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Abstract

Objectives This study had two major aims: (1) to explore the relationship between sleep related difficulties and behavioral and emotional problems in young children, and (2) to identify predictors of child fear and problematic sleep behaviors. Methods Sixty-eight children (34 boys), ages 4–6 years (M = 4.9, SD = 0.9) who experienced nighttime fears and who co-slept with their parents were evaluated using parental reports of internalizing and externalizing behavioral problems, sleep difficulties and related anxiety, as well as child and parental reports of fear. Results Child-reported fear was significantly predicted by internalizing problems when controlling for other variables whereas parent-reported fear was primarily related to child endorsed fears on a preschool fear questionnaire when controlling for the other variables. In contrast, sleep-related problems were primarily related to externalizing behavior problems whereas the number of nights slept alone was primarily related to separation anxiety on a preschool anxiety questionnaire. Conclusions Findings from the present study point to the multiplicity of factors that account for nighttime fears and sleep difficulties in young children. Child fear and separation anxiety were related to co-sleeping. Moreover, internalizing symptoms in young children predicted child fear whereas, externalizing symptoms predicted sleep problems. Based on the reciprocal relationship between emotional/behavior problems and sleep, frequent co-sleeping and nighttime fears might serve as a risk and/or maintaining factor of disrupted sleep practices. When treating nighttime fears in young children, co-sleeping should be targeted for intervention as well.
Predictors of Nighttime Fears and Sleep Problems in Young Children
Renatha El Rafihi-Ferreira, Krystal M. Lewis, Tyler McFayden & Thomas H.
Ollendick
Journal of Child and Family Studies
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Abstract
Objective: '%%( ) * % +,-%,)-
%, ../%- 0-- ,%-(-1 /-2
--.(,/%./.-,/%,0%"Methods:
+(1/- & (%2 1%  (% 34"2  4" ) +,-/
-1.% - )/%, )  ,-%) 0 %-1,-
,%.--5-1- +-5-10,%2%,../%-
-+(2%)%/-,-,%.."Results: ,
.)%%1-./-(,/(--5-1,%)-/--1.
0% )%,-,.)%,(/-% .%
1
-,%/.6%--)-/--1.0%"-/-%2
%,  ,%  )  ,(      +-5-1  0  ,%
)%-.-1%%,-)%,(%,--+(
-,%/-+(6%--" Conclusions: --1%.,%-%(
,-      ,/(  .  ./%    //-  .  -1  .%  -  %,
../%-(-1/-".-%,--+() /
%,-1"302 --5-1%(,%-(-1 /- ,/  / .
)%2 +-5-1 %(,% ,/ %, ,%" 7%- /,/
-%,  )-  -$0  ,%  -  %,2  .6-  /%,-1
--1.%1%0%%8-$---1./.%,%,
,//%"9- -1 -1 .% - (-1 /-2 /%,-1 % 
1.-0--%)"
Keywords:-1.%:%,,%:/-+(:0,%
1.%/--/--%(--%("
;)02.%<.(-1/-2-1.%-%%/
,%/*%11-%%/)/--%0%,
,%2-+(2-%..-1./--.%=-2>-12
=-23%?!-/82#"'1(-/--.%.%0(2
-1-1.%,-%%.%"1"2)(,-%0-12
,%-%.("1"2..8-,,218-1-21-(
/%"1"2..1%%--%%2%/(%2-(..
8--1-"--2%.%-.)(02
-1%/2//2--%,,%2%)%)%-
2
-+(1/(,%%-%/-/-(
=-"2#2#:>%-?2:3%23/8/23(?
@-%2:3%23/8/2!-/82>-12?712"
!.-2/-)-1.%0../(.-1%,-
---1%,)/2--2(%-/%,-1)/10%%2
=--2%-21--2?3-2:>%-?2"-
%((%-/1%)&#/-)-1%.A-2
-<./%,%,-1.%/,-(A<.%(
%,%-/-/-"-%%(2/%,%%%)../(
%,-1)(.2..%,-1---82---1
,-,%-"'6%%./-/%,.-/0-
.6-(//-%,-%-+(,%%"2:@2
-23%2?B.-2"
B1%-%,1-%%.-1.%-*
1-%/%(%%2(,.%0%%"78-1.%-1
%,-%-/.-,-/-.12.-%-/2%/-.
1-%%.%,--+(%B/-@%(//B%%/-2
&2)%,--/..%,-1-..8%
/-./-%(,%.%,/./,B/-@%(//B%%/-2
&"302-01A<./-)-+(%%,%-)
%,,%%/%../(.-1%,--1.%:
.20-/%11%%-1%,%(--(,0
%,6(%%--0/---+(,%B.-2
=-%1?>-1(2#:-?B.-2:>%-?2"
-2..//(./1-00,(--1-.%0
3
-1.%%--%-%0%%0,%&(%
-?B.-2:=-"2#:>-2C--2B,2?2#:
>%-?2:!-/82;1-2?;-5-12:2A:
)?=-2"2%/%0,00-/.%,
,0--/---+(%(,%%%.-0--%.
-1.%-?B.-2:>-2"2#:>%-?2
"
'%%/-%-1-1.%2%,2--+(,%0
-)/--"+,2%((9-"A
/-%1--+(%-%0(-.%)-D%(.
%,-%,1-1"C%//-/(>%--
%%11%%/-)-1.%%8.0,-1,%,
6(2)/(./,%,%(/1/)-1"302
%((>%-2=.--%/-)--%
-1.%,%-))0(..%-0
,%"---1.%2/%,-1)%%%/)-+(-
,%,6(-%((@""/0(%.--1%
%,,,-/./-/-1-%/-%.-6("
=0-1)-1-%--1.%-,%//--
%%-8%)--1.%2%,,%2/%,-12.2-+(2-
0,%2./-%()%0 -%,%
)-%--5-1-+-5-1,%-%,0%-
-1.%"!.%(,%%)%--5-1%(,%),/
/,-,-,."!%/-(,%%)%+-5-1
0%),/%,,%--.-1%%,-"
4
Method
Participants
(,/,-%-//-&(%21%(%34"2
 4"2)0%,-1--)/%,)%"'
/-2,0(%2)//%,.-5
/-//-/-750../0-%%.,(
-,1.-1.%-%(-1/-C.2
0%2B%2?!-/82"'/-8,/%-1
0%-%--)%,,%2%)%-'%",//%/%.
