Eeva T. Aronen

Sleep and Psychiatric Symptoms in School-Age Children

OBJECTIVE To assess associations between the quantity and quality of childrens sleep and parent- and teacher-reported psychiatric symptoms. METHOD Forty-nine physically healthy 7- to 12-year-old children from normal classes participated. They were monitored for 72 consecutive hours with belt-worn activity monitors (actigraphs) to obtain objective data on their daytime and nighttime activity and sleep. In addition, Child Behavior Checklists and Teachers Report Forms were filled out by the parents and teachers, respectively. RESULTS Quantity of sleep was significantly associated with total symptom score on the Teachers Report Form. The highest associations were found between low true sleep time and teacher-reported externalizing symptoms such as aggressive and delinquent behavior and attention and social problems. Sleep parameters were not associated with parent-reported psychiatric symptoms, except for the association found between delayed sleep latency and aggressive, delinquent behavior. CONCLUSIONS The objectively measured amount of school-age childrens sleep was associated with teacher-reported psychiatric symptoms. Parents may be unaware of their childs sleep deficiencies as the behavioral problems may be more evident at school than at home. Sensitive and objective measurements are needed to rule out the possibility of inadequate sleep underlying behavioral problems.

Working Memory and Sleep in 6- to 13-Year-Old Schoolchildren

OBJECTIVE To study the associations between sleep quality/quantity and performance in auditory/visual working memory tasks of different load levels. METHOD Sixty schoolchildren aged 6 to 13 years from normal school classes voluntarily participated. Actigraphy measurement was done during a typical school week for 72 consecutive hours. It was timed together with the working memory experiments to obtain information on childrens sleep during that period. The n-back task paradigm was used to examine auditory and visual working memory functions. RESULTS Lower sleep efficiency and longer sleep latency were associated with a higher percentage of incorrect responses in working memory tasks at all memory load levels (partial correlations, controlling for age, all p values < .05, except in visual 0-back and auditive 2-back tasks); shorter sleep duration was associated with performing tasks at the highest load level only (partial correlations, controlling for age,p < .05). Also in general linear models (controlling for age, gender, and socioeconomic status), sleep efficiency (F = 11.706, p = .050) and latency (F = 3.588, p = .034) were significantly associated with the mean incorrect response rate in auditory working memory tasks. CONCLUSIONS Sleep quality and quantity affect performance of working memory tasks in school-age children. In children with learning difficulties the possibility of underlying sleep problems should be excluded.

Sleep problems of school‐aged children: a complementary view

The aim of this population‐based multicentre study was to evaluate the prevalence rates of sleep problems among 8‐9‐y‐old children. The sample consisted of 5813 Finnish children, making up 10% of the age cohort. Both parents and children provided information. Disturbed sleep was reported by 21.7% of parents. Most of the problems were mild; only 0.3% were serious. Dyssomnias were frequent: 11.1% had difficulties with sleep onset, 7.1% with night waking and 2.3% with waking too early. Multiple sleep problems were present in 9.1% of the children. 17.8% of children reported disturbed sleep, 12.7% had problems many nights and 5.1% every night. In 32.0% of cases, either the parent or the child reported disturbed sleep; 7.4% of these reports came from both the parent and the child, 14.1% from the parent only and 10.3% from the child only. The correspondence between informants was poor (κ= 0.224). Sleeping problems were associated with somatic and psychiatric problems. It is concluded that by restricting questioning to parents only, one‐third of all potential cases of sleep problems may go unnoticed. In order to increase the sensitivity of screening childrens sleep problems, both parents and children should provide information in epidemiological settings as well as in clinical work.

Working memory, psychiatric symptoms, and academic performance at school

Previous studies of the relationship among working memory function, academic performance, and behavior in children have focused mainly on clinical populations. In the present study, the associations of the performance in audio- and visuospatial working memory tasks to teacher reported academic achievement and psychiatric symptoms were evaluated in a sample of fifty-five 6-13-year-old school children. Working memory function was measured by visual and auditory n-back tasks. Information on incorrect responses, reaction times, and multiple and missed responses were collected during the tasks. The childrens academic performance and behavioral and emotional status were evaluated by the Teacher Report Form. The results showed that good spatial working memory performance was associated with academic success at school. Children with low working memory performance, especially audiospatial memory, were reported to have more academic and attentional/behavioral difficulties at school than children with good working memory performance. An increased number of multiple and missed responses in the auditory and visual tasks was associated with teacher reported attentional/behavioral problems and in visual tasks with teacher reported anxiety/depressive symptoms. The results suggest that working memory deficits may underlie some learning difficulties and behavioral problems related to impulsivity, difficulties in concentration, and hyperactivity. On the other hand, it is possible that anxiety/depressive symptoms affect working memory function, as well as the ability to concentrate, leading to a lower level of academic performance at school.

Effectiveness of Melatonin in the Treatment of Sleep Disturbances in Children with Asperger Disorder

Sleep disturbances are common in patients with Asperger disorder. Although these sleep problems are often persistent and may significantly impair the childs daytime well-being, no treatment studies have been reported. In this open clinical trial, the effectiveness of melatonin was studied in a sample of 15 children with Asperger disorder (13 boys, 2 girls) aged 6-17 years using several questionnaires and actigraph measurements. They included assessments of sleep quality, tiredness, and behavior. Melatonin (3 mg/day) was used for 14 days. All the measurements were made three times: before the treatment period, during the treatment (days 12-14), and 3 weeks after the discontinuation of the treatment. The sleep patterns of all the children improved, and half of them displayed excellent responses to melatonin. In particular, actigraphically measured sleep latency decreased from 40.02 +/- 24.09 minutes to 21.82 +/- 9.64 minutes (p = 0.002), whereas sleep duration remained steady at 477.40 +/- 55.56 minutes and 480.48 +/- 50.71 minutes. Despite the short duration of the treatment, behavioral measures also displayed a significant improvement, and most of the effect disappeared after the discontinuation of the melatonin (p = 0.001). In conclusion, melatonin may provide an interesting new and well-tolerated treatment option for children with Asperger disorder suffering from chronic insomnia. However, these results must be confirmed in a controlled study.

