Relationship between family income and trajectories of adjustment in adolescence: Sleep and physical activity as moderators.

INTRODUCTION: Youth from lower-income families experience adjustment problems at higher rates than higher-income peers. While adolescents have little control over family income, they do have some agency over their sleep and physical activity, two factors that have been shown to mitigate the risk of maladjustment. To test this, sleep and physical activity were examined as moderators of the longitudinal relationship between family income (indexed by income-to-needs ratio) and trajectories of adolescent adjustment problems. METHODS: Participants included a socioeconomically diverse community sample of 252 US youth (53% female; 33% Black, 67% White) in 2012-2015. Actigraphy-based sleep duration and quality were indexed, respectively, by minutes (sleep onset to wake excluding awakenings) and efficiency (% minutes scored as sleep from onset to wake). Physical activity and adjustment were youth-reported. Outcomes included internalizing (anxious/depressive) and rule-breaking behavior. Latent growth models estimated trajectories of adjustment across ages 16 and 18 years conditional on family income, sleep, physical activity, and their interactions. RESULTS: Relationships between family income and change in internalizing symptoms were moderated by sleep minutes, and associations between income and change in internalizing symptoms and rule-breaking behavior were moderated conjointly by sleep efficiency and physical activity. CONCLUSIONS: Under conditions of high-quality sleep and more physical activity, adolescents with lower income reported fewer adjustment problems. Conversely, youth with both poor sleep and low physical activity were at the highest risk for maladjustment over time. Findings enhance understanding of individual differences in trajectories of mental health associated with bioregulation, health behaviors, and the sociocultural context.

Onset of substance use: Deviant peer, sex, and sympathetic nervous system predictors.

We evaluated whether the association between deviant peer affiliation and onset of substance use is conditional upon sex and sympathetic nervous system (SNS) reactivity as measured by pre-ejection period (PEP). Community-sampled adolescents (N = 251; M = 15.78 years; 53% female; 66% White, 34% Black) participated in three waves. PEP reactivity was collected during a mirror star-tracer stress task. Alcohol, marijuana, tobacco, or any substance use, as well as binge drinking and sexual activity involving substance use were outcomes predicted by affiliation with deviant peers and two- and three-way interactions with sex and PEP reactivity. Probability of substance use increased over time, but this was amplified for adolescents with greater deviant peer affiliation in conjunction with blunted PEP reactivity. The same pattern of results was also found for prediction of binge drinking and sexual activity involving substance use. Findings are discussed in the context of biosocial models of adolescent substance use and health risk behaviors.

Longitudinal associations between adolescents' sleep and adjustment: Respiratory sinus arrhythmia as a moderator.

Sleep and autonomic nervous system functioning are important bioregulatory systems. Poor sleep and low baseline respiratory sinus arrhythmia (RSA), a measure of parasympathetic nervous system activity, are associated with externalizing behaviors and depressive symptoms in youth. Rarely, however, have measures of these systems been examined conjointly. The present study examined baseline RSA (RSA-B) as a moderator of longitudinal relations between adolescent sleep and adjustment. Participants were 256 adolescents (52% girls, 66% White/European American, 34% Black/African American) from small towns and surrounding rural communities in the southeastern United States. Sleep (minutes, efficiency, variability in minutes and efficiency) was assessed at age 15 via actigraphs across seven nights. RSA-B was derived from electrocardiogram data collected at rest. Adolescents self-reported externalizing problems and depressive symptoms at ages 15 and 17. Controlling for age 15 adjustment, findings generally demonstrated that sleep predicted age 17 adjustment particularly at higher (rather than lower) levels of RSA-B, such that adolescents with good sleep (more minutes and lower variability) and high RSA-B were at lowest risk for maladjustment. The results highlight the value of examining multiple bioregulatory processes conjointly and suggest that promoting good sleep habits and regulation of physiological arousal should support adolescent adjustment.

Parenting, deviant peer affiliation, and externalizing behavior during adolescence: processes conditional on sympathetic nervous system reactivity.

