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Sleep patterns and temperament in the first year of life are closely related. However, research utilizing objective, rather than subjective measurements of sleep and temperament is scarce and results are inconsistent. In addition, a relative lack of longitudinal data prevents inference of causality between the two constructs. In this study, infant sleep was objectively assessed among 95 infants at 3, 6, and 12 months-of-age with an actigraph in the home setting. Reactivity to sound, light, and touch, a specific aspect of temperament, was behaviorally assessed at 3 and 6 months, both during sleep (at home) and during waking (at the laboratory). Expected maturational trends were recorded in sleep, with a temporal increase in sleep efficiency and percent of motionless sleep. Quadratic (i.e., inverse U shape) relations were found, especially among girls, when predicting change in sleep by reactivity thresholds, suggesting that both hyposensitive and hypersensitive infants are at risk for poor sleep quality. These are the first research findings suggesting that low reactivity in infancy might be associated with compromised sleep quality. The observed nonlinear effects may account for null or inconsistent results in previous studies that explored only linear associations between temperament and sleep. Future studies should address both extremes of the temperament continuum when exploring relations with sleep patterns., (© 2015 The Society for Research in Child Development, Inc.)

The aims of this longitudinal study were to examine (a) development of infant sleep and maternal sleep from 3 to 6 months postpartum; (b) concomitant and prospective links between maternal sleep and infant sleep; and (c) triadic links between paternal involvement in infant caregiving and maternal and infant sleep. The study included 57 families that were recruited during pregnancy. Maternal and infant sleep was assessed using actigraphy and sleep diaries for 5 nights. Both fathers and mothers completed a questionnaire assessing the involvement of fathers relative to mothers in infant caregiving. The results demonstrated moderate improvement in infant and maternal sleep percent between 3 and 6 months. Maternal sleep percent at 3 months significantly predicted infant sleep percent at 6 months. Greater paternal involvement in infant daytime and nighttime caregiving at 3 months significantly predicted more consolidated maternal and infant sleep at 6 months. These findings suggest that maternal sleep is an important predictor of infant sleep and that increased involvement of fathers in infant caregiving responsibilities may contribute to improvements in both maternal and infant sleep during the first 6 months postpartum., (© 2015 The Society for Research in Child Development, Inc.)

Background: The relationship between epilepsy and sleep is bidirectional as seizures disrupt sleep and coexisting sleep disorders have detrimental effects on seizure control and quality of life for both the children and their families. Previous research has reported on sleep disturbance in children with epilepsy primarily by subjective parental reports. Actigraphy may provide a more accurate objective evaluation of sleep, but the validity of this sleep measure for children with epilepsy has not yet been assessed. The primary objective of this study was to validate the use of actigraphy as a tool in studying sleep patterns in children with epilepsy., Methods: This was a prospective study comparing sleep and wake epochs recorded for 24 h simultaneously by actigraphy and by continuous video-electroencephalography (VEEG) monitoring in 27 patients aged 2-18 years with medically refractory epilepsy., Results: Strong correlations were found between actigraphy and VEEG sleep variables including night sleep period (r = 0.99), night sleep time (r = 0.96), duration of night wake time (r = 0.93) and number of significant wakings during the night (r = 0.81)., Conclusion: The study results validate that actigraphy is a reliable and objective clinical and research tool for evaluating sleep and wakefulness in children with epilepsy., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: To examine if children who suffer from significant Nighttime Fears (NF) experience higher degree of general fears and behavioral problems and to explore whether effortful control mediates NF association with internalizing problems., Methods: One-hundred and nine preschool children (64 boys) between the ages 4 and 6years suffering from significant NF and 30 healthy children (16 boys) were evaluated using parental reports of behavioral problems [Child Behavior Checklist (CBCL)], parental and child report of fears [Fear Survey Revised for Parents (FSS-PC), Koala Fear Questionnaire (KFQ)], and a measure of effortful control derived from the Child Behavior Questionnaire (CBQ)., Results: Children with severe NF also suffer from an increased level of a wide variety of fears other than NF, and exhibit more behavioral problems than controls both on parental and children's measures of general fears, and main CBCL scale scores (Internalizing, Externalizing, Total score). Additionally, children with NF had lower abilities of effortful control (as manifested in CBQ attention and inhibitory control scales). Attention control mediated NF association to internalizing problems scale., Conclusions: NF may serve as a marker for anxiety vulnerability, and this vulnerability might be mediated by abnormal attentional control. Our finding also highlights the need for a more comprehensive assessment of behavioral problems, fears and anxiety phenomena among children referred with NF., (© 2013.)

