Int.J. Behav. Med.
(2010) 17:298–305
DOI 10.1007/s12529-009-9065-1
Sleep Duration and Regularity are Associated
with Behavioral Problems in 8-year-old Children
Anu-Katriina Pesonen & Katri Räikkönen & E. Juulia Paavonen & Kati Heinonen &
Niina Komsi & Jari Lahti & Eero Kajantie & Anna-Liisa Järvenpää & Timo Strandberg
Published online: 21 October 2009
# International Society of Behavioral Medicine 2009
Abstract
Background Relatively little is known about the signifi-
cance of normal variation in objectively assessed sleep
duration and its regularity in children's psychological
well-being.
Purpose We explored the associations between sleep
duration and regularity and behavioral and emotional
problems in 8-year-old children.
Methods A correlational design was applied among an
epidemiological sample of children born in 1998. Sleep was
registered with an actigraph for seven nights (range 3 to 14)
Sponsored by grants from Signe and Ane Gyllenberg Foundation, the
Academy of Finland, the Juho Vainio Foundation, the John D. and
Catherine T. MacArthur Foundation, and the Yrjö Jahnsson Foundation.
A.-K. Pesonen (*)
Department of Psychology and Institute of Clinical Medicine,
University of Helsinki,
P.O. Box 9, Helsinki 00014, Finland
e-mail: anukatriina.pesonen@helsinki.fi
K. Räikkönen : K. Heinonen : N. Komsi : J. Lahti
Department of Psychology, University of Helsinki,
Helsinki, Finland
E. J. Paavonen : E. Kajantie
National Institute for Health and Welfare,
Helsinki, Finland
A.-L. Järvenpää
Hospital for Children and Adolescents, University of Helsinki,
Helsinki, Finland
T. Strandberg
Department of Health Sciences/Geriatrics,
Unit of General Practice,
University of Oulu and Oulu University Hospital,
Oulu, Finland
E. Kajantie
Hospital for Children and Adolescents,
Helsinki University Central Hospital and University of Helsinki,
Helsinki, Finland
in 2006. Mothers (n=280) and fathers (n=190) rated their
child's behavioral problems with the Child Behavior
Checklist.
Results Children with short sleep duration had an increased
risk for behavioral problems, thought problems, and
Diagnostic and Statistical Manual of Mental Disorders,
4th Edition-based attention-deficit hyperactivity problems
according to maternal ratings. Based on paternal ratings,
short sleep duration was associated with more rule-breaking
and externalizing symptoms. Irregularity in sleep duration
from weekdays to weekends was associated with an
increased risk for specifically internalizing symptoms in
paternal ratings.
Conclusions The results highlight the importance of suffi-
cient sleep duration and regular sleep patterns from
weekdays to weekends. Short sleep duration was associated
specifically with problems related to attentional control and
externalizing behaviors, whereas irregularity in sleep
duration was, in particular, associated with internalizing
problems.
Keywords Actigraphy . ADHD . Behavioral problems .
Epidemiological study . Sleep
Introduction
Insufficient sleep duration in children, assessed generally
either by self-reports or by parents, is associated with
increased psychiatric morbidity in both epidemiological and
clinical studies [1–6]. However, relatively little is known
about the significance of normal variation in objectively
assessed sleep duration and its regularity in relation to
children's psychological well-being, and the findings are
inconsistent.
Epidemiological evidence based on objective assessment
by actigraphy has shown that shorter sleep duration and
poorer sleep quality, a latent factor composed of sleep
Int.J. Behav. Med. (2010) 17:298–305
duration, sleep efficiency, and sleep latency, is associated
with more internalizing and externalizing symptoms [7],
and with more depressive symptoms as self-rated by 8- to
9-year-old children [8]. Similar results have been provided
by Sadeh et al. [9] for children aged 7–13 years. However,
a study among 7-year-old children found no associations
between short sleep duration (tenth percentile, <9 h) and
child behavioral problems as rated by parents or teachers
[10], and one study showed that shorter sleep duration was
associated only with teacher-rated, but not with parent-
rated, internalizing and externalizing symptoms among
children aged 7–12 years [11]. Recent clinical evidence
based on polysomnography of 3–18-year-old children with
sleep-disordered breathing has revealed that short sleep,
based on a one-night assessment and defined as the tenth
percentile for reported norms by age (<9 h for children aged
6-12.9 years [12]), is associated with higher externalizing
concerns and with a significant increase in the diagnosis of
attention-deficit-hyperactivity-disorder (ADHD) [13]. The
ADHD finding is similar to what we have reported in
8-year-old children using actigraphs [14].
