Sleep problems, strengths and difficulties in elementary school children


Aim: To assess behavioral and sleep disturbances in childhood, it is necessary to implement standardized brief questionnaires for children and their parents. Especially complaints of insomnia often are underdiagnosed in pediatric medicine. Methods: We developed a sleep questionnaire (K?SI-KJ) and used it together with German versions of the SDQ (parent and child reports) for epidemiologic studies in Cologne. The sleep questionnaire obtains 33 items for parents and 28 items for children. Ratings were dichotomized for this analysis in “sometimes/ often present” versus “not present”. The German versions of SDQ contain 5 subscales each with 5 items. Data from a sample of 1490 children of fourth grade in elementary schools inCologne(age ranged from 8 to 11 years) are shown. Results: Children indicate signs of sleep disturbances in higher frequency than their parents do. Concerning gender and ethnical group, there no significant differences can be shown. Children with signs of insomnia, dyssomnia, daytime sleepiness or restless sleep showed significantly higher scores for all relevant SDQ subscales in parental and children's reports. Children with signs of parasomnia showed higher scores concerning emotional problems and the SDQ total score. Children with enuresis showed higher scores for all SDQ subscales and the total score.

Share and Cite:

Driouch, J. , Alfer, D. , Fricke-Oerkermann, L. and Lehmkuhl, G. (2013) Sleep problems, strengths and difficulties in elementary school children. Health, 5, 87-94. doi: 10.4236/health.2013.58A2013.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Meltzer, L.J., Johnson, C., Crosette, J., Ramos, M. and Mindell, J.A. (2010) Prevalence of diagnosed sleep disorders in pediatric primary care practices. Pediatrics, 125, e1410-e1418. doi:10.1542/peds.2009-2725
[2] Sadeh, A., Mindell, J. and Rivera, L. (2011) My child has a sleep problem: A cross-cultural comparison of parental definitions. Sleep Medicine, 12, 478-482. doi:10.1016/j.sleep.2010.10.008
[3] Mindell, J.A., Sadeh, A., Wiegand, B., How, T.H. and Goh, D.Y. (2010) Cross-cultural differences in infant and toddler sleep. Sleep Medicine, 11, 274-280. doi:10.1016/j.sleep.2009.04.012
[4] Gregory, A.M. and Sadeh, A. (2012) Sleep, emotional and behavioral difficulties in children and adolescents. Sleep Medicine Reviews, 16, 129-136. doi:10.1016/j.smrv.2011.03.007
[5] Wiater, A.H., Mitschke, A.R., Widdern, S., Fricke, L., Breuer, U. and Lehmkuhl, G. (2005) Sleep disorders and behavioural problems among 8-to 11-year old children. Somnologie, 9, 210-214.
[6] Owens, J.A. (2011) Update in pediatric sleep medicine. Current Opinion in Pulmonary Medicine, 17, 425-430.
[7] Keller, P. and El-Sheikh, M. (2011) Children’s emotional security and sleep: Longitudinal relations and directions of effects. Journal of Child Psychology and Psychiatry, 52, 64-71. doi:10.1111/j.1469-7610.2010.02263.x
[8] Roberts, R.E., Roberts, C.R. and Chan, W. (2008) Persistence and change in symptoms of insomnia among adolescents. Sleep, 31, 177-184.
[9] Stein, M.A., Mendelsohn, J., Obermeyer, W.H., Amromin, J. and Benca, R. (2001) Sleep and behavior problems in school-aged children. Pediatrics, 107, E60. doi:10.1542/peds.107.4.e60
[10] Urschitz, M.S., Guenther, A., Eggebrecht, E., Wolff, J., Urschitz-Duprat, P.M., Schlaud, M. and Poets, C.F. (2003) Snoring, intermittent hypoxia and academic performance in primary school children. American Journal of Respiratory and Critical Care Medicine, 168, 464-468. doi:10.1164/rccm.200212-1397OC
[11] Lehmkuhl, G., Fricke-Oerkermann, L., Wiater, A. and Mitschke, A. (2008) Sleep disorders in children beginning school: Their causes and effects. Deutsches Arzteblatt International, 105, 809-814.
[12] Liu, X., Liu, L. and Wang, R.Z. (2003) Bed sharing, sleep habits, and sleep problems among Chinese school-aged children. Sleep, 26, 89-94.