Background: The aim of our study was to characterize cross-cultural sleep patterns and sleep problems in a large sample of preschool children ages 3-6years in multiple predominantly Asian (P-A) and predominantly Caucasian (P-C) countries/regions., Methods: Parents of 2590 preschool-aged children (P-A countries/regions: China, Hong Kong, India, Japan, Korea, Malaysia, Philippines, Singapore, Thailand; P-C countries: Australia-New Zealand, Canada, United Kingdom, United States) completed an Internet-based expanded version of the Brief Child Sleep Questionnaire (BCSQ)., Results: Overall, children from P-A countries had significantly later bedtimes, shorter nighttime sleep, and increased parental perception of sleep problems compared with those from P-C countries. Bedtimes varied from as early as 7:43pm in Australia and New Zealand to as late as 10:26pm in India, a span of almost 3h. There also were significant differences in daytime sleep with the majority of children in P-A countries continuing to nap, resulting in no differences in 24-h total sleep times (TST) across culture and minimal differences across specific countries. Bed sharing and room sharing are common in P-A countries, with no change across the preschool years. There also were a significant percentage of parents who perceived that their child had a sleep problem (15% in Korea to 44% in China)., Conclusions: Overall, our results indicate significant cross-cultural differences in sleep patterns, sleeping arrangements, and parent-reported sleep problems in preschool-aged children. Further studies are needed to understand the underlying bases for these differences and especially for contributors to parents' perceptions of sleep problems., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Aims: To evaluate: (i) the prevalence of habitual snoring (HS) in a large sample of children aged from birth to 36 months in 14 countries across Asia Pacific; and (ii) the different correlates associated with HS in Caucasians, Chinese and non-Chinese, non-Caucasian Asians., Methods: This was a multi-centre, cross-sectional survey conducted across Asia Pacific. Parents/caregivers of 23,481 infants and toddlers completed an expanded version of the Brief Infant Sleep Questionnaire. We defined HS as snoring more than three nights per week., Results: Chinese and non-Caucasian non-Chinese (NCNC) children had a lower prevalence of HS across the age range from birth to 3 years than their Caucasian counterparts (6.2% and 5.1% vs. 11%, P < 0.01). Boys had a higher prevalence of HS compared to girls (χ(2) = 98.5, P < 0.0001). History of prematurity (OR = 1.37-1.56, CI (1.1-2.17), P < 0.01) and gender (OR = 1.53-1.54, CI (1.26-1.85), P < 0.0001) were found to be significant predictors for HS. Current breastfeeding (OR = 0.69, CI (0.54-0.88), P < 0.005) and greater parental age (OR = 0.86, CI (0.78-0.96), P < 0.01) were protective against HS among NCNC children. HS was less prevalent in younger Chinese subjects (OR = 0.88, CI (0.84-0.93), P < 0.0001). In Caucasians, parents' education (OR = 0.78, CI (0.67-0.91), P < 0.005) and their not sleeping in the same room as their child (OR = 0.62, CI (0.45-0.86), P < 0.005) were negatively associated with parental report of HS., Conclusions: Prevalence of HS shows racial differences among countries across Asia Pacific. Future studies should assess craniofacial structure and body fat distribution as contributory factors for this differential prevalence., (© 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).)

