Bidirectional associations between child sleep problems and internalizing and externalizing difficulties from preschool to early adolescence

Abstract

IMPORTANCE Although multiple cross-sectional and longitudinal studies have established that sleep problems and behavioral difficulties are associated in children, the directionality of this association and whether sleep problems are differentially associated with different types of childhood behavioral difficulties are unclear. Understanding these associations will inform the focus and timing of interventions. OBJECTIVE To determine whether longitudinal and reciprocal associations exist between child sleep problems and externalizing, internalizing, or both behavioral difficulties. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study using nationally representative data from the first 5..