Behavioural Sleep Disorders across the Developmental Age Span: An Overview of Causes, Consequences and Treatment Modalities


Behavioural sleep problems, that is, sleep problems that do not have a physiological aetiology, but rather a behavioural or psychological aetiology, are reported in between 20% - 40% of children and adolescents. These sleep disorders are categorised as Behavioural Insomnia of Childhood (BIC) in the International Classification of Sleep Disorders. BIC can result in short sleep duration and poor quality sleep and can have wide ranging effects on mental and physical health, cognitive and social functioning and development in infants, pre-schoolers, school aged children and adolescents. Each age group have a particular set of behaviourally based sleep disorders. This paper presents a broad overview of BIC and covers essential information about these sleep disorders, their aetiologies, effects on development and non medical treatment modalities.

Share and Cite:

Blunden, S. (2012). Behavioural Sleep Disorders across the Developmental Age Span: An Overview of Causes, Consequences and Treatment Modalities. Psychology, 3, 249-256. doi: 10.4236/psych.2012.33035.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] AASM. (2005). International classification of sleep disorders: Diagnostic and coding manual. Westchester, IL: American Academy of Sleep Medicine.
[2] Archbold, K. H., Pituch, K. J., Panahi, P., & Chervin, R. D. (2002). Symptoms of sleep disturbances among children at two general pediatric clinics. The Journal of Pediatrics, 140, 97-102 doi:10.1067/mpd.2002.119990
[3] Armstrong, K., Quin, R. A., & Dadds, M. R., (1994). The sleep patterns of normal children. The Medical Journal of Australia, 161, 202-206.
[4] Bjorvatn, B., & Pallesen, S. (2009). A practical approach to circadian rhythm sleep disorders. Sleep Medicine Reviews, 13, 47-60. doi:10.1016/j.smrv.2008.04.009
[5] Blader, J., Koplewicz, H., Abikoff, H., & Foley, C. (1997). Sleep problems of elementary school children. A community survey. Archives of Pediatric & Adolescent Medicine, 151, 473-480. doi:10.1001/archpedi.1997.02170420043007
[6] Blunden, S. (2011). Behavioural treatments to encourage solo sleeping in pre-school children: no need for controlled crying. Journal of Child Health Care, 15, 107-117. doi:10.1177/1367493510397623
[7] Blunden, S., & Chervin, R. D. (2010). Sleep, performance and behaviour in Australian indigenous and non-indigenous children: An exploratory comparison. Journal of Paediatric Child Health, 46, 10-16. doi:10.1111/j.1440-1754.2009.01610.x
[8] Blunden, S., Hoban, T. F., & Chervin, R. D. (2006). Sleepiness in children. Sleep Medicine Clinics, 1, 105-118. doi:10.1016/j.jsmc.2005.11.006
[9] Blunden, S., Lushington, K., Lorenzen, B., Wong, J., Balendran, R., & Kennedy, D. (2003). Symptoms of Sleep Breathing Disorders in Children Are Underreported by Parents at General Practice Visits. Sleep Breath, 7, 167-176. doi:10.1007/s11325-003-0167-8
[10] Blunden, S. L., & Beebe, D. W. (2006). The contribution of intermittent hypoxia, sleep debt and sleep disruption to daytime performance deficits in children: Consideration of respiratory and non-respiratory sleep disorders. Sleep Medicine Reviews, 10, 109-118. doi:10.1016/j.smrv.2005.11.003
[11] Blunden, S. L., Lushington, K., Lorenzen, B., Martin, J., & Kennedy, D. (2005). Neuropsychological and psychosocial function in children with a history of snoring or behavioral sleep problems. Journal of Pediatrics, 146, 780-786. doi:10.1016/j.jpeds.2005.01.043
[12] Blunden, S. L., Lushington, K., Lorenzen, B., Ooi, T., Fung, F., & Kennedy, D. (2004) Are sleep problems under-recognised in general practice? Archives of Disease in Childhood, 89, 708-712. doi:10.1136/adc.2003.027011
[13] Buckhault, J. (2011). Insufficient sleep and socioeconomic status. Child Dev Perspectives, 5, 59-65. doi:10.1111/j.1750-8606.2010.00151.x
[14] Carskadon, M., Acebo, C., & Jenni, O. (2004). Regulation of adolescent sleep: Implications for behavior. Annals of the New York Academy Science, 1021, 276-291. doi:10.1111/j.1750-8606.2010.00151.x
[15] Carskadon, M., & Wolfson, A. C. A. (1998), Adolescent sleep patterns, circadian timing, sleepiness at a transition to early school days. Sleep, 21, 871-881.
