Abstract
Empirical evidence suggests young children who have experienced trauma are at risk of developing sleep problems and behavior difficulties, but it is unclear of the specific relation between these behavioral health concerns. The primary purpose of the study is to determine whether sleep problems moderate the relation between traumatic stress and behavior problems in a sample of young children referred for treatment. A secondary purpose is to explore if sleep problems also moderate the relation between specific domains of traumatic stress (i.e., intrusion, avoidance, arousal) and behavior problems. Data from 170 preschoolers ages 3 through 5 referred for treatment were gathered at intake and utilized in this study. Results indicate sleep problems moderate the effect of overall traumatic stress on behavior problems. This statistical finding also was found with intrusive symptoms, and the moderation analyses approached significance with avoidance and arousal. Our findings highlight the importance for clinicians to assess for sleep problems when young children who have experienced trauma are referred to them for treatment, particularly if a low level of overall traumatic stress is present.
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References
Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms and profiles (Vol. 30). Burlington, VT: University of Vermont, research center for children, youth, & families.
Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Sage Publications, Inc.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Arnberg, F. K., Rydelius, P. A., & Lundin, T. (2011). A longitudinal follow-up of posttraumatic stress: From 9 months to 20 years after a major road traffic accident. Child and Adolescent Psychiatry and Mental Health, 5, 1–8. https://doi.org/10.1186/1753-2000-5-8.
Bandura, A. (1978). Social learning theory of aggression. Journal of Communication, 28, 12–29. https://doi.org/10.1111/jcom.1978.28.issue-3.
Becker, S. P. (2014). External validity of children’s self-reported sleep functioning: Associations with academic, social, and behavioral adjustment. Sleep Medicine, 15, 1094–1100. https://doi.org/10.1016/j.sleep.2014.06.001.
Briere, J. (2005). Trauma symptom checklist for young children (TSCYC). Odessa: Psychological Assessment Resources.
Briggs-Gowan, M. J., Carter, A. S., Clark, R., Augustyn, M., McCarthy, K. J., & Ford, J. D. (2010a). Exposure to potentially traumatic events in early childhood: Differential links to emergent psychopathology. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 51, 1132–1140. https://doi.org/10.1111/j.1469-7610.2010.02256.x.
Briggs-Gowan, M. J., Ford, J. D., Fraleigh, L., McCarthy, K., & Carter, A. S. (2010b). Prevalence of exposure to potentially traumatic events in a healthy birth cohort of very young children in the northeastern United States. Journal of Traumatic Stress, 23(6), 725–733. https://doi.org/10.1002/jts.20593.
Brown, T. H., Mellman, T. A., Alfano, C. A., & Weems, C. F. (2011). Sleep fears, sleep disturbance, and PTSD symptoms in minority youth exposed to hurricane Katrina. Journal of Traumatic Stress, 24, 575–580. https://doi.org/10.1002/jts.
Carrion, V. G., Weems, C. F., Ray, R., & Reiss, A. L. (2002). Toward an empirical definition of pediatric PTSD: The phenomenology of PTSD symptoms in youth. Journal of the Academy of Child and Adolescent Psychiatry, 41, 166-173. doi.org/10.1097/00004583-200202000-00010.
Chemtob, C. M., Nomura, Y., & Abramovitz, R. A. (2008). Impact of conjoined exposure to the world trade center attacks and to other traumatic events on the behavioral problems of preschool children. Archives of Pediatric Adolescent Medicine, 162, 126–133. https://doi.org/10.1001/archpediatrics.2007.36.
Chervin, R. D., Dillon, J. E., Archbold, K. H., & Ruzicka, D. L. (2003). Conduct problems and symptoms of sleep disorders in children. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 201–208. https://doi.org/10.1097/00004583-200302000-00014.
Conway, A., McDonough, S. C., MacKenziem, M. J., Follett, C., & Sameroff, A. (2013). Stress-related changes in toddlers and their mothers following the attack of September 11. American Journal of Orthopsychiatry, 83, 536–544. https://doi.org/10.1111/ajop.12055.
Coto, J., Garcia, A., Hart, K., & Graziano, P. A. (2018). Associations between disruptive behavior problems, parenting factors, and sleep problems among young children. Journal of Developmental and Behavioral Pediatrics, 39(8), 610–620. https://doi.org/10.1097/DBP.0000000000000595.
Crick, N. R., & Dodge, K. A. (1994). A review and reformulation of social information-processing mechanisms in children’s social adjustment. Psychological Bulletin, 115, 74–101. https://doi.org/10.1037/0033-2909.115.1.74.
