Effect of Symptoms of Effect of Symptoms of Sleep Problems on School Sleep Problems on School Behavior, Academics and Behavior, Academics and

Quality of LifeQuality of Life

Erin E. Ax, Ph.D. & Kathy L. Bradley-Erin E. Ax, Ph.D. & Kathy L. Bradley-Klug, Ph.D.Klug, Ph.D.

University of South FloridaUniversity of South Florida

Presented at the National Association of School Psychologists Presented at the National Association of School Psychologists Annual MeetingAnnual MeetingNew York CityNew York City

March 27, 2007March 27, 2007

Overview of the PresentationOverview of the Presentation

Statement of the ProblemStatement of the Problem Research QuestionsResearch Questions Participant CharacteristicsParticipant Characteristics ResultsResults Implications/Directions for Future Implications/Directions for Future

ResearchResearch

Statement of the ProblemStatement of the Problem

Sleep problems are experienced by Sleep problems are experienced by approximately 25% of all children approximately 25% of all children (Mindell & Owens, 2003)(Mindell & Owens, 2003)

Sleep problems are inadequately addressed Sleep problems are inadequately addressed (Owens, 2001)(Owens, 2001)

School based prevalence rates are School based prevalence rates are unknownunknown

Sleep problems can impact behavioral and Sleep problems can impact behavioral and academic success at school (e.g., Gozal, academic success at school (e.g., Gozal, 1998)1998)

Sleep problems are treatableSleep problems are treatable

Research QuestionsResearch Questions

1. What is the prevalence of symptoms of 1. What is the prevalence of symptoms of sleep problems/disorders in one school sleep problems/disorders in one school district in the Northeast?district in the Northeast?

Research QuestionsResearch QuestionsIs there a difference between students with Is there a difference between students with

and without symptoms of sleep disorders and without symptoms of sleep disorders as measured by the Sleep Disorders as measured by the Sleep Disorders Inventory for Students – Child Form Inventory for Students – Child Form (SDIS-C)(SDIS-C)

2. on teacher report of student behavior determined by 2. on teacher report of student behavior determined by high scores on the Behavioral Assessment System high scores on the Behavioral Assessment System of Children, Second Edition (BASC-2)?of Children, Second Edition (BASC-2)?

3. on academic achievement related to reading as 3. on academic achievement related to reading as determined by Curriculum-based Measurement determined by Curriculum-based Measurement Reading (R-CBM)?Reading (R-CBM)?

4. on academic achievement related to mathematics as 4. on academic achievement related to mathematics as determined by Curriculum-based Measurement determined by Curriculum-based Measurement Math (M-CBM)?Math (M-CBM)?

5. on student self-report of quality of life determined 5. on student self-report of quality of life determined by high scores on the PedsQL™ 4.0 and low scores by high scores on the PedsQL™ 4.0 and low scores on the Students’ Life Satisfaction Scale (SLSS)?on the Students’ Life Satisfaction Scale (SLSS)?

ParticipantsParticipants

216 2216 2ndnd and 3 and 3rdrd graders graders 36.9% total eligible population36.9% total eligible population One school district One school district Suburb of large city in NortheastSuburb of large city in Northeast

Participant CharacteristicsParticipant Characteristics

Female

Male

Second Grade

Third Grade

Gender Grade

56%

44% 60.2%

39.8%

Participant Characteristics Participant Characteristics (cont’d)(cont’d)

No SleepDisorder

Sleep Disorder

Sleep Disorder Category

82.9%

17.1%

Participant Characteristics Participant Characteristics (cont’d)(cont’d)

Caucasian

Hispanic

Black/AfricanAmerican

Asian

Caucasian

Hispanic

Black/AfricanAmerican

Asian

No Sleep Disorder Symptoms of Sleep Disorder

Ethnicity by Sleep Disorder Category

30.7%

16.2%

6.1%

46.9%

32.4%

21.6%

45.9%

InstrumentsInstruments

Sleep Disorders Inventory for Students Sleep Disorders Inventory for Students (SDIS-C)(SDIS-C)

Behavior Assessment System for Children, Behavior Assessment System for Children, Second Edition (BASC-2)Second Edition (BASC-2) Externalizing ScaleExternalizing Scale Internalizing ScaleInternalizing Scale

Curriculum-based Measurement (CBM)Curriculum-based Measurement (CBM) Reading (R-CBM)Reading (R-CBM) Math (M-CBM)Math (M-CBM)

PedsQLPedsQL™ 4.0 ™ 4.0 Students’ Life Satisfaction Scale (SLSS)Students’ Life Satisfaction Scale (SLSS)

ProceduresProcedures

1.1. IRB approval sought and grantedIRB approval sought and granted

2.2. Endorsement letter, explanation letter, Endorsement letter, explanation letter, consent form and SDIS-C sent home to consent form and SDIS-C sent home to all studentsall students

3.3. PI recruited parents attending PI recruited parents attending conferencesconferences

4.4. PI explained the research study to PI explained the research study to teachers and offered incentivesteachers and offered incentives