Methodological differences in the abovementioned stud-
ies may have contributed to the mixed results, e.g., an
actigraph worn for only one night on the waist [10] versus
an actigraph worn for 4-7 days on the wrist [7–9, 11, 14].
Further, except for two studies [9, 10], very little attention
has been paid to differences in sleep duration between
weekends and weekdays, and to the regularity of sleep
duration. Accordingly, we studied associations between
actigraphy measurements of sleep duration and child
behavioral problems in 8-year-old children by focusing on
average sleep durations during weekdays and weekends.
We hypothesized that shorter sleep duration, especially on
weekdays, would be associated with increased behavioral
problems. In addition, prior evidence links irregularity in
sleep duration with adverse effects on adolescent well-
being [15]. However, it is not known whether there are
significant sleep irregularity already in 8-year-old children,
and whether this is associated with worse behavioral
outcomes. We thus explored whether irregular sleep
duration is associated with increased behavioral problems.
We defined irregular sleep in two different ways, the first
based on the variation in sleep duration and the second on
the variation of waking and bedtimes from weekdays to
weekends.
Methods
Participants
The children came from an urban cohort comprising 1,049
infants born between March and November 1998 [16], In
299
2006, the families were invited to participate in a follow-up
study focusing on physical and psychological development.
Altogether, 912 (86.9% of the initial cohort) gave permis-
sion to be included in the follow-up, and of these, 890
(84.8% of initial cohort) were traced. Since one of the
initial study objectives was to assess how maternal licorice
consumption during pregnancy affects gestational length
and child development [16], the invited sample was
weighted upon maternal licorice consumption during
pregnancy. We invited all 88 children belonging to the
group that was prenatally exposed to high levels of
glycyrrhizin in licorice; 64 participated. The other invited
children had to live within a 35-mile radius from Helsinki,
the capital of Finland, to manage costs related to participant
and researcher travel and accommodation. Of the 271
children exposed to no or low glycyrrhizin who were
invited, 211 participated. Fifty-four children exposed to
moderate glycyrrhizin were invited, and 46 participated.
Non-participation was not related to child's gender, weight,
length, or head circumference at birth, birth order, mode of
delivery, mother's occupational status, age, body mass
index (BMI), or alcohol consumption, maternal licorice
consumption, or stress during pregnancy (p values>0.10);
non-participation was however, related to more frequent
maternal smoking during pregnancy (p=0.02). The Ethics
Committees of the City of Helsinki Health Department and
Helsinki University Hospital of Children and Adolescents
approved the study protocol. Each child and her/his parent
gave written informed consent.
Of the 321 families who participated in the follow-up,
there were 305 actigraphy records, of which 291 (91%)
were valid. Moreover, 306 children had maternal and 226
children paternal ratings of child behavioral problems
available. We excluded four children from the analyses
because of a parent-reported diagnosis of developmental
delay (n=3) or Asperger syndrome (n=1), and 17 father-
ratings because the father did not live in the same
household as his child. Complete data, including both sleep
and behavioral assessments, were available from 280
mothers and 190 fathers.
Sleep
Sleep was objectively measured using actigraphs (Acti-
watch AW4, Cambridge Neurotechnology Ltd., UK). The
devices were worn on the non-dominant wrist for an
average of 7.1 days (SD=1.2; range 3–14), including nights
on weekdays (M=5.1, SD=1.0; range 1–10) and weekends
(M=2.0, SD=0.4; range 1–4). Data were scored with
Actiwatch Activity and Sleep Analysis software (version
5) with medium sensitivity and a 1-min epoch duration. We
instructed the parents to keep a sleep log on bed- and
waking times, temporary pauses in actigraph registration
300
(e.g., while taking a shower), and significant events that
might affect sleep quantity or quality (illness, pain, injury,
travel, or other events likely to disturb sleep). The child was
instructed to press a button (event marker) in the actigraph
at bed- and waking times. A completed sleep log was
obtained from all participants, including both parent-
reported sleep log and event markers on bed- and waking
times by the child. The activity data were visually inspected
to detect significant discrepancies between the sleep log,
event markers, and the activity pattern. If there were several
