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Editorial Perspective: Perils and Promise for Child and Adolescent Sleep and Associated Psychopathology during the COVID-19 Pandemic



It is anticipated that the novel coronavirus disease 2019 (COVID-19) pandemic and associated societal response will have wide-ranging impacts on youth development and mental health. Sleep is crucial for child and adolescent health and well-being, and the potential for sleep problems to emerge or worsen during and following the pandemic is high. This may be particularly true for children and adolescents who are at heightened risk for the onset of sleep and mental health disturbances and for those whom developmental changes impacting sleep are rapidly occurring. Youth with pre-existing psychopathologies (including anxiety and depression) and neurodevelopmental conditions (including attention-deficit/hyperactivity disorder and autism spectrum disorder) could be especially vulnerable to disturbed sleep during this period of change and uncertainty. It is thus imperative that sleep considerations be part of research and clinical initiatives aimed at understanding and mitigating the impact of the COVID-19 pandemic in children and adolescents. This article considers ways in which the pandemic may impact sleep, including research and clinical implications.
Editorial Perspective: Perils and promise for child and
adolescent sleep and associated psychopathology
during the COVID-19 pandemic
Stephen P. Becker,
and Alice M. Gregory
Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati,
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA;
of Psychology, Goldsmiths, University of London, London, UK
First diagnosed in December 2019, the novel coro-
navirus disease (COVID-19) has quickly spread
across the globe and upended daily life for billions
of people. With the implementation of social distanc-
ing interventions, direct human contact has become
highly restricted, with most activities that typically
occupy youths’ lives schooling, extracurricular
activities, and socialization with peers transition-
ing to electronic-based platforms. It is anticipated
that the COVID-19 pandemic and associated societal
response will have wide-ranging impacts on youth
development and mental health (Golberstein, Wen, &
Miller, 2020). Sleep is crucial for child and adoles-
cent health and well-being (Gregory & Sadeh, 2016),
and while we do not yet know how sleep has been
impacted by the COVID-19 crisis, the potential for
sleep problems to emerge or worsen during this
period is high (Altena et al., 2020). This may be
particularly true for children and adolescents, for
whom developmental changes impacting sleep are
rapidly occurring (such as those transitioning into
adolescence) and for those who are at heightened
risk for the onset of sleep and mental health distur-
bances. Youth with preexisting psychopathologies
(including anxiety and depression) and neurodevel-
opmental conditions (including attention-deficit/hy-
peractivity disorder [ADHD] and autism spectrum
disorder [ASD]) may also be particularly vulnerable
to disturbed sleep during this time of great change
and uncertainty. It is thus imperative that sleep
considerations be part of both clinical and research
initiatives aimed at mitigating and understanding
the impact of the COVID-19 pandemic in children
and adolescents. This discussion is timely, not least
because one of the many benefits of sufficient sleep
of good quality is to support the immune system
(Besedovsky, Lange, & Haack, 2019). Here, we
discuss ways in which sleep may be impacted by
the pandemic and outline a research agenda for
investigating this topic further.
Possible negative consequences of COVID-19
for child and adolescent sleep
While data are needed to help us understand the
impact of COVID-19 on sleep, a wider literature
indicates that the pandemic could have an impact
upon sleep in children and adolescents.
At the center of the pandemic is the virus itself.
While symptoms appear to be relatively mild in the
majority of children and adolescents, they can occur
and include both respiratory difficulties and fever.
Illness or hospitalization can have an impact on
sleep (Besedovsky et al., 2019). Isolation and shield-
ing could result in increased sedentary behaviors
and food consumption, which are likely to impact
weight (Rundle, Park, Herbstman, Kinsey, & Wang,
2020) and consequently health and sleep over time.
Children and adolescents may also experience
increased levels of stress, given widespread changes
in family financial situations, health concerns, and
uncertainty about the future. These too can result in
sleep difficulties (Tsai et al., 2018).
Further, social distancing advice to stay indoors
can reduce exposure to sunlight, which is so central
in establishing a consistent sleep routine. The latter
may also be impacted by more flexibility in wake and
sleep time and increased opportunity for prolonged
daytime naps. Remote learning could increase time
spent working in the bedroom or the bed, which
contradicts widespread guidance to keep bedroom
activity to a minimum so as to avoid associating the
bed and bedroom with arousal. Remote learning and
the absence of in-person social interactions also
make it possible that youth spend more time using
technology, including during the presleep period.