Dawson, J. F., & Richter, A. W. (2006). Probing three-way interactions in moderated multiple regression: Development and application of a slope difference test. Journal of Applied Psychology, 91(4), 917–926. https://doi.org/10.1037/0021-9010.91.4.917.
de la Osa, N., Granero, R., Trepat, E., Domenech, J. M., & Ezpeleta, L. (2016). The discriminative capacity of CBCL/1½-5-DSM5 scales to identify disruptive and internalizing disorders in preschool children. European Child and Adolescent Psychiatry, 25, 17–23. https://doi.org/10.1007/s00787-015-0694-4.
DePrince, A. P., Weinzierl, K. M., & Combs, M. D. (2009). Executive function performance and trauma exposure in a community sample of children. Child Abuse & Neglect, 33, 353–361. https://doi.org/10.1016/j.chiabu.2008.08.002.
Fremont, W. P. (2004). Childhood reactions to terrorism-induced trauma: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 381–392. https://doi.org/10.1097/01.CHI.0000112484.08386.50.
Ghosh Ippen, C., Ford, J., Racusin, R., Acker, M., Bosquet, K., Rogers, C., & Edwards, J. (2002). Trauma events screening inventory-parent report revised. San Francisco, CA: The Child Trauma Research Project of the Early Trauma Network and the National Center for PTSD Dartmouth Child Trauma Research Group.
Ghosh Ippen, C., Harris, W. W., Van Horn, P., & Lieberman, A. F. (2011). Traumatic and stressful events in early childhood: Can treatment help those at highest risk? Child Abuse & Neglect, 35, 504–513. https://doi.org/10.1016/j.chiabu.2011.03.009.
Glaser, D. (2000). Child abuse and neglect and the brain – A review. Journal of Child Psychology and Psychiatry, 41, 97–116. https://doi.org/10.1017/S0021963099004990.
Harty, S., Miller, C. J., Newcorn, J. H., & Halperin, J. M. (2009). Adolescents with childhood ADHD and comorbid disruptive behavior disorders: Aggression, anger, and hostility. Child Psychiatry and Human Development, 40, 85–97. https://doi.org/10.1007/s10578-008-0110-0.
Holmes, C., Levy, M., Smith, A., Pinne, S., & Neese, P. (2015). A model for creating a supportive trauma-informed culture for children in preschool settings. Journal of Child and Family Studies, 24, 1650–1659. https://doi.org/10.1007/s10826-014-9968-6.
Insana, S. P., Foley, K. P., Montgomery-Downs, H. E., Kolko, D. J., & McNeil, C. B. (2014). Children exposed to intimate partner violence demonstrate disturbed sleep and impaired functional outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 6, 290–298. https://doi.org/10.1037/a0033108.
Jimenez, M. E., Wade, R., Lin, Y., Morrow, L. M., & Reichman, N. E. (2016). Adverse experiences in early childhood and kindergarten outcomes. Pediatrics, 137, e20151839. https://doi.org/10.1542/peds.2015-1839.
Jones, K., & Harrison, Y. (2001). Frontal lobe function, sleep loss, and fragmented sleep. Sleep Medicine Reviews, 5, 463–475. https://doi.org/10.1053/smrv.2001.0203.
Kamphuis, J., Meerlo, P., Koolhaas, J. M., & Lancel, M. (2012). Poor sleep as a potential causal factor in aggression and violence. Sleep Medicine, 13, 327–334. https://doi.org/10.1016/j.sleep.2011.12.006.
Kisiel, C., Fehrenbach, T., Liang, L., Stolbach, B., McClelland, G., Griffin, G.…& Spinazzola, J. (2014). Examining child sexual abuse in relation to complex patterns of trauma exposure: Findings from the National Child Traumatic Stress Network. Psychological Trauma: Theory, Research, Practice, and Policy, 6, S29-S39. doi: https://doi.org/10.1037/a0037812.
Klein, T. P., DeVoe, E. R., Miranda-Julian, C., & Linas, K. (2009). Young children’s responses to September 11th: The New York City experience. Infant Mental Health Journal, 30, 1–22. https://doi.org/10.1002/imhj.20200.
Kovachy, B., O’Hara, R., Hawkins, N., Gershon, A., Primeau, M., Madej, J…& Carrion, V. (2013). Sleep disturbance in pediatric PTSD: Current findings and future directions. Journal of Clinical Sleep Medicine, 9, 501–510. doi: https://doi.org/10.5664/jcsm.2678.
