Sleep and behavioural problems associate with low mood in Finnish children aged 4-12 years: an epidemiological study.

BACKGROUND: Few studies have examined the associations between sleep, mood and behaviour in young children in the early stages of developing psychopathology. The purpose here was to examine the association of emotional problems, especially mood, with family and child characteristics, sleep and behavioural problems in 4-12 year-old children. METHODS: The sample was population-based and included 1714 children. Parents filled in the Strengths and Difficulties Questionnaire and a background questionnaire on child and family characteristics. The associations between (a) emotional symptoms/mood and background variables, (b) emotional problems and conduct problems/hyperactivity and (c) mood and conduct problems/hyperactivity were examined with ordinal regression in univariate and multivariate models. RESULTS: Of the background variables, child's sleeping problems had the most powerful association with emotional symptoms and mood. Abnormal emotional problems score and emotional symptoms were associated with abnormal conduct problems and hyperactivity scores. Of the emotional symptoms, low mood was the one associated most strongly with conduct problems and hyperactivity after controlling for all significant background variables and other emotional symptoms. CONCLUSIONS: We conclude that in young children sleep problems associate with low mood. Low mood associates with behavioural problems. When a child presents with low mood or behavioural problems, a comprehensive assessment of their psychiatric symptoms, as well as their sleep problems, is recommended.

Psychosocial and somatic outcomes of sleep problems in children: a 4-year follow-up study.

BACKGROUND: Inadequate sleep in children relates to medical and psychosocial problems. However, not much is known about the effects of sleep problems persisting from pre-school to school age on somatic and psychosocial symptoms. OBJECTIVES: To examine the associations between sleep disturbances and psychosocial symptoms, somatic complaints, medical problems at school age. METHODS: This was a population-based 4-year follow-up study of sleep problems in Finnish children (n = 470). Parents filled in Sleep Disturbance Scale for Children during pre-school and school years. Children were categorized into four groups: no sleep problems, sleep problems only at pre-school or only at school age, and persistent sleep problems. At follow-up the parents filled in Child Behavior Checklist and a background questionnaire. RESULTS: The children with persistent sleep problems (9%) had a 16-fold risk of having psychosocial symptoms on subclinical/clinical range compared with the children without sleep problems. The psychosocial symptoms that were related strongest to prolonged sleep problems were aggression, social and attention problems, and anxious/depressed mood. Also, somatic complaints (ninefold risk) and medical problems (P < 0.001) were typical for children with persistent sleep problems. CONCLUSIONS: Persistent sleep problems in children associate with high levels of psychosocial, somatic and medical problems. In paediatric health care more attention should be paid to recognizing, monitoring of the persistence and treatment of sleep problems before school transition period.

Sleep disturbances in a community sample from preschool to school age.

OBJECTIVE: To study the prevalence of various sleep problems at school age in a Finnish community sample and to evaluate the persistence of the sleep problems from the preschool age to school age in a 4-year follow-up. METHODS: Parents completed the Sleep Disturbance Scale for Children questionnaire on their child's sleep during the preschool years (3-6 years) and again during the school years (7-11 years). At follow-up the parents also completed a questionnaire on family structure and socio-economic status. RESULTS: The parents of 481 children completed the questionnaires during both the first study and the follow-up (girls 49%, boys 51%; mean age 9, range 7-11). At the population level, sleep problems slightly declined from preschool to school age (P < 0.05). However, sleep problems at preschool age showed a strong persistence to school age. At the follow-up, 35% of the children who were considered to have a sleep disorder at preschool age still suffered from it at school age. At the community level, this equates to 9% of the children. The children with no sleep problems at preschool age rarely developed sleep problems at school age. CONCLUSIONS: This study showed that various types of sleep problems are common at school age. Sleep problems persisted from preschool to school age at the individual level. It is important to recognize all types of sleep problems, especially persistent ones. Persistent sleep problems in children may cause and exacerbate other somatic, cognitive and psychiatric problems. Therefore, more attention should be focused on sleep problems in paediatric health care with interventions aimed particularly at children with prolonged sleep problems.

Parent-adolescent agreement on psychosocial symptoms and somatic complaints among adolescents with inflammatory bowel disease.