Increased exposure to alerting ‘blue light’ can dis-
rupt melatonin production, meaning that the body
misses out on a biological cue that it is time to fall
asleep (Dijk & Cajochen, 1997). Bringing technology
into the home could also expose some children, some
perhaps for the first time, to cybervictimization and
other online challenges. There is a clear need to
assess and evaluate risk factors that may, indepen-
dently or jointly, impair youths’ sleep during the
COVID-19 pandemic.
Sleep and COVID-19: relevance for child and
adolescent psychopathology
Children and adolescents with preexisting mental
health conditions may be particularly vulnerable to
©2020 Association for Child and Adolescent Mental Health
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Journal of Child Psychology and Psychiatry 61:7 (2020), pp 757–759 doi:10.1111/jcpp.13278
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disturbed sleep during the COVID-19 pandemic or
more prolonged sleep disturbances following the
pandemic. Youth with anxiety or depression may be
especially prone to COVID-related worries and rumi-
nation, which can interfere with sleep onset and
quality. Youth with ASD may have particular diffi-
culty with the extreme changes in routine resulting
from the COVID-19 pandemic, social distancing
measures, and caregivers working from home as well
as engaging in novel home learning. Youth with
neurodevelopmental disorders, including ASD and
ADHD, may be more likely to experience variable
sleep/wake patterns due to possible altered circadian
function, medication use, and co-occurring psy-
chopathologies (Becker, Sidol, Van Dyk, Epstein, &
Beebe, 2017). It is important to understand which
youth are most at risk for COVID-19-related sleep
problems and psychopathologies, why certain sub-
groups may be more likely than others to experience
negative consequences, what factors confer increased
or decreased risk, how sleep and mental health
unfold over time, and the optimal way to address
sleep-related challenges in different populations.
It is also possible that changes in sleep during the
COVID-19 pandemic exacerbate or even contribute
to psychopathology. Worsened sleep may increase
negative affect, resulting in increased susceptibility
to mood and anxiety problems. Shortened or poor
sleep may lead to greater attentional difficulties and
oppositionality for some youth, resulting in behav-
iors that mimic ADHD and commonly co-occurring
symptoms. During and after the COVID-19 pan-
demic, it will be important to assess both sleep
problems and psychopathology, which considered
alongside a developmental and mental health history
should allow for disentangling the emergence, exac-
erbation, and interrelations among these difficulties
(Gregory & Sadeh, 2016).
Adolescent sleep during the COVID-19
pandemic: the perfect storm intensified?
Adolescents may be particularly vulnerable to the
effects of COVID-19-related social isolation. They are
required to physically distance from friends and, for
some, romantic interests while simultaneously expe-
riencing almost 24/7 proximity to caregivers. Adoles-
cents increasingly prioritize peer relationships and
autonomy, and the current situation may result in
both loneliness and unique parentteen challenges or
negotiations (e.g., related to home learning or com-
pliance with COVID-19 public health guidelines). The
COVID-19 crisis likely also impacts activities that are
key to adolescents’ identity (e.g., part-time employ-
ment), physical activity (e.g., sports participation),
and creativity (e.g., arts participation). The loss of
these in-person activities and related peer relation-
ships may contribute to less physical activity,
increased negative affect, more lethargy or napping
behaviors, and greater screen time and online social
networking. These factors have the potential to
directly or jointly impact bedtimes, sleep quality,
and the regularity of sleep/wake patterns.
Potential for a good night’s sleep?
Although children and adolescents may experience
worsened sleep during and as a result of the COVID-
19 crisis, it is also possible that some youth expe-
rience improved sleep in certain domains. First,
strong ‘evening types’ may benefit from greater
flexibility afforded by home learning. Second and
relatedly, there may be more opportunity for obtain-
ing sufficient sleep since less time is spent traveling
to and from school or engaging in social and
extracurricular activities. These considerations may
point to a silver lining for adolescents’ sleep in
particular: in-person schools are closed, meaning
that many adolescents no longer experience early
school start times and may thus be able to establish
and maintain a schedule more aligned to their
endogenous circadian rhythm, in turn also reducing
social jetlag (given more consistency between week-
day and weekend sleep) (Crowley, Wolfson, Tarokh,
& Carskadon, 2018).
Third, youth who experience peer victimization or
academic failure may find the break from in-person
schooling and activities provides a respite from these
stressors. This may, in turn, reduce rumination or
distress around bedtime that can interfere with sleep
onset and quality. However, this respite may only be
temporary, and it will be important to monitor these
youth as the novelty of social distancing wears off.
Finally, youth may experience closer ties to family
during times of crisis, as well as new or renewed
shared activities (e.g., walks, puzzles/games, meals).
These enhanced family bonds may promote feelings of
connection and safety that also promote healthy
sleep. These possible advantages for sleep need to
be considered alongside the multitude of risks
described above meaning that the overall impact of
COVID-19 on sleep is far from clear. It is also possible
that sleep may be improved in certain domains (e.g.,
sleep duration) and not others (e.g., sleep stability).