Links between sleep and psychopathology are complex and likely bidirectional. Sleep problems and alteration of normal sleep patterns have been identified in major forms of child psychopathology including anxiety, depression and attention disorders as well as symptoms of difficulties in the full range. This review summarizes some key findings with regard to the links between sleep and associated difficulties in childhood and adolescence. It then proposes a selection of possible mechanisms underlying some of these associations. Suggestions for future research include the need to 1) use multi-methods to assess sleep; 2) measure sleep in large-scale studies; 3) conduct controlled experiments to further establish the effects of sleep variations on emotional and behavioral difficulties; 4) take an interdisciplinary approach to further understand the links between sleep and associated difficulties., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Night-time fears are very common in preschool and early school years. However, to date, the links between night-time fears and sleep have not been assessed systematically. The aim of this study was to evaluate natural sleep patterns in children with night-time fears, and to assess the association between parental fear-related strategies and children's sleep disruptions., Methods: Sleep was assessed in a sample of 109 preschool children (64 boys and 45 girls) aged 4-6 years suffering from significant night-time fears, and in 30 healthy controls using actigraphy and parental reports., Results: Controls slept significantly better than the children with night-time fears. The disrupted sleep patterns of the children with night-time fears were reflected in a higher number of actigraphic night wakings, shorter periods of continuous sleep, shorter true sleep time, and a lower percentage of actual sleep time. Similar findings were manifested in sleep measures reported by the parents. Parental fear-management strategies were found to be linked to impaired actigraphic sleep measurements., Conclusions: Children with night-time fears are at risk for developing poor sleep quality, which may further compromise their psychological well-being., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Activity-based sleep-wake monitoring or actigraphy has gained a central role as a sleep assessment tool in sleep medicine. It is used for sleep assessment in clinical sleep research, and as a diagnostic tool in sleep medicine. This update indicates that according to most studies, actigraphy has reasonable validity and reliability in normal individuals with relatively good sleep patterns. The validity of actigraphy in special populations or with individuals with poor sleep or with other sleep-related disorders is more questionable. The most problematic validity issue is the low specificity of actigraphy in detecting wakefulness within sleep periods reported with certain devices or samples. Overall, the recent literature adds to previous reports in demonstrating that actigraphy is sensitive in detecting unique sleep patterns associated with specific sleep disorders as well as with other medical or neurobehavioral disorders. Furthermore, actigraphy is sensitive in detecting sleep changes associated with drug treatments and non-pharmacologic interventions. Recent developments include the development of devices specially tailored to detect periodic limb movement in sleep and the introduction of new devices and algorithms. Because of the limitations of actigraphy, it is recommended to use complementary assessment methods (objective and subjective) whenever possible., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Sleep problems are highly prevalent in early childhood. In many cases, parents seek professional help when they suspect their child suffers from a sleep problem. The aim of this study was to explore sleep, demographic and cultural factors associated with parental definition of child sleep problem in a large-scale, cross cultural study., Methods: Parents (or caregivers) of 29,287 infants and toddlers (aged 0-3 years) from 17 countries completed a questionnaire on their child's sleep patterns, sleep setting, and demographic variables., Results: The results indicated that, in comparison to parents from predominantly Caucasian (PC) countries, parents from predominantly Asian (PA) countries were significantly more likely to identify a sleep problem in their children (26% vs 52% overall; 2% vs 17% "severe" sleep problem). Furthermore, whereas infant sleep variables were strong predictors of a sleep problem definition in PC countries, they were significantly less predictive in PA countries where demographic variables played a significant role., Conclusions: These results highlight the need to further explore the role of demographic and cultural variables in determining parental perception of a sleep problem, a perception that relates to help seeking professional treatment for infant sleep problems. Our findings also emphasize the need to educate parents about infant and toddler sleep and to provide parents information and screening tools to help them identify sleep problems in a more evidence-based approach., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Emotion regulation has become a pivotal concept in developmental and clinical research. However, the measurement of regulatory processes has proved extremely difficult, particularly in the context of within-subject designs. Here, we describe a formal conceptualization and a new experimental procedure, the Balloons Game, to measure a regulatory component of emotion-expressive behavior. We present the internal consistency and stability of the indices derived from the Balloons Game in a sample of 121 kindergarten children. External validation against measures that have been associated with emotion regulation processes is also provided. The findings suggest that the Balloons Game provides a reliable tool for the study of regulation of emotion expression in young children., (PsycINFO Database Record (c) 2011 APA, all rights reserved.)

