Grumpy Kids, Cranky Nights: The Association between Sleep Problems and Irritability in Early Childhood

• In Event: Sleep and Behavioral Adjustment in Early and Middle Childhood

Abstract

Objective/Background: Irritability is defined as a proneness to anger, particularly to blocked goal attainment, that is reflected in both behavioral outbursts (e.g., tantrums) and negative mood states (e.g., anger, grumpiness) that is developmentally unexpected and situationally disproportionate. Although irritability is a normative phenomenon in childhood (Copeland, Brotman, & Costello, 2015; Wakschlag et al., 2018), elevated and dysregulated levels of irritability represent a transdiagnostic, cross-cutting phenotype of both internalizing and externalizing psychopathology. Irritability likely reflects the disruption of several emotion-related processes, including emotion generation, emotional reactivity, and emotion regulation. Sleep disturbances have been found to contribute to disruption in a variety of emotion-related processes, and as such, may plausibly exacerbate irritability symptoms. Similarly, irritability may exacerbate settling difficulties which can lead to subsequent sleep problems. However, despite a strong theoretical rationale for an association between sleep problems and irritability, little research has examined the association between these two constructs in children, and no research, to our knowledge, has focused on this association in early childhood. The current study examined the association between sleep problems and irritability in early childhood.
Methods: Participants included 82 primary caregivers of children ages 4 – 5 years (70 females; ages 4–5; M age = 4.85 years; SD = 0.6 years). Primary caregivers completed the Child Sleep Habits Questionnaire (CSHQ; Goodlin-Jones et al., 2008) and completed daily child sleep diaries. Irritability was assessed by parent reports on questionnaires, including the Child Behavior Questionnaire – Anger/Frustration subscale (Rothbart et al., 2001), the Multidimensional Assessment Profile of Disruptive Behavior – Temper Loss subscale (Wakschlag et al., 2012), and a semi-structured interview, the Early Childhood Irritability Impairment Interview (Wakschlag et al., 2020), which were combined using factor analysis into a single irritability factor. Pearson correlations were used to examine the association between sleep (i.e., CSHQ subscales and sleep diary variables) and irritability (i.e., the irritability factor score).
Results: Findings suggested an association between irritability and sleep disturbances across several domains of sleep problems. Children with higher levels of irritability demonstrated more bedtime resistance (r = .26, p < .05), more sleep-related anxiety (r = .27, p < .05), more signaled night awakenings (r = .27, p < .05), took longer to fall asleep (r = .25, p < .05), and had shorter parent-reported nighttime sleep durations (r = -.26, p < .05).
Conclusions: The current study provides important information about the nature of the association between sleep and irritability, a transdiagnostic indicator of psychopathology risk in young children. Findings that children with clinically significant levels of irritability may also be at risk for sleep problems, and vice versa.

Authors

• Caroline P. Hoyniak, Washington University in St. Louis
  Presenting Author

• Lisa J Meltzer, National Jewish Health
  Non-Presenting Author

• Lauren S. Wakschlag, Northwestern University
  Non-Presenting Author

• Susan B. Perlman, Washington University in St. Louis
  Non-Presenting Author