event markers for one night, the most recent was used and
compared with the sleep log. If the sleep log was not
synchronous with the event marker, the event marker was
used to define the bedtime. We found high compliance in
the sleep log registrations in relation to the event markers;
for 71% of the participants, no discrepancies were found,
for 21%, a discrepancy was found for one or two nights,
and for 8%, a discrepancy was found for three or more
nights. Nights were excluded from further sleep analysis if
(a) the actigraph was not in use, (b) information on
bedtimes was missing, (c) the child was asleep according
to the data of reported bedtime, (d) information on waking
time was missing and the activity pattern was not
unequivocally interpretable, or (e) parent reported a change
in normal life due to, for example, illness or travel. Sleep
duration refers to actual sleep time and was analyzed as
both a continuous and a dichotomous variable; following
the lead of other studies, [10, 13] the tenth percentile was
used as the cutoff for short sleep (short sleep: ≤7.7 h/mean
of all nights; ≤7.6 h/mean of weekdays; and ≤7.5 h/mean of
weekends). Since some children slept longer on weekdays
(the nights following Monday to Friday evenings) and
some on weekends, the weekday-to-weekend irregularity in
sleep duration was calculated as the absolute value of the
difference in sleep duration on weekdays and weekends.
Similarly, the irregularity in waking and bedtimes was
calculated as the absolute value of the difference between
the weekday and weekend nights.
Behavioral Problems
Mothers and fathers independently completed the Child
Behavior Checklist 4–18 (CBCL) [17]. The scale
contains 120 symptom items assessed on a three-point
scale ("not true", "somewhat true", and "often true"). We
used the Achenbach software to obtain age- and sex-
adjusted T-values for the eight narrowband and three
broadband scales. In addition, we used six Diagnostic and
Statistical Manual of Mental Disorders (DSM)-oriented
scales (DOS) aimed at covering common childhood
mental disorders [18, 19]. The DOS are based upon 22
clinicians' ratings on the degree of consistency of CBCL
items with corresponding DSM-IV criteria; items that
Int.J. Behav. Med. (2010) 17:298–305
were considered "very consistent" by at least 64% of the
clinicians were then grouped into six separate DOS
(affective problems, anxiety problems, somatic problems,
attention-deficit/hyperactivity problems, oppositional de-
fiant problems, and conduct problems). In addition to
treating the broadband scales and the DOS as continuous,
we used cutoffs at the 82nd percentile [17] for all scales to
indicate clinical problems (0= no problem, 1 =clinical
problem). This cutoff has been reported to provide the
most efficient discrimination of behavioral problems in
normative samples [17].
Statistical Analyses
We used linear regression models to examine associations
between sleep duration (all nights, weekdays, and week-
ends as continuous), weekday-to-weekend irregularity in
sleep duration and in waking and bedtimes, and mother-
and father-rated continuous broadband behavioral prob-
lems, which were log-transformed to attain normality. Next,
we applied binary logistic regression models to examine
associations between sleep duration (all nights, weekdays,
and weekends as continuous and dichotomous) and
clinically significant broadband and DOS-based symptoms.
To avoid multiple testing, we analyzed narrowband sub-
scales only if there was a statistically significant association
in the broadband scales. We adjusted for child gender, age
at testing, a history of chronic neuropsychiatric or somatic
illnesses (dysphasia, atopic eczema, and asthma), parental
level of education (highest of either parent), and maternal
licorice consumption in all analyses.
Results
Initial Analyses
Characteristics of the sample are presented in Table 1. Boys
had shorter sleep duration, and they woke up earlier during
weekends than girls did. Boys exhibited significantly more
broadband symptoms than girls, as indicated by both
informants. Relative to the fathers, the mothers rated their
children as having significantly more symptoms within
each of the scales except for symptoms of ADHD (Table 2).
The correlations between maternal and paternal ratings
were 0.23, 0.21, and 0.27 for internalizing, externalizing,
and total scores, respectively (p for all <0.01). Children
with only father-ratings available did not differ from the
entire sample in the maternal ratings of the broadband
scales (all p values>0.11). The proportions of the children
within the 82nd percentile who had a T-score >63,
indicating a more serious problem [17], were 31% maternal
and 19% in paternal ratings.
Int.J. Behav. Med. (2010) 17:298–305 301

