Early Childhood Sleep Difficulties and Middle Childhood Internalizing and Externalizing Psychopathology Among Children with Histories of Early Adversity

Abstract Children who have experienced adversity, including abuse and neglect, are at elevated risk for both sleep problems and psychopathology. Sleep disturbance may be one pathway by which early adversity confers risk for psychopathology. Previous studies with such children have found associations between sleep difficulties and internalizing and externalizing problems in early childhood, and between sleep and externalizing problems in middle childhood. Here, we sought to examine the links between early childhood sleep difficulties and middle childhood internalizing and externalizing psychopathology in children with histories of early adversity followed longitudinally. Participants were 153 children (44% female) enrolled in a randomized controlled trial of an early childhood parenting intervention following involvement with child protective services. Caregivers reported on children’s sleep difficulties at ages 2, 3, and 4 and children’s internalizing and externalizing problems at ages 8, 9, and 10. Using a structural equation modeling approach, we found that mean levels of early childhood sleep difficulties were significantly and positively associated with internalizing, β = .449, p = .010, 95% CI [.106, .792], but not with externalizing, β = .229, p = .137, 95% CI [-.072, .529], problems in middle childhood, controlling for sex, age 4 psychopathology, and caregiver depression. Findings extend prior work demonstrating associations between sleep problems and psychopathology among children with histories of early adversity. More research is needed to elucidate the potential role of sleep difficulties in the development of internalizing problems in this population.