/--,-%,%--'"!-(/-)
-1/,--$,%(//%(,%2%,(,-%2)
+/"!)%./-)-/"
Insert TABLE 1 here
Procedure
(,/%)/-/-,,0.C%/E/%
.-0%%)%0/%),."')
//-//.-%@%/1.F-0%G
@:-B%/-/B-+( %%@1.-%
@%6;%,%H-/%/3/-F-0%
G@I,6;3F@--H-/G3/%@-1JK
-2(.%-1)-%/%%%--
%,0%-./-%/-/%,0%"@-%)%1-,.,/,-
-.-.-1.%))%%./L%
-%%%%-%)%-%/"'/10%/,
5
-%-%-%%%-%)/%,,+(-%"'%/
,0+,--%-/,-.-%---6)
,-%,.%,-))%%%-/"E0--/%%)
,-/%%,-)%%%-/2%/--
%%%.)-(6%-%"'%,1)%%-/10%-)8
.-0)-)//.%0-(%,-,%-
-0)"
Measures
--0)'.)-1-.-)%-121-2/-
,%(//%(./-1)120./-2%%2
//,--%/%%.,-%"
,J1B(,)%/,(,-%2%8-1(/%,
--)--1MB-2(/%)-(-1.%M
-D%-0)-)%8,06-0-.-
1-1%0(..-1/%%%%--,-J8%/
4--&4/2)/-/-/-1%/)-./%"
%-1.-1%28-/-1%/)-./%
%0%.0-5-%%.-1
.%-(-1/-"1"2J)%2B(2..-2?!-/82A:-
?!-/82:)?=-2-0-%%%--(
/-0--%%%,%%%%-1//,0(-(;%-?
7/82"
,;%-0-(.@%/-;@ 0,()2
>-2=-%1-B-%#2;@)%-%-75-
6
@1%)-%0-/.(-0(7%?-%2
"%--.,%//--%%%%%,%-/.%,
,%(%8-1,-%/L%%,%-%)8"'
;@%#6%--),-J8%/%-/.02
.6-0" .../0%,-%%/%-
%/)-(5"-,%-%,2(.;@
%--/."-"A.../0%,-%%/2)/
//,10--.%---0,,-1//%/%.
%"
@%/B-+(/@B 0,(,-/2C,23/ ---1
2@B%%/,(,-%./-1
%+(%%%%%/-L%-+("'.%%%/-A,-
%/2-1-1.%-.-2-%%-,-6%-
1-1/+,-/%"'%//-%%%.1--+(%/
/%,-%%.%-.0%,/./%%/%1-5-+(2
%/-+(2%%%0/,%0%2.%.,(%/-*%-
%,--+("-,%-%(2-(%/-%/.
%,--+(%%/A%)%"'6%--)%-%
.E-1%-75-@1%2-/8-%E-1%2-.-(
0%1--75-@1%-/-%-%%1-)%/)-
-%%"@%(//0-%.@B0%)-6%--
,%%%%%1(-0(%7-?3%2:,-/"2
"/-%(2(%%)%%./(4".
%-4".%,--+(%%/"
7
0(/.-.-%@%/%@7%-0(
/.-C0%!-/82&2@%%%%%.%-,
%//-"@-%%,-%--/-L%.%2-
%/-1-1.-/:1%/1--%(.
."'@20,(9-2!-/8--%2%%)-
1--/-%%-/(-1/-01--%/--0()E-1%
%,8-1/10%:)0275-0%-.%/%--
0"'6%--)%-%.E-1%-75-@1%2
-/8-%E-1%2-.-(0%1--75-@1%-
/-%-%%1-)%/)--%%"/-%(2
%,%%%%1--/-%%-/(4"A"
70/8%NA(%7J'%%--%-0,(
B/-/-C%/-%-5%%.0
,%-/-%-,-,%"'7J%)(%-
,%%%%%)%%,%(//,,%B/-/?C%/22
1,%.(-0(.75-0%-
-/-(0";)02%)%%27J)%
-%.E-1%-75-@1%2-/8-%E-1%2-
.-(0%1--75-@1%-/-%-%%1-)%/
)--%%"'7J"AA/--%%-)/,-%-/
%-%not true2somewhat or sometimes true 2very true or often true
/-()-,%)-%"'7J(%-%/%
'@%2--5-1@%2E+-5-1@%2-%+-)
-%/%E-(C/02 ,%%$B-+%29)-2/2,
@%2B--2-B11%%-"''%/%.B-+(@%2,
8
@%2--5-1@%-E+-5-1@%)%-%%("
'/%61-A/-%-/-/-12)%
%/%)---0-1"%%(2B-+(@%
4"A2,@%4"2+-5-1,%4"---5-1
,%4"&)%-).-,%%%%6--
/-%%-/%"
Data Analysis
-(%%)%/-/%-173@%%/%.)"'