Table 1 Characteristics of the participants and sleep variables

Girls N=145 Boys N=135 P

Mean (SD) N (%) Mean (SD) N (%)

Child
Age (years) 8.1 (0.3) 8.2 (0.3) .06
Weight (kg) 28.4 (5.2) 29.0 (5.6) .34
Height (cm) 130.4 (5.3) 131.9 (5.9) .03
Body mass index (kg/m2) 16.7 (2.2) 16.7 (2.2) .99
Parent-reported history of medical diagnoses by a physician
Asthma 6 (4.2) 11 (8.2) .13
Allergic rhinitis 12 (8.4) 13 (9.5) .83
Atopic eczema 15 (10.6) 20 (14.8) .20
Other allergic symptoms 21 (14.9) 26 (20) .18
Dysphasia 1 (0.7) 3 (2.1) .29
Parent
Highest education of two
High school diploma 15 (10.3) 22 (16.3) .14
Vocational education 47 (32.4) 29 (21.5)
Bachelor's degree 22 (15.2) 20 (14.8)
Master's degree 61 (42.1) 64 (47.4)
Child's sleep duration measured by actigraphy (decimal hours)
Weekdays 8.5 (.69) 8.3 (.66) .002
Weekends 8.6 (.74) 8.3 (.73) .002
Average 8.5 (.65) 8.3 (.63) .001
Absolute difference in sleep duration between weekdays and weekends 0.5 (0.4) 0.5 (0.4) .78
Child's waking and bedtimes (hours:minutes)
Waking time on weekdays 7:24 (0:37) 7:17 (0:34) .11
Waking time on weekends 7:56 (0:42) 7:44 (0:49) .03
Bed time on weekdays 21:21 (0:39) 21:18 (0:42) .52
Bed time on weekends 21:52 (0:41) 21:50 (0:57) .81
Absolute value of the difference in waking times between weekdays and weekends 0:41 (0:28) 0:34 (0:30) .07
(hours)
Absolute value of the difference in bed times between weekdays and weekends (hours) 0:37 (0:29) 0:37 (0:31) .95