BACKGROUND: This study examined associations between permissive parenting, deviant peer affiliations, and externalizing behavior across mid to late adolescence in a plausible indirect effects model of change over time with deviant peer affiliation serving as the mediator. We also evaluated potential conditional indirect effects wherein these relationships may be moderated by sex and sympathetic nervous system (SNS) activity, indexed by skin conductance level (SCL) reactivity. METHOD: Participants included 242 community-sampled adolescents (M = 15.79 years; 48% boys; 66% European American, 34% African American) with two additional longitudinal assessments lagged by 1 year. Permissive parenting, SCL reactivity, and sex were considered as time invariant predictors of repeated measures of deviant peer affiliation and externalizing behavior in latent growth models that tested whether any of the direct or indirect associations were conditional on sex or SCL reactivity. RESULTS: Evidence was found for indirect effects of permissive parenting on externalizing behavior via deviant peer affiliation, but only for males with lower SCL reactivity to stress. Additionally, these effects were found on latent intercepts, but not slopes indexing change over time, perhaps reflecting established individual differences in relationships among these variables. CONCLUSIONS: Findings are discussed in the context of biosocial models of adolescent development and risk factors that may inform interventions for vulnerable youth.

Deviant Peer Behavior and Adolescent Delinquency: Protective Effects of Inhibitory Control, Planning, or Decision Making?

We examined relations between adolescent perceptions of deviant peer behavior and delinquency as moderated by inhibitory control, planning, and decision making in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development at age 15 (N = 991). Adolescents reported perceptions of deviant peer behavior. Inhibitory control, planning, and decision making were assessed behaviorally. Delinquency was evaluated with a latent variable comprised of parent-guardian perceptions of adolescent delinquency and adolescent self-reports. Only inhibitory control moderated the relationship between deviant peer behavior and delinquency, showing that better inhibition protected against delinquency in contexts of high levels of adolescent perceptions of deviant peer behavior. Findings are discussed in the context of theories of adolescent delinquency and risk taking.

Codevelopment Between Key Personality Traits and Alcohol Use Disorder From Adolescence Through Young Adulthood.

OBJECTIVE: Personality traits related to negative emotionality and low constraint are strong correlates of alcohol use disorder (AUD), but few studies have evaluated the prospective interplay between these traits and AUD symptoms from adolescence to young adulthood. METHOD: The Minnesota Twin Family Study (N = 2,769) was used to examine the developmental interplay between AUD symptoms and three personality measures of constraint, negative emotionality, and aggressive undercontrol from ages 17 to 29. RESULTS: Results from random-intercept, cross-lagged panel models showed that low constraint and aggressive undercontrol predicted subsequent rank-order increases in AUD symptoms from ages 17 to 24. AUD symptoms did not predict rank-order change in these traits from ages 17 to 24. There was support for both cross-effects from ages 24 to 29. Biometric analysis of the twin data showed genetic influences accounted for most of the phenotypic correlations over time. CONCLUSION: Results are consistent with the notion that personality traits related to low constraint and aggressive undercontrol are important vulnerability/predisposition factors for the development of early adult AUD. In later young adulthood, there is more evidence for the simultaneous codevelopment of personality and AUD. Implications are addressed with attention to personality-based risk assessments and targeted AUD prevention approaches.

Trajectories of sleep and cardiac sympathetic activity indexed by pre-ejection period in childhood.

Fragmented and insufficient sleep has been implicated in disrupted autonomic nervous system activity during resting state conditions in typically developing children. Towards explication of these relations over development, the current study tested reciprocal relations between the development of sleep parameters (efficiency, duration, latency) and cardiac sympathetic nervous system (SNS) activity indexed by pre-ejection period (PEP) during waking-resting state conditions throughout middle and late childhood. Whether sleep derives changes in PEP or vice versa was examined. A longitudinal design was employed and latent growth modelling was used to examine the research questions. During the first assessment, 282 children aged 9.44 years (65% European American, 35% African American) participated. Two more assessments followed, with a 1-year lag between consecutive study waves. Sleep was examined with 7 nights of actigraphy in the child's home. Controlling for many potential confounds (sex, race/ethnicity, body mass index and family socioeconomic status), higher sleep efficiency and more sleep minutes predicted increases in PEP (less SNS activity) over 3 years. PEP did not predict changes in sleep efficiency or duration over time and there were no significant effects for sleep latency. Findings highlight the probable direction of effects between these two key bioregulatory systems. High levels of cardiac SNS activity are associated with many negative health outcomes, and thus these findings may have important implications.

Vi. Marital conflict, vagal regulation, and children's sleep: a longitudinal investigation.