,(,--0%)%/-0%1.,2
@-,2-%,,%7J,@%2.1%
,B-"%,)%,1%%--(%%)/-/)%
,(,--0%.-%"B--1-,--0%2
-/-11,/./%2)-/-%,)%)-(-
0/%,4"A""212%+2E27J--5-127J
E+-5-12@B,-B-+(2@2-;@,-B../"
Results
3-%2%-0-%2-@%-/-%.0%
,%--'"
Insert TABLE 2 here
,-1.)%%1-./-(-1%%,-r
4"&2pO"2--5-1%(,%r 4"pO"A2+-5-1%(,%r
4"2pO"A2-1-.%,-@4"2,O"A"9-
,/%)--,1%%-2-(7J--5-1)%
.-%1-./-,/.,.74"2p4"2
//--1."A<.0-/B*%C4"A"
9
@-,-1.)%%1-./-(@r4"2
pO"A"9---%,)%1%%-2@74"-;@
,-B../74"1%%1-./-,/%pO"2//--1
.0<.0-/B*%C4"&"
7J,@%)%%1-./-(7J--5-1r4"
A2pO"27JE+-5-1r4"&2pO"2;@,-B../r4"2
pO"2-.1%,B-r4"A2pO"A"9---
%,)%1%%-27JE+-5-1)%-(%1-./-,/.7J
,,%74"#A2pO"2//--1.0&<.0-/
B*%C4"&"
.1%,B-)%%1-./-(7J%,
,%2%--0r4"A2pO"A2@B,-B-+(r4"#2p
O"A2-,r4"&#2pO""9---%,)%
1%%-2@B,-B-+()%-(%1-./-,/..
1%,B-74"2pO"A2//--1.,,+(<.
0-/B*%C4""
Discussion
'%%()*%+,-%,)-%,
../%-0--,%-(-1/-:-
-.(,/%./.-%,0%"!.--1%-/
,--(--5-1%%7J--5-12@2-;@
,-B../,//,-,-,.2%/-.-1
.%(,%%"!.--1%%-/+-5-1%%7J
E+-5-12and--5-1%%@B,-B-+(,/%,
,%--.-1%%,-2%,(%,,-1%/-
10
(,%%"'%%%,0%,,.--%,,%
./-%%/)both--5-1-+-5-1../%"
@0%%/%%%11%-%,)-%,
../%-0--,%-/-=1(2E-29%
?%2:;2P/82-2@%-%?>-/582#:/2
P8-?E,%-2A:-23-%-2!(2B-?7-/2
";2)%)--5-1%(,%,//.-
+-5-1%(,%-/.,/%,../%"'%.--1%
,-,/(../%-1.%-%,
../%-(-1/-"
-//-/)(,%%2%%-%--5-1
%(,%-/-,/-1."302-1.,/
/../%)%,-1--)-"'.--1-1.
%%1-./-,/./%,-1%%-11(%"
2),%1-./-(1.6-/(..%-%-1/-"
2/-%((@"/-.%%%/-)-
/%,-1--+(2-%-110%.-+(,%--
/-)%,),-%"
%,-1%-%)--.-(%1%%(,-%
-1-1.%-/->%-?2";)02%
%1((0-10%--1/-%6-/%%%%0
%)-/%,-1%%%/)-/%-1)8-12,%,
)/-/%.)%.%,2-1-1---)2
)2?3%%2&:3-22>(?;)2:2'858(2
11
?/2"=0-,-/.%,-,(%/--.
(-1/-2/%,-1/-/-/--1)-%--
0../%,,/-%6-/.%,//"'
/--.,%%-/.%-%,,%%8(,%
%1-./-0,-/-1)/(,/(../%
%"
'1.6-/(./%,-1,-%75-%,0
-1%,)8%'%810-0/8./%,-1
%/-%,,-"%%//-.,./%2-/-1
%,//%/%-//81-%2-/%%(,
-%-%,,-%-/--,-%-0,,,,-
/(%-%0-0--%"3%,/./(2.-%--1.
-%,)-%,-02.%/%-/
,/.,--10%--1-%-.(-0---
/-L%%,../%-+-5-1---5-1%(,%"
-2+,-1./%%%/)/L%%,../(%//.
../0-0--,---1=1(?2"
!.--1%%1-),0%%/,%5%%%/-
)-%,,%-+-5-1,%-/-=1("2:
;"2#:C.20%2@%2B%%,QG?32:
-2:-1"2"E+-5-1%(,%).-
%1-./-,/.%,../%.-%-%,-1-2+,-/-1
-1%2%%-/-1-12%,-1%%28-1)%,2-)8-1
,.--%,"B%%/-%)-%,-0,%8(
12
/-2%/-%../-%,-,%+/-
-0../%"J/8.%,/-/,%-1--
-/%(2.)///%/%.--5-1-+-5-1
,%"!--20,%/-/,%%,,-%2%
/%%,%%/-%%/)0(.,%(/,1%
=1(?2"-%/%%/-(+,-/%1-./-
.%)%+/0,%2%-%,-%
.+,%,../%.+-5-1,%"/-
+,,%-0%.%-1%28-1/828-1
%2/"2)/16%,,--,,/%-(-1
%(--,,/1%-(-+%-..0-%
/-"
-%-1,/%,,%--1.%/-0-
)-1./-2,-/.0,-1,0-0--0--
%%%,-"C/-%%0..0-/.%,,0-
-/---+((5-1-0--%.-1.%2-/-1.
-)/%-%2%/%'170',('7'2-?
B.-221-070',(-/-1@--00@(7'
@@:>-"2#:>%-?22-,(J)%"2
A:C."2"
%/%%+,-0--./%)/(,(-
,---%,)-%,-0,%-/-"
E(-=1(2E(2!L--2-@-,--0--
./%.6-(%%/)%,,%--
13
--5-1-0+-5-1,%"+,2%/
%11%%/8.--%-1.,--1/-%%/)
--5-1-+-5-1,%=1("2:0%-"2
A"3020%--/1%,-%(-1
/10%-,%-,-/-%,%%/)%,
../%---5-1-+-5-1,%-/-"
=0--.-/.,-0%-/0-%,2.
%%%-0%1,-,%(/,1(-*%-2-
-%,%)/%,-1--1.%"2/,-
/--%,%(-.-/%,%2%%/(3/2
7%8(2--&-.-.-%)-%/%%-/-%
)8(-%/-/(%1-./-%,../%";(%2
C%-)%11-.-,/%%/%,-1-(
/)/-/%(.%.-12-1.-1%-
,-D%2-.-1%,-,-D%)%%(%,%
-%%-1/-%,%-%/(*/%"'.2
.%%%+,6(2,-%-%.%,-0-
-1-.-/(-(/2%/-%(-(+,/-%,
%.,%/%"
J-%.,%-%(%/8-)1"'%%(
0%,,%%(1,--/,-%-%"
%%%%%*/0%%.%,%/%/1,(2---0%0
.%-1%,,-%%-1)/80/)--)%"%
---/(%%,16-./---(%%.
