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A Community Survey

Joseph C. Blader, PhD; Harold S. Koplewicz, MD; Howard Abikoff, PhD; Carmel Foley, MD

Arch Pediatr Adolesc Med. 1997;151(5):473-480.

Abstract
Objective
To examine the prevalence, co-occurrence, and correlates of sleep problems among elementary school children.

Design
Survey.

Setting
General community.

Participants
The parents of 987 children aged 5 to 12 years completed an anonymous survey distributed in their children's schools.

Main Outcome Measures
The survey form asked about background characteristics, children's sleep environment, sleep habits, adult interventions, sleep history, and specific sleep problems.

Results
Bedtime resistance was the most prevalent sleep problem (27%). Sleep-onset delays (11.3%), night waking (6.5%), morning wake-up problems (17%), and fatigue complaints (17%) were also common. Among children with sleep-onset problems, 80% displayed bedtime resistance, while 34% of bedtime resisters had onset problems. Onset problems correlated with more fears, night waking, psychiatric and medical conditions, the need for reassurance and caregiver proximity, and history of sleep problems. Bedtime resistance was associated with an inconsistent bedtime and falling asleep away from bed. Those who display delayed sleep onset and bedtime resistance also wake later, suggesting that sleep-phase delays may maintain these problems.

Conclusions
The results confirm bedtime resistance as parents' principal sleep-related complaint for this age group but reveal a subgroup more prone to insomnia, night waking, and anxiety-related features. Phase delay findings suggest the importance of limits around wake-up time as well as bedtime. The results highlight the importance of distinctly evaluating bedtime resistance, sleep onset, sleep maintenance, waking, and emotional adjustment.

Arch Pediatr Adolesc Med. 1997;151:473-480

Author Affiliations
From the Division of Child and Adolescent Psychiatry, Long Island Jewish Medical Center, New Hyde Park, NY. Drs Blader, Koplewicz, and Abikoff are now at the Child Study Center of New York University Medical Center, New York.

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