HHS Public Access Author manuscript Author Manuscript
J Sleep Res. Author manuscript; available in PMC 2017 June 01. Published in final edited form as: J Sleep Res. 2016 June ; 25(3): 341–349. doi:10.1111/jsr.12382.
Sleep Mediates The Link Between Resiliency And Behavioral Problems in Children At High and Low Risk For Alcoholism Ilana S. Hairston, Deirdre A. Conroy, Mary M. Heitzeg, Nasreen Z. Akbar, Kirk J. Bower, and Robert A. Zucker
Summary Author Manuscript
Children of alcoholic parents are at greater risk for developing substance use problems. Having a parent with any mental illness increases the risk for sleep disorders in children. Using actigraphy, this study objective characterized sleep in children of alcoholics and community controls over a period of one week. We further examined whether sleep characteristics of the children mediate the relationship between self-regulation indices (i.e., undercontrol and resiliency) and outcome measures of function (e.g., problem behaviors and perceived conflict at home).
Author Manuscript
Eighty-two children (53 boys, 29 girls, 7.2–13.0 yrs.) were recruited from the ongoing Michigan Longitudinal Study. Seventeen participants had no parental history of alcohol abuse or dependence (FH−), 43 had at least one parent who was a recovered alcoholic, and 22 had at least one parent who met diagnostic criteria within the past three years. Sleep was assessed with actigraphy and sleep diaries for one week, and combined with secondary analysis of data collected for the longitudinal study. FH− children had more objectively measured total sleep time (TST). More TST was associated with greater resiliency and behavioral control, few teacher-reported behavioral problems, and less child-reported conflict at home. Further, TST partially mediated the relationship between resiliency and perceived conflict, and between resiliency and externalizing problems. These findings suggest that in high-risk homes, the opportunity to obtain sufficient sleep is reduced, and that insufficient sleep further exacerbates the effects of impaired dispositional selfregulatory capacity on behavioral and emotional regulation.
Introduction
Author Manuscript
Children with alcoholic parents are at greater risk for developing alcoholism and other substance use problems (Wong et al., 2006, Hill et al., 2011). While the mechanisms that relay risk are complex, it has been consistently found that the tendency to develop substance use problems is linked to persistent self-regulatory difficulties (Block et al., 1988). This investigation examined the contributory role of children’s sleep to the child’s capacity to self-regulate, and to the behavioral and emotional outcomes of self-regulation. For the purpose of this study, self-regulation was conceptualized as indices of ‘ego control’ and
Corresponding author: Ilana S. Hairston, School of Behavioral Sciences, Academic College of Tel Aviv - Jaffa, 2 Rabeno Yeruham St., Box 8401, Jaffa 6818211, Israel, Tel: +972-3-6802503, ; Email: [email protected] Author contributions: Dr. Hairston participated in data collection, analysis, and is the primary author. Dr. Conroy participated in study design, execution, and editing of manuscript; Dr. Akbar participated in a large portion of data collection and preliminary analyses; Dr. Brower participated in study design and editing of manuscript; Dr. Zucker is PI of the study, in charge of all aspects of its execution.
Hairston et al.
Page 2
Author Manuscript
‘resiliency’ (Block and Block, 1980, Eisenberg et al., 2004), where ego control refers to impulse inhibition/expression, and resiliency refers to the dynamic capacity to modify the degree of control in accordance with situational demands (Letzring et al., 2005). Behavioral outcomes were defined as problem behaviors reported by the teachers, while children’s perceptions of conflict and cohesion in their homes, were used as proxies for their emotional coping.
Author Manuscript
Self regulation is highly adaptive, but requires effort to control impulses and desires (Baumeister, 2014), which can be taxed the longer an individual engages in tasks that require control, leading to lapses in performance (Hagger et al., 2010). Baumeister (2014) proposed that self-control is replenished by rest, suggesting that well-rested individuals have greater self-control. Indeed, sleep disturbances lower children’s ability to regulate, control, or inhibit emotion and behavior (Dahl and Harvey, 2007), and are associated with elevated internalizing and externalizing problems (Wong et al., 2010, Mindell et al., 1999, Sadeh et al., 2015, Sivertsen et al., 2015). Of specific relevance, parental ratings of sleep problems in children as young as four were associated with early onset of substance use and substancerelated problems during adolescence and young adulthood (Wong et al., 2010).