We examined longitudinal relations between adult interpartner conflict (referred to as marital conflict) and children's subsequent sleep minutes and quality assessed objectively via actigraphy, and tested parasympathetic nervous system (PNS) activity indexed through respiratory sinus arrhythmia reactivity (RSA-R) and initial sleep as moderators of predictive associations. At Wave 1 (W1), children (85 boys, 75 girls) with a mean age of 9.43 years (SD=.69) reported on marital conflict, and their sleep was assessed with actigraphs for seven nights. Sleep minutes, sleep efficiency, sleep activity, and number of long wake episodes were derived. RSA-R was measured in response to a lab challenge. Sleep parameters were assessed again 1 year later at Wave 2 (W2; mean age=10.39; SD=.64). Analyses consistently revealed 3-way interactions among W1 marital conflict, sleep, and RSA-R as predictors of W2 sleep parameters. Sleep was stable among children with more sleep minutes and better sleep quality at W1 or low exposure to marital conflict at W1. Illustrating conditional risk, marital conflict predicted increased sleep problems (reduced sleep minutes, worse sleep quality) at W2 among children with poorer sleep at W1 in conjunction with less apt physiological regulation (i.e., lower levels of RSA-R or less vagal withdrawal) at W1. Findings build on the scant literature and underscore the importance of simultaneous consideration of bioregulatory systems (PNS and initial sleep in this study) in conjunction with family processes in the prediction of children's later sleep parameters.

Sleep and cognitive performance: the role of income and respiratory sinus arrhythmia reactivity.

A health disparities view suggests that low family income status acts as a risk factor for poor cognitive functioning. A biosystems view suggests that poor sleep and poor stress response system functioning are also risk factors. These views are rarely integrated to test multiplicative risk or protective effects from social-cultural and biological variables. We investigated interactions among familial income, children's sleep and respiratory sinus arrhythmia reactivity (RSA reactivity, indexing parasympathetic nervous system reactivity) in the prediction of cognitive performance of school-aged children. Participants were 282 children (146 boys; 35% African American and 65% European American; M age = 9.42 years, SD = .71). Mothers reported on family income. Children's sleep quality (efficiency) and duration (minutes) were assessed via a week of actigraphy. Children's RSA reactivity to an attention demanding and frustrating star tracing challenge was assessed in the lab. Children completed standardized cognitive assessments examining attention, processing speed, and crystallized cognitive functioning. Findings show that more optimal sleep efficiency and RSA reactivity interact to confer protection against poor cognitive performance, particularly for children from lower income homes. Results build on the literature and suggest that interactions between biological systems and socioeconomic variables are key for understanding children's cognitive performance.

Coping Responses in the Context of Family Stress Moderate the Association Between Childhood Anxiety and Adolescent Depressive Symptoms.

Anxiety and depressive symptoms are common and highly interrelated. A relatively consistent temporal pattern of anxious and depressive symptoms has emerged from previous studies, such that the development of anxiety tends to precede and predict the development of depression rather than the other way around. Whether high levels of childhood anxiety predict depressive symptoms in late adolescence may depend, in part, on the ways in which children cope with stressful events. Accordingly, the present study used latent intercept models to examine involuntary and voluntary coping responses to familial stress as potential moderators of the association between childhood anxiety and adolescent depressive symptoms. Two hundred twenty-seven participants completed questionnaires measuring demographic variables as well as anxiety, depressive symptoms, and coping responses at a minimum of one time point over four waves of data collection (T1 Mage = 10.26 years, T2 Mage = 15.77 years, T3 Mage = 16.75 years, T4 Mage = 17.68 years). We found that childhood anxiety was positively associated with adolescent depressive symptoms when children reported higher levels of involuntary responses to family stress (e.g., rumination or physiological arousal) in conjunction with either lower levels of voluntary engaged responses (e.g., problem solving or emotion regulation) or higher levels of voluntary disengaged responses (e.g., avoidance or denial). These results shed light on the conditions under which childhood anxiety is associated with adolescent depressive symptoms and underscore the need for continued longitudinal and developmental research on this topic.

The legacy of harsh parenting: Enduring and sleeper effects on trajectories of externalizing and internalizing symptoms.