[13] Paavonen, E.J., Porkka-Heiskanen, T. and Lahikainen, A.R. (2009) Sleep quality, duration and behavioral symptoms among 5 -6-year-old children. European Child & Adolescent Psychiatry, 18, 747-754. doi:10.1007/s00787-009-0033-8
[14] Lavigne, J.V., Arend, R., Rosenbaum, D., Smith, A., Weissbluth, M., Binns, H.J. and Christoffel, K.K. (1999) Sleep and behavior problems among preschoolers. Journal of Developmental & Behavioral Pediatrics, 20, 164-169. doi:10.1097/00004703-199906000-00005
[15] Verhulst, F.C., van der Ende, J. and Rietbergen, A. (1997) Ten-year time trends of psychopathology in Dutch children and adolescents: No evidence for strong trends. Acta Psychiatrica Scandinavica, 96, 7-13. doi:10.1111/j.1600-0447.1997.tb09898.x
[16] Szklo-Coxe, M., Young, T., Peppard, P.E., Finn, L.A. and Benca, R.M. (2010) Prospective associations of insomnia markers and symptoms with depression. American Journal of Epidemiology, 171, 709-720. doi:10.1093/aje/kwp454
[17] Roane, B.M. and Taylor, D.J. (2008) Adolescent insomnia as a risk factor for early adult depression and substance abuse. Sleep, 31, 1351-1356.
[18] Dopfner, M., Lehmkuhl, G., Berner, W., Flechtner, H., Schwitzgebel, P., von Aster, M. and Steinhausen, H.C. (1993) Documentation of psychopathologic findings: A procedure for the evaluation of psychological disorders in children and adolescents. Z Kinder Jugendpsychiatr, 21, 90-100.
[19] Bub, K.L., Buckhalt, J.A. and El-Sheikh, M. (2011) Children’s sleep and cognitive performance: A crossdomain analysis of change over time. Developmental Psychology, 47, 1504-1514. doi:10.1037/a0025535
[20] Soffer-Dudek, N., Sadeh, A., Dahl, R.E. and RosenblatStein, S. (2011) Poor sleep quality predicts deficient emotion information processing over time in early adolescence. Sleep, 34, 1499-1508.
[21] Markowitsch, H.J. (2002) Functional retrograde amnesiaamnestic block syndrome. Cortex, 38, 651-654. doi:10.1016/S0010-9452(08)70030-3
[22] Ohayon, M.M. (2008) From wakefulness to excessive sleepiness: What we know and still need to know. Sleep Medicine Reviews, 12, 129-141. doi:10.1016/j.smrv.2008.01.001
[23] Mindell, J.A. (1999) Empirically supported treatments in pediatric psychology: Bedtime refusal and night wakings in young children. Journal of Pediatric Psychology, 24, 465-481. doi:10.1093/jpepsy/24.6.465
[24] Stores, G. (1996) Practitioner review: Assessment and treatment of sleep disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 37, 907-925. doi:10.1111/j.1469-7610.1996.tb01489.x
[25] Goodlin-Jones, B., Tang, K., Liu, J. and Anders, T.F. (2009) Sleep problems, sleepiness and daytime behavior in preschool-age children. Journal of Child Psychology and Psychiatry, 50, 1532-1540. doi:10.1111/j.1469-7610.2009.02110.x
[26] Surman, C.B., Adamson, J.J., Petty, C., Biederman, J., Kenealy, D.C., Levine, M., Mick, E. and Faraone, S.V. (2009) Association between attention-deficit/hyperactivity disorder and sleep impairment in adulthood: Evidence from a large controlled study. Journal of Clinical Psychiatry, 70, 1523-1529. doi:10.4088/JCP.08m04514
[27] Johnson, E.O., Roth, T., Schultz, L. and Breslau, N. (2006) Epidemiology of DSM-IV insomnia in adolescence: Lifetime prevalence, chronicity, and an emergent gender difference. Pediatrics, 117, e247. doi:10.1542/peds.2004-2629
[28] Kraenz, S., Fricke, L., Wiater, A., Mitschke, A., Breuer, U. and Lehmkuhl, G. (2004) Haufigkeit und belastungsfaktoren bei schlafstorungen im einschulalter. Prax Kinderpsychol Kinderpsychiatr, 53, 3-18.