Objective: To assess the feasibility of conducting home-based sleep restriction studies with actigraphic monitoring of sleep and a new online continuous performance test (OCPT)., Methods: Thirty-four university undergraduate students (24 females, 19-30years old) underwent repeated home assessments using self-administered OCPT following a regular night of sleep (8h or more) and following sleep restriction (4h of sleep) in a within-between subjects counter-balanced design. Actigraphy was used to monitor sleep. OCPT sessions were scheduled in the morning and the evening of days following normal and restricted sleep., Results: OCPT measures demonstrated acceptable test-retest reliability. Actigraphic monitoring revealed good compliance with sleep requirements, and reported alertness reflected significant effects of sleep manipulation (p<.0001). In comparison to performance following an 8-h sleep night, sleep restriction to 4h was associated with a significant increase in omission errors in the high-target section of the test (p<.0005) and with a significant increase in omission errors in the low-target section of the test (p<.01)., Conclusions: These preliminary results support the feasibility of conducting home-based sleep restriction studies and the validity of the online version of the OCPT, suggesting that it may serve as a sensitive tool for assessment of sleep restriction/deprivation., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Objectives: The goals of this study were to assess: (a) the involvement of fathers and mothers in overall and nighttime infant caregiving; (b) the links between paternal involvement in infant care and infant sleep patterns during the first 6 months., Methods: Fifty-six couples recruited during their first pregnancy, participated in the study. After delivery (1 and 6 months), both parents completed a questionnaire assessing the involvement of fathers relative to mothers in infant caregiving. Infant sleep was assessed using actigraphy and sleep diaries., Results: Mothers were significantly more involved than fathers in daytime and nighttime caregiving. A higher involvement of fathers in overall infant care predicted and was associated with fewer infant night-wakings and with shorter total sleep time after controlling for breastfeeding., Conclusions: The findings highlight the importance of including fathers in developmental sleep research. Future studies should explore mechanisms underlying the relations between paternal involvement and infant sleep.

Behavioral insomnia is a very common problem throughout childhood. It has negative impact on children and their families and can persist for many years if not treated. Interventions based on cognitive-behavioral therapy (CBT) principles have mainly focused on withdrawing excessive parental bedtime involvement and helping children develop self-soothing strategies for falling asleep and resuming sleep during the night. With young children, these interventions are mostly based on training and modifying parental behaviors. Changing parental sleep-related expectations, beliefs and perceptions is an important component in these interventions. With older children and adolescents, more versatile interventions exist and they include additional components of CBT including relaxation and stress reduction techniques, modifying cognitive processes related to worrying and anxiety, positive imagery training and others. Extensive research has established the efficacy of behavioral interventions in early childhood. However, research on interventions for older children has been very limited and has failed to provide sufficient information on the efficacy of specific CBT techniques for childhood insomnia., (Copyright 2010 Elsevier B.V. All rights reserved.)

Infant sleep undergoes dramatic evolution during the first year of life. This process is driven by underlying biological forces but is highly dependent on environmental cues including parental influences. In this review the links between infant sleep and parental behaviors, cognitions, emotions and relationships as well as psychopathology are examined within the context of a transactional model. Parental behaviors, particularly those related to bedtime interactions and soothing routines, are closely related to infant sleep. Increased parental involvement is associated with more fragmented sleep. Intervention based on modifying parental behaviors and cognitions have direct effect on infant sleep. It appears that parental personality, psychopathology and related cognitions and emotions contribute to parental sleep-related behaviors and ultimately influence infant sleep. However, the links are bidirectional and dynamic so that poor infant sleep may influence parental behaviors and poor infant sleep appears to be a family stressor and a risk factor for maternal depression., ((c) 2009 Elsevier Ltd. All rights reserved.)

Background: To assess the prevalence of parental behaviors and other factors of sleep ecology and to analyze their relationships with sleep outcomes in a large sample of children ages birth to 36months in multiple countries/regions., Methods: Parents of 29,287 infants and toddlers (48% boys; Australia, Canada, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, Philippines, Singapore, Taiwan, Thailand, United Kingdom, United States, and Vietnam) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire., Results: Overall, there is a high level of parental involvement in sleep onset and sleep maintenance for young children, with significant differences in parenting behaviors across cultural groups. For predominantly-Caucasian, the most common behavior occurring at bedtime is falling asleep independently in own crib/bed (57%), compared to just 4% of those children living in predominantly-Asian regions. Parental behaviors and sleep ecology, including parental presence at sleep onset, bedtime, and bedtime routine, significantly explain a portion of the variance in sleep patterns. Overall, parental behaviors are more highly predictive of nighttime sleep outcomes in predominantly-Caucasian regions. Finally, parental involvement in sleep onset mediates the relationship between cosleeping and sleep outcomes., Conclusions: Overall, the best predictors of nighttime sleep are related to parental behaviors at bedtime and during the night. Furthermore, sleep disruption and decreased total sleep associated with bed sharing and room sharing are mediated by parental presence at bedtime. These findings provide additional support for addressing parental behaviors in behavioral interventions for infant and toddler sleep problems., (Copyright 2010 Elsevier B.V. All rights reserved.)