[16] Carter, P., Taylor, B. J., Williams, S. M., & Taylor, R. W. (2011). Longitudinal analysis of sleep in relation to BMI and body fat in children: The FLAME study. British Medicine Journal, 342, d2712.
[17] Chaput, J. P. Bouchard, C., & Tremblay, A. (2008). The association between sleep duration and weight gain in adults: A 6-year prospective study from the Quebec family study. Sleep, 31, 517-23.
[18] Chavin, W., & Tinson, S. (1980). Children with sleep difficulties. Health Visitor, 53, 477-480.
[19] Chervin, R., Dillon, J., Bassetti, C., Ganoczy, D., & Pituch, K. (1997). Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep, 20, 1185-1192.
[20] Chervin, R. D., Archbold, K. H., Dillon, J. E., Panahi, P., Pituch, K. J., Dahl, R. E., & Guilleminault, C, (2002) Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics, 109, 449- 456. doi:10.1542/peds.109.3.449
[21] Copes, K., & Rosentweig, J. (1972). The effects of sleep deprivation on motor performance of ninth grade students. Journal of Sports Medicine, 12, 47-53.
[22] Cortesi, F., Giannotti, F., Sebastiani, T., Bruni, & O,Ottaviano, S. (2004). Knowledge of sleep in Italian high school students: Pilot-test of a school-based sleep educational program. The Journal of Adolescent Health, 34, 344-351.
[23] Cortesi, F., Giannotti, F., Sebastiani, T., Vagnoni, C., & Marioni, P., (2008). Cosleeping versus solitary sleeping in children with bedtime problems: Child emotional problems and parental distress. Behavorial Sleep Medicine, 6, 89-105. doi:10.1080/15402000801952922
[24] Dahl, R. (1996). The impact of inadequate sleep on children’s daytime cognitive function. Seminars in Pediatric Neurology, 3, 44-50. doi:10.1016/S1071-9091(96)80028-3
[25] Dahl, R. E., Pelham, W. E., & Wierson, M. (1991). The role of sleep disturbances in attention deficit disorder symptoms: A case study. Journal of Pediatric Psychology, 16, 229-239. doi:10.1093/jpepsy/16.2.229
[26] De Sousa, I., Araújo, J. F., & De Azevedo, C. V. M. (2007). The effect of a sleep hygiene education program on the sleep-wake cycle of Brazilian adolescent students. Sleep and Biological Rhythms, 5, 251-258. doi:10.1111/j.1479-8425.2007.00318.x
[27] Everson, C., Laatsch, C. D., & Hogg, N. (2005). Antioxidant defence responses to sleep loss and sleep recovery. American Journal of Physiology Regulatory, Integrative and Comparetive Physiology, 288, R374-R383. doi:10.1152/ajpregu.00565.2004
[28] Fallone, G., Acebo C., Arnedt, J., Seifer, R., & Carskadon, M. (2001). Effects of acute sleep restriction on behavior, sustained attention, and response inhibition in children. Perceptual and Motor Skills, 93, 213-229.
[29] Goldberg, E. (2002). The executive brain: Frontal lobes and the civilised mind. Oxford University Press: Oxford.
[30] Gordon, J., King, N. J., Gullone, E., Muris, P., & Ollendick, T. H. (2007). Treatment of children’s nighttime fears: The need for a modern randomised controlled trial. Clinical Psychology Reviews, 27, 98-113. doi:10.1016/j.cpr.2006.07.002
[31] Gozal, D., & Kheirandish-Gozal, L. (2007). Neurocognitive and behavioral morbidity in children with sleep disorders. Current Opinion in Pulmonary Medicine, 13, 505-509. doi:10.1097/MCP.0b013e3282ef6880
[32] Gregory, A., & Eley, T. C. (2005). Sleep problems, anxiety and cogntive style in school aged children. Infant and Child Development, 14, 435-444.
[33] Gupta, R., Saini, D. P., Acharya, U., & Miglani, N. (1994). Impact of television on children. Indian Journal of Pediatrics, 61, 153-159. doi:10.1007/BF02843606
[34] Hanlon, E., Andrzejewski, M. E., Harder, B. K., Kelley, A. E., & Benca, R. M. (2005). The effect of REM sleep deprivation on motivation for food reward. Behavioural Brain Research, 163, 58-69.