Author Manuscript
Parent psychopathology is a contributing factor for the development and/or maintenance of sleep problems in children (e.g., Shang et al., 2006). Specifically, we recently demonstrated that children of alcoholic parents slept less, and tended to nap during the day more than children from control families (Conroy et al., 2015). Similarly, Tarokh and Carskadon (2010) found that children with an alcoholic parent exhibited less power in the delta band and spindle range compared to controls, suggesting that brain mechanisms associated with sleep in these children are altered. Combined, this body of work suggests that children of parents with a history of alcoholism are more likely to have a poorer sleep, which may cause or amplify emotional and behavioral problems, and impede his/her emotional coping. The current study assessed the effects of parental history of alcoholism on sleep patterns in 8–13 year old offspring from the Michigan Longitudinal Study (MLS, Zucker et al., 2000, Zucker et al., 1996). The hypotheses tested were that [1] sleep will be more disrupted in children of alcoholic parents; [2] children with more sleep disturbance will have more problem behaviors at school, and will experience their home as more conflictual and less cohesive. [3] That differences in sleep patterns will mediate the relationship between self-regulation indices and outcome measures of function.
Materials and Methods Sample
Author Manuscript
The sample consisted of 82 children (53 boys and 29 girls), from the second and third generation of the MLS. For 17 children, neither parent had a history of alcohol abuse or dependence (FH−, age 10.93±1.34, range 8.1–12.8 yrs.), 43 had at least one parent who met diagnosis in the past but not currently (FH-past, age 10.35±1.33, range 7.2–12.8 yrs.), and 22 had at least one parent who met DSM-IV-TR diagnostic criteria within the past three years (FH-current, age 10.76±1.25, range 8.4–13.0 yrs.). Inclusion criteria were willingness to complete the study protocol. Exclusion criteria included any medical or psychiatric problem that could affect sleep, and the presence of fetal alcohol effects. J Sleep Res. Author manuscript; available in PMC 2017 June 01.
Hairston et al.
Page 3
Measures
Author Manuscript
Daily Sleep Diaries—Aided by a parent, each morning children reported on bedtime, time to fall asleep, wake-up time, and if and when the actigraph was removed. Variables derived from the diaries included: bedtime, rise-time, time in bed (TIB), sleep onset latency (SOL), and total sleep time (TST). Actigraphy—The actigraph is a wristwatch-like device that collects continuous movementgenerated data used to estimate sleep/wake patterns. The actigraphs also recorded light level exposure ≥ 10 lux, which was cross-referenced with bedtime and wake-up time. Epoch length was set to 1 minute. Data were downloaded and analyzed using Actiwatch® Sleep Analysis Software V5.0 (Philips Respironics, Bend, OR). Variables derived from actigraphs were TST, wake after sleep onset (WASO), and sleep efficiency (SE).
Author Manuscript
The Pediatric Sleep Questionnaire (PSQ) (Chervin et al., 2000)—The PSQ is a 45item instrument, completed by the child’s parent, used to identify several types of sleep problems. Responses are “yes”=1, “no”=0, and “don’t know”=missing. A higher score on the PSQ indicates greater sleep problems with daytime consequences. California Child Q-Sort—The CCQ (Block and Block, 1980) consists of 100 personality and behavior descriptive card items. The rater (an experienced MLS staff member, wellacquainted with the child) describes the child by placing each card in one of the 9 categories ranging from 1 (least descriptive) to 9 (most descriptive). The normalized scales included in this study were resiliency and behavioral undercontrol.
Author Manuscript
The Moos Family Environment Scale (FES, Moos and Moos, 2002)—The FES measures family social environment as perceived by family members, in this investigation – by the child. The two subscales used here were – ‘conflict’, the extent of open aggression, anger, and conflicted interactions among family members (Kuder-Richardson=.75, 8-week test-retest reliability=.85), and ‘cohesion’, the extent of commitment, concern, and support provided by family members to one another (Kuder-Richardson Formula=.78, 8-week testretest reliability=.86).
Author Manuscript
Child Behavior Checklist (Achenbach, 1991)—The CBCL provides assessment of the child’s social and emotional functioning as ascertained by the child’s teacher. The instrument yields scores on several narrow-band subscales, including social withdrawal, somatic problems, anxious/depressed, attention problems, delinquent behavior, and aggressive behavior. Two broadband subscales are derived concerning externalizing behaviors, composed of the aggressive behavior and delinquent behavior subscales; and the internalizing behaviors, composed of social withdrawal, somatic problems, and anxiety/ depression subscales. In this study the broadband externalizing and internalizing scales, and attention problems were used. Procedure Internal review boards of the University of Michigan and Michigan State University approved the study. This study combined sleep-related data collected for this report, with
J Sleep Res. Author manuscript; available in PMC 2017 June 01.
Hairston et al.