Next, we tested whether any of the background
variables (maternal licorice consumption during pregnan-
cy, current BMI, parental educational attainment, child
age, dysphasia, atopic eczema, and asthma) were signif-
icantly associated with the continuous sleep duration over
all nights. We found that children with a history of atopic
eczema had shorter sleep duration (MD=0.3 h, 95% CI
0.1 to 0.6, p=0.006) than children without such a history.
Similarly, children with a history of asthma had shorter
sleep duration than asthma-free children. (MD=0.4 h, 95 CI
0.1 to 0.7, p=0.02). No other significant associations
emerged.
We found normal distributions for variables measuring
irregular sleep. Some children slept longer, and some shorter
on weekdays relative to weekend nights. Similarly, some
children went to bed or woke up later during weekdays, some
earlier during weekdays relative to weekend nights/mornings.
The range of the values of absolute difference between the
sleep durations, waking, and bedtimes varied from 0 to 1.9,
2.5, and 2.3 h, respectively.
Relationships Between the Sleep Variables
Out of the 26 children belonging to the category of short
sleepers on weekdays (<10th percentile, 7.6 h), only ten
(38%) belonged to the category of short sleepers assessed
on the basis of weekend nights (χ2=26.6, p<0.001; <10th
percentile, 7.5 h). Table 3 shows the unadjusted correlations
between the sleep variables. We found high correlations
between waking and bedtimes during weekdays and
weekends and across the week, and between sleep durations
during weekdays and weekends. Shorter sleep duration at
both weekday and weekend nights was associated with later
bedtimes only on weekends. Similarly, irregularity in sleep
302 Int.J. Behav. Med. (2010) 17:298–305

Table 2 Descriptive statistics of behavioral problems

Maternal rating N=280 Paternal rating N=190

Girls N=145 Boys N=135 Girls N=113 Boys N=94

Mean (SD) Mean (SD) P Mean (SD) Mean (SD) P P1

CBCL broadband scales

Internalizing 49.4 (9.0) 53.2 (10.0) .001 45.9 (7.9) 48.6 (9.6) .03 <.001
Externalizing 49.7 (7.7) 51.9 (9.2) .03 46.4 (8.4) 49.0 (9.8) .05 .001
Total problems 48.4 (8.6) 51.5 (9.2) .004 44.3 (9.0) 47.1 (10.9) .05 <.001
CBCL DOS scales
Affective disorder 54.6 (5.3) 56.2 (6.6) .03 53.2 (5.5) 54.0 (5.5) .35 .006
Anxiety disorder 52.7 (4.4) 53.2 (5.1) .40 51.8 (3.4) 52.5 (4.6) .28 .05
Somatic problems 55.7 (6.1) 56.3 (6.7) .49 53.6 (4.9) 53.8 (4.9) .78 <.001
ADHD 52.7 (4.4) 53.2 (4.7) .46 51.7 (3.1) 52.4 (4.1) .19 .16
Oppositional defiant disorder 53.9 (4.3) 55.9 (5.6) .001 52.9 (4.3) 54.5 (5.4) .02 .05
Conduct disorder 52.9 (5.1) 54.5 (5.9) .02 51.6 (3.5) 53.4 (5.2) .003 .05

P1 p value of paired t test between maternal and paternal ratings, both genders included, CBCL Child Behavior Checklist, DOS DSM-oriented
symptom scales, ADHD symptoms of attention deficit hyperactivity disorder

duration was associated to later waking and bedtimes only
on weekends. Irregularity in sleep duration was correlated
only modestly with irregularity in waking and bedtimes
(p values<.25).
Sleep Duration and Maternal Ratings of Child Behavioral
Problems
Sleep duration as a continuous variable (all nights,
weekdays, and weekends) was not significantly associat-
ed with any of the continuous broadband scores in
maternal ratings (all p values>0.16). Table 4 on the
dichotomous analyses shows that children who had a short
sleep duration over all nights were 2.6-fold more likely to
have a clinically significant total problems score and 3.9-
fold more likely to have DOS-based attention-deficit/
hyperactivity problems. We then analyzed the narrowband
scales and found that the odds ratios were significant for
attention problems (OR 3.3; 95% CI 1.2 to 8.8, p=0.02)
and thought problems (OR 4.0; 95% CI 1.6 to 10.1,
p=0.003). These odds ratios held essentially the same
when using the sleep duration on weekdays. Weekday to
weekend irregularities in sleep duration or in waking or
bedtimes were not associated with mother-rated child