14
/0(2),0-1%-%.%,-%-/(:%,../-/(:
&)8.%,-%:-%,"'%1(2-1)%.
%.,-%-%2)%.-,0-11%,/./-.%,
//%/%-%,,-"B-,--.%(%
)+/,-.;@%/2-%-%)-0-
75"-%-1/8.0%/%-7500%-
-%-,%//-2%-/%%(..%%0%
%/%.75-,,-"2%-).)
/--%-,//%---/-%%-/(%%.%
%%)1-(6-75-%,"
-/-/%-2%%(./%-,--1(.-1.%-
/%,-1"'-8%)--1.%2-+(%%-%,,%
%.+,-1%,%./---..-/%"B%
,2/-)-1.%001-.---5-1
%(,%"J.-2-+(-./-00%../%-/
0,--,/,%(/,1("7%-/,/-%,
)--$0,%-%,2/%,-1--1.%
1%0%%8-$---1./%.%,%,"-%//%%2/
%,-1-1)-1.%%/-%%1%.-0--"
%%%%+,../%.(-0----1.
-%,,-%-(-1/-)/---1-.(%1-./-,/%
./.--10"
Compliance with Ethical Standards
Conflict of Interest
15
'%/(0-/-./.-%"
Ethical Approval
B,/%,.-%%-00-1-,/,-%)-//-/
)/%-%.-%--$--%//-
);%-8/--%--%/,/
%-%"B%(,/%),,0(F-0%(.G@2G
@C7"
Informed Consent
-./-%-)%-.-0,/,-%-/-%("
Author Contributions
CC%1--+/%(2%%%)-(%%2-)
,,">3J%%%)-(%%-/-)-1.
%(--1..--%/,"'3-(52).%%
-/-)-1--1..--%/,"';!,
%1-%(2%%%)-(%%2-/-)-1-
-1..--%/,"
References
B/-/2'"3"?C%/2J"B""Manual for the ASEBA Preschool Forms
& Profiles"7-1-2'F-0%(.-2C%/-.-2
R2?%"
B.-2"B"2=-%12=""?>-1(2""#",,%-1
/--%/-%)-+(%%"Journal of the American Academy
16
of Child and Adolescent Psychiatry22&" 
"#$"/"&&""
B/-@%(//B%%/-"&"Diagnostic and statistical manual of
mental disorders"A""9%-1-2 B/-@%(//B%%/-"
7%27";"3"?-%23"J""QG,JH-1@1% %
E%/%,B0QG;S%T--Q%"Journal of
Epilepsy and Clinical Neurophysiology2&2&"
7-2"?3%2@""@%(//0-.)-),--1
%/%.%-1-+(%(,%-(-1 //-"Journal of
Anxiety Disorders, 2A" "$*"*-+%"#""
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1-5-+(%B%%-(%%./-1%--+(-
%,"Journal of Anxiety Disorders22A" 
"$*"*-+%"&"""
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0%%%(%,-1-/-),%/-
,%-,-%%%"70,3/-22AA" 
"$AA
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-%.1"Journal of the American Academy of Child and Adolescent
Psychiatry,2AAA"
17
-2B"="2?!-/82'";""'-,1%.%0-1
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Psychiatry, 20(2##"
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Clinical Psychology Review2#&" "$*"/,""#"
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.%./--%/-%6-/(2/--2%0(22+,/-%2
%/%2-/,-10%"Behaviour Research and Therapy2A
#" "$*""#"&"&
=1(2B"3"2E(2'""2!D--2'"="2?@-2C""E1%.
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and Adolescent Medicine,2&&&&A" "$/,"""&&"
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%0""&"#"
18
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B%-@%/%"Infant and Child Development22AA&" 
"$/"A#
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Journal: Official Publication of The World Association for Infant Mental
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19
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-,%//-"European Journal of Pediatrics, 1712##A" 
"#$%&"
J)%2>"3"2B(2>"2..-23""?!-/82'";"A"'-1
-1.%-(-1/-),(0-1-+(%(,%
---10/-1"Journal of Anxiety Disorders2&&" 
"$*"*-+%"""
3/2@"27%8(2"2?-2@"&"-.-%,%%-/-
,,%--.-%)-%/%%-0%%-%/0-
/-%"Sleep and Hypnosis252#"
3-2"B"22B"2>(2"2?;)2'";""@-0%-
%,/%--.-%-%/%%//,%-" Sleep
Medicine,2&&I" "$*"%,""""
3%2@"23/8/2;"23(27"?@-%2E"";)%%/-
/.%MBehaviour Research and Therapy2&&2#" 
"$A##
3%2@"23/8/2;"2!-/82'";"2>-12""?712""
-D%-1.%,-I/-1%..6-/(2/--21-%2
/,-10%-%0(. Behaviour Research and Therapy2&2&"
"$A##AA
!-/82'";"&"C(-0(.C0%0(/
.-C"Behaviour Research and Therapy2212AI"
20
!-/82'";"2;1,-2J"@"2?;-5-12C"3""1-070
',()1.-2Journal of Behavior Therapy and
Experimental Psychiatry, 22(2),&"
@2"2-23"B"23%2"3"2?B.-2"B"",-1-1
/B1B-+%--B-+%-B%%/-%),
(-'-1"Journal of Abnormal Child Psychology, [Epub ahead of
print]. "#$%#&#
C.2C"20%2E""3"2B%2"C"2?!-/82'""7.