Page 4
Author Manuscript
secondary analysis of data collected from the parent Michigan Longitudinal Study. For sleep data collection, parents signed informed consent and children signed their assent to participate in the study, after which a detailed explanation of how to complete the sleep diaries, and the PSQ was explained to the parent. The actigraph was placed on the nondominant wrist of the child, who was instructed only to remove the device for showers or swimming. During the study, children maintained their usual sleep-wake schedule. Data Analysis
Author Manuscript
Due to children removing the watches, or returning the equipment early, a dataset was considered complete with 4–6 days of analyzable actigraphy nights. Group and gender comparisons consisted of either ANOVAs for continuous variables, or Chi-Square Test for ordinal variables. Partial η2 was used in ANOVAs, allowing for independent estimate of effect sizes of the different factors. Relationships between variables of interest were assessed using correlation tests. Mediation analyses, using structural equation modeling (SEM), were run after demonstrating significant correlations between variables of interest. 1000-iteration bootstrapped, biased-corrected confidence intervals (CI) were calculated to provide empirical estimation of CIs. Equation-level goodness-of-fit and effect sizes were also calculated. Gender and age were controlled for in all analyses.
Results Demographics
Author Manuscript
There were 53 boys and 29 girls in the study sample (FH− 16M/1F; FH past 27/16; FH current 10/12), mean age 10.53±1.33. 52% were Caucasian, 18% African American, 13% Hispanics, and 16% of mixed ethnicity. About 80% of parents had a partner, and the median income across groups was $30–50K. Chi-square analyses yielded a significant difference in gender distribution across groups (Pearson χ2=10.07, p=.007). All other measures did not differ between groups (p>.05). None of the children reported any drinking experience by the time of the study, and only one child endorsed trying to smoke cigarettes. Age, gender and week vs. weekend night effects on sleep measures
Author Manuscript
An average of five days of actigraphy and diary days, per child were used. Age and gender effects were tested using a multivariate ANOVAs. For sleep measures, all variables were entered as dependent measures, gender as the independent variable, and age as a covariate. There was a significant age-dependent decline in total sleep time both for diary report (F 2 1,80=13.189, p=.001, Partial η =.16), and for actigraphy scored TST (F 1,80=7.775, p=.007, Partial η2=.089), with an age-dependent increase in reported bedtimes (F 1,80=8.089, p=.006, Partial η2=.10). There was no gender effect on any of the sleep variables (Fs =
J Sleep Res. Author manuscript; available in PMC 2017 June 01. Published in final edited form as: J Sleep Res. 2016 June ; 25(3): 341–349. doi:10.1111/jsr.12382.
Sleep Mediates The Link Between Resiliency And Behavioral Problems in Children At High and Low Risk For Alcoholism Ilana S. Hairston, Deirdre A. Conroy, Mary M. Heitzeg, Nasreen Z. Akbar, Kirk J. Bower, and Robert A. Zucker
Summary Author Manuscript
Children of alcoholic parents are at greater risk for developing substance use problems. Having a parent with any mental illness increases the risk for sleep disorders in children. Using actigraphy, this study objective characterized sleep in children of alcoholics and community controls over a period of one week. We further examined whether sleep characteristics of the children mediate the relationship between self-regulation indices (i.e., undercontrol and resiliency) and outcome measures of function (e.g., problem behaviors and perceived conflict at home).
Author Manuscript
Eighty-two children (53 boys, 29 girls, 7.2–13.0 yrs.) were recruited from the ongoing Michigan Longitudinal Study. Seventeen participants had no parental history of alcohol abuse or dependence (FH−), 43 had at least one parent who was a recovered alcoholic, and 22 had at least one parent who met diagnostic criteria within the past three years. Sleep was assessed with actigraphy and sleep diaries for one week, and combined with secondary analysis of data collected for the longitudinal study. FH− children had more objectively measured total sleep time (TST). More TST was associated with greater resiliency and behavioral control, few teacher-reported behavioral problems, and less child-reported conflict at home. Further, TST partially mediated the relationship between resiliency and perceived conflict, and between resiliency and externalizing problems. These findings suggest that in high-risk homes, the opportunity to obtain sufficient sleep is reduced, and that insufficient sleep further exacerbates the effects of impaired dispositional selfregulatory capacity on behavioral and emotional regulation.