AIM: To investigate parent-adolescent agreement on psychosocial and somatic symptoms in adolescents with inflammatory bowel disease (IBD). METHODS: A questionnaire-based postal survey comprising Finnish adolescents aged 10-18 years with IBD (n = 156) and their parents. Emotional, behavioural and somatic symptoms were measured using the Child Behaviour Checklist (parent report) and the Youth Self-Report. RESULTS: In paediatric IBD, adolescents and parents agreed on the presence of a psychosocial problem (in subclinical/clinical range) in 5% of the cases but disagreed in 21%. In 74% of the dyads, respondents agreed that no problems existed. Agreement in reporting psychosocial or somatic symptoms was poor to low (κ = 0.00-0.38). The lowest agreement was on anxious/depressed mood (κ = 0.02) and thought problems (κ = 0.00) and the highest on social problems. The parents reported more somatic symptoms in their adolescents than the adolescents themselves (p < 0.001). CONCLUSION: Young IBD patients and their parents disagree in reporting psychosocial and somatic symptoms of the patients. The adolescents as well as their parents need to be involved; otherwise, many symptoms of clinical significance would go unnoticed.

Parental smoking, nasal resistance and rhinitis in children.

AIM: To determine whether parent-reported perennial rhinitis or objectively measured nasal resistance is more common in children from smoking families. To assess tonsillar size, nasopharyngeal airway and upper airway surgery frequency in children with smoking and non-smoking parents. METHODS: Ninety-five children (age 3-6 years, median 68 months) participated in this prospective cross-sectional clinical study. History of nasal symptoms was obtained, and all underwent an ear-nose-throat examination, anterior rhinomanometry and a lateral cephalogram. Regular smoking by either parent and their child's snoring was inquired about with a parental questionnaire. We compared children with a parental smoker and children without a parental smoker in the family. RESULTS: Smoking in the family led to increased risk for perennial rhinitis in the children up to 2.76-fold (aOR, 95%CI 1.00-7.67), but with no difference in nasal resistance between children from smoking and non-smoking households. Neither tonsillar size, nasopharyngeal airway nor upper airway surgery was associated with parental smoking. CONCLUSIONS: Parental smoking is associated with symptoms of perennial rhinitis in children. The possible role of environmental tobacco smoke should be taken into account in parent counselling and in evaluation of children being treated for symptoms of rhinitis and nasal obstruction.

The experience of hospital-related fears of 4- to 6-year-old children.

BACKGROUND: There is little information available on a 4- to 6-year-old child's subjective experience of hospital-related fears, even though the data collected from parents and hospital staff indicate that hospitalization is an anxiety-producing experience for young children. METHODS: A qualitative method was chosen using a purposive sample of 90 children. The data were gathered via semi-structured interview from 2004 to 2006. The data were analysed using the structure of Colaizzi's Method of Phenomenological Analysis. RESULTS: The essential fears were fears related to nursing interventions and pain, to the separation from parents and being left alone, to the lack of information, and to instruments and equipment. Children expressed their fears verbally or through their actions. The meaning of hospital-related fear formed four main clusters: insecurity, injury, helplessness, and rejection. CONCLUSIONS: For young children, an experience of hospital-related might be so traumatic that it influences the well-being of the child. The fear may damage the sense of security felt by the children, and weaken the child's willingness to trust health-care professionals. The children often expressed their fear in a contradictory manner or denied it. Children need the help of adults to express their hospital-related fears, including the objects of these fears.

Sleep problems and daytime tiredness in Finnish preschool-aged children-a community survey.

BACKGROUND: Sleep is important to the well-being and development of children. Specially, small children are vulnerable to the effects of inadequate sleep. However, not much is known about the frequency of all types of sleep problems and daytime tiredness in preschool-aged children. OBJECTIVE: To evaluate the prevalence of a wide spectrum of sleep problems, daytime tiredness and associations between these in 3- to 6-year-old Finnish children. METHODS: A population-based study where parents of 3- to 6-year-old children (n= 904) living in Helsinki filled in the Sleep Disturbance Scale for Children (SDSC). RESULTS: Of the children, 45% had at least one sleep-related problem occurring at least three times a week: 14.1% were unwilling to go to bed, 10.2% had difficulties in falling asleep, 10.2% had bruxism, 6.4% sleep talking, 2.1% sleep terrors, 8.2% had sleep-related breathing problem, 11.2% had excessive sweating while falling asleep and 12.9% excessive sweating during sleep. Age and gender were related to phenotype of the sleeping problems. In multiple regression analysis, the difficulties in initiating and maintaining sleep were most strongly associated with tiredness in the morning and during the day. CONCLUSIONS: Different types of sleep problems are frequent in preschool-aged children. Poor sleep quality is associated with morning and daytime tiredness. In screening for sleep problems in children, attention should be paid not only to sleep amount but also to sleep quality.