-.-1.%-/%,-1,%B-5/-/"
-.B-+( %%2A2A" "$*"*-+%""""
C.2C"20%2E""3"2@%23"J""2B%%,QG2"7"?32
"7""-/,-/-Q%-%%0Q
,%/1"C0%@%/1'@S/2182A#" 
,$$+""1$"A&$$,%/1"0-,A#
B"A"1-00-./%,%%"
Clinical Psychology Review, 252" "$*"/,"A""
2B"2'858(2J"2?/2B""@--1--.-%,"Sleep
Medicine Review, 2&I" "$*"%0""A"&"
/2B"2P8-2"?E,%-2C"A"@%%--1)8-1-%-1
../%/%%.%((,/%%.0,%M
ournal of reproductive and Infant Psychology2&2##"
"$&A&&&&
21
-12";"2=2"""2?-129"'""B%%/-)-/
%,,%-,-./%2,--%%%-0
,%"Journal of Sleep Research2152&#&" !"$*"&A"
""+"
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;(%-123"A"J--0,%%%/)%,
,%-%-1-%("The Jounal of the American Medical
Association Pediatrics, 1692A#AA" "$*,/%"A"#"
-2B""E--0,%-%,..--%
(%"European Child & Adolescent Psychiatry2102" 
"#$%###&"
,-/2";"2C,2C"23/ -2"?-123""'%/.
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"The final publication is available at link.springer.com”.
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... Rafihi-Ferreira et al. [9] found that internalising behaviours were positively associated with parent-reported child nighttime fear in a sample of preschool aged children whose parents attended a nighttime fear treatment program. ...
... With respect to focus, some children experience one specific fear, while others experience multiple fears, with nighttime fears generally clustering into presentations of separation fears (being away from parents), darkness-related fears (sounds, shadows), personal safety fears (being harmed by an intruder) and fears of the imagination (e.g., ghosts; [1][2][3][4]). With respect to behavioural difficulties manifesting as a result of nighttime fears, children may demonstrate resistance and refusal to participate in activities leading up to bedtime, they may cry and call out at bedtime, they may be unable to stay in a darkened bedroom or leave their room for other reasons [9,[22][23][24][25]. ...
... Overall, the findings suggest that higher levels of nighttime and darkness fears and their behavioural manifestations are related to higher levels of both internalising (e.g., anxiety), and externalising (e.g., conduct problems) behaviours, as well as sleep problems. The findings therefore are consistent with previous research reporting links between nighttime fears, internalising, externalising, and sleep problems in preschool aged children [8,9] and thus support the overall validity of the subscale and total scale scores. ...
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This paper outlines the development and psychometric evaluation of the Fears and Worries at Nighttime—Young Children (FAWN-YC) scale; a parent-rated measure for children aged 3–5 years. Based on previous literature, it was hypothesised that the measure would be represented by a six-factor solution, with four clusters of fear types and two behavioural manifestations of fears. Exploratory factor analysis (EFA; N = 436) and confirmatory factor analysis (CFA; N = 383), resulted in a final 17 items that loaded onto 3 factors: Nighttime Fear Focus (8 items, α = 0.92), Bedtime/Sleep Avoidance and Interference (5 items, α = 0.90), and Dark Fear (4 items, α = 0.88). Evidence of convergent validity was found through strong associations between the total score and subscales of the FAWN-YC with measures of child anxiety, fear, sleep, externalizing and conduct problems. Furthermore, there was support for divergent validity (through a very weak to no relationship with a measure of prosocial behaviours), and evidence for temporal stability was also established with 2-week test–retest reliability. Overall, the results provide strong preliminary evidence for the reliability and validity of the FAWN-YC total score and subscales. Implications for the use of the measure in research and clinical practice are discussed.
... In addition, sleep and anxiety have an overlap between regulatory systems, thus when one system dysregulates that disrupts the others [16,17]. A growing body of research has made efforts to explore the directionality of the relationship of sleep disturbances with anxiety [18][19][20][21][22]. Several studies indicate that children's anxiety can predict sleep disturbances [14,18,19]. ...
... In addition, sleep and anxiety have an overlap between regulatory systems, thus when one system dysregulates that disrupts the others [16,17]. A growing body of research has made efforts to explore the directionality of the relationship of sleep disturbances with anxiety [18][19][20][21][22]. Several studies indicate that children's anxiety can predict sleep disturbances [14,18,19]. Likewise, more sleep disturbances are associated with elevated anxiety [20,21,23]. ...
... Hence, early screening and intervention for sleep disturbance may be valuable to prevent children from developing serious psychiatric disorders. In addition, the results of several studies indicate that children's anxiety can predict sleep problems [14,18,19]. However, in our study it was not detected that children's anxiety predicted later sleep problems. ...
Article
Objective: This study, based on a three-wave longitudinal study, aimed to examine bidirectional relationships between sleep disturbances, resilience and anxiety symptoms among preschool children. Methods: In total, 1169 children in the junior class of preschools were investigated three times with an interval of one year, in Anhui Province, China. Children's sleep disturbances, resilience and anxiety symptoms were all assessed in the three-wave surveys. Then, 906 children at baseline (T1), 788 children in the first follow-up study (T2), and 656 children in the second follow-up study (T3) were included in the analysis. Autoregressive cross-lagged modeling analyses were performed to examine bidirectional relationships between sleep disturbances, resilience and anxiety symptoms using Mplus 8.3. Results: The mean age of the children was 3.6 ± 0.4 years at T1, 4.6 ± 0.4 years at T2, and 5.6 ± 0.4 years at T3, respectively. The results indicated that sleep disturbances at T1 significantly predicted anxiety symptoms at T2 (β = 0.111, P = 0.001); and sleep disturbances at T2 significantly predicted anxiety symptoms at T3 (β = 0.108, P = 0.008). Resilience only at T2 significantly predicted anxiety symptoms at T3 (β = -0.120, P = 0.002). Anxiety symptoms did not significantly predict the two variables (sleep disturbances and resilience) at any wave. Conclusion: This study suggests that more sleep disturbances are longitudinally associated with subsequent high anxiety symptoms; inversely, high resilience will alleviate subsequent anxiety symptoms. These findings highlight the importance that early screening for sleep disturbances and anxiety, and strengthening resilience are beneficial to prevent preschool children from developing higher anxiety symptoms.
