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Poster #85 - Adverse Childhood Experiences and Increased Vulnerability to Sleep Problems among Children Investigated for Maltreatment

Fri, March 22, 7:45 to 9:15am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Background: Sleep is a modifiable health-risk behavior and fundamental to child development. Children’s sleep is considerably impacted by the family environment, with increasing evidence suggesting that stress and family-dysfunction impairs children’s sleep (El-Sheikh & Kelly, 2017). Children characterized by chaotic home environments, inconsistent schedules, and insufficient parental monitoring are at elevated risk for poor sleep (Appelhans et al., 2014). Critical to this research are data from a growing number of studies showing that exposure to childhood maltreatment and related adversity negatively affect sleep in adulthood (Greenfield, Lee, Friedman, & Springer, 2011). However, absent from this literature is an understanding of the interconnections between experiences of childhood adversity and sleep among children investigated for childhood maltreatment. We also lack an advanced understanding of the associations between cumulative versus specific types of adversity and children’s sleep. Such an understanding is critical to intervene early and disrupt negative consequences of poor sleep on children’s health and well-being. Taking a developmental approach, this study investigated the association between adverse childhood experiences (ACEs) and increased vulnerability to sleep problems among children investigated for maltreatment.

Method: This study used existing data collected through the National Survey of Child and Adolescent Well-Being (NSCAW-II), which included a sample of 3,262 child welfare-involved children stratified into three age groups (2-5 years, 6-10 years, 11-17 years). The majority of children were male (51.1%), remained in the home (68.8%), and racially/ethnically identified as White (39.9%), followed by Hispanic/Latino(a) (25.8%), Black/African American (24.9%), Multi-Race (7.6%), or “Other” (1.8%). Approximately half of the families were low-income, with 50.3% of families’ income at or below the federal poverty line (FPL), 28.6% at or below 200% of the FPL, and 21.1% greater than 200% of the FPL. For each age group, multivariate regression analyses were conducted to examine the relationship between total ACEs and sleep problems, controlling for demographic characteristics. Next, bivariate correlations were conducted with individual ACE types and sleep problems; those ACEs that were significantly correlated with sleep were then entered into regression models to determine the extent to which specific types of adversity were associated with children’s sleep problems.

Results: Across all three age groups, total ACEs significantly predicted increased sleep problems: 2-5 years (M=3.50, SD=1.59; b=.30, SE=.08, p<.001), 6-10 years (M=3.50, SD=1.61; b=.22, SE=.05, p<.001), 11-17 years (M=4.15, SD=1.73; b=.25, SE=.04, p<.001). For children aged 2-5 years, significant ACE predictors of sleep problems included sexual abuse, emotional abuse, and parental mental illness. Among children aged 6-10 years and 11-17 years, significant ACE predictors included emotional neglect, sexual abuse, and parental mental illness. See Table 1 for results of the regression analyses for specific ACE types.

Conclusions: Findings from this study suggest that, in addition to cumulative experiences of adversity, delineating specific types of adversity may offer more precise targets to intervene on children’s sleep among children investigated for maltreatment. This research may thus better inform how child- and family-serving systems can assess for ACEs and then use this information to integrate behavioral health and developmental services to meet children’s unique needs.

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