Table 3 Correlations of the sleep variables

Waking Waking Bedtime Bedtime Irregularity in Irregularity Sleep Sleep

time time weekdays weekends waking times in bedtimes duration duration
weekdays weekends weekdays weekends

Waking time .61***

weekends
Bedtime .72*** .64***
weekdays
Bedtime .50*** .58*** :70***
weekends
Irregularity in −.09 .60*** .14* .32***
waking times
Irregularity in −.02 .28*** .56*** .56*** .33***
bedtimes
Sleep duration .13 −.11 −.11 −.31*** −.22* .07
weekdays
Sleep duration .05 .20*** −.11 −.31*** .17** −.22*** .64***
weekends
Irregularity in .01 .13* .08 .13* .25*** .21*** −.01 .01
sleep
duration

***p<.001, **p<.01, *p<.05, all associations are unadjusted

Int.J. Behav. Med. (2010) 17:298–305 303

Table 4 Logistic regressions between short sleep duration and behavioral problems (clinical vs. non-clinical)

Sleep duration on all nights (<10th Sleep duration on weekdays Sleep duration on weekends
vs.≥10th percentile) (<10th vs.≥10th percentile) (<10th vs.≥10th percentile)

Odds ratio (95% CI) P Odds ratio (95% CI) P Odds ratio (95% CI) P

Mother CBCL broadband scales

Internalizing 1.6 (0.6 to 4.5) .34 1.9 (0.7 to 4.9) .20 0.4 (0.1 to 1.6) .18
Externalizing 1.8 (0.7 to 4.9) .26 1.5 (0.6 to 4.2) .41 0.8 (0.3 to 2.4) .66
Total problems 2.6 (1.0 to 6.6) .04 2.8 (1.1 to 6.8) .03 0.7 (0.2 to 2.2) .55
Affective disorder 1.5 (0.6 to 4.1) .44 1.7 (0.7 to 4.4) .27 0.7 (0.2 to 2.2) .55
Mother CBCL DOS-scales
Anxiety disorder 1.2 (0.4 to 3.7) .77 1.0 (0.3 to 3.4) .89 0.4 (0.1 to 1.8) .24
Somatic problems 1.7 (0.6 to 4.8) .37 1.4 (0.5 to 4.2) .52 0.6 (0.2 to 2.1) .41
ADHD 3.9 (1.5 to 9.9) .004 2.7 (1.1 to 6.9) .04 1.4 (0.5 to 3.7) .51
Oppositional defiant disorder 2.1 (0.8 to 6.0) .15 1.3 (0.5 to 3.9) .62 0.9 (0.3 to 2.9) .86
Conduct disorder 2.1 (0.8 to 5.5) .14 1.8 (0.7 to 4.6) .25 0.9 (0.3 to 2.6) .87
Father CBCL broadband scales
Internalizing 1.4 (0.4 to 4.9) .58 1.3 (0.4 to 4.4) .69 1.5 (0.5 to 4.7) .49
Externalizing 1.9 (0.6 to 6.3) .31 0.9 (0.2 to 3.2) .79 2.9 (1.0 to 8.0) .05
Total problems 1.5 (0.4 to 5.1) .51 0.9 (0.2 to 3.7) .91 2.5 (0.9 to 6.7) .08
Father CBCL DOS-scales
Affective disorder 1.9 (0.6 to 6.3) .31 1.9 (0.5 to 6.3) .32 2.5 (0.9 to 7.3) .09
Anxiety disorder 0.5 (0.1 to 2.5) .43 0.2 (0.0 to 1.9) .35 0.7 (0.2 to 2.6) .60
Somatic problems 1.0 (0.3 to 3.7) .98 1.4 (0.4 to 4.8) .55 0.6 (0.2 to 2.2) .60
ADHD 1.7 (0.5 to 5.6) .40 1.0 (0.3 to 4.0) 1.0 2.0 (0.7 to 6.3) .22
Oppositional defiant disorder 0.9 (0.2 to 3.4) .87 0.8 (0.2 to 3.2) .80 2.7 (1.0 to 7.7) .06
Conduct disorder 1.3 (0.4 to 4.3) .71 1.2 (0.3 to 4.2) .77 2.4 (0.8 to 7.0) .10

