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

The contribution of sleep problems to emotional and behavioral problems among young children within the context of known risk factors for psychopathology was examined. Data on 2- and 3-year-olds, representative of Canadian children without a chronic illness, from three cross-sectional cohorts of the Canadian National Longitudinal Study of Child and Youth were analysed (n = 2996, 2822, and 3050). The person most knowledgeable (PMK), usually the mother, provided information about her child, herself, and her family. Predictors included: child health status and temperament; parenting and PMK depressive symptomatology; family demographics (e.g., marital status, income) and functioning. Child sleep problems included night waking and bedtime resistance. Both internalizing/emotional (i.e., anxiety) and externalizing/behavioral problems (i.e., hyperactivity, aggression) were examined. Adjusting for other known risk factors, child sleep problems accounted for a small, but significant, independent proportion of the variance in internalizing and externalizing problems. Structural equation models examining the pathways linking risk factors to sleep problems and emotional and behavioral problems were a good fit of the data. Results were replicated on two additional cross-sectional samples. The relation between sleep problems and emotional and behavioral problems is independent of other commonly identified risk factors. Among young children, sleep problems are as strong a correlate of child emotional and behavioral problems as PMK depressive symptomatology, a well-established risk factor for child psychopathology. Adverse parenting and PMK symptomatology, along with difficult temperament all contribute to both sleep problems and emotional and behavioral problems. Children's sleep problems appear to exacerbate emotional and behavioral problems.