Childhood depressive symptoms predict psychiatric problems in young adults.

Objective: To evaluate the predictive value of childhood depressive symptoms for psychiatric symptoms, adaptive functioning, and self-performance in young adults. Method: The study sample consisted of 111 young adults born during 1975–1976 in the Helsinki region. The young adults were assessed in childhood (10 to 11 years of age) using the Childrens Depression Inventory (CDI) and at the age of 20 to 21 years using Achenbachs Young Adult Self Report (YASR), the Beck Depression Inventory (BDI), and the Wallston Self-Performance Survey. Results: Self-reported depressive symptoms in childhood predicted psychiatric symptoms (especially aggression), poor adaptive functioning, and low self-esteem in young adulthood. Conclusions: Depressive symptoms in children should be addressed to prevent later psychiatric problems. The CDI may be a measure of nonspecific psychopathology rather than of pure depression—thus, it may be a good screening tool for child populations.

Psychiatric disorders in 8–9-year-old children based on a diagnostic interview with the parents

Using three questionnaires, the Rutter Parent Questionnaire (RA2), The Rutter Teacher Questionnaire (RB2) and the Children’s Depression Inventory (CDI), we screened 8–9-year-old children representing a total annual birth cohort (N=60007) in Finland. In a second stage we interviewed the parents of 119 screen negative, and 316 screen positive children by using a structured parent interview. At the population level the overall prevalence rate for psychiatric disturbance was 21.8%, higher among boys (29.8%) than among girls (12.8%). Nine percent of the children were in urgent need of treatment and, in addition, 25% were in need of assessment. The prevalence of different levels of disturbance was: reactive 9.5%; neurotic 18.4%; borderline 3.1%; and other severe disorders 2.3%. The prevalence of different diagnostic groups were: anxiety disorder 5.2%; depressive disorder 6.2%; specific fears 2.4%; defiant and conduct disorder 4.7%; and attention-deficit hyperactivity-disorder 7,1%. The prevalence for the most common single first Axis-I DSM-III-R diagnoses were: attention-deficit hyperactivity-disorder 7%; dysthymia 4.6%; adjustment disorder with mixed disturbance of emotion and conduct 3.4%; oppositional defiant disorder 2.7%; specific fear 1.7%; anxiety disorder 1.5%; enuresis nocturnal 1.5%; and depression 1.4%. Only 3.1% of the children had visited health professionals for psychiatric problems during the previous three months. Only a minority of the children with psychiatric disturbances had ever consulted health professionals for their problems. Of all the children, 7.5% had a severe psychiatric disturbance that had lasted for more than 3 years.

Long-term effects of an early home-based intervention.

OBJECTIVE To evaluate the long-term effects of an early home-based intervention on the quantity and quality of psychiatric symptoms in adolescents. METHOD The material consisted of 160 families with a baby born in 1975-1976. First, the families were classified with a weighted risk index into low- and high-risk families. Eighty families attended a 5-year-long family counseling program (10 times/year). The other half of the families served as a control group for the effects of counseling. The mental state of the adolescents was assessed at age 14 to 15 years by the Child Behavior Checklist and the Youth Self-Report. RESULTS The adolescents in the counseling families scored significantly fewer total symptoms on both the parent and the youth reports. The counseling reduced more effectively internalizing than externalizing symptoms. The counseling predicted better mental health in adolescence in both low- and high-risk families. CONCLUSIONS Home-based early intervention can have positive long-term effects on the mental state of adolescents. These results can be used when programs for primary prevention in families with small children are planned.

Four-year follow-up study of sleep and psychiatric symptoms in preadolescents: relationship of persistent and temporary sleep problems to psychiatric symptoms.

ABSTRACT. The course of sleep disturbances in preadolescents was assessed during a 4-year follow-up, and psychiatric problems associated with persistent and temporary sleep problems were investigated in an epidemiological setting. A representative random sample of 1,290 children, their parents, and school teachers filled out various questionnaires when the children were aged 8 and 12 years. Response rates to the relevant items varied between 66.8% and 81.2%. Parental reports of sleep problems decreased from 23.4% to 9.1% during the 4-year period, whereas childrens reports remained steady at 18%. Persistent sleep disturbances were found in 12% of children, and 33.3% of sleep problems reported at age 8 were continued. Both current and persistent sleep disturbances were associated with the broad range of mental health problems reported by teachers. However, multivariate modeling suggested that especially current sleep problems were associated with an increased risk for psychiatric problems (odds ratio [OR] 2.45; 95% confidence interval [CI] 1.20–4.99), particularly emotional problems (OR 2.92; 95% CI 1.58–5.38).

Behavioural and emotional symptoms in 8–9-year-old children

We present epidemiological data from a multi-centre study on psychiatric symptoms among 6017 8–9-year-old children representing a total annual birth cohort (N=60007) in Finland. The results are based on three questionnaires: the Rutter Parent Scale (RA2), the Rutter Teacher Scale (RB2), the Children’s Depression Inventory (CDI). The proportion of children that scored above the cutoff points, indicating probable psychiatric disturbance, were 11.2% for the RA2, 13.9% for the RB2 and 6.9% for the CDI. Twenty-four percent of the subjects scored above the cutoff point on at least one of the questionnaires. Low family social status and disrupted family relations correlated strongly with high rates of symptoms in the children.