Childhood Sleep Problems as Predictors of Adolescent Internalizing Problems: the Intermediary Role of Emotional Reactivity



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Persistent sleep problems in childhood are predictive of internalizing problems in adolescence (e.g., anxiety and mood disorders), yet limited longitudinal data exist examining the specific types of sleep problems that forecast adolescent internalizing symptoms. Furthermore, possible mechanisms linking these problems over time has received limited empirical attention. The current study examined predictive relations between bedtime and middle of the night sleep problems during third grade and internalizing problems at age fifteen. The mediational role of emotional reactivity in fifth grade (i.e., during pre-adolescence) also was examined. Method: Participants (N=1085) were recruited as part of a large multi-site NICHD study assessing child health and development. Mother reported sleep problems (bedtime problems and nighttime waking problems) during third grade, emotional reactivity during fifth grade, and internalizing symptoms at age fifteen were entered into a series of regression-based Ordinary Least Squares (OLS) process models. Conditional process analyses were used to predict direct and indirect effects of child sleep problems on adolescent internalizing problems through emotional reactivity. Sex was examined as a moderator of mediational models. Results: Bedtime sleep problems, but not nighttime waking problems, were a significant predictor of adolescent internalizing problems. For girls, but not boys, emotional reactivity in fifth grade partially explained the relationship between bedtime problems and internalizing problems in adolescence. Conclusion: Longitudinal associations between childhood sleep difficulties and later internalizing problems appear to vary based on the nature of sleep disturbance. Specifically, problems before the sleep period but not during the sleep period predict later internalizing problems, suggesting that later anxiety may be preceded by behavioral problems possibly related to bedtime anxiety in youth. Findings also suggest that higher levels of emotional reactivity in late childhood/early adolescence serve as a mechanism through which these problems are linked for girls only. These results add to a growing literature underscoring the reciprocal relations between sleep and emotional functioning across development. Limitations of the study and implications for future research and clinical practice are discussed.



Sleep, Youth, Internalization