Considerations for research and practice
There are a number of important implications of
youth sleep during and after the COVID-19 crisis for
research and practice. Perhaps, most fundamen-
tally, studies will be needed to examine whether, and
if so how, the COVID-19 crisis and associated
physical distancing impact child and adolescent
sleep over time. For example, what domains of sleep
are most clearly impacted, for better or for worse?
Are changes in sleep temporary, or will a subset of
youth experience longer-term sleep disturbances
that originated during the COVID-19 pandemic? Will
changes in sleep patterns (such as the possibility of
increasingly late bedtime in adolescents) result in
©2020 Association for Child and Adolescent Mental Health
758 Stephen P. Becker and Alice M. Gregory J Child Psychol Psychiatr 2020; 61(7): 757–9
difficulties once normality starts to return (e.g.,
when schools reopen and early mornings are
required once more)? Is sleep particularly impacted,
in the short or long term, in children and adolescents
experiencing certain risk factors, including mental
health or neurodevelopmental conditions? It will also
be important to evaluate COVID-19-related factors
(e.g., personal loss, family financial strain, stress
uncertainty) that may predict or maintain sleep
disturbances in youth. Some home environments
will have increased risks (e.g., increases in domestic
violence, alcohol/drug use, child abuse/neglect) for
both child sleep disturbances and psychopathology.
Care will need to be made before extrapolating
results to other situations, as the multiplicity of
factors related to COVID-19 will mean that it is
difficult to make direct comparisons to other situa-
tions (such as the impact of social isolation on sleep
under different circumstances). Monitoring access to
existing resources (prescription medication, services
in and outside of the school context) will also be
important as will establishing the best interventions
for those who struggle with their sleep during and
following COVID-19. Insomnia symptoms in children
and adolescents can be treated with cognitive behav-
ioral therapy for insomnia (CBT-I; Dewald-Kauf-
mann, de Bruin, & Michael, 2019) and given the
reduction in face-to-face contact, rigorous studies
need to further establish the extent to which online
delivery systems are effective in youth. Establishing
healthy sleep practices is important, and statutory
guidance to educate about the importance of sleep
comes into UK schools from September 2020 (UK
Department of Education, 2019). This guidance is
quite timely, and its impact needs evaluation. It is
noteworthy that medicines for insomnia in children
are not approved by the US Food and Drug Admin-
istration or the European Medicines Agency for
insomnia in children (Bruni et al., 2018). Studies
should therefore also establish whether there has
been an increase in prescription of medicine for
insomnia in children and to monitor use over time.
In conclusion, as this pandemic unfolds, there
remains great uncertainty and risk to the health
and well-being of children and adolescents. Support-
ing our youth to get a good night’s sleep is just one
way that we can help them cope with the uncertain
days ahead.
S.B. is supported by grants from the National Institute of
Mental Health (NIMH; K23MH108603) and the Institute
of Education Science (IES; R305A160064,
R305A160126). The content is solely the responsibility
of the authors and does not necessarily represent the
official views of the National Institutes of Health or the
U.S. Department of Education. The authors have
declared that they have no competing or potential
conflicts of interest.
Stephen P. Becker, Division of Behavioral Medicine
and Clinical Psychology, Cincinnati Children’s
Hospital Medical Center, 3333 Burnet Avenue,
Cincinnati, OH 45229-3039, USA; Email: stephen.
Alice M. Gregory, Department of Psychology, Gold-
smiths, University of London, New Cross, London
SE14 6NW, UK; Email:
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Accepted for publication: 6 May 2020
First published online: 31 May 2020
©2020 Association for Child and Adolescent Mental Health
doi:10.1111/jcpp.13278 Child and adolescent sleep during COVID-19 759
... Thus, COVID-19 has changed adolescents' sleep patterns. 5 Remote learning during COV-ID-19 resulted in later bedtimes and wake times for adolescents. 6 In addition, adolescents had increased difficulties in initiating and maintaining sleep, and experienced an increase in delayed sleep/wake behaviors during the pandemic. ...
... 47 This is because social distancing has decreased academic pressure and peer conflict, and allowed greater flexibility and more opportunities for obtaining sufficient sleep, as less time is spent commuting to school. 5,14 Nevertheless, Korean adolescents still have poor mental health, and most do not meet the recommended sleep duration. 48,49 This can be attributed to the academic stress caused by excessive homework given to Korean adolescents engaging in extracurricular activities and competitive educational environments. ...