... The study of nighttime fears is critical, as they may be related to emotional and other difficulties in children, including internalizing and externalizing symptoms, sleep difficulties, and anxietyspecific symptoms (El Rafihi-Ferreira et al., 2019;Orgilés et al., 2021). In this regard, children who show nighttime fears are likely to experience anticipatory anxiety before going to bed, but also to meet the criteria for at least one anxiety disorder (e.g., specific phobia, generalized anxiety, separation anxiety; Lewis et al., 2021;Muris et al., 2001). ...
... This was shown to be a similar profile as the previous one, but with a much higher fear of imaginary stimuli. Attending to studies that reported associations between nighttime fears and maladaptive coping strategies with emotion-related problems and other difficulties, such as sleep problems (e.g., El Rafihi-Ferreira et al., 2019;Garnefski et al., 2007;Orgilés et al., 2021;Quy et al., 2018Quy et al., , 2020, our results suggest the existence of two possible risk patterns or profiles. They are characterized by presenting concurrently high levels of nighttime fears and maladaptive coping strategies and seem to have a lower but considerable prevalence. ...
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Background: Nighttime fears are common among school-aged children and may be linked to psychological difficulties, while coping strategies may vary and affect their emotional well-being. This study aimed to identify patterns of nighttime fears and coping styles in school-aged children using Latent Profile Analysis. Subsequently, possible predictors of the latent profiles were tested through multinomial logistic regression analysis. Method: A sample of 786 Spanish-speaking children (aged 8 to 12; Mage = 9.66, = 1.20; 51.3% girls) participated and completed self-report measures of nighttime fears and coping responses. Results: The results revealed four latent profiles: (1)"low fears, low self-control" (24.2%), (2)"high fears (except for imaginary fears), maladaptive coping" (22.8%), (3)"moderate fears, adaptive coping" (44.9%), and (4)"high fears, maladaptive coping" (8.1%). The regression analysis revealed that sociodemographic characteristics and children's perceived helpfulness of coping strategies were predictors of the latent profiles. Conclusions: These findings suggest the presence of distinct patterns and heterogeneous subgroups, which may emerge as higher or lower risk profiles. It highlights the need to consider the existing patterns to provide tailored interventions targeting nighttime fears.
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Background Brazil is home to 50 million children and adolescents, whose mental health needs require context-sensitive research. Although scientific output is growing in the country, publications are scattered and often inaccessible. Methods This systematic review compiles prevalence estimates, assessment instruments, and interventions for child and adolescent mental health in Brazil (PROSPERO registration: CRD42023491393). We searched international (PubMed, Web of Science, PsycINFO, Google Scholar) and national (Scielo, Lilacs, Brazilian Digital Library of Theses and Dissertations) databases up to July 2024. Reference lists, reviews, and experts were consulted. Extraction followed Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) and Cochrane manuals. Results This review appraises 734 studies on 2,576 prevalence estimates, 908 studies on 912 instruments, and 192 studies on 173 intervention trials. Point prevalence of any mental disorder ranged from 10.8% (age 12) to 19.9% (ages 7 to 14), although a nationally-representative study is lacking. There is a rise of self-harm notifications, reaching 133.1 in 2019 (per 100,000 aged 10-19). Indigenous youth face suicide rates of 11 (age 10 to 14), far exceeding national averages (0.652). There is severe violence exposure (21% of adolescents reported domestic physical violence in the previous month), disproportionately impacting Black youth and heightening risks for depression and substance use. Reliable instruments exist for assessing psychopathology, yet most lack psychometric and cross-cultural validation. Interventions remain under-implemented; the largest trials adapted international substance-use prevention programs, showing null effects. High-quality studies are mainly funded by public investment. Discussion This compilation provides accessible data for professionals, facilitating translation of science to practice. Brazilian sociocultural challenges impact youth mental health, with public health priorities including violence, systemic racism, and indigenous youth suicide. National research must develop culturally-sensitive resources for mental health, including scalable interventions focused on social minorities. Funding The Stavros Niarchos Foundation.
Article
Background Nighttime fears are highly prevalent in children, ranging from normative fears to triggering fear‐related anxiety disorders. The lack of available assessment instruments recently prompted the development of the Nighttime Fears Scale (NFS) for children aged 8–12 years. The present study aimed to adapt and psychometrically evaluate the parent‐reported version for children aged 3–8 years (NFS‐P) as a complement for younger children. Methods Two hundred eighty‐four Spanish‐speaking parents (47% girls) completed the NFS‐P and anxiety measures. Results Confirmatory factor analyses supported a four‐factor structure of the NFS‐P. Strong internal consistency and validity evidence were obtained. No significant differences were found in NFS‐P scores between sexes and age groups. Conclusions The findings offer support for the use of the NFS‐P as a valuable instrument in clinical and research settings, supplementing the NFS for older children. Both scales provide an efficient means to comprehensively assess the presence and intensity of typical nighttime fears across preschool and school years.
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This paper outlines the development and psychometric evaluation of the Fears and Worries at Nighttime - Young Children (FAWN-YC) scale; a parent-rated measure for children aged 3–5 years. Exploratory factor analysis (EFA; N = 436) and confirmatory factor analysis (CFA; N = 383), resulted in a final 17 items that loaded onto 3 factors: Nighttime Fears (8 items, α = .92), Bedtime/Sleep Avoidance and Interference (5 items, α = .90), and Dark Fear (4 items, α = .88). Evidence of convergent validity was found through strong associations between the total score and subscales of the FAWN-YC with measures of child anxiety, fear, sleep, externalizing and conduct problems. Furthermore, there was support for divergent validity (through a very weak to no relationship with a measure of prosocial behaviours), and evidence for temporal stability was also established with 2-week test-retest reliability. Overall, the results provide strong preliminary evidence for the reliability and validity of the FAWN-YC total score and subscales.
