Sleep Trajectories in Child Protective Services-Referred Children and Links to Externalizing Symptoms

• In Event: 2-188 - Early Childhood Child Maltreatment, Risk Factors, and Effects on Children’s Health

Integrative Statement

Sleep patterns are an important early marker of children’s biobehavioral adaptation (Sadeh et al., 2000). Atypical sleep patterns are common in childhood, with 20-30% of children demonstrating some form of sleep disturbance in the first three years of life (Owens et al., 2008). Poor sleep patterns, such as short nighttime sleep, have been linked to a range of negative developmental outcomes, including poor academic functioning, hyperactivity, and social and emotional behavioral problems (e.g., Silvertsen et al., 2015; Touchette et al., 2009). However, it remains unclear whether children who have experienced adversity, such as maltreatment, demonstrate atypical sleep patterns and whether these sleep patterns are linked with developmental outcomes. The current study explored trajectories of sleep during infancy and toddlerhood in Child Protective Services (CPS)-referred children and examined whether these sleep patterns were linked with internalizing and externalizing symptoms in early childhood.

Participants included 203 children whose parents were referred to CPS due to allegations of abuse and/or neglect (Table 1). Parents were randomized to receive Attachment and Biobehavioral Catch-Up (ABC; Dozier, Bernard, & Meade, 2013) or the control intervention, Developmental Education for Families. Using a sleep diary, parents recorded all periods of time their children were asleep over a 24-hour period at up to four time points: prior to receiving the intervention, four weeks after the intervention, at age two, and at age three. The Child Behavior Checklist (CBCL; Achenbach, 1994) assessed internalizing and externalizing behaviors during early childhood (M = 26.46 months, SD = 3.42).

Latent growth curve modeling (LGCM) examined individual patterns of infant sleep at baseline, change in sleep patterns over time, and whether baseline sleep or changes in sleep were associated with CBCL scores. At baseline (around 1 month of age), on average, children slept a total of 13.23 hours per day (SE = 0.21, p < .001). The intercept for total sleep varied significantly (B = 3.67, SE = 1.12, p = .001), with an estimated 26% of children falling below the minimum recommended amount of sleep in a 24-hour period for infants (Paruthi et al., 2016). Children’s total sleep declined by 0.03 hours per month (SE = 0.01, p < .001.). Additionally, children had an average of 3.74 sleep episodes per day at baseline (SE = 0.08, p < .001), and this declined by 0.03 episodes per month (SE = 0.002, p < .001). More total sleep at baseline was associated with significantly fewer externalizing symptoms on the CBCL (B = -0.73, SE = 0.07, p < .001). No effect was found for internalizing symptoms (B = -0.003, SE = 0.04, p = .94). Intervention status was unrelated to sleep and CBCL scores.
Consistent with prior research, CPS-referred children with higher total sleep in infancy exhibited fewer externalizing behavior problems in early childhood. Sleep is a promising target for interventions aimed at promoting regulation during early childhood. These findings highlight the need for future research to examine sleep patterns in maltreated children and other high-risk samples as a predictor of later developmental outcomes.

Authors

• Lindsay Zajac, University of Delaware
  Presenting Author

• Sarah Prendergast, Colorado State University
  Non-Presenting Author

• Kenneth Feder, Johns Hopkins Bloomberg School of Public Health
  Non-Presenting Author

• Catherine Kuhns, University of Maryland
  Non-Presenting Author

• Bridget Cho, University of Kansas
  Non-Presenting Author

• Mary Dozier, University of Delaware
  Non-Presenting Author