Introduction
Author Manuscript
Children with alcoholic parents are at greater risk for developing alcoholism and other substance use problems (Wong et al., 2006, Hill et al., 2011). While the mechanisms that relay risk are complex, it has been consistently found that the tendency to develop substance use problems is linked to persistent self-regulatory difficulties (Block et al., 1988). This investigation examined the contributory role of children’s sleep to the child’s capacity to self-regulate, and to the behavioral and emotional outcomes of self-regulation. For the purpose of this study, self-regulation was conceptualized as indices of ‘ego control’ and
Corresponding author: Ilana S. Hairston, School of Behavioral Sciences, Academic College of Tel Aviv - Jaffa, 2 Rabeno Yeruham St., Box 8401, Jaffa 6818211, Israel, Tel: +972-3-6802503, ; Email: [email protected] Author contributions: Dr. Hairston participated in data collection, analysis, and is the primary author. Dr. Conroy participated in study design, execution, and editing of manuscript; Dr. Akbar participated in a large portion of data collection and preliminary analyses; Dr. Brower participated in study design and editing of manuscript; Dr. Zucker is PI of the study, in charge of all aspects of its execution.
Hairston et al.
Page 2
Author Manuscript
‘resiliency’ (Block and Block, 1980, Eisenberg et al., 2004), where ego control refers to impulse inhibition/expression, and resiliency refers to the dynamic capacity to modify the degree of control in accordance with situational demands (Letzring et al., 2005). Behavioral outcomes were defined as problem behaviors reported by the teachers, while children’s perceptions of conflict and cohesion in their homes, were used as proxies for their emotional coping.
Author Manuscript
Self regulation is highly adaptive, but requires effort to control impulses and desires (Baumeister, 2014), which can be taxed the longer an individual engages in tasks that require control, leading to lapses in performance (Hagger et al., 2010). Baumeister (2014) proposed that self-control is replenished by rest, suggesting that well-rested individuals have greater self-control. Indeed, sleep disturbances lower children’s ability to regulate, control, or inhibit emotion and behavior (Dahl and Harvey, 2007), and are associated with elevated internalizing and externalizing problems (Wong et al., 2010, Mindell et al., 1999, Sadeh et al., 2015, Sivertsen et al., 2015). Of specific relevance, parental ratings of sleep problems in children as young as four were associated with early onset of substance use and substancerelated problems during adolescence and young adulthood (Wong et al., 2010).
Author Manuscript
Parent psychopathology is a contributing factor for the development and/or maintenance of sleep problems in children (e.g., Shang et al., 2006). Specifically, we recently demonstrated that children of alcoholic parents slept less, and tended to nap during the day more than children from control families (Conroy et al., 2015). Similarly, Tarokh and Carskadon (2010) found that children with an alcoholic parent exhibited less power in the delta band and spindle range compared to controls, suggesting that brain mechanisms associated with sleep in these children are altered. Combined, this body of work suggests that children of parents with a history of alcoholism are more likely to have a poorer sleep, which may cause or amplify emotional and behavioral problems, and impede his/her emotional coping. The current study assessed the effects of parental history of alcoholism on sleep patterns in 8–13 year old offspring from the Michigan Longitudinal Study (MLS, Zucker et al., 2000, Zucker et al., 1996). The hypotheses tested were that [1] sleep will be more disrupted in children of alcoholic parents; [2] children with more sleep disturbance will have more problem behaviors at school, and will experience their home as more conflictual and less cohesive. [3] That differences in sleep patterns will mediate the relationship between self-regulation indices and outcome measures of function.
Materials and Methods Sample
Author Manuscript
The sample consisted of 82 children (53 boys and 29 girls), from the second and third generation of the MLS. For 17 children, neither parent had a history of alcohol abuse or dependence (FH−, age 10.93±1.34, range 8.1–12.8 yrs.), 43 had at least one parent who met diagnosis in the past but not currently (FH-past, age 10.35±1.33, range 7.2–12.8 yrs.), and 22 had at least one parent who met DSM-IV-TR diagnostic criteria within the past three years (FH-current, age 10.76±1.25, range 8.4–13.0 yrs.). Inclusion criteria were willingness to complete the study protocol. Exclusion criteria included any medical or psychiatric problem that could affect sleep, and the presence of fetal alcohol effects. J Sleep Res. Author manuscript; available in PMC 2017 June 01.
Hairston et al.
Page 3
Measures
Author Manuscript
Daily Sleep Diaries—Aided by a parent, each morning children reported on bedtime, time to fall asleep, wake-up time, and if and when the actigraph was removed. Variables derived from the diaries included: bedtime, rise-time, time in bed (TIB), sleep onset latency (SOL), and total sleep time (TST). Actigraphy—The actigraph is a wristwatch-like device that collects continuous movementgenerated data used to estimate sleep/wake patterns. The actigraphs also recorded light level exposure ≥ 10 lux, which was cross-referenced with bedtime and wake-up time. Epoch length was set to 1 minute. Data were downloaded and analyzed using Actiwatch® Sleep Analysis Software V5.0 (Philips Respironics, Bend, OR). Variables derived from actigraphs were TST, wake after sleep onset (WASO), and sleep efficiency (SE).