Psychiatric symptoms of children and adolescents with juvenile neuronal ceroid lipofuscinosis.

BACKGROUND: Juvenile neuronal ceroid lipofuscinosis (JNCL) is one of the most common neurodegenerative disorders in childhood and adolescence. The clinical picture includes diverse and complex psychiatric symptoms that are difficult to treat. Only symptomatic treatment is available. To improve symptomatic therapy, it is important to recognize the symptoms. The purpose of this study was to identify predominant psychiatric symptoms in patients with JNCL. METHODS: The study included 27 patients with JNCL with and without psychotropic treatment. The mean age was 15.2 (range 9-21) years. Characteristic psychiatric symptoms in this patient group were clarified by using the following standardized questionnaires filled in by parents, teachers and the patients themselves: Child Behavior Checklist (CBCL), Teacher Report Form (TRF) and Children's Depression Inventory (CDI). The symptoms were recorded for the entire study group and compared between patients with and without psychotropic treatment and between genders. RESULTS: The patients had a large number of psychiatric symptoms according to the CBCL and TRF. The most commonly reported symptoms were social, thought, attention problems, somatic complaints and aggressive behaviour. Patients receiving psychotropic medication had more psychiatric symptoms according to the CBCL and TRF. Moreover, female patients had more problems than male patients according to the CBCL. The total psychiatric symptom score was at clinical or borderline range for psychiatric disturbance in 74% of patients. The number of depressive symptoms reported by the patients themselves was low. CONCLUSIONS: JNCL patients suffer from a multitude of psychiatric symptoms. To improve drug choice and dosage, a thorough evaluation of these symptoms by standardized methods is needed before initiating treatment. Progress and possible adverse effects of treatment should be monitored on a regular basis.

Working memory, psychiatric symptoms, and academic performance at school.

Previous studies of the relationship among working memory function, academic performance, and behavior in children have focused mainly on clinical populations. In the present study, the associations of the performance in audio- and visuospatial working memory tasks to teacher reported academic achievement and psychiatric symptoms were evaluated in a sample of fifty-five 6-13-year-old school children. Working memory function was measured by visual and auditory n-back tasks. Information on incorrect responses, reaction times, and multiple and missed responses were collected during the tasks. The children's academic performance and behavioral and emotional status were evaluated by the Teacher Report Form. The results showed that good spatial working memory performance was associated with academic success at school. Children with low working memory performance, especially audiospatial memory, were reported to have more academic and attentional/behavioral difficulties at school than children with good working memory performance. An increased number of multiple and missed responses in the auditory and visual tasks was associated with teacher reported attentional/behavioral problems and in visual tasks with teacher reported anxiety/depressive symptoms. The results suggest that working memory deficits may underlie some learning difficulties and behavioral problems related to impulsivity, difficulties in concentration, and hyperactivity. On the other hand, it is possible that anxiety/depressive symptoms affect working memory function, as well as the ability to concentrate, leading to a lower level of academic performance at school.

Auditory event-related potential indices of increased distractibility in children with major depression.

OBJECTIVE: Children with major depression (MD) exhibit short-term memory and concentration deficits. Using auditory event-related potentials (ERPs), we aimed to determine whether these problems could be caused by a dysfunction in auditory sensory memory, attentional orienting, or both. METHODS: The subjects were 10 treatment-naïve children with MD and 10 controls. Sound sequences, consisting of frequent stimuli (syllable /ka/, P = 0.08), infrequent deviant stimuli (/ta/, P = 0.01 ), and novel sounds ( P = 0.01 ) were played through loudspeakers while the children watched silent videos and ignored the sound stimuli. Auditory sensory memory was studied by eliciting the ERPs mismatch negativity (MMN) and late discriminative negativity (LDN), and the P3a was used as an index of involuntary attention switch. RESULTS: The children with MD had shorter MMN and LDN latencies than the controls. The late component of the P3a (lP3a) was enhanced in amplitude in the patients as compared with that in the controls. CONCLUSIONS: Auditory sensory memory appears to function normally in children with MD. However, the ERP findings indicated enhanced sensory sensitivity and attentional distractibility in these children. This increased distractibility might underlie the concentration difficulties that compromise school performance in children with MD.