Objective: This study aimed to investigate the association of sleep with mental health among Korean adolescents during the coronavirus disease (COVID-19) pandemic. Methods: Using data from the 16th Korea Youth Risk Behavior Web-Based Survey (2020) of 46,475 adolescents, we examined sleep duration and satisfaction and examined mental health for depressive symptoms, anxiety, and suicidal ideation. The data were analyzed using complex sample descriptive statistics and a multiple logistic regression model. Results: In 2020, the average sleep duration was 6.3 hours, and the sleep satisfaction rate was 30.8%. Depressive symptom and suicidal ideation rates were 24.2 and 10.3, respectively. These values are slightly better than those previously reported, before COVID-19. However, poor sleep was still associated with mental health. The likelihood of mental health problems was higher among those who slept for six hours or less than for those who slept for eight hours or more (p<0.05). Additionally, the results showed that the lower the sleep satisfaction, the higher the likelihood of mental health problems (p<0.05). Conclusion: Even after the COVID-19 outbreak, poor sleep associated with mental health problems remained as high as before the outbreak of COVID-19.
... 90,91 Sleep also seems to be impacted for adolescents during this period, and understanding the long-term impacts of COVID-19 on sleep might be prudent. 92 Overall, this paper serves as an additional step in understanding the context in which sleep problems can develop and provides valuable insights into potential clinical and policy intervention targets that may allow for better sleep in adolescence. This period of life is a time of rapid growth and development, and sleep is a necessary factor that aids proper development during this time. ...
It is estimated that around 70% of adolescents are not getting sufficient sleep. The impact of poor sleep during adolescence is related to both increased psychopathology and poorer academic and social functioning. While studies have established a link at the community level between earlier school start times and poorer sleep, there remain open questions about other aspects of community such as neighborhood factors and stressful life events. In this study, we investigated the impact of three neighborhood factors (chaos, stability, and efficacy) and recent life stressors on adolescent (n = 1354) sleep habits at ages 12, 14, and 16 in a sample of children at who were either maltreated or at a high risk for maltreatment via the Longitudinal Survey on Child Abuse and Neglect (LONGSCAN). Overall, greater life stressors before age 12, led to greater sleep difficulties. Additionally, while neighborhood stability did not seem to predict more sleep problems, increased neighborhood chaos and lower collective efficacy predicted more sleep problems. These findings suggest it is important to assess the impact of various neighborhood factors separately, as the granular approach provided more nuance in understanding risk factors to poor sleep in adolescents. On a policy level, one implication is to intervene in reducing factors that lead to increased neighborhood chaos (e.g., vandalism, open drug activities) and promote collective neighborhood efficacy (e.g., developing neighborhood programs to increase interactions and trust between neighbors).
... Sleep disorders increased with irregular sleeping patterns, such as difficulties in falling or staying asleep and increase in nightmares and/or sleep tremors [67,68]. A likely explanation of these phenomena is that solation might have reduced children's ability to successfully regulate behavior and emotions and consequently sleep problems emerged or worsened [69,70]. Evidence supported the need of psychological and psychiatric care for adolescents during the health emergency. ...
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In this article, the developments in the field of COVID-19 pandemic published in the Italian Journal of Pediatrics in 2021 are reflected. We describe progresses in SARS-CoV-2 transmission route, clinical presentation, diagnosis, treatment, and access to health care facilities in children. They led to substantial changes in the clinical approach.
... On the other hand, this result is consistent with most recent studies, which support that childhood neglect and abuse may confer risk for insomnia (66,67). Combined analyses of trauma, stress, sleep neurobiology, and psychophysiology offer possible insights (68). ...
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Background Adolescents who have experienced childhood trauma are more likely to have insomnia and psychotic-like experiences (PLEs) than adolescents from other ethnic groups. However, little is known about the youth of ethnic minorities. This study aimed to investigate the epidemiology of childhood trauma and its relationship with insomnia and PLEs in Chinese Zhuang adolescents, focusing on the role of a specific type of trauma and accumulation. Methods A questionnaire of Childhood Trauma Questionnaire-Short Form (CTQ-SF), Athens Insomnia Scale (AIS), and Chinese Version Community assessment psychic experiences-8 (CCAPE- 8) were all completed by 1,493 Chinese Zhuang adolescents. Chi-square and multivariate logistic regression analyses examined the association between childhood trauma and insomnia/PLEs. Results The incidences of emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN) occurred at rates of 5.63, 5.02, 6.56, 23.98, and 33.15%, respectively. EA, SA, EN, and PN were all positively related to insomnia (OR: 1.314–7.720, all p < 0.05). EA and SA were positively associated with PLEs (OR: 2.131–3.202, all p < 0.001). Adolescents who had experienced three or more types of traumas were more likely to have insomnia (OR = 6.961, p < 0.001) and PLEs (OR = 3.558, p < 0.001). Conclusion The most common type of childhood trauma is PN. Childhood trauma has the primary effect on insomnia/PLE. A significant dose-response relationship was found between Childhood trauma and insomnia/ PLEs. This association varied depending on the type and accumulation of exposure.
