WASHINGTON – When a child is sleep deprived, it shows at school.
In a study of 74 healthy 6− to 12-year-old students, experimentally reducing the duration of their sleep at home for 1 week resulted in academic and attention problems significant enough that teachers could detect differences between children who had had enough sleep and those who had not–without being told which ones were which (Sleep 2005;28:1280–6).
The results strongly suggest that information about sleep should be obtained for all children who present with academic difficulty or behavior problems, particularly those with inattentive symptoms, Gahan Fallone, Ph.D., said during a report of his findings at a conference for science reporters sponsored by the American Medical Association.
“As clinicians, we have to ask about sleep in patients who present with these behavior indicators,” said Dr. Fallone of the Forest Institute of Professional Psychology, Springfield, Mo.
Increasing evidence suggests that children and adolescents are not getting as much sleep as they need to function optimally in school. Most of the studies demonstrating a link between lack of sleep and adverse effects on school performance have used either self-reports of sleep duration or laboratory-induced sleep deprivation.
This study attempted to isolate the specific effects of sleep loss by using home-based sleep restriction in healthy, well-functioning children who had no mood or psychiatric diagnoses, including attention-deficit hyperactivity disorder.
In a 3-week period during the school year, children slept on their typical schedule the first week. During week 2, they were randomized to either an optimized sleep condition in which they spent 10 or more hours in bed or to a restricted condition in which children in third grade and above spent 6.5 hours or less in bed while those in first and second grade were allowed no more than 8 hours in bed. In week 3, the children switched sleep conditions.
Several methods were used to ensure compliance, including daily sleep diaries, twice-daily phone calls, and wrist activity monitors. At the end of each week, teachers were asked to rate the children on 34 items that assessed attention problems, academic performance, hyperactive-impulsive behavior, oppositional-aggressive behavior, and mood. The teachers were not told which schedule the students were following.
Significant differences from baseline were seen on the academic problems portion of the questionnaire, which had a scoring range of 2–18. Compared with a baseline score of 6.86, the mean rating during the optimized sleep condition was 7.03; the mean rose to 7.67 for the sleep-restricted condition. On the School Situations Questionnaire, children in the sleep-restricted period had significantly more attention problems and a greater mean severity of attention problems, compared with baseline: From a possible 0–9 range, mean severity was 1.26 during restricted sleep, compared with 0.99 during optimized sleep periods and 0.80 at baseline.
In contrast, there were no significant changes during the 3 weeks in the areas of hyperactive-impulsive behavior, oppositional-aggressive behavior, or mood, said Dr. Fallone, who did this research while working at Brown Medical School, Providence, R.I.
Based on these findings and data from other studies, Dr. Fallone suggested the following advice for parents:
▸ Remove media (such as television and video games) and other distractions from your child's bedroom.
▸ Consider getting your child to bed on time as important as getting him or her to school on time.
▸ Use the average time in bed for the healthy children in this study during the baseline week as a guideline: 10 hours for first and second graders; 9.75 hours for third and fourth graders; and 9.2 hours for fifth through seventh graders.
▸ Eliminate the use of caffeine.
▸ Keep children's bedtimes and wake-up times the same on weekends as they are on school days.
These results suggest that while insufficient sleep may be the core deficit in some children with attention problems, it is not likely to be the core problem when excessive hyperactivity and impulsivity are present. Dr. Fallone and his associates currently are analyzing data from a follow-up study in children aged 12–17 who have attention-deficit hyperactivity disorder. The study's aim is to assess the amount of sleep these children get and the impact of sleep duration on their response to stimulant medication.
Significant increases were seen in academic and attention problems, but not in hyperactivity, aggressiveness, or mood. COURTESY DONNA FRANKI