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Longitudinal repeated-measures study of the associations between sleep patterns and emotional and behavioral problems

Guiyin Zhu1, Fan Zhu1, Shuang Yang1

  • 1Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.

Sleep Medicine
|March 3, 2026
PubMed

Insights

Maintaining healthy sleep patterns in children is linked to fewer emotional and behavioral issues. Poor or declining sleep increases risks for internalizing and externalizing problems and reduces prosocial behaviors.

Area of Science:

  • Child psychology
  • Sleep science
  • Behavioral health

Background:

  • Childhood emotional and behavioral problems are a significant public health concern.
  • Sleep plays a crucial role in child development and well-being.
  • Understanding the impact of sleep pattern changes on behavior is vital for early intervention.

Purpose of the Study:

  • To investigate the longitudinal association between sleep pattern changes and emotional/behavioral problems in 9-11-year-old children.
  • To identify specific sleep dimensions contributing to healthy sleep scores.
  • To categorize changes in sleep patterns and their subsequent impact on behavior.

Main Methods:

  • A one-year longitudinal study of 1821 fourth-graders in Beijing, China (2024-2025).
  • A healthy sleep score (0-6) was created from six dimensions: timing, duration, efficiency, alertness, satisfaction, and regularity.
  • Sleep patterns (poor, moderate, healthy) and changes (stable healthy, stable poor, declined, etc.) were analyzed alongside parent-reported emotional/behavioral problems using the Strengths and Difficulties Questionnaire.

Main Results:

  • 31.6% of children maintained healthy sleep patterns throughout the study.
  • Each unit increase in healthy sleep score correlated with lower internalizing/externalizing scores and higher prosocial scores.
  • Compared to stable healthy sleep, stable poor or declined sleep patterns significantly increased risks for internalizing/externalizing problems and decreased prosocial behaviors.

Conclusions:

  • Maintaining healthy sleep patterns is associated with reduced internalizing and externalizing problems in children.
  • Healthy sleep is linked to a higher probability of prosocial behaviors.
  • Sleep pattern changes, particularly declines, pose risks to children's emotional and behavioral health.
Abstract

Keywords:
ChildrenMental healthSleep durationSleep patternSleep quality

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