Sleep problems in early childhood linked to psychosis during Adolescence

Sleep is an essential factor for proper cognitive development and emotional functioning in childhood.

Behavioral sleep problems in childhood are distinctively associated with the onset of psychosis and Borderline Personality Disorder (BPD) in adolescence in different pathways, finds a study published in the journal, JAMA Psychiatry, 2020.

Persistent nightmares in childhood have been prospectively associated with psychosis and borderline personality disorder (BPD) in adolescence. But the extent to which they are interlinked is unexplored. To understand the association researchers at the University of Birmingham, examined the prospective associations between several parent-reported sleep problems in early childhood and psychotic and BPD symptoms at 11 to 13 years of age and the potential mediation of the associations by depression at 10 years of age.

Lead researcher, Dr Isabel Morales-Muñoz, explained: "We know from previous research that persistent nightmares in children have been associated with both psychosis and borderline personality disorder. But nightmares do not tell the whole story – we have found that, in fact, a number of behavioral sleep problems in childhood can point towards these problems in adolescence."

The study conducted on Pregnant women from Avon, United Kingdom, with expected dates of delivery from April 1, 1991, to December 31, 1992. 13,488 participants in the Avon Longitudinal Study of Parents and Children birth cohort were assessed. They were followed up for more than 13 years.

Researchers assessed the Psychotic experiences at 12 to 13 years of age using the Psychosis-Like Symptom Interview and BPD symptoms at 11 to 12 years of using the UK Childhood Interview for DSM-IV Borderline Personality Disorder. Night-time sleep duration, night awakening frequency, bedtime, and regularity of sleep routines were assessed as reported by the parents when the child was 6, 18, and 30 months and 3.5, 4.8, and 5.8 years of age.

The researchers revealed the following key points from the study:

• 7155 participants (3718 girls [52%]) reported on psychotic experiences at 12 to 13 years of age and 6333 (3280 girls [52%]) reported on BPD symptoms at 11 to 12 years of age.

• Higher night awakening frequency at 18 months of age and less regular sleep routines at 6 months, 30 months, and 5.8 years of age were significantly associated with psychotic experiences in adolescence.

• shorter night-time sleep duration and later bedtime at 3.5 years of age were significantly associated with BPD symptoms.

• Results of mediation analysis were consistent with all these associations, except for later bedtime at 3.5 years and BPD in adolescence, which had no association.

• Depression at 10 years of age mediated the associations between frequent night awakenings at 18 months of age and irregular sleep routines at 5.8 years of age with psychosis.

The researchers concluded that some behavioral sleep problems in childhood are distinctively associated with the onset of psychosis and BPD in adolescence. Furthermore, depression at 10 years of age may mediate only the association with psychosis and hence more personalized interventions in psychosis and BPD are needed.