Lavigne, J. V., Arend, R., Rosenbaum, D., Smith, A., Weissbluth, M., Binns, H. J…& Christoffel, K. K. (1999). Sleep and behavior problems among preschoolers. Journal of Developmental and Behavioral Pediatrics, 20, 164–169. doi: https://doi.org/10.1097/00004703-1999060000-00005.
McKelvey, L. M., Selig, J. P., & Whiteside-Mansell, L. (2017). Foundations for screening adverse childhood experiences: Exploring patterns of exposure through infancy and toddlerhood. Child Abuse and Neglect, 70, 112–121. https://doi.org/10.1016/j.chiabu.2017.06.002.
Milot, T., Ethier, L. S., St-Laurent, D., & Provost, M. A. (2010). The role of trauma symptoms in the development of behavioral problems in maltreated preschoolers. Child Abuse & Neglect, 34, 225–234. https://doi.org/10.1016/j.chiabu.2009.07.006.
Noll, J. G., Trickett, P. K., Susman, E. J., & Putnam, F. W. (2006). Sleep disturbances and childhood sexual abuse. Journal of Pediatric Psychology, 31, 469–480. https://doi.org/10.1093/jpepsy/jsjo40.
O’Brien, R. M. (2007). A caution regarding rules of thumb for variance inflation factors. Quality and Quantity, 41(5), 673–690. https://doi.org/10.1007/s11135-006-9018-6.
Pedhazur, E. (1997). Multiple regression in behavioral research: Explanation and prediction (3rd ed.). New York, NY: Holt, Rinehart and Winston.
Perry, B. D. (2009). Examining child maltreatment through a neurodevelopmental lens: Clinical applications of the neurosequential model of therapeutics (NMT). Journal of Trauma and Loss, 14, 1–16. https://doi.org/10.1080/15325020903004350.
Preacher, K. J., Curran, P. J., & Bauer, D. J. (2006). Computational tools for probing interactions in multiple linear regression, multilevel modeling, and latent curve analysis. Journal of Educational and Behavioral Statistics, 31, 437–448. https://doi.org/10.3102/10769986031004437.
Reid, G. J., Hong, R. Y., & Wade, T. J. (2009). The relation between common sleep problems and emotional and behavioral problems among 2- and 3-year-olds in the context of known risk factors for psychopathology. Journal of Sleep Research, 18, 49–59. https://doi.org/10.1111/j.1365-2869.2008.00692.x.
Rafihi-Ferreira, R. E., Lewis, K. M., McFayden, T., & Ollendick, T. H. (2019). Predictors of nighttime fears and sleep problems in young children. Journal of Child and Family Studies, 28(4), 941–949. https://doi.org/10.1007/s10826-019-01332-9.
Roberts, Y. H., Ferguson, M., & Crusto, C. A. (2013). Exposure to traumatic events and health-related quality of life in preschool-aged children. Quality of Life Research, 22, 2159–2168. https://doi.org/10.1007/s11136-012-0330-4.
Scheeringa, M. S., & Zeanah, C. H. (2008). Reconsideration of harm’s way: Onsets and comorbidity patterns of disorders in preschool children and their caregivers following hurricane Katrina. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 508–518. https://doi.org/10.1080/15374410802148178.
Sloan, M., & Mann, S. (2016). Effects of war, terrorism and armed conflict on young children: A systematic review. Child Psychiatry & Human Development, 47, 950–965. https://doi.org/10.1007/s10578-016-0626-7.
Vitaro, F., Brendgen, M., & Barker, E. D. (2006). Subtypes of aggressive behaviors: A developmental perspective. International Journal of Behavioral Development, 30, 12–19. https://doi.org/10.1177/0165025406059968.
U.S. Department of Health and Human Services. (2020). Child maltreatment 2018. Washington, DC: U.S. Government Printing Office.
Wamser-Nanney, R., & Chesher, R. E. (2018). Presence of sleep disturbances among child trauma survivors: Comparison of caregiver and child reports. Journal of Child and Adolescent Trauma, 11, 391–399. https://doi.org/10.1007/s40653-017-0198-0.
Wittmann, L., Zehnder, D., Schredl, M., Jenni, O. G., & Landolt, M. A. (2010). Posttraumatic nightmares and psychopathology in children after road traffic accidents. Journal of Traumatic Stress, 23, 232–239. https://doi.org/10.1002/jts.20514.
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Mesman, G.R., John, S.G., Dougherty, E.H. et al. Sleep as a Moderator of Young Children’s Traumatic Stress and Behavior Problems: a Treatment-Referred Sample. Journ Child Adol Trauma 14, 311–319 (2021). https://doi.org/10.1007/s40653-020-00318-w
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DOI: https://doi.org/10.1007/s40653-020-00318-w