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Insomnia is a sleep disorder that affects not only adults but also children. It can have a significant impact on a child’s well-being and development, leading to various issues such as daytime sleepiness, irritability and impaired academic performance. While the management of childhood insomnia typically involves behavioural interventions and, in some cases, medication, this article explores the scope of homoeopathic treatment approaches. This review article explores different therapeutic approaches for managing sleep disorders in children, such as behavioural therapies, cognitive-behavioural therapy for insomnia, light therapy and medication management. The insights provided in this review aim to offer an understanding of the scope and effectiveness of homoeopathy in treating childhood insomnia by understanding both the philosophical and therapeutic aspects of treatment, providing a holistic approach to address the underlying causes and improve sleep quality in children.
Article
Авторами представлен взгляд на проблему страхов у детей старшего дошкольного возраста. Ставится задача изучить теоретические аспекты особенностей проявления страхов у старших дошкольников и определить наиболее эффективные методы для их профилактики и коррекции. Для достижения этой задачи были рассмотрены теоретические положения различных теорий: фрустрационно-агрессивной теории, теоретические подходы на основе развития, когнитивного подхода, социально-психологического подхода. Особо отмечается, что на страхи дошкольников влияют психологические особенности детей старшего дошкольного возраста: тревожность, впечатлительность, эмоциональность. Определена специфика страхов у детей в данном возрасте, рассмотрены виды страхов, которые выделял А. И. Захаров, а также изучены предпосылки появления страхов с точки зрения трех концепций. Результаты теоретического исследования показали, что страхи детей старшего дошкольного возраста являются нормой, если они возрастные. Отмечается, что у детей могут возникнуть и невротические страхи, которые обуславливаются воздействием различных внешних факторов и сказываются на психике ребенка. Если страхи дошкольников начинают серьезно препятствовать их повседневной жизни или вызывать значительное страдание, то у ребенка снижается самооценка и уровень психологической защиты. На основе результатов исследования были выделены приемы профилактики и преодоления страхов, основными из которых являются: игровая деятельность и арт-педагогика. The authors present a view on the problem of fears in older preschool children. The task is to study theoretical aspects of the peculiarities of manifestation of fears in older preschool children and to determine the most effective methods for their prevention and correction. To achieve this task, the theoretical provisions of various theories were considered: frustration-aggressive theory, theoretical approaches based on development, cognitive approach, socio-psychological approach. It is especially noted that fears of preschoolers are influenced by psychological features of children of senior preschool age: anxiety, impressionability, emotionality. The specificity of fears in children at this age is determined, the types of fears, which were distinguished by A. I. Zakharov, are considered, and the prerequisites for the emergence of fears from the point of view of three concepts are studied. The results of the theoretical study showed that the fears of children of senior preschool age are the norm, if they are age-related. It is noted that children can also have neurotic fears, which are conditioned by the impact of various external factors and affect the psyche of the child. If the fears of preschoolers begin to seriously interfere with their daily life or cause significant suffering, the child's self-esteem and the level of psychological defense decreases. Based on the results of the study, the techniques of preventing and overcoming fears were identified, the main ones being: play activities and art pedagogy.
Article
Fears related to death and darkness are common during adolescence. The aim of this cross-sectional study was to investigate the association between these two types of fear, considering trait-anxiety and gender differences. A total of 171 16–18 years old adolescents (99 girls and 72 boys) completed paper-and-pencil questionnaires (Intensity of Fear of the Dark Scale, Multidimensional Fear of Death Scale, Spielberger Trait-State Anxiety Inventory – Trait version). According to our results, girls had higher levels of fear and anxiety than boys. Fear for significant others was the most intensively feared aspect of fear of death among both genders. Fear of the dark was associated with fear of death and trait anxiety, and the effect of trait anxiety on fear of the dark was partially mediated by fear of death. These results underline the symbolic association between fear of the dark and fear of death and have possible treatment implications.
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Little is known about the co-sleeping behaviors of school-aged children, particularly among anxious youth who commonly present for the treatment of sleep problems. The current study examined the occurrence of co-sleeping in both healthy and clinically anxious children and its associated sleep patterns. A total of 113 children (ages 6–12), 75 with primary generalized anxiety disorder and 38 healthy controls, participated along with their primary caregiver. Families completed structured diagnostic assessments, and parents reported on their child’s co-sleeping behaviors and anxiety severity. Children provided reports of anxiety severity and completed one week of wrist-based actigraphy to assess objective sleep patterns. A significantly greater proportion of anxious youth compared to healthy children co-slept, and greater anxiety severity was related to more frequent co-sleeping. Co-sleeping in anxious youth was associated with a delay in sleep timing and with greater sleep variability (i.e., more variable nightly sleep duration). All analyses controlled for child age, race/ethnicity, family income, and parental marital status. Co-sleeping is highly common in anxious school-aged children, with more than 1 in 3 found to co-sleep at least sometimes (2–4 times a week). Co-sleeping was even more common for youth with greater anxiety severity. Increased dependence on others to initiate and maintain sleep may contribute to poorer sleep in this population via shifted schedules and more variable sleep patterns.
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Nighttime fear, including fear of monsters and the dark, is common. For most children and adolescents, nighttime fears are transient. However, approximately 10% experience severe nighttime fear that negatively impacts sleep, adjustment, and family life. Research conducted in the 1980s indicates that cognitive-behavioural therapy can reduce nighttime fear in as few as three sessions. The aims of the present study were to replicate and extend earlier research by evaluating a cognitive-behavioural treatment package for children’s severe nighttime fear, and addressing methodological issues in previous studies. A manualised, multi-component treatment package was developed, based on current evidence-based practice for the treatment of children’s anxiety. Interventions included graded exposure, muscle relaxation, cognitive restructuring, and social and material reinforcement. Treatment was individually tailored and delivered via weekly modules. A multiple baseline across-subjects design was utilised. Four ‘families’—1 parent and 1 child—participated; children’s ages ranged from 6 to 10 years. Families attended five weekly intervention sessions and a one-month follow-up. Multiple outcome measures were administered pre- and post-treatment. All children displayed changes consistent with reduced nighttime fear following treatment, including fewer phobic symptoms, reduced general fear, and improved nighttime and general behaviour. These changes were maintained at follow-up. Parents reported a high degree of satisfaction with the program and would recommend it to other families. The results support the effectiveness of manualised, parent-assisted treatment for nighttime fear in as few as three sessions. In cases of severe nighttime fear, therapist support is recommended. Treatment implications for children with complex presentations are discussed.