Poor sleep and psychiatric symptoms at school: an epidemiological study.

The objective of this study was to evaluate associations between sleep problems and psychiatric symptoms at school. A random sample consisting of 5813 eight- to nine-year-old children was selected from ordinary schools. Both parents' and children's reports of sleep problems were taken into account. The psychiatric symptoms were addressed according to the teachers' reports (the Rutter Scale B). Children with severe sleep problems were more likely to have a psychiatric disturbance according to the Rutter B Scale (OR 2.45, 95% CI 1.85-3.25). Logistic regression models showed that severe sleep problems were highly associated with emotional problems (OR 2.74, 95% CI 1.84-4.13), school attendance problems (OR 2.53, 95% OR 1.45-4.41), behavioural problems (OR 2.44, 95% CI 1.59-3.75) and hyperactivity (OR 2.02, 95% CI 1.30-3.13). Over 95% of severe sleep problems were reported only by the children themselves. In conclusion, children with severe sleep problems have substantially more teacher-reported psychiatric symptoms than those with no or mild sleep complaints. In diagnosing sleep disorders, it is important to include children as informants because relevant information may be overlooked when only parents are questioned.

New antidepressive and antipsychotic drugs in juvenile neuronal ceroid lipofuscinoses--a pilot study.

Patients with juvenile neuronal ceroid lipofuscinosis (JNCL) often have severe psychiatric symptoms. These are common in their mid-teens and include such symptoms as anxiety and affective and psychotic disorders. The older antidepressants and antipsychotics do not seem to be effective and often cause many adverse effects. Therefore, we wanted to try the new psychotropic drugs in Finnish patients with JNCL. We also wanted to determine the profile of these drugs in this patient group. Fourteen Finnish patients with JNCL receiving psychotropic drug treatment with citalopram, risperidone, olanzapine or quetiapine, were included. The mean age at initiation of the new psychotropic drugs was 13.8 years. Indications for treatment were psychotic symptoms, affective symptoms, anxiety and an inadequate response to other psychotropic drugs, or even adverse reactions. Information on psychiatric symptoms and current treatment was gathered from interviews and from the medical records. Indications and the clinical outcome of the treatment were determined by a consensus of the assessments by parents and physicians. The psychotropic drugs most commonly used in Finnish patients with JNCL are citalopram and risperidone. The clinical outcome was good or satisfactory in 70%. The adverse effects most commonly reported were fatigue, weight gain and aggravation of extrapyramidal symptoms. Little research has been done in this area and there are no good guidelines for treatment of psychiatric symptoms in patients with JNCL. Therefore, every patient should be treated with the safest and most commonly used drugs in the lowest possible doses.

Associations of age and gender with activity and sleep.

Associations between age/gender and activity/sleep (measured by actigraphs) in 66 healthy children aged 5-12 y were studied. With increasing age, daytime motor activity and total sleep time decreased and activity pattern changed. No gender differences were found. It was concluded that in this age group there is an age-dependent change in the amount and pattern of motor activity and sleep due to developmental and/or environmental factors.

Childhood depressive symptoms predict psychiatric problems in young adults.

OBJECTIVE: To evaluate the predictive value of childhood depressive symptoms for psychiatric symptoms, adaptive functioning, and self-performance in young adults. METHOD: The study sample consisted of 111 young adults born during 1975-1976 in the Helsinki region. The young adults were assessed in childhood (10 to 11 years of age) using the Children's Depression Inventory (CDI) and at the age of 20 to 21 years using Achenbach's Young Adult Self Report (YASR), the Beck Depression Inventory (BDI), and the Wallston Self-Performance Survey. RESULTS: Self-reported depressive symptoms in childhood predicted psychiatric symptoms (especially aggression), poor adaptive functioning, and low self-esteem in young adulthood. CONCLUSIONS: Depressive symptoms in children should be addressed to prevent later psychiatric problems. The CDI may be a measure of nonspecific psychopathology rather than of pure depression--thus, it may be a good screening tool for child populations.

Effects of early intervention on psychiatric symptoms of young adults in low-risk and high-risk families.

Effects of early risk and intervention on the psychiatric symptoms of young adults were studied. By means of a weighted risk index, 160 families with a baby born in 1975-1976 were classified as being at low or high risk. Half of the families attended a five-year family counseling program, the other half served as a control group. At age 20-21 years, the young adults from the counseled families had significantly fewer psychiatric symptoms than did those from the control families. A significant interaction between family risk and counseling was found. Implications for preventive intervention efforts are discussed.