Author Manuscript
The Pediatric Sleep Questionnaire (PSQ) (Chervin et al., 2000)—The PSQ is a 45item instrument, completed by the child’s parent, used to identify several types of sleep problems. Responses are “yes”=1, “no”=0, and “don’t know”=missing. A higher score on the PSQ indicates greater sleep problems with daytime consequences. California Child Q-Sort—The CCQ (Block and Block, 1980) consists of 100 personality and behavior descriptive card items. The rater (an experienced MLS staff member, wellacquainted with the child) describes the child by placing each card in one of the 9 categories ranging from 1 (least descriptive) to 9 (most descriptive). The normalized scales included in this study were resiliency and behavioral undercontrol.
Author Manuscript
The Moos Family Environment Scale (FES, Moos and Moos, 2002)—The FES measures family social environment as perceived by family members, in this investigation – by the child. The two subscales used here were – ‘conflict’, the extent of open aggression, anger, and conflicted interactions among family members (Kuder-Richardson=.75, 8-week test-retest reliability=.85), and ‘cohesion’, the extent of commitment, concern, and support provided by family members to one another (Kuder-Richardson Formula=.78, 8-week testretest reliability=.86).
Author Manuscript
Child Behavior Checklist (Achenbach, 1991)—The CBCL provides assessment of the child’s social and emotional functioning as ascertained by the child’s teacher. The instrument yields scores on several narrow-band subscales, including social withdrawal, somatic problems, anxious/depressed, attention problems, delinquent behavior, and aggressive behavior. Two broadband subscales are derived concerning externalizing behaviors, composed of the aggressive behavior and delinquent behavior subscales; and the internalizing behaviors, composed of social withdrawal, somatic problems, and anxiety/ depression subscales. In this study the broadband externalizing and internalizing scales, and attention problems were used. Procedure Internal review boards of the University of Michigan and Michigan State University approved the study. This study combined sleep-related data collected for this report, with
J Sleep Res. Author manuscript; available in PMC 2017 June 01.
Hairston et al.
Page 4
Author Manuscript
secondary analysis of data collected from the parent Michigan Longitudinal Study. For sleep data collection, parents signed informed consent and children signed their assent to participate in the study, after which a detailed explanation of how to complete the sleep diaries, and the PSQ was explained to the parent. The actigraph was placed on the nondominant wrist of the child, who was instructed only to remove the device for showers or swimming. During the study, children maintained their usual sleep-wake schedule. Data Analysis
Author Manuscript
Due to children removing the watches, or returning the equipment early, a dataset was considered complete with 4–6 days of analyzable actigraphy nights. Group and gender comparisons consisted of either ANOVAs for continuous variables, or Chi-Square Test for ordinal variables. Partial η2 was used in ANOVAs, allowing for independent estimate of effect sizes of the different factors. Relationships between variables of interest were assessed using correlation tests. Mediation analyses, using structural equation modeling (SEM), were run after demonstrating significant correlations between variables of interest. 1000-iteration bootstrapped, biased-corrected confidence intervals (CI) were calculated to provide empirical estimation of CIs. Equation-level goodness-of-fit and effect sizes were also calculated. Gender and age were controlled for in all analyses.
Results Demographics
Author Manuscript
There were 53 boys and 29 girls in the study sample (FH− 16M/1F; FH past 27/16; FH current 10/12), mean age 10.53±1.33. 52% were Caucasian, 18% African American, 13% Hispanics, and 16% of mixed ethnicity. About 80% of parents had a partner, and the median income across groups was $30–50K. Chi-square analyses yielded a significant difference in gender distribution across groups (Pearson χ2=10.07, p=.007). All other measures did not differ between groups (p>.05). None of the children reported any drinking experience by the time of the study, and only one child endorsed trying to smoke cigarettes. Age, gender and week vs. weekend night effects on sleep measures
Author Manuscript
An average of five days of actigraphy and diary days, per child were used. Age and gender effects were tested using a multivariate ANOVAs. For sleep measures, all variables were entered as dependent measures, gender as the independent variable, and age as a covariate. There was a significant age-dependent decline in total sleep time both for diary report (F 2 1,80=13.189, p=.001, Partial η =.16), and for actigraphy scored TST (F 1,80=7.775, p=.007, Partial η2=.089), with an age-dependent increase in reported bedtimes (F 1,80=8.089, p=.006, Partial η2=.10). There was no gender effect on any of the sleep variables (Fs =