Guided by developmental models examining the legacy of childhood caregiving environments, we examined the longitudinal pattern of associations between harsh parenting and children's internalizing and externalizing symptoms across late childhood to late adolescence. Participants included 199 youth (48.7% female, 65.3% White, 32.2% Black, 2.5% biracial) and their mothers and fathers from a diverse range of socioeconomic backgrounds. The study utilized a multi-informant, longitudinal design including five waves of data (youths' mean ages were 9, 10, 11, 17, and 18 across waves). Harsh parenting at Age 9 predicted higher levels of (a) externalizing symptoms at Ages 11, 17, and 18 and (b) internalizing symptoms at Ages 17 and 18. Developmental sensitivity analyses revealed that the magnitude of the more distal association between early harsh parenting and later internalizing and externalizing symptoms was statistically stronger as compared to more proximal associations. Bidirectional analyses revealed that externalizing symptoms at Age 9 predicted harsh parenting at Ages 9, 10, 11, 17, and 18. Whereas links between harsh parenting and internalizing symptoms were consistent with a sleeper effects model, links between harsh parenting and externalizing symptoms provided some support for both enduring and sleeper effects models. Findings inform an understanding of youth developmental sensitivity to harsh parenting and the downstream consequences of harsh parenting. Results have important translational implications, including testing the long-term efficacy of therapeutic programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trajectories of actigraphy-derived sleep duration, quality, and variability from childhood to adolescence: downstream effects on mental health.

STUDY OBJECTIVES: We examined growth trajectories of four actigraphy-derived sleep parameters (sleep minutes, sleep efficiency, and variability in sleep minutes and efficiency across a week of assessments) across childhood and adolescence and examined individual differences in trajectories according to participants' race/ethnicity and sex. We also assessed the predictive effect of growth trajectories of sleep parameters on growth trajectories of mental health outcomes and moderation by race and sex. METHOD: Youth (N = 199, 49% female, 65% white, 32% black, 3% biracial) and their parents participated in five waves of data (M ages were 9, 10, 11, 17, and 18 across waves). Participants were from a diverse range of socioeconomic backgrounds. RESULTS: Across participants, sleep minutes, sleep efficiency, and variability in sleep minutes and efficiency demonstrated significant linear change across childhood and adolescence. Whereas sleep duration shortened over time, sleep efficiency improved. Youth exhibited increases in night-to-night variability in sleep minutes and reductions in night-to-night variability in sleep efficiency. Highlighting the importance of individual differences, some race- and sex-related effects emerged. Black youth and male youth experienced steeper declines in their sleep duration across development relative to their respective counterparts. Black youth also demonstrated smaller improvements in sleep efficiency and greater variability in sleep efficiency compared to white youth. Finally, trajectories of sleep efficiency and variability in sleep minutes predicted trajectories of internalizing symptoms and externalizing behaviors. CONCLUSIONS: Findings showed significant changes in developmental trajectories of four sleep parameters across childhood and adolescence. We discuss the empirical and translational implications of the findings.

Marital conflict, allostatic load, and the development of children's fluid cognitive performance.

Relations between marital conflict, children's respiratory sinus arrhythmia (RSA), and fluid cognitive performance were examined over 3 years to assess allostatic processes. Participants were 251 children reporting on marital conflict, baseline RSA, and RSA reactivity (RSA-R) to a lab challenge were recorded, and fluid cognitive performance was measured using the Woodcock-Johnson III. A cross-lagged model showed that higher levels of marital conflict at age 8 predicted weaker RSA-R at age 9 for children with lower baseline RSA. A growth model showed that lower baseline RSA in conjunction with weaker RSA-R predicted the slowest development of fluid cognitive performance. Findings suggest that stress may affect development of physiological systems regulating attention, which are tied to the development of fluid cognitive performance.

Codevelopment of externalizing and internalizing symptoms in middle to late childhood: sex, baseline respiratory sinus arrhythmia, and respiratory sinus arrhythmia reactivity as predictors.