[29] Stein, M.A., Mendelsohn, J., Obermeyer, W.H., Amromin, J. and Benca. R. (2001) Sleep and behavior problems in school-aged children. Pediatrics, 107, E60. doi:10.1542/peds.107.4.e60
[30] Liu, X. and Zhou, H. (2002) Sleep duration, insomnia and behavioral problems among Chinese adolescents. Psychiatry Research, 111, 75-85. doi:10.1016/S0165-1781(02)00131-2
[31] Johnson, E.O., Chilcoat, H.D. and Breslau, N. (2000) Trouble sleeping and anxiety/depression in childhood. Psychiatry Research, 94, 93-102. doi:10.1016/S0165-1781(00)00145-1
[32] Gregory, A.M. and O’Connor, T.G. (2002) Sleep problems in childhood: A longitudinal study of developmental change and association with behavioral problems. Psychoneuroendocrinology, 27, 489-503.
[33] Frolich, J., Lehmkuhl, G. and Wiater, A. (2005) Sleep disorders in children with attention-deficit hyperactivity disorder—Results of a polysomnographic study. Z Kinder Jugendpsychiatr Psychother, 33, 205-216. doi:10.1024/1422-4917.33.3.205
[34] Hoedlmoser, K., Kloesch, G., Wiater, A. and Schabus, M. (2010) Self-reported sleep patterns, sleep problems, and behavioral problems among school children aged 8 -11 years. Somnologie-Schlafforschung und Schlafmedizin, 14, 23-31.
[35] Smedje, H., Broman, J.E. and Hetta, J. (1999) Parents’ reports of disturbed sleep in 5 -7-year-old Swedish children. Acta Paediatrica, 88, 858-865. doi:10.1080/08035259950168793
[36] Chervin, R.D., Archbold, K.H., Dillon, J.E., Pituch, K.J., Panahi, P., Dahl, R.E. and Guilleminault, C. (2002) Association between symptoms an inattention, hyperactivity, restless legs and periodic leg movements. Sleep, 25, 213-218.
[37] Gottlieb, D.J., Vezina, R.M., Chase, C., Lesko, S.M., Heeren, T.C., Weese-Mayer, D.E., Auerbach, S.H. and Corwin, M.J. (2003) Symptoms of sleep-disordered breathing in 5-year-old children are associated with sleepiness and problem behaviors. Pediatrics, 112, 870-877. doi:10.1542/peds.112.4.870
[38] O’Brien, L.M., Ivanenko, A., Crabtree, V.M., Holbrook, C.R., Bruner, J.L., Klaus, C.J. and Gozal, D. (2003) The effect of stimulants on sleep characteristics in children with attention deficit/hyperactivity disorder. Sleep Medicine, 4, 309-316. doi:10.1016/S1389-9457(03)00071-6
[39] Mulvaney, S.A., Goodwin, J.L., Morgan, W.J., Rosen, G.R., Quan, S.F. and Kaemingk, K.L. (2005) Behavior problems associated with sleep disordered breathing in school-aged children—The Tucson children’s assessment of sleep apnea study. Journal of Pediatric Psychology, 31, 322-330. doi:10.1093/jpepsy/jsj035
[40] Urschitz, M.S., Eitner, S., Wolff, J., Guenther, A., Urschitz-Duprat, P.M., Schlaud, M. and Poets, C.F. (2007) Risk factors for sleep-related hypoxia in primary school children. Pediatric Pulmonology, 42, 805-812. doi:10.1002/ppul.20658
[41] Ersu, R., Arman, A.R., Save, D., Karadag, B., Karakoc, F., Berkem, M. and Dagli. E. (2004) Prevalence of snoring and symptoms of sleep-disordered breathing in primary school children in Istanbul. Chest, 126, 19-24. doi:10.1378/chest.126.1.19
[42] Frolich, J. And Lehmkuhl, G. (1998) Diagnostik und Differentialdiagnostik von Schlafstorungen im Kindesalter. Fortschr Neurol Psychiatr, 66, 553-569.
[43] Laberge, L., Carrier, J., Lespérance, P., Lambert, C., Vitaro, F., Tremblay, R.E. and Montplaisi, J. (2000) Sleep and circadian phase characteristics of adolescent and young adult males in a naturalistic summertime condition. Chronobiology International, 17, 489-501. doi:10.1081/CBI-100101059

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.