... The results of studies have shown a decrease in the duration of sleep of children and adolescents on weekdays and weekends [17]. In turn, lack of sleep can affect emotional health, concentration, and immune function [18][19][20]. Insufficient sleep can increase the risk of cardiometabolic disease in both children and adolescents, as well as cause anxiety changes, which may be exacerbated by poor mental health during the COVID-19 pandemic [20,21]. ...
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The COVID-19 pandemic has significantly disrupted the functioning of society. Issues of deteriorating health were among the main problems resulting from restrictions such as self-isolation, social distancing, and remote education. The aim of this research was to attempt to probe the psychophysical condition of students after more than a year of remote education. The survey method (CAPI) was used to collect the data on a representative sample of 1000 students in Poland and 1022 in Ukraine. The research sample was selected in a randomly stratified manner, taking into account such characteristics as: gender, age, and place of residence. The results of the research showed that 44% of Polish and 50% of Ukrainian students experienced health problems. The burden of remote education mainly contributed to the reduction of physical fitness. Young Poles more often paid attention to the deterioration of mental well-being, and Ukrainians to the deterioration of their physical condition. Based on the conducted analyses, it was also established that health problems appeared more often among the females, students with lower social support and with lower trust levels. The main risk factors were Internet addiction, secondary effects of the pandemic, and negative remote education experiences. Research has shown that remote education and problems that arise in students’ households during the pandemic may have significantly contributed to the deterioration of their psychophysical condition.
... The reduction in offline gathering activities during the epidemic has led to a reduction in the frequency of college students participating in social activities, sports, and art activities. Decreased physical activity and social relationships may lead to increased time spent on electronic devices, increased online socialization, and increased likelihood of sleepiness and naps, which may individually or collectively affect bedtime and sleep quality [52]. ...
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Background: The outbreak of COVID-19 has seriously threatened the health of people around the world. To prevent the spread of the epidemic, Chinese universities have implemented closed management of campuses. The implementation of restrictive measures has gradually caused changes in the quality of sleep and the psychological state of college students. In addition, college students are faced with the dual pressure of employment and study, and the psychological pressure is huge. Therefore, it is necessary to investigate sleep and depressive symptoms among college students. Methods: Using the method of stratified cluster sampling, 6695 college students were selected from three universities in Jiangxi, Anhui, and Xinjiang provinces from April to May 2022. The Chinese version of the Pittsburgh sleep quality index (PSQI) and the self-rating depression scale (SDS) were used for the survey. Hierarchical logistic regression analysis was used to analyze the relationship between the PSQI and the SDS. Results: Overall, during the outbreak of COVID-19, 69.0% of males and 73.5% of females had poor sleep quality among Chinese college students and the detection rate of depressive symptoms was 43.6% for males and 47.8% for females, respectively. Taking students with good sleep quality as references, after controlling for covariates, hierarchical logistic regression shows that Chinese college students with poor sleep quality have a higher OR value (OR = 12.0, 95%CI: 10.2~14.1, p < 0.001), especially in males (OR = 43.8, 95%CI:30.2~63.6, p < 0.001). For both males and females, the OR value of college students with the following characteristics was higher: rural college students (males, OR = 50.32, 95%CI: 32.50-77.93; females, OR = 8.03, 95%CI: 6.45-9.99), overweight college students (males, OR = 62.17, 95%CI: 19.47-198.53; females, OR = 16.67, 95%CI: 6.48-42.88), and college students drinking sugar-sweetened beverages (males, OR = 59.00, 95%CI: 36.96-94.18; females, OR = 8.16, 95%CI: 6.63-10.05) (p < 0.001). Conclusions: Poor sleep quality is associated with depressive symptoms among Chinese college students, especially college males. Our research suggests that it is necessary to consider the improvement of sleep quality and depressive symptoms among college students during the COVID-19 epidemic.