We investigated the roles of sex and respiratory sinus arrhythmia (RSA), an index of autonomic parasympathetic nervous system activity, as predictors of codeveloping externalizing and internalizing symptoms in middle childhood. We expected that sex, baseline RSA (RSA-B), and RSA reactivity (RSA-R) to two types of tasks would interact to differentiate co-occurring trajectories of symptoms. We tested these hypotheses by combining longitudinal data from two independent samples (n = 390; 210 girls, 180 boys) with repeated measures at ages 8, 9, 10, and 11. RSA-R was measured in response to a socially stressful and frustrating stressor. Indicators of growth in externalizing and internalizing symptoms were derived from multiple domain growth models and used in person-centered growth mixture analyses. Three groups of externalizing and internalizing trajectories were found. Profile membership was predicted by several two-way interactions among sex, RSA-B, or RSA-R but was not predicted by three-way interactions. Children with low RSA-B and strong RSA withdrawal, girls with low RSA-B, and girls with strong RSA withdrawal were more likely to be on a developmental trajectory of low externalizing symptoms and moderately elevated internalizing symptoms. Membership in the high externalizing and high internalizing trajectory was predicted by weak RSA withdrawal for boys and strong RSA withdrawal for girls. The type of stressor task also played a role in predicting probability of profile membership. Results are discussed in the context of developmental psychobiology and implications for the codevelopment of psychopathology symptoms in childhood.

The interactive roles of parenting, emotion regulation and executive functioning in moral reasoning during middle childhood.

We examined mother-child co-operative behaviour, children's emotion regulation and executive function, as well as combinations of these factors, as predictors of moral reasoning in 89 10-year-old children. Dyadic co-operation was coded from videotaped observations of laboratory puzzle and speech tasks. Emotion regulation was derived from maternal report, and executive functioning was assessed with the Tower of London task. Moral reasoning was coded during mother-child conversations about morally ambiguous, peer-conflict situations. Two significant interactions indicated that children from more co-operative dyads who also had higher executive function skills had higher moral reasoning scores than other children, and children lower in both emotion regulation and executive function had lower moral reasoning scores than other children. The results contribute to the literature on the multiple and interactive levels of influence on moral reasoning in childhood.

Neighborhood environment and adolescent sleep: The role of family socioeconomic status.

OBJECTIVES: Socioeconomic status (SES) and neighborhood context are influential predictors of adolescent sleep, yet little is known about how they may interact to influence sleep. We examined multiple dimensions of family SES as moderators of associations between neighborhood risk and multiple sleep parameters. METHODS: Participants were 323 adolescents (Mage = 17.4 years, SD = 0.86; 48% male; 60% White/European American, 40% Black/African American). Sleep was assessed using 7 nights of actigraphy from which sleep duration (minutes from onset to wake time), efficiency, long wake episodes, and variability in minutes over the week were derived. Youth reported on their sleep/wake problems and sleepiness, as well as their perceptions of safety and violence in their neighborhoods. Parents reported on SES indices, including income-to-needs ratio and perceived financial stability. RESULTS: Lower SES (income-to-needs, perceived financial stability) was associated with lower sleep efficiency and more frequent long wake episodes. Lower neighborhood safety and greater community violence concerns were related to greater subjective sleep problems. Moderation effects illustrated two general patterns. For actigraphy-derived sleep variables, lower neighborhood safety was associated with poor sleep only among youth from lower-income families. For subjective sleep/wake problems and daytime sleepiness, associations between neighborhood risk and sleep difficulties were pronounced for higher SES youth, while lower SES youth had greater sleep problems regardless of neighborhood factors. CONCLUSIONS: Findings suggest that several dimensions of SES and neighborhood risk may be consequential for adolescents' sleep. Moderation effects highlight the significance of considering multiple contextual influences towards a better understanding of adolescents' sleep.

Family income as a moderator of relations between sleep and physical health during adolescence.

OBJECTIVES: Sleep duration, quality, and consistency are associated with overall physical health in adolescence, yet the effects of sleep on development may be not uniform because both sleep and physical health vary systematically along gradients of family income. To understand "for whom" sleep may be particularly beneficial, the present study tested family income as a moderator of relations between youth sleep and physical health. METHODS: Three hundred twenty-three youth (M age=17.39years; 53% female; 41% Black, 59% White) wore wrist actigraphs for 1week at home. Four well-recognized sleep parameters were derived: minutes, efficiency, long wake episodes, and variability in minutes across the week. Parents reported family income, and mothers rated adolescents' physical health. In independent path models, physical health was regressed onto each indicator of sleep, family income, and Sleep × Family Income interactions to test potential moderation effects. RESULTS: Associations between sleep and physical health were moderated by family income. Lower sleep efficiency, more long wake episodes, and more variability in sleep minutes were associated with poorer physical health among adolescents from lower-income families. At optimal levels of all sleep variables, income-based differences in physical health were mitigated. Youth from higher-income families tended to have better physical health regardless of their sleep. CONCLUSIONS: Findings build evidence that sleep has relations with physical health for low-income youth in particular. Clinicians and other service providers working with youth might benefit from considering the role of sleep in prevention and interventions programs geared toward improving health.

