1. Children without a regular bedtime had worse scores on a standardized measure of behavior than those with regular bedtimes.
2. Children who modified their irregular bedtime to a regular bedtime showed improvement in their behavioral scores.
Evidence Rating Level: 1 (Excellent)
Study Rundown: The connection between sleep and children’s behavior has been widely studied. However, evidence of a causal relationship between the two has been limited by the cross-sectional nature and small sample sizes of prior studies. This prospective cohort study used a nationally representative sample to assess the impact of regular bedtimes on childhood behavior. Researchers used parental interviews to assess bedtime regularity and a questionnaire administered at ages three, five and seven to assess behavior. The study found that children with regular bedtimes had better behavioral scores than those without a regular bedtime. In addition, a positive association was observed between the lack of a regular bedtime and worsening behavior. However, among children who went from not having a regular bedtime to having a regular bedtime, improved behavior scores were noted. The study is limited by reliance on parental report of sleeping behavior,. The study demonstrates that sleep schedules have statistically and clinically significant impact on childhood behavior which is both dose-dependent and reversible. Therefore, it encourages physicians to screen children and make recommendations for regular sleep schedules.
In-Depth [prospective cohort study]: 10,230 children and their parents were included from the UK Millennium Cohort Study, a nationally representative cohort of children born between 2000 and 2002. Parent interviews and Strengths and Difficulties Questionnaires (SDQ), a validated, brief behavioral screening questionnaire, completion at ages three, five and seven were used in analysis. Differences in difference analysis was completed to compare changes over time in behavior in the control group to the change over time in the studied group, this difference is expressed as a β value. Analysis was also adjusted for a variety of statistically significant confounding variables from mother’s self-rated confidence in parenting to time spent watching television. Results showed that children without regular bedtimes were more likely to have higher scores on the SDQ (indicating worse behavior) than children with regular bedtimes, and this relationship increased as the number of years with irregular bedtimes increased (irregular at any one age, β=0.53; irregular any two ages, β= 1.04, irregular at all three ages, β=2.10, p<.001). Children without regular bedtimes who later developed a regular pattern had improved behavioral scores; children who changed between age three and age seven had a difference in behavioral score of β= -0.63, whereas those that changed from age five to age seven had a difference of β= -1.02.
By Laurel Wickberg and Leah H. Carr
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