Background: To characterize cross-cultural sleep patterns and sleep problems in a large sample of children ages birth to 36 months in multiple predominantly-Asian (P-A) and predominantly-Caucasian (P-C) countries., Methods: Parents of 29,287 infants and toddlers (predominantly-Asian countries/regions: China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam; predominantly-Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire., Results: Overall, children from P-A countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to both bed-share and room-share than children from P-C countries, p<.001. Bedtimes ranged from 19:27 (New Zealand) to 22:17 (Hong Kong) and total sleep time from 11.6 (Japan) to 13.3 (New Zealand) hours, p<.0001. There were limited differences in daytime sleep. Bed-sharing with parents ranged from 5.8% in New Zealand to 83.2% in Vietnam. There was also a wide range in the percentage of parents who perceived that their child had a sleep problem (11% in Thailand to 76% in China)., Conclusions: Overall, children from predominantly-Asian countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to room-share than children from predominantly-Caucasian countries/regions. These results indicate substantial differences in sleep patterns in young children across culturally diverse countries/regions. Further studies are needed to understand the basis for and impact of these interesting differences., (Copyright 2010 Elsevier B.V. All rights reserved.)

The objective is to examine underlying associations between childhood fears, behavior problems and neurobehavioral functioning (NBF) in school-age children. Healthy, regular school children (N = 135), from second, fourth and sixth grade classes were assessed. Data regarding children's fears and behavioral problems were obtained with the Revised Fear Survey Schedule for Children, the Child Behavior Checklist, and NBF was assessed using a computerized neurobehavioral evaluation system. Significant correlations between childhood fears and NBF measures and somatic complaints were found. Children who reported higher levels of fears demonstrated lower working memory span (r = 0.24, p < 0.05), lower motor speed (r = -0.23, p < 0.05), and had more somatic complaints (r = 0.20, p < 0.05). Furthermore, younger children reported less fears than older ones and girls reported more fears than boys. These results highlight significant association between childhood fears, NBF and behavior problems in a non-clinical group children. Lower working memory span is an important component of executive control that may be an underlying factor in fears and anxiety in children.

Sleep problems are very prevalent during infancy. The most common problems are those related to night wakings and sleep-disordered breathing (SDB). Most common night waking problems do not have identified physiologic etiology. Their causes appear to be behavioral or developmental by nature, and they usually respond well to behavioral interventions. SDB may result from a variety of anatomic and neurologic factors and is associated with a variety of medical and developmental disorders. Because of the high prevalence of sleep problems during infancy, their persistence, their potential adverse developmental effects, and the positive treatment outcomes, pediatricians should serve as the primary address for screening and referral to proper assessment and treatment.

Infant sleep is a major source of concern for many parents. The aims of this longitudinal study were to assess: (a) the development of sleep patterns among infants, (b) the development of maternal cognitions regarding infant sleep, and (c) the relations between these domains during the 1st year of life. Eighty-five mothers were recruited during pregnancy and completed a questionnaire aimed at assessing maternal sleep-related cognitions. After delivery (at 1, 6, and 12 months) sleep was assessed using actigraphy and sleep logs, and maternal cognitions were reassessed. The findings demonstrated significant predictive and concomitant links between maternal cognitions and infant sleep. Maternal soothing behaviors mediated the relations between these domains.

This paper reviews the scientific Literature regarding the relationships between parenting and infant sleep. The first part of the paper briefly addresses the development of sleep and sleep disorders during the first years of life. The evolution of these problems is described in the context of a transactional model which assumes that there are dynamic and bidirectional influences between infants' sleep and different physiological and psycho-social factors. The second part of the paper focuses on the role parents may have in the development of infant sleep patterns. In particular the paper describes: (A) findings demonstrating significant Links between infants sleep and parental nighttime involvement and soothing behaviors; (B) studies demonstrating the efficacy of interventions aimed at improving infant sleep, that are based on changing parental practices at night; and (C) studies focusing on exploring the links between parental factors, such as parental sleep-related perceptions and psychopathology and between parental nighttime behavior and infant sleep.

This study was designed to provide data on sleep patterns during the first 3 years, based on a large US-Canada Internet sample, to assess the prevalence of parental interventions and related factors of infant sleep ecology and to evaluate the links between sleep ecology and sleep. Five thousand six parents completed a web-based online questionnaire about their children, aged from birth to 36 months. The questionnaire included items pertaining to sleep patterns, sleep environment, sleep-related parental interventions, sleep position, and demographic information. The results reflected clear sleep-related developmental changes including a decrease in daytime sleep and total sleep time, as well as consolidation of sleep during the night, which was manifested in a decrease in night wakings and nocturnal wakefulness. Sleep ecology and parental behaviors significantly explained a portion of the variance in the child's sleep patterns. Parental interventions that encourage independence and self-soothing were associated with extended and more consolidated sleep, especially in comparison to more active interactions that were associated with shorter and more fragmented sleep. These findings provide parents and professionals reference data for assessing sleep in young children. Furthermore, the results provide information on specific ecological factors that are associated with increased risk for sleep problems.

