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August 26, 2011

Are tired children more aggressive children?

O’Brien, L.M., Lucas, N.H., Felt, B.T., Hoban, T.F., Ruzicka, D.L., Jordan, R., Guire, K., & Chervin, R.D. (2011/in press). Aggressive behaviour, bullying, snoring, and sleepiness in schoolchildren. Sleep Medicine, XXX.

This is another paper which has not actually been published yet, but which has been accepted for publication. These authors note that a specific sleep related problem, called sleep-disordered breathing (SDB), might contribute toward children’s aggressive behaviour. SDB can range from simple snoring through to complete obstruction of the airway which causes problems sleeping and may include frequent awakenings. SDB has already been associated with other difficulties such as being hyperactive, inattentive and possibly aggression. However, the link with aggression has not been assessed in a general, standard school population and has been restricted to clinic-referred children.

341 young people from 2nd and 5th grades (around 7 and 10 years old) took part. Parents reported on their children’s snoring, sleepiness, inattentive/hyperactive behaviour, and bullying. Teachers also reported on problem inattentive/hyperactive or conduct disordered behaviour, and bullying.

The effects of age, gender, and free school lunch qualification (i.e. Socio-Economic Status) were controlled for. Then they tried to predict whether children did or did not (i) have conduct problems (ii) bully others.
  • (i) Conduct problems: SDB score predicted Conduct problems, even after controlling for stimulant medication. This seemed to be mainly due to reports of sleepiness rather than reports of snoring.
  • (ii) Bullying: SDB did not predict Bullying in a composite measure, but when broken down by parent and teacher rating, SDB did predict parent reports of bullying. This seemed to be mainly due to reports of sleepiness rather than reports of snoring. However, when use of stimulants was included this became the only significant predictor of parent identified bullying.
  • Discipline referrals were also investigated for 198 children, and 33 of those children had two or more referrals. This referral group had higher SDB scores and were reported to be sleepier than the non-referred group. This seemed again to be mainly due to reports of sleepiness rather than reports of snoring. 
The authors note that snoring is more commonly reported as a symptom characteristic of SDB, so sleepiness may reflect something other than biologically based difficulties. For example, the first thing that comes to mind for me is the possibility that parents are simply not putting their children to bed early enough. The authors cite research evidence supporting such a possibility.

The authors also argue that the effects of sleep difficulties might be seen primarily in how well the prefrontal cortex in the brain works – this area, at the front of the brain, is involved in our planning ability and our ability to stop our selves acting on impulse (known as “executive functions”) as well as being involved in emotional control. Encouraging a good sleep routine may therefore be an additional issue which anti-bullying efforts might want to integrate into their messages.

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