Predictors and correlates of sleep-related problems in anxious youth
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Abstract
Anxiety disorders constitute the most common and debilitating mental health disturbance experienced by youth today. Sleep-related problems (SRPs) are highly prevalent among anxious youth and encompass a variety of problems including nighttime fears, insomnia, and refusal to sleep alone. Sleep problems and anxiety have been proposed to have a reciprocal relationship, whereby disturbed sleep increases a child's vulnerability to developing anxiety, and increased anxiety then interferes with sleep. Given that chronic sleep disturbance is associated with a range of behavioral and physical problems in youth and predicts future psychopathology, it is important to elucidate the nature of sleep problems in anxious youth.
The present study investigated the relationship between sleep and anxiety utilizing a sample of 101 youth, ages 6-17, with a primary anxiety disorder. Families completed a structured diagnostic interview and self-report questionnaires about child anxiety and mood symptoms, behavior problems, parent psychopathology, and family functioning. Parents also completed the Children's Sleep Habits Questionnaire (CSHQ), a measure designed to assess children's sleep habits and problems. The CSHQ covers a range of SRPs in various domains, including bedtime resistance, sleep onset latency, sleep anxiety, night wakings, parasornnias, and daytime sleepiness. Total scores of 41 or greater on the CSHQ are indicative of clinical sleep disturbance.
Statistical analyses were conducted to examine the data for differences across demographic and diagnostic variables, using chi-square tests for categorical and t-tests for continuous variables. Hierarchical linear regressions were also performed to determine the unique and linear contributions of child and family characteristics on SRPs.
Findings revealed that SRPs were highly prevalent across all anxious youth, but the nature of these problems varied by diagnosis. SRPs also differed as a function of age, with younger children experiencing greater nighttime difficulties and adolescents struggling with more daytime sleepiness. Certain child characteristics, including heightened anxiety sensitivity and severity of depressive symptoms, were found to predict greater SRPs. Several family factors, including impaired family functioning, maternal psychopathology, and parental intrusiveness, were also found to predict SRPs. Taken together, results of the present study suggest that sleep difficulties are widespread among anxious youth and walTant greater research and clinical attention.
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Thesis (Ph.D.)--Boston University
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