Marital conflict, respiratory sinus arrhythmia, and allostatic load: interrelations and associations with the development of children's externalizing behavior.

Allostatic load theory hypothesizes that stress and the body's responses to stressors contribute to longer term physiological changes in multiple systems over time (allostasis), and that shifts in how these systems function have implications for adjustment and health. We investigated these hypotheses with longitudinal data from two independent samples (n = 413; 219 girls, 194 boys) with repeated measures at ages 8, 9, 10, and 11. Initial parental marital conflict and its change over time indexed children's exposure to an important familial stressor, which was examined in interaction with children's respiratory sinus arrhythmia (RSA) reactivity to laboratory tasks (stress response) to predict children's basal levels of RSA over time. We also investigated children's sex as an additional possible moderator. Our second research question focused on examining whether initial levels and changes in resting RSA over time predicted children's externalizing behavior. Boys with a strong RSA suppression response to a frustrating laboratory task who experienced higher initial marital conflict or increasing marital conflict over time showed decreases in their resting RSA over time. In addition, boys' initial resting RSA (but not changes in resting RSA over time) was negatively related to change over time in externalizing symptoms. Findings for girls were more mixed. Results are discussed in the context of developmental psychobiology, allostatic load, and implications for the development of psychopathology.

Developmental trajectories of respiratory sinus arrhythmia and preejection period in middle childhood.

Autonomic nervous system (ANS) activity has been linked repeatedly to children's socioemotional and behavioral adaptive functioning and development, yet the literature on how various indexes of ANS activity develop in childhood is sparse. We utilized latent growth modeling to investigate the development of respiratory sinus arrhythmia (RSA), an established index of parasympathetic nervous system (PNS), and preejection period (PEP), a marker of sympathetic nervous system (SNS) influence on the heart, in children aged 8-10 years. At age 8, 251 children (128 girls, 123 boys; 162 European American, 89 African American) participated. Longitudinal data were collected during two additional waves when children were 9 and 10 years of age, with a 1-year lag between each wave. Children's RSA and PEP exhibited significant stability over time. Marginally significant variability was found among children in how RSA changed over time (slope), but there was no significant interindividual variability in PEP changes over development. A conditional growth curve model (i.e., one with predictor variables) showed that initial levels of RSA and PEP and the slope of RSA over time were predicted by several demographic factors including the child's sex and race; RSA of European American children showed significant increases over time while African American children had higher initial RSA but no significant change over time. Findings extend basic knowledge in developmental biopsychology and have implications for research focusing on ANS measures as important predictors, moderators, and mediators of childhood adaptation.

Trajectories of sleep problems in childhood: associations with mental health in adolescence.

STUDY OBJECTIVES: We examined initial levels (intercepts) of sleep-wake problems in childhood and changes in sleep-wake problems across late childhood (slopes) as predictors of externalizing behavior problems, depressive symptoms, and anxiety in adolescence. To ascertain the unique effects of childhood sleep problems on adolescent mental health, we controlled for both childhood mental health and adolescent sleep problems. METHODS: Participants were 199 youth (52% boys; 65% White/European American, 35% Black/African American). Sleep-wake problems (e.g. difficulty sleeping and waking up in the morning) were assessed during three time points in late childhood (ages 9, 10, and 11) with self-reports on the well-established School Sleep Habits Survey. At age 18, multiple domains of mental health (externalizing behavior problems, depressive symptoms, and anxiety) and sleep-wake problems were assessed. RESULTS: Latent growth curve modeling revealed that children with higher levels of sleep-wake problems at age 9 had consistently higher levels of such problems between ages 9 and 11. The initial level of sleep-wake problems at age 9 predicted externalizing behaviors, depressive symptoms, and anxiety at age 18, controlling for mental health in childhood and concurrent sleep-wake problems in adolescence. The slope of sleep-wake problems from ages 9 to 11 did not predict age 18 mental health. CONCLUSIONS: Youth who had higher sleep-wake problems during late childhood had higher levels of mental health problems in adolescence even after controlling for childhood mental health and concurrent sleep-wake problems. Findings illustrate that childhood sleep problems may persist and predict adolescent mental health even when potentially confounding variables are rigorously controlled.