The associations are adjusted for child gender, age at testing, a history of chronic neuropsychiatric or somatic illnesses (dysphasia, atopic eczema,
and asthma), parental level of education (highest of either parent), and maternal licorice consumption
95% CI 95% confidence interval, CBCL Child Behavior Checklist, DOS DSM-oriented symptom scales, ADHD symptoms of attention deficit
hyperactivity disorder

behavioral problems (all p values>0.17, >.62, and >.44,
respectively).
Sleep Duration and Paternal Ratings of Child Behavioral
Problems
In paternal ratings, the child's sleep duration analyzed as a
continuous variable (all nights, weekdays, and weekends)
was not related to any of the continuous broadband scores
(all p values>0.08). Table 4 on the dichotomous analyses
shows that short sleep duration on weekends was associated
with a 2.9-fold risk of a clinically significant externalizing
score. In analyzing the narrowband scales, we found that
short sleep duration on weekends was associated with
significantly higher odds ratios for rule-breaking behavior
(OR=3.9, 95% CI 1.1 to 12.4, p=0.04).
Increase of one standard deviation in weekday-to-
weekend irregularity in sleep duration was associated with
a 0.2 standard deviation (SD) increase in total problem
score (95% CI 0.0 to 0.3, p=0.03) and a 0.2 SD increase in
internalizing (95% CI 0.0 to 0.4, p=0.01) score. Irregularity
in waking or bedtimes was not associated with behavior
problems (all p values>.59 for irregularity in waking and
>.12 for bedtimes). We also examined whether the effect of
irregularity in sleep duration on behavior problems held
when adjusting for bedtimes on weekdays and weekends,
and found only a slight increase in the p values (B=0.2,
95% CI 0.0 to 0.3, p=0.05 for total and B=0.2 95% CI 0.0
to 0.4, p=0.02 for internalizing score).
Discussion
This study is among the few epidemiological studies that
have investigated the significance of objectively assessed
sleep duration in child behavioral problems. We also
304
explored whether irregularity in sleep duration or in waking
and bedtimes can be found among 8-year-olds and whether
it is associated with child behavior problems.
We found no associations between continuous measures
of average sleep duration, during either weekdays or
weekends and child behavioral problems. Our findings
parallel earlier observations in an epidemiological sample
[7] and also observations in a clinic-based sample of 5–11-
year-old children [20]. However, we found that among
those children who on average slept less than 7.7 h per
night, corresponding to the generally used tenth percentile
threshold for short sleep [10, 13], the risks for mother-rated,
clinically significant total problem scores, thought prob-
lems, and DSM-IV-based ADHD symptoms were 2.8- to
4.5-fold higher than in children with longer sleep duration.
Further analyses showed that short sleep, especially during
weekdays (<7.6 h per night), accounted for these results.
We also found that the short sleep duration on weekends
(<7.5 h per night) was associated with a 2.9- to 3.9-fold
increased risk for father-assessed rule-breaking behavior
and externalizing symptoms. Importantly, these associations
did not cover several behavioral problems, but were limited
to problems related to attentional control and externalizing
behaviors.
Previous actigraphy- or polysomnography-based studies
have applied the tenth percentile as the cutoff for short
sleep. While Nixon et al. [10] found no associations
between short sleep and child attentional functioning or
externalizing symptoms, they did report more emotional
lability among children with short sleep. Consistent with
our study, Owens et al. [13] described associations between
short sleep and higher externalizing symptoms and a
significant increase in the rates of ADHD diagnosis.
However, significant differences exist between the studies;
both earlier studies were based only on a one-night
assessment, and their tenth cutoff was considerably higher
(<9 h) than ours (<7.7 h). The present results also
complement our previous findings by showing that the
associations of short sleep duration are not restricted to
symptoms of ADHD, but cover a broader spectrum of
externalizing problems [14].
