7.11 (Conceptual model below).
Separate models were conducted for each problem behavior and parent vs. adolescent report of sleep problems. W1
Sleep Problems W2 W3
Behavioral/ Emotional Problems
DISCUSSION
Parent and adolescent reports of adolescents’ sleep problems were only weakly correlated, suggesting differences in their perceptions.
Parents may be more out of touch with their children’s sleep patterns throughout adolescence, as they surrender supervision (Steinberg, 2014).
Sleep problems were relatively stable over time, as were behavioral and emotional problems.
Consistent with past research (Pieters et al., 2015), sleep problems were associated with more behavioral and emotional problems. These correlations replicated across both youth and parent reports of sleep problems.
As predicted, and in line with past research (Lycett et al., 2014), sleep problems earlier in adolescence predicted more hyperactivity and peer problems.
However, these relationships only emerged for parent reports of sleep problems, and were only predictive of these more overt problem behaviors.
Adolescent reported sleep problems failed to predict any parent reported behavior problems over time, perhaps due to differences in the two informants’ perspectives.
However, adolescent reported sleep problems were predicted by more conduct problems at the previous wave.
Perhaps parents may provide a more unbiased portrayal of overt adolescent problem behaviors (e.g., hyperactivity & conduct problems), while adolescents provide more accurate information on sleep problems.
An adolescent report of problem behaviors, especially those related to internalizing symptoms, may show more of the predicted relationships.
Results of this study provide only limited support for the predicted bi-directional relationships.
The study is limited by small sample size and subjective reports of sleep problems. Other sleep measures (e.g., duration or efficiency) may show different relationships with behavioral and emotional problems.
In addition, the study used a limited definition for behavioral and emotional problems.
Future studies should continue examining bi-directional relationships between sleep and psychosocial adjustment using multiple methods to assess both sleep problems and extending the behavioral outcomes investigated (e.g., by including physical aggression and depression).
PARTICIPANTS
DESCRIPTIVES AND CORRELATIONS
83 adolescents
Recruited from middle schools serving low-income, urban neighborhoods in Southeastern United States
50% female
95% African American
Followed over time, with mean ages:
13.3 years at Wave 1
14.7 years at Wave 2
16.1 years at Wave 3
Adolescents in this sample demonstrated relatively few sleep problems (Figure 1), behavioral problems, or emotional problems (Figure 2).
Adolescent and parent reports of sleep problems were only modestly correlated within each time point (r = 0.30 to .35, p <.01).
Sleep problems were moderately stable over time (adolescent report: r= .40 to .48, p <.001; parent report: r= .45 to .76, p <.001).
Adolescents reported significantly more sleep problems than parents at all waves (6.81≤ t ≥ 13.35, p <.001). This disparity appeared to grow over time.
Within each wave, the four problem scales of the SDQ were positively correlated with one another (r = .31 to .53, p <.05) and negatively correlated with prosocial behavior (r = -.31 to -.62 p <.05).
All SDQ scales were moderately stable (r = .52 to .84, p <.05).
For the four problem SDQ subscales, parents reported similar levels at Wave 1 and Wave 2, but fewer problem behaviors at wave 3 (2.14 ≤ t ≥ 3.96, p <.05).
Levels of prosocial behavior did not change over time.
At Wave 1, parent reported (but not adolescent reported) sleep problems were positively correlated with conduct problems, emotional problems, and hyperactivity (r = .29 to .39, p <.05) and negatively correlated with prosocial behavior (r = -.24, p <.05).
At Wave 2, parent reported sleep problems were positively correlated with conduct problems, emotional problems, and hyperactivity (r = .25 to .36, p < .05)
At Wave 3, parent reported sleep problems were positively correlated with conduct problems and hyperactivity (r = .25 to .40, p <.05), while adolescent reported sleep problems were positively correlated with peer problems (r = .28, p <.05)
METHODS
Adolescent sleep problems
Reported by adolescents and their parents at each wave
22 items from the Sleep History section of the Adolescent Sleep Health Survey (Owens, 2002)
Weekly frequency of disruptions to sleep/wake cycle, insomnia, daytime sleepiness, parasomnias (e.g., nightmares, sleepwalking), sleep disordered breathing, and overall sleep quality
Rated from “Never”(1) to “Every day” (5)
Items averaged (youth α = 0.73; parents α = 0.64)
Adolescent behavioral and emotional problems
Reported by parents at each wave
Strengths & Difficulties Questionnaire (Goodman, 1997)
5 items for each subscale, rated “Not true” (1) to “True” (3) and averaged:
Conduct problems (α = 0.57)
Emotional problems (α = 0.71)
Hyperactivity/Inattention (α = 0.70)
Peer problems (α = 0.53)
Prosocial behavior (α = 0.72)
Figure 1. Total sleep problems reported by adolescents and parents across waves
*** = p <.001
Figure 2. Adolescent behavioral and emotional problems reported by parents across waves
* = p <.05; ** = p <.01; *** = p <.001