Sleep Difficulties May Be Associated With Behavioral, Communication Disorders in Preschoolers

Child who has fallen asleep at a desk.
In this sample of preschoolers, sleep disorders were commonly reported and associated with specific diagnostic categories.

According to study data published in the International Journal of Environmental Research and Public Health, preschoolers with behavioral and communication disorders may have higher rates of sleep problems than preschoolers with developmental coordination disorder and relational disorders.

Investigators abstracted data from the clinical records of 296 children (aged 1-6 years) who received a psychiatric evaluation at the Hôpital en Santé Mentale Rivière-des-Prairies in Montréal, Quebec, Canada. Records from July 2006 through September 2009 were accessed for the study. Children with autism or intellectual disabilities were excluded from the study.

Related Articles

Psychiatric diagnoses obtained from the evaluations were pooled into 4 categories: behavioral, relational, developmental coordination, and communication disorders. Results from the parent-reported sleep problems subscale of the Child Behavior Checklist were extracted and compared across diagnostic categories.

The final sample comprised 228 children (mean age, 47.79±13.62 months; 74.1% boys), and more than a fifth of children (21.6%) reached the borderline or clinical threshold for sleep problems. Overall, 39.0% of children were diagnosed with a behavioral disorder, 44.7% with a relational disorder, 76.8% with developmental coordination disorder, and 77.6% with a communication disorder. Comorbidity was high, with 89.9% of children receiving a diagnosis in 2 or more categories.

In analyses adjusted for family composition and maternal education level, a diagnosis of a behavioral disorder (B, 1.08; P =.04) or communication disorder (B, 1.74; P =.05) was significantly associated with parent-reported sleep problems. In contrast, having a diagnosis of developmental coordination disorder was associated with fewer parent reports of sleep problems (B, −2.35; P =.01), and relational disorders had no association with sleep reports (B, 0.62; P =.27).

Parents of children with behavioral disorders were also more likely to report that their child had trouble falling asleep (P =.04), whereas parents of children with communication disorders were more likely to report their child waking often at night (P =.04). Parents of children with developmental coordination disorder were less likely to report either sleep symptom. The cumulative number of psychiatric diagnoses did not appear to influence mean raw total score on the Child Behavior Checklist sleep problems scale (P =.56).

In this sample of preschoolers, sleep disorders were commonly reported and associated with specific diagnostic categories. As study limitations, investigators cited the lack of control group, which would have allowed comparisons between children with and without psychiatric diagnoses. “A better understanding of the relationship between sleep and psychiatric disorders in this vulnerable population will provide insight into the use of more specific and appropriate interventions,” the investigators wrote.


Chénier-Leduc G, Béliveau MJ, Dubois-Comtois K, Butler B, Berthiaume C, Pennestri MH. Sleep difficulties in preschoolers with psychiatric diagnoses. Int J Environ Res Public Health. 2019;16(22):4485.