Objective This study evaluated the quality of sleep and smartphone addiction in Korean adolescents during the coronavirus disease 19 pandemic and analyzed their effects on perceived quality of life.Methods An online survey system provided by the Gwangmyeong City Health Center located in Gyeonggi-do, Korea, was completed by 1,678 local middle school students from April 1 to June 30, 2021. We measured quality of life using the KIDSCREEN-27 health-related quality of life questionnaire, quality of sleep using the Korean version of the Pittsburgh Sleep Quality Index, and smartphone addiction using the Smartphone Addiction Self-Diagnosis Scale. Bed times, wake times, and total sleep hours were also recorded.Results Sleep quality and quantity were directly associated with smartphone addiction. The results indicated that lower quality of life was associated with lower sleep quality, delayed onset of sleep, shorter total sleep time, and higher smartphone addiction. Female students reported lower quality of life, lower sleep quality, delayed sleep phases, shorter total sleep hours, and higher smartphone addiction scores than did male students.Conclusion Our results suggest that adolescents’ quality of life is threatened by poor sleep, which in turn could be due to unhealthy smartphone usage. Girls were more heavily affected by this trend than were boys. Preparations to intervene for further mental health issues that might follow are necessary.
La pandemia por COVID-19 es un evento adverso y factor de riesgo para la salud integral de los adolescentes y jóvenes, asociado a trastornos de estrés, ansiedad y depresión, sin embargo, la perspectiva ecológica plantea que la percepción del evento o situación juega un papel central en la adaptación y salud mental. Por otra parte, la detección de factores de riesgo-protección es la base de una intervención efectiva. El objetivo de este estudio fue construir una medida multidimensional válida y confiable para explorar la percepción subjetiva y las respuestas psicológicas de los adolescentes y jóvenes ante la pandemia por COVID-19. Se realizó un estudio instrumental en el que participaron 727 adolescentes de 13 a 24 años (M= 18.36; DE= 2.9) de la Ciudad de México. Se elaboró la Encuesta de Percepción Juvenil del COVID-19 (EPJ COVID-19) que fue aplicada en línea. Un análisis factorial por componentes principales (n= 410) arrojó una solución de ocho factores: Miedo y preocupaciones, Indicadores de estrés, Presiones escolares, Conductas preventivas, Cambios de rutinas, Dinámica familiar, Relajación y esparcimiento, y Socialización virtual (VE = 59.07%). Un análisis factorial confirmatorio con el método de máxima verosimilitud (n= 317) corroboró un modelo de ocho factores mostrando índices aceptables de ajuste, el cual también presentó una buena consistencia interna (α total= .863). Los resultados sugieren que la EPJ COVID-19 es una medida válida y confiable que puede ser usada para valorar de manera integral la percepción y respuestas de los adolescentes y jóvenes ante la pandemia para diseñar intervenciones basadas en evidencia.
Objectives: Children and young people (CYP) with special educational needs (SEN) are more likely to experience disturbed sleep and poor mental wellbeing. This study explored the differential impact of the coronavirus disease 2019 (COVID-19) pandemic on the sleep and mental wellbeing of CYP with and without SEN.Methods: The National Institute of Health Research Children and Young People MedTech Cooperative, Sheffield Children’s National Health Service (NHS) Foundation Trust, and The Sleep Charity carried out an online survey between June 23, 2020, and August 17, 2020. The 77-item survey was shared on social media platforms.Results: A total of 559 participants were included in the analyses, and 15.74% of them reported having CYP with SEN. While sleep changes due to the pandemic were largely similar for both groups, CYP with SEN were more likely to get up or wake up during the night than those without SEN (40.91% vs. 27.18%). CYP with SEN were significantly more likely than those without SEN to be demotivated (61.44% vs. 31.57%), sad and tearful (36.15% vs. 19.35%), or anxious and stressed (41.67% vs. 18.54%) during the pandemic, and the increased anxiety was more likely to contribute to poorer sleep (43.48% vs. 14.82%).Conclusions: While the majority of CYP in both groups reported sleep changes due to the pandemic, CYP with SEN experienced more sleep disturbance. The findings provide initial evidence to suggest that the pandemic may have had a greater impact on the sleep and mental wellbeing of CYP with SEN than those without SEN.
Latar Belakang: Tidur adalah salah satu kebutuhan dasar manusia yang berfungsi mengembalikan kondisi tubuh. Bagi anak-anak tidur menjadi hal yang sangat penting untuk kesehatan fisik dan mental, karena mereka berada pada fase pertumbuhan dan perkembangan. Kebutuhan tidur yang cukup dan berkualitas dapat meningkatkan kualitas hidup anak, memori, semangat belajar, konsentrasi, dan perilaku. Penelitian ini bertujuan untuk mengidentifikasi kualitas tidur anak usia sekolah di masa pandemi COVID 19. Metode: Rancangan penelitian ini adalah descriptive cross sectional. Penelitian ini adalah penelitian daring yang dilaksanakan dari tanggal Pebruari-Maret 2021 dengan jumlah 202 responden anak usia sekolah berasal dari sembilan kabupaten di Propinsi Bali. Hasil: dari 202 responden sebanyak 128 responden (63,4%) mengalami gangguan pola tidur selama pandemi COVID-19. Kesimpulan: Kondisi pandemi dapat berdampak pada tidur anak, sehingga jika tidak tertangani dapat menimbulkan masalah kesehatan pada anak. Oleh karena itu, dibutuhkan dukungan dari orang tua dalam memfasilitasi tidur anak yang berkualitas.