Our results parallel also the few earlier experimental
studies in children showing that experimentally induced
sleep deprivation hampers attentional functioning, specifi-
cally manifesting as increased inattentiveness during the
following days [21, 22]. Although our study was correla-
tional, the findings may imply that children with short sleep
duration on average suffer from long-term sleep insuffi-
ciency. In support of this hypothesis, longitudinal evidence
suggests that a tendency to have short sleep assessed by
parents of 4–19-year-old-children, predicts higher scores on
self-reported anxious/depressed behavior, aggressive be-
havior, and attentional problems 14 years later [23].
Int.J. Behav. Med. (2010) 17:298–305
Touchette et al. [24] have elucidated the developmental
significance of sleep duration on child development. They
identified two sleep duration patterns of short sleep (short
persistent and short increasing) based on yearly parental
reports of sleep duration of children aged 2–6 years. Results
indicated that both of these profiles, i.e., children with
persistently short sleep duration and children with an
increasing trend towards shorter sleep had heightened risks
for hyperactivity-impulsivity compared with persistently
long sleepers.
We also observed normally distributed variation in
irregularity of sleep duration from weekends to weekends
and found that this irregularity is associated with
increased internalizing and total problem scores. Impor-
tantly, we did not observe any effects of irregularity due
to varying waking or bedtimes on behavioral problems.
Similar evidence, based on objective sleep measures, is
not available. Prior evidence does show, however, that
irregular sleep patterns are likely to develop towards
adolescence, with a marked shift in later bedtime with
increasing age. Longer sleep duration on weekends
relative to weekdays has been found to emerge from
the age of nine onwards [25]. We did not observe longer
sleep durations on average on weekends over weekdays
among these 8-year-olds. Yet, some individual 8-year-old
children had a sizable irregularity in their sleep patterns,
which impacted on their behavior. Our results are in line
with studies in adults and adolescents [15, 26, 27]
showing that irregular sleep patterns, whether assessed
objectively or by self-reports, are associated with a
heightened risk for psychiatric morbidity.
Our study is based on a large epidemiological dataset,
and we relied solely on objective sleep parameters which
increases the validity of this study relative to studies relying
only on parental reports [28]. However, some limitations
should be considered. First, some evidence suggests that
seven nights are required to gather valid data on sleep
duration [29]. While we had seven nights on average, the
analyses based on weekdays and weekends separately
consisted of fewer nights. Second, although we had two
informants on child behavioral problems, we did not find
associations to be consistent across informants. A potential
explanation for this may be the uneven sample sizes across
maternal and paternal data, the highest statistical power
being in maternal ratings. The fathers also reported
significantly less problems than the mothers did, which fits
the evidence showing that low agreement between different
informants regarding psychopathology in children is the
rule rather than the exception [30]. This gap has been
shown to indicate situation-specific behavior of the child,
i.e. child behavior is different across interaction partners
and settings, rather than measurement error [30, 31].
Despite the inconsistencies, reports of each parent have
Int.J. Behav. Med. (2010) 17:298–305
shown to have considerable predictive validity from
childhood to adulthood [32].
In summary, short sleep duration and irregularity in its
duration from weekdays to weekends is associated with
increased behavioral problems in 8-year-old-children. This
cross-sectional study does not prove causality. Further
studies are needed to elucidate the potential mechanisms
by which short sleep of irregularity in sleep duration
contributes to development of clinically significant be-
havior problems.
Conflicts of Interest None.
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