Article
Abstract Objective To compare the efficacy of a developmentally appropriate cognitive–behavioral therapy protocol for preschoolers with severe nighttime fears and sleep-related problems, with an active control treatment. Methods Ninety children aged four to six years (63% boys) with severe nighttime fears and their parents were randomized to either cognitive–behavioral therapy including parent involved play (CBT-PIP) or to a structurally equivalent non-directive treatment (TEPT; triadic expressive play therapy). Treatment conditions were also equivalent in parent- and child-rated credibility and expectancy, and in therapist-rated compliance. Children and parents were assessed at baseline, during the first intervention week and four weeks after treatment. Measures included actigraphy, daily sleep logs, structured diagnostic interviews and parent questionnaires. Results Significant reductions were observed in nighttime fears and objectively and subjectively measured sleep disruptions in both intervention groups following treatment. Parent reports indicated more advantageous outcomes for CBT-PIP compared to TEPT, with greater reductions in sleep problems and co-sleeping as well as higher customer satisfaction in the former group. Conclusions While CBT-PIP showed no significant advantage compared to the active control in reducing fears or in improving objectively measured sleep, it was significantly more beneficial in reducing the adverse behavioral features of nighttime fears.
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Behavioural and emotional problems in Finnish three-year-olds was studied using the Child Behavior Checklist for ages 2-3 as a standardised rating scale at well-baby clinics in two cities in Finland. Altogether 374 questionnaires were analysed which is 71% of the target population. When compared with studies from other countries the mean scores and prevalences of preschool children's problem behaviours were rather similar. Boys were reported to be more destructive than girls. Parental education level, living in one-parent family and parental unemployment were associated with a higher level of problem behaviours. No significant differences were found in emotional or behavioural problems related to the child's day care. Co-sleeping with parents was associated with sleep problems.
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Anxiety disorders constitute the most common mental health disturbance experienced by youth. Sleep-related problems (SRPs) are highly prevalent among anxious youth and encompass a variety of problems including nighttime fears, insomnia, and refusal to sleep alone. Given that chronic sleep disturbance is associated with a range of behavioral and physical problems in youth and predicts future psychopathology, it is important to elucidate the nature of SRPs in anxious youth. The present study investigated the relationship between sleep problems and anxiety sensitivity in a sample of 101 anxious youth, ages 6-17. Heightened anxiety sensitivity significantly predicted prolonged sleep onset latency across the sample, even after accounting for severity of anxiety, depression, and age. Results support previous research indicating that SRPs are common among anxious youth and suggest that anxiety sensitivity may play a particularly important role in sleep onset latency. Copyright © 2015. Published by Elsevier Ltd.
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Childhood sleep problems have been linked to a range of adverse health outcomes, but there is limited knowledge as to the temporal association between sleep problems and subsequent emotional and behavioral problems in young children. To examine whether sleep problems in toddlers aged 18 months are related to both concurrent and subsequent emotional and behavioral problems in preschool children aged 5 years. A large population-based longitudinal study was conducted in September 2014 using data from the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health from June 1, 1999, to December 31, 2008. A total of 32 662 children or pregnancies were included. Sleep was assessed by mother-reported child sleep duration and nocturnal awakenings. Emotional and behavioral problems were measured with items from the Child Behavior Checklist and operationalized according to recommended clinical cutoffs, corresponding to T scores of greater than 65 (93rd percentile). Risk ratios (RRs) were calculated using negative binomial regression, controlling for emotional and behavioral problems at 18 months and other relevant covariates. Short sleep duration (≤10 hours) in 556 children (1.7%) and frequent nocturnal awakenings (≥3 times) in 1033 children (3.2%) at 18 months significantly predicted both concurrent and later incidence of emotional and behavioral problems at 5 years. The longitudinal RRs were generally larger for internalizing problems, with adjusted RRs of 1.59 (95% CI, 1.23-2.08) for both short sleep duration and 1.57 (95% CI, 1.28-1.93) for nocturnal awakenings; RRs for externalizing problems were 1.77 (95% CI, 1.37-2.30) and 1.25 (95% CI, 1.00-1.58), respectively. Additional adjustment for emotional and behavioral problems at 18 months slightly reduced the strength of these associations, and all RRs remained significant in the fully adjusted models. Early sleep problems predict later development of emotional and behavioral problems. Intervention studies are needed to examine whether sleep programs targeting early childhood may avert the onset of later adverse outcomes.
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To examine if children who suffer from significant Nighttime Fears (NF) experience higher degree of general fears and behavioral problems and to explore whether effortful control mediates NF association with internalizing problems. One-hundred and nine preschool children (64 boys) between the ages 4 and 6years suffering from significant NF and 30 healthy children (16 boys) were evaluated using parental reports of behavioral problems [Child Behavior Checklist (CBCL)], parental and child report of fears [Fear Survey Revised for Parents (FSS-PC), Koala Fear Questionnaire (KFQ)], and a measure of effortful control derived from the Child Behavior Questionnaire (CBQ). Children with severe NF also suffer from an increased level of a wide variety of fears other than NF, and exhibit more behavioral problems than controls both on parental and children's measures of general fears, and main CBCL scale scores (Internalizing, Externalizing, Total score). Additionally, children with NF had lower abilities of effortful control (as manifested in CBQ attention and inhibitory control scales). Attention control mediated NF association to internalizing problems scale. NF may serve as a marker for anxiety vulnerability, and this vulnerability might be mediated by abnormal attentional control. Our finding also highlights the need for a more comprehensive assessment of behavioral problems, fears and anxiety phenomena among children referred with NF.