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In the current global home confinement situation due to the COVID‐19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation, sleep disturbance can have direct consequences upon next day emotional functioning. In this paper we summarize what is known about the stress‐sleep link and confinement as well as effective insomnia treatment. We discuss those effects of the current home confinement situation that can disrupt sleep but also those that could benefit sleep quality. We suggest adaptions of cognitive behavioral therapy elements that are feasible to implement for those facing changed work schedules and requirements, those with health anxiety and those handling childcare and homeschooling, whilst also recognizing the general limitations imposed on physical exercise and social interaction. Managing sleep problems as best as possible during home confinement can limit stress and possibly prevent disruptions of social relationships.
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The COVID‐19 pandemic is causing substantial morbidity and mortality, straining health care systems, shutting down economies, and closing school districts. While it is a priority to mitigate its immediate impact, we want to call attention to the pandemic’s longer‐term effect on children’s health: COVID‐19, via these school closures, may exacerbate the epidemic of childhood obesity and increase disparities in obesity risk. In many areas of the U.S., the COVID‐19 pandemic has closed schools and some of these school systems are not expected to re‐open this school year. The experiences in Hong Kong, Taiwan and Singapore suggest that social distancing orders, if lifted after short periods, will have to be periodically re‐instated to control COVID‐19 flare ups. In short, we anticipate that the COVID‐19 pandemic will likely double out‐of‐school time this year for many children in the U.S. and will exacerbate the risk factors for weight gain associated with summer recess.
Sleep and immunity are bidirectionally linked. Immune system activation alters sleep, and sleep in turn affects the innate and adaptive arm of our body's defense system. Stimulation of the immune system by microbial challenges triggers an inflammatory response, which, depending on its magnitude and time course, can induce an increase in sleep duration and intensity, but also a disruption of sleep. Enhancement of sleep during an infection is assumed to feedback to the immune system to promote host defense. Indeed, sleep affects various immune parameters, is associated with a reduced infection risk, and can improve infection outcome and vaccination responses. The induction of a hormonal constellation that supports immune functions is one likely mechanism underlying the immune-supporting effects of sleep. In the absence of an infectious challenge, sleep appears to promote inflammatory homeostasis through effects on several inflammatory mediators, such as cytokines. This notion is supported by findings that prolonged sleep deficiency (e.g., short sleep duration, sleep disturbance) can lead to chronic, systemic low-grade inflammation and is associated with various diseases that have an inflammatory component, like diabetes, atherosclerosis, and neurodegeneration. Here, we review available data on this regulatory sleep-immune crosstalk, point out methodological challenges, and suggest questions open for future research.
Insomnia is one of the most prevalent sleep disorders in school-aged children and adolescents. Although cognitive behavioral therapy for insomnia (CBT-i) is the first-line treatment for adults, and existing studies show promising effects also for children and adolescents, the number of randomized controlled trials in younger age groups is rather small. CBT-i techniques for school-aged children and adolescents include bedtime shifts (including sleep restriction), stimulus control, thought challenging, psychoeducation, and relaxation techniques. The integration of parents, especially in school-aged children with insomnia, is highly recommended. More research is needed to investigate specific characteristics and models of child and adolescent insomnia.
The maturation of sleep regulatory systems during adolescence in combination with psychosocial and societal pressures culminate in a "Perfect Storm" of short and ill-timed sleep and the associated consequences for many youngsters. This model, first described by Carskadon in 2011, guides our current thinking of adolescent sleep behavior. Since the original description, the field has moved forward with remarkable pace, and this review aims to summarize recent progress and describe how this new work informs our understanding of sleep regulation and sleep behavior during this developmental time frame.