Objective: The goal was to assess stress reactions in young children during and after war and the effects of a new brief intervention., Methods: Two separate studies were conducted. In study I, we assessed war exposure and stress reactions of 74 children (2-7 years of age) in a sheltered camp during the second Israel-Lebanon war (July to August 2006). Their exposure to war experiences and their stress reactions were assessed through parental reports during the last week of the war. In addition to standard care, 35 children received a brief intervention (Huggy-Puppy intervention) aimed at encouraging them to care for a needy Huggy-Puppy doll that was given to them as a gift. The effects of the Huggy-Puppy intervention were assessed in a follow-up interview 3 weeks after the war. Study II assessed the efficacy of group administration of the Huggy-Puppy intervention to 191 young children, compared with 101 control subjects. The effects of the intervention on stress-related symptoms after the war were assessed in telephone interviews with the parents., Results: Study I indicated that, during the war, most children had significant exposure to war-related experiences and had severe stress reactions. The Huggy-Puppy intervention was associated with significant reductions in stress reactions in the postwar assessment. A higher level of attachment and involvement with the doll was associated with better outcomes. The results of study II indicated that group administration of the Huggy-Puppy intervention was associated with significant reductions in stress reactions., Conclusion: These studies suggest that the Huggy-Puppy intervention may offer pediatricians and other child health care professionals a promising, cost-effective intervention for children during stressful times.

The links between sleep and attention-deficit hyperactivity disorder (ADHD) have been a topic for intense ongoing research and clinical interest. Previous narrative literature reviews conveyed a consensus that parents of children with ADHD are more likely to report sleep problems in their children in comparison to parents of control children. However, when objective measures are considered the results appear to be more complex and inconsistent. This review is based on a meta-analysis of relevant polysomnographic studies. We assessed measures related to sleep architecture, breathing disorders, and periodic limb movements in sleep (PLMS), and the role of potential moderators such as age, gender, and other methodological factors. The meta-analysis revealed only one significant combined effect that indicates that children with ADHD are more likely than controls to suffer from PLMS. Factors such as age, gender, inclusion of adaptation night, and comorbidity appear to play a moderating role in the associations between sleep characteristics and ADHD. To provide new insight regarding the links between sleep and ADHD research in this field should adopt new strict guidelines and consider the role of multiple pertinent moderating factors.

This study assessed the effects of modest sleep restriction and extension on children's neurobehavioral functioning (NBF). The sleep of 77 children (age: M = 10.6 years; range = 9.1-12.2 years) was monitored for 5 nights with activity monitors. These children (39 boys and 38 girls) were all attending regular 4th- and 6th-grade classes. Their NBF was assessed using computerized tests on the 2nd day of their normal sleep schedule. On the 3rd evening, the children were asked to extend or restrict their sleep by an hour on the following 3 nights. Their NBF was reassessed on the 6th day following the experimental sleep manipulation. Sleep restriction led to improved sleep quality and to reduced reported alertness. The sleep manipulation led to significant differential effects on NBF measures. These effects may have significant developmental and clinical implications.

The aim of this study was to examine the associations between sleep and neurobehavioral functioning (NBF) in school-age children. These variables were assessed for 135 unreferred, healthy school children (69 boys and 66 girls), from second-, fourth-, and sixth-grade classes. Objective assessment methods were used on the participants in their regular home settings. Sleep was monitored using actigraphy for 5 consecutive nights; and NBF was assessed using a computerized neurobehavioral evaluation system, administered twice, at different times of the day. Significant correlations between sleep-quality measures and NBF measures were found, particularly in the younger age group. Children with fragmented sleep were characterized by lower performance on NBF measures, particularly those associated with more complex tasks such as a continuous performance test and a symbol-digit substitution test. These children also had higher rates of behavior problems as reported by their parents on the Child Behavior Checklist. These results highlight the association between sleep quality, NBF, and behavior regulation in child development; and raise important questions about the origins of these associations and their developmental and clinical significance.