[35] Heins, E., Seitz, C., Schüz, J., Toschke, A., Harth, K., Letzel, S., & B?hler, E. (2007). Bedtime, television and computer habits of primary school children in Germany. Gesundheitswesen, 69, 151-157. doi:10.1055/s-2007-971061
[36] Hiscock, H., Bayer, J. K., Hampton, A., Ukoumunne, O. C., & Wake, M., (2008). Long-term mother and child mental health effects of a population-based infant sleep intervention: Ccluster-randomized, controlled trial. Pediatrics, 122, e621-e627. doi:10.1542/peds.2007-3783
[37] Hiscock, H., Canterford, L., Ukoumunne, O., & Wake, M., (2007). Adverse associations of sleep problems in Australian preschoolers: National population study. Pediatrics, 119, 86-93. doi:10.1542/peds.2006-1757
[38] Hiscock, H., & Wake, M., (2001). Infant sleep problems and postnatal depression: A community-based study. Pediatrics, 107, 1317-1322. doi:10.1542/peds.107.6.1317
[39] Ivanenko, A J, K., (2008) Sleep disturbances in children with psychiatric disorders. Seminars in Pediatric Neurology, 15, 70-78. doi:10.1016/j.spen.2008.03.008
[40] Johnson, J., Cohen, P., Kasen, S., & Brook, J. S. (2004). Association between television viewing and sleep problems during adolescence and early adulthood. Archives of Pediatrics and Adolescent Medicine, 158, 562-568. doi:10.1001/archpedi.158.6.562
[41] Kahn, A., Van de Merckt, C., Rebuffat, E., Mozin, M., Sottiaux, M., Blum, D., & Hennart, P. (1989). Sleep problems in healthy preadolescents. Pediatrics, 84, 542-546.
[42] Kerr, S., & Jowett, S. (1994). Sleep problems in pre-school children: A review of the lieterature. Child Care Health Development, 20, 379-391. doi:10.1111/j.1365-2214.1994.tb00400.x
[43] Kryger, M., Roth, T., & Dement, W. C. (1994). Principles and practices of sleep medicine (2nd ed.). Philadelphia: W.B. Saunders Company.
[44] Kushnir, J., & Sadeh, A. (2011). Assesment of a brief intervention for nighttime fears in preschool children. European Journal of Pediatrics, Article ID:21594575. doi:10.1007/s00431-001-1488-4
[45] Laureys, S., Peigneux, P., Perrin, F., & Maquet, P. (2002). Sleep and motor skill learning. Neuron, 35, 5-7. doi:10.1016/S0896-6273(02)00766-3
[46] Marcotte, A., Thache,r P., Butters, M., Bortz, J., Acebo, C., & Carskadon, M. (1998). Parental report of sleep problems in children with attentional and learning disorders. Journal of Developmental and Be- havioral Pediatrics, 19, 178-186. doi:10.1097/00004703-199806000-00005
[47] McKenna, J. (2000). Cultural influences on infant and childhood sleep biology and the science that studies it: Toward a more inclusive paradigm. In G. Loughlin, J. L. Carroll & C. L. Marcus (Eds.), Sleep and breathing in children: A developmental approach. New York, NY: Marcel Dekker, 199-230.
[48] Meltzer, L. (2010). Clinical management of behavioral insomnia of childhood: Treatment of bedtime problems and night wakings in young children. Behavioral Sleep Medicine, 8, 172-189. doi:10.1080/15402002.2010.487464
[49] Minde, K. (2002). Treatment of sleep problems in small children. Acta Paediatrics, 91, 866-867. doi:10.1111/j.1651-2227.2002.tb02845.x
[50] Mindell, J., Kuhn, B., Lewin, D., Meltzer, L., & Sadeh, A. (2006). Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29, 1263-1276.
[51] Mindell, J., Owens, J., & Carskadon, M. (1999). Developmental features of sleep. Child and Adolescent Psychiatric Clinics of North America, 8, 695-725.
[52] Mindell, J., & Owens, J. A. (2003). Sleep problems in pediatric practice: clinical issues for the pediatric nurse practitioner. Journal of Pediatric Health Care, 17, 324-331.
[53] Mindell, J., Telofski, L. S., Weigand, B., & Kurtz, E. (2009). A nightly bedtime routine: Impact on sleep in young children and maternal mood. Sleep, 32, 599-606.
