Trajectories of sleep in Child Protective Services (CPS)-referred children predict externalizing and internalizing symptoms in early childhood

Background: Previous studies have established links between poor sleep and negative developmental outcomes. However, it remains unclear whether young maltreated children demonstrate atypical sleep patterns and whether sleep duration is associated with emotional and behavioral problems. Objective: Explore trajectories of sleep among Child Protective Services (CPS)-referred children and examine whether sleep duration is significantly associated with externalizing and internalizing symptoms, even when controlling for the home environment. Participants: Participants included 197 children (M-age at first assessment = 10.24 months, SD = 6.39) whose parents were referred to CPS due to allegations of maltreatment. Methods: Parents completed sleep diaries for their children at up to five time-points and the preschool version of the Child Behavior Checklist (CBCL) when children were approximately 2 years of age (M-age = 26.40 months, SD = 3.36). The Home Observation for Measurement of the Environment Scale (HOME) assessed the quality of the early home environment. Results: Results from latent growth curve modeling demonstrated that CPS-referred children significantly varied (B = 3.28, SE = 0.90, p < .001) in the amount they slept in a 24-hour period at baseline (i.e., 4.1 months of age), and the amount of total sleep in a 24-hour period significantly decreased across time (B-1 = -0.03, SE = 0.01, p < .001). When controlling for characteristics of the home environment, total sleep in a 24-hour period at baseline significantly inversely predicted externalizing (B = - 1.03, SE = 0.06, p < .001) and internalizing symptoms (B = -0.19, SE = 0.03, p < .001) in early childhood. Conclusions: This study is an important first step in exploring trajectories of sleep among CPS-referred children. Findings underscore sleep as a promising target for interventions aimed at promoting regulation and highlight the need for future research to examine sleep in maltreated children as a predictor of later developmental outcomes.