Dr. Somnus, of Somnus Pediatrics, encounters numerous children in his practice who are affected by poor sleep habits. He suspects that there is a strong connection between disturbed sleep and behavioral problems in the children he sees. He is exploring what research suggests about the link between poor sleep and poor behavior as well as recommendations of possible intervention techniques that could improve sleep habits and behaviors among his patients. Backed up by research collected as a group, the team can conclude that poor sleep is severely detrimental to the neurobehavioral, as well as cognitive, development of children. However, the research also shows numerous intervention methods that both parents and Dr. Somnus can implement to achieve better outcomes for those children affected by inadequate sleep.
Research conducted by Sadeh, Gruber, and Raviv highlights a clear link between sleep quality and behavioral functioning and development in school-aged children. Within this study, a total of one hundred and thirty five (69 boys and 66 girls) healthy school-aged children from three distinct class groups (2nd, 4th, and 6th grades) were assessed objectively, using actigraphy and neurobehavioral functioning evaluations, in their homes for five consecutive nights. (Sadeh, Gruber & Raviv, 2002). The use of three distinct class groups in this study emphasizes a developmental perspective on this issue. More specifically, the researchers of this study were interested in comparing the effects of reduced sleep on behavioral functioning between younger and older children. In addition to this, the team of researchers also tested the neurobehavioral functioning of participants at two separate times during the day to consider when sleep quality more affected their performance; either earlier in the day, or later in the day. (Sadeh et al., 2002). The actigraph measures used in this study included: sleep onset time, morning awakening time, total sleep time, true sleep time (excluding periods of wakefulness), sleep percent, number of night wakings, longest sleep durations, and periods of quiet sleep with no movement. (Sadeh et al., 2002). Neurobehavioral functioning evalutations included tests such as: finger tapping, reaction time, continuous performance (CPT), symbol-digit substitution (SBS), visual digit span, and serial digit learning. (Sadeh et al., 2002). The CBCL was used to assess behavioral issues in the perspective of parents. (Sadeh et al., 2002).
Overall, the results show that sleep fragmentation can indeed negatively affect neurobehavioral functioning in almost all aspects of performance. Interestingly, the CPT results indicate that fragmented sleep increases impulsivity and behavioral inhibitionempirically linked to psychopathology in children, especially so in the younger ones compared to the older ones. (Sadeh et al., 2002). In terms of the time of day, poor sleepers tend to be largely affected during the early morning hours due to high levels of sleepiness or sleep inertia, and later in the day, some of these group differences disappeared. This suggests that both quantity and quality of sleep play a crucial role in alertness and performance among school-aged children. (Sadeh et al., 2002). Reports by parents on the CBCL indicated that, in general, good sleepers behaved better and regulated emotions better than poor sleepers. (Sadeh et al., 2002). There is a solid theoretical and empirical background that may lead to the interpretation that the compromised neurobehavioral functioning is a result of reduced alertness, or increased sleepiness associated with sleep fragmentation. (Sadeh et al., 2002, p.412).
Another source, research by Vriend, Davidson, Corkum, Rusak, Chambers, and McLaughlin, revealed that even slight but, cumulative differences in sleep duration over the course of a few nights, can present dire consequences in the daytime functioning of children. In this study thirty-two children between the ages of 8-10years were tested for three weeks using actigraphs; these children were randomly assigned to either go to bed one hour earlier or later for 4 nights, and then switched and completed the opposite conditions as well. (Vriend et al., 2013). After each week, both subjective and objective measurements where used to consider each child’s emotional and cognitive functioning. (Vriend et al., 2013). Evidence showed that the children given the shorter duration of sleep versus the longer sleeper time, showed significant impairment in areas including: positive affective response, emotional regulation, short-term and working memories, and attention span. (Vriend et al., 2013).
Altogether, this study achieved a sleep difference of merely one hour or so in participants. Even this modest amount of sleep manipulation over the course of two weeks turned out to display a distinct difference between those that went from short-long and those that went from long-short in their sleep cyles. Many deteriorating effects in aspects of memory, attention and response were observed among parents of children during their short sleep duration week; however, not so in every aspect. In general however, shorter sleep durations clearly impaired critical areas of neurobehavioral functioning in children studied in this study. (Vriend et al., 2013). Although poor sleep cannot be considered the sole cause of behavioral issues, it is important to note that the potential for behavioral issues and diminished functioning increases tremendously with inadequate sleep in children.
Due to the copious amounts of evidence pertaining to the disastrous effects of improper sleep in young children, it is highly recommended that Dr. Somnus intervenes as soon as possible to rectify poor sleep habits in his patients. Intervention should be inclusive of parents as well, as they play a key role in the management and modeling of healthy behaviors in younger children. First and foremost, it is recommended that Somnus Pediatrics publically promotes sleep as a health-related behavior and stresses the importance of both quality and quantity of sleep among children. Tackling these poor sleep patterns and encouraging healthy sleep hygiene at an earlier age can create the foundation for children to better manage their sleep as they develop.
According to a study conducted by Bonuck, Blank, True-Felt, and Chervin, The most modifiable, prevalent, and consequential sleep problems in early childhood are insufficient sleep, behavioral sleep problems, and sleep-disordered breathing. Therefore, Dr. Somnus is recommended to focus his intervention on these specific categories. He should collaborate with parents to consider ways in encouraging children to sleep earlier, and maintain a regular bedtime schedule. In addition, he should rule out possible sleep and behavioral disorders among his patients so that he can alter and personalize his intervention techniques as needed.
Sleep problems can be prevented through implementation of proper sleep hygiene to regulate the internal circadian rhythm of developing children. This in turn conditions behavioral expression and regulation, as well as reduces excessive stimulation. (Bonuck et al., 2016). For younger children in particular, this includes interventions such as: instigating a regular bedtime routine, sleeping without the presence of parents in the room, and eliminating access to electronics and screen time fifteen to thirty minutes prior to settling down for the night. (Bonuck et al., 2016). Overall, anything that helps parents regulate the quantity and quality of sleep that their children receive is a good start to improving the development of neurobehavioral functioning and emotional regulation in children of all ages, but particularly younger ones.