[54] Moore, P. J., Adler, N. E., Williams, D. R., & Jackson, J. S. (2002). Socioeconomic status and health: The role of sleep. Psychosomatic Medicine, 64, 337-344.
[55] Morgenthaler, T., Owens, J., Alessi, C., Boehlecke, B., Brown, T. M., Coleman, J. Jr., Friedman, L., Kapur, V. K., Lee-Chiong, T., Pancer, J., & Swick, T. J. (2006) Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young childre. Sleep, 29, 1277-1281.
[56] Moseley, L., & Gradisar, M. (2009). Evaluation of a school-based intervention for adolescent sleep problems. Sleep, 32, 334-341.
[57] Murray, L., & Ramchandani, P. (2007). Infant sleep problems: Might prevention be better than cure? Archives of Diseases in Childhood, 92, 943-944. doi:10.1136/adc.2007.124628
[58] O'Brien, L. M., Mervis C. B., Holbrook C. R., Bruner J. L., Smith N. H., McNally, N., McClimment, M. C., & Gozal, D. (2004). Neurobehavioral correlates of sleep-disordered breathing in children. Journal of Sleep Research, 13, 165-172. doi:10.1111/j.1365-2869.2004.00395.x
[59] Olds, T., Ridley, K., & Dollman, J. (2006). Screenieboppers and extreme screenies: The place of screen time in the time budgets of 10 - 13 year-old Australian children. Australian and New Zealand Journal of Public Health, 30, 137-142. doi:10.1111/j.1467-842X.2006.tb00106.x
[60] Owens-Stively, J., Frank, N., Smith, A., Hagino, O., Spirito, A., Arrigan, M., & Alario, A. (1997). Child temperament, parenting discipline style, and daytime behavior in childhood sleep disorders. Journal of Developmental and Behavioral Pediatrics, 18, 314-321. doi:10.1097/00004703-199710000-00005
[61] Owens, J., & Dalzell, V. (2005). Use of the “BEARS” sleep screening tool in a pediatric residents’ continuity clinic: A pilot study. Sleep Medicine, 6, 63-69. doi:10.1016/j.sleep.2004.07.015
[62] Owens, J, Maxim, R., McGuinn, M., N =obile, C., Msall, M., & Alario, A. (1999). Television viewing habits and sleep disturbance in school aged children. Pediatrics, 104, e27-e41. doi:10.1542/peds.104.3.e27
[63] Owens, J., Opipari, L., Nobile, C., & Spirito, A. (1998). Sleep and day-time behavior in children with obstructive sleep apnea and behavioral sleep disorders. Pediatrics, 102, 1178-1184. doi:10.1542/peds.102.5.1178
[64] Owens, J., Veasey, S., & Rosen, R. (2001). Physician, heal thyself: sleep, fatigue, and medical education. Sleep, 24, 493-495.
[65] Pearl, P., Efron, L., & Stein, M. (2002). Children, sleep and behaviour: A complex association. Minerva Pedaitrica, 54, 79-91.
[66] Plihal, W., & Born, J. (1997). Effects of early and late nocturnal sleep on declarative and porcedural memory. Journal of Cognitive Neuroscience, 9, 534-547. doi:10.1162/jocn.1997.9.4.534
[67] Sadeh, A. (2005). Cognitive-behavioral treatment for childhood sleep disorders. Clinical Psychology Review, 25, 612-628. doi:10.1016/j.cpr.2005.04.006
[68] Sadeh, A., Gruber, R., & Raviv, A. (2002). Sleep, neurobehavioral functioning, and behavior problems in school-age children. Child Development, 73, 405-417. doi:10.1111/1467-8624.00414
[69] Sadeh, A., Gruber, R., & Raviv, A. (2003). The effects of sleep restriction and extension on school-age children: What a difference an hour makes. Child Development, 74, 444-455. doi:10.1111/1467-8624.7402008
[70] Sadeh, A., Raviv, A., & Gruber, R. (2000). Sleep patterns and sleep disruptions in school-age children. Developmental Psychology, 36, 291-301. doi:10.1037/0012-1649.36.3.291
[71] Sadeh, A., Raviv, A., & Gruber, R. (2000). Sleep patterns and sleep disruptions in school-age children. Developmental Psychology, 36, 291-301. doi:10.1037/0012-1649.36.3.291
[72] Scher, A., &Blumberg, O. (1999). Night waking among 1-year-olds: A study of maternal separation anxiety. Child Care Health and Development, 25, 323-334.