5.5. Complete packet sent home second time Complete packet sent home second time and third timeand third time

Procedures Procedures (cont’d)(cont’d)

6.6. Teachers completed TRSTeachers completed TRS

7.7. PI provided refreshments to thank PI provided refreshments to thank teachersteachers

8.8. PI accessed R-CBM data archivallyPI accessed R-CBM data archivally

9.9. Teachers administered M-CBM probes Teachers administered M-CBM probes

10.10. PI administered Peds QLPI administered Peds QL™ 4.0 and SLSS ™ 4.0 and SLSS to study participantsto study participants

Data AnalysesData Analyses

Descriptive statistics calculatedDescriptive statistics calculated Assumptions testedAssumptions tested MANOVAMANOVA Follow-up testsFollow-up tests

Research Question OneResearch Question One

1. What is the prevalence of symptoms of 1. What is the prevalence of symptoms of sleep problems/disorders in one school sleep problems/disorders in one school district in the Northeast?district in the Northeast? 17.1% had symptoms of a sleep disorder 17.1% had symptoms of a sleep disorder

0102030405060708090

100

OSAS PLMD DSPS EDS

No Sleep Disorder

Sleep Disorder

Research Question TwoResearch Question Two

2. Is there a difference between students 2. Is there a difference between students with and without symptoms of sleep with and without symptoms of sleep disorders as measured by the SDIS-C on disorders as measured by the SDIS-C on teacher report of behavior?teacher report of behavior?

InstrumentInstrument No Sleep DisorderNo Sleep Disorder Sleep DisorderSleep Disorder

Externalizing Externalizing MeanMean

48.8648.86 53.4653.46

Internalizing Internalizing MeanMean

47.0947.09 52.4052.40

Research Question ThreeResearch Question Three

3. Is there a difference between students 3. Is there a difference between students with and without symptoms of sleep with and without symptoms of sleep disorders as measured by the SDIS-C on disorders as measured by the SDIS-C on reading achievement?reading achievement?

InstrumentInstrument No Sleep DisorderNo Sleep Disorder Sleep DisorderSleep Disorder

R-CBM MeanR-CBM Mean 119.22119.22 99.2699.26

Research Question FourResearch Question Four

4. Is there a difference between students 4. Is there a difference between students with and without symptoms of sleep with and without symptoms of sleep disorders as measured by the SDIS-C on disorders as measured by the SDIS-C on math achievement?math achievement?

InstrumentInstrument No Sleep DisorderNo Sleep Disorder Sleep DisorderSleep Disorder

M-CBM MeanM-CBM Mean 24.0424.04 19.6319.63

Research Question FiveResearch Question Five

5. Is there a difference between students 5. Is there a difference between students with and without symptoms of sleep with and without symptoms of sleep disorders as measured by the SDIS-C on disorders as measured by the SDIS-C on quality of life and subjective well-being?quality of life and subjective well-being?

InstrumentInstrument No Sleep DisorderNo Sleep Disorder Sleep DisorderSleep Disorder

PedsQL 4.0 MeanPedsQL 4.0 Mean 76.9476.94 75.8175.81

SLSS MeanSLSS Mean 4.544.54 4.514.51

LimitationsLimitations

Threats to internal validityThreats to internal validity InstrumentationInstrumentation Selection biasSelection bias

Threats to external validityThreats to external validity Population validityPopulation validity Ecological validityEcological validity Specificity of variablesSpecificity of variables

Implications for School Implications for School PsychologistsPsychologists

Early identification of sleep disordersEarly identification of sleep disorders Early intervention for sleep disordersEarly intervention for sleep disorders Pre-servicePre-service

Educate future practitioners on pediatric Educate future practitioners on pediatric health issueshealth issues

CollaborationCollaboration PractitionersPractitioners

Continuing professional developmentContinuing professional development Education – educators, parents, policy Education – educators, parents, policy

makersmakers

Directions for Future ResearchDirections for Future Research

Continue sleep research using teacher Continue sleep research using teacher reportsreports

Further investigate Further investigate Relationship between hyperactivity, Relationship between hyperactivity,

aggression, conduct problems and sleepaggression, conduct problems and sleep Relationship between internalizing Relationship between internalizing

symptomssymptoms Conduct research on state achievement Conduct research on state achievement

test and sleeptest and sleep Follow-up with current cohort using PSG Follow-up with current cohort using PSG

ConclusionConclusion

Symptoms of sleep disorders occurred in Symptoms of sleep disorders occurred in nearly one-fifth of the samplenearly one-fifth of the sample

Difference between students with and Difference between students with and without symptoms of sleep disorders on without symptoms of sleep disorders on school behavior, academic achievement, school behavior, academic achievement, and quality of life was significant and quality of life was significant Students with symptoms of sleep disorders Students with symptoms of sleep disorders

performed significantly worse onperformed significantly worse on ReadingReading Internalizing behaviorsInternalizing behaviors Externalizing behaviorsExternalizing behaviors