Sleep and psychiatric symptoms in school-age children.

OBJECTIVE: To assess associations between the quantity and quality of children's sleep and parent- and teacher-reported psychiatric symptoms. METHOD: Forty-nine physically healthy 7- to 12-year-old children from normal classes participated. They were monitored for 72 consecutive hours with belt-worn activity monitors (actigraphs) to obtain objective data on their daytime and nighttime activity and sleep. In addition, Child Behavior Checklists and Teacher's Report Forms were filled out by the parents and teachers, respectively. RESULTS: Quantity of sleep was significantly associated with total symptom score on the Teacher's Report Form. The highest associations were found between low true sleep time and teacher-reported externalizing symptoms such as aggressive and delinquent behavior and attention and social problems. Sleep parameters were not associated with parent-reported psychiatric symptoms, except for the association found between delayed sleep latency and aggressive, delinquent behavior. CONCLUSIONS: The objectively measured amount of school-age children's sleep was associated with teacher-reported psychiatric symptoms. Parents may be unaware of their child's sleep deficiencies as the behavioral problems may be more evident at school than at home. Sensitive and objective measurements are needed to rule out the possibility of inadequate sleep underlying behavioral problems.

Sleep problems of school-aged children: a complementary view.

The aim of this population-based multicentre study was to evaluate the prevalence rates of sleep problems among 8-9-y-old children. The sample consisted of 5813 Finnish children, making up 10% of the age cohort. Both parents and children provided information. Disturbed sleep was reported by 21.7% of parents. Most of the problems were mild; only 0.3% were serious. Dyssomnias were frequent: 11.1% had difficulties with sleep onset, 7.1% with night waking and 2.3% with waking too early. Multiple sleep problems were present in 9.1% of the children. 17.8% of children reported disturbed sleep, 12.7% had problems many nights and 5.1% every night. In 32.0% of cases, either the parent or the child reported disturbed sleep; 7.4% of these reports came from both the parent and the child, 14.1% from the parent only and 10.3% from the child only. The correspondence between informants was poor (kappa = 0.224). Sleeping problems were associated with somatic and psychiatric problems. It is concluded that by restricting questioning to parents only, one-third of all potential cases of sleep problems may go unnoticed. In order to increase the sensitivity of screening children's sleep problems, both parents and children should provide information in epidemiological settings as well as in clinical work.

Effects of infant temperament and early intervention on the psychiatric symptoms of adolescents.

OBJECTIVE: To evaluate effects of infant temperament traits and early home-based intervention on psychiatric symptoms in adolescence. METHOD: The sample comprised 100 children born in 1975-1976. The families of 54 children received family counseling during the first 5 years of the child's life (10 times/year); 46 children served as a control group for counseling. At age 6 months the infants' temperament traits were evaluated by the Carey Infant Temperament Questionnaire filled out by the mother. At age 14 to 15 years the psychiatric symptoms of the adolescents were assessed by the Child Behavior Checklist and the Youth Self-Report. RESULTS: A fussy/demanding temperament in infancy was found to predict psychiatric symptoms in adolescence. A family counseling program during infancy protected subjects from developing psychiatric symptoms in adolescence. CONCLUSIONS: It may be possible to improve the psychosocial prognosis of children at temperamental risk by home-based intervention focused on parent-child interaction.

Long-term effects of an early home-based intervention.

OBJECTIVE: To evaluate the long-term effects of an early home-based intervention on the quantity and quality of psychiatric symptoms in adolescents. METHOD: The material consisted of 160 families with a baby born in 1975-1976. First, the families were classified with a weighted risk index into low- and high-risk families. Eighty families attended a 5-year-long family counseling program (10 times/year). The other half of the families served as a control group for the effects of counseling. The mental state of the adolescents was assessed at age 14 to 15 years by the Child Behavior Checklist and the Youth Self-Report. RESULTS: The adolescents in the counseling families scored significantly fewer total symptoms on both the parent and the youth reports. The counseling reduced more effectively internalizing than externalizing symptoms. The counseling predicted better mental health in adolescence in both low- and high-risk families. CONCLUSIONS: Home-based early intervention can have positive long-term effects on the mental state of adolescents. These results can be used when programs for primary prevention in families with small children are planned.