Background: Sleep disturbances, in particular insomnia, represent a common problem in children with neurodevelopmental disabilities (NDDs). Currently, there are no approved medications for insomnia in children by the US Food and Drug Administration or European Medicines Agency and therefore they are prescribed off-label. We critically reviewed pediatric literature on drugs as well as nonpharmacological (behavioral) interventions used for sleep disturbances in children with NDDs. Methods: PubMed, Ovid (including PsycINFO, Ovid MEDLINE(®) , and Embase), and Web of Knowledge databases were searched through February 12, 2017, with no language restrictions. Two authors independently and blindly performed the screening. Results: Good sleep practices and behavioral interventions, supported by moderate-to-low level evidence, are the first recommended treatments for pediatric insomnia but they are often challenging to implement. Antihistamine agents, such as hydroxyzine or diphenhydramine, are the most widely prescribed sedatives in the pediatric practice but evidence supporting their use is still limited. An increasing body of evidence supports melatonin as the safest choice for children with NDDs. Benzodiazepines are not recommended in children and should only be used for transient insomnia, especially if daytime anxiety is present. Only few studies have been carried out in children's and adolescents' zolpidem, zaleplon, and eszopiclone, with contrasting results. Limited evidence supports the use of alpha-agonists such as clonidine to improve sleep onset latency, especially in attention deficit/hyperactivity disorder subjects. Tricyclic antidepressants, used in adults with insomnia, are not recommended in children because of their safety profile. Trazodone and mirtazapine hold promise but require further studies. Conclusions: Here, we provided a tentative guide for the use of drugs for insomnia in children with NDDs. Well-controlled studies employing both objective polysomnography and subjective sleep measures are needed to determine the efficacy, effectiveness, and safety of the currently prescribed pediatric sleep medicines in children with NDDs.
The current study examines the association between parental support and adolescent sleep under varying levels of family stress. Participants included 316 adolescents (Mage = 16.40 years, 43% male) and their parents (Mage = 45.67 years, 91% mothers) from diverse ethnic backgrounds. Both adolescents and parents completed questionnaires and adolescents wore wrist actigraphs and completed self-reports on their sleep for 7 consecutive days. Results indicated that under contexts of family stress, more parental support was linked to longer sleep duration, less sleep variability, and less time spent awake during the night. Findings suggest that under contexts of family stress, cohesive family relationships may provide a sense of stability and security that is necessary for healthful sleep.
Substantial research attention has been devoted to understanding the importance and impact of sleep in children and adolescents. Traditionally, this has focused on mean sleep variables (e.g., a child’s “typical” or average sleep duration), yet research increasingly suggests that intraindividual variability (IIV) of sleep/wake patterns (sometimes referred to as sleep variability or night-to-night variability) regularly occurs and may have implications for adjustment. A systematic search of five electronic databases identified 52 empirical studies published between 2000 and 2015 that examined correlates of sleep IIV in children and adolescents, with a recent increase in the publication rate of such studies. Identified studies were often atheoretical and included post hoc analyses, though IIV in select aspects of sleep does appear to be associated with increasing age/pubertal status, non-White race, physical and neurodevelopmental conditions (e.g., attention-deficit/hyperactivity disorder; autism), psychopathology symptoms (e.g., anxiety, depression, inattention), body weight, stress, aspects of cognitive functioning, and poorer sleep functioning/habits. The limited intervention work examining sleep IIV in adolescents is promising, though studies are needed using more rigorous intervention designs. Clinical sleep recommendations may not only need to address overall sleep duration and sleep habits but also the stability of sleep duration and timing. It will be important for future research examining sleep IIV in children and adolescents to use a developmental framework in advancing theory pertaining to the causes, mechanisms, moderators, and outcomes of sleep IIV in youth, and a conceptual model is proposed to help guide such efforts.
Background: Hippocrates flagged the value of sleep for good health. Nonetheless, historically, researchers with an interest in developmental psychopathology have largely ignored a possible role for atypical sleep. Recently, however, there has been a surge of interest in this area, perhaps reflecting increased evidence that disturbed or insufficient sleep can result in poor functioning in numerous domains. Aims and scope: This review outlines what is known about sleep in the psychiatric diagnoses most relevant to children and for which associations with sleep are beginning to be understood. While based on a comprehensive survey of the literature, the focus of the current review is on the latest science (largely from 2010). There is a description of both concurrent and longitudinal links as well as possible mechanisms underlying associations. Preliminary treatment research is also considered which suggests that treating sleep difficulties may result in improvements in behavioural areas beyond sleep quality. Findings and conclusion: To maximise progress in this field, there now needs to be: (a) greater attention to the assessment of sleep in children; (b) sleep research on a wider range of psychiatric disorders; (c) a greater focus on and examination of mechanisms underlying associations; (d) a clearer consideration of developmental questions and (e) large-scale well-designed treatment studies. While sleep problems may sometimes be missed by parents and healthcare providers; hence constituting a hidden risk for other psychopathologies - knowing about these difficulties creates unique opportunities. The current excitement in this field from experts in diverse areas including developmental psychology, clinical psychology, genetics and neuropsychology should make these opportunities a reality.