Sleep disorders are frequently associated with childhood behavioral problems and mental illnesses such as anxiety disorders. To identify promising behavioral targets for therapy of pediatric anxiety disorders, we investigated the associations between specific sleep and behavioral problems.
We conducted retrospective reviews of 105 patients aged 4-12 years who met the DSM-IV criteria for primary diagnosis of generalized anxiety disorder (GAD; n = 33), separation anxiety disorder (SAD;n = 23), social phobia (SP; n = 21), or obsessive-compulsive disorder (OCD;n = 28). Sleep problems were evaluated using the Children's Sleep Habits Questionnaire (CSHQ) and behavioral problems by the Spence Children's Anxiety Scale (SCAS), Oppositional Defiant Behavior Inventory (ODBI), and Depression Self-Rating Scale for Children (DSRS-C).
Depressive behavior was weakly correlated with CSHQ subscores for sleep onset delay and night waking but not with total sleep disturbance. Anxiety was correlated with bedtime resistance, night waking, and total sleep disturbance score. Oppositional defiance was correlated with bedtime resistance, day time sleepiness, sleep onset delay,and most strongly with total sleep disturbance.Multiple regression analyses revealed that OBDI score had the strongest positive association with total sleep disturbance and the strongest negative association with total sleep duration.
Sleep problems in children with anxiety disorders are closely related to anxiety and oppositional defiant symptoms.