[73] Sekine, M., Chandola, T., Martikainen, P., McGeoghegan, D., Marmot, M., & Kagamimori, S. (2006). Explaining social inequalities in health by sleep: The Japanese civil servants study. Journal of Public Health, 28, 63-67. doi:10.1093/pubmed/fdi067
[74] Short, M., Gradisar, M., Wright, H., Lack, L. C., Dohnt, H., & Carskadon, M. A. (2011). Time for bed: parent-set bedtimes associated with improved sleep and daytime functioning in adolescents. Sleep, 34, 797-800.
[75] Silva, R., Abilio, V. C., Takatsu, A. L., Kameda, S. R., Grassl, C., Chehin, A. B. et al. (2004). Role of hippocampal oxidative stress in memory deficits induced by sleep deprivation in mice. Neuropharmacology, 46, 895-903. doi:10.1016/j.neuropharm.2003.11.032
[76] Smedje, H., Broman, J., & Hetta, J., (2001). Associations between disturbed sleep and behavioural difficulties in 635 children aged six to eight years: a study based on parents’ perceptions. European Child Adolescent Psychiatry, 10, 1-9. doi:10.1007/s007870170041
[77] Spiegel, K, Leproult, R., & Van Cauter, E. (1999). Impact of sleep debt on metabolic and endocrine function. Lancet, 354, 1435-1439. doi:10.1016/S0140-6736(99)01376-8
[78] Steenari, M.-R., Vuontela, V., Paavonen, E., Julia, A., Carlson, S., Fjallberg, M., & Aronen, E. T. (2003). Working memory and sleep in 6- to 13-year-old schoolchildren. American Academy of Child and Adolescent Psychiatry, 42, 85-92. doi:10.1097/00004583-200301000-00014
[79] Stores, G. (1999). Children’s sleep disorders: Modern approaches, developmental effects, and children at risk. Development Medicine & Child Neurology, 41, 568-573. doi:10.1017/S001216229900119X
[80] Valent, F., Brusaferro, S., & Barbone, F. (2001). A case crossover study of sleep and childhood injury. Pediatrics, 107, E23. doi:10.1542/peds.107.2.e23
[81] Van den Bulck, J. (2004). Television viewing, computer game playing and internet use and self reported time in bed and time out of bed in secondary school children. Sleep, 27, 101-104.
[82] Vgontzas, A. N., Papaliaga, H.-M., Calhoun, M., S. Calhoun, Vela-Bueno, A., Chrousos, G. P., & Bixler, E. O. (2008). Short sleep duration and obesity: the role of emotinal stress and sleep disturbances. International Journal of Obesity, 32, 801-809.
[83] Walker, M., & Stickgold, R. (2004). Sleep-dependent learning and memory consolidation. Neuron, 44, 121-133. doi:10.1016/j.neuron.2004.08.031
[84] Weissbluth, M. (1984). Sleep duration, temperament, and Conners’ ratings of three-year-old children. Journal of Developmental and Behavioral Pediatrics, 5, 120-123.
[85] Wojnar, M., Ilgen, M. A., Wojnar, J., McCammon, R. J., Valenstein, M., & Brower, K. J. (2009). Sleep problems and suicidality in the National Comorbidity Survey Replication. Journal of Psychiatric Research, 43, 526-531. doi:10.1016/j.jpsychires.2008.07.006
[86] Wolfson, A., Spaulding, N., Dandrow, C., & Baroni, E. (2007). Middle school start times: The importance of a good night’s sleep for young adolescents. Behavioral Sleep Medicine, 5, 194-209.
[87] Wolfson, A. R., & Carskadon, M. A. (2003). Understanding adolescents’ sleep patterns and school performance: A critical appraisal. Sleep Medicine Reviews, 7, 491-506. doi:10.1016/S1087-0792(03)90003-7
[88] Wong, M, Brower, K., Fitzgerald, H., & Zucker, R. (2004). Sleep problems in early childhood and early onset of alcohol and other drug use in adolescence. Alcoholism, Clinical and Experimental Research, 28, 578-587. doi:10.1097/01.ALC.0000121651.75952.39
[89] Yokomaku, A. M., Misao, K., Omoto, F. Yamagishi, R., Tanaka, K. Takada, K., & Kohyama, J. (2008). A study of the association between sleep habits and problematic behaviours in preschool children. Chronoboilogy International, 25, 549-564.

Copyright © 2024 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.